bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leveraging Social and Structural Determinants of Health at the Centers for Disease Control and Prevention: A Systems-Level Opportunity to Improve Public Health
Authors: Lipshutz Judith A. , Hall Jeffrey E. , Penman-Aguilar Ana , Skillen Elizabeth , Naoom Sandra , Irune Ikovwa 
Published: May 2021

Context:
Social and structural determinants of health (SDOH) have become part of the public health and health care landscape. The need to address SDOH is reinforced by morbidity and mortality trends, including a recent multiyear decrease in life expectancy and persistent health disparities. Leadership on SDOH-related efforts has come from public health, health care, private philanthropy, and nongovernmental entities.

Strategy:
The Centers for Disease Control and Prevention (CDC) has been addressing SDOH through both disease- or condition-specific programs and crosscutting offices. Guidance from public health partners in the field has led the CDC to consider more strategic approaches to incorporating SDOH into public health activities.

Implementation:
The CDC's crosscutting SDOH Workgroup responded to external recommendations to develop a specific vision and plan that aims to integrate SDOH into the agency's infrastructure. The group also sponsors CDC forums for sharing research and trainings on embedding SDOH in programs. The group created a Web site to centralize CDC SDOH research, data sources, practice tools, programs, and policies.

Progress:
The CDC has shown strong leadership in prioritizing SDOH in recent years. Individual programs and crosscutting offices have developed various models aimed at ensuring that public health research and practice address SDOH.

Discussion:
Building sustainable SDOH infrastructures in public health institutions that reach across multiple health topics and non–health organizations could increase chances of meeting public health morbidity and mortality reduction goals, including decreasing health disparities. Although public health priorities and socioeconomic trends will change over time, experience suggests that social and structural factors will continue to influence the public's health. The CDC and state, tribal, local, and territorial public health institutions have played important leadership roles in the system of community and service organizations that interface with communities they mutually serve to address SDOH. Continued capacity-building could help grow and sustain an SDOH infrastructure that advances this work.
Diagnosed Concussion and Undiagnosed Head Trauma Is Associated With Long-Term Concussion-Related Symptoms in Former College Football Players
Authors: Jacks Dean E. , Tereshko William D. , Moore Justin B. 
Published: May 2021

Objective
Head trauma experienced in contact football is a growing health concern, but limited research has been conducted to assess associations between head trauma exposure and long-term concussion-related symptoms among former college football players.

Design
We surveyed 275 former college football players who were at least 10 yrs after competition to determine the association between head trauma exposure and concussion-related symptoms later in life. Respondents provided data on their youth, high school and college playing experience, undiagnosed head injury, diagnosed concussions, and eight concussion-related symptoms. A Poisson regression was conducted to examine the association between playing experience and reported head trauma with reported symptom count, and significance was set at P ≤ 0.05.

Results
Few participants reported diagnosed concussions in college (17.5%), but a large number reported undiagnosed football-related head injuries (68.8%) that might have resulted in a concussion. A few participants (40.7%) reported concussion-related symptoms. After controlling for age, high school football participation, and nonfootball concussions (lifetime), diagnosed concussions in high school or college did not significantly predict concussion symptoms later in life. However, undiagnosed football head injury (range = 1–8 injuries) reported 350%–855% greater concussion-related symptoms later in life.

Conclusions
Undiagnosed head injuries, which are less likely to be managed by a healthcare professional, were significantly associated with concussion-related symptoms later in life. These findings suggest that proper identification and management of concussions may prevent later symptoms, but more research is needed to test this conclusion.
Evolving Bilateral Hypermetabolic Axillary Lymphadenopathy on FDG PET/CT Following 2-Dose COVID-19 Vaccination
Authors: Weeks Joanna K. , O’Brien Sophia R. , Rosenspire Karen C. , Dubroff Jacob G. , Pantel Austin R. 
Published: May 2021

Abstract
A 50-year-old woman with stage IV sigmoid adenocarcinoma presented for restaging FDG PET/CT status post neoadjuvant chemotherapy/immunotherapy and diverting sigmoid colostomy. FDG PET/CT demonstrated FDG uptake in the known sigmoid mass and in abdominopelvic lymph node metastases. Bilateral, asymmetric, hypermetabolic axillary lymphadenopathy was also observed, an atypical pattern of spread for colon cancer. Further investigation revealed the patient had received both doses of COVID-19 vaccine in the 2 months prior to presentation. The authors discuss immunogenic nodal hypermetabolism following vaccination against COVID-19 and incorporating vaccination history to aid in PET/CT interpretation, especially in malignancies involving the axillae.
Late PET/CT Findings of COVID-19 Pneumonia With 2 Different Radiopharmaceuticals in a Patient
Authors: Şahin Özlem , Kaya Buğra , Aydın Zeynep , Karaağaç Mustafa , Kanyılmaz Gül 
Published: May 2021

Abstract
We present the 68Ga-PSMA and 18F-FDG PET/CT findings comparatively of a 67-year-old prostate cancer and malignant melanoma patient who had COVID-19 pneumonia 3 months ago. In 68Ga-PSMA PET/CT, ground-glass opacities showing markedly increased PSMA uptake were observed in the patient’s lungs. It was learned that the patient had COVID-19 pneumonia 3 months ago and was treated in the intensive care unit for 13 days. In 18F-FDG PET/CT, FDG uptake was minimal in the same areas. In the midterm period after COVID-19 pneumonia, lung PSMA uptake is more intense than FDG, which may help better understand the disease’s healing phase.
Orbital Lateral Cantal Distance Can Predict the Cephalometric Characteristic of Mandible in Iranian Population
Authors: Solhjoo Somayeh , Sayadi Mahtab , Navid Shadan , Toolee Heidar 
Published: May 2021

Abstract
Orbitofacial anthropometrics have become an important tool used in reconstructive surgery. The authors attempt to evaluate the relation between orbital lateral canthal distance and the cephalometric characteristic of mandible in Iranian population.
In a cross-sectional study, anthropometric parameters of face in 200 subjects (100 males and 100 females) with mean age of 34.39 ± 18.83 were evaluated by three-dimensional computed tomography imaging.
In this study, there was not a significant difference in the age of sex groups (P = 0.183). Also, there was no significant difference in the left and right mandible angle in different sex groups (P = 0.25, P
=
0.124, respectively). There were significant differences in the anterior mandible distance, inferior mandible angle distance (P = 0.0001) and lateral cantus distance of sex groups (P = 0.0001). There was a significant correlation between lateral contuse distance and left mandible angle (r = 0.226, P = 0.001), right mandible angle (r = 0.283, P = 0.00), mandible angle (r = -0.266, P = 0.00), anterior mandible angle distance (r = 0.655, P = 0.00), and inferior mandible angle distance (r = 0.582, P = 0.00).
Here, we conclude that orbital lateral canthal distance can predict the cephalometric characteristic of mandible in Iranian population.
Simultaneous Orthognathic Surgery With Asian Double Eyelid Suture Blepharoplasty
Authors: Khoo Lee Seng , Hsiao Yen-Chang , Huang Jung-Ju , Chang Frank Chun-Shin , Wang Yi-Chin , Liao Yu-Fang , Chen Zung-Chung , Lo Lun-Jou , Chen Jyh-Ping , Chen Yu-Ray 
Published: May 2021

Background:
The main objective of contemporary orthognathic surgery is to correct dentofacial deformities. Nonetheless, many adjunct procedures to enhance the esthetic outcome in orthognathic surgical cases have been successfully incorporated to improve patient satisfaction. The authors report our preliminary experience of performing simultaneous orthognathic surgery with Asian double eyelid suture method blepharoplasty in the same surgical setting.

Method:
This case series report includes all 19 consecutive cases presenting to the Chang Gung Craniofacial Center for combined orthognathic surgery with Asian double eyelid suture method blepharoplasty. The double eyelid crease height was measured as the vertical line between the upper eyelid margin (eyelid lash) and the upper eyelid crease, observed at the mid-pupillary line with the eyes in primary gaze.

Results:
There were no complications or relapse reported within this time period. There was significant improvement in the left and right mid-pupillary double eyelid crease height postsurgery. There were no statistically significant differences between the left and right mid-pupillary double eyelid crease heights after surgery indicating good eyelid crease height symmetry bilaterally was obtained.

Conclusions:
Orthognathic surgery combined with suture method blepharoplasty can be safely performed in the same surgical setting without inappropriate rise in costs or operating room time. This case series demonstrates that excellent esthetic results can be obtained in simultaneous bimaxillary orthognathic surgery with suture method Asian blepharoplasty.
Simultaneous Use of Bioabsorbable and Nonbioabsorbable Packing Materials During Closed Reduction of a Nasal Bone Fractures
Authors: Han Song Hyun , Kim Soon Heum , Jo Dong In 
Published: May 2021

Abstract
The nasal packing material after closed reduction of nasal bone fracture may be bioabsorbable or nonbioabsorbable. To investigate the usefulness of the packing method using bioabsorbable and nonbioabsorbable materials simultaneously, a chart review was retrospectively performed involving 255 patients. Group A (n = 119), Nasopore (bioabsorbable) was cut appropriately and packed, and subsequently, supportive packing with Merocel (nonbioabsorbable) was performed. Group B (n = 78), nasal packing was performed with Vaseline roll gauze. Group C (n = 49), packed only Merocel. Pain and rhinorrhea were significantly lower in Merocel + Nasopore group (P < 0.05). It is thought that rhinorrhea is reduced by less mucosal irritation and maximizing the discharge absorption capacity by using Merocel and Nasopore simultaneously. By packing Nasopore first, pain is thought to be reduced by reducing the contact surface between Merocel and the injured mucosa and preventing a direct force to the fracture site. Therefore, our packing method, which uses Merocel and Nasopore simultaneously, can be recommended because it can provide sufficient support for the reduced fracture site, cause less pain, and maximize discharge absorption.
Surgical Management of Facial Fractures in Geriatric Patients
Authors: Yovev Tsanko , Burnic Aida , Kniha Kristian , Knobe Matthias , Hölzle Frank , Modabber Ali 
Published: May 2021

Abstract
Facial fractures comprise a substantial part of traumatology. Due to aging of the population, over the last 20 years, there has been a pattern of redistribution of these fractures with a higher incidence at an older age. The aim of this study was to retrospectively analyze the epidemiology, pattern, and surgical management of facial fractures in geriatric patients presenting at a single tertiary trauma center.
This study included patients aged ≥70 years who presented with facial bone fractures between 2008 and 2017 and were treated with surgical interventions. Parameters such as age, sex, American Society of Anesthesiologists classification, Glasgow Coma Scale score, fracture type, fracture mechanism, concomitant injuries, duration of hospitalization, and postoperative complications were evaluated.
A total of 300 patients were included: 118 men (39.3%) and 182 women (60.7%). The mean age was 78.8 years. An orbital floor fracture was the most common injury (35.1%). The most common cause of fracture was a fall at home (67%). A total of 113 patients (37.7%) had 162 concomitant injuries, 35 patients (11.7%) suffered from polytrauma, and 7 patients developed postoperative complications. The average length of stay was 1.67 days in the intensive care unit and 5.50 days in the standard ward. Polytrauma, pre-existing medical conditions, and oral anticoagulation had a significant impact on the duration of hospitalization.
Facial fractures are common in combination with other injuries. Women are more often affected than men, and falling at home is the most common cause of facial injuries. Postoperative complications are rare.
A Quantitative Analysis of Surgical Smoke Exposure as an Occupational Hazard
Authors: Stewart Camille L. , Raoof Mustafa , Lingeman Robert , Malkas Linda , Flores Viviana , Caldwell Kerry , Fong Yuman , Melstrom Kurt 
Published: May 2021

Objective:
We hypothesized that OR airborne PM was different in quantity and mutagenic potential than office air and cigarette smoke.

Summary of Background Data:
Exposure to surgical smoke has been equated to cigarette smoking and thought to be hazardous to health care workers despite limited data.

Methods:
PM was measured during 15 operations in ORs with 24.8 ± 2.0 air changes/h, and in controls (cigarettes, office air with 1.9–2.9 air changes/h). Mutagenic potential was assessed by gamma Histone 2A family member X staining of DNA damage in small airway epithelial cells co-cultured with PM.

Results:
Average PM concentration during surgery was 0.002 ± 0.002 mg/m3 with maximum values at 1.08 ± 1.30 mg/m3. Greater PM correlated with more diathermy (ρ = 0.69, P = 0.006). Values were most often near zero, resulting in OR average values similar to office air (0.002 ± 0.001 mg/m3) (P = 0.32). Cigarette smoke average PM concentration was significantly higher, 4.8 ± 5.6 mg/m3 (P < 0.001). PM collected from 14 days of OR air caused DNA damage to 1.6% ± 2.7% of cultured cells, significantly less than that from office air (27.7% ± 11.7%, P = 0.02), and cigarette smoke (61.3% ± 14.3%, P < 0.001).

Conclusions:
The air we breathe during surgery has negligible quantities of PM and mutagenic potential, likely due to low frequency of diathermy use coupled with high airflow. This suggests that exposure to surgical smoke is associated with minimal occupational risk.
Synthetic blood and blood products for combat casualty care and beyond
Authors: Cap Andrew P. , Cannon Jeremy W. , Reade Michael C. 
Published: May 2021

ABSTRACT
Synthetic biology adopts an engineering design approach to create innovative treatments that are reliable, scalable, and customizable to individual patients. Interest in substitutes for allogenic blood components, primarily red blood cells and platelets, increased in the 1980s because of concerns over infectious disease transmission. However, only now, with emerging synthetic approaches, are such substitutes showing genuine promise. Affordable alternatives to donated blood would be of enormous benefit worldwide. Several approaches to replacing the oxygen-carrying function of red cells are under advanced investigation. Hemoglobin-based oxygen carriers incorporate modifications to reduce the renal toxicity and nitric oxide scavenging of free hemoglobin. While use of earlier-generation hemoglobin-based oxygen carriers may be limited to circumstances in which blood transfusion is not an option, recent advances in chemical modification of hemoglobin may eventually overcome such problems. Another approach encases hemoglobin molecules in biocompatible synthetic nanoparticles. An alternative is the ex vivo production of red cells in bioreactors, with or without genetic manipulation, that offers the potential of a universal donor product. Various strategies to manufacture synthetic platelets are also underway, ranging from simple phospholipid liposomes encapsulating adenosine diphosphate and decorated with fibrinogen fragments, to more complex capsules with multiple receptor peptide sequences. Ex vivo production of platelets in bioreactors is also possible including, for example, platelets derived from induced pluripotent stem cells that are differentiated into a megakaryocytic lineage. Prior to clinical use, trials assessing synthetic blood components must evaluate meaningful safety and effectiveness outcomes in relatively large numbers of critically ill patients. Overcoming these challenges may be as much a hurdle as product design. This article reviews the state of the science of the synthetic biology approach to developing blood component substitutes.
Injury characteristics, initial clinical status, and severe injuries associated with spinal fractures in a retrospective cohort of 506 trauma patients
Authors: Weber Hugues , Breton Arnaud , Cyteval Catherine , Millet Ingrid , Girard Mehdi , Lonjon Nicolas , Capdevila Xavier , Charbit Jonathan 
Published: May 2021

BACKGROUND
Our aim was to describe the characteristics of vertebral fractures, the presence of associated injuries, and clinical status within the first days in a severe trauma population.

METHODS
All patients with severe trauma admitted to our level 1 trauma center between January 2015 and December 2018 with a vertebral fracture were analyzed retrospectively. The fractures were determined by the AO Spine classification as stable (A0, A1, and A2 types) or unstable (A3, A4, B, and C types). Clinical status was defined as stable, intermediate, or unstable based on clinicobiological parameters and anatomic injuries. Severe extraspinal injuries and emergent procedures were studied. Three groups were compared: stable fracture, unstable fracture, and spinal cord injury (SCI) group.

RESULTS
A total of 425 patients were included (mean ± SD age, 43.8 ± 19.6 years; median Injury Severity Score, 22 [interquartile range, 17–34]; 72% male); 72 (17%) in the SCI group, 116 (27%) in the unstable fracture group, and 237 (56%) in the stable fracture group; 62% (95% confidence interval [CI], 57–67%) had not a stable clinical status on admission (unstable, 30%; intermediate, 32%), regardless of the group (p = 0.38). This decreased to 31% (95% CI, 27–35%) on day 3 and 23% (95% CI, 19–27%) on day 5, regardless of the group (p = 0.27 and p = 0.25). Progression toward stable clinical status between D1 and D5 was 63% (95% CI, 58–68%) overall but was statistically lower in the SCI group. Severe extraspinal injuries (85% [95% CI, 82–89%]) and extraspinal emergent procedures (56% [95% CI, 52–61%]) were comparable between the three groups. Only abdominal injuries and hemostatic procedures significantly differed significantly (p = 0.003 and p = 0.009).

CONCLUSION
More than the half of the patients with severe trauma had altered initial clinical status or severe extraspinal injuries that were not compatible with safe early surgical management for the vertebral fracture. These observations were independent of the stability of the fracture or the presence of an SCI.

LEVEL OF EVIDENCE
Prognostic and epidemiological, level III.
Dose-dependent association between blood transfusion and nosocomial infections in trauma patients: A secondary analysis of patients from the PAMPer trial
Authors: Ladhani Husayn A. , Ho Vanessa P. , Charbonnet C. Clare , Sperry Jason L. , Guyette Francis X. , Brown Joshua B. , Daley Brian J. , Miller Richard S. , Harbrecht Brian G. , Phelan Herb A. , Claridge Jeffrey A. 
Published: May 2021

BACKGROUND
The Prehospital Air Medical Plasma (PAMPer) trial demonstrated a survival benefit to trauma patients who received thawed plasma as part of early resuscitation. The objective of our study was to examine the association between blood transfusion and nosocomial infections among trauma patients who participated in the PAMPer trial. We hypothesized that transfusion of blood products will be associated with the development of nosocomial infections in a dose-dependent fashion.

METHODS
We performed a secondary analysis of prospectively collected data of patients in the PAMPer trial with hospital length of stay of at least 3 days. Demographics, injury characteristics, and number of blood products transfused were obtained to evaluate outcomes. Bivariate analysis was performed to identify differences between patients with and without nosocomial infections. Two logistic regression models were created to evaluate the association between nosocomial infections and (1) any transfusion of blood products, and (2) quantity of blood products. Both models were adjusted for age, sex, and Injury Severity Score.

RESULTS
A total of 399 patients were included: age, 46 years (interquartile range, 29–59 years); Injury Severity Score, 22 (interquartile range, 12–29); 73% male; 80% blunt mechanism; and 40 (10%) deaths. Ninety-three (27%) developed nosocomial infections, including pneumonia (n = 67), bloodstream infections (n = 14), catheter-associated urinary tract infection (n = 10), skin and soft tissue infection (n = 8), Clostridium difficile colitis (n = 7), empyema (n = 6), and complicated intra-abdominal infections (n = 3). Nearly 80% (n = 307) of patients received packed red blood cells (PRBCs); 12% received cryoprecipitate, 69% received plasma, and 27% received platelets. Patients who received any PRBCs had more than a twofold increase in nosocomial infections (odds ratio, 2.15; 95% confidence interval, 1.01–4.58; p = 0.047). The number of PRBCs given was also associated with the development of nosocomial infection (odds ratio, 1.10; 95% confidence interval, 1.05–1.16; p < 0.001).

CONCLUSION
Trauma patients in the PAMPer trial who received a transfusion of at least 1 U of PRBCs incurred a twofold increased risk of nosocomial infection, and the risk of infection was dose dependent.

LEVEL OF EVIDENCE
Therapeutic/care management, level IV.