bluuebunny/crossref_metadata_2025_split huggingface dataset:
Female Veterans’ Willingness to Seek Veterans Health Administration and Non–Veterans Health Administration Services for Suicidal Thoughts and Mental Health Concerns
Authors: Monteith Lindsey L. , Holliday Ryan , Hoffmire Claire A. , Bahraini Nazanin H. 
Published: January 2021

Background:
The extent to which female veterans are willing to seek Veterans Health Administration (VHA) and non-VHA care when they are suicidal or experiencing mental health (MH) concerns is unknown.

Objectives:
The objectives of this study were to: (1) examine whether current, past, and never VHA using female veterans’ willingness to seek VHA care differs from their willingness to seek non-VHA care if suicidal or experiencing MH symptoms; (2) examine if VHA use, military sexual trauma, and suicidal ideation and attempt are associated with female veterans’ willingness to use VHA and non-VHA care when experiencing suicidal thoughts or MH symptoms.

Research Design:
A cross-sectional anonymous survey.

Subjects:
Four hundred thirty nine female veterans, including current, past, and never VHA users were included.

Measures:
General Help-Seeking Questionnaire, Self-Injurious Thoughts and Behaviors Interview, and the VA Military Sexual Trauma Screening Questions.

Results:
Current VHA users reported more willingness to use VHA than non-VHA care; conversely, past and never VHA users reported less willingness to use VHA care relative to non-VHA care. Military sexual assault and none or past VHA use were associated with lower willingness to use VHA care if suicidal or experiencing MH symptoms. In contrast, those with none or past VHA use reported greater willingness to use non-VHA care if suicidal or experiencing MH symptoms, while prior suicide attempt was associated with lower willingness.

Conclusions:
Ensuring that acceptable and effective suicide prevention services are available to female veterans in both VHA and community settings is critical. Increasing help-seeking intentions among female veterans who have attempted suicide or experienced military sexual assault is also essential.
How to One Up a Pandemic
Authors: Topor Lauren , Balser David , Bruhnding Paul , Dvorak James , Anderson Carly , Tanguay Bethany , Seidel Erica , Tonkin Brionn , Senk Alexander 
Published: January 2021

Abstract
Drastic and rapid changes to medical education are uncommon because of regulations and restrictions designed to ensure consistency among medical school curriculums and to safeguard student well-being. As a consequence of the COVID-19 pandemic, medical education had to break away from its conventions and transition from time-honored teaching methods to innovative solutions. This article explores the anticipated and actual efficacy of the swift conversion of a specialty elective from a traditional in-person format to a fully virtual clerkship. In addition, it includes a noninferiority study to determine where a virtual classroom may excel or fall short in comparison with conventional clinical rotations.
Rehabilitation Nursing Challenges for Patients With Lower Limb Amputation
Authors: Parnell Brittany , Urton Michael 
Published: January 2021

Abstract
There are over 185,000 amputations annually in the United States, and most of these patients will receive a short inpatient rehabilitation hospital stay as part of their recovery. Complications in care after amputation can negatively impact rehabilitation and subsequent disposition and community reintegration after discharge. The purpose of this article is to discuss the literature, significance, and practice recommendations for three specific challenges—skin integrity, postamputation pain, and falls. The focus population is rehabilitation patients who have undergone nontraumatic, lower limb amputation. Information about the incidence and risks of these complications give nurses necessary knowledge to improve care delivery, reduce suffering, and improve patient safety for postamputation patients during inpatient rehabilitation.
The Road to Family Resiliency: A Case Report of a Family’s Experiences Following Adolescent Stroke
Authors: Szigeti Zara , Nalder Emily , King Gillian , Farthing Julie , Gauvin-Lepage Jérôme 
Published: January 2021

Abstract

Purpose
This study generated an understanding of familial resiliency following an adolescent’s stroke and what resiliency-related outcomes were important to this family.

Design and Methods
A qualitative case study design was used to collect data during an in-person interview. The interview was transcribed verbatim and analyzed using thematic analysis.

Findings
Participants’ narratives revealed that reengaging and establishing new activities, reconstructing identities, and changing perceptions regarding health and life itself were important resiliency-related outcomes.

Conclusions
The findings from this case study highlight innovative strategies that can be used to facilitate resiliency during strenuous times in a family’s life, such as following an adolescent’s stroke.

Clinical Relevance
Clinicians and service providers have the opportunity to help facilitate resiliency by identifying which protective factors and positive outcomes are most important to a family following an adolescent’s stroke, allowing clinicians to assist in achieving these outcomes. This research illustrates ways for families to convert resources into personally meaningful resiliency-related outcomes. Further research is needed to study familial resiliency as a part of an intervention to promote occupational engagement.
Reliability and Validity of the Function-Focused Care Checklist for Caregivers
Authors: Resnick Barbara , Boltz Marie , Galik Elizabeth 
Published: January 2021

Abstract

Purpose
The purpose of this study was to test the reliability and validity of the Function-Focused Care Checklist for Caregivers using Rasch analysis.

Design
This was a descriptive study using data from the study “Testing the Dissemination and Implementation of Function-Focused Care for Assisted Living Using the Evidence Integration Triangle.” The study was approved by a university institutional review board.

Methods
A Rasch analysis was completed, which included 691 staff–resident observations from 85 assisted living facilities.

Findings
There was evidence of internal consistency (alpha coefficient of .93), construct validity except for a high OUTFIT statistic for wheelchair mobility, and hypothesis testing based on an increase in performance of function-focused care by caregivers over 12 months.

Conclusions
The findings provided psychometric support for the measure and guidance for revisions.

Clinical Relevance
This measure can be used clinically to teach caregivers to provide function-focused care to residents in assisted living.
Breast Implant–Associated Anaplastic Large Cell Lymphoma Online Education Tools
Authors: Yesantharao Pooja S. , Hunt Megan F. , Bekheet Faraah , Manahan Michele A. 
Published: January 2021

Purpose
In light of highly publicized media coverage on breast implant recalls and Food and Drug Administration hearings on breast implant safety, online searches of these topics have surged. It is thus critical to determine whether such searches are providing meaningful information for those who use them. Patient/laywomen-directed online education materials on breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) must not only be comprehensible but also accurate, actionable, and culturally concordant, especially as more diverse populations turn to the internet for breast implant–related information. This study assessed the overall suitability of BIA-ALCL patient–directed educational text and video-based materials online.

Methods
This was a cross-sectional, multimetric investigation of online text– and video-based patient-directed educational materials for BIA-ALCL using multiple validated measures. Two reviewers assessed each resource. Kruskal-Wallis and Fisher exact analyses were used as appropriate to compare text- and video-based online resources.

Results
In total, 30 websites and 15 videos were evaluated, more than half (56%) of which were from academic/physician or governmental/nonprofit sources. Overall, website and video content, as well as quality, varied by source. Academic/physician or governmental/nonprofit sources tended to be more comprehensive and have higher-quality information than commercial/media outlet sources. Median actionability of websites was 38%, well below the threshold of 70% used in the literature to identify actionable resources. The median suitability score for BIA-ALCL websites was 57%, which is considered “adequate” based on published thresholds. The mean overall Cultural Sensitivity Assessment Tool score for websites was 2.4; Cultural Sensitivity Assessment Tool scores higher than 2.5 are generally regarded as culturally sensitive. In general, videos were more understandable than websites. Substantial interrater reliability across the validated tools used in this study was noted using Pearson correlation coefficients.

Conclusions
Online resources varied in content and quality by source. As BIA-ALCL becomes an increasingly salient topic among both providers and patients, it is important to empower women with accurate information about this implant-associated cancer. Of available resources, providers should refer patients or those seeking more information to websites from governmental/academic organizations (“.gov” or “.org” domains) and videos from academic/physician or governmental sources, given that among high-quality resources, these were most clear/comprehensible. Overall, there is a need for improved online content on this topic.
Application of Autologous Cartilage Transplantation in the Reconstruction of Congenital Nasal Soft Triangle Deformities in Asians
Authors: Ma Zhibing , Wang Yawen , Chen Gang , Wang Jinming , Zhang Jun , Huang Jinlong 
Published: January 2021

Background
Nasal soft triangle is one of the areas usually left unattended in most rhinoplasties, whereas its unique anatomy puts it at great risk of deformities. Its appearance is critical to the natural contour of the nasal tip lobule. The purpose of this study was to evaluate the outcome of autologous cartilage transplantation in treating congenital nasal soft triangle deformities in Asians.

Methods
From January 2016 to January 2018, 32 patients underwent the procedure, in which costal cartilage, septal cartilage, or conchal cartilage was taken. All cases were operated upon using the external rhinoplasty approach. The cartilage was carved into battens as the lateral and intermediate crura grafts to reconstruct the dome of alar cartilage and treat the soft triangle deformities. The costal cartilage or septal cartilage was used as a columella strut. At the same time, a prosthesis or costal cartilage scaffold was placed onto the nasal dorsum, and finally the fascia was placed on the tip of the nose to relieve tension. The changes of the angle between the intermediate and lateral crura of the alar cartilage before and after cartilage graft and the difference between the greatest distance from the long axis of the nostrils to the alar rim before and after surgery were statistically analyzed. In addition, we compared the preoperative and postoperative nasal contour and evaluated the outcome of soft tissue triangle deformities and asymmetry correction and the whole procedure.

Results
The angle between the lateral and medial crura of the 32 patients decreased from 51.5 ± 10.9 degrees preoperatively to 37.2 ± 5.9 degrees at completion of the nasal dome reconstruction (P < 0.05). The maximum distance from the long axis of the nostrils to the alar rim was 3.3 ± 0.6 mm preoperatively and 1.9 ± 0.7 mm postoperatively (P < 0.05). The patients were followed up for 6 to 18 months, and the noses were with natural contour and tactile impression and without any serious complications. The degree of satisfaction was 87.5%.

Conclusions
The application of autologous cartilage is an ideal choice to treat soft triangle deformities, which can result in significant improvement of the nasal contour and high degree of satisfaction postoperatively.
Le Fort Fractures With Maxillary Immobility
Authors: Liao Han-Tsung , Mittal Rashu , Kang Gavin , Chen Chien-Tzung 
Published: January 2021

Background
Le Fort fractures with maxillary immobility are an uncommon presentation of facial trauma often associated with the disturbance of occlusion. Historically, cases involving high Le Fort fractures require a coronal extensive approach to mobilize the maxilla for occlusion restoration. Here, we review our institutional series of immobile Le Fort fractures and present their treatment approach, outcomes, classification, and then rationalize our treatment with a concept philosophy.

Materials and Methods
We treated 12 consecutive patients with unilateral and bilateral immobile Le Fort fractures from 2010 to 2017. The mean age was 27.1 years. Ten patients had a unilateral greenstick Le Fort III fracture. Five patients also had associated mandible fractures. Intraoperative occlusions could only be restored after Le Fort I osteotomy was performed on the side of the immobile Le Fort fracture. The mean follow-up period was 1.6 years.

Results
All patients presented good long-term occlusion restoration. There were no cases of nonunion or significant complications. None of the patients complained of any malar or periorbital cosmetic issues during follow-up sessions.

Conclusions
We presented an institutional series and classification of unusual Le Fort fractures with maxillary immobility, including a previously unreported fracture configuration of greenstick unilateral Le Fort III fractures combined with complete contralateral Le Fort I fracture. Based on our moment concept to rationalize treatment, as well as a systematic review of published literature, we advocate the judicious use of Le Fort I osteotomy to efficiently and safely treat these unusual fractures.
Using Various Skin Graft Techniques in Major Burn Reconstruction
Authors: Wu Chang-Ju , Li Jung-Jie , Liao Wen-Chieh , Wang Tien-Hsiang , Perng Cherng-Kang , Ma Hsu , Shih Yu-Chung , Chen Mei-Chun , Lin Chih-Hsun 
Published: January 2021

Purpose
Four hundred and ninety-nine patients had burn injuries in an explosion in Taiwan on June 27, 2015, 24 were admitted to the intensive care units of Taipei Veterans General Hospital. This study details our experience with surgical management of these patients, focusing primarily on various skin graft techniques.

Materials and Methods
This single-center retrospective study included patients who underwent at least one of the previously mentioned skin graft techniques because of extensive skin defects. The demography, burn diagram, treatment modalities, postoperative outcome, and costs were all analyzed, and a comparison with traditional mesh skin grafts was performed. The literature was also reviewed.

Results
Fourteen patients underwent the Meek skin graft technique. Only 3 received ReCell and 1 cultured epithelial autograft (CEA) at separate time point. Overall, the autologous skin grafts, including Meek/ReCell/CEA were completed within 6 months. The average skin graft success rate was approximately 72.9%, 79.2%, and 38% in Meek, ReCell, and CEA, respectively. The infection rate was approximately 35.7%, 25%, and 100% in Meek, ReCell, and CEA, respectively. The average surgical cost and total medical cost were significantly higher in patients who underwent Meek/ReCell/CEA treatments.

Conclusions
In our experience, Meek and ReCell treatments had acceptable success rates, but CEA treatment not. ReCell and CEA treatments are useful in the event of extremely limited donor sites, and they are fragile, easily infected, and technically challenging. These techniques also require longer hospitalization and tend to be more expensive, all factors that should be considered when assessing treatment options.
Molecular Dynamics Analysis of a Flexible Loop at the Binding Interface of the SARS-CoV-2 Spike Protein Receptor-Binding Domain
Authors: Williams Jonathan K. , Wang Baifan , Sam Andrew , Hoop Cody L. , Case David A. , Baum Jean 
Published: January 2021

AbstractSince the identification of the SARS-CoV-2 virus as the causative agent of the current COVID-19 pandemic, considerable effort has been spent characterizing the interaction between the Spike protein receptor-binding domain (RBD) and the human angiotensin converting enzyme 2 (ACE2) receptor. This has provided a detailed picture of the end point structure of the RBD-ACE2 binding event, but what remains to be elucidated is the conformation and dynamics of the RBD prior to its interaction with ACE2. In this work we utilize molecular dynamics simulations to probe the flexibility and conformational ensemble of the unbound state of the receptor-binding domain from SARS-CoV-2 and SARS-CoV. We have found that the unbound RBD has a localized region of dynamic flexibility in Loop 3 and that mutations identified during the COVID-19 pandemic in Loop 3 do not affect this flexibility. We use a loop-modeling protocol to generate and simulate novel conformations of the CoV2-RBD Loop 3 region that sample conformational space beyond the ACE2 bound crystal structure. This has allowed for the identification of interesting substates of the unbound RBD that are lower energy than the ACE2-bound conformation, and that block key residues along the ACE2 binding interface. These novel unbound substates may represent new targets for therapeutic design.
Impact of COVID-19 pandemic on use of Pediatric Emergency Health Services in a Tertiary Care Pediatric Hospital in North India
Authors: Sodani Ravitanaya , Gupta Shalu , Kumar Virendra 
Published: January 2021

AbstractObjectiveTo compare Pediatric Emergency attendance pre-COVID 19 to that during COVID 19 pandemic and to study changes in patient profiles attending Pediatric Emergency Department during COVID 19 pandemic.MethodsWe conducted a retrospective cross-sectional observational study and collected data from Medical Record Section during the COVID-19 pandemic from January to June 2020 and compared it with data from 2019 in similar months. Data collected was analyzed to find out the impact of COVID – 19 on use of pediatric emergency health services with respect to patient attendance, age and clinical profile before and during COVID-19 in a tertiary care hospital in New Delhi.ResultsWe observed a 43% decline in PED visits which increased to 75% during the period of lock-down (p value = 0.005). There was a significant decrease in children of age group 1-5 years attending PED. Mortality rate during lockdown had gone up by nearly 3times than the average monthly mortality.ConclusionsWhile children might not have been directly affected by the COVID-19 pandemic, but the fear of COVID 19 and measures taken to control the pandemic has affected the health seeking behavior of patients to an extent that indirectly caused more damage than anticipated.
Risk factors for bacterial infections in patients with moderate to severe COVID-19: A case control study
Authors: Nasir N. , Rehman F. , Omair S.F. 
Published: January 2021

ABSTRACTObjectiveBacterial infections are known to complicate respiratory viral infections and are associated with adverse outcomes in COVID-19 patients. A case control study was conducted to determine risk factors for bacterial infections where cases were defined as moderate to severe/critical COVID-19 patients with bacterial infection and those without were included as controls. Logistic regression analysis was performed.ResultsOut of a total of 50 cases and 50 controls, greater proportion of cases had severe or critical disease at presentation as compared to control i.e 80% vs 30% (p<0.001). Hospital acquired pneumonia (72%) and Gram negative organisms (82%) were predominant. Overall antibiotic utilization was 82% and was 64% in patients who had no evidence of bacterial infection. The median length of stay was significantly longer among cases compared to controls (12.5 versus 7.5 days) (p=0.001). The overall mortality was 30%, with comparatively higher proportion of deaths among cases (42% versus 18%) (p=0.009). Severe or critical COVID-19 at presentation (AOR: 4.42 times; 95% CI; 1.63-11.9) and use of steroids (AOR: 4.60; 95% CI 1.24-17.05) were independently associated with risk of bacterial infections. These findings have implications for antibiotic stewardship as antibiotics can be reserved for those at higher risk for bacterial superinfections.
Impact of Residential Neighborhood and Race/Ethnicity on Outcomes of Hospitalized Patients with COVID-19 in the Bronx
Authors: Miller Dwayvania , Sarwal Amara , Yu Bo , Gomez Edgar , Perez-Gutierrez Victor , Gossai Marcia , Valdez Elisenda , Mendez Astrid , Chaudry Sarah , Venugopal Usha , Dimitrov Vihren , Kasubhai Moiz , Menon Vidya 
Published: January 2021

AbstractThe socially vulnerable have been most affected due to the COVID-19 pandemic, similar to the aftermath of any major disaster. Racial and social minorities are experiencing a disproportionate burden of morbidity and mortality.The aim of this study was to evaluate the impact of residential location/community and race/ethnicity on outcomes of COVID-19 infection among hospitalized patients within the Bronx. This was a single center retrospective observational cohort study that included SARS-CoV2 positive adult residents of the Bronx (stratified as residents of South Bronx vs Rest of Bronx) hospitalized between March-May 2020. Data extracted from hospital electronic medical records included residential addresses, race, comorbidities, and insurance details. Comorbidity burden other clinical and laboratory details were also assessed to determine their correlation to COVID-19 severity of illness and outcomes of mortality and length of stay.As expected, the COVID-19 pandemic differentially affected outcomes in those in the more socially disadvantaged area of the South Bronx versus the rest of the Bronx borough. Residents of the South Bronx had a significantly higher comorbidity burden and had public insurance to access medical care in comparison to the remainder of the Bronx. Interestingly, for the patient population studied there was no observed difference in 30-day mortality by race/ethnicity among those infected with COVID- 19 in spite of the increased disease burden observed.This adds an interesting perspective to the current literature, and highlights the need to address the social/economic factors contributing to health access disparity to reduce the adverse impact of COVID-19 in these communities.