bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chatbot-Assisted Care Management
Authors: Schario Mark E. , Bahner Carol A. , Widenhofer Theresa V. , Rajaballey Joan I. , Thatcher Esther J. 
Published: November 2021

Purpose/Objectives:
Chatbots are automated conversation pathways that users can access through text message or email on smartphones or other connected devices. In care management, they can be used to monitor patients' health conditions or recovery from procedures. This article describes nurse care managers' experiences using chatbots in patient care, illustrated through two patient case reviews. Considerations for planning and implementing chatbot technology in care management settings are discussed.

Primary Practice Setting:
This care management service is part of an accountable care organization that serves 582,000 patients in University Hospitals of Cleveland, Ohio. Care management focuses on patients with chronic conditions, recent hospital discharges, and other needs. Care managers comprise a centralized team as well as embedded staff in select primary care practices.

Findings/Conclusions:
The two patient cases are exemplars from the care management program serving patients recently discharged from the hospital with ongoing chronic conditions that increase risk for readmission. Use of chatbots helped overcome obstacles to conventional care management outreach and resulted in improved outcomes and strong trusting relationships with the care managers.

Implications for Care Management Practice:
Patients who typically do not respond to other types of care manager outreach may respond to text message–based, asynchronous chatbot communication. Interpersonal relationships between care managers and patients can be strengthened by chatbot support. Chatbot technology tracks patients' progress and offers insights to patients and clinicians to facilitate earlier interventions when problems occur. Chatbots make frequent patient contact to collect and provide routine information, allowing care managers to spend more time on high-value interactions that require clinical judgment. Potential concerns about chatbots include effect on labor force, information security, health equity, and oversight of content.
Postpartum Depressive Symptoms and Experiences During COVID-19
Authors: Goyal Deepika , Beck Cheryl Tatano , Webb Rebecca , Ayers Susan 
Published: November 2021

Abstract

Purpose:
To identify postpartum depression risk and describe experiences of women in the first 6 weeks after giving birth during the COVID-19 pandemic.

Study Design and Methods:
Using a convergent mixed-methods approach, we recruited a convenience sample of women living in the United States who gave birth March 1, 2020 or later from social media Web sites. Participants completed the Postpartum Depression Screening Scale-Short Form and provided written answers to open-ended questions regarding their experiences at home with their new infant.

Results:
Our 262 participants were on average 32.6 years of age, the majority were White (82%), married or partnered (91.9%), and college educated (87.4%). Mean postpartum depression score was 17.7 (SD = 5.9) with 75% scoring ≥14, indicating significant postpartum depressive symptoms. Qualitative content analysis revealed five themes: Isolation and seclusion continue; Fear, anxiety, and stress filled the days; Grieving the loss of normal: It's just so sad; Complicated by postpartum depression: A dark time; and There is a silver lining. Quantitative and qualitative findings provided a holistic view of women's depressive symptoms and experiences at home with their infants during the COVID-19 pandemic.

Clinical Implications:
Although policies that reduce risk of COVID-19 exposure and infection for patients and the health care team must continue to be implemented, the adverse effects of depressive symptoms on maternal–infant wellbeing within the context of increased isolation due to the pandemic need to be kept at the forefront. Nurses need to be aware of the consequences of women sheltering in place and social distancing on maternal–infant outcomes, particularly on depression and likelihood of breastfeeding.
Refining Orthognathic Surgery Results by Synchronous Cheek Fat Compartment Augmentation with Fat Grafting in Adult Females with Class III Skeletal Profiles
Authors: Denadai Rafael , Wallace Christopher Glenn , Chou Pang-Yun , Lo Lun-Jou , Chen Yu-Ray , Chang Chun-Shin 
Published: November 2021

Summary:
Patients with maxillomandibular disharmony may present with a flat to concave midface. The effects of orthognathic surgery concomitant with midface fat grafting on facial appearance and midface volumetric and positional change have not formally been assessed to date. The authors’ approach for synchronous orthognathic surgery and fat grafting is described and evaluated. Adult female patients (n = 20) who underwent synchronous two-jaw orthognathic surgery and cheek-specific fat grafting (1.9 ± 0.6 cm3 per side) for correction of skeletal class III deformity and anteromedial cheek deficiency were prospectively included. Preoperative and postoperative photographs were appraised by 42 blinded raters using facial appearance scales for beauty, attractiveness, and pleasantness parameters. The three-dimensional midface soft-tissue volume change and postoperative cheek mass position were computed. Facial imaging data from gender-, ethnic-, and facial pattern–matched adult patients (n = 20) who underwent isolated two-jaw orthognathic surgery (n = 20) were included for comparison. The three-dimensional facial norms database–derived cheek mass position information (2.19 ± 1.31mm) was also adopted for analysis. Patients treated with the synchronous procedure had significantly (p < 0.001) increased facial appearance–related perception change for beauty (2.9 ± 1.6), attractiveness (2.8 ± 1.8), and pleasantness (3.0 ± 1.5) parameters, three-dimensional midface volume change (1.8 ± 0.5 cm3), and postoperative cheek mass position (2.16 ± 0.47 mm) in comparison with those treated with the isolated procedure (2.0 ± 1.5, 1.9 ± 1.6, 2.3 ± 1.6, 0.6 ± 0.2 cm3, and 1.84 ± 0.43 mm, respectively). Healthy female individuals had similar and larger cheek mass position than patients treated with synchronous (p > 0.05) and isolated (p < 0.001) procedures, respectively. Synchronous orthognathic surgery and check-specific fat grafting resulted in superior enhancement of facial appearance and midface volume and position compared with isolated orthognathic surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Gingivosupraperiosteoplasty following Presurgical Maxillary Orthopedics Is Associated with Normal Midface Growth in Complete Unilateral and Bilateral Cleft Patients at Mixed Dentition
Authors: Mejia Martha , Wolfe Erin M. , Murphy Blake D. , Rothenberg Leonard , Tejero Ana , Bauer Mislen , Wolfe S. Anthony 
Published: November 2021

Background:
Passive orthodontic appliances and gingivosupraperiosteoplasty are adjuncts that can be used by surgeons at the time of primary cleft lip repair. These treatments, along with the surgical technique of cleft lip and palate repair, may impact midface growth. The objective of this study was to describe the authors’ protocol for unilateral and bilateral cleft lip repair and to evaluate midfacial growth in a cohort of patients at mixed dentition who had undergone presurgical passive orthodontic appliance therapy and gingivosupraperiosteoplasty at the time of unilateral and bilateral cleft lip repair.

Methods:
Fifteen complete unilateral and 15 complete bilateral cleft lip and palate patients underwent passive orthodontic appliance treatment and primary lip repair with gingivosupraperiosteoplasty. Lateral cephalograms were analyzed by three blinded reviewers. Mean cephalometric measurements at mixed dentition were compared to cephalometric values for noncleft patients, unilateral cleft lip and palate patients who did not undergo gingivoperiosteoplasty or presurgical treatment, and unilateral cleft lip and palate patients who underwent gingivoperiosteoplasty/nasoalveolar molding with independent samples t tests.

Results:
Mean cephalometric values were within age-specific normal values for sella-nasion–A point, sella-nasion–B point, A point–nasion–B point, and facial axis. Eighty-seven (13/15) percent of unilateral cleft lip and palate patients and 93 percent (14/15) of bilateral cleft lip and palate patients did not exhibit skeletal class III malocclusion. There was no significant difference between cephalometric values for our patients and patients who did not receive gingivosupraperiosteoplasty or presurgical treatment or who underwent the gingivoperiosteoplasty/nasoalveolar molding protocol.

Conclusions:
Presurgical passive orthodontic appliances, combined with gingivosupraperiosteoplasty at the time of lip repair, leads to normal maxillary development in most patients at mixed dentition. Assessment of midface growth at skeletal maturity is required.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Costal Cartilage Spring Graft for Late Correction of Cleft Lip Nose Deformity: New Technique
Authors: Erol Onur O. , Agaoglu Galip 
Published: November 2021

Background:
Late correction of cleft lip nose deformity continues to be a challenge because of the weakness of cartilages and the collapsing forces of tight contracted soft tissues. The authors describe the new technique of costal cartilage spring graft for columella and lower lateral cartilage as a block to achieve symmetric, aesthetically more durable, and acceptable results for the late correction of cleft lip nose deformity.

Methods:
Late cleft lip nose repair with simultaneous rhinoplasty was performed in 92 patients with unilateral cleft lip nose deformity. For correction of cleft lip nose deformity, a strut graft 2 to 3 mm in width, 0.5 to 1 mm in thickness, and 5 to 7 cm in length was prepared from costal cartilage (autograft or allograft). The strut graft was curved and bowed with fingers to simulate the medial and lateral crura of the alar cartilage. A crescent-shaped skin excision from the alar rim and a vertical incision in the columella were made. The intercrural and alar areas were dissected to create sufficient space for the insertion of a bow-shaped spring cartilage graft. After insertion of the cartilage graft, the alar rim was closed with continuous 6-0 Monocryl and the columella was closed with 5-0 Vicryl.

Results:
Correction of depressed alar cartilage and webbing, lengthening the columella using spring costal cartilage, and symmetric nostrils were achieved in all cases. The mean follow-up period was 5 years (range, 2 to 15 years).

Conclusion:
These procedures, septoplasty, and simultaneous rhinoplasty provided long-term satisfactory results in the late correction of cleft lip nose deformity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Safety Comparison of Abdominoplasty and Brazilian Butt Lift: What the Literature Tells Us
Authors: Del Vecchio Daniel A. , Wall Simeon J. , Mendieta Constantino G. , Aslani Alexander A. , Hoyos Alfredo E. , Mallucci Patrick L. , Whitaker Iain S. 
Published: November 2021

Background:
Although abdominoplasty is a mainstay of the plastic surgeon, the safety of the Brazilian butt lift (BBL) has been questioned, effectively being prohibited in some countries. The central rationale for the safety concern over the BBL stems from a publication stating a mortality rate of one in 3000. The question remains: What is the real safety of these procedures?

Methods:
Focusing on mortality, literature searches were performed for BBL and for abdominoplasty. The 2017 Aesthetic Surgery Education and Research Foundation survey data and publication were examined and analyzed. Additional data from the American Association for Accreditation of Ambulatory Surgical Facilities were obtained independently.

Results:
Abdominoplasty and BBL appear to have similar safety based on mortality; however, the nature of their mortalities is different. Although most abdominoplasty deaths are secondary to deep venous thrombosis/pulmonary embolism—inherent circulatory thrombotic abnormality—BBL mortality is associated with iatrogenic pulmonary fat embolism. BBL mortality rates from more recent surveys on BBL safety demonstrate a mortality of one in 15,000.

Conclusions:
Although deep venous thrombosis/pulmonary embolism will always remain an abdominoplasty risk, intraoperative BBL pulmonary fat embolism has the potential to be reduced dramatically with a better understanding of dynamic anatomy, surgical instrumentation, and technique. The authors are now presented with a better lens with which to view a more accurate safety profile of BBL surgery, including its place among other commonly performed aesthetic procedures.
Advanced imaging in acute ischemic stroke: an updated guide to the hub-and-spoke hospitals
Authors: Sharobeam Angelos , Yan Bernard 
Published: November 2021

Purpose of review
The purpose of this review is to summarize the role of the hub-and-spoke system in acute stroke care, highlight the role of advanced imaging and discuss emerging concepts and trials relevant to the hub-and-spoke model.

Recent findings
The advent of advanced stroke multimodal imaging has provided increased treatment options for patients, particularly in rural and regional areas. When used in the hub-and-spoke model, advanced imaging can help facilitate and triage transfers, appropriately select patients for acute therapy and treat patients who may otherwise be ineligible based on traditional time metrics.
Recent, ongoing trials in this area may lead to an even greater range of patients being eligible for acute reperfusion therapy, including mild strokes and patients with large core infarct volumes.

Summary
Integration of advanced imaging into a hub-and-spoke system, when complemented with other systems including telemedicine, improves access to acute stroke care for patients in regional and rural areas.
Shared components of heritability across genetically correlated traits
Authors: Ballard Jenna Lee , O’Connor Luke Jen 
Published: November 2021

AbstractMost disease-associated genetic variants are pleiotropic, affecting multiple genetically correlated traits. Their pleiotropic associations can be mechanistically informative: if many variants have similar patterns of association, they may act via similar pleiotropic mechanisms, forming a shared component of heritability. We developed Pleiotropic Decomposition Regression (PDR) to identify shared components and their underlying genetic variants. We validated PDR on simulated data and identified limitations of existing methods in recovering the true components. We applied PDR to three clusters of 5-6 traits genetically correlated with coronary disease, asthma, and type II diabetes respectively, producing biologically interpretable components. For CAD, PDR identified components related to BMI, hypertension and cholesterol, and it clarified the relationship among these highly correlated risk factors. We assigned variants to components, calculated their posterior-mean effect sizes, and performed out-of-sample validation. Our posterior-mean effect sizes pool statistical power across traits and substantially boost the correlation (r2) between true and estimated effect sizes compared with the original summary statistics: by 94% and 70% for asthma and T2D out of sample, and by a predicted 300% for CAD.
Representation of Drosophila larval behaviors by muscle activity patterns
Authors: Zhou Jinrun , Huang Zenan , Li Xinhang , Song Zhiying , Sun Yixuan , Ping Junyu , Chen Xiaopeng , Fei Peng , Zheng Nenggan , Gong Zhefeng 
Published: November 2021

AbstractHow muscle actions are coordinated to realize animal movement is a fundamental question in behavioral study. To obtain the overall muscular activity patterns accompanying behaviors at high spatiotemporal resolution is technically difficult. In this work, we used light sheet microscopy to simultaneously image and analyze the activity, length and orientation of Drosophila larval muscles across body segments at single muscle resolution in nearly free behaviors. For typical behavioral modes such as peristalsis, head cast and turning, larval muscles showed behavioral mode specific activity patterns. Unexpectedly, reorientation of larval head involves muscle tone in the apparently motionless posterior segments. With a STGCN(spatial temporal graph convolution neural network)-Generator model, sequence of larval behavioral poses outlined by morphological patterns of muscles could be accurately predicted based on the time series of ventral but not dorsal muscle activities, and vice versa. Laser ablation of ventral but not dorsal muscles interrupted peristaltic wave and undermined head cast in both frequency and amplitude. Our results provide a simplified muscle activity representation of soft body motion that can be used for probing the key components of animal motor control.
The online delivery of exercise oncology classes supported with health coaching: A pilot randomized controlled trial
Authors: Eisele Maximilian , Twomey Rosie , Pohl Andrew J. , McDonough Meghan H. , McNeely Margaret L. , Ester Manuel , Daun Julia T. , Culos-Reed S. Nicole 
Published: November 2021

AbstractPurposeThe primary objective was to investigate the feasibility of a synchronous, online delivered, group-based, supervised, exercise oncology maintenance program supported with health coaching.MethodsAll participants had previously completed a 12-week group-based exercise study. In the current study, participants were randomized to a 12-week exercise oncology maintenance class with or without health coaching. The primary outcome was feasibility, assessed as intervention attendance, safety and fidelity, study recruitment, attrition and outcome assessment completion. Additionally, semi-structured interviews at the end of the intervention provided participants’ perspectives on intervention feasibility.ResultsForty participants (n8WK=25; n12WK=15) enrolled in the study. Feasibility was confirmed for recruitment rate (42.6%), attrition rate (2.5%), safety (no adverse events), health coaching attendance (97%), health coaching fidelity (96.7%), class attendance (91.2%), class fidelity (92.6%), and assessment completion (questionnaire=98.8%; physical functioning=97.5%). Based on the qualitative feedback, feasibility was facilitated by the convenience, while the diminished ability to connect with other participants online was a drawback compared to in-person delivery.ConclusionThe synchronous online delivery of an exercise oncology maintenance class, the additional health coaching support, and the tools used to measure the intervention effectiveness were feasible for individuals living with and beyond cancer.
The immunogenicity and reactogenicity of four COVID-19 booster vaccinations against SARS-CoV-2 variants of concerns (Delta, Beta, and Omicron) following CoronaVac or ChAdOx1 nCoV-19 primary series
Authors: Angkasekwinai Nasikarn , Niyomnaitham Suvimol , Sewatanon Jaturong , Phumiamorn Supaporn , Sukapirom Kasama , Senawong Sansnee , Toh Zheng Quan , Umrod Pinklow , Somporn Thitiporn , Chumpol Supaporn , Ritthitham Kanokphon , Jantraphakorn Yuparat , Srisutthisamphan Kanjana , Chokephaibulkit Kulkanya 
Published: November 2021

AbstractThe CoronaVac (Sinovac Biotech) and ChAdOx1(Oxford-AstraZeneca) are two widely used COVID-19 vaccines. We examined the immunogenicity of four COVID-19 booster vaccine: BBIBP-CorV (Sinopharm Biotech), ChAdOx1, 30μg-BNT162b2 and 15μg-BNT162b2 (Pfizer-BioNTech), in healthy adults who received a two-dose CoronaVac or ChAdOx1 8-12 weeks earlier. Among the 352 participants (179 CoronaVac and 173 ChAdOx1 participants), 285 (81%) were female, and median age was 39(IQR: 31-47) years. 98%(175/179) and 99%(172/173) of Coronavac and ChAdOx1 participants remained seropositive at baseline. Two weeks post-booster, both 30μg- and 15μg-BNT162b2 induced the highest anti-RBD IgG concentration (BAU/mL); Coronavac-prime: 30μg-BNT162b2, 5152.2(95%CI 4491.7-5909.8); 15μg-BNT162b2, 3981.1(3397.2-4665.4); ChAdOx1, 1358.0(1141.8-1615.1); BBIBP-CorV, 154.6(92.11-259.47); ChAdOx1-prime: 30μg-BNT162b2, 2363.8(2005.6-2786.1; 15μg-BNT162b2, 1961.9(1624.6-2369.1); ChAdOx1, 246.4(199.6-304.2); BBIBP-CorV, 128.1(93.5-175.4). Similarly, both 30μg- and 15μg-BNT162b2 boosting induced the highest neutralizing antibodies (nAb) titres against all variants and highest T-cell response evaluated by interferon gamma released asssays. While all BNT162b2 or heterologous ChAdOx1-boosted participants had nAb against Omicron, these were <50% for BBIBP-CorV and 75% for homologous ChAdOx1-boosted participants. There was significant decrease in nAb (>4-fold) 16-20 weeks post booster. Heterologous boosting with BNT162b2 following CoronaVac or ChAdOx1 primary series is most immunogenic. A lower dose BNT162b2 may be considered as booster in settings with limited vaccine supply.
Transdiagnostic Profiles of Behaviour and Communication Relate to Academic and Socioemotional Functioning and Neural White Matter Organisation
Authors: Mareva Silvana , Akarca Danyal ,   The CALM team, Holmes Joni 
Published: November 2021

AbstractBackgroundBehavioural and language difficulties co-occur in multiple neurodevelopmental conditions. Our understanding of these problems has arguably been slowed by an overreliance on study designs that compare deficit/diagnostic groups and fail to capture the overlap across different neurodevelopmental disorders and the heterogeneity within them.MethodsWe recruited a large transdiagnostic cohort of children with complex needs (N = 805) to identify distinct subgroups of children with common profiles of behavioural and language strengths and difficulties. We then investigated whether and how these data-driven groupings could be distinguished from a comparison sample (N = 158) on measures of academic and socioemotional functioning and patterns of global and local white matter connectome organisation. Academic skills were assessed via standardised measures of reading and maths. Socioemotional functioning was captured by the parent-rated version of the Strengths and Difficulties Questionnaire.ResultsWe identified three distinct subgroups of children, each with different levels of difficulties in structural language, pragmatic communication, and hot and cool executive functions. All three subgroups struggled with academic and socioemotional skills relative to the comparison sample, potentially representing three alternative but related developmental pathways to difficulties in these areas. The children with the weakest language skills had the most widespread difficulties with learning, whereas those with more pronounced difficulties with hot executive skills experienced the most severe difficulties in the socioemotional domain. Each data-driven subgroup could be distinguished from the comparison sample based on both shared and subgroup-unique patterns of neural white matter organisation. Children with the most pronounced deficits in language, cool executive, or hot executive function were differentiated from the comparison sample by altered connectivity in predominately thalamocortical, temporal-parietal-occipital, and frontostriatal circuits, respectively.ConclusionThese findings advance our understanding of commonly co-morbid behavioural and language problems and their relationship to behavioural outcomes and neurobiological substrates. Transdiagnostic Profiles of Behaviour and Communication Relate to Academic and Socioemotional Functioning and Neural White Matter Organisation