bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Care Utilization of Individuals Affected by Homelessness
Authors: Madigan Dana , Friedman Lee S. 
Published: March 2021

Objectives:
To describe individuals coded as homeless in state-level data comprising of outpatient and inpatient cases over a multi-year period to provide public health surveillance data on the health care utilization and needs of this population.

Research Design:
In this cross-sectional study, outpatient and inpatient visits coded for homelessness were identified from the Illinois Hospital Discharge Database from January 1, 2011 through December 31, 2018. Demographic characteristics, primary diagnosis and comorbid conditions, and hospital course of treatment were described. Predictors of discharge to a health care facility versus routine discharge to home or self-care were evaluated using multivariable logistic regression.

Results:
There were 154,173 patient visits predominantly involving males, those aged 25–64 years, and non-Hispanic Whites and African Americans. The majority had comorbidities of depression, psychosis, and/or substance abuse (70.2%) and a routine discharge to home or self-care (81.9%). Discharge to home or self-care relative to another health care institution was associated with having charity coverage and being Black/African American.

Conclusions:
Those experiencing homelessness experience a high burden of health concerns. Hospital billing records can be used to prioritize the distribution of limited public health resources for health care programs and interventions among those experiencing homelessness.
Estimating and Evaluating Tuberculosis Incidence Rates Among People Experiencing Homelessness, United States, 2007–2016
Authors: Self Julie L. , McDaniel Clint J. , Bamrah Morris Sapna , Silk Benjamin J. 
Published: March 2021

Objectives:
Persons experiencing homelessness (PEH) are disproportionately affected by tuberculosis (TB). We estimate area-specific rates of TB among PEH and characterize the extent to which available data support recent transmission as an explanation of high TB incidence.

Methods:
We estimated TB incidence among PEH using National Tuberculosis Surveillance System data and population estimates for the US Department of Housing and Urban Development’s Continuums of Care areas. For areas with TB incidence higher than the national average among PEH, we estimated recent transmission using genotyping and a plausible source-case method. For cases with ≥1 plausible source case, we assessed with TB program partners whether available whole-genome sequencing and local epidemiologic data were consistent with recent transmission.

Results:
During 2011–2016, 3164 TB patients reported experiencing homelessness. National incidence was 36 cases/100,000 PEH. Incidence estimates varied among 21 areas with ≥10,000 PEH (9–150 cases/100,000 PEH); 9 areas had higher than average incidence. Of the 2349 cases with Mycobacterium tuberculosis genotyping results, 874 (37%) had ≥1 plausible source identified. In the 9 areas, 23%–82% of cases had ≥1 plausible source. Of cases with ≥1 plausible source, 63% were consistent and 7% were inconsistent with recent transmission; 29% were inconclusive.

Conclusions:
Disparities in TB incidence for PEH persist; estimates of TB incidence and recent transmission vary by area. With a better understanding of the TB risk among PEH in their jurisdictions and the role of recent transmission as a driver, programs can make more informed decisions about prioritizing TB prevention strategies.
Arm Motor Recovery After Ischemic Stroke: A Focus on Clinically Distinct Trajectory Groups
Authors: Kline Danielle K. , Lin David J. , Cloutier Alison , Sloane Kelly , Parlman Kristin , Ranford Jessica , Picard-Fraser Matthew , Fox Annie B. , Hochberg Leigh R. , Kimberley Teresa Jacobson 
Published: March 2021

Background and Purpose:
Recovery of arm function poststroke is highly variable with some people experiencing rapid recovery but many experiencing slower or limited functional improvement. Current stroke prediction models provide some guidance for clinicians regarding expected motor outcomes poststroke but do not address recovery rates, complicating discharge planning. This study developed a novel approach to defining recovery groups based on arm motor recovery trajectories poststroke. In addition, between-group differences in baseline characteristics and therapy hours were explored.

Methods:
A retrospective cohort analysis was conducted where 40 participants with arm weakness were assessed 1 week, 6 weeks, 3 months, and 6 months after an ischemic stroke. Arm recovery trajectory groups were defined on the basis of timing of changes in the Fugl-Meyer Assessment Upper Extremity (FMA-UE), at least the minimal clinically important difference (MCID), 1 week to 6 weeks or 6 weeks to 6 months. Three recovery trajectory groups were defined: Fast (n = 19), Extended (n = 12), and Limited (n = 9). Between-group differences in baseline characteristics and therapy hours were assessed. Associations between baseline characteristics and group membership were also determined.

Results:
Three baseline characteristics were associated with trajectory group membership: FMA-UE, NIH Stroke Scale, and Barthel Index. The Fast Recovery group received the least therapy hours 6 weeks to 6 months. No differences in therapy hours were observed between Extended and Limited Recovery groups at any time points.

Discussion and Conclusions:
Three clinically relevant recovery trajectory groups were defined using the FMA-UE MCID. Baseline impairment, overall stroke severity, and dependence in activities of daily living were associated with group membership and therapy hours differed between groups. Stratifying individuals by recovery trajectory early poststroke could offer additional guidance to clinicians in discharge planning.

(See Supplemental Digital Content 1 for Video Abstract, available at: http://links.lww.com/JNPT/A337.)
Prediction of Nociception in Children Using the Nociceptive Flexion Reflex Threshold and the Bispectral Index—A Prospective Exploratory Observational Study*
Authors: Mauritz Maximilian D. , Uhlenberg Felix , Bashir-Elahi Dario , Werther Tobias , Gottschalk Urda , Ebenebe Chinedu Ulrich , Bergers Marlies , Giordano Vito , Vettorazzi Eik , Singer Dominique , Deindl Philipp 
Published: March 2021

Objectives:
The prediction of patient responses to potentially painful stimuli remains a challenge in PICUs. We investigated the ability of the paintracker analgesia monitor (Dolosys GmbH, Berlin, Germany) measuring the nociceptive flexion reflex threshold, the cerebral sedation monitor bispectral index (Medtronic, Dublin, Ireland), the COMFORT Behavior, and the modified Face, Legs, Activity, Cry, Consolability Scale scores to predict patient responses following a noxious stimulus.

Design:
Single-center prospective exploratory observational study.

Setting:
Fourteen-bed multidisciplinary PICU at the University Children’s Hospital, University Medical Center Hamburg Eppendorf, Germany.

Patients:
Children on mechanical ventilation receiving analgesic and sedative medications.

Interventions:
Noxious stimulation by way of endotracheal suctioning.

Measurements and Main Results:
Two independent observers assessed modified Face, Legs, Activity, Cry, Consolability and COMFORT Behavior Scales scores during noxious stimulation (n = 59) in 26 patients. Vital signs were recorded immediately before and during noxious stimulation; bispectral index and nociceptive flexion reflex threshold were recorded continuously. Mean prestimulation bispectral index (55.5; CI, 44.2–66.9 vs 39.9; CI, 33.1–46.8; p = 0.007), and COMFORT Behavior values (9.5; CI, 9.2–13.2 vs 7.5; CI, 6.7–8.5; p = 0.023) were significantly higher in observations with a response than in those without a response. Prediction probability (P
k) values for patient responses were high when the bispectral index was used (P
k = 0.85) but only fair when the nociceptive flexion reflex threshold (P
k = 0.69) or COMFORT Behavior Scale score (P
k = 0.73) was used. A logistic mixed-effects model confirmed the bispectral index as a significant potential predictor of patient response (p = 0.007).

Conclusions:
In our sample of ventilated children in the PICU, bispectral index and nociceptive flexion reflex threshold provided good and fair prediction accuracy for patient responses to endotracheal suctioning.
The Value of Interleukin-10 in the Early Diagnosis of Neonatal Sepsis: A Meta-Analysis
Authors: Wang Qiang , Peng Guoxuan , Gan Lebin , Deng Zhihong , Zeng Ling , Deng Jin 
Published: March 2021

Objectives:
Interleukin-10 is a significant marker in neonatal sepsis. This meta-analysis evaluated the accuracy of interleukin-10 expression in the diagnosis of neonatal sepsis.

Data Source:
Summary of literature review.

Study Selection:
A literature search strategy was developed, including PubMed, EMBASE, Web of Science, MEDLINE, and the Cochrane Library. All publications published till October 1, 2020, were retrieved; the key words were “sepsis” and “interleukin-10.”

Data Extraction:
The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were used to evaluate the data, and the heterogeneity of the combined results was tested according to the I2
value.

Data Synthesis:
A total of six articles involving 879 newborns were included in the study. The combined sensitivity was 0.82 (95% CI, 0.78–0.86), the specificity was 0.79 (95% CI, 0.75–0.82), the positive likelihood ratio was 4.17 (95% CI, 2.6–6.69), and the negative likelihood ratio was 0.25 (95% CI, 0.16–0.39). The area under the summary receiver operating characteristic curve was 0.88 (95% CI, 0.86–0.91), and the Q index was 0.81. The combined diagnostic odds ratio was 17.52 (95% CI, 8.95–34.29).

Conclusions:
Based on the results of the meta-analysis, interleukin-10 is a useful biomarker in the early diagnosis of neonatal sepsis. Its sensitivity, specificity, and diagnostic ability are excellent. However, it needs to be combined with clinical history data for comprehensive judgment and should not be used alone for diagnosis.
Explantation in Tissue Expander and Direct-to-Implant Reconstruction with Acellular Dermal Matrix: How to Avoid Early Reconstructive Failures
Authors: Cohen Leslie E. , Bogue Jarrod T. , Jin Julia , Disa Joseph J. 
Published: March 2021

Background:
In the United States, approximately 57,000 tissue expander/implant-based breast reconstructions are performed each year. Complete submuscular tissue expander coverage affords the best protection against implant exposure but can restrict lower pole expansion. The benefits of using acellular dermal matrix are enticing, but questions remain as to whether or not its presence increases reconstructive failures. The purpose of this study was to investigate predictors of explantation in those patients with acellular dermal matrix reconstructions and to discuss salvage techniques.

Methods:
An approved retrospective review was conducted of 137 patients undergoing 234 individual breast reconstructions over 4 years performed by a single plastic surgeon (J.D.) at a single institution. Patients who underwent implant-based reconstruction with either immediate placement of a tissue expander that was subsequently exchanged for a permanent implant at a second operation or immediate placement of a permanent implant when indicated were included.

Results:
One hundred thirty-seven patients who underwent 234 implant-based breast reconstructions using acellular dermal matrix met criteria. There was an overall 23 percent complication rate, including any cellulitis, seroma, skin necrosis, and hematoma formation. Significant preoperative risk factors for any postoperative complication included body mass index greater than 25 kg/m2 and a history of radiation therapy before acellular dermal matrix placement. Radiation therapy was found to be a significant risk factor for postoperative skin necrosis. Of explantations, many fluid cultures grew Gram-negative bacteria.

Conclusions:
Skin necrosis is a serious risk factor for explantation in implant-based reconstruction with acellular dermal matrix. The reconstructive surgeon should consider early excision of any skin necrosis as soon as it is identified.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
HIV-1 infection and the lack of viral control are associated with greater expression of interleukin-21 receptor on CD8+ T cells
Authors: Dalel Jama , Ung Seng K. , Hayes Peter , Black S. Lucas , Joseph Sarah , King Deborah F. , Makinde Julia , Gilmour Jill 
Published: March 2021

Objectives:
Interleukin-21 (IL-21) has been linked with the generation of virus-specific memory CD8+ T cells following acute infection with HIV-1 and reduced exhaustion of CD8+ T cells. IL-21 has also been implicated in the promotion of CD8+ T-cell effector functions during viral infection. Little is known about the expression of interleukin-21 receptor (IL-21R) during HIV-1 infection or its role in HIV-1-specific CD8+ T-cell maintenance and subsequent viral control.

Methods:
We compared levels of IL-21R expression on total and memory subsets of CD8+ T cells from HIV-1-negative and HIV-1-positive donors. We also measured IL-21R on antigen-specific CD8+ T cells in volunteers who were positive for HIV-1 and had cytomegalovirus-responding T cells. Finally, we quantified plasma IL-21 in treatment-naive HIV-1-positive individuals and compared this with IL-21R expression.

Results:
IL-21R expression was significantly higher on CD8+ T cells (P = 0.0256), and on central memory (P = 0.0055) and effector memory (P = 0.0487) CD8+ T-cell subsets from HIV-1-positive individuals relative to HIV-1-negative individuals. For those infected with HIV-1, the levels of IL-21R expression on HIV-1-specific CD8+ T cells correlated significantly with visit viral load (r = 0.6667, P = 0.0152, n = 13) and inversely correlated with plasma IL-21 (r = −0.6273, P = 0.0440, n = 11). Lastly, CD8+ T cells from individuals with lower set point viral load who demonstrated better viral control had the lowest levels of IL-21R expression and highest levels of plasma IL-21.

Conclusion:
Our data demonstrates significant associations between IL-21R expression on peripheral CD8+ T cells and viral load, as well as disease trajectory. This suggests that the IL-21 receptor could be a novel marker of CD8+ T-cell dysfunction during HIV-1 infection.
Comprehensive Cleft Care Delivery in Developing Countries: Impact of Geographic and Demographic Factors
Authors: Kantar Rami S. , Abyad Omar Al , Melhem Antonio , Chahine Elsa M. , Kassam Serena N. , Annan Beyhan , Nader Marie K. , Keith Kristen , Breugem Corstiaan C. , Hamdan Usama S. 
Published: March 2021

Introduction:
The authors analyzed the insights of participants and faculty members of Global Smile Foundation's Comprehensive Cleft Care Workshops concerning the barriers and interventions to multidisciplinary cleft care delivery, after stratification based on demographic and geographic factors.

Methods:
During 2 simulation-based Comprehensive Cleft Care Workshops organized by Global Smile Foundation, participants and faculty members filled a survey. Surveys included demographic and geographic data and investigated the most relevant barrier to multidisciplinary cleft care and the most significant intervention to deliver comprehensive cleft care in outreach settings, as perceived by participants.

Results:
The total response rate was 57.8%. Respondents reported that the greatest barrier to comprehensive cleft care was financial, and the most relevant intervention to deliver multidisciplinary cleft care was building multidisciplinary teams. Stratification by age, gender, and geographical area showed no statistical difference in reporting that the greatest barrier to cleft care was financial. However, lack of multidisciplinary teams was the most important barrier according to respondents with less than 5 years of experience (P = 0.03). Stratification by gender, years in practice, specialty, and geographical area showed no statistical difference, with building multidisciplinary teams reported as the most significant intervention. However, increased training was reported as the main intervention to cleft care for those aged less than 30 years old (P = 0.04).

Conclusions:
Our study delivers an assessment for barriers facing multidisciplinary cleft care delivery and interventions required to improve cleft care delivery. The authors are hoping that stratification by demographic and geographic factors will help them delineate community-specific road maps to refine cleft care delivery.
Per-oral Endoscopic Myotomy and Other Applications of Third Space Endoscopy: Current Status and Future Perspectives
Authors: Mandavdhare Harshal S. , Mishra Shubhra , Kumar Antriksh , Shah Jimil , Samanta Jayanta , Gupta Pankaj , Singh Harjeet , Dutta Usha 
Published: March 2021

Introduction:
The modification of NOTES (natural orifice transluminal endoscopic surgery) by mucosal safety flap has introduced us to the world of third space endoscopy (TSE). POEM (per-oral endoscopic myotomy) for achalasia cardia being its first vista, the realm expanded so that we can now remove en bloc a subepithelial/intramural tumor by POET (per-oral endoscopic tumor resection), perform G-POEM (gastric per-oral endoscopic myotomy) for refractory gastroparesis, restore esophageal continuity in complete obstruction by performing POETRE (per-oral endoscopic tunneling for the restoration of the esophagus), divide the septum in Zenker diverticulum completely with negligible risk of perforation by Z-POEM (Zenker per-oral endoscopic myotomy) and relieve constipation in Hirschsprung disease by PREM (per-rectal endoscopic myotomy). However, the real potential of TSE became evident with the introduction of POEM with fundoplication. TSE has opened the gates of the peritoneal cavity. Improved expertise and equipment will make the role of endoscopist complimentary to the surgeon with the dawn of a new field in therapeutic endoscopy.

Areas Covered:
This review intends to comprehensively discuss the various aspects of POEM for achalasia studied so far followed by a brief discussion about other applications of TSE and the future perspectives in this exciting field.
Advantages of the Left-handed Ultrasonic Shears Technique for Robotic Gastrectomy
Authors: Nishi Masaaki , Shimada Mistuo , Yoshikawa Kozo , Tokunaga Takuya , Kashihara Hideya , Takasu Chie , Yoshikawa Masato , Wada Yuma , Yoshimoto Toshiaki , Nakasu Chiharu 
Published: March 2021

Purpose:
The aim of this study was to investigate advantages of the left-handed ultrasonic shears technique in robotic gastrectomy for gastric cancer.

Methods:
We retrospectively analyzed 67 consecutive gastric cancer patients who underwent robotic gastrectomy. Fifty-six patients underwent gastrectomy with the left-handed ultrasonic shears technique (the left hand group), and 11 patients underwent surgery with the conventional approach (the conventional group). Intraoperative and postoperative outcomes were compared between the 2 groups.

Results:
Operative blood loss, morbidity, and mortality were similar between the 2 groups. We observed a trend toward a shorter operation time and higher number of retrieved lymph nodes in the left hand group compared with the conventional group. Console time (docking-gastrectomy) in the left hand group was significantly shorter than in the conventional group (192.20 vs. 218.36 min, P<0.05). In robotic distal gastrectomy, both operation time and console time in the left hand group were significantly shorter than in the conventional group (276.10 vs. 354.80 min, 176.43 vs. 209.20 min, P<0.05 for both). The postoperative intra-abdominal infectious complication (Clavien Dindo≥1) rate in the left hand group was significantly lower than that in the conventional group (0% vs. 20%, P<0.05).

Conclusions:
Use of the left-handed ultrasonic shears technique is safe and provides a technically superior operative environment with satisfactory postoperative results.
Neuro-COVID-19 is more than anosmia: clinical presentation, neurodiagnostics, therapies, and prognosis
Authors: Schweitzer Finja , Kleineberg Nina N. , Göreci Yasemin , Onur Oezguer A. , Franke Christiana , Warnke Clemens 
Published: March 2021

Purpose of review
To provide an overview on current knowledge of neurological symptoms and complications of COVID-19, and to suggest management concepts.

Recent findings
Headache, dizziness, excessive tiredness, myalgia, anosmia/hyposmia, and ageusia/dysgeusia are common nonspecific neurological manifestations during early COVID-19 disease found in the majority of patients. Less frequent but more severe and specific neurological manifestations include Guillain--Barré syndrome, encephalopathy, encephalitis/meningitis, epileptic seizures, and cerebrovascular events. Beyond standard neurological examination, these require a more extensive work-up, including cerebrospinal fluid assessment, neurophysiological evaluation, neuroimaging, and cognitive testing. Symptomatic treatment is advisable unless the neurological complication's immune pathogenesis is proven.

Summary
Neurological manifestations of COVID-19 occur during the acute, para-infectious, and ‘recovery’ phase. Therapeutic management depends on the clinical presentation and neurological work-up.
Universal Rule for Covid 19 and Herd Immunity in the US
Authors: Kuriyan Jacob G. 
Published: March 2021

AbstractA new Universal rule for Covid 19 data is derived in this paper using the SIR model.It relates infection and removal rates and is validated by the global Covid 19 data. Over 186,000 data points, from 190 countries and the states of the US, for the period April 1 to December 12, 2020 - fall on a single line, as the Universal rule predicts, transcending geography, ethnicity and race.The Universal rule requires that Herd immunity begin when just 25% of the population is vaccinated. With the anticipated 100 million vaccinations in the first 100 days of the Biden administration, Herd immunity may be imminent in the US.The Universal rule promotes a temporary stasis with continuing infections and hospitalizations and becomes a barrier to runaway infections, making it practically impossible to reach Herd immunity, as Sweden discovered. Reduced infected population seems to be a third option to stifle the epidemic - a little known accomplishment, first by North Dakota and subsequently by twelve other U.S. states, including South Dakota.