bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends and Correlates of Age-Disparate Sexual Partnerships in the United States: The National Health and Nutrition Examination Surveys
Authors: White Jodie L. , Patel Eshan U. , Grabowski Mary Kate , Petersen Molly R. , Gaydos Charlotte A. , Quinn Thomas C. , Tobian Aaron A.R. 
Published: August 2021

Abstract
This national survey demonstrates age-disparate (≥5 years; AD-5) sexual partnerships remain common among males and females aged 20 to 29 years in the United States (2005–2016). Females reported more older AD-5 partners, and males reported more younger AD-5 partners. Having AD-5 partners was associated with greater lifetime and recent number of sexual partners.
Supraventricular Tachycardia as the Initial Presentation of New-Onset Lupus
Authors: Rayburn David , Gerke Steven 
Published: August 2021

Abstract
Systemic lupus erythematosus (SLE) is a chronic, autoimmune, multisystem disorder that can sometimes be life-threatening. The presentation varies widely given the wide range of clinical and serological manifestations coupled with the disease's ability to affect any organ. Prognosis depends on the organ systems involved, as well as the severity of the involvement. This case involves a 17-year-old with initial presentation of supraventricular tachycardia subsequently found to have pancreatitis, myocarditis, and nephritis secondary to a new diagnosis of SLE. Systemic lupus erythematosus can involve virtually any organ system, which leads to the variable nature of presentation, as was the case for our patient and his presentation being supraventricular tachycardia from underlying myocarditis secondary to SLE. Lupus myocarditis is rare, but when present often indicates severe systemic illness. The echocardiogram will often show global hypokinesis without evidence of coronary artery disease. This was the case with our patient. His echocardiogram demonstrated new-onset systolic left-sided heart failure due to nonischemic cardiomyopathy with an ejection fraction of 25%. Unfortunately for our patient, he had several poor prognostic factors on his initial presentation prior to any treatment being started, including renal disease, male, age (17 years), low socioeconomic status, African American race, and high disease activity. Systemic lupus erythematosus is the great mimicker and can present in a variety of ways. Given its ability to involve virtually any organ system, it is important to consider it on the differential diagnoses, especially in patients with a strong family history.
Review of Reported Adverse Events Occurring Among the Homeless Veteran Population in the Veterans Health Administration
Authors: Soncrant Christina , Mills Peter D. , Pendley Louis Robin P. , Gunnar William 
Published: August 2021

Background
United States veterans face an even greater risk of homelessness and associated medical conditions, mental health conditions, and fatal and nonfatal overdose as compared with nonveterans. Beginning 2009, the Department of Veterans Affairs developed a strategy and allocated considerable resources to address veteran homelessness and the medical conditions commonly associated with this condition.

Objective
This study aimed to examine the Veterans Health Administration National Center for Patient Safety database for patient safety events in the homeless veteran population to mitigate future risk and inform policy.

Methods
This was a retrospective, descriptive quality improvement study of reported patient safety events of homeless veterans enrolled in Veterans Health Administration care between January 2012 and August 2020. A validated codebook was used to capture individual patient characteristics, location and type of event, homeless status, and root causes of the events and proposed actions for prevention.

Results
Suicide attempt or death, elopement, delay in care, and unintentional opioid overdose were the most common adverse events reported for this population. Root causes include issues with policies, procedures, and care processes for managing and evaluating homeless patients for the risk of suicidal or overdose behaviors and discharge, poor interdisciplinary communication, and coordination of patient care. Actions included standardization of procedures for discharge, overdose and suicide risk, staff education, and purchasing new equipment.

Conclusions
Suicide and opioid overdose are the most serious reported health care–related adverse events in the unsheltered homeless veteran population. Failures to recognize homelessness status, communicate status, and coordinate available services are root causes of these events.
Modeling the Effects of HIV and Aging on Resting-State Networks Using Machine Learning
Authors: Luckett Patrick H. , Paul Robert H. , Hannon Kayla , Lee John J. , Shimony Joshua S. , Meeker Karin L. , Cooley Sarah A. , Boerwinkle Anna H. , Ances Beau M. 
Published: August 2021

Background:
The relationship between HIV infection, the functional organization of the brain, cognitive impairment, and aging remains poorly understood. Understanding disease progression over the life span is vital for the care of people living with HIV (PLWH).

Setting:
Virologically suppressed PLWH (n = 297) on combination antiretroviral therapy and 1509 HIV-uninfected healthy controls were evaluated. PLWH were further classified as cognitively normal (CN) or cognitively impaired (CI) based on neuropsychological testing.

Methods:
Feature selection identified resting-state networks (RSNs) that predicted HIV status and cognitive status within specific age bins (younger than 35 years, 35–55 years, and older than 55 years). Deep learning models generated voxelwise maps of RSNs to identify regional differences.

Results:
Salience (SAL) and parietal memory networks (PMNs) differentiated individuals by HIV status. When comparing controls with PLWH CN, the PMN and SAL had the strongest predictive strength across all ages. When comparing controls with PLWH CI, the SAL, PMN, and frontal parietal network (FPN) were the best predictors. When comparing PLWH CN with PLWH CI, the SAL, FPN, basal ganglia, and ventral attention were the strongest predictors. Only minor variability in predictive strength was observed with aging. Anatomically, differences in RSN topology occurred primarily in the dorsal and rostral lateral prefrontal cortex, cingulate, and caudate.

Conclusion:
Machine learning identified RSNs that classified individuals by HIV status and cognitive status. The PMN and SAL were sensitive for discriminating HIV status, with involvement of FPN occurring with cognitive impairment. Minor differences in RSN predictive strength were observed by age. These results suggest that specific RSNs are affected by HIV, aging, and HIV-associated cognitive impairment.
Appendiceal Neuroendocrine Tumor Detected by 18F-FDG PET/CT
Authors: Zhang Yu , Liu Huipan , Zhang Wei , Chen Yue 
Published: August 2021

Abstract
Appendiceal neuroendocrine tumor is very rare, and it is difficult to make a definite diagnosis before operation due to absence of specific clinical features. We report the 18F-FDG PET/CT findings in a patient with an appendiceal neuroendocrine tumor.
Simulathon 2020
Authors: Thyagarajan Sujatha , Ramachandra Geethanjali , Jamalpuri Vijayanand , Calhoun Aaron W. , Nadkarni Vinay , Deutsch Ellen S. ,   for the Pediatric Simulation Training and Research Society (PediSTARS)
Published: August 2021

Summary Statement
The disaster management cycle is an accepted model that encompasses preparation for and recovery from large-scale disasters. Over the past decade, India's Pediatric Simulation Training and Research Society has developed a national-scale simulation delivery platform, termed the Simulathon, with a period prevalence methodology that integrates with core aspects of this model. As an exemplar of the effectiveness of this approach, we describe the development, implementation, and outcomes of the 2020 Simulathon, conducted from April 20 to May 20 in response to the nascent COVID-19 pandemic disaster. We conclude by discussing how aspects of the COVID-19 Simulathon enabled us to address key aspects of the disaster management cycle, as well as challenges that we encountered. We present a roadmap by which other simulation programs in low- and middle-income countries could enact a similar process.
Manual Conservation of Supplemental Oxygen in Low-Resource Settings During the COVID-19 Pandemic
Authors: Lampotang Samsun , DeStephens Anthony , Zarour Ilana , Lizdas David , Gravenstein Nikolaus , Johnson William , Acar Yahya , Feldman Jeffrey M. 
Published: August 2021

Summary Statement
Using a simulated adult COVID-19 patient with hypoxemia, we investigated whether caregivers interrupting oxygen flow by manually occluding oxygen tubing with pliers during exhalation can conserve oxygen while maintaining oxygenation. Oxygen pinching reduced oxygen use by 51% to 64%, maintained simulated oxygen saturation between 88% and 90%, and increased simulated average alveolar partial pressure of oxygen from a room air baseline of approximately 131 to 294–424 mm Hg compared with 607 mm Hg with 10 liters per minute (LPM) continuous oxygen flow. Simulation provided a methodology to rapidly evaluate a technique that has begun to be used with COVID-19 patients in low-resource environments experiencing an acute oxygen shortage.
“Early” Reoperation to Treat Complications Following Laparoscopic Colorectal Surgery: The Sooner the Better
Authors: Rotholtz Nicolas A. , Angeramo Cristian A. , Laporte Mariano , Matzner Perfumo Mariana , Schlottmann Francisco , Bun Maximiliano E. 
Published: August 2021

Background:
Some postoperative complications after laparoscopic colorectal surgery (LCS) require reoperation to be treated. However, if the timing to perform this reoperation has some influence on outcome remains elusive. The aim of this study was to analyze if the timing to perform the reoperation has some influence in postoperative outcomes.

Methods:
A retrospective analysis of patients undergoing LCS and required a reoperation during the period 2000 to 2019 were included. The cohort was divided into 2 groups: early reoperation (ER): ≤48 hours or delayed reoperation (DR): ≥48 hours based on the interval between the suspicion of a complication and reoperation. Demographics, operative variables, and postoperative outcomes were compared between groups.

Results:
A total of 1843 LCS were performed, 68 (43%) were included in ER and 91 (57%) in DR. A computed tomography scan was less frequently performed in the ER (ER: 45% vs. DR: 70%; P=0.001). The rates of re-laparoscopy (ER: 86% vs. 73%; P=0.04) and negative findings in the reoperation (ER: 13% vs. DR: 1%, P=0.001) were higher in ER. There were no statistically significant differences in overall major morbidity (ER: 9% vs. DR: 21%; P=0.06) and mortality rate (ER: 4% vs. DR: 8.7%; P=0.28) between groups. The need of intensive care unit was significantly higher and the length of stay longer for patients in the DR group.

Conclusions:
Despite a greater risk of negative findings, ER within 48 hours after the suspicion of a complication after a LCS offers higher chances of using a laparoscopic approach and it could probably provide better postoperative outcomes.
The impact of prehospital time intervals on mortality in moderately and severely injured patients
Authors: Waalwijk Job F. , van der Sluijs Rogier , Lokerman Robin D. , Fiddelers Audrey A.A. , Hietbrink Falco , Leenen Luke P.H. , Poeze Martijn , van Heijl Mark ,   the Pre-hospital Trauma Triage Research Collaborative (PTTRC)
Published: August 2021

BACKGROUND
Modern trauma systems and emergency medical services aim to reduce prehospital time intervals to achieve optimal outcomes. However, current literature remains inconclusive on the relationship between time to definitive treatment and mortality. The aim of this study was to investigate the association between prehospital time and mortality.

METHODS
All moderately and severely injured trauma patients (i.e., patients with an Injury Severity Score of 9 or greater) who were transported from the scene of injury to a trauma center by ground ambulances of the participating emergency medical services between 2015 and 2017 were included. Exposures of interest were total prehospital time, on-scene time, and transport time. Outcomes were 24-hour and 30-day mortality. Generalized linear models including inverse probability weights for several potential confounders were constructed. A generalized additive model was constructed to enable visual inspection of the association.

RESULTS
We included 22,525 moderately and severely injured patients. Twenty-four-hour and 30-day mortality were 1.3% and 7.3%, respectively. On-scene time per minute was significantly associated with 24-hour (relative risk [RR], 1.029; 95% confidence interval, 1.018–1.040) and 30-day mortality (RR, 1.013; 1.008–1.017). We found that this association was also present in patients with severe injuries, traumatic brain injury, severe abdominal injury, and stab or gunshot wound. An on-scene time of 20 minutes or longer demonstrated a strong association with 24-hour (RR, 1.797; 1.406–2.296) and 30-day mortality (RR, 1.298; 1.180–1.428). Total prehospital (24-hour: RR, 0.998; 0.990–1.007; 30-day: RR, 1.000, 0.997–1.004) and transport (24-hour: RR, 0.996; 0.982–1.010; 30-day: RR, 0.995; 0.989–1.001) time were not associated with mortality.

CONCLUSION
A prolonged on-scene time is associated with mortality in moderately and severely injured patients, which suggests that a reduced on-scene time may be favorable for these patients. In addition, transport time was found not to be associated with mortality.

LEVEL OF EVIDENCE
Prognostic and Epidemiologic; level III.
Are rib fractures stable? An analysis of progressive rib fracture offset in the acute trauma setting
Authors: Head William , Kumar Neha , Thomas Christopher , Leon Stuart , Dieffenbaugher Sean , Eriksson Evert 
Published: August 2021

BACKGROUND
Rib fractures serve as both a marker of injury severity and a guide for clinical decision making for trauma patients. Although recent studies have suggested that rib fractures are dynamic, the degree of progressive offset remains unknown. The purpose of this study was to further characterize the change that takes place in the acute trauma setting.

METHODS
A 4-year (2016–2019) retrospective assessment of adult trauma patients with rib fracture(s) admitted to a level I trauma center was performed. Initial and follow-up computed tomography scans were analyzed to determine the magnitude of offset. Relevant clinical course variables were examined, and location of chest wall instability was examined using the difference of interquartile range of median change. Statistical Product and Services Solutions (Version 25, IBM Corp. Armonk, NY) was then used to generate a neural network—multilayer perceptron that highlighted independent variable importance.

RESULTS
Fifty-three patients met the inclusion criteria for severe injury. Clinical course variables that either trended or significantly predicted the occurrence of progressive offset were Abbreviated Injury Scale Thoracic Scores (3.1 ± 0.4 no progression vs. 3.4 ± 0.6 yes progression; p = 0.121), flail segment (14% no progression vs. 43% yes progression; p = 0.053), and number of ribs fractured (4 [2–8] no progression vs. 7 [5–9] yes progression; p = 0.023). The location of progressive offset largely corresponded to the posterolateral region as demonstrated by the differences of interquartile range of median change. The neural network demonstrated that ribs 4 to 6 (normalized importance [NI], 100%), the posterolateral region (NI, 87.9%), and multiple fractures per rib (NI, 66.6%) were valuable in predicting whether progressive offset occurred (receiver operating characteristic curve − area under the curve = 0.869).

CONCLUSION
Rib fractures are not stable, particularly for those patients with multiple fractures in the mid-to-upper ribs localized to the posterolateral region. These findings may identify both trauma patients with worse outcomes and help develop better management strategies for rib fractures.

LEVEL OF EVIDENCE
Prognostic and epidemiological, level III.
Pediatric craniocerebral gunshot injuries: A National Trauma Database study
Authors: Lannon Melissa M. , Duda Taylor , Martyniuk Amanda , Engels Paul T. , Sharma Sunjay V. 
Published: August 2021

BACKGROUND
We aimed to determine the outcomes and prognostic factors in pediatric craniocerebral gunshot injury (CGI) patients. Pediatric patients may have significantly different physiology, neuroplasticity, and clinical outcomes in CGI than adults. There is limited literature on this topic, mainly case reports and small case series.

METHODS
We queried the National Trauma Data Bank for all pediatric CGI between 2014 and 2017. Patients were identified using International Classification of Diseases, Ninth Revision, codes. Demographic, emergency department, and clinical data were analyzed. Subgroup analysis was attempted for groups with Glasgow Coma Scale (GCS) scores of 9 to 15 and ages 0 to 8 years.

RESULTS
In a 3-year period, there were 209 pediatric patients (aged 0–18 years) presenting to American hospitals with signs of life. The overall mortality rate was 53.11%. A linear relationship was demonstrated showing a mortality rate of 79% by initial GCS in GCS score of 3, 56% in GCS scores of 4 to 8, 22% in GCS scores of 9 to 12, and 5% in GCS scores of 13 to 15. The youngest patients, aged 0 to 8 years, had dramatically better initial GCS and subsequently lower mortality rates. Regression analysis showed mortality benefit in the total population for intracranial pressure monitoring (odds ratio, 0.267) and craniotomy (odds ratio, 0.232).

CONCLUSION
This study uses the National Trauma Data Bank to quantify the prevalence of pediatric intracranial gunshot wounds, with the goal to determine risk factors for prognosis in this patient population. Significant effects on mortality for invasive interventions including intracranial pressure monitoring and craniotomy for all patients suggest low threshold for use of these procedures if there is any clinical concern. The presence of a 79% mortality rate in patients with GCS score of 3 on presentation suggests that as long as there is not a declared neurologic death, intracranial pressure monitoring and treatment measures including craniotomy should be considered by the consulting clinician.

LEVEL OF EVIDENCE
Prognostic and epidemiological, level III.
EXCESS DEATHS FROM ALL CAUSES AND BY COVID-19 IN BRAZIL IN 2020
Authors: dos Santos Alcione Miranda , de Souza Bruno Feres , de Carvalho Carolina Abreu , Garcia Campos Marcos Adriano , Alves de Oliveira Bruno Luciano Carneiro , Diniz Eduardo Moraes , Freitas Carvalho Branco Maria dos Remédios , de Sousa Queiroz Rejane Christine , de Carvalho Vitória Abreu , Machado Araújo Waleska Regina , da Silva e Antônio Augusto Moura 
Published: August 2021

SUMMARYObjectiveTo estimate the 2020 all-cause and COVID-19 excess mortality according to sex, age, race/color, and state, and to compare mortality rates by selected causes with that of the five previous years in Brazil.MethodsData from the Mortality Information System were used. Expected deaths for 2020 were estimated from 2015 to 2019 data using a negative binomial log-linear model.ResultsExcess deaths in Brazil in 2020 amounted to 13.7%, and the ratio of excess deaths to COVID-19 deaths was 0.90. Reductions in deaths from cardiovascular diseases (CVD), respiratory diseases, and external causes, and an increase in ill-defined causes were all noted. Excess deaths were also found to be heterogeneous, being higher in the Northern, Center-Western, and Northeastern states. In some states, the number of COVID-19 deaths was lower than that of excess deaths, whereas the opposite occurred in others. Moreover, excess deaths were higher in men, in those aged 20 to 59, and in black, yellow, or indigenous individuals. Meanwhile, excess mortality was lower in women, individuals aged 80 years or older, and in whites. Additionally, deaths among those aged 0 to 19 were 7.2% lower than expected, with reduction in mortality from respiratory diseases and external causes. There was also a drop in mortality due to external causes in men and in those aged 20 to 39 years. Furthermore, reductions in deaths from CVD and neoplasms were noted in some states and groups.ConclusionThere is evidence of underreporting of COVID-19 deaths and of the possible impact of restrictive measures in the reduction of deaths from external causes and respiratory diseases. The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes.
Estimating data-driven COVID-19 mitigation strategies for safe university reopening
Authors: Yang Qihui , Gruenbacher Don M. , Scoglio Caterina M. 
Published: August 2021

AbstractAfter one pandemic year of remote or hybrid instructional modes, universities in the United States are now planning for an in-person fall semester in 2021. However, it is uncertain what the vaccination rate will look like after students, faculty, and staff return to campus. To help inform university-reopening policies, we collected survey data on social contact patterns and developed an agent-based model to simulate the spread of COVID-19 in university settings. In this paper, we aim to identify the immunity threshold that, if exceeded, would lead to a relatively safe on-campus experience for the university population. With relaxed non-pharmaceutical interventions, we estimated that immunity in at least 60% of the university population is needed for safe university reopening. Still, attention needs to be paid to extreme events that could lead to huge infection size spikes. At an immune level of 60%, continuing non-pharmaceutical interventions, such as wearing masks, could lead to an 89% reduction in the maximum cumulative infection, which reflects the possible non-negligible infection size from extreme events.
Treatment interruption is a risk factor for sickness presenteeism: a large-scale cross-sectional study during the COVID-19 pandemic
Authors: Okawara Makoto , Ishimaru Tomohiro , Tateishi Seiichiro , Hino Ayako , Tsuji Mayumi , Ogami Akira , Nagata Tomohisa , Matsuda Shinya , Fujino Yoshihisa ,   for the CORoNaWork project
Published: August 2021

AbstractObjectivesThis study examined the relationship between interruption to routine medical care during the coronavirus disease 2019 pandemic and sickness presenteeism among workers in Japan.MethodsA cross-sectional study using data obtained from an internet monitor questionnaire was conducted. Interruption to medical care was defined based on the response “I have not been able to go to the hospital or receive treatment as scheduled.” The fraction of sickness presenteeism days in the past 30 days was employed as the primary outcome. A fractional logit model was used for analysis to treat bounded data.ResultsOf the 27,036 participants, 17,526 (65%) were workers who did not require routine medical care, 8,451 (31%) were using medical care as scheduled, and 1,059 (4%) experienced interrupted medical care. The adjusted odds ratio (aOR) of sickness presenteeism was significantly higher among workers who experienced interrupted medical care (3.44; 95% confidence interval [CI]: 3.04–3.89) than those who did not require routine medical care. In terms of symptoms, the highest aOR was observed among workers with mental health symptoms (aOR: 5.59, 95%CI: 5.04–6.20).ConclusionsThis study suggests the importance of continuing necessary treatment during a pandemic to prevent presenteeism.