bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paracomplete truth theory with KFS-definable determinateness
Authors: Cramer Marcos 
Published: April 2021

Abstract
One way to deal with the liar paradox is the paracomplete approach to theories of truth, which gives up proofs by contradiction, and the law of the excluded middle. This allows one to reject both the liar sentence and its negation. The simplest paracomplete theory of truth is $\textit {KFS}$ due to Saul Kripke. At face value, this theory suffers from the problem that it cannot say anything about the liar paradox, so a defender of this theory cannot explain their rejection of the liar sentence within the language of $\textit {KFS}$. This was one of the motivations for Hartry Field to extend $\textit {KFS}$ with a conditional that is not definable within $\textit {KFS}$. With the help of this conditional, Field defines a determinateness operator that can be used to explain one’s rejection of the liar sentence within the object language of his theory. Field’s determinateness operator can be transfinitely iterated to create stronger notions of determinateness required to explain the rejection of paradoxical sentences involving the determinateness operator. In this paper, we show that Field’s complex extension of $\textit {KFS}$ is not required in order to express rejection of paradoxical sentences like the liar sentence. Instead, one can work with a transfinite hierarchy of determinateness operators that are definable in $\textit {KFS}$. This allows for Field’s philosophically appealing treatment of the liar sentence, the truth-teller and strengthenings of the liar sentence to be reproducible within the theory $\textit {KFS}$, which is semantically much simpler than Field’s extension of $\textit {KFS}$ with a conditional.
The high-energy aerial insectivore lifestyle of swallows does not produce clear thermogenic side effects
Authors: Zhang Yufeng , Yap Kang Nian , David Kyle T , Swanson David L 
Published: April 2021

Abstract
Ecological traits related to pace of life, such as foraging strategies and activity levels, influence daily energy expenditure (DEE) and can affect fitness. A fast pace of life tends to be supported by high-energy aerobic activity and is positively correlated with high DEE and basal and maximal metabolic rates in some endotherms. Given that maximal capacities for exercise and thermogenesis are both functions of aerobic muscle output and are often positively correlated with each other, high-energy aerobic lifestyles might be associated with high aerobic capacities, which would be expected to produce high thermogenic capacities as a side effect. We tested whether the high-energy aerial insectivore lifestyle in swallows is correlated with elevated basal and maximal thermogenic metabolic rates. We measured basal (BMR) and summit (Msum = maximum cold-induced metabolic rate) metabolic rates in 6 species of swallows (Hirundinidae) and combined these data with literature data for additional swallows (n = 10 for BMR; n = 8 for Msum) and non-aerial insectivore birds (n = 215 for BMR; n = 64 for Msum) to address the hypothesis that swallows have higher BMR and Msum than non-aerial insectivores. BMR in swallows was significantly higher than for non-aerial insectivore birds for phylogenetically adjusted analyses after correcting for body mass and region of origin (tropical vs. temperate). In contrast, Msum did not differ significantly between swallows and non-aerial insectivores. Thermogenic scope (Msum – BMR), however, was lower in tropical non-aerial insectivore birds compared with tropical swallows and temperate birds. This suggests that the aerial insectivore lifestyle elevates maintenance costs, but maximum thermogenic capacities are not clearly upregulated, despite tropical swallows having higher thermogenic scope than tropical non-aerial insectivores. These data suggest that the high-energy aerial insectivore lifestyle does not produce strong thermogenic side effects in swallows.
Default mode network functional connectivity negatively associated with trait openness to experience
Authors: Marstrand-Joergensen Maja Rou , Madsen Martin K , Stenbæk Dea S , Ozenne Brice , Jensen Peter S , Frokjaer Vibe G , Knudsen Gitte M , Fisher Patrick M 
Published: April 2021

AbstractEvaluating associations between the five-factor personality domains and resting-state functional connectivity networks (e.g. default mode network, DMN) highlights distributed neurobiological systems linked to behaviorally relevant phenotypes. Establishing these associations can highlight a potential underlying role for these neural pathways in related clinical illness and treatment response. Here, we examined associations between within- and between-network resting-state functional connectivity with functional magnetic resonance imaging and the five-factor personality domains: Openness to experience (Openness), Extraversion, Neuroticism, Agreeableness and Conscientiousness. We included data from 470 resting-state scan sessions and personality assessments in 295 healthy participants. Within- and between-network functional connectivity from 32 a priori defined regions was computed across seven resting-state networks. The association between functional connectivity and personality traits was assessed using generalized least squares. Within-network DMN functional connectivity was significantly negatively associated with trait Openness (regression coefficient = −0.0010; [95% confidence interval] = [−0.0017, −0.0003]; PFWER = 0.033), seemingly driven by association with the Fantasy subfacet. Trait Extraversion was significantly negatively associated with functional connectivity between the visual and dorsal attention networks and positively associated with functional connectivity between the frontoparietal and language networks. Our findings provide evidence that resting-state DMN is associated with trait Openness and gives insight into personality neuroscience.
Improving Medical Student Comfort and Competence in Performing Gynecological Exams: A Systematic Review
Authors: Kirubarajan Abirami , Li Xinglin , Got Tiffany , Yau Matthew , Sobel Mara 
Published: April 2021

PurposePerforming a gynecological exam is an essential skill for physicians. While interventions have been implemented to optimize how this skill is taught in medical school, it remains an area of concern and anxiety for many medical students. To date, a comprehensive assessment of these interventions has not been done. The authors conducted a systematic review of the literature on interventions that aim to improve medical student education on gynecological exams.MethodThe authors searched 6 databases (Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, Scopus, Web of Science Core Collection, and ERIC [Proquest]) from inception to August 4, 2020. Studies were included if they met the following criteria: focus on medical students, intervention with the purpose of teaching students to better perform gynecological exams, and reported outcomes/evaluation. Extracted data included study location, study design, sample size, details of the intervention and evaluation, and context of the pelvic exam. All outcomes were summarized descriptively; key outcomes were coded as subjective or objective assessments.ResultsThe search identified 5,792 studies; 50 met the inclusion criteria. The interventions described were diverse, with many controlled studies evaluating multiple methods of instruction. Gynecological teaching associates (GTAs), or professional patients, were the most common method of education. GTA-led teaching resulted in improvements in student confidence, competence, and communication skills. Physical adjuncts, or anatomic models and simulators, were the second most common category of intervention. Less resource-intensive interventions, such as self-directed learning packages, online training modules, and video clips, also demonstrated positive results in student comfort and competence. All studies highlighted the need for improved education on gynecological exams.ConclusionsThe literature included evaluations of numerous interventions for improving medical student comfort and competence in performing gynecological exams. GTA-led teaching may be the most impactful educational tool described, though less resource-intensive interventions can also be effective.
Virtual Telesimulation for Medical Students During the COVID-19 Pandemic
Authors: Ray Jessica M. , Wong Ambrose H. , Yang Thomas J. , Buck Samuel , Joseph Melissa , Bonz James W. , Auerbach Marc A. , Couturier Katherine , Tomassoni Anthony J. , Schwartz Michael L. , Evans Leigh V. 
Published: April 2021

Problem
In March 2020, the novel coronavirus 2019 (COVID-19) became a global pandemic. Medical schools around the United States faced difficult decisions, temporarily suspending hospital-based clerkship rotations for medical students due to potential shortages of personal protective equipment and a need to social distance. This decision created a need for innovative, virtual learning opportunities to support undergraduate medical education.

Approach
Educators at Yale School of Medicine developed a novel medical student curriculum converting high-fidelity, mannequin-based simulation into a fully online virtual telesimulation format. By using a virtual videoconferencing platform to deliver remote telesimulation as an immersive educational experience for widely dispersed students, this novel technology retains the experiential strengths of simulation-based learning while complying with needs for social distancing during the pandemic. The curriculum comprises simulated clinical scenarios that include live patient actors; facilitator interactions; and real-time assessment of vital signs, labs, and imaging. Each 90-minute session includes 2 sets of simulation scenarios and faculty-led teledebriefs. A team of 3 students performs the first scenario, while an additional team of 3 students observes. Teams reverse roles for the second scenario.

Outcomes
The 6-week virtual telesimulation elective enrolled the maximum 48 medical students and covered core clinical clerkship content areas. Communication patterns within the virtual telesimulation format required more deliberate turn-taking than normal conversation. Using the chat function within the videoconferencing platform allowed teams to complete simultaneous tasks. A nurse confederate provided cues not available in the virtual telesimulation format.

Next Steps
Rapid dissemination of this program, including online webinars and live demonstration sessions with student volunteers, supports the development of similar programs at other universities. Evaluation and process improvement efforts include planned qualitative evaluation of this new format to further understand and refine the learning experience. Future work is needed to evaluate clinical skill development in this educational modality.
The Use of a Hartmann’s Pouch for Bowel Vaginoplasty: A Case Report
Authors: Zak, Peter William , Chow Ian , Zhu Xiao , Sell Harry W. , Rusilko Paul J. , Stofman Guy M. 
Published: April 2021

Summary:
Bowel vaginoplasty is a well-described procedure utilizing a pedicled segment of large or small bowel. It has most commonly been used for vaginal agenesis, male-to-female gender affirmation surgery when the phallus skin is not sufficient, or a revision after failure of the primary reconstruction. Our case report describes the usage of a pedicled segment of large bowel to reconstruct the vagina after severe stricture of the original reconstruction. We were able to provide relief of the symptomatic Hartmann’s pouch mucocele, urethral stricture, and provide a functional introitus and vaginal canal. This technique can provide a framework that can be used as a salvage plan in patients with previously irritated and inhospitable defects.
Survey Outcomes of Lipedema Reduction Surgery in the United States
Authors: Herbst Karen L. , Hansen Emily A. , Cobos Salinas Leopoldo M. , Wright Thomas F. , Larson Ethan E. , Schwartz Jaime S. 
Published: April 2021

Background:Lipedema is a loose connective tissue disease affecting the limbs of women, that is difficult to lose by diet, exercise, or bariatric surgery. Publications from Europe demonstrate that lipedema reduction surgery improves quality of life for women with lipedema. There are no comparable studies in the United States (USA). The aim of this study was to collect data from women with lipedema in the USA who have undergone lipedema reduction surgery in the USA to determine if quality of life, pain, and other measures improved after lipedema reduction surgery.Methods:Subjects were recruited and consented online for a 166-item questionnaire in REDCap. In total, 148 women answered the questionnaire after undergoing lipedema reduction surgery in the USA. Significance set atP< 0.05 was determined by ANOVA, Tukey’s multiple comparison test, or pairedt-test.Results:Quality of life improved in 84% and pain improved in 86% of patients. Ambulation improved most in lipedema Stage 3 (96%). Weight loss occurred in all stages by 3 months after surgery. Complications included growth of loose connective tissue within and outside treated areas, tissue fibrosis, anemia, blood clots, and lymphedema.Conclusions:Women with lipedema noticed significant benefits after lipedema reduction surgery in the USA. Prospective studies are needed to assess benefits and complications after lipedema reduction surgery in the USA.
A Herniorrhaphy Lamination Technique for the Reconstruction of Midline Abdominal Wall Defects
Authors: Kurabayashi Takashi , Asato Hirotaka , Suzuki Yasutoshi , Takada Goro , Ishizuka Noriyuki , Sasaki Shoichi , Moteki Michihiko 
Published: April 2021

Summary:
The primary goal of abdominal wall reconstruction is to prevent hernia recurrence through robust and durable repair. Synthetic mesh utilization can provide sound strength but is susceptible to extrusion, infection, and intestinal fistulization. The use of autologous fasciae latae to reinforce the primary fascial reapproximation has mostly been abandoned, presumably because synthetic patches are readily available. There is a specific demand for a sustainable, less-invasive, and ready-to-use repair method without mesh. The authors devised a herniorrhaphy lamination technique using local musculofascial flaps inspired by composite laminates. In this procedure, the primary fascial reapproximation is reinforced with 3 additional laminated musculofascial layers: (1) turnover hinge flaps of the anterior sheath of the rectus abdominis, (2) bilateral rectus abdominis, and (3) advancement flaps of newly generated edges of the fascia of the rectus sheath. Our technique’s stability is essentially due to the mechanical superiority of the centralized pipe-like structure of musculofascia. Between February 2009 and November 2019, we used the lamination technique to repair midline incisional hernias in 10 patients. The operative procedure was successful in all patients, and there has been no evidence of recurrence. The follow-up period ranged from 12 to 69 months, with a mean follow-up of 35 months. The herniorrhaphy lamination technique to reinforce the primary repair can help prevent hernia recurrence. Although our technique is suitable for a small-sized defect, it is less invasive, and can be readily applied. Because it does not include any mesh, it is suitable for the contaminated abdominal wall reconstruction.
Neourethra Creation in Gender Phalloplasty: Differences in Techniques and Staging
Authors: Berli Jens U. , Monstrey Stan , Safa Bauback , Chen Mang 
Published: April 2021

Summary:
The creation of a sensate, aesthetic, and functional phallus for transmasculine individuals has high reported complication rates. Neourethra reconstruction is the most challenging aspect of this surgery, with widely varying techniques and staging between providers. In an operation of this complexity, surgeons should not be expected to offer all the options, but rather the specific variation that works in their given setting. For some, it is single-stage phalloplasty with full-length urethroplasty. For others, staged phalloplasty with separation of perineal masculinization from phallus reconstruction works better. In this expert opinion article, the authors strive to give an overview of the principles behind, and a detailed explanation of, the technical details of creating the penile and bulbar urethra during phalloplasty. The authors focus on the three most common strategies: single-stage phalloplasty; two-stage phalloplasty with a metoidioplasty-first approach; and two-stage phalloplasty with a phalloplasty-first (Big Ben method) approach. It is not the authors’ intent to establish the “best” or “only” way, but rather to compile different options with their respective pros and cons.
Reconstructive Management of Gunshot Wounds to the Frontal Sinus
Authors: Soto Edgar , Ovaitt Alyssa K. , Clark Ashlynn R. , Tindal Rachel R. , Chiasson Katherine F. , Aryanpour Zain , Ananthasekar Shivani , Grant John H. , Myers René P. 
Published: April 2021

Introduction
In the last decade, we have seen a steady increase in the incidence of frontal sinus trauma due to gunshot wounds and a decrease in motor vehicle trauma. Penetrating gunshot wounds to the frontal sinus present a unique challenge to the reconstructive surgeon because they require careful consideration of the management principles of plastic surgery. Despite previous reviews on frontal sinus trauma, there are no studies examining the management techniques of frontal sinus fractures due specifically to gunshot wounds. In this study, we aim to retrospectively evaluate the use of a variety of tissue flaps in intervention and associated outcomes.

Methods
A retrospective chart review was completed on all patients with gunshot wound(s) to the frontal sinus from January 2010 to January 2018 at a single institution. The patients were classified based on the fracture pattern (anterior vs posterior table vs both), degree of displacement, presence of nasofrontal outflow tract injury, and evidence of cerebrospinal fluid leak. Patients were then stratified according to the type of reconstruction performed (cranialization, obliteration and need for free flap) and evaluated for major and minor complications after reconstruction.

Results
In this study, we present outcome data from 28 cases of frontal sinus trauma due to gunshot wounds. There was a statistically significant difference (P = 0.049) in the type reconstructive strategy employed with each type of flap, with pericranial flaps primarily used in cranialization, temporal grafts were more likely to be used in obliteration, and free flaps were more likely to be used in cranialization. The overall major complication rate was 52% (P = 0.248), with the most common acute major complication was cerebrospinal fluid leak (39%) and major chronic was abscess (23.5%).

Conclusions
This report explores the management of frontal sinus trauma and presents short-term outcomes of treatment for penetrating gunshot wounds at a tertiary referral center.
The Deltopectoral/Internal Mammary Artery Perforator Flap Revisited
Authors: Angrigiani Claudio , Rancati Alberto , Varela Ignacio , Rancati Agustin , Nahabedian Maurice Y. , Neligan Peter 
Published: April 2021

Abstract
Current understanding of the vascular anatomy of the anterior chest wall suggests that perfusion of the deltopectoral flap may be compromised when crossing the midline at the anterior thoracic wall. The traditional deltopectoral flap is designed longitudinally over the ipsilateral side to avoid the risk of distal flap necrosis. The purpose of this article is to present our experience and results with 26 deltopectoral flaps that were designed and raised with the perforating vessels on the ipsilateral side with the majority of the flap crossing the midline extending to the contralateral side. This anatomic variation in flap design indicates that the sternal midline is not a barrier and that the internal mammary perforator flap may be raised on different longitudinal axes.
Marginal Impact of Tocilizumab Monotherapy on Anti-HLA Alloantibodies in Highly Sensitized Kidney Transplant Candidates
Authors: Daligault Mélanie , Bardy Béatrice , Noble Johan , Bourdin Anne , Masson Dominique , Naciri Bennani Hamza , Bugnazet Mathilde , Malvezzi Paolo , Rostaing Lionel , Jouve Thomas 
Published: April 2021

Background.
Highly HLA–sensitized kidney transplant candidates are difficult to desensitize, which reduces their chances of receiving a transplant.

Methods.
We administered tocilizumab as a monotherapy (8 mg/kg once a mo) to 14 highly sensitized kidney transplant candidates. Highest mean fluorescence intensities of anti-HLA antibodies obtained before and after tocilizumab administration were compared from raw and diluted sera.

Results.
The administration of tocilizumab significantly reduced dominant anti-HLA antibody sensitization. However, this decrease in mean fluorescence intensities was minor compared with the initial values.

Conclusions.
Tocilizumab as a monotherapy was not sufficient to allow highly sensitized kidney–transplant candidates to undergo transplantation and, therefore, was not an effective desensitization method.
Genetic liability for substance use associated with medical comorbidities in electronic health records of African- and European-ancestry individuals
Authors: Hartwell Emily E. , Merikangas Alison K. , Verma Shefali S. , Ritchie Marylyn D. ,   Regeneron Genetics Center, Kranzler Henry R. , Kember Rachel L. 
Published: April 2021

AbstractPolygenic risk scores (PRS) represent an individual’s summed genetic risk for a trait and can serve as biomarkers for disease. Less is known about the utility of PRS as a means to quantify genetic risk for substance use disorders (SUDs) than for many other traits. Nonetheless, the growth of large, electronic health record-based biobanks makes it possible to evaluate the association of SUD PRS with other traits. We calculated PRS for smoking initiation, alcohol use disorder (AUD), and opioid use disorder (OUD) using summary statistics from the Million Veteran Program sample. We then tested the association of each PRS with its primary phenotype in the Penn Medicine BioBank (PMBB) using all available genotyped participants of African or European ancestry (AFR and EUR, respectively) (N=18,612). Finally, we conducted phenome-wide association analyses (PheWAS) separately by ancestry and sex to test for associations across disease categories. Tobacco use disorder was the most common SUD in the PMBB, followed by AUD and OUD, consistent with the population prevalence of these disorders. All PRS were associated with their primary phenotype in both ancestry groups. PheWAS results yielded cross-trait associations across multiple domains, including psychiatric disorders and medical conditions. SUD PRS were associated with their primary phenotypes, however they are not yet predictive enough to be useful diagnostically. The cross-trait associations of the SUD PRS are indicative of a broader genetic liability. Future work should extend findings to additional population groups and for other substances of abuse.