bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary care workforce paradox
Authors: White Ryan , Keahey David , Luck Morgan , Dehn Richard W. 
Published: September 2021

ABSTRACT

Objective:
Primary care workforce projections continue to predict significant physician shortages. An oversupply of primary care physician assistants (PAs) and NPs also is predicted. This paradox calls into question the assumptions that underlie workforce projection models, which likely underestimate the primary care contributions of PAs and NPs.

Methods:
Federally qualified health center data from the 2016-2019 Uniform Data System were used to calculate the number of clinic visits per full-time equivalent (FTE) physician, PA, and NP. Visits per FTE were compared across provider type to determine provider-specific productivity ratios.

Results:
The combined PA and NP productivity ratio increased relative to physicians in each year, ranging from 0.85 in 2016 to 0.88 in 2019. Clinic visits per FTE for PAs and family physicians were nearly equivalent.

Conclusions:
Primary care workforce projection models should be reexamined to more accurately capture the productivity of PAs and NPs.
Attentional interference by pain in a dishabituation procedure: an experimental investigation
Authors: De Paepe Annick L. , Crombez Geert 
Published: September 2021

Abstract
The ability to habituate to pain may be adaptive, and it may enable us to pursue valuable goals despite the pain. In this study, we experimentally investigated this idea using the primary task paradigm in which participants had to identify the color of a circle (blue or yellow) as quickly as possible while ignoring painful or tactile distractors that are presented on some of the trials. In the first experiment, we were interested whether the attentional interference effect because of the presentation of the distractors and its habituation would differ between painful and tactile distractor stimuli. In the second experiment, we investigated dishabituation (ie, the phenomenon that the introduction of a different stimulus results in an increase of the decremented response to the original stimulus). We expected habituation of the attentional interference to occur both in the tactile and the painful distractor condition, but to be less complete in the painful condition. Moreover, we hypothesized that the dishabituation would be stronger for the painful than for the tactile distractors. We did find evidence for an interference effect because of the presence of distractors. We also found habituation of attentional interference. However, the interference and its habituation were no different for tactile and painful distractors. Moreover, we did not find evidence for dishabituation. These are the first studies of their kind. Implications and guidelines for future research are formulated.
The “CIV Classification,” a New Proposal for the Architectural Grading of Vulvar Lichen Sclerosus
Authors: Boero Veronica , Liverani Carlo A. , Brambilla Massimiliano , Monti Ermelinda , Tozzi Roberto , Murina Filippo , Di Loreto Eugenia , Cipriani Sonia , Libutti Giada , Cetera Giulia E. , Iorio Maria , Dell'Acqua Andrea , Parazzini Fabio 
Published: September 2021

Objectives
The purpose of this cross-sectional study was to prepare a reliable and easy-to-use architectural classification for vulvar lichen sclerosus (VLS) aimed at defining the morphological patterns of this condition.

Materials and Methods
An expert panel composed by 7 physicians with expertise in clinical care of vulvar conditions outlined the architectural criteria for the definition of VLS severity (phimosis of the clitoris, involvement of the interlabial sulci, narrowing of the vulvar introitus), identifying 5 grades to build up a classification. Thirteen physicians with 2–30 years expertise in vulvar diseases (nonexpert group) were asked to evaluate 3–5 pictures from 137 patients. Each physician individually assigned a grade to each case, according to the previously mentioned criteria. Interrater reliability was analyzed by means of intraclass correlation coefficient (ICC). The reliability concerning the 2 classifications of each rater was analyzed by means of κ statistic. Intraobserver and interobserver reliability in vivo was analyzed by means of κ index.

Results
This study provides a new classification of VLS, based on defined anatomical criteria and graded into mutually exclusive progressive classes.
The ICC analysis showed a substantial interrater reliability of the classification, ICC = 0.89 (0.87–0.91), both in the expert panel and in the nonexpert group (ICC = 0.92 and 0.87, respectively). An “almost perfect” intraobserver and interobserver reliability was achieved among physicians in vivo (κ = 0.93).

Conclusions
Our classification showed a high reliability. It is easy to use, and it can be applied in clinical practice and eventually, in the evaluation of regenerative and cosmetic surgery.
Nursing Moral Distress and Intent to Leave Employment During the COVID-19 Pandemic
Authors: Sheppard Katherine N. , Runk Barbara G. , Maduro Ralitsa S. , Fancher Monica , Mayo Andrea N. , Wilmoth Donna D. , Morgan Merri K. , Zimbro Kathie S. 
Published: September 2021

Background:
Complexity in nursing practice creates an intense and stressful environment that may lead to moral distress (MD) and registered nurses (RNs) seeking other employment.

Local Problem:
In 2020, the RN turnover rate was 8%, with postpandemic turnover projected to reach 13%.

Methods:
The Measure of Moral Distress for Health Care Professionals (MMD-HP) was used to measure the frequency and level of RNs' MD.

Results:

t tests showed significant differences for 16 of 27 MMD-HP items in RN intent to leave. RNs had 2.9 times the odds of intent to leave (P = .019) due to perceived issues with patient quality and safety and 9.1 times the odds of intent to leave (P < .001) due to perceived issues with the work environment. Results explained 40.3% of outcome variance.

Conclusions:
MD related to work environment or patient quality and safety were significant factors in RN intent to leave their position.
Anatomy behind the Paramedian Platysmal Band: A Combined Cadaveric and Computed Tomographic Study
Authors: Davidovic Kristina , Frank Konstantin , Schenck Thilo L. , Cohen Steven R. , Dayan Steven , Gotkin Robert H. , Sykes Jonathan M. , Liew Steven , Gavril Diana , Cotofana Sebastian 
Published: September 2021

Background:
The muscular hypothesis explanation of the pathophysiology behind paramedian platysmal bands does not seem to provide a sufficient explanation for the clinical presentation of these platysmal bands in aged individuals with cervical soft-tissue laxity. The purpose of this study was to investigate the fascial relationships of the anterior neck to enhance appropriate surgical treatment.

Methods:
Retrospective analysis of computed tomographic scans of 50 Caucasian individuals (mean age, 55.84 ± 17.5 years) and anatomical dissections of 20 Caucasian and 10 Asian body donors (mean age, 75.88 ± 10.6 years) were conducted. Fascial adhesions were classified according to platysma fusion types, and platysma mobility was tested during dissection procedures.

Results:
Fusion between the left and right platysma muscles occurred in 64 percent in the suprahyoid region and in 20 percent at the thyroid cartilage, and in 16 percent, the platysma attached to the mandible without fusion. In the absence of muscular fibers, a fascial adhesion zone with limited mobility was observed where the superficial cervical fascia fused with the investing layer of the deep cervical fascia.

Conclusions:
Muscular contraction of the platysma results in elevation of the most medial platysma muscle fibers, which are not attached in the fascial adhesion zone. The presence of a fatty layer deep to the platysma enables platysmal movement and anterior and inferior gliding of the skin and platysma when cervical soft-tissue laxity exists. Surgical treatments should include transection of the fascial adhesion; this could potentially prevent the recurrence of paramedian platysmal bands.
Osseous Genioplasty: Prevention of Witch’s Chin Deformity with No-Degloving Technique
Authors: Zhang Ben H. , Byrd Rosemarie , Bradley Conor , Volpicelli Elizabeth J. , Gibstein Alexander R. , Fisher Mark , Lee Justine C. , Bradley James P. 
Published: September 2021

Background:
Osseous genioplasty is a powerful procedure that can correct chin dysmorphology; however, traditional techniques may result in chin ptosis or a “witch’s chin” deformity. Iatrogenic chin ptosis is thought to be caused by excessive degloving of soft tissue with a failure to reattach the mentalis muscle. In the authors’ study, they compared the “no-degloving” technique (using a 90-degree plate with lag-screw fixation) to the “traditional” technique, for minimization of chin ptosis.

Methods:
The authors compared genioplasty techniques for consecutive patients: group 1 (traditional) underwent degloving for fixation of a stair-step plate, whereas group 2 (no-degloving) underwent lag-screw fixation (n = 50; 25 patients per group). The authors compared operating room time, advancement, complications, preoperative-to-postoperative vertical height change of the pogonion and menton (obtained through cone beam computed tomographic scans), surgeons’ assessment of witch’s chin, and FACE-Q surveys.

Results:
No-degloving versus traditional groups had similar age and sex distributions, horizontal/vertical change (5 mm/2 mm versus 6 mm/2 mm), length of surgery, and complication rate (5 percent). The traditional group had more deviation from expected position for both the pogonion (3.4 mm versus 1.2 mm; p ≤ 0.05) and menton (2.9 mm versus 0.8 mm; p ≤ 0.05), and more occurrences of witch’s chin (six versus zero). No-degloving was superior for several FACE-Q scales, including Chin Appearance, Quality of Life, Satisfaction with Decision to Undergo Procedure, and Satisfaction with Outcome.

Conclusion:
No-degloving osseous genioplasty is a safe, reproducible technique that results in decreased soft-tissue ptosis and increased patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Racial disparities in triage of adolescent patients after bullet injury
Authors: Andrade Erin G. , Onufer Emily J. , Thornton Melissa , Keller Martin S. , Schuerer Douglas J.E. , Punch LJ 
Published: September 2021

BACKGROUND
While pediatric trauma centers (PTCs) and adult trauma centers (ATCs) exhibit equivalent trauma mortality, the optimal care environment for traumatically injured adolescents remains controversial. Race has been shown to effect triage within emergency departments (EDs) with people of color receiving lower acuity triage scores. We hypothesized that African-American adolescents were more likely triaged to an ATC than a PTC compared with their White peers.

METHODS
Institutional trauma databases from a neighboring, urban Level I PTC and ATC were queried for gunshot wounds in adolescents (15–18 years) presenting to the ED from 2015 to 2017. The PTC and ATC were compared in terms of demographics, services, and outcomes. Results were analyzed using univariate analysis and logistic regression.

RESULTS
Among 316 included adolescents, 184 were treated in an ATC versus 132 in a PTC. Patients at the PTC were significantly more likely to be younger (16.1 vs. 17.5 years; p < 0.001), White (16% vs. 5%; p = 0.001), and privately insured (41% vs. 30%; p = 0.002). At each age, the proportion of Whites treated at the PTC exceeded the proportion of African-Americans. At the PTC, patients were more likely to receive inpatient and outpatient social work follow-up (89% vs. 1%, p < 0.001). Adolescents treated at the PTC were less likely to receive opioids (75% vs. 56%, p = 0.001) at discharge and to return to ED within 6 months (25% vs. 11%, p = 0.005). On multivariate logistic regression, African-American adolescents were less likely to be treated at a PTC (odds ratio, 0.30; 95% confidence interval, 0.10–0.85; p = 0.02) after controlling for age and Injury Severity Score.

CONCLUSION
Disparities in triage of African-American and White adolescents after bullet injury lead to unequal care. African-Americans were more likely to be treated at the ATC, which was associated with increased opioid prescription, decreased social work support, and increased return to ED.

LEVEL OF EVIDENCE
Therapeutic/Care Management, Level IV.
Observational management of penetrating occult pneumothoraces: Outcomes and risk factors for interval tube thoracostomy placement
Authors: Beattie Genna , Cohan Caitlin M. , Tang Annie , Chen Joshua Y. , Victorino Gregory P. 
Published: September 2021

BACKGROUND
Guidelines for penetrating occult pneumothoraces (OPTXs) are based on blunt injury. Further understanding of penetrating OPTX pathophysiology is needed. In observational management of penetrating OPTX, we hypothesized that specific clinical and radiographic features may be associated with interval tube thoracostomy (TT) placement. Our aims were to (1) describe OPTX occurrence in penetrating chest injury, (2) determine the rate of interval TT placement in observational management and clinical outcomes compared with immediate TT placement, and (3) describe risk factors associated with failure of observational management.

METHODS
Penetrating OPTX patients presenting to our level 1 trauma center from 2004 to 2019 were reviewed. Occult pneumothorax was defined as a pneumothorax on chest computed tomography but not on chest radiograph. Patient groups included immediate TT placement versus observation. Clinical outcomes compared were TT duration and complications, need for additional thoracic procedures, length of stay (LOS), and disposition. Clinical and radiographic factors associated with interval TT placement were determined by multivariable regression.

RESULTS
Of 629 penetrating pneumothorax patients, 103 (16%) presented with OPTX. Thirty-eight patients underwent immediate TT placement, and 65 were observed. Twelve observed patients (18%) needed interval TT placement. Regardless of initial management strategy, TT placement was associated with longer LOS and more chest radiographs. Chest injury complications and outcomes were similar. Factors associated with increased odds of interval TT placement included Chest Abbreviated Injury Scale score of ≥4 (adjusted odds ratio [aOR], 7.38 [95% confidence interval, 1.43–37.95), positive pressure ventilation (aOR, 7.74 [1.07–56.06]), concurrent hemothorax (aOR, 6.17 [1.08–35.24]), and retained bullet fragment (aOR, 11.62 [1.40–96.62]) (all p < 0.05).

CONCLUSION
The majority of patients with penetrating OPTX can be successfully observed with improved clinical outcomes (LOS, avoidance of TT complications, reduced radiation). Interval TT intervention was not associated with risk for adverse outcomes. In patients undergoing observation, specific clinical factors (chest injury severity, ventilation) and imaging features (hemothorax, retained bullet) are associated with increased odds for interval TT placement, suggesting need for heightened awareness in these patients.

LEVEL OF EVIDENCE
Prognostic, level IV.
Potential Impacts of Mass Nutritional Supplementation on Measles Dynamics: A Simulation Study
Authors: Noori Navideh , Skrip Laura A. , Oron Assaf P. , McCarthy Kevin A. , Proctor Josh L. , Chabot-Couture Guillaume , Althouse Benjamin M. , Phelan Kevin P.Q. , Trehan Indi 
Published: September 2021

AbstractThe bidirectional interaction between undernutrition and infection can be devastating to child health. Nutritional deficiencies impair immunity and increase susceptibility to infection. Simultaneously, infections compound undernutrition by increasing metabolic demand, and impairing nutrient absorption. Treatment of acute malnutrition (wasting) can reverse some of its deleterious effects and reduce susceptibility to infectious diseases. Nutrition-specific approaches may be packaged with other interventions, including immunization, to support overall child health. To understand how mass nutritional supplementation, treatment of wasting, and vaccination affect the dynamics of a vaccine-preventable infection, we developed a population-level, compartmental model of measles transmission stratified by age and nutrition status. We simulated a range of scenarios to assess the potential reductions in measles infection and mortality associated with targeted therapeutic feeding for children who are wasted and with a mass supplementation intervention. Nutrition interventions were assumed to increase engagement with the health sector, leading to increased vaccination rates. We found that the combination of wasting treatment and mass supplementation coverage followed by an increase in vaccination coverage of non-wasted children from a baseline of 75% to 85%, leads to 34-57% and 65-77% reduction in measles infection and mortality and 56-60% reduction in overall mortality among wasted children, compared with the wasting treatment alone. Our work highlights the synergistic benefits that may be achieved by leveraging mass nutritional supplementation as a touch point with the health system, to increase rates of vaccination and improve child survival beyond what would be expected from the additive benefits of each intervention.
Ultrasound exposure enhances cellular uptake of nanoscale cargos
Authors: Bansal Kahkashan , Rajwar Anjali , Shekhar Himanshu , Bhatia Dhiraj 
Published: September 2021

AbstractDNA nanotechnology utilizes DNA as a structural molecule to design palette of nanostructures with different shapes and sizes. DNA nanocages have demonstrated significant potential for drug delivery. Therefore, enhancing the delivery of DNA nanocages into cells can improve their efficacy as drug delivery agents. Numerous studies have reported the effects of ultrasound for enhancing drug delivery across biological barriers. The mechanical bioeffects caused by cell-ultrasound interaction can cause sonoporation, leading to enhanced uptake of drugs, nanoparticles, and chemotherapeutic agents through membranes. Whether ultrasound exposure can enhance the delivery of DNA nanocages has not been explored, which is the focus of this study. Specifically, we investigated the effects of ultrasound on the cellular uptake of propidium Iodide, fluorescent dextrans, and DNA nanostructures). We provide evidence of modulation of pore formation in the cell membrane by ultrasound by studying the intracellular uptake of the impermeable dye, propidium iodide. Treatment of cells with low amplitudes of ultrasound enhanced the uptake of different sizes of dextrans and DNA based nanodevices. These findings could serve as the foundation for further development ultrasound-enabled DNA nanostructure delivery and for specific understanding of underlying biological mechanisms of interaction between ultrasound parameters and cellular components; the knowledge that can be further explored for potential biological and biomedical applications.
DeepREAL: A Deep Learning Powered Multi-scale Modeling Framework Towards Predicting Out-of-distribution Receptor Activity of Ligand Binding
Authors: Cai Tian , Abbu Kyra Alyssa , Liu Yang , Xie Lei 
Published: September 2021

AbstractDrug discovery has witnessed intensive exploration of the problem of drug-target physical interactions over two decades, however, a strong drug binding affinity to a single target often fails to translate into desired clinical outcomes. A critical knowledge gap needs to be filled for correlating drug-target interactions with phenotypic responses: predicting the receptor activities or function selectivity upon the ligand binding (i.e., agonist vs. antagonist) on a genome-scale and for novel chemicals. Two major obstacles compound the difficulty on this direction: known data of receptor activity is far too scarce to train a robust model in light of genome-scale applications, and real-world applications need to deploy a model on data from various shifted distributions. To address these challenges, we have developed an end-to-end deep learning framework, DeepREAL, for multi-scale modeling of genome-wide receptor activities of ligand binding. DeepREAL utilizes self-supervised learning on tens of millions of protein sequences and pre-trained binary interaction classification to solve the data distribution shift and data scarcity problems. Extensive benchmark studies that simulate real-world scenarios demonstrate that DeepREAL achieves state-of-the-art performance in out-of-distribution settings.
Morphological alternations of intracerebral arterial during middle age: a community cohort study
Authors: Zhang Boyu , Yang Zidong , Li Jing , Wang Bei , Shi Huazheng , Wang He , Li Yuehua 
Published: September 2021

AbstractBackgroundAmple evidence has suggested that vascular modifications are associated with aging. To expand previous understanding of age-related vascular changes, we examined the association between aging and cerebrovascular morphologies.Methods1176 participants aged 35 to 75 years recruited from Shanghai, China were included in this study. Cerebrovascular morphological features comprising arterial branch density, radius, and tortuosity were quantified using three-dimensional magnetic resonance angiography. Linear regression was used to examine the association between age and vasculature features.ResultsAge was found to be a significant predictor for cerebrovascular morphological alterations after adjusting for vascular risk factors. However, after dividing subjects into subgroups based on their age, aging was found to be significantly correlated with all three morphometric features only in the 45-54 subgroup after adjusting for the other vascular risk factors. Smoking gives rise to a more rapid age-related changes in vascular morphologies, while alcohol consumption could decelerate those age-related alterations.ConclusionsRapid alternations in all three morphological features assessed have been noticed to be associated with aging in the 45-54 subgroup, suggesting the potential importance of the 5th decade for early preservation method of vascular aging.FundingNational Natural Science Foundation of China.
Using Artificial Intelligence-based models to predict the risk of Mucormycosis among COVID-19 Survivors: An Experience from India
Authors: Syed-Abdul Shabbir , Babu A. Shoban , Bellamkonda Raja Shekhar , Itumalla Ramaiah , Acharyulu GVRK , Krishnamurthy Surya , Santosh Ramana Y. Venkat , Mogilicharla Naresh , Malwade Shwetambara , (Jack) Li Yu-Chuan 
Published: September 2021

AbstractIntroductionIndia reported a severe public health challenge not only due to the COVID-19 outbreak but also the increasing number of associated mucormycosis cases since 2021. This study aimed at developing artificial intelligence-based models to predict the risk of mucormycosis among the patients at the time of discharge from the hospital.MethodsThe dataset included 1229 COVID-19 positive patients, and additional 214 inpatients, COVID-19 positive as well as infected with mucormycosis. We used logistic regression, decision tree, and random forest, and the extreme gradient boosting algorithm. All our models were evaluated with 5-fold validation to derive a reliable estimate of the model error.ResultsThe logistic regression, XGBoost, and random forest performed equally well with AUROC 95.0, 94.0, and 94.0 respectively. This study also determined the top five variables namely obesity, anosmia, de novo diabetes, myalgia, and nasal discharge, which showed a positive impact on the risk of mucormycosis.ConclusionThe developed model has the potential to predict the patients at high risk and thus, consequently initiating preventive care or aiding in early detection of mucormycosis infection. Thus, this study holds potential for early treatment and better management of patients suffering from COVID-19 associated mucormycosis.