bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating Potential Impacts of a Preferential Vaccine Recommendation for Adults 65 Years of Age and Older on US Influenza Burden
Authors: Morris Sinead E. , Grohskopf Lisa A. , Ferdinands Jill M. , Reed Carrie , Biggerstaff Matthew
Published: February 2023

Background:

High-dose, adjuvanted, and recombinant influenza vaccines may offer improved effectiveness among older adults compared with standard-dose, unadjuvanted, inactivated vaccines. However, the Advisory Committee on Immunization Practices (ACIP) only recently recommended preferential use of these “higher-dose or adjuvanted” vaccines. One concern was that individuals might delay or decline vaccination if a preferred vaccine is not readily available.

Methods:

We mathematically model how a recommendation for preferential use of higher-dose or adjuvanted vaccines in adults ≥65 years might impact influenza burden in the United States during exemplar “high-” and “low-”severity seasons. We assume higher-dose or adjuvanted vaccines are more effective than standard vaccines and that such a recommendation would increase uptake of the former but could cause (i) delays in administration of additional higher-dose or adjuvanted vaccines relative to standard vaccines and/or (ii) reductions in overall coverage if individuals only offered standard vaccines forego vaccination.

Results:

In a best-case scenario, assuming no delay or coverage reduction, a new recommendation could decrease hospitalizations and deaths in adults ≥65 years by 0%–4% compared with current uptake. However, intermediate and worst-case scenarios, with assumed delays of 3 or 6 weeks and/or 10% or 20% reductions in coverage, included projections in which hospitalizations and deaths increased by over 7%.

Conclusions:

We estimate that increased use of higher-dose or adjuvanted vaccines could decrease influenza burden in adults ≥65 in the United States provided there is timely and adequate access to these vaccines, and that standard vaccines are administered when they are unavailable.
Aberrant parasympathetic responses in acupuncture therapy for restoring immune homeostasis
Authors: Liu Jing , Dong Shun , Liu Shenbin
Published: February 2023

Acupuncture is an effective therapy used worldwide to treat various diseases, including infections, allergic disorders, autoimmune diseases, and immunodeficiency syndromes. Except for the hypothalamic-pituitary-adrenal axis, acupuncture exerts its regulatory effect mainly by producing autonomic reflexes, including somatic-sympathetic and somatic-parasympathetic reflexes. In this review, we discuss the updated progress of the cholinergic vagal efferent pathway, vagal-adrenal axis, local spinal sacral-parasympathetic pathway, and the somatotopic evocation of parasympathetic responses related to restoring immune homeostasis within acupuncture therapy. Targeting the parasympathetic reflex offers scientific instruction for the design of acupuncture protocols for immunological diseases, providing more specialized comprehensive treatment recommendations.

Graphical abstract:

http://links.lww.com/AHM/A49
Psychiatric Disorders Are Predictive of Worse Pain Severity and Functional Outcomes After Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg
Authors: Bi Andrew S. , Shankar Dhruv S. , Avendano John P. , Borowski Lauren E. , Jazrawi Laith M. , Cardone Dennis A.
Published: February 2023

Objective:

To determine whether concomitant psychiatric diagnoses and medication use were associated with postfasciotomy outcomes in patients with chronic exertional compartment syndrome (CECS).

Design:

Retrospective comparative cohort study.

Setting:

Single academic medical center from 2010 to 2020.

Patients:

All patients above 18 years old who underwent fasciotomy for CECS.

Assessment of Risk Factors/Independent Variables:

Psychiatric history was recorded from electronic health records including disease diagnosis and medications.

Main Outcome Measures:

The 3 main outcome measures were postoperative pain using the Visual Analog Scale, functional outcomes using the Tegner Activity Scale, and return to sport.

Results:

Eighty one subjects (legs), 54% male, with an average age of 30 years and follow-up of 52 months were included. 24 subjects (30%) had at least one psychiatric diagnosis at the time of surgery. Regression analysis found psychiatric history to be an independent predictor of worse postoperative pain severity and postoperative Tegner scores (P < 0.05). Furthermore, subjects with psychiatric disorders not on medication had worse pain severity (P < 0.001) and Tegner scores (P < 0.01) versus controls, whereas subjects with a psychiatric disorder on medication had better pain severity (P < 0.05) versus controls.

Conclusions:

History of psychiatric disorder was predictive of worse postoperative pain and activity outcomes after fasciotomy for CECS. Use of psychiatric medication was associated with improvement in pain severity in some domains.
Image Quality and Artifact Reduction of a Cochlear Implant With Rotatable Magnets
Authors: Winchester Arianna , Kay-Rivest Emily , Bruno Mary , Hagiwara Mari , Moonis Gul , Jethanamest Daniel
Published: February 2023

Objective

To determine if metal reduction magnetic resonance imaging sequences and changes in implant placement minimize artifact from cochlear implants and improve visualization of intracranial structures.

Study Design

Cadaveric study.

Setting

Tertiary referral center.

Patients

Five cadaveric heads.

Interventions

Specimens were implanted with Advanced Bionics HiRes Ultra3D devices at nasion-external auditory canal angles of 90, 120, and 160 degrees, and distances from the external auditory canal of 9 or 12 cm. Standard brain/internal auditory canal (IAC) sequences with metal artifact reducing technique were acquired in a 1.5T scanner.

Main Outcome Measures

The primary outcome was visibility of 14 intracranial structures graded on a 4-point scale (1, structures <50% visible; 2, >50% visible with some areas nonvisible from artifact; 3, artifact present but adequate for diagnosis; and 4, high quality). Scores were determined by experienced head and neck radiologists and compared with one-way analysis of variance.

Results

Imaging sequences included axial 5-mm whole-brain turbo spin echo (TSE) T2 with right to left and anterior to posterior encoding, fluid-attenuation inversion recovery high bandwidth, axial 5-mm whole-brain slice-encoding metal artifact correction (SEMAC), axial IAC constructive interference in steady state, and axial 3-mm T1 IAC with and without fat saturation. T1 IACs in axial and coronal planes were best for ipsilateral structures overall (mean [standard deviation {SD}], 3.8 [0.6] and 3.8 [0.5]). SEMAC (mean [SD], 3.5 [0.8]) was superior to TSE with anterior to posterior encoding (mean [SD], 3.5 [0.9) for ipsilateral cortex, cerebellopontine angle, and brainstem/cerebellum, and equivalent for the inner ear. Constructive interference in steady state and T1 with fat saturation were poor for all ipsilateral structures (mean, 2.8 [p < 0.01]; mean, 3.1 [p < 0.01]). The 120 degrees/12 cm position was overall best, although the 120 degrees/9 cm position still afforded visualization of ipsilateral structures; other angles and distances conferred slight advantages for specific structures of interest.

Conclusions

SEMAC and T2 TSE with anterior to posterior encoding sequences provide artifact suppression while retaining excellent image quality. Different placement angles did not confer improvement in visualization, although placement distances provided slight advantages for some structures.
Targeted Next-Generation Sequencing in Children With Bilateral Sensorineural Hearing Loss: Diagnostic Yield and Predictors of a Genetic Cause
Authors: Boudewyns An , van den Ende Jenneke , Peeters Nils , Van Camp Guy , Hofkens-Van den Brandt Anouk , Van Schil Kristof , Wouters Kristien , Wuyts Wim
Published: February 2023

Objective

To investigate the diagnostic yield of targeted next-generation sequencing using hearing loss panels and to identify patient-related factors that are associated with a definite genetic cause.

Study Design

Retrospective chart review.

Setting

Tertiary referral center.

Patients

Children with congenital or late-onset, bilateral sensorineural hearing loss.

Intervention(s)

Diagnostic.

Main Outcome Measure(s)

The number of patients with a definite genetic diagnosis.

Results

We report on 238 patients with hearing loss: 130 were male and 108 were female. About 55% had congenital hearing loss. A genetic cause was identified in 94 of the patients (39.5%), with 72.3% of these showing nonsyndromic and 27.6% showing syndromic hearing loss. The diagnostic yield was highest among North African patients (66.7%). A multiple linear regression model shows that profound hearing loss, family history of hearing loss, congenital hearing loss, and North African ethnicity are significantly related to identifying a genetic cause.

Conclusions

Targeted next-generation sequencing using a panel of hearing loss genes identified a genetic diagnosis in almost 40% of children with bilateral sensorineural hearing loss. We describe the predictors of a genetic diagnosis, and this information may be used during genetic counseling.
Initial Stage of Disease Similar for White and Black Patients With Early-Onset Colorectal Cancer at a Safety-Net Hospital
Authors: Chiu Laura S. , Huang Kevin Z. , Xu Xixi , Heeren Timothy , Haque Rubiya , Schroy Paul S.
Published: February 2023

Background:

Non-Hispanic Black (NHB) patients with early-onset colorectal cancer (EOCRC) are more likely to present with advanced-stage disease than their Non-Hispanic White (NHW) counterparts. To further elucidate whether differences in tumor biology or disparities in access to care may be responsible, we examined the association between race/ethnicity and initial stage of disease, time to diagnosis, and tumor characteristics among NHW and NHB patients with EOCRC cared for in a safety-net health care setting.

Methods:

We performed a retrospective cohort study of NHW and NHB patients diagnosed with primary EOCRC who received care at Boston Medical Center between January 2000 and May 2020. We compared demographics, risk factors, presenting signs/symptoms, time to diagnosis, health care utilization, and tumor characteristics (stage, grade, location, and mutational status).

Results:

We identified 103 patients (mean age 41.5±7.2 y, 53.4% men), including 40 NHWs and 63 NHBs, with EOCRC. NHB and NHW patients were similar with respect to demographics, presenting signs/symptoms, and risk factor distribution. There were also no significant differences between NHWs and NHBs with respect to the advanced stage of disease at presentation (45.0% vs. 42.9%, P=0.83), the median time to diagnosis [152 d (IQR, 40 to 341) vs. 160 d (IQR, 61 to 312), P=0.79] or tumor characteristics, except for a predilection for proximal disease among NHBs (30.2% vs. 15.0%).

Conclusions:

NHB patients were no more likely than NHW patients to present with advanced-stage disease, aggressive tumor histology, or experience delays in diagnosis within a safety-net health care system.
Pediatric coronavirus disease 2019 in Africa
Authors: van der Zalm Marieke M. , Dona’ Daniele , Rabie Helena
Published: February 2023

Purpose of review

Three years into the coronavirus disease 2019 (COVID-19) pandemic, data on pediatric COVID-19 from African settings is limited. Understanding the impact of the pandemic in this setting with a high burden of communicable and noncommunicable diseases is critical to implementing effective interventions in public health programs.

Recent findings

More severe COVID-19 has been reported in African settings, with especially infants and children with underlying comorbidities at highest risk for more severe disease. Data on the role of tuberculosis and HIV remain sparse. Compared to better resourced settings more children with multisystem inflammatory disease (MISC) are younger than 5 years and there is higher morbidity in all settings and increased mortality in some settings. Several reports suggest decreasing prevalence and severity of MIS-C disease with subsequent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variant waves. Whether this decrease continues remains to be determined. Thus far, data on long-COVID in African settings is lacking and urgently needed considering the severity of the disease seen in the African population.

Considering the differences seen in the severity of disease and short-term outcomes, there is an urgent need to establish long-term outcomes in children with COVID-19 and MIS-C in African children, including lung health assessment.
Developing Cultural Humility Through an Interprofessional Clinical Education Experience
Authors: Frie Kathryn , Timm Jennifer
Published: February 2023

Background:

An interprofessional clinical education model operating student-led, faculty-guided clinics partnered with rural Midwest American communities lacking health care access.

Purpose:

To evaluate how an internship, guided by the Theory of Cultural Humility, during the COVID-19 pandemic supported development of cultural humility in interprofessional health profession students.

Approach:

Nursing, exercise science, public health, and social work participants completed an internship during early phases of the COVID-19 pandemic, despite many experiences being suspended. Quantitative evaluation using pre-/postadministration of Foronda's Cultural Humility Scale was completed across 3 periods measuring change in cultural humility.

Results:

Total scores of Foronda's Cultural Humility Scale increased for all 3 periods (n = 11, n = 74, and n = 44), demonstrated by aggregate data and statistical analysis. The largest change occurred in the first period.

Conclusions:

Engaging interprofessional students in experiential learning during real-life, real-time public health events creates reflection of complex practice issues while developing cultural humility.
The application of health recommender systems based on knowledge graph: a scoping review
Authors: Zhang Xu , Yi Mo , Sun Yue , Han Shuyu , Zhang Wenmin , Wang Zhiwen
Published: February 2023

Background:

Tailored knowledge graph-based recommender systems (KGRSs) have been demonstrated to be able to provide accurate and effective health recommendations to users, and thus significantly reduce health care costs. They are now strongly recommended to be applied in the health care field.

Objective:

This scoping review aims to identify the current application of KGRSs, their target users and performance metrics, and the potential limitations of implementing health recommender systems in clinical practice.

Methods:

A review of the studies published from inception to November 1, 2022 was conducted, using key search terms in 6 scientific databases to identify health recommender systems based on knowledge graph technology. Key information from the included studies was extracted and charted. The scoping review was reported following the PRISMA Extension for Scoping Reviews.

Result:

We included 16 studies and 5 grants totally about the health recommender systems based on knowledge graph technology. They were used in different health areas: traditional Chinese medicine, health management, disease-related decision support, diet, and nutrition recommendations. Among them, 6 studies were for the general public and 6 were for physicians. A total of 13 (81.25%) studies evaluated the KGRS using performance metrics, such as accuracy, recall, F1 score, and area under the curve. All studies pointed out the limitations of the recommender systems and provided directions for their subsequent optimization and improvement.

Conclusion:

This review describes the state-of-the-art and potential limitations of KGRS used in the health care field. This novel approach has been proven to be effective in overcoming the drawbacks of traditional algorithms, helping users filter massive amounts of data to find out the personalized information they need. Its great potential in digital health needs to be further explored.
Internet-Delivered Sexually Transmitted Infection and Teen Pregnancy Prevention Program: A Randomized Trial
Authors: Kissinger Patricia J. , Green Jakevia , Latimer Jennifer , Schmidt Norine , Ratnayake Aneeka , Madkour Aubrey Spriggs , Clum Gretchen , Wingood Gina M. , DiClemente Ralph J. , Johnson Carolyn
Published: February 2023

Background

Black older-teenaged women have disproportionately high rates of sexually transmitted infections (STI) and unintended pregnancy (UTP). Internet-based interventions can be delivered to large groups of people in a relatively inexpensive manner. In this randomized trial, we examine the efficacy of an evidence-based STI/UTP prevention intervention adapted for older teens and for Internet delivery.

Methods

Black women aged 18–19 years who were not pregnant/seeking to become pregnant were enrolled (n = 637) and randomized to an 8-session intervention or attention control and were followed up at 6/12 months postintervention. The primary outcome was defined as uptake of reliable contraceptives. Other secondary outcomes were examined, including intention to use condoms, intention to use reliable contraception, and STI or pregnancy rates.

Results

Overall, at baseline, reliable contraception was 54.8% and dual protection was 29.4%, and the prevalence of STI was 11.1%. Participants were similar by arm for most factors considered. Participation and follow-up rates were excellent (60.9% and 80.3%). There was no statistically significant difference in uptake of reliable contraception for intervention versus controls at 6 months (1.45 [0.99–2.12]) or 12 months (1.33 [0.92–1.91]). At 6 months, several secondary outcomes were improved/trended toward improvement in intervention compared with control, but this effect waned by 12 months, except for intention to use condoms which remained improved.

Conclusion and Relevance

The intervention was efficacious for increasing some self-reported UTP and STI prevention behaviors, which waned over time, and the intervention had minimal impact on STI or pregnancy rates suggesting that this type of online intervention may need additional components.
Immediate and Ongoing Impact of COVID-19 on Chlamydia Treatment in Australia
Authors: Engstrom Teyl , Baliunas Dolly , Smith Angela , Dean Judith A. , Pole Jason D.
Published: February 2023

Background

The COVID-19 pandemic has impacted the sexual health and well-being of individuals, directly through risk of contracting COVID-19, and indirectly through government lockdowns. Government restrictions were especially strict and long-lasting in Australia, they also varied by state, offering an interesting opportunity to study the impacts of varying restrictions. This study compares the impact of the COVID-19 pandemic and resulting restrictions on chlamydia treatment prescriptions during 2020, through to July 2021 between different states and demographic groups in Australia.

Methods

The rate of prescriptions per 100,000 population filled each month from January 2017 to July 2021 from Australia's Pharmaceutical Benefits Scheme for Azithromycin with a restricted indication to treat Chlamydia trachomatis was used to measure chlamydia treatment. The impact of COVID-19 lockdowns was modeled using an interrupted time-series Poisson regression model.

Results

The data included 520,025 prescriptions to treat chlamydia, averaging 37.5 prescriptions per month per 100,000 population. Prescriptions declined 26% in April to May 2020 when initial COVID-19 lockdowns began in Australia; prescriptions increased in the following months but remained on average 21% below prepandemic (2017–2019) levels through to July 2021. Prescriptions declined the most in 1 Australian state, Victoria, both in the initial lockdown and the following period; generally, states with more COVID-19 cases saw bigger reductions in prescriptions.

Conclusions

This is the first study to examine how treatment for chlamydia in Australia was impacted by the COVID-19 pandemic and restrictions not only in the immediate-term, but also ongoing up to July 2021, providing important information for planning for sexual health services in future pandemics.
Mindfulness-based interventions and cognitive function in cancer survivors: a systematic review and meta-analysis
Authors: Flynn Michelle J. , Abolhosseini Shokouh , Gamboa Jessame , Campbell Tavis S. , Carlson Linda E.
Published: February 2023

Background:

Deterioration in cognitive function is common among cancer survivors undergoing treatment. These problems may persist for several years after completion of treatment and can adversely affect cancer survivors' treatment adherence and quality of life. The cause of cognitive changes in cancer survivors is unclear, although it is likely a complex interaction of disease-related, treatment-related, and psychological factors. Mindfulness-based interventions (MBIs) are one promising intervention for cancer survivors to alleviate unwanted and burdensome side effects, including disruptions in cognitive function. The aim of the current review was to synthesize the literature on MBIs and cognitive function in cancer survivors.

Methods:

We searched five databases from inception on May 27, 2021 (original search), and May 4, 2022 (updated search): PubMed, MEDLINE Ovid, EMBASE Ovid, PsycInfo Ovid, CINAHL EBSCO, and Web of Science. Articles were screened at the abstract and full-text level by two reviewers.

Results:

A total of 1916 records were retrieved, and 24 unique studies met the inclusion criteria. There was significant variability across studies regarding type of MBIs investigated, types of cognitive outcome measures used, and study assessment timelines. Eleven studies were included in a meta-analysis of self-reported cognitive function, significantly favoring MBIs over inactive controls (ie, usual care) (standardized mean difference = 0.86; 95% confidence interval = 0.32–1.41). A similar model, including four studies, compared MBIs with active controls (ie, music listening, metacognition treatment, fatigue education and support, walking program); this model also demonstrated a statistically significant pooled effect (standardized mean difference = 0.61; 95% confidence interval = 0.23–0.99). Owing to a small number of studies, meta-analysis could not be completed for objectively assessed cognitive function; a narrative summary for this outcome revealed mixed results.

Conclusions:

MBIs demonstrated evidence for improving cognitive function among cancer survivors and particularly self-reported cognitive function. However, most studies demonstrated a high risk of bias and significant concerns regarding study quality. Further research is needed to determine the effects of MBIs on both self-reported and objectively assessed cognitive function for cancer survivors, as well as optimal intervention structure and timing.
Follicular Helper T-Cell–derived Nodal Lymphomas: Study of Histomorphologic, Immunophenotypic, Clinical, and RHOA G17V Mutational Profile
Authors: Jain Surabhi , Goswami Ansh , Lone Moien R. , Ramteke Prashant , Gogia Ajay , Aggarwal Mukul , Viswanathan Ganesh K. , Kakkar Disha , Mandal Trisha , Sharma Atul , Sahoo Ranjit , Baldia Anshu , Sharma Mehar C. , Bakhshi Sameer , Pramanik Raja , Dhawan Rishi , Kumar Lalit , Mallick Saumyaranjan
Published: February 2023

The study was designed to review the demographic, clinical, and pathologic characteristics of follicular helper T cells (TFH)-derived nodal PTCL in India including angioimmunoblastic T-cell lymphoma (AITL), peripheral T-cell lymphoma (PTCL) with follicular helper T cell phenotype (P-TFH), and follicular T-cell lymphoma with additional immunohistochemistry (IHC) and RHOAG17V mutational analysis, as well as their impact on survival. This retrospective study included 88 cases of PTCL that were reclassified using IHC for TFH markers (PD1, ICOS, BCL6, and CD10) and dendritic-meshwork markers (CD21, CD23). Cases of TFH cell origin were evaluated for RHOAG17V mutation using Sanger sequencing and amplification-refractory mutation system–polymerase chain reaction (PCR) (validated using cloning and quantitative PCR) with detailed clinicopathologic correlation. Extensive re-evaluation with added IHC panel resulted in a total of 19 cases being reclassified, and the final subtypes were AITL (37 cases, 42%), PTCL—not otherwise specified (44, 50%), P-TFH (6, 7%), and follicular T-cell lymphoma (1, 1%). The presence of at least 2 TFH markers (>20% immunopositivity) determined the TFH origin. AITL patients tended to be male and showed increased presence of B-symptoms and hepatosplenomegaly. Histomorphology revealed that 92% of AITL cases had pattern 3 involvement. Sanger sequencing with conventional PCR did not yield any mutation, while RHOAG17V was detected by amplification-refractory mutation system–PCR in AITL (51%, P=0.027) and P-TFH (17%), which was validated with cloning followed by sequencing. Cases of RHOAG17V-mutant AITL had a worse Eastern Cooperative Oncology Group performance status initially but fared better in terms of overall outcome (P=0.029). Although not specific for AITL, RHOAG17V mutation shows an association with diagnosis and requires sensitive methods for detection due to low-tumor burden. The mutant status of AITL could have prognostic implications and translational relevance.
Brief Report: Challenges in Obtaining the Informed Perspectives of Stakeholders Regarding HIV Molecular Epidemiology
Authors: Bollinger Juli M. , Geller Gail , May Elizabeth , Brewer Janesse , Henry Leslie Meltzer , Sugarman Jeremy
Published: February 2023

Background:

HIV molecular epidemiology (HIV-ME) is now being used in a variety of ways, including molecular HIV surveillance to help identify and respond to emerging HIV transmission clusters as specified in the Ending the HIV Epidemic in the U.S. initiative. However, HIV-ME in general, and its use for cluster detection and response, in particular, raises significant ethical and social concerns, which have spurred vigorous debates. Nevertheless, there is a paucity of information regarding how these potential benefits and concerns are perceived among people living with HIV and people without HIV at an increased risk.

Setting:

Virtual engagement with US participants.

Methods:

We rigorously developed a brief informational video about HIV-ME and conducted a series of in-depth interviews with people living with HIV and people without HIV at an increased risk.

Results:

Through extensive stakeholder engagement during the video development process and subsequent in-depth interviews (N = 24), several preliminary findings surfaced. In contrast to the high level of concern raised by some critics of HIV-ME, our data appear to show broad support for it. In addition, we observed conflation of perspectives about HIV-ME with concerns about HIV public health surveillance more generally.

Conclusion:

Our experiences reveal substantial communication challenges related to the nature of HIV-ME that need to be overcome to ensure that it is properly understood, which is necessary for meaningfully engaging stakeholders in discussions about its use. Moreover, ongoing, responsive, engagement efforts are critical. Additional systematic data are needed to help inform policy making and practice regarding HIV-ME.
National Trends in Orthognathic Surgery: A Multi-Institutional Analysis of 6640 Patients
Authors: Kalmar Christopher L. , Chaker Sara , Pontell Matthew E. , O’Sick Nicholas R. , Golinko Michael S.
Published: February 2023

Background:

LeFort I osteotomy (LF1) and bilateral sagittal split osteotomy (BSSO) have unique operative challenges and inherent anatomic considerations that predispose to certain adverse outcomes, yet their respective complication profiles continue to be debated given conflicting results from single-center investigations. The purpose of this study is to perform a multi-institutional analysis of complications, socioeconomic trends, and financial charges associated with orthognathic surgery.

Methods:

A retrospective cohort study was conducted of orthognathic procedures performed in the United States from 2010 through 2020 using the Pediatric Health Information System. Patients younger than 12 years of age were excluded. Medical complications, surgical complications, and admission costs were compared across procedures. Socioeconomic determinants and trends across regions of the country were also analyzed.

Results:

During the study interval, 6640 patients underwent orthognathic surgery, including LF1 (59.2%, n=3928), BSSO (14.4%, n=959), and double-jaw surgery (26.4%, n=1753). Patients undergoing LF1 were more likely to experience overall complications (P<0.001), infections (P<0.001), and blood transfusions (P<0.001) than those undergoing BSSO. High-volume hospitals were more likely to perform double-jaw procedures than other hospitals (P<0.001), yet high-volume hospitals were less likely to have surgical complications (P=0.014). Patient admission charges related to orthognathic operations at high-volume hospitals were less than other hospitals (P<0.001). Household income was higher for orthognathic procedures performed at high-volume hospitals (P<0.001). White patients were 1.5 times more likely to choose a farther, higher volume hospital for orthognathic surgery than the one locally available (P=0.041).

Conclusions:

LeFort I osteotomy procedures had higher infection and transfusion rates than BSSO procedures. High-volume hospitals were more likely to perform double-jaw procedures, yet high-volume hospitals had fewer complications and decreased admission charges. Future study will be needed to further elucidate case-mix index details and socioeconomic determinants of health contributing to these disparities.
A Proposed Clinical Coagulation Score for Research in Trauma-Induced Coagulopathy
Authors: Eitel Andrew P. , Moore Ernest E. , Sauaia Angela , Kelher Marguerite R , Vigneshwar Navin G. , Bartley Matthew G. , Handley Jamie B. , Burlew Clay C. , Campion Eric M. , Fox Charles J. , Lawless Ryan A. , Pieracci Frederic M. , Platnick Kenneth B. , Moore Hunter B. , Cohen Mitchell J. , Silliman Christopher C.
Published: February 2023

Background

Trauma-induced coagulopathy (TIC) has been the subject of intense study for greater than a century and it is associated with high morbidity and mortality. The Trans-Agency Consortium for Trauma-Induced Coagulopathy (TACTIC), funded by the National Health Heart, Lung and Blood Institute, was tasked with developing a clinical TIC score, distinguishing between injury-induced bleeding from persistent bleeding due to TIC. We hypothesized that the TACTIC clinical TIC score would correlate with laboratory measures of coagulation, transfusion requirements, and mortality.

Methods

Trauma activation patients requiring a surgical procedure for hemostasis were scored in the operating room (OR) and in the first ICU day by the attending trauma surgeon. Conventional and viscoelastic (thrombelastography, TEG) coagulation assays, transfusion requirements, and mortality were correlated to the coagulation scores using the Cochran-Armitage trend test or linear regression for numerical variables.

Results

Increased OR TIC scores were significantly associated with abnormal conventional and viscoelastic measurements, including hyperfibrinolysis incidence, as well as with higher mortality and more frequent requirement for massive transfusion (p < 0.0001 for all trends). Patients with OR TIC score greater than 3, were over 31 times more likely to have an ICU TIC score greater than 3 (Relative risk: 31.6; 95% Confidence interval: 12.7-78.3; p < 0.0001).

Conclusions

A clinically defined TIC score obtained in the OR reflected the requirement for massive transfusion and mortality in severely injured trauma patients, and also correlated with abnormal coagulation assays. The OR TIC score should be validated in multicenter studies.

Level of Evidence

Prognostic and Epidemiological Level II
Hospital variability in adoption of alcohol and drug screening in adult trauma patients
Authors: Silver Casey M. , Visenio Michael R. , Thomas Arielle C. , Reddy Susheel , Raven Maria C. , Kanzaria Hemal K. , Plevin Rebecca E. , Stey Anne M.
Published: February 2023

BACKGROUND

Despite recommendations to screen all injured patients for substance use, single-center studies have reported underscreening. This study sought to determine if there was significant practice variability in adoption of alcohol and drug screening of injured patients among hospitals participating in the Trauma Quality Improvement Program.

METHODS

This was a retrospective observational cross-sectional study of trauma patients 18 years or older in Trauma Quality Improvement Program 2017–2018. Hierarchical multivariable logistic regression modeled the odds of screening for alcohol and drugs via blood/urine test while controlling for patient and hospital variables. We identified statistically significant high and low-screening hospitals based on hospitals' estimated random intercepts and associated confidence intervals (CIs).

RESULTS

Of 1,282,111 patients at 744 hospitals, 619,423 (48.3%) were screened for alcohol, and 388,732 (30.3%) were screened for drugs. Hospital-level alcohol screening rates ranged from 0.8% to 99.7%, with a mean rate of 42.4% (SD, 25.1%). Hospital-level drug screening rates ranged from 0.2% to 99.9% (mean, 27.1%; SD, 20.2%). A total of 37.1% (95% CI, 34.7–39.6%) of variance in alcohol screening and 31.5% (95% CI, 29.2–33.9%) of variance in drug screening were at the hospital level. Level I/II trauma centers had higher adjusted odds of alcohol screening (adjusted odds ratio [aOR], 1.31; 95% CI, 1.22–1.41) and drug screening (aOR, 1.16; 95% CI, 1.08–1.25) than Level III and nontrauma centers. We found 297 low-screening and 307 high-screening hospitals in alcohol after adjusting for patient and hospital variables. There were 298 low-screening and 298 high-screening hospitals for drugs.

CONCLUSION

Overall rates of recommended alcohol and drug screening of injured patients were low and varied significantly between hospitals. These results underscore an important opportunity to improve the care of injured patients and reduce rates of substance use and trauma recidivism.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.
National trends and clinical outcomes of interventional approaches following admission for infected necrotizing pancreatitis in the United States
Authors: Tran Zachary , Xu Jane , Verma Arjun , Ebrahimian Shayan , Cho Nam Yong , Benharash Peyman , Burruss Sigrid
Published: February 2023

BACKGROUND

With recent studies demonstrating the efficacy of minimally invasive approaches following infected necrotizing pancreatitis, latest guideline recommendations support their use. However, large-scale studies are lacking, and the national landscape following these guidelines remains poorly characterized. The present study examined trends in intervention strategies and the association of approach on clinical outcomes and resource use in a nationally representative cohort.

METHODS

The 2016–2019 National Inpatient Sample was queried for adult hospitalizations for pancreatitis with infected necrosis. Patients were classified as drain only (DO) if they received only percutaneous or endoscopic drainage, minimally invasive (MIS) if they underwent endoscopic or laparoscopic debridement, and Open if they underwent open debridement. The primary outcome was in-hospital mortality, while secondary outcomes included perioperative complications, home discharge, and resource use. Multivariable regression models were developed to evaluate the association of intervention with clinical and financial endpoints.

RESULTS

Of 4,605 patients who received interventions, 1,735 (37.6%) were DO, 1,490 (32.4%) were MIS, and 1,380 (30.0%) were considered Open. The proportion of DO and MIS increased, while Open declined (2016, 47.0%; 2019, 24.6%; p < 0.001). Compared with Open, MIS had lower rates of abdominal compartment syndrome while having greater rates of preoperative closed drainage (31.9% vs. 13.8%, p < 0.001). After adjustment, odds of in-hospital mortality, respiratory failure, prolonged ventilation, and acute kidney injury were significantly higher in the Open cohort compared with MIS. Hospitalization duration was longer (β, +12.1 days; 95% confidence interval, 6.8–17.5), and costs were higher (β, +$58.7K; 95% confidence interval, 33.5–83.9) in Open compared with MIS.

CONCLUSION

Minimally invasive approaches for infected pancreatic necrosis have increased over time, while open necrosectomy has declined. Open approaches compared with drainage only or minimally invasive debridement were associated with greater odds of numerous in-hospital complications and resource burden.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
Reduced Community-acquired Respiratory Virus Infection, but Not Non–virus Infection, in Lung Transplant Recipients During Government-mandated Public Health Measures to Reduce COVID-19 Transmission
Authors: Keller Brian C. , Ma Jianing , Peng Jing , Ramsammy Verai
Published: February 2023

Background.

Community-acquired respiratory viruses (CARVs) are an important cause of morbidity and mortality in lung transplant (LTx) recipients. Despite routine mask-wearing, LTx patients remain at a higher risk of CARV infection than the general population. In 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19 and a novel CARV, emerged leading federal and state officials to implement public health nonpharmaceutical interventions (NPIs) to curb its spread. We hypothesized that NPI would be associated with the reduced spread of traditional CARVs.

Methods.

A single-center, retrospective cohort analysis comparing CARV infection before a statewide stay-at-home order, during the stay-at-home order and subsequent statewide mask mandate, and during 5 mo following the elimination of NPI was performed. All LTx recipients followed by and tested at our center were included. Data (multiplex respiratory viral panels; SARS-CoV-2 reverse transcription polymerase chain reaction; blood cytomegalovirus and Epstein Barr virus polymerase chain reaction; blood and bronchoalveolar lavage bacterial and fungal cultures) were collected from the medical record. Chi-square or Fisher exact tests were utilized for categorical variables. A mixed-effect model was used for continuous variables.

Results.

Incidence of non-COVID CARV infection was significantly lower during the MASK period than during the PRE period. No difference was noted in airway or bloodstream bacterial or fungal infections, but cytomegalovirus bloodborne viral infections increased.

Conclusions.

Reductions in respiratory viral infections, but not bloodborne viral infections nor nonviral respiratory, bloodborne, or urinary infections, were observed in the setting of public health COVID-19 mitigation strategies, suggesting the effectiveness of NPI in preventing general respiratory virus transmission.
Urinary Incontinence in Turkish Women
Authors: Yilmaz Sema Dereli , Erkal Aksoy Yasemin
Published: February 2023

PURPOSE:

The study was performed to determine how urinary incontinence (UI) affects women's daily lives and sexual health and how UI is perceived.

DESIGN:

Qualitative descriptive phenomenological design was used.

SUBJECTS AND SETTING:

The study was conducted in a family health center in Konya, Turkey, with official permission of the ministry of health. Study participants comprised 101 women with UI, but data from 12 women were excluded because they refused to respond to questions; therefore, data analysis is based on responses from 89 respondents.

METHODS:

Data were compiled via in-depth interviews using a semistructured questionnaire. Data collection and analysis processes were carried out simultaneously. Study data were examined using phenomenological content and thematic analyses. Document portraits and a code map of data were created using qualitative data analysis software.

RESULTS:

Participants' mean age was 46.25 (SD: 11.68) years. Thirty-three codes were identified to detect the effects of UI on women's daily lives. These codes were reviewed and combined into 5 main themes: religious issues, sexual problems, feeling restricted, psychological exposure, and internalization.

CONCLUSIONS:

Urinary incontinence causes women to experience environmental, psychological, and religious challenges during daily life. Healthcare professionals should give counsel and assistance by determining the issues for women with UI to promote coping with problems and offer referral for specialist care when necessary.
Sleep Problems in Individuals With Intestinal Stomas and Determining the Quality of Sleep
Authors: Avci Işik Sevcan , Balanuye Berrak , Budak Ertürk Elif , Karahan Azize , Üstündağ Çiğdem , Uğurlu Ziyafet , Ören Hin Aysel , Aydin Durucan , Göçmen Baykara Zehra , Acarlar Hülya , Akar Emine , Köşker Yasemin , Koç Mehmet Ali
Published: February 2023

PURPOSE:

The aim of this study was to determine sleep problems and the sleep quality of individuals with intestinal stomas.

DESIGN:

Descriptive quantitative design was used.

SUBJECTS AND SETTING:

The research was carried out from September 2018 to September 2019 at 3 university hospitals with stoma units located in Ankara, Turkey. The study sample comprised 222 individuals with intestinal ostomies who were being monitored in these 3 centers. Approximately half (N = 113, 50.9%) had an ileostomy and 68.5% (N = 152) had a temporary stoma. More than half of the participants (N = 116, 52.3%) reported current sleep problems, 59.5% (N = 132) reported that their stoma affected their sleep, and 64% (N = 142) had problems at night due to their stomas, reporting that they woke up frequently during their main sleep period due to ostomy-related problems.

METHODS:

Three instruments were used to measure study outcomes: the researcher-designed instrument determining the descriptive characteristics of individuals with intestinal stomas, the Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale.

RESULTS:

The mean Pittsburgh Sleep Quality Index score was found to be above 5 (13.42, SD: 3.01) indicating poor sleep quality. The mean Epworth Sleepiness Scale score was 7.54 (SD: 6.37) indicating that participants had daytime sleepiness. The mean Pittsburgh Sleep Quality Index scores of participants with ileostomies (P = .002) and those with temporary stomas (P = .009) were found to be significantly higher.

CONCLUSIONS:

Study findings indicate that individuals with intestinal stomas have poor sleep quality and problems with daytime sleepiness; those with ileostomies and temporary stomas had the worst quality of sleep.
Emergence of Unusual Microorganisms in Microflora of Pilonidal Sinuses
Authors: Banerjee Tuhina , Singh Aradhana , Anurag  , Pal Sourav , Basu Somprakas
Published: February 2023

PURPOSE:

Recent reports have noted an emergence of unusual organisms in microflora of pilonidal sinus (PNS); this study was undertaken to identify the primary microbial flora associated with infected primary PNS over a period of 1 year.

DESIGN:

A prospective multiple case series.

SUBJECTS AND SETTING:

A case series of 20 patients with primary PNS in a tertiary care center in Varanasi, India, was studied. The study was conducted at the Department of Microbiology and General Surgery, Institute of Medical Sciences, Varanasi, over a period of 1 year (September 2016 to July 2017).

METHODS:

Purulent exudate (pus) samples were collected from 20 patients with primary PNS from the discharging sinuses by aseptic methods. Samples were assessed for aerobic and anaerobic flora by conventional culture and molecular methods. Antimicrobial susceptibility testing was done for bacterial isolates. Bacterial diversity was compared with the demographic and clinical profile of the sinuses by multiple correspondence analysis.

RESULTS:

Of the total cases, 11 (55%) had purulent discharge, among which all showed polymicrobial flora. The ratio of aerobic to anaerobic organisms was 1:2 (16/32). Escherichia coli (E. coli, 4, 36.36%) and Enterococcus faecalis (E. faecalis, 4, 36.36%) were commonly isolated. Bifidobacterium was the most frequent anaerobe. Detailed molecular analysis revealed the presence of Kocuria flava as an unusual pathogen. On statistical analysis, factors like male gender, increased body mass index, absence of hair in sinus, presence of features of hirsutism, and absence of Fusobacteria were closely associated with one another in these PNS cases.

CONCLUSIONS:

The case series revealed the predominance of anaerobes in primarily infected PNS cases. Bifidobacterium spp and unusual pathogens like K. flava were among the emerging pathogens in infected PNS. Use of better molecular diagnostic facilities in addition to the conventional methods might enhance the verified diversity of microorganisms in such cases.
Inferring social influence in animal groups across multiple timescales
Authors: Sridhar Vivek H. , Davidson Jacob D. , Twomey Colin R. , Sosna Matthew M. G. , Nagy Máté , Couzin Iain D.
Published: February 2023

Many animal behaviours exhibit complex temporal dynamics, suggesting there are multiple timescales at which they should be studied. However, researchers often focus on behaviours that occur over relatively restricted temporal scales, typically ones that are more accessible to human observation. The situation becomes even more complex when considering multiple animals interacting, where behavioural coupling can introduce new timescales of importance. Here, we present a technique to study the time-varying nature of social influence in mobile animal groups across multiple temporal scales. As case studies, we analyse golden shiner fish and homing pigeons, which move in different media. By analysing pairwise interactions among individuals, we show that predictive power of the factors affecting social influence depends on the timescale of analysis. Over short timescales the relative position of a neighbour best predicts its influence and the distribution of influence across group members is relatively linear, with a small slope. At longer timescales, however, both relative position and kinematics are found to predict influence, and nonlinearity in the influence distribution increases, with a small number of individuals being disproportionately influential. Our results demonstrate that different interpretations of social influence arise from analysing behaviour at different timescales, highlighting the importance of considering its multiscale nature.

This article is part of a discussion meeting issue ‘Collective behaviour through time’.
Challenges of mismatching timescales in longitudinal studies of collective behaviour
Authors: Ogino Mina , Strauss Eli D. , Farine Damien R.
Published: February 2023

How individuals’ prior experience and population evolutionary history shape emergent patterns in animal collectives remains a major gap in the study of collective behaviour. One reason for this is that the processes that can shape individual contributions to collective actions can happen over very different timescales from each other and from the collective actions themselves, resulting in mismatched timescales. For example, a preference to move towards a specific patch might arise from phenotype, memory or physiological state. Although providing critical context to collective actions, bridging different timescales remains conceptually and methodologically challenging. Here, we briefly outline some of these challenges, and discuss existing approaches that have already generated insights into the factors shaping individual contributions in animal collectives. We then explore a case study of mismatching timescales—defining relevant group membership—by combining fine-scaled GPS tracking data and daily field census data from a wild population of vulturine guineafowl (
Acryllium vulturinum
). We show that applying different temporal definitions can produce different assignments of individuals into groups. These assignments can then have consequences when determining individuals' social history, and thus the conclusions we might draw on the impacts of the social environment on collective actions.

This article is part of a discussion meeting issue ‘Collective behaviour through time’.