bluuebunny/crossref_metadata_2025_split huggingface dataset:
The polytrauma patient: Current concepts and evolving care
Authors: Lee Christopher , Rasmussen Todd E. , Pape Hans-Christoph , Gary Joshua L. , Stannard James P. , Haller Justin M. 
Published: April 2021

Abstract
Principles of care in the polytraumatized patient have continued to evolve with advancements in technology. Although hemorrhage has remained a primary cause of morbidity and mortality in acute trauma, emerging strategies that can be applied pre-medical facility as well as in-hospital have continued to improve care. Exo-vascular modalities, including the use of devices to address torso hemorrhage and areas not amenable to traditional tourniquets, have revolutionized prehospital treatment. Endovascular advancements including the resuscitative endovascular balloon occlusion of the aorta (REBOA), have led to dramatic improvements in systolic blood pressure, although not without their own unique complications. Although novel treatment options have continued to emerge, so too have concepts regarding optimal time frames for intervention. Though prior care has focused on Injury Severity Score (ISS) as a marker to determine timing of intervention, current consensus contends that unnecessary delays in fracture care should be avoided, while respecting the complex physiology of certain patient groups that may remain at increased risk for complications. Thromboelastography (TEG) has been one technique that focuses on the unique pathophysiology of each patient, providing guidance for resuscitation in addition to providing information in recognizing the at-risk patient for venous thromboembolism. Negative pressure wound therapy (NPWT) has emerged as a therapeutic adjuvant for select trauma patients with significant soft tissue defects and open wounds. With significant advancements in medical technology and improved understanding of patient physiology, the optimal approach to the polytrauma patient continues to evolve.
Finding the Gaps in Retesting for Chlamydia and Gonorrhea: Differences Across High-Volume Testing Departments in an Urban Health Care Setting
Authors: McCool-Myers Megan , Turner Daria , Henn Megan C. , Sheth Anandi N. , Karlow Samantha L. , Kottke Melissa J. 
Published: April 2021

Background
The Centers of Disease Control and Prevention guidelines recommend that all patients be retested 3 months after a positive chlamydia (CT) or gonorrhea (GC) result. However, retest rates are generally low, and only a quarter of patients return to clinic for retesting. This analysis explored retesting patterns in a high sexually transmitted infection (STI)/human immunodeficiency virus (HIV)-risk setting to illuminate gaps in adherence to guideline recommendations.

Methods
Retrospective chart data from a large urban safety-net institution were analyzed descriptively. Patients who received a positive CT/GC test from January to February 2017 were followed up for at least 4 months to assess if retesting occurred within approximately 3 months.

Results
Our sample of 207 patients was primarily non-Hispanic Black (92.8%), younger than 25 years (63.3%) and women (60.4%). Over half had been initially diagnosed with CT, one-third with GC, and one-tenth with both CT and GC. Eighty-nine (43.0%) patients were retested during the observed period; mean time between tests was 2.7 months. Retesting was most common in infectious diseases/HIV primary care (73.6%) and obstetrics/gynecology (44.9%). Patients who were first diagnosed in emergency medicine were significantly less likely to be retested. Retested patients included a large number of HIV-positive men (31 of 89 total) and pregnant women (23 of 54 women).

Conclusions
Forty-three percent of patients were retested within approximately 3 months of their initial positive CT/GC diagnosis, exceeding previously published rates. Nonetheless, in light of the growing STI epidemic, health care systems should prioritize retesting across high-volume testing specialties, rethink retesting models, and facilitate referrals to ensure that patients receive guideline-recommended, comprehensive STI care.
Case Report: Idiopathic Sclerosing Orbital Inflammation
Authors: Bachman Groth Jane A. , Harris Gerald J. 
Published: April 2021

SIGNIFICANCE
Idiopathic sclerosing orbital inflammation (ISOI) is characterized by insidious, chronic, progressive inflammation and fibrosis that damage ocular structures and produce a mass effect. This case highlights the challenges in diagnosis and management of ISOI, as well as the associated ocular morbidities, including potential vision loss.

PURPOSE
The purpose of this study was to provide education regarding a rare condition that exhibits variable presentation and has an unpredictable success rate with regard to treatment paradigm. Improved therapeutic options are promising. Ultimately, early detection and management are key and may allow for better visual outcome.

CASE REPORT
A 46-year-old woman presented with complaints of chronic right-sided facial headaches and eye pain and gradual right globe prominence over the previous 6 months. Worsening vision and decreased right peripheral visual field were also noted. Upon examination, an afferent pupillary defect and florid disc edema were evident. Imaging studies revealed an orbital and extraorbital infiltrative mass involving the right orbital apex, inferior orbital fissure, pterygopalatine fossa, and cavernous sinus. Right anterior orbitotomy with biopsy revealed fragments of fibroconnective and adipose tissue with sclerosis and chronic focal inflammation, consistent with ISOI. Treatment included intravenous methylprednisone, followed by oral prednisone, beginning at 60 mg/d with a slow taper thereafter. Signs and symptoms improved dramatically and eventually resolved. Vision significantly improved, and the afferent pupillary defect resolved. The patient remained asymptomatic at 3-month follow-up.

CONCLUSIONS
Idiopathic sclerosing orbital inflammation is difficult to diagnose and manage. No large studies exist because of the rare nature of the disease. Slowly progressive, nonspecific signs and symptoms may delay recognition and treatment. Orbital imaging and histopathologic analysis are critical for definitive diagnosis. Conventional treatment with corticosteroids is not uniformly successful, but newer combined therapy options can improve outcomes. Early identification and treatment are key to management and ultimate preservation of function and vision.
Near-point Findings in Children with Autism Spectrum Disorder and in Typical Peers
Authors: Coulter Rachel Anastasia , Bade Annette , Jenewein Erin C. , Tea Yin C. , Mitchell G. Lynn 
Published: April 2021

SIGNIFICANCE
Clinicians can better diagnose and manage vision problems of autism spectrum disorder (ASD) children by establishing a standard of care for this population. Results also reinforce the importance of a comprehensive binocular vision evaluation in all patients with ASD.

PURPOSE
The purposes of this study were to compare near-point and ocular motility test findings in ASD children and typically developing (TD) peers and to compare findings among ASD children by level of verbal communication.

METHODS
Sixty-one children and adolescents (ASD, 34; TD, 27) aged 9 to 17 years completed an eye examination protocol including tests of distance and near phoria, near point of convergence, near fusional convergence and divergence, accommodative response, and Northeastern State University College of Optometry oculomotor testing. Testing was completed through refractive correction. Parents of ASD children provided information regarding subjects' verbal communication level (nonverbal, uses short words, verbal).

RESULTS
Distance phoria did not differ significantly between groups. Near phoria of ASD subjects was more exophoric (difference, 2.8 prism diopters). Mean near point of convergence break and recovery were 7.0 and 8.02 cm, respectively, in ASD subjects and 2.19 and 3.99 cm in TD subjects. Near fusional divergence and convergence showed no significant difference. Autism spectrum disorder subjects had significantly poorer stereoacuity (P < .0001) and, on Northeastern State University College of Optometry Oculomotor Testing, reduced fixation, poorer accuracy and stamina/ability, and increased head and body movement. Monocular estimation method retinoscopy results did not differ significantly between ASD and TD subjects. No significant differences in phoria, near point of convergence, and near fusional divergence or convergence were observed between ASD subgroups (nonverbal, uses short words, verbal).

CONCLUSIONS
Autism spectrum disorder children are more likely to show receded near point of convergence, poor fixation, inaccurate saccades, erratic pursuits, and exophoric posture. These differences occur, regardless of reported verbal communication level.
Longitudinal Opioid Surveillance Project Involving Toxicologic Analysis of Postmortem Specimens from 9 Counties in Michigan Suggests the Discovery of New High-Intensity Drug Trafficking Areas
Authors: Stevens Christine , Li Tong , Ton Erinn , Zou Jalynn , Douglas Elizabeth , Jones Prentiss 
Published: April 2021

Abstract
Acetyl fentanyl (AF) is a Schedule I fentanyl analog that has been increasingly seen in heroin and fentanyl polydrug toxicity overdoses in Michigan (MI). Drug users are often unaware of the presence of AF in their drugs because it is often sold mixed into or disguised as heroin. High levels of AF in heroin drug products can cause increased incidence of overdose. This article describes data from a longitudinal opioid surveillance program and details 102 decedents in MI who were found to have evidence of heroin in their postmortem blood. A large portion of these decedents were also found to have evidence of fentanyl and AF. Our data further show significant overlap in incidence rates of AF and heroin-related overdose deaths in several MI counties, suggesting that AF is becoming enmeshed in heroin trafficking. Furthermore, we report unprecedented high incidence rates of AF and heroin-related overdose deaths in Calhoun county, and we propose that it is a high-intensity drug trafficking area. Highways US-131 and US-31 are likely used to transport these drugs. More study is needed into the drug trafficking trends in MI to ascertain drug sources and monitor the ever developing and dangerous polydrug heroin combinations.
Meaning of fabric orthoses to long-term users with multiple sclerosis: An interpretative phenomenological analysis
Authors: Snowdon Nicola , Booth Susan , McLean Sionnadh , Wheat Jon , Piercy Hilary 
Published: April 2021

Background:
Fabric orthoses are elasticated garments designed to provide support to the musculoskeletal system. They may benefit people with multiple sclerosis; however, in this population, their acceptability is largely unexplored.

Objectives:
This study aimed to explore the meaning that fabric orthoses hold for people with multiple sclerosis and factors influencing acceptability.

Study Design:
This is a qualitative study using an interpretative phenomenological analysis to explore the meaning ascribed to lived experience.

Methods:
Four people with multiple sclerosis participated in face-to-face semi-structured interviews. Two used upper limb orthotic sleeves for involuntary movement control, one used orthotic shorts, and one used a soft ankle brace. Three participants had fabric orthoses they no longer used. Themes were validated by peer review.

Findings:
Two themes were identified. “Giving back control” describes how perceived physical benefits, such as decreased involuntary movement and improved stability, led to important benefits in autonomy and self-image. Orthoses were not worn longer-term where self-image was not improved. “Learning to live with an orthosis” captures the way in which participants learnt from experience over months or years how to maximize effectiveness and overcome disadvantages. Acceptability was determined specific to the contexts in which the orthoses were used, with the social appropriateness of appearance and the demands of tasks being important considerations.

Conclusions:
Fabric orthoses can be acceptable to people with multiple sclerosis. Professionals should be mindful of the active learning process that users engage in as they learn about the pros and cons of orthotic use. Further research into effectiveness is needed.
Immediate effect of prefabricated and UCBL foot orthoses on alignment of midfoot and forefoot in young people with symptomatic flexible flatfoot: A radiographic evaluation
Authors: Mahdiyar Zahra , Saeedi Hassan , Vasaghi-Gharamaleki Behnoosh , Abdollah Vahid 
Published: April 2021

Background:Radiographic imaging has been considered the gold standard in evaluating the skeletal alignment of the foot in static weightbearing. The effects of foot orthoses on the alignment of foot bones have been mostly evaluated using lateral view x-rays. The posterior–anterior view has not been investigated extensively.Objectives:To investigate the effects of 2 foot orthoses: University of California Biomechanics Laboratory Orthosis (UCBL) and a prefabricated orthosis (P-FFO) on the alignment of foot bones on anterior–posterior x-rays in young people with symptomatic flexible flatfoot (SFF).Study Design:This is a randomized, crossover study.Methods:Fifteen participants (mean [SD], 23.67 ± 2 years) with SFF were randomly imaged in 3 different conditions: shoes only, shoes + P-FFO, and shoes + UCBL. The talonavicular coverage, the first and the second talometatarsal angles, the intermetatarsal angle, and the cuboid abduction angle (CAA) were measured on weightbearing, anterior–posterior x-ray images for each condition.Results:Both orthotic designs demonstrated a significant reduction in the talonavicular coverage, the first and the second talometatarsal angles, and the CAA compared with the shoe-only condition (P< .001). The talonavicular coverage angle reduced by ∼11% using P-FFO compared with UCBL (P< .005). No significant differences were observed for other angles between the 2 orthotic conditions.Conclusions:Both orthotic conditions improved the talonavicular coverage, first and the second talometatarsal angle, and CAA in young people with SFF. The walls of the UCBL orthosis did not result in further correction of the talonavicular coverage angle compared with the prefabricated FFO design.
Understanding the effects of quantitatively prescribing passive-dynamic ankle-foot orthosis bending stiffness for individuals after stroke
Authors: Koller Corey , Reisman Darcy , Richards James , Arch Elisa 
Published: April 2021

Background:
Passive-dynamic ankle-foot orthosis (PD-AFO) bending stiffness, which assists plantar flexor function, can be prescribed to improve poststroke gait. However, outcomes with PD-AFOs are variable likely because of improper personalization. We implemented a prescription model that objectively personalizes PD-AFO bending stiffness based on each individual's level of plantar flexor weakness (quantitatively prescribed PD-AFO).

Objectives:
To evaluate whether a quantitatively prescribed PD-AFO improves peak paretic plantar flexion moment compared with the original AFO for individuals after stroke and to examine the immediate effects of wearing a quantitatively prescribed PD-AFO.

Study Design:
This is a repeated-measures study.

Methods:
PD-AFO bending stiffness was personalized for 10 individuals after stroke through the previously developed prescription model. Participants underwent an instrumented gait analysis while wearing their original AFO and the quantitatively prescribed PD-AFO.

Results:
Participants' peak paretic plantar flexion moment significantly increased while wearing the quantitatively prescribed PD-AFO compared with the original AFO. In addition, participants showed different levels of improvements in a series of other key biomechanical and walking performance parameters with PD-AFO use. Some participants showed improvements in all parameters, whereas others showed moderate to no improvements.

Conclusions:
Quantitatively prescribed PD-AFO bending stiffness resulted in inconsistent improvements in biomechanical and walking performance parameters, which warrants further investigation. Future work should investigate whether more consistent benefits are seen with faster walking speeds and longer-term PD-AFO use. In addition, future work should conduct larger-scale studies that aim to understand and optimize orthosis-patient matching for all AFO designs/characteristics.
Second-generation mother-to-child HIV transmission in South Africa is characterized by poor outcomes
Authors: Millar Jane R. , Fatti Isabella , Mchunu Noxolo , Bengu Nomonde , Grayson Nicholas E. , Adland Emily , Bonsall David , Archary Moherndran , Matthews Philippa C. , Ndung’u Thumbi , Goulder Philip 
Published: April 2021

Objective:
The worldwide incidence of pregnancy for women living with perinatal HIV infection is increasing. Subsequently, there is growing risk of second-generation mother-to-child HIV transmission. The infant clinical outcomes for such a phenomenon have yet to be described.

Design:
As part of a wider observational study in KwaZulu-Natal, South Africa, six infants with in-utero HIV infection were identified as being born to mothers with perinatal HIV infection.

Methods:
Blood results and clinical data were collected in the first 3 years of life. In two cases, sample availability allowed confirmation by phylogenetic analysis of grandmother-to-mother-to-child HIV transmission.

Results:
Outcomes were poor in all six cases. All six mothers had difficulty administering twice daily combination antiretroviral therapy to their infants due to difficulties with acceptance, disclosure, poor health and being themselves long-term nonprogressors. Nonnucleoside reverse transcriptase inhibitor-resistant virus was detected in all mothers tested. None of the infants maintained suppression of viraemia on combination antiretroviral therapy. One infant died, and another was lost to follow-up.

Conclusion:
As the numbers of second-generation mother-to-child transmissions increase, it is important to highlight that this mother–infant dyad represents an extremely vulnerable group. In order for them to survive and thrive, these infants’ mothers require their specific needs to be addressed and given intensive support.
The impact of viraemia on inflammatory biomarkers and CD4+ cell subpopulations in HIV-infected children in sub-Saharan Africa
Authors: Prendergast Andrew J. , Szubert Alexander J. , Pimundu Godfrey , Berejena Chipo , Pala Pietro , Shonhai Annie , Hunter Patricia , Arrigoni Francesca I.F. , Musiime Victor , Bwakura-Dangarembizi Mutsa , Musoke Philippa , Poulsom Hannah , Kihembo Macklyn , Munderi Paula , Gibb Diana M. , Spyer Moira J. , Walker A. Sarah , Klein Nigel 
Published: April 2021

Objective:
To determine the impact of virological control on inflammation and cluster of differentiation 4 depletion among HIV-infected children initiating antiretroviral therapy (ART) in sub-Saharan Africa.

Design:
Longitudinal cohort study.

Methods:
In a sub-study of the ARROW trial (ISRCTN24791884), we measured longitudinal HIV viral loads, inflammatory biomarkers (C-reactive protein, tumour necrosis factor alpha, interleukin 6 (IL-6), soluble CD14) and (Uganda only) whole blood immunophenotype by flow cytometry in 311 Zimbabwean and Ugandan children followed for median 3.5 years on first-line ART. We classified each viral load measurement as consistent suppression, blip/post-blip, persistent low-level viral load or rebound. We used multi-level models to estimate rates of increase or decrease in laboratory markers, and Poisson regression to estimate the incidence of clinical events.

Results:
Overall, 42% children experienced viral blips, but these had no significant impact on immune reconstitution or inflammation. Persistent detectable viraemia occurred in one-third of children and prevented further immune reconstitution, but had little impact on inflammatory biomarkers. Virological rebound to ≥5000 copies/ml was associated with arrested immune reconstitution, rising IL-6 and increased risk of clinical disease progression.

Conclusions:
As viral load testing becomes more available in sub-Saharan Africa, repeat testing algorithms will be required to identify those with virological rebound, who need switching to prevent disease progression, whilst preventing unnecessary second-line regimen initiation in the majority of children with detectable viraemia who remain at low risk of disease progression.
Black men who have sex with men living in states with HIV criminalization laws report high stigma, 23 U.S. cities, 2017
Authors: Baugher Amy R. , Whiteman Ari , Jeffries William L. , Finlayson Teresa , Lewis Rashunda , Wejnert Cyprian 
Published: April 2021

Objectives:
To examine the association between HIV laws, perceived community stigma, and behaviors and to compare differences between and within Black and White men who have sex with men (MSM).

Design/Methods:
National HIV Behavioral Surveillance conducted interviews and HIV testing with MSM in 23 U.S. cities in 2017 using venue-based sampling methods. We used weighted cross-sectional data to compare MSM living in states with versus without HIV laws using Rao–Scott chi-square tests. We modeled the association between stigma and state HIV laws within racial groups to obtain adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs).

Results:
Among 7392 MSM, 56% lived in a state with HIV laws. In law states, Black MSM were more likely than White MSM to report their community would discriminate against persons with HIV (PWH) (59 versus 34%), not support the rights of PWH (20 versus 9%), not be friends with PWH (19 versus 10%), believe PWH ‘got what they deserved’ (27 versus 16%), and be intolerant of MSM (14 versus 5%). Adjusted for confounders, Black MSM in HIV law states were more likely to think their community would discriminate against PWH (aPR, 1.14; 95% CI, 1.02–1.29; P = 0.02) and be intolerant toward MSM (aPR, 2.02; 95% CI, 1.43–2.86; P < 0.001) than Black MSM in states without such laws.

Conclusions:
HIV laws were related to higher stigma, but only for Black MSM. Future research regarding HIV-related laws should account for racial/ethnic disparities. Modernizing laws can delegitimize stigma and promote focusing on effective HIV prevention strategies.