bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing Clinic First Guiding Actions Across 4 Family Medicine Residency Clinics
Authors: Adam Patricia , Hersch Derek , Peek C.J. 
Published: May 2021

Problem
Family medicine faculty and residents have observed that continuity clinic is often unsatisfying, attributed to a lack of patient and team continuity and erratic clinic schedules pieced together after the prioritization of hospital service and rotation schedules.

Approach
In 2019, a 3-year Clinic First project, called Clinic as Curriculum (CaC), was launched across the 4 family medicine residencies of the Department of Family Medicine and Community Health, University of Minnesota Medical School. The department began publishing quarterly CaC dashboard data. Each clinic completed a baseline assessment of their performance on the 13 Building Blocks of High-Performing Primary Care. Using their baseline data, each clinic identified which block or blocks, in addition to the blocks on continuity of care and resident scheduling, to focus on. The plan is to collaboratively implement the overall and local goals using dashboard data and iterative process improvement over 3 years.

Outcomes
At baseline, clinics functioned quite well with respect to the 13 building blocks, but CaC dashboard data varied across the 4 clinics, with large variation between clinics on how frequently faculty were scheduled in the clinic and the proportion of total clinic visits seen by faculty. Resident continuity rates were low (range, 38%–47%). Level loading (consistent physician availability to meet patient demand) rates ranged from 1 to 11 days a month. Regarding resident schedules, 2 programs are moving from 4-week to 2-week inpatient blocks, and 2 programs are exploring longitudinal scheduling. One clinic will assign faculty and residents to specific clinic days. Two clinics are implementing microteams of 1 faculty and 3–4 residents.

Next Steps
The authors plan to analyze the dashboard data longitudinally; explore microteams, team continuity, and team scheduling adherence; and develop and implement resident scheduling changes over the next 3 years.
Anterior Canal Reconstruction and Fusion for Myelopathy Caused by Degenerative Cervical Kyphosis and Stenosis With or Without Ossification of the Posterior Longitudinal Ligament
Authors: Yang Haisong , Sun Yuling , Wang Liang , Guo Qunfeng , Jiang Jingjing , Lu Xuhua 
Published: May 2021

Study Design:
This was a retrospective study.

Objective:
To introduce an anterior surgical technique for myelopathy caused by degenerative cervical kyphosis and stenosis (DCKS) with or without ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data:
The optimal approach in the treatment of DCKS remains a controversy because each anterior or posterior route surgery has advantages and disadvantages.

Materials and Methods:
In the period from June 2017 through June 2019, a consecutive cohort of adults diagnosed with DCKS underwent anterior canal reconstruction and fusion (ACRF). All patients underwent x-ray, computed tomography, and magnetic resonance imaging of the cervical spine. Radiologic assessment included kyphosis, canal area, canal reconstruction, OPLL, and spinal cord curvature and morphology. The Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological status. Surgery-related and implant-related complications were all recorded. Follow-up was carried out at 3, 6, 12, 24, and 36 months postoperation.

Results:
Fourty-one patients were included in the study, of which 19 presented with OPLL. Postoperatively, the canal area were significantly greater at last follow-up compared with preoperation (208.4 vs. 123.2 mm2; P=0.001). There was significant kyphosis correction (−17.6 vs. 8.5 degrees, P=0.001) at last follow-up. Ninety-six segmental canal reconstruction were performed, 89 (92.7%) reached bone fusion at both grooves with a mean time of 7.9 months. On sagittal magnetic resonance imaging, 33 (80.5%) patients presented with lordosis in the spinal cord curvature, 8 (19.5%) with straight. The mean JOA score at last follow-up was significantly better than preoperation (15.0 vs. 9.3 points; P<0.01). One patient presented with cerebrospinal fluid leakage, 1 with screw displacement and 2 with dysphagia.

Conclusion:
ACRF, receiving good correction of kyphosis, amplified canal area, solid instrumented fusion and circumferential decompression, is an effective and safe surgical technique for cervical myelopathy caused by DCKS with or without OPLL.

Level of Evidence:
Level III—a retrospective analysis.
The Effects of Surgery on Postural Instability in Patients With Cervical Compressive Myelopathy
Authors: Yano Toma , Fujishiro Takashi , Obo Takuya , Nakano Atsushi , Nakaya Yoshiharu , Hayama Sachio , Mori Katsunori , Baba Ichiro , Neo Masashi 
Published: May 2021

Study Design:
A retrospective study.

Objective:
To investigate the effects of surgery on the subjective perception of bodily unsteadiness and the objective measurements of postural instability in patients with cervical compressive myelopathy (CCM).

Summary of Background Data:
Several studies have demonstrated that CCM patients have impaired postural stability and investigated its surgical outcomes. However, these studies have only objectively measured postural stability by using a stabilometer or three-dimensional motion capture system. There have been no studies examining the subjective perception of postural instability in CCM patients.

Materials and Methods:
We retrospectively reviewed patients who underwent decompressive surgery for CCM. The Fall Efficacy Scale-International (FES-I) and a self-prepared questionnaire were used to evaluate subjective perception of bodily unsteadiness. To objectively assess postural instability, a stabilometric analysis was performed with the following parameters: sway area (SwA, cm2), sway velocity (SwV, cm/s), and sway density (SwD, /cm). The evaluations were performed preoperatively, during the early postoperative period (3–6 mo postoperatively), and at 1-year postoperatively in patients with CCM. The evaluation results were compared with age-matched, sex-matched, and body mass index-matched healthy subjects.

Results:
We included 70 CCM patients and 36 healthy subjects in this study. In both the FES-I and self-prepared questionnaire, CCM patients reported significantly milder postoperative bodily unsteadiness. The stabilometric parameters were significantly improved during the postoperative period when compared with preoperative values. Nevertheless, neither the self-reported outcome measures nor stabilometric parameters of CCM patients reached the levels of those in healthy controls in the postoperative period.

Conclusion:
This was the first study to examine CCM surgical outcomes in terms of both subjective perception and objective postural instability. While both objective postural stability and subjective perception improved following decompressive surgery, they did not reach the levels seen in healthy participants.

Level of Evidence:
Level III.
A Direct Estimate of the Impact of PM2.5, NO2, and O3 Exposure on Life Expectancy Using Propensity Scores
Authors: Schwartz Joel D. , Di Qian , Requia Weeberb J. , Dominici Francesca , Zanobetti Antonella 
Published: May 2021

Background:
Many studies have reported associations of air pollutants and death, but fewer examined multiple pollutants, or used causal methods. We present a method for directly estimating changes in the distribution of age at death using propensity scores.

Methods:
We included all participants in Medicare from 2000 to 2016 (637,207,589 person-years of follow-up). We fit separate logistic regressions modeling the probability of death at each year of age from 65 to 98 or older as a function of exposure to particulate matter less tha 2.5 µM in diameter (PM2.5), NO2, and O3, using separate propensity scores for each age. We estimated the propensity score using gradient boosting. We estimated the distribution of life expectancy at three counterfactual exposures for each pollutant.

Results:
The estimated increase in mean life expectancy had the population been exposed to 7 versus 12 µg/m3 PM2.5 was 0.29 years (95% CI = 0.28, 0.30). The change in life expectancy had the population been exposed to 10 versus 20 ppb of NO2 was −0.01 years (95% CI = −0.015, −0.006). The increase in mean life expectancy had the population been exposed to 35 versus 45 ppb of O3 was 0.15 years (95% CI = 0.14, 0.16). Each of these effects was independent and additive.

Conclusions:
We estimated that reducing PM2.5 and O3 concentrations to levels below current standards would increase life expectancy by substantial amounts compared with the recent increase of life expectancy at age 65 of 0.7 years in a decade. Our results are not consistent with the hypothesis that exposure to NO2 decreases life expectancy.
Leveraging Pathogen Sequence and Contact Tracing Data to Enhance Vaccine Trials in Emerging Epidemics
Authors: Kahn Rebecca , Wang Rui , Leavitt Sarah V. , Hanage William P. , Lipsitch Marc 
Published: May 2021

Introduction:
Advance planning of vaccine trials conducted during outbreaks increases our ability to rapidly define the efficacy and potential impact of a vaccine. Vaccine efficacy against infectiousness (VEI) is an important measure for understanding a vaccine’s full impact, yet it is currently not identifiable in many trial designs because it requires knowledge of infectors’ vaccination status. Recent advances in genomics have improved our ability to reconstruct transmission networks. We aim to assess if augmenting trials with pathogen sequence and contact tracing data can permit them to estimate VEI.

Methods:
We develop a transmission model with a vaccine trial in an outbreak setting, incorporate pathogen sequence data and contact tracing data, and assign probabilities to likely infectors. We then propose and evaluate the performance of an estimator of VEI.

Results:
We find that under perfect knowledge of infector-infectee pairs, we are able to accurately estimate VEI. Use of sequence data results in imperfect reconstruction of transmission networks, biasing estimates of VEI towards the null, with approaches using deep sequence data performing better than approaches using consensus sequence data. Inclusion of contact tracing data reduces the bias.

Conclusion:
Pathogen genomics enhance identifiability of VEI, but imperfect transmission network reconstruction biases estimate toward the null and limits our ability to detect VEI. Given the consistent direction of the bias, estimates obtained from trials using these methods will provide lower bounds on the true VEI. A combination of sequence and epidemiologic data results in the most accurate estimates, underscoring the importance of contact tracing.
Early-life Farm Exposure and Ovarian Reserve in a US Cohort of Women
Authors: Upson Kristen , Weinberg Clarice R. , Nichols Hazel B. , Dinse Gregg E. , D’Aloisio Aimee A. , Sandler Dale P. , Baird Donna D. 
Published: May 2021

Background:
In a previous exploratory study, we reported lower concentrations of the ovarian reserve biomarker anti-Müllerian hormone (AMH) in adulthood with prenatal farm exposure. We now examine this association as well as childhood farm exposure using enrollment data from the Sister Study, a large US cohort of women.

Methods:
We collected prenatal and childhood farm exposure data by questionnaire and telephone interview. However, serum AMH data were available only for a nested subset: premenopausal women ages 35–54 subsequently diagnosed with breast cancer (n = 418 cases) and their matched controls (n = 866). To avoid potential bias from restricting analyses to only premenopausal controls, we leveraged the available cohort data. We used data from both premenopausal cases and controls as well as postmenopausal women ages 35–54 (n = 3,526) (all presumed to have undetectable AMH concentrations) and applied weights to produce a sample representative of the cohort ages 35–54 (n = 17,799). The high proportion of undetectable AMH concentrations (41%) was addressed using reverse-scale Cox regression. An adjusted hazard ratio (HR) <1.0 indicates that exposed individuals had lower AMH concentrations than unexposed individuals.

Results:
Prenatal exposure to maternal residence or work on a farm was associated with lower AMH concentrations (HR 0.66; 95% confidence intervals [CI] = 0.48 to 0.90). Associations between childhood farm residence exposures and AMH were null or weak, except childhood contact with pesticide-treated livestock or buildings (HR 0.69; 95% CI = 0.40 to 1.2).

Conclusions:
Replication of the prenatal farm exposure and lower adult AMH association raises concern that aspects of prenatal farm exposure may result in reduced adult ovarian reserve.
Immediate Tendon Transfer with Nerve Repair in Low Combined Ulnar and Median Nerve Injury
Authors: Reyad Khaled A. , Behiri Ahmed M. , El Lamie Karim K. , Sayed Mohamed A. , Abd Elsabour Sabah Hala M. 
Published: May 2021

Background:
Combined median-ulnar nerve injury at the level of distal forearm (below the musculotendinous junction) causes a detrimental effect on hand functions, which have a great impact on patients’ hands as well as a financial burden. Many previous authors advocated early or immediate tendon transfer in solitary median or ulnar nerve injuries.

Methods:
This study included 20 patients with combined distal ulnar-median nerve injury, who were divided into 2 groups. Group I (control) included 10 patients who underwent primary (group fascicular) repair of both nerves only. Group II (study) included 10 patients underwent primary (group fascicular) repair with immediate tendon transfer simultaneously: opponenplasty using extensor indicies and adductoplasty extensor carpi radialis brevis with appropriate splinting, postoperative rehabilitation, and biofeedback facilities.

Results:
Twenty patients (age: 18–38 years) were affected. The response of median and ulnar nerves showed invariable results in both groups, whilst the hand grip, hand pinch, and opposition showed marked improvements in group II. Moreover, inter-phalangeal and metacarpophalangeal joints of thumb showed no deformities in group II in comparison with high level of deformities in group I, owing to early regain of thumb movements.

Conclusions:
Immediate (during neurorrhaphy) tendon transfer may offer additional merits over nerve repair only for distal combined ulnar and median injury, as it offers scarless field, no adhesion, and no joint edema, leading to very early return to normal hand functions with a consequent decrease of thumb deformities, better hand grip, and key pinch.
The High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults With HIV (HEALTH): A Research Protocol
Authors: Oliveira Vitor H. F. , Erlandson Kristine M. , Cook Paul F. , Jankowski Catherine , MaWhinney Samantha , Dirajlal-Fargo Sahera , Knaub Leslie , Hsiao Chao-Pin , Horvat Davey Christine , Webel Allison R. 
Published: May 2021

Abstract
The High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults With HIV (HEALTH), which incorporates an exercise and biobehavioral coaching intervention, has the following overall goals: (a) to determine whether high-intensity interval training (HIIT) mitigates physical function impairments, fatigue, and impairments in mitochondrial bioenergetics of older people living with HIV (PLWH) to a greater extent than continuous moderate exercise (CME); and (b) to determine whether a biobehavioral coaching and mobile health text messaging intervention after HIIT or CME can promote long-term adherence to physical activity. The HEALTH study is a randomized trial of 100 older PLWH (≥50 years of age) who self-report fatigue and have a sedentary lifestyle. Enrolled participants will be randomized to 16 weeks of supervised HIIT or CME training, followed by a 12-week maintenance phase, involving a mobile health coaching intervention. Outcomes of the HEALTH study will inform the development of scalable, effective exercise recommendations tailored to the unique needs of aging PLWH.
The national institutes of health's approach to address research gaps in pancreatitis, diabetes and early detection of pancreatic cancer
Authors: Serrano Jose , Rinaudo Jo Ann , Srivastava Sudhir , Ghosh Sharmistha , Unalp-Arida Aynur , Andersen Dana K. 
Published: May 2021

Purpose of review
Diseases of the pancreas are a broad spectrum of conditions resulting from metabolic, inflammatory, and neoplastic processes (pancreatitis, pancreatogenic diabetes, and pancreatic cancers). Pancreatic diseases cause significant morbidity, mortality, and cost.

Recent findings
Research progress in diseases of the exocrine pancreas (chronic pancreatitis [CP], pancreatogenic diabetes mellitus, and pancreatic cancer) has been hampered by the disorders’ heterogeneity, the limitations of previous small cross-sectional studies, the inability to safely obtain pancreatic tissue for study, and the lack of structured epidemiology tools, genetic testing, and biomarker development.

Summary
Given the increasing incidence and prevalence of CP and its complications, high mortality rate, and associated healthcare cost, the National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute funded the Consortium for the study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer (CPDPC) to identify research gaps and foster multidisciplinary collaborations to better diagnose, characterize and manage CP and its sequelae and to understand the diabetes/pancreatic cancer association.
The studies undertaken by the CPDPC are described in other articles in this journal's issue.
Techniques in bacterial strain typing: past, present, and future
Authors: Simar Shelby R. , Hanson Blake M. , Arias Cesar A. 
Published: May 2021

Purpose of review
The advancement of molecular techniques such as whole-genome sequencing (WGS) has revolutionized the field of bacterial strain typing, with important implications for epidemiological surveillance and outbreak investigations. This review summarizes state-of-the-art techniques in strain typing and examines barriers faced by clinical and public health laboratories in implementing these new methodologies.

Recent findings
WGS-based methodologies are on track to become the new ‘gold standards’ in bacterial strain typing, replacing traditional methods like pulsed-field gel electrophoresis and multilocus sequence typing. These new techniques have an improved ability to identify genetic relationships among organisms of interest. Further, advances in long-read sequencing approaches will likely provide a highly discriminatory tool to perform pangenome analyses and characterize relevant accessory genome elements, including mobile genetic elements carrying antibiotic resistance determinants in real time. Barriers to widespread integration of these approaches include a lack of standardized workflows and technical training.

Summary
Genomic bacterial strain typing has facilitated a paradigm shift in clinical and molecular epidemiology. The increased resolution that these new techniques provide, along with epidemiological data, will facilitate the rapid identification of transmission routes with high confidence, leading to timely and effective deployment of infection control and public health interventions in outbreak settings.
Needs Based Assessment of Trauma Systems 2, is it ready for primetime? A natural experiment testing its reliability
Authors: Ashley Dennis W. , Pracht Etienne E. , Tetzlaff-Bemiller Melissa J. , Medeiros Regina S. , Atkins Elizabeth V. ,   and the Georgia Research Institute for Trauma Study Group
Published: May 2021

INTRODUCTION
Needs Based Assessment of Trauma Systems 2 (NBATS-2) attempts to predict the impact on patient volume and travel time for patients when a new trauma center (TC) is added to the system. The purpose of this study was to examine NBATS-2 predictive accuracy regarding expected volume and travel times of trauma patients at a newly designated TC and nearby legacy TCs when compared with actual data.

METHODS
Needs Based Assessment of Trauma Systems predictive model for volume of trauma patients at the new TC was run based on 25th, 50th, and 75th percentiles of both state and National Trauma Data Bank (NTDB) patients per 100 TC beds. This was compared with the actual number of trauma patients from the State Discharge Data set before (2011–2012) and after (2016–2017) designation of the TC. Analysis was then augmented using the geographic information system (ArcGIS) spatial modeling to characterize median travel times for actual trauma patients, before and after designation of the TC.

RESULTS
Both state and NTDB 25th, 50th, and 75th percentiles resulted in significant overestimation of volume at the new TC in 2016. After another year of TC maturation (2017), overestimation decreased but was still present. The 25th percentile from state and NTDB data sets provided the most accurate predictions. For the legacy TCs, the model switched from under to overestimation as the state and NTDB percentiles increased. The geographic information system accurately showed patients traveling <40 minutes to a TC nearly doubled.

CONCLUSION
Needs Based Assessment of Trauma Systems 2 provides an excellent template for state strategic planning; however, it overestimates new TC volume and under/overestimates volumes for legacy TCs depending on the state and NTDB percentiles used. This study shows that population density of the county in which the new or legacy TC is located should be considered when choosing the appropriate state or NTDB percentile. The geographic information system appropriately showed a decrease in trauma patient travel times after TC designation.

LEVEL OF EVIDENCE
Care Management, level V.
Geographical and temporal distribution of SARS-CoV-2 globally: An attempt to correlate case fatality rate with the circulating dominant SARS-CoV-2 clades
Authors: Sarkar Rakesh , Chawla-Sarkar Mamta , Majumdar Swagata , Lo Mahadeb , Chattopadhyay Shiladitya 
Published: May 2021

AbstractUncontrolled high transmission is driving the continuous evolution of SARS-CoV-2, leading to the nonstop emergence of the new variants with varying sensitivity to the neutralizing antibodies and vaccines.Wehave analysed of 8,82,740 SARS-CoV-2 genome sequences, collected and sequenced during late December 2019 to 25 March 2021 from all across the world. The findings revealed differences in temporal and spatial distribution,and predominance of various clades/variants among six different continents.We found no clear association between the pathogenic potential of the various clades by comparing the case fatality rate (CFR) of 170 countries with the predominant SARS-CoV-2 clades in those countries, demonstrating the insignificance of the clade specific mutations on case fatality. Overall, relying on a large-scale dataset,this study illustratedthe time-basedevolution andprevalence of various clades/variantsamong different geographic regions.The study may help in designing continent specific vaccines in the future.