bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sources of Medications Used by Children and Adolescents for Intentional Ingestion
Authors: Larson Emma K. , Johnson Kyle P. , Sheridan David C. 
Published: October 2021

Introduction
Suicide is a leading cause of death among adolescents. Oregon ranks 17th nationally for youth suicide rates, and ingestion of medications as a means of suicide is common. Despite the high prevalence of intentional poisoning among youth in Oregon, information about medications used by children and adolescents for attempted suicide, in particular the sources of medications, is not readily available.

Methods
The objective of this study is to describe types and sources of medications used for intentional ingestion among patients seen by the Doernbecher Children's Hospital Child and Adolescent Psychiatry Consultation-Liaison Service. This was a retrospective analysis of patients seen by the Child and Adolescent Psychiatry Consultation-Liaison Service for intentional ingestion from 2015 to 2017. Data on 434 total intentional ingestions were collected, including demographic information, types of medications ingested, and sources of both over-the-counter (OTC) and prescription (Rx) medications. Ingestions without intent of suicide were excluded. Descriptive analysis of ingestion data was performed.

Results
Intentional ingestions included Rx and OTC medications in similar frequencies. For Rx medications, 68% of ingestions included patients' own Rxs. Eighty-eight percent of ingestions that were not the patients' own Rx belonged to someone else living in their home. For OTC medications, 66% of medications were available at home.

Conclusions
Intentional ingestions among adolescents most frequently involve medications that are readily available in their homes, and these include both OTC and Rx medications. This study highlights the importance of securing medications at home as a preventative measure and the importance of anticipatory guidance for primary care providers.
Contributions of Community-Based Organizations Funded by the Centers for Disease Control and Prevention's HIV Testing Program
Authors: Marano-Lee Mariette , Williams Weston , Uhl Gary , Eke Adanze , Joshua Tanesha , Xu Songli , Carter Jarvis , Rakestraw Antonya , Dunbar Erica 
Published: October 2021

Context:
HIV testing is a critically important first step in preventing and reducing HIV transmission. Community-based organizations (CBOs) are uniquely positioned to provide HIV testing and other prevention services to populations disproportionately affected by HIV infection.

Objective:
The purpose of this analysis was to assess CDC-funded health department (HD) and CBO testing programs during 2012-2017, including the number of tests and HIV positivity.

Design:
This is an analysis of National HIV Prevention Program Monitoring and Evaluation HIV testing data submitted between 2012 and 2017 to CDC.

Setting:
Sixty-one CDC-funded state and local HDs in the United States, Puerto Rico, and the US Virgin Islands and between 122 and 175 CDC-funded CBOs, depending on the year.

Participants:
Persons who received HIV testing at CDC-funded CBOs and HDs.

Main Outcome Measure:
The number of HIV tests and positivity at CBOs were compared with HDs overall and to HDs in non-health care settings that, like CBOs, include HIV risk data and are in similar locations.

Results:
CBOs accounted for 7625 (8%) new diagnoses but conducted only 3% of the almost 19 million CDC-funded HIV tests from 2012 to 2017. Newly diagnosed HIV positivity at CBOs (1.4%) was nearly 3 times the new positivity at HDs overall (0.5%) and twice that of new positivity at HDs in non-health care settings (0.7%). A higher proportion of tests at CBOs were conducted among groups at risk, and new HIV positivity was higher for most demographic and population groups than new HIV positivity at HDs in non-health care settings.

Conclusion:
These findings demonstrate the essential role CDC-funded CBOs have in reaching, testing, and diagnosing groups at high risk for acquiring HIV infection.
Performance, Detection, Contamination, Compliance, and Cointervention Biases in Rehabilitation Research
Authors: Armijo-Olivo Susan , Mohamad Norazlin , Sobral de Oliveira-Souza Ana Izabela , de Castro-Carletti Ester Moreira , Ballenberger Nikolaus , Fuentes Jorge 
Published: October 2021

Abstract
Bias is a systematic error that can cause distorted results leading to incorrect conclusions. Intervention bias (i.e., contamination bias, cointervention bias, compliance bias, and performance bias) and detection bias are the most common biases in rehabilitation research. A better understanding of these biases is essential at all stages of research to enhance the quality of evidence in rehabilitation trials. Therefore, this narrative review aims to provide insights to the readers, clinicians, and researchers about contamination, cointervention, compliance, performance, and detection biases and ways of recognizing and mitigating them. The literature selected for this review was obtained mainly by compiling the information from several reviews looking at biases in rehabilitation. In addition, separate searches by biases and looking at reference lists of selected studies as well as using Scopus forward citation for relevant references were used.
This review provides several strategies to guard against the impact of bias on study results. Clinicians, researchers, and other stakeholders are encouraged to apply these recommendations when designing and conducting rehabilitation trials.
Therapeutic Ultrasound and Shockwave Therapy for Tendinopathy
Authors: Smallcomb Molly , Khandare Sujata , Vidt Meghan E. , Simon Julianna C. 
Published: October 2021

Abstract
Tendon injury is prevalent and costly in the United States, comprising 45% of the 66 million musculoskeletal injuries and costing $114 billion annually. Surgical and therapeutic methods, such as arthroscopic surgery, dry needling, and physical therapy, produce mixed success in reintroducing a healing response in tendinopathy due in part to inconsistent dosing and monitoring. Ultrasound is one therapeutic modality that has been shown to noninvasively induce bioeffects in tendon that may help promote healing. However, results from this modality have also been mixed. This review compares the current state of the field in therapeutic ultrasound and shockwave therapy, including low-intensity therapeutic ultrasound, extracorporeal shockwave therapy, and radial shockwave therapy, and evaluates the efficacy in treating tendinopathies with ultrasound. We found that the mixed successes may be attributed to the wide variety of achievable parameters within each broader treatment type and the lack of standardization in measurements and reporting. Despite mixed outcomes, all three therapies show potential as an alternative therapy with lower-risk adverse effects than more invasive methods like surgery. There is currently insufficient evidence to conclude which ultrasound modality or settings are most effective. More research is needed to understand the healing effects of these different therapeutic ultrasound and shockwave modalities.
A Monte Carlo Simulation to Estimate the Additional Cost Associated With Adverse Medication Events Leading to Intraoperative Hypotension and/or Hypertension in the United States
Authors: Nanji Karen C. , Shaikh Sofia D. , Jaffari Alireza , Franz Calvin , Bates David W. 
Published: October 2021

Objectives
Intraoperative hypertension and hypotension are common and often related to adverse medication events (AMEs). The study objective is to estimate the annual additional fully allocated costs to the U.S. healthcare system related to AMEs associated with clinically significant intraoperative hypertension and hypotension.

Methods
Using anesthesia-trained observers in randomly selected operating rooms, we estimated the rates of clinically significant intraoperative hypotension and hypertension. We conducted systematic literature reviews to estimate incidence and additional costs of acute kidney injury (AKI), acute myocardial injury, and stroke after intraoperative hypotension and hypertension. We used Monte Carlo simulation to estimate annual costs to the U.S. healthcare system.

Results
Intraoperative hypotension (mean arterial pressure <55 mm Hg for >6 minutes) occurred in 11 of 277 operations (3.97%), hypotension (>30% drop from baseline mean arterial pressure in patients with coronary artery disease) in 9 operations (3.25%) and hypertension in 14 operations (5.05%). After hypotension, incremental incidence of AKI was 1.46% (additional cost $17,289/case), acute myocardial injury was 0.75% ($21,340/case), and stroke was 0.05% ($19,903/case). After hypertension, incremental stroke incidence was 4.76% ($28,320/case). Annually in the United States, we estimated 11,513 cases of AKI, 5914 of acute myocardial injury, 345 of stroke after intraoperative hypotension, and 47,774 cases of stroke after intraoperative hypertension, costing the U.S. $1.7 billion (90% confidence interval, $1.4–$2.0 billion), of which $923 million (90% confidence interval, $763–$1101 million) is preventable.

Conclusions
Adverse medication events related to blood pressure are frequent, costly, and can cause considerable patient harm. Cost estimates for these events may provide a means of prioritizing safety improvements to reduce cost of care and improve patient outcomes.
Coronary artery plaque progression and cardiovascular risk scores in men with and without HIV-infection
Authors: Shaikh Kashif , Bhondoekhan Fiona , Haberlen Sabina , Nakanishi Rine , Roy Sion K. , Alla Venkata M. , Brown Todd T. , Lee Juhwan , Osawa Kazuhiro , Almeida Shone , Rahmani Sina , Nezarat Negin , Sheidaee Nasim , Kim Michael , Jayawardena Eranthi , Kim Nicolas , Hathiramani Nicolai , Palella Frank J. , Witt Mallory , Ahmad Khadije , Kingsley Lawrence , Post Wendy S. , Budoff Matthew J. 
Published: October 2021

Objective:
The aim of this study was to assess the association of cardiovascular disease (CVD) risk scores and coronary artery plaque (CAP) progression in HIV-infected participants.

Methods:
We studied men with and without HIV-infection enrolled in the Multicenter AIDS Cohort Study (MACS) CVD study. CAP at baseline and follow-up was assessed with cardiac computed tomography angiography (CCTA). We examined the association between baseline risk scores including pooled cohort equation (PCE), Framingham risk score (FRS), and Data collect of Adverse effects of anti-HIV drugs equation (D:A:D) and CAP progression.

Results:
We studied 495 men (211 HIV-uninfected, 284 HIV-infected). The adjusted odds ratio (aOR) of total plaque volume (TPV) and noncalcified plaque volume (NCPV) progression in the highest relative to lowest tertile was 9.4 [95% confidence interval (95% CI) 2.4–12.1, P < 0.001)] and 7.7 (95% CI 3.1–19.1, P < 0.001) times greater, respectively, among HIV-uninfected men in the PCE atherosclerotic cardiovascular disease (ASCVD) high vs. low-risk category. Among HIV-infected men, the association for TPV and NCPV progression for the same PCE risk categories, odds ratio (OR) 2.8 (95% CI 1.4–5.8, P < 0.01) and OR 2.4 (95% CI 1.2–4.8, P < 0.05), respectively (P values for interaction by HIV = 0.02 and 0.08, respectively). Similar results were seen for the FRS risk scores. Among HIV-uninfected men, PCE high risk category identified the highest proportion of men with plaque progression in the highest tertile, although in HIV-infected men, high-risk category by D:A:D identified the greatest percentage of men with plaque progression albeit with lower specificity than FRS and PCE.

Conclusion:
PCE and FRS categories predict CAP progression better in HIV-uninfected than in HIV-infected men. Improved CVD risk scores are needed to identify high-risk HIV-infected men for more aggressive CVD risk prevention strategies.
Retroposition of the Vestigial Cartilage in Patients With Microtia: A Novel Technique to Enhance Projection of the Reconstructed Ear
Authors: Badawy Mohamed Samir , Elshahat Ahmed 
Published: October 2021

Background:
The projection of the reconstructed auricle is an important step in ear reconstruction. The novel use of the vestigial cartilage can successfully replace the projection piece harvested from the costal cartilage, improve the three-dimensional contour of the reconstructed auricle, and help deepening of the concha, compensate for mastoid atrophy in patients with hemifacial microsomia.

Methods:
A total of 34 patients with microtia were included and classified according to the Nagata classification. Anotia and atypical cases with deficient cartilage are excluded. Two-stage auricle reconstruction was performed. The first stage included retroposition of the vestigial cartilage, framework implantation and lobule transposition. After 3 to 6 months, the second stage was performed and included elevation of the reconstructed auricle and coverage by split-thickness skin graft.

Results:
The results were satisfactory regarding the shape, symmetry, maintenance of the auriculocephalic angle, and stability of the reconstructed ear. The vestigial cartilage was classified into 3 different types according to its shape. Type 1(V1) cartilage is a sausage-shaped cartilage that can be directly used as a projection piece. Type 2(V2) cartilage is a flat-shaped cartilage that should be folded upon itself. Type 3(V3) cartilage is an atypical type where the cartilage does not have a specific shape. This type can be used as it is or reconfigured with sutures according to the amount of projection needed. Moreover, 87% of patients were satisfied with the appearance of their new ears, 90% of patients can wear their glasses or sunglasses, and 94% of patients can easily clean their new ear.

Conclusions:
According to the shape and amount of the available vestigial cartilage, it can be used as a projection piece either alone or with an augmentation piece from the costal cartilage.
Development and Application of Three Steps Training Mode for Endoscopic Transnasal Transsphenoidal Approach
Authors: Li Chuzhong , Zhu Haibo , Zheng Jiaping , Liu Chunhui , Gui Songbai , Zhao Peng , Bai Jiwei , Zhang Yazhuo 
Published: October 2021

Objective:
The model of endoscopic transnasal transsphenoidal approach (METTA) were made and the application of the 3-steps training mode in the endoscopic transnasal transsphenoidal approach (ETTA) training was discussed.

Methods:
The plastic skull model was used to make a simple METTA model; the multicolor and multi-material 3D printing technology was used to make a METTA simulation model and the perfusion cadaver head specimen was used as the gold standard training model. Then 3 neurosurgeons evaluated the 3 types of models. Level 1 training group only received perfusion cadaveric head specimen training; level 2 training group with 3D printing METTA model plus cadaver head specimen training, and level 3 training group with simple model, 3D printing model and cadaver head specimen training group. The authenticity of the model and the training effect were evaluated according to the operation time and the damage degree to the surrounding structures.

Results:
The results showed that perfusion cadaveric head specimens scored the highest in each item. The simplified model was superior to the 3D printing METTA in simulating the shape and elasticity of pituitary tumor tissue. The score of surgical skill training was the same as that of 3D printing METTA. In terms of the training effect, the doctors who had received 3 steps training had the highest score, which was better than the other 2 groups.

Conclusions:
The application of 3 steps training mode with simple training model, 3D printing model and perfusion cadaver head specimen can improve the effect of ETTA operation training.
Three-Dimensional Measurement of the Zygomatic–Maxillary Complex in Unilateral Cleft Lip and Palate Patients With Maxillary Retrusion
Authors: Zheng Yilue , Jiang Chanyuan , Ma Hengyuan , Yin Ningbei , Zhai Junya , Tong Haizhou , Song Tao 
Published: October 2021

Abstract
The purpose of this study was to investigate the anatomical features of the zygomatic–maxillary complex in unilateral cleft lip and palate (UCLP) patients with maxillary retrusion. Individuals were grouped and craniofacial measurements were carried out for 34 individuals in the UCLP with maxillary retrusion group (UMRG) and 50 from a control group (CG). The authors measured the length, width, and height of the maxilla and zygoma and also measured predetermined regions on the midface in each group. Independent sample group t tests were performed to determine differences between groups (with significance set at P < 0.05). Multiple points on the midface (the most posterior point on the contour of the maxillary alveolar process, lowest point of the zygomaticomaxillary suture, furthest point to the zygomatic self-base plane, superior point in the infraorbital foramen, and lowest point of the inferior margin of the orbit) to the coronal plane were smaller in the UMRG than in the CG (all results P < 0.05). In addition, the maxillary length was significantly reduced in the UMRG than in the CG (P < 0.05). In summary, for the UCLP patients with maxillary retrusion, the deficiency in the midface gradually reduced going upward, with the deficiency in the maxillary alveolar level the most serious. The zygoma was influenced to a lesser extent.
Outcomes of Bifocal Transport Distraction Osteogenesis for Repairing Complicated Unilateral Alveolar Cleft
Authors: Altaweel Alaa Abdelqader , Lababidy Adeeb Safwan , Abd-Ellatif El-Patal Mohamed , Elsayed Shadia Abdelhameed , Eldin Mohamed Shams , Dabbas Jamal , Meneim Marwa Hassan Abd-El , Kharma Mohamed Yaser 
Published: October 2021

Objectives:
This study aimed to assess the outcomes of bifocal transport distraction osteogenesis (BTDO) for closure of a wide or previously failed unilateral alveolar cleft.

Methods:
Patient in this study had a large alveolar cleft that had not healed with bone grafts. Bone-borne distraction was used under general anesthesia. Intraoperative complications as bleeding and trauma to neighboring teeth were documented. Postoperative complications as wound dehiscence, paresthesia, infection, and bleeding were recorded. Complications including changes in bone segment movement, activation force loss, and occlusal interferences were observed during the activation phase. During the consolidation phase, problems including gingival recession, pulpal vitality, and cosmetic concerns were evaluated. Postoperative, periapical, occlusal, and orthopantomograms were used to evaluate bone gain and bone generation in the distracted area.

Results:
Ten patients (6 males and 4 females) with unilateral alveolar cleft were included, with mean age of 9.5 ± 2.5 years. Average cleft width was 12.25 ± 2.54 mm. There was no intraoperative or postoperative bleeding. Only 1 patient had a wound dehiscence (10%). All patients had mild postoperative pain and edema in upper lip. Only 1 patient complained of numbness in infraorbital nerve's innervated region. Radiographs revealed bone formation in cleft area and bone healing in distracted chamber.

Conclusions:
Bifocal transport distraction osteogenesis improves success rate of an alveolar cleft treatment especially a wide or previously failed one. This technique associated with minimal complications when careful planning and cooperation from a patient are combined. It can be recommended when other modalities for alveolar cleft are failed. Patients also tolerate the device well.
Increased Plasma Hyaluronan Levels are Associated With Acute Traumatic Coagulopathy
Authors: Walker Shannon C. , Richter Robert P. , Zheng Lei , Ashtekar Amit R. , Jansen Jan O. , Kerby Jeffrey D. , Richter Jillian R. 
Published: October 2021

ABSTRACT

Introduction:
Acute traumatic coagulopathy (ATC) is an endogenous impairment in hemostasis that often contributes to early mortality after trauma. Endothelial glycocalyx damage is associated with trauma-induced coagulation abnormalities; however, the specific relationship between hyaluronan (HA), a key glycocalyx constituent, and ATC has not been evaluated.

Methods:
We performed a secondary analysis of prospectively collected data from a recent study in which trauma patients (>18 years) admitted to our Level I trauma center with an ABC Score≥2 were enrolled. Partial thromboplastin time (PTT), international normalized ratio (INR), and thromboelastography (TEG) parameters were recorded at arrival. Injury characteristics and clinical outcomes were obtained. Plasma HA levels were measured in healthy controls (HC) and in trauma subjects at arrival (t = 0 h) and 12, 24, and 48 h. ATC was defined as admission INR>1.2 or PTT≥36.5 s. Comparisons of HA levels were assessed, and Spearman's correlations were performed between 0 h and 24 h HA levels, coagulation measures and clinical outcomes. P values < 0.05 were considered significant.

Results:
Forty-eight trauma patients and 22 controls were enrolled for study. Sixteen trauma subjects were coagulopathic at admission. HA levels in subjects with ATC were higher than non-coagulopathic subjects at all time points and elevated above HC levels at 24 and 48 h. At arrival, HA levels correlated with TEG R-time, PTT, and INR. HA levels at 24 h correlated with increased transfusion requirements and intensive care unit and hospital lengths of stay.

Conclusion:
Shed HA is associated with early coagulation abnormalities in trauma patients, which may contribute to worse outcomes. These findings highlight the need for additional studies to evaluate the mechanistic role of HA in ATC.
Long-Term Outcomes After Midurethral Mesh Sling Surgery for Stress Urinary Incontinence
Authors: Dejene Sara Z. , Funk Michele Jonsson , Pate Virginia , Wu Jennifer M. 
Published: October 2021

Objectives
Although midurethral mesh slings are the criterion standard surgical treatment for stress urinary incontinence (SUI), limited data exist regarding long-term outcomes. Thus, our objectives were to evaluate the long-term risk of sling revision and the risk of repeat SUI surgery up to 15 years after the initial sling procedure and to identify predictors of these outcomes.

Methods
Using a population-based cohort of commercially insured individuals in the United States, we identified women aged 18 years or older who underwent a sling procedure between 2001 and 2018. For sling revision, we evaluated indications (mesh exposure or urinary retention). We estimated the cumulative risks of sling revision and repeat SUI surgery annually using Kaplan-Meier survival curves and evaluated predictors using Cox proportional hazards models.

Results
We identified 334,601 mesh sling surgical procedures. For sling revision, the 10-year and 15-year risks were 6.9% (95% confidence interval [CI], 6.7–7.0) and 7.9% (95% CI, 7.5–8.3), with 48.7% of sling revisions associated with mesh exposure. The 10-year and 15-year risks of repeat SUI surgery were 14.5% (95% CI, 14.2–14.8) and 17.9% (95% CI, 17.3–18.6). Women aged 18–29 years had an elevated risk for both sling revision (hazard ratio, 1.20; 95% CI, 1.15–1.25) and repeat SUI surgery (hazard ratio, 1.30; 95% CI, 1.25–1.37) compared with women 70 years and older.

Conclusions
In our study population, the 15-year risk of sling revision was 7.9%, with nearly half of revisions due to mesh exposure. These findings provide critical long-term data to support informed decisions for women and health care providers considering midurethral mesh slings.