bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ninety-Day Readmission Rates in a Geriatric Hip Fracture Population, From a Bundled Care Payment Initiative Perspective
Authors: Bair Jeffrey M. , O'Mara Gardner Kristin , Tank Jason C. , Georgiadis Gregory M. , Redfern Roberta E. 
Published: October 2021

Objective:
To determine the incidence of hospital readmission in a geriatric hip fracture population within 90 days.

Methods:
Analysis of patients ≥60 years of age presenting with a fragility fracture of the hip from a prospective geriatric hip fracture program registry was performed. Demographics, diagnoses, treatments, complications, hospital events, and readmission for any cause within 30 and 90 days were collected. Readmission events were categorized as defined by Bundled Care Payment Initiative (BCPI)/Care for Joint Replacement payment model.

Results:
The population included 305 patients. All-cause readmission at 30 and 90 days was 11.5% and 19.7%, respectively. Surgical site infection or prosthesis failure accounted for 2.6% of 90 days readmissions. Application of the BCPI rules identified 44 of 60 readmitted patients (73.3%) with causes attributable to the surgical event: medical (0.7%), hospital (12.1%), and mechanical (2.6%). Death within 30 days was the largest contributor to hospital-related events.

Conclusions:
This study identified a 90-day readmission rate of nearly 20% in patients with geriatric fragility fractures. Application of the BCPI definitions currently used in the Care for Joint Replacement payment model will result in more readmissions being attributed to the index surgical event than classically considered. If bundled payment models remain the future, further investigation of this population's risk factors for readmission is needed in light of these findings.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Removal of Antibiotic Cement-Coated Interlocking Nails
Authors: Abalkhail Talal B , Elhessy Ahmed H , Conway Janet D. 
Published: October 2021

Objectives:
To report the outcomes of antibiotic cement-coated interlocking nail (ACCIN) removal, detail a removal technique that mitigates debonding of coating, and describe how to address occurrences intraoperatively.

Design:
Retrospective case series.

Setting:
Level II trauma center.

Patients:
Twenty-eight patients who underwent ACCIN removal between January 2014 and August 2019.

Intervention:
Removal of ACCINs that were coated using the silicone tubing method.

Main Outcome Measurements:
Successful removal of the nail with intact antibiotic coating.

Results:
A total of 42 ACCIN removals were included in this study. Successful ACCIN removal was achieved in 37 cases (88.1%), with debonding in only 5 cases (11.9%). Eight nails (19%) required 1 additional removal procedure, and 3 nails (7.1%) required 2 additional removal procedures. The main reasons for the additional procedures were nonunion and persistent infection.

Conclusions:
ACCIN insertion and removal can be challenging. The proper technique of coating and insertion can facilitate later removal. Removal of knee-long fusion rods can be more challenging.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Using Reformatted Axial Computed Tomography Images in Isolation Will Miss Narrow S1 Transsacral Screw Corridors
Authors: Hadeed Michael , Woods David , Koerner Jason , Strage Katya , Chu Xiangquan , Simon Violette , Mauffrey Cyril , Parry Joshua A. 
Published: October 2021

Objective:
To evaluate S1 transsacral (TS) corridors on reformatted and nonreformatted computed tomography (CT) images to determine which most reliably identifies narrow corridors.

Design:
Retrospective cohort.

Setting:
Level 1 trauma center.

Patients:
Two hundred forty-five patients with operative pelvic ring injuries.

Intervention:
CT scan review.

Main Outcome Measurements:
Preoperative CT scans were evaluated to determine the width of the S1 TS corridor on standard axial nonreformatted (ANR), axial reformatted (AR), and coronal reformatted images. Sensitivity and specificity of each format to detect a narrow corridor (<10 mm on AR or coronal reformatted) were calculated. Patients with S1 TS screws were evaluated to determine the rate of screw breach with narrow corridors.

Results:
The axial width of the S1 TS corridor was consistently smaller on ANR versus AR images (mean difference 1.4mm, 95% confidence interval 1.1–1.5). The corridor width on ANR images was on average 86% of the AR measurement. ANR images had the highest sensitivity and specificity (100% and 98%) for detecting S1 TS corridors <10 mm. Fifty-three S1 TS screws were placed in corridors ranging 10–23 mm on AR images and 7–19 mm on ANR images. Four (57%) of the 7 screws placed in corridors less than 10 mm in width on ANR images breached the sacral cortex.

Conclusion:
Using ANR images to measure the S1 TS corridor consistently measured smaller widths than AR images and identified all narrow corridors. A high rate of screw breach was noted with screw placement in narrow corridors.

Level of Evidence:
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Therapeutic Drug Monitoring of the Echinocandin Antifungal Agents: Is There a Role in Clinical Practice? A Position Statement of the Anti-Infective Drugs Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology
Authors: Kim Hannah Yejin , Baldelli Sara , Märtson Anne-Grete , Stocker Sophie , Alffenaar Jan-Willem , Cattaneo Dario , Marriott Deborah J.E. 
Published: October 2021

Purpose:
Reduced exposure to echinocandins has been reported in specific patient populations, such as critically ill patients; however, fixed dosing strategies are still used. The present review examines the accumulated evidence supporting echinocandin therapeutic drug monitoring (TDM) and summarizes available assays and sampling strategies.

Methods:
A literature search was conducted using PubMed in December 2020, with search terms such as echinocandins, anidulafungin, caspofungin, micafungin, or rezafungin with pharmacology, pharmacokinetics (PKs), pharmacodynamics (PDs), drug–drug interactions, TDM, resistance, drug susceptibility testing, toxicity, adverse drug reactions, bioanalysis, chromatography, and mass spectrometry. Data on PD/PD (PK/PD) outcome markers, drug resistance, PK variability, drug–drug interactions, assays, and TDM sampling strategies were summarized.

Results:
Echinocandins demonstrate drug exposure–efficacy relationships, and maximum concentration/minimal inhibitory concentration ratio (Cmax/MIC) and area under the concentration–time curve/MIC ratio (AUC/MIC) are proposed PK/PD markers for clinical response. The relationship between drug exposure and toxicity remains poorly clarified. TDM could be valuable in patients at risk of low drug exposure, such as those with critical illness and/or obesity. TDM of echinocandins may also be useful in patients with moderate liver impairment, drug–drug interactions, hypoalbuminemia, and those undergoing extracorporeal membrane oxygenation, as these conditions are associated with altered exposure to caspofungin and/or micafungin. Assays are available to measure anidulafungin, micafungin, and caspofungin concentrations. A limited-sampling strategy for anidulafungin has been reported.

Conclusions:
Echinocandin TDM should be considered in patients at known risk of suboptimal drug exposure. However, for implementing TDM, clinical validation of PK/PD targets is needed.
Piggyback Photochromic Contact Lens for Visual Rehabilitation and Photophobia Management in Traumatic Aniridia
Authors: Miyoshi Letícia H. , Hollaender Marianna A. , Giglio Veronica B. , Villela Flavio F. , Alves Milton R. 
Published: October 2021

Abstract:
We report herein a case of fitting with a photochromic silicone hydrogel contact lens under a rigid gas-permeable lens (piggyback system) for photophobia and low vision correction after traumatic aniridia and aphakia. A 40-year-old woman was referred to our practice for contact lens fitting in her right eye, which was left aphakic after an open globe injury. She also presented traumatic aniridia in the right eye, and her left eye had been previously eviscerated. A successful fitting was obtained with a photochromic silicone hydrogel (senofilcon A) contact lens, with a Dk/t of 121 × 10−9, under an aspheric design, +13.00 D rigid gas-permeable lens. The patient displayed visual acuity and contrast sensitivity improvement and reported decreased photophobia.
Occam's razor dulled: the occurrence of multiple genetic diagnoses
Authors: Linscott Kristin B. , Cassady Jennifer A. , Robin Nathaniel H. 
Published: October 2021

Purpose of review
A single genetic diagnosis, especially from the analysis of a limited number of genes, may not signal the end of a diagnostic odyssey. When a patient with a genetic syndrome presents with symptoms that are not usually associated with their disease phenotype, additional genetic testing is warranted.

Recent findings
Although multiple co-existing genetic diagnoses may sound unlikely, many recent studies and case reports have demonstrated that this scenario is more common than expected. Studies involving whole exome and genome sequencing have identified a frequency of multiple genetic diagnoses and have identified clinical findings that make a second diagnosis more likely, which we have seen reflected in recent cases from our own clinic and consult service. These include multisystem disease, consanguinity, well described aneuploidies with rare or new symptoms, and complex structural chromosomal anomalies which may include multiple chromosomes and breakpoints that disrupt gene function.

Summary
Identifying a second diagnosis can have vast implications for patient management and counseling. Patients can be followed with appropriate medical screening and early interventions to support optimal child development. Furthermore, the patient's family can be impacted by ending the diagnostic odyssey, providing testing for other at-risk family members, and offering prenatal options.
Uterus transplantation: the importance of uterine natural killer cells
Authors: Lucander Aaron C.K. , Porrett Paige M. 
Published: October 2021

Purpose of review
Murine studies have established that uterine natural killer (uNK) cells are critical regulators of normal placentation and fetal development in mammals. However, the biology of uNK cells in humans remains poorly understood. This ignorance represents a costly knowledge gap, as disordered placentation is thought to underpin a variety of pregnancy complications that impact maternal and neonatal health. In the context of uterus transplantation (UTx), uNK cells are anticipated to play a critical role within the allograft. Here, we review the current understanding of uNK cells in pregnancy biology and explore how this critically important cell population may contribute to pregnancy and graft outcomes in uterus transplant recipients.

Recent findings
Recent studies have characterized differences in NK cell populations between anatomic compartments in humans. In the endometrium, at least five phenotypically and functionally distinct subpopulations of uNK cells have been identified, with research into mechanisms regulating their differentiation and function currently underway.

Summary
Further elucidating uNK cell biology has the potential to influence the outcomes of pregnancy and UTx and benefit human health. UTx is a unique opportunity to study uNK cell biology and may shed light on mechanisms by which immunological tolerance is established at the maternal–fetal interface.
Women's Mental Health and Wellbeing in the Interconception Period
Authors: Leiferman Jenn A. , Jewell Jennifer S. , Huberty Jennifer L. , Lee-Winn Angela E. 
Published: October 2021

Abstract

Purpose:
Promoting women's health during the interconception period is critical for the health of future pregnancies.

Methods:
This was a cross-sectional study to better understand interconception mental health and wellbeing using a convenience sample of women recruited on social media who completed an online survey.

Results:
Women who participated in the survey (N = 146) were 1 to 4 years since last pregnancy, primarily non-Hispanic White (81.2%), with an average age of 30 years (SD = 5.0; range = 19-47 years); 20% were insured by Medicaid. Depression, anxiety, stress, social support, mindfulness, and resilience were assessed. Approximately 22.9% reported depressive symptomatology, 18.8% symptoms of anxiety, 6.5% high stress, and 52.9% moderate stress. These patterns differed across years after giving birth, with percentages peaking for depressive symptoms during the first to second year (χ2 = 9.81, p = 0.007), and anxiety symptoms peaking after the third year (χ2 = 7.28, p = 0.026). Women reported moderate scores on wellbeing measures, with resilience scores decreasing as years since last pregnancy increased (F = 3.24, p = 0.042). Less than 25% reported that a provider discussed depressed mood during the interconception period.

Clinical Implications:
Our findings revealed high prevalence and temporal patterns of depressive and anxiety symptoms during the interconception period, identifying a need for nurses to continue to follow-up with their patients about mental health concerns well after the traditionally defined 1 year postpartum. Further investigation of women's mental health and wellbeing and their unique needs during the interconception period is warranted.
Racial Disparities in Stillbirth Risk Factors among non-Hispanic Black Women and non-Hispanic White Women in the United States
Authors: Henry Carrie J. , Higgins Melinda , Carlson Nicole , Song Mi-Kyung 
Published: October 2021

Abstract

Introduction:
Historically, stillbirth risk factors are more prevalent among non-Hispanic Black women than non-Hispanic White women, including age < 20, lower formal educational attainment, prepregnancy obesity, smoking, hypertension, diabetes, short interpregnancy interval, small for gestational age newborn, late prenatal care, and previous cesarean birth. We examined whether these disparities have changed since 2011 and identified a group of risk factors that differed between Black women and White women when accounting for correlations among variables.

Methods:
In a random sample of 315 stillbirths from the National Center for Health Statistics' 2016 fetal death data, Black women and White women were compared for each risk factor using t-tests or chi-square tests. Variables with p ≤ .20 were analyzed using multivariate analysis of variance.

Results:
In this sample, Black women experiencing stillbirth were less likely to have a Bachelor's degree (12.94% vs. 28.49%, p = .04), and more likely to be obese (44.5% vs. 29.1%, p = .01) than White women. Multivariate analysis accounting for correlations among variables showed a group of risk factors that differed between Black women and White women: age < 20, lower education, prepregnancy obesity, hypertension (chronic and pregnancy-associated), nulliparity before stillbirth, and earlier gestation.

Clinical Implications:
Less formal education, obesity, age <20, hypertension, chronic and pregnancy-associated, nulliparity, and earlier gestation are important to consider in multilevel stillbirth prevention interventions to decrease racial disparity in stillbirth. Respectfully listening to women and taking their concerns seriously is one way nurses and other health care providers can promote equity in health outcomes for childbearing women.
Lack of Trust, Insufficient knowledge and Risk denial; an in-depth Understanding of Health workers Barriers to uptake of the Covid-19 vaccine at Iganga Hospital Eastern Uganda, and Mengo Hospital Kampala Uganda
Authors: Muhamadi Lubega , Edith Namulema , James Waako , Tumwesigye Nazarius Mbona , Museene Safinah Kisu , Mukakaarisa Hellen , Peterson Stefan Swartling , Ekström Anna Mia 
Published: October 2021

AbstractCovid 19 Vaccine hesitancy among health workers remains a major hindrance to the governments vaccine roll out plan among health workers and other target populations in Uganda.We conducted 12 focus group discussions and 20 in-depth interviews with health workers (vaccinated and unvaccinated) to understand barriers to vaccine acceptance in their own perspective and context in central and eastern Uganda. Reported barriers to vaccine acceptance included: gross lack of trust, fear of side effects, risk denial and insufficient information about the vaccine amidst negative publicity about the vaccine from the internet and social media platforms. Others were health system inhibition factors and religious beliefs against the vaccine.We recommend a health work context specific information, education and dissemination strategy to create awareness, information and more knowledge about the vaccine to health workers.We also recommend a sustained government media campaign to give more information about the vaccine and also dispel the negative publicity and misinformation about the vaccine.Dialogue with health workers at all levels of care, positive peer influence, use of religious and opinion leaders as well as government ensuring accessibly to various Covid 19 vaccines and putting vaccine posts outside hospital settings to limit exposure to Covid patients could also increase uptake of the vaccine among health workers.
A deep learning based graph-transformer for whole slide image classification
Authors: Zheng Yi , Gindra Rushin , Betke Margrit , Beane Jennifer E. , Kolachalama Vijaya B. 
Published: October 2021

AbstractDeep learning is a powerful tool for assessing pathology data obtained from digitized biopsy slides. In the context of supervised learning, most methods typically divide a whole slide image (WSI) into patches, aggregate convolutional neural network outcomes on them and estimate overall disease grade. However, patch-based methods introduce label noise in training by assuming that each patch is independent with the same label as the WSI and neglect the important contextual information that is significant in disease grading. Here we present a Graph-Transformer (GT) based framework for processing pathology data, called GTP, that interprets morphological and spatial information at the WSI-level to predict disease grade. To demonstrate the applicability of our approach, we selected 3,024 hematoxylin and eosin WSIs of lung tumors and with normal histology from the Clinical Proteomic Tumor Analysis Consortium, the National Lung Screening Trial, and The Cancer Genome Atlas, and used GTP to distinguish adenocarcinoma (LUAD) and squamous cell carcinoma (LSCC) from those that have normal histology. Our model achieved consistently high performance on binary (tumor versus normal: mean overall accuracy = 0.975 ± 0.013) as well as three-label (normal versus LUAD versus LSCC: mean accuracy = 0.932 ± 0.019) classification on held-out test data, underscoring the power of GT-based deep learning for WSI-level classification. We also introduced a graphbased saliency mapping technique, called GraphCAM, that captures regional as well as contextual information and allows our model to highlight WSI regions that are highly associated with the class label. Taken together, our findings demonstrate GTP as a novel interpretable and effective deep learning framework for WSI-level classification.
Assessment of knowledge about human papillomavirus vaccination among primary school girls in Arba Minch town, South Ethiopia, 2020. An institution-based cross-sectional study
Authors: Ukumo Eshetu Yisihak , Gebremeskel Feleke , Abebe Samuel , Minanmo Desta Markos , Ukke Gebresilasea Gendisha 
Published: October 2021

AbstractIntroductionCervical cancer is the second leading cause of cancer-related mortality among females in Ethiopia. The knowledge regarding human papillomavirus vaccination and its acceptability among adolescent girls affects the human papillomavirus vaccine uptake, however, the status of knowledge of the human papillomavirus vaccination among adolescent girls in Ethiopia, particularly in this study area is not well known. Therefore, this study aimed to determine the knowledge of human papillomavirus vaccination and associated factors among primary school girls in Arba Minch town, South Ethiopia, 2020.MethodsA school-based cross-sectional study in which 516 school girls participated was conducted on January 24, 2020. The study participants were selected by a simple random sampling technique. A pre-tested and self-administered questionnaire was used to collect the data. Data was entered to Epi_data version 4.6 and exported to SPSS Version 23 for analysis. The logistic regression model was used to identify the statistically significant variables for knowledge of the human papillomavirus vaccination.ResultsThe overall knowledge level of the study participants in this study was 71.7%. Their main information source was social media 41.74% followed by health care workers 29.69%.ConclusionsNearly three-fourths of the study participants were knowledgeable about human papillomavirus vaccination. The knowledge about the human papillomavirus vaccination shows a positive association with age, education level, and access to information sources, and parents’ educational status.
Public Perception of COVID-19 Vaccines on Twitter in the United States
Authors: Xie Zidian , Wang Xueting , Jiang Yan , Chen Yuhan , Huang Shengyuan , Ma Haoxuan , Anand Ajay , Li Dongmei 
Published: October 2021

AbstractBackgroundCOVID-19 vaccines play a vital role in combating the COVID-19 pandemic. Social media provides a rich data source to study public perception of COVID-19 vaccines.ObjectiveIn this study, we aimed to examine public perception and discussion of COVID-19 vaccines on Twitter in the US, as well as geographic and demographic characteristics of Twitter users who discussed about COVID-19 vaccines.MethodsThrough Twitter streaming Application Programming Interface (API), COVID-19-related tweets were collected from March 5th, 2020 to January 25th, 2021 using relevant keywords (such as “corona”, “covid19”, and “covid”). Based on geolocation information provided in tweets and vaccine-related keywords (such as “vaccine” and “vaccination”), we identified COVID-19 vaccine-related tweets from the US. Topic modeling and sentiment analysis were performed to examine public perception and discussion of COVID-19 vaccines. Demographic inference using computer vision algorithm (DeepFace) was performed to infer the demographic characteristics (age, gender and race/ethnicity) of Twitter users who tweeted about COVID-19 vaccines.ResultsOur longitudinal analysis showed that the discussion of COVID-19 vaccines on Twitter in the US reached a peak at the end of 2020. Average sentiment score for COVID-19 vaccine-related tweets remained relatively stable during our study period except for two big peaks, the positive peak corresponds to the optimism about the development of COVID-19 vaccines and the negative peak corresponds to worrying about the availability of COVID-19 vaccines. COVID-19 vaccine-related tweets from east coast states showed relatively high sentiment score. Twitter users from east, west and southern states of the US, as well as male users and users in age group 30-49 years, were more likely to discuss about COVID-19 vaccines on Twitter.ConclusionsPublic discussion and perception of COVID-19 vaccines on Twitter were influenced by the vaccine development and the pandemic, which varied depending on the geographics and demographics of Twitter users.