bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Nationwide Analysis of Cleft Palate Repair: Impact of Local Anesthesia on Operative Outcomes and Hospital Cost
Authors: Vu Giap H. , Humphries Laura S. , Zimmerman Carrie E. , Kalmar Christopher L. , Bartlett Scott P. , Swanson Jordan W. , Taylor Jesse A. 
Published: May 2021

Background:
This study investigates the associations between local anesthesia practice and perioperative complication, length of stay, and hospital cost for palatoplasty in the United States.

Methods:
Patients undergoing cleft palate repair between 2004 and 2015 were abstracted from the Pediatric Health Information System database. Perioperative complication, length of stay, and hospital cost were compared by local anesthesia status. Multiple logistic regressions controlled for patient demographics, comorbidities, and hospital characteristics.

Results:
Of 17,888 patients from 49 institutions who met selection criteria, 8631 (48 percent), 4447 (25 percent), and 2149 (12 percent) received epinephrine-containing lidocaine, epinephrine-containing bupivacaine, and bupivacaine or ropivacaine alone, respectively. The use of epinephrine-containing bupivacaine or bupivacaine or ropivacaine alone was associated with decreased perioperative complication [adjusted OR, 0.75 (95 percent CI, 0.61 to 0.91) and 0.63 (95 percent CI, 0.47 to 0.83); p = 0.004 and p = 0.001, respectively]. Only bupivacaine- or ropivacaine-alone recipients experienced a significantly reduced risk of prolonged length of stay on adjusted analysis [adjusted OR, 0.71 (95 percent CI, 0.55 to 0.90); p = 0.005]. Risk of increased cost was reduced in users of any local anesthetic (p < 0.001 for all).

Conclusions:
Epinephrine-containing bupivacaine or bupivacaine or ropivacaine alone was associated with reduced perioperative complication following palatoplasty, while only the latter predicted a decreased postoperative length of stay. Uses of epinephrine-containing lidocaine, epinephrine-containing bupivacaine, and bupivacaine or ropivacaine alone were all associated with decreased hospital costs. Future prospective studies are warranted to further delineate the role of local anesthesia in palatal surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Craniosynostosis Develops in Half of Infants Treated for Hydrocephalus with a Ventriculoperitoneal Shunt
Authors: Bryant Justin R. , Mantilla-Rivas Esperanza , Keating Robert F. , Rana Md Sohel , Manrique Monica , Oh Albert K. , Magge Suresh N. , Murnick Jonathan , Oluigbo Chima O. , Myseros John S. , Rogers Gary F. 
Published: May 2021

Background:
Craniosynostosis following placement of a ventriculoperitoneal shunt for hydrocephalus has been sporadically described. The purpose of this investigation was to determine the general risk of developing craniosynostosis in this patient population.

Methods:
The authors retrospectively reviewed records and radiographs of infants who underwent ventriculoperitoneal shunt placement for hydrocephalus from 2006 to 2012. Recorded variables included date of shunt placement, demographics, comorbidities, cause of hydrocephalus, shunt type, and number of shunt revisions. Axial computed tomographic images obtained before and immediately after shunt placement and 2 to 4 years after shunt placement were evaluated by a panel of clinicians for evidence of craniosynostosis. Patients with preshunt craniosynostosis, craniosynostosis syndromes, or poor-quality computed tomographic images were excluded. Data were analyzed using STATA Version 15.1 statistical software.

Results:
One hundred twenty-five patients (69 male and 56 female patients) were included. Average age at shunt placement was 2.3 ± 2.58 months. Sixty-one patients (48.8 percent) developed craniosynostosis at a median of 26 months after shunt placement. Of these, 28 patients fused one suture; the majority involved the sagittal suture (n = 25). Thirty-three patients fused multiple sutures; the most common were the coronal (n = 32) and the sagittal (n = 30) sutures. Multivariable logistic regression identified older age at shunt placement and more shunt revisions as independent predictors of craniosynostosis. Shunt valve type was not significant.

Conclusions:
Craniosynostosis developed in nearly half of infants who underwent ventriculoperitoneal shunt placement for hydrocephalus. The sagittal suture was most commonly involved. The effect of suture fusion on subsequent cranial growth, shunt failure, or the development of intracranial pressure is unclear.

CLINICAL QUESITON/LEVEL OF EVIDENCE:
Risk, III.
A Report of Gender Bias and Sexual Harassment in Current Plastic Surgery Training: A National Survey
Authors: Chen Wendy , Schilling Benjamin K. , Bourne Debra A. , Myers Sara , De La Cruz Carolyn 
Published: May 2021

Background:
Gender bias and sexual misconduct continue to pervade medicine. The authors hypothesize that gender bias and sexual misconduct disproportionately and negatively affect female plastic surgery trainees.

Methods:
A national survey of plastic surgery trainees (2018 to 2019) was conducted using previously validated sexual harassment surveys adapted for relevance to plastic surgery. Respondents were queried about experiences with workplace gender bias and harassment; personal and professional impact; and reporting practices. Analyses included chi-square, logistic regression, and analysis of variance. Significance was accepted for values of p < 0.05.

Results:
There were 236 responses (115 female respondents; 20.1 percent response rate). Most respondents were Caucasian (Asian/Pacific Islander, n = 34) residents (n = 123). The feeling of hindrance to career advancement was greater for women, by 10-fold (p < 0.001), and increased with age (p = 0.046). Women felt uncomfortable challenging attitudes regarding gender inequality (p < 0.001), regardless of training levels (p = 0.670) or race (p = 0.300). Gender bias diminished female trainees’ career goals/ambition (p < 0.001). Women were more likely to experience sexual harassment, in the form of jokes (p = 0.003) and comments about their body or sexuality (p = 0.014). Respondents reported the majority of perpetrators of harassment to be attending physicians (30 percent) and other trainees (37 percent). Most common reasons to not report incidents included “futility” (29 percent) and “fear” (20 percent). Women experienced at least three symptoms of depression/anxiety, significantly higher than men (p = 0.001).

Conclusions:
Gender bias and sexual misconduct negatively affect female trainees’ attitudes toward their career. Two-thirds of cases of sexual harassment originate from other physicians. Minority trainees are less prepared to address transgressions and more likely to experience sexual coercion. Trainees perceive a culture nonconducive to reporting. These findings can guide changes and discussions surrounding workplace culture in plastic surgery training.
Tips and Tricks in Gender-Affirming Mastectomy
Authors: Salibian Ara A. , Gonzalez Eduardo , Frey Jordan D. , Bluebond-Langner Rachel 
Published: May 2021

Summary:
Gender-affirming mastectomy has become a highly sought-after procedure for the treatment of gender dysphoria and has been shown to improve quality of life in transgender and gender-nonbinary individuals. Aesthetic outcomes after double-incision mastectomy can be influenced by several factors; however, certain operative variables can be controlled to obtain aesthetic and reproducible results. Chest wall contour is arguably the most critical component of these procedures and requires highlighting the definition of the pectoralis muscle. Planning incisions within the inferior and lateral borders of the pectoralis major rather than the inframammary fold, and ensuring removal of all breast tissue in the lateral and medial chest and the axillary tail, will help obtain an aesthetically pleasing chest wall shape while concealing scars. Finally, attention to nipple resizing and repositioning inferiorly and laterally relative to the borders of the pectoralis muscle are critical to an aesthetic outcome. The authors have found that appropriate preoperative planning to control these three factors—(1) contour, (2) nipple position, and (3) scars—and critical analysis and adjustment of on-table results will help achieve the goals of creating an aesthetic and gender-congruent chest.
BIA-ALCL and Textured Breast Implants: A Systematic Review of Evidence Supporting Surgical Risk Management Strategies
Authors: Nelson Jonas A. , McCarthy Colleen , Dabic Stefan , Polanco Thais , Chilov Marina , Mehrara Babak J. , Disa Joseph J. 
Published: May 2021

Background:
Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a significant public health concern for women with breast implants. The increase in incidence rates underscores the need for improved methods for risk reduction and risk management. The purpose of this study was to perform a systematic review to assess surgical risk reduction techniques and analyze communication/informed consent practices in patients with textured implants.

Methods:
A systematic review of the literature was conducted in PubMed (legacy), Embase (Embase.com), and Scopus with four search strategies including key terms centered around breast reconstruction and BIA-ALCL.

Results:
A total of 571 articles were identified, of which 276 were included in the final review after duplicates were removed. After review, no articles were determined to fit the inclusion criteria of demonstrating data-driven evidence of BIA-ALCL risk reduction through surgical measures, demonstrating a significant lack of data on risk reduction for BIA-ALCL.

Conclusions:
Risk management for BIA-ALCL is an evolving area requiring additional investigation. Although removal of textured devices in asymptomatic patients is not currently recommended by the Food and Drug Administration, variability in estimates of risk has led many patients to electively replace these implants in an effort to decrease their risk of developing BIA-ALCL. To date, however, there is no evidence supporting the concept that replacing textured implants with smooth implants reduces risk for this disease. This information should be used to aid in the informed consent process for patients presenting to discuss management of textured breast implants.
Elective Implant Removal and Replacement in Asymptomatic Aesthetic Patients with Textured Devices
Authors: Calobrace M. Bradley 
Published: May 2021

Summary:
The management of patients with breast implants requires secondary procedures through the life of the implant, sometimes in the early postoperative period and more commonly many years after the initial surgery. In performing revisional procedures, removal and replacement of the implants is often required for a variety of reasons. With growing concerns of implant safety, implant exchange or removal with or without a capsulectomy has been increasingly requested by patients. In particular, textured breast implants have been under increased scrutiny secondary to their association with breast implant–associated anaplastic large cell lymphoma. Unfortunately, to date, there are no data and very little guidance as to the appropriate management of patients currently with textured implants as well as patients with a history of having had textured implants placed in the past. The surgeon must not only consider the appropriate management of patients with uncomplicated, asymptomatic textured devices but also consider the appropriate management when faced with another indication for revisional surgery and the need determine the appropriate course of action. An algorithm for the management of the explantation patient in general will be introduced in this review with a focus on the rationale, planning, and management of patients with an uncomplicated, asymptomatic textured implants.
The Capsule Question: How Much Should Be Removed with Explantation of a Textured Device?
Authors: Nahabedian Maurice Y. 
Published: May 2021

Summary:
Current controversies surrounding breast implants are focused not only on the implant but also on the capsule. There has been tremendous discussion regarding how much of the capsule, if any, should be removed during explantation for benign conditions. The appearance of benign capsules is highly variable ranging from a thin membrane to densely fibrotic with calcifications. The options for capsulectomy include none, partial, complete, complete-intact, and en bloc. Some patients are requesting en bloc capsulectomy even in the absence of anaplastic large cell lymphoma; however, the scientific evidence only supports this for patients with capsular malignancies. The purpose of this article is to review the old and new evidence to answer the question regarding how much capsule should be removed during explantation for benign conditions.
Evaluation of gait outcomes for individuals with established unilateral transfemoral amputation following the provision of microprocessor controlled knees in the context of a clinical service
Authors: Carse Bruce , Scott Helen , Brady Laura , Colvin John 
Published: May 2021

Background:
Microprocessor controlled knees (MPKs) have been shown to improve gait outcomes for individuals with unilateral transfemoral amputation (TFA); however, previous studies have limitations, which may affect their applicability.

Objectives:
To compare gait outcomes between non-MPK and MPK conditions within a large and diverse cohort of established TFAs in the pragmatic context of an operational clinical service and to identify any demographic variables that correlate with changes in gait outcomes.

Study Design:
This is a retrospective cohort study.

Methods:
Full-body three-dimensional motion capture and a portable breath gas analyser were used to evaluate gait-specific outcomes both pre-MPK and 6 months post-MPK provisions in TFAs (n = 32). The primary outcome measure was gait profile score, along with the following secondary outcome measures: walking velocity, step length, step length symmetry ratio, step time symmetry ratio, vertical ground reaction force symmetry index, base of support, center of mass deviation, and oxygen cost of walking.

Results:
Data showed statistically significant improvement in gait profile score from 11.2° ± 2.2° to 10.1° ± 2.1° (p < 0.01) between non-MPK and MPK conditions. Other outcomes which showed significant improvement were walking velocity (p < 0.01), step length (p < 0.01), vertical ground reaction force symmetry index (p < 0.01), and center of mass deviation (p < 0.05).

Conclusions:
MPK provision offered significant gait improvements to this cohort of TFAs in an operational clinical setting. There still remains a large gap in gait outcomes between this cohort and those of healthy unimpaired adults. Improvements in socket design, prosthetic foot design, and physiotherapy intervention could further reduce this gap.
Use of Environmental Variables to Predict SARS-CoV-2 Spread in the U.S.
Authors: Haring R. Sterling , Trende Sean , Ramirez Christina M. 
Published: May 2021

AbstractBackgroundThe COVID-19 pandemic has challenged even the most robust public health systems world-wide, leaving state and local health departments, hospitals, and physicians with little guidance on planning and resource allocation. Efforts at predicting the virus’ spread have largely failed to capture the nuances presented by national and local geographic, environmental, and sociological variables.ObjectiveUsing county-level data from the United States, we sought to measure the extent to which these demographic, geographic, and environmental variables correlate with the spread of COVID-19.MethodsUsing demographic data from the US Census Bureau’s American Community Survey, weather station data from the National Oceanic and Atmospheric Administration (NOAA), and COVID-19 case data from the Center for Systems Science and Engineering at Johns Hopkins University and the New York State Department of Health, we employed Bayesian hierarchical modeling with zero-inflated Negative Binomial regression to calculate correlations between these variables, COVID-19 case count, and rate of viral spread. Key predictors were identified and measured during two periods of two weeks each: March and June of 2020. The resultant model was then employed to predict case counts and spread rate for early July 2020.ResultsWhile demographic and environmental factors explain viral spread well, our findings challenge earlier conclusions about how these factors related to viral progress. Using these factors alone, we were able to predict spread to within 1% in all but 8 counties (99.9%), and within 0.1% in all but 51 counties (98.4%). The model was subsequently able to predict early July viral spread to within 0.5% in 98% of counties. Contrary to earlier findings, temperature had variable effect; as Spring temperatures warmed, cases decreased, but Summer heat increased cases, likely reflecting movement of populations from indoors to outdoors and back in. States varied little in their case rate relative to the model, and much of the variation could be linked to known “superspreader” events.ConclusionWhile environmental and demographic variables can help predict COVID-19 spread rates, some relationships are variable in ways earlier research failed to identify.Role of Funding SourceThere was no funding supporting this work.
A Developmental Reduction of the Excitation:Inhibition Ratio in Association Cortex during Adolescence
Authors: Larsen Bart , Cui Zaixu , Adebimpe Azeez , Pines Adam , Alexander-Bloch Aaron , Bertolero Max , Calkins Monica E. , Gur Raquel E. , Gur Ruben C. , Mahadevan Arun S. , Moore Tyler M. , Roalf David R. , Seidlitz Jakob , Sydnor Valerie J. , Wolf Daniel H. , Satterthwaite Theodore D. 
Published: May 2021

AbstractAdolescence is hypothesized to be a critical period for the development of association cortex. A reduction of the excitation:inhibition (E:I) ratio is a hallmark of critical period development; however it has been unclear how to assess the development of the E:I ratio using non-invasive neuroimaging techniques. Here, we used pharmacological fMRI with a GABAergic benzodiazepine challenge to empirically generate a model of E:I ratio based on multivariate patterns of functional connectivity. In an independent sample of 879 youth (ages 8-22 years), this model predicted reductions in the E:I ratio during adolescence, which were specific to association cortex and related to psychopathology. These findings support hypothesized shifts in E:I balance of association cortices during a neurodevelopmental critical period in adolescence.TeaserInhibitory maturation of the association cortex reflects an adolescent critical period.
Density of Pied Crows Corvus albus in two of South Africa’s protected areas
Authors: Johnson Thomas F. , Murn Campbell 
Published: May 2021

AbstractIn recent decades, the pied crow Corvus albus population has grown in southern Africa, and this may have had impacts on other species. Conservationists and land managers may question the degree of threat posed by pied crows to other species, but a scarcity of ecological information on pied crows limits evidence-based decision-making. Using a distance density function we provide initial pied crow density estimates of 0.24 crows km-2 (0.12-0.5; 95% CI) and 0.18 crows km-2 (0.07-0.45; 95% CI) in two protected areas in the Northern Cape Province of South Africa. We infer that pied crow density is negatively associated with the normalised difference vegetation index (NVDI).
Reading-related brain changes in audiovisual processing: cross-sectional and longitudinal MEG evidence
Authors: Caffarra Sendy , Lizarazu Mikel , Molinaro Nicola , Carreiras Manuel 
Published: May 2021

AbstractThe ability to establish associations between visual objects and speech sounds is essential for human reading. Understanding the neural adjustments required for acquisition of these arbitrary audiovisual associations can shed light on fundamental reading mechanisms and help reveal how literacy builds on pre-existing brain circuits. To address these questions, the present longitudinal and cross-sectional MEG studies characterize the temporal and spatial neural correlates of audiovisual syllable congruency in children (4-9 years old, 22 males and 20 females) learning to read. Both studies showed that during the first years of reading instruction children gradually set up audiovisual correspondences between letters and speech sounds, which can be detected within the first 400 ms of a bimodal presentation and recruit the superior portions of the left temporal cortex. These findings suggest that children progressively change the way they treat audiovisual syllables as a function of their reading experience. This reading-specific brain plasticity implies (partial) recruitment of pre-existing brain circuits for audiovisual analysis.Significance StatementLinking visual and auditory linguistic representations is the basis for the development of efficient reading, while dysfunctional audiovisual letter processing predicts future reading disorders. Our developmental MEG project included a longitudinal and a cross-sectional study; both studies showed that children’s audiovisual brain circuits progressively change as a function of reading experience. They also revealed an exceptional degree of neuroplasticity in audiovisual neural networks, showing that as children develop literacy, the brain progressively adapts so as to better detect new correspondences between letters and speech sounds.
Short-term elevations in glucocorticoids do not alter telomere lengths: A systematic review and meta-analysis of non-primate vertebrate studies
Authors: Zane Lauren , Ensminger David C. , Vázquez-Medina José Pablo 
Published: May 2021

AbstractBackgroundThe neuroendocrine stress response allows vertebrates to cope with stressors via the activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis, which ultimately results in the secretion of glucocorticoids (CORT). Glucocorticoids have pleiotropic effects on behavior and physiology, and might influence telomere length dynamics. During a stress event, CORT mobilizes energy towards survival mechanisms rather than to telomere maintenance. Additionally, reactive oxidative species produced in response to increased CORT levels can damage telomeres, also leading to telomere shortening. In our systematic review and meta-analysis, we tested whether CORT levels impact telomere length and if this relationship differs among time frame, life history stage, or stressor type. We hypothesized that elevated CORT levels are linked to a decrease in telomere length.MethodsTo test this hypothesis, we conducted a literature search for studies investigating the relationship between telomere length and CORT levels in non-human vertebrates using four search engines: Web of Science, Google Scholar, Pubmed and Scopus, last searched on September 27th, 2020. This review identified 31 studies examining the relationship between CORT and telomere length. We pooled the data using Fisher’s Z for 15 of these studies. All quantitative studies underwent a risk of bias assessment. This systematic review study was registered in the Open Science Framework Registry (https://osf.io/rqve6).ResultsThe pooled effect size from fifteen studies and 1066 study organisms shows no relationship between CORT and telomere length ((Fisher’s Z= 0.1042, 95% CI = 0.0235; 0.1836). While these results support some previous findings, other studies have found a direct relationship between CORT and telomere dynamics, suggesting underlying mechanisms or concepts that are not currently taken into account in our analysis. The risk of bias assessment revealed an overall low risk of bias with occasional instances of bias from missing outcome data or bias in the reported result.ConclusionWe highlight the need for more targeted experiments to understand how conditions, such as experimental timeframes, stressor(s), and stressor magnitudes can drive a relationship between the neuroendocrine stress response and telomere length.