bluuebunny/crossref_metadata_2025_split huggingface dataset:
Centralization of Prehospital Triage Improves Triage of Pediatric Trauma Patients
Authors: Gutierrez Peter S. , Travers Curtis , Geng Zhi , Little Wendalyn K. 
Published: March 2020

Introduction
This study describes the experience at a level 1 pediatric trauma center before and after the centralization of prehospital trauma triage, focusing on the rate of undertriage of trauma patients. Before centralization, emergency physicians were responsible for triaging these patients with mainly physiology-based criteria; after centralization, paramedics in a communication center performed this function using the same criteria.

Methods
This retrospective study includes 10 years of pediatric trauma registry patients at our institution, 5 years before and after centralization of prehospital triage. Rates of undertriage were calculated by both the Cribari Method and by disposition from the emergency department. Logistic regression was used to assess the effect of centralization on the incidence of undertriage while adjusting for differences in case-mix.

Results
Over the 10-year study period, 1862 trauma activations meeting inclusion and exclusion criteria were recorded in the trauma registry: 893 patients in the precentralization and 969 in the postcentralization groups. After centralization of the triage process, there were statistically significant decreases in the rates of undertriage from 8.7% to 4.2% (adjusted odds ratio, 0.49; 95% confidence interval, 0.33–0.73) when analyzed by the Cribari Method and from 37.7% to 27.7% when analyzed by disposition from the emergency department (adjusted odds ratio, 0.66; 95% confidence interval, 0.64–0.81). This represents a reduction in undertriage by 51.7% and 26.5%, respectively.

Conclusions
Centralization of prehospital trauma triage at a level 1 pediatric trauma facility significantly reduced undertriage rates. Trauma centers should consider similar processes to improve prehospital triage.
Point-of-Care Ultrasound Diagnosis of Perforated Appendicitis in the Pediatric Emergency Department: A Case Series
Authors: Azhdam Devora Bita , Marin Jennifer R. 
Published: March 2020

Abstract
Point-of-care ultrasound (POCUS) is being used for clinical decision making with increasing frequency across a broad range of indications in pediatric emergency medicine (PEM). We present a series of 4 patients in whom POCUS was used to facilitate a diagnosis of perforated appendicitis.
Nasolabial Revisions in Unilateral Incomplete Cleft Lip: One Surgeon’s 28-Year Experience
Authors: Tan Stephan P. K. , Ganske Ingrid M. , Mulliken John B. 
Published: March 2020

Background:
Repair of unilateral incomplete cleft lip is the surgeon’s opportunity to achieve a superior result with few revisions.

Methods:
This study is a retrospective review of consecutive patients with unilateral incomplete cleft lip, defined as a defect extending 30 to 90 percent of cutaneous labial height, treated between 1985 and 2013 by one surgeon. Rates and types of revisions were collected, and photographs of patients who did not have a revision were reviewed to determine whether a revision was needed.

Results:
One hundred thirty-six patients met inclusion criteria. Fifty-seven percent needed revision of the mucosal free margin; less than 10 percent needed other minor labial revisions. Fifteen percent required a nasal revision, most commonly reelevation of the lower lateral cartilage. Over time, the only statistically significant change in frequency was increased revisions of the free border.

Conclusions:
Nasal revision rates are low in unilateral incomplete cleft lip compared to complete forms in previously published data by the senior author (J.B.M.). In contrast, labial revisions of the free margin are more common. The reason is that the surgeon became more cognizant of vermilion-mucosal deficiency on the noncleft side and more likely to offer a submucosal flap or dermis-fat graft to level the lip for normal upper incisor show.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Use of a Split Pedicled Gracilis Muscle Flap in Robotically Assisted Vaginectomy and Urethral Lengthening for Phalloplasty: A Novel Technique for Female-to-Male Genital Reconstruction
Authors: Cohen Oriana , Stranix John T. , Zhao Lee , Levine Jamie , Bluebond-Langner Rachel 
Published: March 2020

Summary:
The authors describe the technique of robotic vaginectomy, anterior vaginal flap urethroplasty, and use of a longitudinally split pedicled gracilis muscle flap to recreate the bulbar urethra and help fill the vaginal defect in female-to-male gender-affirming phalloplasty. Vaginectomy is performed by means of the robotically assisted laparoscopic transabdominal approach. Concurrently, gracilis muscle is harvested and passed through a tunnel between the groin and the vaginal cavity. It is then split longitudinally, and the inferior half is passed into the vaginal cavity; it is inset into the vaginal cavity. Following urethroplasty, the superior half of the gracilis flap is placed around the vaginal flap to buttress this suture line with well-vascularized tissue. From May of 2016 to March of 2018, 16 patients underwent this procedure. The average age of the patients was 35.1 ± 8.8 years, average body mass index was 31.4 ± 5.5 kg/m2, and average American Society of Anesthesiologists class was 1.8 ± 0.6. The average length of surgery was 423.6 ± 84.6 minutes, with an estimated blood loss of 246.9 ± 84.9 ml. Patients were generally out of bed on postoperative day 1, ambulating on postoperative day 2, and discharged to home on postoperative day 3 (average day of discharge, 3.4 ± 1.4 days). At a mean follow-up time of 361.1 ± 175.5 days, no patients developed urinary fistula at the urethroplasty site. The authors’ use of the longitudinally split gracilis muscle in first-stage phalloplasty represents a novel approach to providing well-vascularized tissue to achieve both urethral support and closure of intrapelvic dead space, with a single flap, in a safe, efficient, and reproducible manner.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Impact of Patient Safety Incidents Reported by the General Public in Korea
Authors: Pyo Jeehee , Lee Won , Jang Seung Gyeong , Choi Eun Young , Ock Minsu , Lee Sang-Il 
Published: March 2020

Objective
The study aimed to investigate the impacts of patient safety incident (PSI) experienced by the general public.

Methods
We conducted a self-administered online survey, in which we examined the following experiences of the patients and the caregivers: the level of harm induced by PSIs, difficulties due to PSIs, posttraumatic stress disorder (PTSD), and posttraumatic embitterment disorder, etc. A χ2 test was performed to identify differences in difficulties because of the direct and indirect experience of PSIs. A 1-way analysis of variance was performed to identify the differences in the total PTSD and posttraumatic embitterment disorder scores according to the characteristics of PSIs.

Results
Of the survey participants who indirectly experienced PSIs, 27.2% and 29.3% reported that they experienced sleep disorder and eating disorder, respectively. However, of the participants who directly experienced PSIs, 40.7% and 42.6% reported experiencing sleep disorder and eating disorder, respectively. The average PTSD scores of the participants who experienced permanent disability and death were 83.8 points for less than 6 months of elapsed time since the incident, 80.8 points for 6 months to less than 5 years, and 94.7 points for 5 years or more; they did not demonstrate a statistically significant difference (P = 0.217).

Conclusions
This study suggested that the general public who experienced PSIs have numerous difficulties at the time of the incident and the trauma or the resentment of the general public does not quickly regress even if time passes.
Detecting Spatial Cores and Temporal Trends of Repeat STIs to Plan Pre-exposure Prophylaxis (PrEP) Scale-up in DC
Authors: Das Suparna , Allston Adam , Kharfen Michael 
Published: March 2020

Background:
Repeat sexually transmitted infections (STIs) in DC primarily results from untreated sexual partners. This analysis aims to identify high-risk areas and temporal trends of repeat STIs for pre-exposure prophylaxis scale-up and STI mitigation in DC.

Methods:
We identified repeat infections in the DC Department of Health STI and HIV data management systems, diagnosed from 2014 to 2018. The cases were geocoded and aggregated by census tracts. Poisson discrete scan statistic was implemented in SaTScan software to find clusters. Weighted moving average was used to compare temporal trends of repeat STIs. We used χ2 analysis to identify association with demographic variables.

Results:
We identified 8535 repeat STIs from 2014 to 2018. Of these, 61.84% were among men, most cases were among blacks (34.75%) and 47.45% represented gonorrhea cases. The high-risk spatial clusters were identified as those tracts that had relative risk (relative risk > 1; P-value < 0.001). We identified one significant radius of risk covering tracts of wards 7 and 8 and parts of wards 5 and 6. We spotted positive temporal trends in cluster 1 and outside the cluster. We found significant associations of repeat STIs with gender (χ2 = 317.27, P < 0.001), age (χ2 = 539.26, P < 0.001), HIV coinfections (χ2 = 352.06, P < 0.001), and year of diagnoses (χ2 = 1.5, P < 0.01).

Conclusions:
Our findings indicate spatial disparities in DC for repeat STIs. This analysis is critical for pre-exposure prophylaxis planning, STI prevention strategies such as expedited partner therapies and condom distribution strategies in DC should prioritize the high-risk spatial cores.
Perinatal Antiretroviral Intensification to Prevent Intrapartum HIV Transmission When Antenatal Antiretroviral Therapy Is Initiated Less Than 8 Weeks Before Delivery
Authors: Lallemant Marc , Amzal Billy , Sripan Patumrat , Urien Saïk , Cressey Tim R. , Ngo-Giang-Huong Nicole , Klinbuayaem Virat , Rawangban Boonsong , Sabsanong Prapan , Siriwachirachai Thitiporn , Jarupanich Tapnarong , Kanjanavikai Prateep , Wanasiri Phaiboon , Koetsawang Suporn , Jourdain Gonzague , Le Coeur Sophie ,   on behalf of the PHPT-5 site investigators
Published: March 2020

Introduction:
Infants born to women living with HIV initiating combination antiretroviral therapy (cART) late in pregnancy are at high risk of intrapartum infection. Mother/infant perinatal antiretroviral intensification may substantially reduce this risk.

Methods:
In this single-arm Bayesian trial, pregnant women with HIV receiving standard of care antiretroviral prophylaxis in Thailand (maternal antenatal lopinavir-based cART; nonbreastfed infants 4 weeks' postnatal zidovudine) were offered “antiretroviral intensification” (labor single-dose nevirapine plus infant zidovudine-lamivudine-nevirapine for 2 weeks followed by zidovudine-lamivudine for 2 weeks) if their antenatal cART was initiated ≤8 weeks before delivery. A negative birth HIV-DNA polymerase chain reaction (PCR) followed by a confirmed positive PCR defined intrapartum transmission. Before study initiation, we modeled intrapartum transmission probabilities using data from 3738 mother/infant pairs enrolled in our previous trials in Thailand using a logistic model, with perinatal maternal/infant antiretroviral regimen and predicted viral load at delivery as main covariates. Using the characteristics of the women enrolled who received intensification, prior intrapartum transmission probabilities (credibility intervals) with/without intensification were estimated. After including the transmission data observed in the current study, the corresponding Bayesian posterior transmission probability was derived.

Results:
No intrapartum transmission of HIV was observed among the 88 mother/infant pairs receiving intensification. The estimated intrapartum transmission probability was 2·2% (95% credibility interval 0·5–6·1) without intensification versus 0·3% (0·0–1·6) with intensification. The probability of superiority of intensification over standard of care was 94·4%. Antiretroviral intensification appeared safe.

Conclusion:
Mother/infant antiretroviral intensification was effective in preventing intrapartum transmission of HIV in pregnant women receiving ≤8 weeks antepartum cART.
Semiautomated Renal Cortex Volumetry in Multislice Computed Tomography: Effect of Slice Thickness and Iterative Reconstruction Algorithms
Authors: Houbois Christian , Haneder Stefan , Merkt Martin , Holz Jasmin A. , Morelli John , Kiel Alexandra , Doerner Jonas , Maintz David , Puesken Michael 
Published: March 2020

Objective
The aim of the study was to evaluate the effect of slice thickness, iterative reconstruction (IR) algorithm, and kernel selection on measurement accuracy and interobserver variability for semiautomated renal cortex volumetry (RCV) with multislice computed tomography (CT).

Methods
Ten patients (62.4 ± 17.2 years) undergoing abdominal biphasic multislice computed tomography were enrolled in this retrospective study. Computed tomography data sets were reconstructed at 1-, 2-, and 5-mm slice thickness with 2 different IR algorithms (iDose, IMRST) and 2 different kernels (IMRS and IMRR) (Philips, the Netherlands). Two readers independently performed semiautomated RCV for each reconstructed data set to calculate left kidney volume (LKV) and split renal function (SRF). Statistics were calculated using analysis of variance with Geisser-Greenhouse correction, followed by Tukey multiple comparisons post hoc test. Statistical significance was defined as P ≤ 0.05.

Results
Semiautomated RCV of 120 data sets (240 kidneys) was successfully performed by both readers. Semiautomated RCV provides comparable results for LKV and SRF with 3 different slice thicknesses, 2 different IR algorithms, and 2 different kernels. Only the 1-mm slice thickness showed significant differences for LKV between IMRR and IMRS (P = 0.02, mean difference = 4.28 bb) and IMRST versus IMRS (P = 0.02, mean difference = 4.68 cm3) for reader 2. Interobserver variability was low between both readers irrespective of slice thickness and reconstruction algorithm (0.82 ≥ P ≥ 0.99).

Conclusions
Semiautomated RCV measurements of LKV and SRF are independent of slice thickness, IR algorithm, and kernel selection. These findings suggest that comparisons between studies using different slice thicknesses and reconstruction algorithms for RCV are valid.
Can Dual-Energy Computed Tomography Quantitative Analysis and Radiomics Differentiate Normal Liver From Hepatic Steatosis and Cirrhosis?
Authors: Doda Khera Ruhani , Homayounieh Fatemeh , Lades Felix , Schmidt Bernhard , Sedlmair Martin , Primak Andrew , Saini Sanjay , Kalra Mannudeep K. 
Published: March 2020

Objectives
This study aimed to assess if dual-energy computed tomography (DECT) quantitative analysis and radiomics can differentiate normal liver, hepatic steatosis, and cirrhosis.

Materials and Methods
Our retrospective study included 75 adult patients (mean age, 54 ± 16 years) who underwent contrast-enhanced, dual-source DECT of the abdomen. We used Dual-Energy Tumor Analysis prototype for semiautomatic liver segmentation and DECT and radiomic features. The data were analyzed with multiple logistic regression and random forest classifier to determine area under the curve (AUC).

Results
Iodine quantification (AUC, 0.95) and radiomic features (AUC, 0.97) differentiate between healthy and abnormal liver. Combined fat ratio percent and mean mixed CT values (AUC, 0.99) were the strongest differentiators of healthy and steatotic liver. The most accurate differentiating parameters of normal liver and cirrhosis were a combination of first-order statistics (90th percentile), gray-level run length matrix (short-run low gray-level emphasis), and gray-level size zone matrix (gray-level nonuniformity normalized; AUC, 0.99).

Conclusion
Dual-energy computed tomography iodine quantification and radiomics accurately differentiate normal liver from steatosis and cirrhosis from single-section analyses.
Peristaltic Contrast Media Injection Improved Image Quality and Decreased Radiation and Contrast Dose When Compared With Direct Drive Injection During Liver Computed Tomography
Authors: Saade Charbel , Karout Lina , Khalife Sarah , Mayat Ahmad , Pillay Sugendran , Chan Edward , Maroun Gilbert , Alam Raquelle , Shattal Mohammad Abu , Naffaa Lena 
Published: March 2020

Purpose
The aim of this study was to compare hepatic vascular and parenchymal image quality between direct and peristaltic contrast injectors during hepatic computed tomography (HCT).

Methods
Patients (n = 171) who underwent enhanced HCT and had both contrast media protocols and injector systems were included; group A: direct-drive injector with fixed 100 mL contrast volume (CV), and group B: peristaltic injector with weight-based CV. Opacification, contrast-to-noise ratio, signal-to-noise ratio, radiation dose, and CV for liver parenchyma and vessels in both groups were compared by paired t test and Pearson correlation. Receiver operating characteristic curve, visual grading characteristics, and Cohen κ were used.

Results
Contrast-to-noise ratio: compared with hepatic vein for functional liver, contrast-to-noise ratio was higher in group B (2.17 ± 0.83) than group A (1.82 ± 0.63); portal vein: higher in group B (2.281 ± 0.96) than group A (2.00 ± 0.66). Signal-to-noise ratio for functional liver was higher in group B (5.79 ± 1.58 Hounsfield units) than group A (4.81 ± 1.53 Hounsfield units). Radiation dose and contrast media were lower in group B (1.98 ± 0.92 mSv) (89.51 ± 15.49 mL) compared with group A (2.77 ± 1.03 mSv) (100 ± 1.00 mL). Receiver operating characteristic curve demonstrated increased reader in group B (95% confidence interval, 0.524–1.0) than group A (95% confidence interval, 0.545–1.0). Group B had increased revenue up to 58% compared with group A.

Conclusions
Image quality improvement is achieved with lower CV and radiation dose when using peristaltic injector with weight-based CV in HCT.
The Impact of Arterial Phase on the Detection of Cervical Lymph Node Metastasis From Papillary Thyroid Carcinoma: A Quantitative Evaluation on Multiphasic Computed Tomography
Authors: Gürsoy Çoruh Ayşegül , Uzun Çağlar , Kul Melahat , Akkaya Zehra , Halil Elhan Atilla , Gökcan Kürşat 
Published: March 2020

Objective
The purpose of this study was to assess the diagnostic performance of multiphasic computed tomography (CT) in the discrimination of metastatic lymph nodes (LNs) of papillary thyroid cancer by using quantitative parameters.

Methods
This study enrolled 272 pathologically proven metastatic and benign LNs. Multiphasic CT was utilized by using nonenhanced, arterial (25-second delay), and venous (80-second delay) phases. Mean tissue attenuation values (MAVs) of metastatic and benign LNs were measured, and normalized MAV (common carotid artery and paraspinal muscle) and wash-in and wash-out percentages were also calculated.

Results
The arterial phase showed the highest diagnostic performance in differentiation (area under the curve ± standard error, 0.97 ± 0.02; 95% confidence interval, 0.94–1.0; P < 0.001). Cutoff values for MAVs, normalized MAVs, and wash-in and wash-out percentages to predict metastatic LNs were calculated as 109 HU, 0.33, 1.93, 122.5, and −5.6 (sensitivity: 93.4%, 93.3%, 90.4%, 94.1%, and 97.8%, and specificity: 99.3%, 90.4%, 98.5%, 92.6%, and 99.3%, respectively).

Conclusions
Early-phase enhanced CT and the use of quantitative parameters derived from multiphasic CT improve the detection of cervical lymph node metastasis from papillary thyroid cancer.
Diffuse Alveolar Hemorrhage in Primary Versus Secondary Antiphospholipid Syndrome
Authors: Sangli Swathi S. , Ryu Jay H. , Baqir Misbah 
Published: March 2020

Background
Diffuse alveolar hemorrhage (DAH) occurs in patients with both primary and secondary antiphospholipid antibody syndrome (APS). We sought to determine the differences in clinical presentation, management, and outcomes of DAH in these patients.

Methods
We performed a medical records review study and reviewed 30 patients with DAH in the setting of primary and secondary antiphospholipid syndrome seen at our institution between January 1, 1997, and December 31, 2018. We analyzed their demographics, clinical presentation, laboratory values, imaging studies, lung pathology results, management, and outcomes.

Results
The patients in the secondary APS cohort were younger (median age, 48.5 vs 58 years) and comprised more females (75% vs 17%) compared with those with primary APS (p < 0.05). Two thirds of patients in the secondary APS group were anemic compared with less than one fourth in the primary APS group (p = 0.005). At the time of the first episode of DAH, the patients in the secondary APS required invasive and noninvasive ventilation, antibiotics, and combination immunosuppressive therapy (includes a combination of glucocorticoids with immunosuppressants or intravenous immunoglobulins or plasma exchange) more often compared with those with primary APS. There was only one in-hospital death (3% in-hospital mortality). One-year and 5-year mortality rates were 20% and 27%, respectively, with no significant difference between the primary and secondary APS groups.

Conclusions
Diffuse alveolar hemorrhage in the setting of APS, especially secondary APS, can be severe. However, in-hospital mortality is uncommon with current management strategies.
Examining Fall Risk Assessment in Geriatric Rehabilitation Settings Using Translational Research
Authors: Rivers Catherine A. , Roher Haley , Boissonault Bruce A. , Klinger Christopher A. , Mirza Raza M. , Foty Richard 
Published: March 2020

Abstract

Purpose
The objective of this study was to identify gaps in and to improve the falls prevention strategy (FPS) of an inpatient rehabilitation facility (IRF) in Toronto, Canada.

Design
A modified version of the Stanford Biodesign Methodology was used.

Methods
Chart reviews, a focus group (n = 8), and semistructured interviews (n = 8) were conducted to evaluate the FPS.

Findings
Admission Functional Independence Measure score, age, and gender significantly correlated with risk for a fall. The tool used at this IRF was not effectively capturing patients who were at high risk for falls. All healthcare providers interviewed were knowledgeable of fall risks; however, a patient’s fall risk status was rarely discussed as a team.

Conclusions
The findings informed recommendations to improve the overall FPS at this IRF.

Clinical Relevance
Staff may require more coaching for implementing preventative measures/ensuring accountability and evaluating whether current strategies work. These insights can guide improvement initiatives at similar facilities elsewhere.
Management and Reconstruction of a Massive Neonatal Neck Teratoma
Authors: Aivaz Marudeen , Manrique Monica , Bryant Justin R. , Mantilla-Rivas Esperanza , Oh Albert K. , Rogers Gary F. , Boyajian Michael J. 
Published: March 2020

Abstract
Cervical teratoma is a rare tumor comprised of multiple tissue types. These masses can result in significant functional and aesthetic complications, and surgical intervention is the mainstay of treatment. The authors report the treatment and 8-year follow-up of a patient born with a massive cervicofacial teratoma. The mass was diagnosed in utero and required perinatal airway management. The patient underwent several procedures to enhance his appearance and function early on in life with an excellent outcome at intermediate follow-up.