bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Permanent Supportive Housing on Health Care Utilization and Spending Among New Jersey Medicaid Enrollees Experiencing Homelessness
Authors: DeLia Derek , Nova Jose , Chakravarty Sujoy , Tiderington Emmy , Kelly Taiisa , Cantor Joel C. 
Published: March 2021

Background:
Permanent supportive housing (PSH) programs have the potential to improve health and reduce Medicaid expenditures for beneficiaries experiencing homelessness. However, most research on PSH has been limited to small samples of narrowly defined populations.

Objective:
To evaluate the effects of PSH on Medicaid enrollees across New Jersey.

Research Design:
Linked data from the Medicaid Management Information System and the Homeless Management Information System were used to compare PSH-placed Medicaid enrollees with a matched sample of other Medicaid enrollees experiencing homelessness. Comparisons of Medicaid-financed health care utilization and spending measures were made in a difference-in-differences framework 6 quarters before and after PSH placement.

Subjects:
A total of 1442 Medicaid beneficiaries enrolled in PSH and 6064 Medicaid-enrolled homeless individuals not in PSH in 2013–2014.

Results:
PSH placement is associated with a 14.3% reduction in emergency department visits (P<0.001) and a 25.2% reduction in associated spending (P<0.001). PSH also appears to reduce inpatient utilization and increase pharmacy spending with neutral effects on primary care visits and total costs of care (TCOC).

Conclusions:
Placement in PSH is associated with lower hospital utilization and spending. No relationship was found, however, between PSH placement and TCOC, likely due to increased pharmacy spending in the PSH group. Greater access to prescription drugs may have improved the health of PSH-placed individuals in a way that reduced hospital episodes with neutral effects on TCOC.
Explaining Service Use and Residential Stability in Supported Housing
Authors: Schutt Russell K. , Schultz Mark , Mitchell-Miland Chantele , McCarthy Sharon , Chinman Matthew , Ellison Marsha 
Published: March 2021

Background:
The behavioral model of health service use identified health needs, service preferences (predispositions), and service availability (enabling factors) as important predictors, but research has not conceptualized consistently each type of influence nor identified their separate effects on use of substance abuse and mental health services or their value in predicting service outcomes.

Objectives:
To test hypotheses predicting use of substance abuse and mental health services and residential stability and evaluate peer specialists’ impact.

Research Design:
Randomized trial of peer support added to standard case management in VA-supported housing program (Housing and Urban Development-VA Supportive Housing program).

Subjects:
One hundred sixty-six dually diagnosed Veterans in Housing and Urban Development-VA Supportive Housing program in 2 cities.

Measures:
Average VA service episodes for substance abuse and mental illness; residential instability; preferences for alcohol, drug, and psychological services; extent of alcohol, drug, and psychological problems; availability of a peer specialist.

Results:
Self-assessed health needs, mediated by service preferences, and assignment to a peer specialist predicted use of VA behavioral health services and residential stability, as did chronic medical problems, sex, and race.

Conclusions:
The behavioral model identifies major predictors of health service use and residential stability, but must recognize the mediating role of service preferences, the differing effects of alcohol and drug use, the unique influences of social background, and the importance of clinical judgment in needs assessment. Service availability and residential stability can be increased by proactive efforts involving peer specialists even in a health care system that provides services without a financial barrier.
Desmoplastic Small Round Cell Tumor With Ascending Intraspinal Metastasis at Recurrence: Case Report and Review of the Literature
Authors: Cacciotti Chantel , Samji Nasrin , Cox Stephanie , Yikilmaz Ali , Hann Crystal , Marin Jorge A. , Fowler JoAnn , VanHouwelingen Lisa , Athale Uma 
Published: March 2021

Background:
Desmoplastic small round cell tumor (DSRCT) is a rare and aggressive malignancy commonly involving the abdomen and/or pelvic peritoneum. Despite aggressive therapy, the prognosis remains poor. Central nervous system relapse is rare in abdominal/pelvic primary DSRCT.

Observation:
We report a case of a 10-year-old female with a large pelvic DSRCT and involvement of the rectosigmoid colon and liver. Following treatment with chemotherapy, and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy an initial response was noted. With progressive lower limb weakness, recurrence with perineural invasion in the lumbosacral nerve root involving the conus was noted 2.5 years from diagnosis. Cerebrospinal fluid showed tumor cells with a molecular confirmation.

Conclusions:
Perineural invasion and ascending paralysis secondary to primary abdominal DSRCT has not been previously reported to our knowledge. We recommend a high index of suspicion for early and accurate diagnosis of this rare presentation.
Pediatric Index of Mortality 3—An Evaluation of Function Among ICUs In South Africa*
Authors: Solomon Lincoln J. , Naidoo Kuban D. , Appel Ilse , Doedens Linda G. , Green Robin J. , Long Michael A. , Morrow Brenda , Parker Noor M. , Parris Denise , Robroch Afke H. , Salie Shamiel , Singh Shivani A. , Argent Andrew C. 
Published: March 2021

Objectives:
To evaluate the performance of the Pediatric Index of Mortality 3 as mortality risk assessment model.

Design:
This prospective study included all admissions 30 days to 18 years old for 12 months during 2016 and 2017. Data gathered included the following: age and gender, diagnosis and reason for PICU admission, data specific for the Pediatric Index of Mortality 3 calculation, PICU outcomes (death or survival), and length of PICU stay.

Setting:
Nine units that care for children within tertiary or quaternary academic hospitals in South Africa.

Patients:
All admissions 30 days to 18 years old, excluding premature infants, children who died within 2 hours of admission, or children transferred to other PICUs, and those older than 18 years old.

Interventions:
None.

Measurements and Main Results:
There were 3,681 admissions of which 2,253 (61.3%) were male. The median age was 18 months (interquartile range, 6–59.5 mo). There were 354 deaths (9.6%). The Pediatric Index of Mortality 3 predicted 277.47 deaths (7.5%). The overall standardized mortality ratio was 1.28. The area under the receiver operating characteristic curve was 0.81 (95% CI 0.79–0.83). The Hosmer-Lemeshow goodness-of-fit test statistic was 174.4 (p < 0.001). Standardized mortality ratio for all age groups was greater than 1. Standardized mortality ratio for diagnostic subgroups was mostly greater than 1 except for those whose reason for PICU admission was classified as accident, toxin and envenomation, and metabolic which had an standardized mortality ratio less than 1. There were similar proportions of respiratory patients, but significantly greater proportions of neurologic and cardiac (including postoperative) patients in the Pediatric Index of Mortality 3 derivation cohort than the South African cohort. In contrast, the South African cohort contained a significantly greater proportion of miscellaneous (including injury/accident victims) and postoperative noncardiac patients.

Conclusions:
The Pediatric Index of Mortality 3 discrimination between death and survival among South African units was good. Case-mix differences between these units and the Pediatric Index of Mortality 3 derivation cohort may partly explain the poor calibration. We need to recalibrate Pediatric Index of Mortality 3 to the local setting.
Ultrasound-Guided Quadratus Lumborum Block for Postoperative Pain in Abdominoplasty: A Randomized Controlled Study
Authors: Meouchy Michelle G. , Awaida Cyril J. , Jabbour Hicham J. , Rayess Youssef A. , Jabbour Samer F. , Nasr Marwan W. 
Published: March 2021

Background:Postoperative pain after abdominoplasty can delay postoperative ambulation, leading to life-threatening complications. Previous reports have shown the utility of quadratus lumborum block in providing adequate pain relief and avoiding side effects after numerous abdominal operations. The purpose of this randomized controlled trial was to demonstrate the efficacy of the quadratus lumborum block in abdominoplasty.Methods:Patients were randomly allocated to receive a bilateral quadratus lumborum block with either ropivacaine or normal saline. Postoperative cumulative analgesic medication consumption, pain severity at rest and on movement, and quality of recovery were evaluated and compared in both groups.Results:Twenty patients were allocated to each group. Total morphine dose received in the postanesthesia care unit was lower in the ropivacaine group than in the control group, with a mean of 3.4 mg and 6.6 mg, respectively. Cumulative tramadol consumption per patient in the first 48 hours postoperatively was significantly lower in the ropivacaine group compared with the control group (42.5 mg versus 190 mg;p= 0.0031). The Numeric Rating Scale both at rest and with effort was significantly lower in the ropivacaine group compared with the control group. The median quality of recovery for the ropivacaine group was 133 compared with 112 for the control group (p< 0.0001).Conclusions:Quadratus lumborum block in abdominoplasty reduces postoperative pain and opioid consumption and improves the quality of recovery. Further studies are needed to compare the quadratus lumborum block to more traditional blocks.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, II.
Corset Autodermis External Obliqueplasty Reinforcement of Rectus Diastasis and Umbilical Hernia Repairs during Abdominoplasty
Authors: Perry Dylan J. , Driscoll Daniel N. 
Published: March 2021

Summary:
Abdominoplasty is among the most commonly performed aesthetic operations and is frequently combined with rectus abdominis musculoaponeurotic plication of rectus diastasis and repair of umbilical and ventral hernias. The authors present a spare parts technique to assist in reinforcement of both rectus diastasis plication and hernia repair during abdominoplasty operations using an autodermis onlay reinforcement graft. The graft is harvested from the excess abdominal pannus normally discarded during abdominoplasty and is inset on tension between the bilateral semilunar lines and plicated along a concave “corset” contour. This reduces distracting forces on the hernia and diastasis repairs and further augments abdominal contour. This technique has been performed for 8 years on 82 low-surgical-risk patients, without any noted increase in complications. The corset autodermis external obliqueplasty is a spare parts technique that may reduce recurrence of rectus diastasis and abdominal hernias repaired at the time of abdominoplasty and is an alternative strategy to mesh placement in this risk-averse aesthetic surgery population.
HLA-associated preadaptation in HIV Vif is associated with higher set point viral load and faster CD4+ decline in Zambian transmission pairs
Authors: Connolly Sarah , Carlson Jonathan M. , Schaefer Malinda , Bere Alfred , Kilembe William , Allen Susan , Hunter Eric 
Published: March 2021

Objective (s):
We investigated the relationship between human leukocyte antigen (HLA)-associated preadaptation for the entire subtype C HIV-1 proteome of the transmitted founder virus and subsequent HIV-1 disease progression in a cohort of heterosexual linked transmission pairs in Zambia.

Design:
An adaptation model was used to calculate an adaptation score for each virus-HLA combination in order to quantify the degree of preadaptation of the transmitted virus to the linked recipient's HLA alleles. These scores were then assessed for their relationship to viral load and longitudinal CD4+ decline in the recipient.

Methods:
Viral RNA was extracted from the plasma of the donor partner and the linked recipient near the time of transmission, as well as longitudinally from the linked recipient. Viral adaptation scores were calculated for each individual and each protein in the subtype C HIV-1 proteome.

Results:
The majority of HLA-associated sites were located in Gag, Pol and Nef; however, proportional to protein length, the accessory and regulatory proteins contained a relatively high proportion of HLA-associated sites. Over the course of infection, HLA-mediated immune adaptation increased for all proteins except Vpu and gp120. Preadaptation was positively associated with higher early set point viral load and faster CD4+ decline. When examined by protein, preadaptation in Pol and Vif were statistically significantly associated with these markers of disease progression.

Conclusion:
Adaptation in Pol had the greatest impact on viral control. Despite containing a large proportion of HLA-associated sites, Vif was the only regulatory or accessory protein for which preadaptation significantly correlated with disease progression.
Load-Bearing Capacity and Design Advantages of a Custom-Made, Thin Pure-Titanium Cranioplasty (CranioTop)
Authors: Lewitz Marc , Salma Asem , Welzel Saravia Heinz , Sakellaropoulou Ioanna , Sarkis Hraq Mourad , Ewelt Christian , Fortmann Thomas , Wilbers Eike , Schipmann Stephanie , Suero Molina Eric , Santacroce Antonio , Zawy Alsofy Samer 
Published: March 2021

Background:
Adequate and stable coverage of cranial contour and continuity defects of any origin is a common challenge in neurosurgical clinics. This study presents the results of investigations concerning the mechanical load-bearing capacity and design advantages of custom-made implants made from a thin, pure-titanium sheet (CranioTop) (CLinstruments, Attendorn, Germany) for covering complex cranial defects.

Methods:
In 9 test series, the stability of three differently shaped and sized thin titanium sheet implants was tested using vertical, uniaxial compression with 3 different compression stamps, to investigate the behaviour of these implants in relation to punctiform as well as planar forces.

Results:
All 9 model implants showed elastic behavior in the synchronously recorded force/displacement diagrams at an impression of up to 2 mm. The forces at 2 mm deformation were between 170.1 and 702.7 Newton.

Conclusion:
Cranioplasty using CranioTop is a stable procedure for covering skull defects, even those of large dimensions. An added advantage is the significant reduction in effort required to prepare the area of the bone margins compared to other current techniques of cranioplasty.
Anatomical Features in Lower-Lip Depressor Muscles for Optimization of Myectomies in Marginal Mandibular Nerve Palsy
Authors: Vejbrink Kildal Villiam , Jensson David , Weninger Wolfgang J. , Meng Stefan , Tzou Chieh-Han John , Rodriguez-Lorenzo Andrés 
Published: March 2021

Introduction:
Myectomies of the lower-lip depressor muscles, with the aim to improve facial balance in unilateral facial paralysis, have unexplained high recurrence rates. A potential explanation is that these recurrences are due to inadequate resection through the muscle width, leaving lateral muscle fibers intact.

Aim:
Revisit the anatomy of the lower-lip depressor muscles and suggest an optimization of the surgical technique. Perform a literature review to identify recurrence rates and surgical technique of the procedure.

Materials and Methods:
Ten fresh hemifaces were dissected. The following measurements of depressor labii inferioris and depressor anguli oris were made: the widths of the muscles, the distance from the mandibular midline to the lateral borders of the muscles, and the intraoral distance from the lateral canine to the lateral border of depressor anguli oris. A literature review was performed.

Results:
The width of depressor labii inferioris was 20 ± 4 mm and depressor anguli oris 14 ± 3 mm. The distance from the midline to the lateral border of depressor labii inferioris was 32 ± 4 mm and 54 ± 4 mm for depressor anguli oris. The literature review revealed a mean recurrence rate of 21%.

Discussion:
A potential optimization of the surgical technique in lower-lip depressor myectomies is to extend the muscle resection laterally. To ensure inclusion of the whole width of the depressor muscles and decrease the recurrence rates of the procedure, the measurements presented in this study should be kept in mind during surgery.
Anatomical Findings and Short-term Efficacy of Fascial Anatomy-guided Infrapyloric Lymphadenectomy in Laparoscopic Radical Gastrectomy for Gastric Cancer
Authors: Xu Yanchang , Li Zhixiong , Pan Guofeng , Wu Haiyan , Li Junpeng , Lin Wenlin , Chen Jian , Cai Zhifeng 
Published: March 2021

Objective:
The aim was to investigate the anatomical layers of the specific fascia involved in infrapyloric lymphadenectomy in laparoscopic radical gastrectomy for gastric cancer and to analyze the short-term efficacy of an anatomy-guided surgical approach.

Materials and Methods:
On the basis of many years of clinical practice in fascial anatomy-guided laparoscopic radical gastrectomy for gastric cancer, we proposed anatomical considerations for infrapyloric lymphadenectomy in this procedure and investigated the anatomy of the mesentery and mesenteric fusion in this region, including the specific starting and ending points and the plane of the operation. We also retrospectively analyzed the clinical data of 265 patients who underwent fascial anatomy-guided infrapyloric lymphadenectomy in laparoscopic radical gastrectomy for gastric cancer from January 2015 to January 2019 and compared the short-term efficacy between the fascial anatomy-guided laparoscopic infrapyloric lymphadenectomy plus mesogastric excision group and the laparoscopic infrapyloric lymphadenectomy group.

Results:
Extensive mesenteric fusion and folds exist in the infrapyloric region of the stomach, and removal of the medial fold (medial leg) and lateral fold (lateral leg) of the infrapyloric mesogastrium during surgery is easily missed, resulting in incomplete removal of the infrapyloric mesogastrium. Baseline data were comparable between the laparoscopic infrapyloric lymphadenectomy plus mesogastric excision group and the laparoscopic infrapyloric lymphadenectomy group. The mean operative time for infrapyloric lymphadenectomy, the number of positive lymph nodes harvested in the infrapyloric region, and the number of patients with mesenteric metastasis in the infrapyloric region were not significantly different (P>0.05). The number of harvested lymph nodes was higher in the laparoscopic infrapyloric lymphadenectomy plus mesogastric excision group than in the laparoscopic infrapyloric lymphadenectomy group (5.09±3.30 vs. 4.13±2.90, P<0.05), and intraoperative blood loss was lower in the former group than in the latter group (5.89±3.78 vs. 25.21±11.24 mL, P=0.000).

Conclusion:
Fascial anatomy-guided laparoscopic infrapyloric lymphadenectomy enables systematic and complete removal of the lymph nodes and mesentery of the infrapyloric region with less intraoperative blood loss.
Use of disease-modifying drugs during pregnancy and breastfeeding
Authors: Dobson Ruth , Hellwig Kerstin 
Published: March 2021

Purpose of review
The fact that multiple sclerosis (MS) predominantly affects women has been recognized for many years. As the age at diagnosis is decreasing, and treatment options are becoming more complex, increasing numbers of women are facing decisions about the use of disease modifying therapy (DMT) in and around pregnancy.

Recent findings
New data are rapidly becoming available, particularly regarding the safety of therapies in both pregnancy and breastfeeding. Effective treatment and suppression of relapses is key to ensuring good outcomes in the longer term for the woman, however this must be balanced against individual risk of relapse and risks to the fetus. Women should be advised that it is possible to breastfeed while taking selected DMT.

Summary
In this review, we discuss evidence surrounding the safety of DMTs in both pregnancy and breastfeeding, and use this knowledge to suggest approaches to pregnancy and family planning in women with MS.
Validation of Automated Biventricular Myocardial Segmentation from Coronary Computed Tomographic Angiography for Multimodality Image Fusion
Authors: Piccinelli Marina , Dahiya Navdeep , Folks Russell D , Yezzi Anthony , Garcia Ernest V 
Published: March 2021

AbstractPurposeImage fusion strategies of myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA) have shown increased diagnostic power. However, their clinical feasibility is hindered by the lack of efficient algorithms for the extraction of cardiac anatomy from CCTA datasets. The aim of this work was to validate our previously published algorithm for automated cardiac segmentation of CCTAs in a larger cohort of subjects while testing its application in clinical settings.MethodsThree borders were automatically and manually extracted on sixty-three clinical CCTAs: left and right endocardia (LV, RV) and the biventricular epicardium (EPI). Impact of image resolutions and inter-operator variability on accuracy and robustness of automated processing were evaluated. Automated algorithm accuracy was assessed with the Dice Similarity Coefficient (DSC) and the surface-to-surface distance metric. Relevant quantities were compared for automated versus manual segmentations: LV and RV volumes, myocardial mass and LV myocardial mass.ResultsLower resolution images offered an acceptable trade-off for accuracy and processing time (45 sec). DSC for LV, RV, EPI borders were 0.88, 0.80 and 0.89. Automated versus manual correlation coefficients for LV and RV vol, myo and LV mass were 0.96, 0.73, 0.84 and 0.67 with inter-operator agreement > 0.93 for three variables. Consistent and improved results were evidenced at higher resolutions.ConclusionOur algorithms allowed efficient automated cardiac segmentation from CT imagery with minimal user intervention, clinically acceptable times and accuracy. The reported results show promise for its use in a clinical environment, specifically in the context of image fusion.