bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breaking the Cycle
Authors: Edge Naph'tali B. 
Published: November 2021

Purpose/Objectives:
Approximately 100,000 people in the United States are affected by sickle cell disease (SCD). Sickle cell disease represents one of the highest readmitting diagnoses at this organization. The purpose of this study is to determine the impact of implementing care coordination interventions to reduce hospital readmissions of patients with SCD.

Primary Practice Setting:
The setting for conducting the interventions took place at the flagship hospital of a seven hospital system in Houston, TX. The hospital is a not-for-profit, faith-based, 907-bed academic facility that provides highly specialized health services to the community and the world. The population of focus was adult patients (18 years of age and older) admitted to the hospital with a primary diagnosis of SCD.

Findings/Conclusion:
Two interventions were implemented: Disease-specific discharge education and scheduling postdischarge follow-up appointments prior to discharge. These interventions were conducted by bedside nurses, case managers, and SCD champions over a 6-month period. The 30-day readmission rate for SCD was reduced by 22%. There was also a 0.9-day reduction in length of stay and a 17% reduction in emergency, observation, and inpatient encounters of patients with SCD.

Implications for Case Management Practices:
This project found that implementing evidence-based care coordination interventions can reduce the 30-day readmission rate for patients with SCD. Implementation of effective evidence-based care coordination is a key aspect to reducing hospital readmissions of patients with SCD. Partnering with community networks is also important in addressing readmission risk factors including management of social determinants of health that increase hospital visits. Consistent, patient-centered education using simple and convenient tools helps improve understanding, applicability, and self-care management.
Unmet Prenatal Expectations During the COVID-19 Pandemic
Authors: Goyal Deepika , Rosa Liana De La , Mittal Leena , Erdei Carmina , Liu Cindy H. 
Published: November 2021

Abstract

Purpose:
To explore the experiences of pregnant women who were living in the United States during the COVID-19 pandemic.

Study Design and Methods:
Using a qualitative design, we used data obtained from women in their second or third trimester of pregnancy who participated in the Perinatal Experiences and COVID-19 Effects (PEACE) Study from May 21 to December 22, 2020.

Results:
361 of 408 pregnant women (88%) who participated in the PEACE study during that timeframe provided narrative comments. Participants had a mean age of 33.2 years (SD = 3.7) with a high percentage of White women (91.4%). At the time of participation, women were between 2.4 and 8.6 months into the COVID-19 pandemic. Just under half were pregnant for the first time (n = 177). Content analysis of responses revealed an overall sense of “unmet expectations” within two themes involving the role of relationships: 1) losing the experience of going through pregnancy together and 2) loss of social support and expected relationship building. Differences were noted between participants giving birth for the first time and participants with other children at home.

Clinical Implications:
This study offers insight for nurses and other clinicians taking care of pregnant women during times of public health crises and provides implications for the care of women as the pandemic continues. Nurses can help women plan for future health care changes that may disrupt their support needs as seen during the COVID-19 pandemic. Nurses should also be aware of possible enduring effects of prenatal unmet needs on later outcomes.
Child Temperament as a Predictor of Parents' Potential for Emotional Abuse
Authors: Pekdoğan Serpil , Kanak Mehmet 
Published: November 2021

Abstract
Children who are constantly criticized and humiliated by their parents and whose needs for affection and attention are not sufficiently addressed are defined as people with personality traits, low self-confidence, and antisocial behaviors. These personality traits have a significant influence on the shaping of the child's temperament. Therefore, emotional abuse negatively affects both the personality and success of the child. In line with this, child temperament was analyzed as a predictor of the emotional abuse potential of parents who have children between the ages of 4 and 6. The experimental group of the study consisted of 237 parents. Data were collected using The Scale for Emotional Abuse Potential of Parents with Children Aged 3 to 6 and Temperament Assessment Battery for Children–Revised: Parent Form. In the data analysis, the intervariable relationship was determined by the Pearson correlation coefficient, and the predictors of emotional abuse potentials were determined by multiple regression analysis. As a result of the analysis, a significant negative correlation was found between shyness and parents' emotionally abusive behaviors, a significant positive correlation between those behaviors and surgency, and negative affectivity. A positive correlation was found between persistence and the parents' emotional abuse preventive behaviors. In terms of predictive variables, it was found that the causality subdimension of the emotional abuse potentials of parents was significantly predicted by the negative affectivity subdimension of temperament, and emotional abuse preventive potentials of parents were significantly predicted by the persistence subdimension of temperament.
Utilization of Monitored Beds for Children Admitted With Unintentional Poisonings
Authors: Smola Cassi , Wu Chang L. , Narayanan Sridaran , Nichols Michele H. , Pruitt Chris 
Published: November 2021

Objectives
Children with unintentional poisonings (UPs) are frequently admitted to monitored beds (MBs), though most require minimal interventions. We aimed to (1) describe clinical factors and outcomes for children admitted for UPs and (2) identify clinical factors associated with MB placement.

Methods
In this single-center retrospective cohort study, we studied patients younger than 6 years admitted from the emergency department (ED) for UPs over a 5-year period to a quaternary-care children's hospital. Primary outcome was disposition (MB vs non-MB). Secondary outcomes included length of stay, escalation of inpatient care, 7-day readmission, and death. Covariates included age, certainty of ingestion, altered mental status, and ED provider training level. Subanalysis of drug class effect on disposition was also studied. Associations of clinical factors with MB placement were tested with multivariable logistic regression.

Results
Of 401 patients screened, 345 subjects met inclusion criteria. Most subjects (308 of 345 [89%]) were admitted to MBs. Children with high certainty of ingestion (adjusted odds ratio [aOR], 4.2; 95% confidence interval [CI], 1.52–11.58), altered mental status (aOR, 5.82; 95% CI, 2.45–13.79), and a fellow (vs faculty) ED provider (aOR, 2.34; 95% CI, 1.04–5.24) were more likely to be admitted to MBs. No escalations of care, readmissions, or deaths occurred. Exposures to cardiac drugs had increased MB placement (aOR, 6.74; 95% CI, 1.93–23.59).

Conclusions
The majority of children admitted for UPs were placed in MBs. Regardless of inpatient placement, no adverse events were observed, suggesting opportunities for optimized resource utilization. Future research may focus on direct costs, inpatient interventions, or prospective outcomes to validate these findings.
Direct-to-Implant Prepectoral Breast Reconstruction: Patient-Reported Outcomes
Authors: Safran Tyler , Al-Halabi Becher , Viezel-Mathieu Alex , Hazan Jessica , Dionisopoulos Tassos 
Published: November 2021

Background:
Direct-to-implant prepectoral breast reconstruction has recently experienced a resurgence in popularity because of its lower levels of postoperative pain and animation deformity. BREAST-Q, a well-validated patient-reported outcomes tool, was used to assess patient satisfaction and quality of life. The goal of this study was to assess patient-reported outcomes at 6-month and 1-year follow-up after direct-to-implant prepectoral breast reconstruction.

Methods:
Sixty-nine consented adult patients undergoing a total of 110 direct-to-implant, prepectoral, postmastectomy breast reconstructions completed BREAST-Q questionnaires immediately preoperatively, and at 6 and 12 months thereafter.

Results:
Mean breast satisfaction decreased nonsignificantly from 61.3 preoperatively to 58.6 at 12 months after reconstruction (p = 0.32). Psychosocial well-being improved nonsignificantly from 67.1 preoperatively to 71.1 at 12-month follow-up (p = 0.26). Physical well-being of the chest was insignificantly different, from 74.4 to 73.3 at 12-month follow-up (p = 0.62). Finally, sexual well-being similarly remained nonsignificantly changed from 60.2 preoperatively, to 59.1 at 12 months (p = 0.80). The use of acellular dermal matrix and postmastectomy radiotherapy did not have any significant effects on patient-reported outcomes. Through regression analysis, neoadjuvant chemotherapy, increased age, and incidence of rippling were found to negatively influence BREAST-Q results.

Conclusions:
Patients who underwent direct-to-implant prepectoral breast reconstruction demonstrated an overall satisfaction with their outcomes. As prepectoral breast reconstruction continues to advance and grow in popularity, patient-reported outcomes such as those presented in this study become of paramount importance in practice.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Current Management of Sternal Wounds
Authors: Hamaguchi Ryoko , Shekar Prem S. , Johnson Jennifer A. , Orgill Dennis P. 
Published: November 2021

Learning Objectives:
After studying this article, the participant should be able to: 1. Describe the pathogenesis, classification, and risk factors of sternal wound infection. 2. Discuss options for sternal stabilization for the prevention of sternal wound infection, including wiring and plating techniques. 3. Discuss primary surgical reconstructive options for deep sternal wound infection and the use of adjunctive methods, such as negative-pressure wound therapy.

Summary:
Poststernotomy sternal wound infection remains a life-threatening complication of open cardiac surgery. Successful treatment relies on timely diagnosis and initiation of multidisciplinary, multimodal therapy.
A Correlation between Upper Extremity Compressive Neuropathy and Nerve Compression Headache
Authors: Gfrerer Lisa , Chartier Christian , Lans Jonathan , Eberlin Kyle R. , Austen William Gerald 
Published: November 2021

Background:
Compressive neuropathies of the head/neck that trigger headaches and entrapment neuropathies of the extremities have traditionally been perceived as separate clinical entities. Given significant overlap in clinical presentation, treatment, and anatomical abnormality, the authors aimed to elucidate the relationship between nerve compression headaches and carpal tunnel syndrome, and other upper extremity compression neuropathies.

Methods:
One hundred thirty-seven patients with nerve compression headaches who underwent surgical nerve deactivation were included. A retrospective chart review was conducted and the prevalence of carpal tunnel syndrome, thoracic outlet syndrome, and cubital tunnel syndrome was recorded. Patients with carpal tunnel syndrome, cubital tunnel syndrome, and thoracic outlet syndrome who had a history of surgery and/or positive imaging findings in addition to confirmed diagnosis were included. Patients with subjective report of carpal tunnel syndrome/thoracic outlet syndrome/cubital tunnel syndrome were excluded. Prevalence was compared to general population data.

Results:
The cumulative prevalence of upper extremity neuropathies in patients undergoing surgery for nerve compression headaches was 16.7 percent. The prevalence of carpal tunnel syndrome was 10.2 percent, which is 1.8- to 3.8-fold more common than in the general population. Thoracic outlet syndrome prevalence was 3.6 percent, with no available general population data for comparison. Cubital tunnel syndrome prevalence was comparable between groups.

Conclusions:
The degree of overlap between nerve compression syndromes of the head/neck and upper extremity suggests that peripheral nerve surgeons should be aware of this correlation and screen affected patients comprehensively. Similar patient presentation, treatment, and anatomical basis of nerve compression make either amenable to treatment by nerve surgeons, and treatment of both entities should be an integral part of a formal peripheral nerve surgery curriculum.
Representation of African American Patients in Social Media for Breast Reconstruction
Authors: Hassan Abbas M. , Chappell Ava G. , Ketheeswaran Suvethavarshini , Joshi Chitang , Boyd Riley M. , Wan Rou , Carabaño Miguel , Koko Deima , Perez Laura C. , Ellis Marco F. , Galiano Robert D. 
Published: November 2021

Background:
Social media use by plastic surgeons may contribute to the overall increase in breast reconstruction in the United States. However, recent data show a concerning decrease in breast reconstruction in African American women. The purpose of this study was to analyze the inclusion of African American women in social media posts for breast reconstruction, with the premise that this may be a possible contributing factor to decreasing rates of breast reconstruction in this population.

Methods:
Data from several social media platforms were obtained manually on December 1, 2019. Each image was analyzed using the Fitzpatrick scale as a guide.

Results:
A total of 2580 photographs were included that met the authors’ criteria. Only 172 photographs (6.7 percent) were nonwhite. This study surveyed 543 surgeons, 5 percent of whom were nonwhite. The analysis of the results from the random sample of the top plastic surgery social media influencers showed that only 22 (5 percent) of the photographs uploaded were nonwhite patients. Furthermore, 30 percent of surgeons did not have any photographs of nonwhite patients uploaded.

Conclusions:
Numerous factors can contribute to the disparity between the growing trend of white patients seeking reconstructive surgery compared to the decreasing trend of African American patients, one of which may be the disparity in their representation in social media, particularly among common platforms and social media influencers. This study highlights the evolving factors that may impair African American breast cancer patients’ access to safe, effective breast reconstruction, which must be identified and resolved.
Robotic Rectus Abdominis Muscle Flap following Robotic Extirpative Surgery
Authors: Asaad Malke , Pisters Louis L. , Klein Geraldine T. , Adelman David M. , Oates Scott D. , Butler Charles E. , Selber Jesse C. 
Published: November 2021

Summary:
Vascularized tissue for obliteration of large pelvic dead spaces created by extirpative surgery has been shown to reduce complication rates. As more extensive resections are performed robotically, plastic surgeons have been challenged to reconstruct the resulting defects using a minimally invasive approach. The goal of this study was to report the authors’ experience with robotic harvest of the rectus abdominis muscle for reconstruction of pelvic defects. The authors conducted a retrospective case series of patients who underwent robotic flap harvest following robotic extirpative surgery at their institution. Patient demographics, surgical characteristics, and postoperative outcomes were collected. These were compared to a retrospective cohort of patients who underwent open rectus abdominis muscle harvest. The authors identified seven male patients who underwent robotic flap harvest for pelvic reconstruction between 2013 and 2019. Their mean age was 66 ± 6 years and mean body mass index was 31 ± 5 kg/m2. Six patients (86 percent) had a history of radiation therapy and five patients (71 percent) received hormone therapy or chemotherapy. Surgical-site complications occurred in two patients. One patient developed ventral hernia. The donor-site complication rate was 19 percent (n = 18) in patients who underwent open rectus abdominis muscle harvest (n = 95). This study demonstrates the safety, efficacy, and reproducibility of robotic harvest of the rectus abdominis muscle in complex, multidisciplinary, minimally invasive pelvic surgery. The technique avoids violation of the anterior rectus sheath and wound complications related to open flap harvest, and early experience suggests reduced donor-site morbidity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Nasal Tip Shaping Finesse in Rhinoplasty
Authors: Savetsky Ira L. , Avashia Yash J. , Rohrich Rod J. 
Published: November 2021

Summary:
Anatomic subtleties of the nasal tip have a dramatic impact on the overall appearance of the nose. Mastery of normal nasal aesthetics and anatomy is a critical prerequisite to adeptly performing nasal tip refinement during open rhinoplasty. This article and series of videos aim to provide a focused review of nasal tip analysis, anatomy, and surgical technique, with particular emphasis on pertinent tip sutures and cartilage grafts.
Distinct Differences in Gastroesophageal Junction and Gastric Adenocarcinoma in 2194 Patients
Authors: Nakauchi Masaya , Vos Elvira L. , Carr Rebecca A. , Barbetta Arianna , Tang Laura H. , Gonen Mithat , Russo Ashley , Janjigian Yelena Y. , Yoon Sam S. , Sihag Smita , Rusch Valerie W. , Bains Manjit S. , Jones David R. , Coit Daniel G. , Molena Daniela , Strong Vivian E. 
Published: November 2021

Objective:
We sought to compare gastroesophageal junction (GEJ) cancer and gastric cancer (GC) and identify clinicopathological and oncological differences.

Summary Background Data:
GEJ cancer and GC are frequently studied together. Although the treatment approach for each often differs, clinico-pathological and oncological differences between the 2 have not been fully evaluated.

Methods:
We retrospectively identified patients with GEJ cancer or GC who underwent R0 resection at our center between January 2000 and December 2016. Clinicopathological characteristics, disease-specific survival (DSS), and site of first recurrence were compared.

Results:
In total, 2194 patients were analyzed: 1060 (48.3%) with GEJ cancer and 1134 (51.7%) with GC. Patients with GEJ cancer were younger (64 vs 66 years; P < 0.001), more often received neoadjuvant treatment (70.9% vs 30.2%; P < 0.001), and had lower pathological T and N status. Five-year DSS was 62.2% in patients with GEJ cancer and 74.6% in patients with GC (P < 0.001). After adjustment for clinicopathological factors, DSS remained worse in patients with GEJ cancer (hazard ratio, 1.78; 95% confidence interval, 1.40–2.26; P < 0.001). The cumulative incidence of recurrence was approximately 10% higher in patients with GEJ cancer (P < 0.001). The site of first recurrence was more likely to be hematogenous in patients with GEJ cancer (60.1% vs 31.4%; P < 0.001) and peritoneal in patients with GC (52.9% vs 12.5%; P < 0.001).

Conclusions:
GEJ adenocarcinoma is more aggressive, with a higher incidence of recurrence and worse DSS, compared with gastric adenocarcinoma. Distinct differences between GEJ cancer and GC, especially in patterns of recurrence, may affect evaluation of optimal treatment strategies.
Anticipating future SARS-CoV-2 variants of concern through ab initio quantum mechanical modeling
Authors: Zaccaria Marco , Genovese Luigi , Farzan Michael , Dawson William , Nakajima Takahito , Johnson Welkin , Momeni Babak 
Published: November 2021

AbstractEvolved SARS-CoV-2 variants are currently challenging the efficacy of first-generation vaccines, largely through the emergence of spike protein mutants. Among these variants, Delta is presently the most concerning. We employ an ab initio quantum mechanical model based on Density Functional Theory to characterize the spike protein Receptor Binding Domain (RBD) interaction with host cells and gain mechanistic insight into SARS-CoV-2 evolution. The approach is illustrated via a detailed investigation of the role of the E484K RBD mutation, a signature mutation of the Beta and Gamma variants. The simulation is employed to: predict the depleting effect of the E484K mutation on binding the RBD with select antibodies; identify residue E484 as a weak link in the original interaction with the human receptor hACE2; and describe SARS-CoV-2 Wuhan strand binding to the bat Rhinolophus macrotis ACE2 as more optimized than the human counterpart. Finally, we predict the hACE2 binding efficacy of a hypothetical E484K mutation added to the Delta variant RBD, identifying a potential future variant of concern. Results can be generalized to other mutations, and provide useful information to complement existing experimental datasets of the interaction between randomly generated libraries of hACE2 and viral spike mutants. We argue that ab initio modeling is at the point of being aptly employed to inform and predict events pertinent to viral and general evolution.
MTSviewer: a database to visualize mitochondrial targeting sequences, cleavage sites, and mutations on protein structures
Authors: Bayne Andrew N. , Dong Jing , Amiri Saeid , Farhan Sali M.K. , Trempe Jean-François 
Published: November 2021

AbstractSummaryMitochondrial dysfunction is implicated in a wide array of human diseases ranging from neurodegenerative disorders to cardiovascular defects. The coordinated localization and import of proteins into mitochondria are essential processes that ensure mitochondrial homeostasis and consequently cell survival. The localization and import of most mitochondrial proteins are driven by N-terminal mitochondrial targeting sequences (MTS’s), which interact with import machinery and are removed by the mitochondrial processing peptidase (MPP). The recent discovery of internal MTS’s - those which are distributed throughout a protein and act as import regulators or secondary MPP cleavage sites – has expanded the role of both MTS’s and MPP beyond conventional N-terminal regulatory pathways. Still, the global mutational landscape of MTS’s remains poorly characterized, both from genetic and structural perspectives. To this end, we have integrated a variety of tools into one harmonized R/Shiny database called MTSviewer (https://neurobioinfo.github.io/MTSvieweR/) which combines MTS predictions, cleavage sites, genetic variants, pathogenicity predictions, and N-terminomics data with structural visualization using AlphaFold models of human and yeast mitochondrial proteomes.Availability and ImplementationMTSviewer is freely available on the web athttps://neurobioinfo.github.io/MTSvieweR/.Source code is available athttps://github.com/neurobioinfo/MTSvieweR.Contacteanfrancois.trempe@mcgill.ca;sali.farhan@mcgill.ca