bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of stage I testicular cancer
Authors: Padayachee Jerusha , Clark Roderick , Warde Padraig , Hamilton Robert J. 
Published: November 2021

Purpose of review
Testicular cancer is the most common solid malignancy amongst young men, and a large proportion present with stage I disease. The options for management following radical orchiectomy are multifold. We review here approaches to treatment in this setting, providing an update on recent publications.

Recent findings
At Princess Margaret Cancer Centre, we maintain a nonrisk adapted active surveillance approach. With a dedicated surveillance program using low-dose computed tomography imaging, patients are appropriately identified early for treatment on relapse. There are ongoing investigations into minimizing toxicities of treatments for relapse, and in particular, retroperitoneal lymph node dissection (RPLND) presents an attractive alternative. This, though, remains investigational in the setting of seminoma.

Summary
Testicular cancer is a highly curable malignancy. In stage I disease, an active surveillance approach following radical orchiectomy is preferred, irrespective of risk-profile. This approach serves to limit the toxicity of adjuvant treatment in a significant proportion of patients, while maintaining excellent survival outcomes.
Gentamicin Susceptibility in Neisseria gonorrhoeae and Treatment Outcomes for Urogenital Gonorrhea After 25 Years of Sustained Gentamicin Use in Malawi
Authors: Matoga Mitch , Chen Jane S. , Krysiak Robert , Ndalama Beatrice , Massa Cecilia , Bonongwe Naomi , Mathiya Esther , Kamtambe Blessing , Jere Edward , Chikaonda Tarsizio , Golparian Daniel , Unemo Magnus , Cohen Myron S. , Hobbs Marcia M. , Hoffman Irving F. 
Published: November 2021

Background
Gentamicin has been used for the treatment of gonorrhea in Malawi since 1993. However, declining clinical cure rates have been suspected. We evaluated current Neisseria gonorrhoeae susceptibility to gentamicin in vitro and clinically.

Methods
Men with acute urethritis were recruited at the Bwaila District Hospital STI Clinic in Lilongwe, Malawi, between January 2017 and August 2019. All men provided urethral swabs for etiological testing at enrollment and test of cure (TOC), 1 week later, using Gram-stained microscopy and culture. We used Etest to determine minimum inhibitory concentrations (MICs) of gentamicin, azithromycin, cefixime, ceftriaxone, ciprofloxacin, and spectinomycin; disc diffusion for tetracycline susceptibility; and whole-genome sequencing (WGS) to verify/refute treatment failure.

Results
Among 183 N. gonorrhoeae culture-positive men enrolled, 151 (82.5%) had a swab taken for TOC. Of these 151 men, 16 (10.6%) had a positive culture at TOC. One hundred forty-one baseline isolates were tested for gentamicin susceptibility using Etest: 2 (1.4%), MIC = 2 μg/mL; 111 (78.7%), MIC = 4 μg/mL; and 28 (19.9%), MIC = 8 μg/mL. All isolates were susceptible to azithromycin, cefixime, ceftriaxone, and spectinomycin, whereas 63.1% had intermediate susceptibility or resistance to ciprofloxacin. Almost all (96.1%) isolates were resistant to tetracycline. All examined isolates cultured at TOC (n = 13) had gentamicin MICs ≤8 μg/mL. Ten men had pretreatment and posttreatment isolates examined by whole-genome sequencing; 2 (20%) were verified new infections (4119 and 1272 single-nucleotide polymorphisms), whereas 8 (80%) were confirmed treatment failures (0–1 single-nucleotide polymorphism).

Conclusions
Gentamicin MICs poorly predict gonorrhea treatment outcome with gentamicin, and treatment failures are verified with gonococcal strains with in vitro susceptibility to gentamicin. The first-line treatment of gonorrhea in Malawi should be reassessed.
Digital Scarlet Letters: Sexually Transmitted Infections in the Electronic Medical Record
Authors: Bennett Sarah , Newman-Griffis Denis R. , Beach Mary Catherine , Gross Marielle 
Published: November 2021

Abstract
The harms of implicit bias in clinical settings are acknowledged but poorly understood and difficult to overcome. We discuss how structural components of electronic medical record (EMR) user interfaces may contribute to sex and gender-based discrimination against patients via constant, duplicative presentation of stigmatizing sexually transmitted infection (STI) data irrespective of clinical significance. Via comparison with symbolism and representative quotes in Hawthorne's 1850 novel The Scarlet Letter, we propose a metaphor to examine how EMRs function as a platform for moral judgment, which may display an indelible “scarlet letter” for pregnant patients with STI history. We consider whether current depictions of STIs in EMRs are structurally unjust and may contribute to biased treatment by directing attention to violations of hegemonic sex/gender norms regarding sexual behavior and thus triggering moral judgments of maternal fitness. We conclude with recommendations for how to address these challenges to improve ethical stewardship of sensitive sexual/reproductive health data.
Partner Seeking and Sexual Behavior in the United States During the COVID-19 Pandemic, March 2020 to March 2021
Authors: Rushmore Julie , Copen Casey E. , Schneider John , Lamuda Phoebe S.M. , Taylor Bruce G. , Kirkcaldy Robert D. , Bernstein Kyle T. 
Published: November 2021

Abstract
We examined partner seeking and sexual behaviors among a representative sample of US adults (n = 1161) during the first year of the COVID-19 pandemic. Approximately 10% of survey respondents sought a new partner, with age and sexual identity being associated with partner seeking behavior. Approximately 7% of respondents had sex with a new partner, which marks a decrease as compared with a prepandemic estimate from 2015 to 2016 in which 16% of US adults reported having sex with a new partner during the past year. Among respondents who had in-person sex with a new partner during the first year of the pandemic, public health guidelines for in-person sexual activity were infrequently followed.
The Association Between Initial Serum Bicarbonate Levels and the Management of Dehydrated Children in the Emergency Department
Authors: Moustafa Moustafa , Sawaya Rasha D. , Lakissian Zavi , Sharara-Chami Rana 
Published: November 2021

Objectives
There is no consensus in the current literature on the relevance of serum bicarbonate levels, cutoff benchmarks and the management of dehydration; therefore, this study aims to explore whether an association can be established between initial serum bicarbonate levels and the subsequent management of children between the ages of 0 to 36 months presenting to the emergency department (ED) with dehydration.

Methods
The study is a single center, retrospective review of 335 charts of children between 0 and 36 months of age presenting to the ED of an urban academic tertiary hospital between June 2014 and June 2016 with a medical history suggestive of dehydration and documented serum bicarbonate levels during their visits.

Results
A total of 310 charts were analyzed. No significant difference was found between mean serum bicarbonate levels of admitted and discharged patients (18.82 mmol/L vs 18.75 mmol/L; P = 0.89). Children with serum bicarbonate levels below 15 mmol/L were significantly more likely to receive a fluid bolus (P = 0.00) in the ED but neither the length of stay in the ED (P = 0.07) nor in the hospital (P = 0.41) was affected. Bounce backs within 7 days of discharge were not associated with serum bicarbonate levels at first presentation, but rather with a shorter duration of diarrhea (P = 0.013).

Conclusions
Initial serum bicarbonate level of dehydrated children does not appear to be associated with the severity of dehydration, vomiting, diarrhea and the patients' management in the ED or the hospital. Initial serum bicarbonate is associated with the decision to administer fluid boluses and potential bounce back.
Variability in Point-of-Care Lung Ultrasound Findings in Pediatric COVID-19 Patients
Authors: Lee Thomas , Goldberg Bradley , Pade Kathryn , Uya Atim , Cohen Stephanie , Bergmann Kelly , Abulfaraj Maher , Lam Samuel H. F. , Elkhunovich Marsha 
Published: November 2021

Abstract
Point-of-care ultrasound (POCUS) has been described as a useful tool for identification of coronavirus disease 2019 (COVID-19) in adults and children. Although several case reports describe POCUS findings in children with COVID-19, to our knowledge, there have been no published multicenter case series describing the large heterogeneity in lung POCUS findings in pediatric COVID-19. This series includes 7 symptomatic patients with COVID-19 who had a lung POCUS performed at 6 institutions by pediatric emergency attendings and fellows. The findings were variable, ranging from no findings to the appearance of B-lines, pleural abnormalities, consolidations, and a pleural effusion. Further studies are needed to improve our understanding, characterization, and prognostic correlation of POCUS findings in this novel disease in children.
Effects of a modified passive socket system on short-term changes in residuum volume and comfort: A preliminary study in transtibial amputees
Authors: Atallah Huthaifa , Kenney Laurence , Howard David , Liu Anmin , Head John 
Published: November 2021

Background:
Changes in residuum volume are a common problem in lower-limb amputees during prosthesis usage, and can lead to poor suspension, impaired gait, and tissue damage. Residuum volume can be affected by the in-socket air pressure, which will influence fluid flow in and around the residuum. The use of “active” pumps to reduce air pressure has been shown to conserve the residuum volume, but these are expensive and unlikely to be widely available. An alternative, passive approach, based on Boyles' law, is to introduce a larger distal void volume at the end of the socket and hence reduce the change in pressure for a given change in volume.

Objectives:
To compare the performance across three test conditions (passive—conventional, with standard distal void; passive—with increased distal void; and active system) in terms of residuum volume changes and comfort.

Study design:
Repeated-measures experiment under three test conditions.

Methods:
Five transtibial amputee participants (three males and two females), aged between 27 and 67 years, and of mobility grade K2 or K3, were fitted with a bespoke test prosthesis that was adapted to include the three test conditions. Residuum volume was measured before and after walking under each test condition (presented in a random order). Comfort was also assessed after walking with each test condition.

Results:
The reduction in residuum volume, relative to the baseline volume, was higher for the conventional passive system (4.2% ± 2.8%) compared with the modified passive (1.4% ± 1.4%) and active (1.6% ± 1.1%) systems.

Conclusion:
The use of a passive suspension system with an increased distal void within the socket may help to stabilize the residuum volume during prosthesis usage.
3D-printed prostheses in developing countries: A systematic review
Authors: Abbady Hnady E.M.A. , Klinkenberg Edwin T.M. , de Moel Lisanne , Nicolai Noa , van der Stelt Merel , Verhulst Arico C. , Maal Thomas J.J. , Brouwers Lars 
Published: November 2021

Background:
According to the World Health Organization, only 5%–15% of people in lower-income countries have access to prostheses. This is largely due to low availability of materials and high costs of prostheses. 3D-printing techniques have become easily accessible and can offer functional patient-specific components at relatively low costs, reducing or bypassing the current manufacturing and postprocessing steps. However, it is not yet clear how 3D-printing can provide a sustainable solution to the low availability of limb prostheses for patients with amputations in lower-income countries.

Objective:
To evaluate 3D-printing for the production of limb prostheses in lower-income countries and lower–middle-income countries (LLMICs).

Study design:
Systematic Review.

Methods:
Literature searches, completed in April 2020, were performed in PubMed, Embase, Web of Science, and Cochrane Library. The search results were independently screened and reviewed by four reviewers. Only studies that examined interventions using prostheses in LLMICs for patients with limb amputations were selected for data extraction and synthesis. The web was also searched using Google for projects that did not publish in a scientific journal.

Results:
Eighteen studies were included. Results were reported regarding country of use, cost and weight, 3D-printing technology, satisfaction, and failure rate.

Conclusion:
Low material costs, aesthetic appearance, and the possibility of personalized fitting make 3D-printed prostheses a potential solution for patients with limb amputations in LLMICs. However, the lack of (homogeneous) data shows the need for more published (scientific) research to enable a broader availability of knowledge about 3D-printed prostheses for LLMICs.
Integrating a Transdiagnostic Psychological Intervention Into Routine HIV Care: A Mixed-Methods Evaluation of the Common Elements Treatment Approach in Mozambique
Authors: Fabian Katrin E. , Muanido Alberto , Cumbe Vasco F. J. , Mukunta Chombalelo , Manaca Nelia , Dorsey Shannon , Hammett Wilson H. , Wagenaar Bradley H. 
Published: November 2021

Introduction:
We integrated a transdiagnostic psychological intervention (Common Elements Treatment Approach [CETA]) into routine HIV care in Sofala, Mozambique. This task-shared program screens and treats newly diagnosed HIV+ patients with comorbid mental health symptoms.

Methods:
A mixed-methods evaluation included demographics, intake screening scores, mental health symptoms, and barriers/facilitators to implementation examined through interviews. Multilevel models were used to analyze factors associated with symptom improvement and loss to follow-up (LTFU).

Results:
From March 2019 to June 2020, 820 individuals were screened for CETA treatment; 382 (46.6%) showed clinically significant mental health symptoms and attended 1484 CETA sessions. Of CETA patients, 71.5% (n = 273/382) had general mental distress, 7.3% (n = 28) had alcohol abuse/dependence, 12.0% (n = 46) had suicidal ideation, and 3.7% (n = 14) had other violent ideation; 66.2% (n = 253) had experienced at least 1 traumatic event at intake. Mental health symptoms decreased by 74.1% (17.0 to 4.4) after 5 CETA sessions, and 37.4% of patients (n = 143) achieved a ≥50% symptom reduction from intake. LTFU was 29.1% (n = 111), but 59.5% of LTFU patients (n = 66) achieved a ≥50% symptom reduction before LTFU. Facilitators for CETA implementation included readiness for change given the unaddressed burden of mental illness. Barriers included complexity of the intervention and stigma.

Conclusions:
Approximately 45% of newly diagnosed HIV+ individuals in Mozambique have clinically significant mental health symptoms at diagnosis. Integrating CETA into routine HIV platforms has in-context feasibility. Future implementation studies can optimize strategies for patient retention and scale-up.
Human Trafficking in Rehabilitation: What Nurses Need to Know
Authors: Franklin Melissa I. , Koszalinski Rebecca S. 
Published: November 2021

Abstract
Violence and human trafficking are frequently paired and violate human rights. Human trafficking is a complex, global health issue. Trafficking survivors report seeking medical care for women’s services, physical abuse, mental health, and gastrointestinal issues while being held in captivity. However, the majority of healthcare providers are unaware or unprepared to intervene, thus missing the chance to identify victims during these encounters. Rehabilitation nurses are no exception. Trafficking victims may come in contact with rehabilitation nurses because of injuries or chronic diseases caused by trafficking abuse. This article shares human trafficking red flags, victims’ access to services, barriers to identification, and nursing interventions and implications.
Trends in Distal Esophageal and Gastroesophageal Junction Cancer Care
Authors: Kalff Marianne C. , van Berge Henegouwen Mark I. , Baas Peter C. , Bahadoer Renu R. , Belt Eric J. T. , Brattinga Baukje , Claassen Linda , Ćosović Admira , Crull David , Daams Freek , van Dalsen Annette D. , Dekker Jan Willem T. , van Det Marc J. , Drost Manon , van Duijvendijk Peter , Eshuis Wietse J. , van Esser Stijn , Gaspersz Marcia P. , Görgec Burak , Groenendijk Richard P. R. , Hartgrink Henk H. , van der Harst Erwin , Haveman Jan Willem , Heisterkamp Joos , van Hillegersberg Richard , Kelder Wendy , Kingma B. Feike , Koemans Willem J. , Kouwenhoven Ewout A. , Lagarde Sjoerd M. , Lecot Frederik , van der Linden Philip P. , Luyer Misha D. P. , Nieuwenhuijzen Grard A. P. , Olthof Pim B. , van der Peet Donald L. , Pierie Jean-Pierre E. N. , Pierik E. G. J. M. Robert , Plat Victor D. , Polat Fatih , Rosman Camiel , Ruurda Jelle P. , van Sandick Johanna W. , Scheer Rene , Slootmans Cettela A. M. , Sosef Meindert N. , Sosef Odin V. , de Steur Wobbe O. , Stockmann Hein B. A. C. , Stoop Fanny J. , Voeten Daan M. , Vugts Guusje , Vijgen Guy H. E. J. , Weeda Víola B. , Wiezer Marinus J. , van Oijen Martijn G. H. , Gisbertz Suzanne S. 
Published: November 2021

Objective:
This study evaluated the nationwide trends in care and accompanied postoperative outcomes for patients with distal esophageal and gastro-esophageal junction cancer.

Summary of Background Data:
The introduction of transthoracic esophagectomy, minimally invasive surgery, and neo-adjuvant chemo(radio)therapy changed care for patients with esophageal cancer.

Methods:
Patients after elective transthoracic and transhiatal esophagectomy for distal esophageal or gastroesophageal junction carcinoma in the Netherlands between 2007–2016 were included. The primary aim was to evaluate trends in both care and postoperative outcomes for the included patients. Additionally, postoperative outcomes after transthoracic and tran-shiatal esophagectomy were compared, stratified by time periods.

Results:
Among 4712 patients included, 74% had distal esophageal tumors and 87% had adenocarcinomas. Between 2007 and 2016, the proportion of transthoracic esophagectomy increased from 41% to 81%, and neo-adjuvant treatment and minimally invasive esophagectomy increased from 31% to 96%, and from 7% to 80%, respectively. Over this 10-year period, postoperative outcomes improved: postoperative morbidity decreased from 66.6% to 61.8% (P = 0.001), R0 resection rate increased from 90.0% to 96.5% (P <0.001), median lymph node harvest increased from 15 to 19 (P <0.001), and median survival increased from 35 to 41 months (P = 0.027).

Conclusion:
In this nationwide cohort, a transition towards more neo-adju-vant treatment, transthoracic esophagectomy and minimally invasive surgery was observed over a 10-year period, accompanied by decreased postoperative morbidity, improved surgical radicality and lymph node harvest, and improved survival.
Pelvic Organ Prolapse Takes Up Space in the Bedroom: A Mixed Method Exploration of the Circular Sexual Response Cycle in Women With Pelvic Organ Prolapse
Authors: Shah Fatima I. , Ramage Kaylee , Scime Natalie V. , Brennand Erin A. , Walker Lauren M. 
Published: November 2021

Objective
Pelvic organ prolapse (POP) is a multidimensional reproductive health issue, which negatively affects women’s sexual well-being. Using the circular sexual response cycle as a framework, we sought to evaluate women’s sexual experiences living with POP.

Methods
Measures of genital self-image, sexual distress, sexual satisfaction, and sexual function were administered before conducting semistructured interviews. Participants were 16 heterosexual partnered women seeking surgical and nonsurgical treatment for symptomatic POP.

Results
Standardized questionnaires indicated normal genital self-image, sexual satisfaction, and sexual function; however, sexual distress scores exceeded normal cutoffs. Eight themes emerged, including reasons for having sex, willingness to initiate and sexual receptivity, contextual factors, sexual stimuli, sexual arousal, responsive desire, outcomes, and spontaneous sexual desire. In contrast to quantitative findings, themes demonstrated sexual difficulty. Women with POP mainly engage in sex out of obligation and report reduced sexual initiation and receptiveness, as well as a negative impact on genital self-image. Pelvic organ prolapse was perceived to adversely affect subjective arousal, responsive desire, and spontaneous desire, despite intact physiological arousal. Difficulty experiencing subjective arousal was profound and seemed to be limited by preoccupation with POP. Sexual satisfaction and rewards were diminished after POP, including orgasmic capacity. Rewarding motivators to engage in sex were seldom discussed and often overshadowed by experiencing guilt and obligation related to sex.

Conclusions
The circular sexual response cycle largely fit participants’ experiences; however, POP inhibits subjective arousal, which prevents responsive desire for many. Patients may need better support to cope with preoccupation with POP, indicating that addressing the psychosocial symptoms of POP should be prioritized.
The unequal impact of interhospital transfers on emergency general surgery patients: Procedure risk and time to surgery matter
Authors: Coimbra Raul , Barrientos Robert , Allison-Aipa Timothy , Zakhary Bishoy , Firek Matthew 
Published: November 2021

BACKGROUND
The impact of interhospital transfer on outcomes of patients undergoing emergency general surgery (EGS) procedures is incompletely studied. We set out to determine if transfer before definitive surgical care leads to worse outcomes in EGS patients.

METHODS
Using the National Surgical Quality Improvement Project database (2013–2019), a retrospective cohort study was conducted including nine surgical procedures encompassing 80% of the burden of EGS diseases, performed on an urgent/emergent basis. The procedures were classified as low risk (open and laparoscopic appendectomy and laparoscopic cholecystectomy) and high risk (open cholecystectomy, laparoscopic and open colectomy, lysis of adhesions, perforated ulcer repair, small bowel resection, and exploratory laparotomy). Time to surgery was recorded in days. The impact of interhospital transfer on outcomes (mortality, major complications, 30-day reoperations, and 30-day readmissions) and length of stay, according to procedure risk and time to surgery, were analyzed by multivariate logistic regression and inverse probability treatment of the weighting with treatment effect in the treated.

RESULTS
A total of 329,613 patients were included in the study (284,783 direct admission and 44,830 transfers). Adjusted mortality (3.1% vs. 10.4%; adjusted odds ratio [AOR], 1.28; p < 0.001), major complications (6.7% vs. 18.9%; AOR, 1.39; p < 0.001), 30-day reoperations (3.1% vs. 6.4%; AOR, 1.22; p < 0.001), and length of stay (2 vs. 5) were higher in transferred patients. Transfer had no effect on 30-day readmissions (6% vs. 8.5%; AOR, 1.04; p = 0.063). These results were also observed in high-risk surgery patients and in the late surgery group. The results were further confirmed after robust propensity score weighting was performed.

CONCLUSION
We have demonstrated that delays to surgical intervention affect outcomes and that interhospital transfer of EGS patients for definitive surgical care has a negative impact on mortality, development of postoperative complications, and reoperations in patients undergoing high-risk EGS procedures. These findings may have important implications for regionalization of EGS care.

LEVEL OF EVIDENCE
Prognostic/epidemiological, level III.