bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of Complex Interventions
Authors: Gesell Sabina B. , Prvu Bettger Janet , Lawrence Raymona H. , Li Jing , Hoffman Jeanne , Lutz Barbara J. , Grudzen Corita , Johnson Anna M. , Krishnan Jerry A. , Hsu Lewis L. , Zwart Dorien , Williams Mark V. , Schnipper Jeffrey L. 
Published: July 2021

Background:
Despite the well-documented risks to patient safety associated with transitions from one care setting to another, health care organizations struggle to identify which interventions to implement. Multiple strategies are often needed, and studying the effectiveness of these complex interventions is challenging.

Objective:
The objective of this study was to present lessons learned in implementing and evaluating complex transitional care interventions in routine clinical care.

Research Design:
Nine transitional care study teams share important common lessons in designing complex interventions with stakeholder engagement, implementation, and evaluation under pragmatic conditions (ie, using only existing resources), and disseminating findings in outlets that reach policy makers and the people who could ultimately benefit from the research.

Results:
Lessons learned serve as a guide for future studies in 3 areas: (1) Delineating the function (intended purpose) versus form (prespecified modes of delivery of the intervention); (2) Evaluating both the processes supporting implementation and the impact of adaptations; and (3) Engaging stakeholders in the design and delivery of the intervention and dissemination of study results.

Conclusion:
These lessons can help guide future pragmatic studies of care transitions.
Protein S: function, regulation, and clinical perspectives
Authors: Majumder Rinku , Nguyen Tina 
Published: July 2021

Purpose of review
Protein S (PS) is an essential natural anticoagulant. PS deficiency is a major contributor to acquired hypercoagulability. Acquired hypercoagulability causes myocardial infarction, stroke, and deep vein thrombosis in millions of individuals. Yet, despite its importance in hemostasis, PS is the least understood anticoagulant. Even after 40 years since PS was first described, we are still uncovering information about how PS functions. The purpose of this review is to highlight recent findings that advance our understanding of the functions of PS and explain hypercoagulability caused by severe PS deficiency.

Recent findings
PS has long been described as a cofactor for Activated Protein C (APC) and Tissue Factor Pathway Inhibitor (TFPI). However, a recent report describes direct inhibition of Factor IXa (FIXa) by PS, an activity of PS that had been completely overlooked. Thrombophilia is becoming a more frequently reported disorder. Hereditary PS deficiency is an anticoagulant deficiency that results eventually in thrombophilia. In addition, PS deficiency is a predisposing factor for venous thromboembolism (VTE), but an effect of PS deficiency in arterial thrombosis, such as arterial ischemic stroke, is uncertain. Plasma PS concentration decreases in pregnant women. Inherited thrombophilias are important etiologies for recurrent pregnancy loss, and anticoagulation therapy is of benefit to women with recurrent pregnancy loss who had documented only PS deficiency.
Hypoxia is a risk factor for VTE, and hypoxia downregulates plasma PS level. Importantly, COVID-19 can lead to hypoxemia because of lung damage from IL6-driven inflammatory responses to the viral infection. Because hypoxia decreases the abundance of the key anticoagulant PS, we surmise that the IL6-induced cytokine explosion combined with hypoxemia causes a drop in PS level that exacerbates the thrombotic risk in COVID-19 patients.

Summary
This review is intended to advance understanding of the anticoagulant function of an important plasma protein, PS. Despite 40+ years of research, we have not had a complete description of PS biology as it pertains to control of blood coagulation. However, the picture of PS function has become sharper with the recent discovery of FIXa inhibition by PS. Hemostasis mediated by PS now includes regulation of FIXa activity alongside the cofactor activities of PS in the TFPI/APC pathways. In addition, the direct inhibition of FIXa by PS suggests that PS, particularly a small derivative of PS, could be used to treat individuals with PS deficiencies or abnormalities that cause thrombotic complications.
Equity in kidney transplant allocation – North American perspective
Authors: Yilma Mignote , Hirose Ryutaro 
Published: July 2021

Purpose of review
Seven years have passed since the implementation of the kidney allocation policy by the Organ Procurement and Transplantation Network in the United States, the purpose of this article is to review the impact of these policy changes in addressing disparity and inequities in access to transplantation as well as to assess future directions needed in achieving equity in kidney transplantation.

Recent findings
The 2014 kidney allocation system policy aimed to improve access to transplantation through various approaches by reducing organ/recipient longevity mismatches, prioritizing highly sensitized patients, and backdating waitlist time to start of dialysis. The policy however did not improve utilization of high-kidney donor profile index kidneys or decrease kidney discard rate.

Summary
Although the supply-to-demand gap for waitlisted patients has decreased there are several areas that need further investigation, including geographic disparity, barriers in referral for transplantation, evaluating the impact of transplant education, and transplant center waitlist practices on inequities that exist in the prewaitlist stage that impact access to transplantation.
Effect of Child Position on Pain Experience During Lumbar Puncture: A Prospective Pilot Study
Authors: Chavanes Philippine , Benadiba Joy , Caci Hervé , Poirée Marilyne 
Published: July 2021

Background:
This study aimed to evaluate the impact of patient’s position on pain and anxiety during lumbar puncture (LP).

Materials and Methods:
A randomized controlled trial included children between 2 and 18 years old receiving at least 2 therapeutic LPs. They were randomly assigned to undergo lateral decubitus position or sitting position LP. Primary outcome was the maximum LP-induced pain, secondary endpoint the maximum LP-induced anxiety score.

Results:
Twenty-eight patients were randomized. For patients under 6 years old, mean of Face, Leg, Activity, Cry, and Consolability were 2.8/10±3.0 (median=1) at first time and 1.5±1.7 (median=1) at second time. For patients 6 to 18 years old, mean of visual analog scale were 2.2±2.2 (median=1.5) at first time and 3.2±2.8 (median=3) at second time. There was no significant differences according to position on anxiety among children.

Conclusions:
Results did not demonstrate whether lateral decubitus position could generate less pain and anxiety than sitting position.
Toilet Injuries Presenting to Emergency Departments, 2000–2019
Authors: Yingst Bradley , Reeves Patrick T. , Krishnamurthy Jayasree , Pasman Eric A. , Nylund Cade M. 
Published: July 2021

Objective
Toilet training is a major developmental milestone. Unsupervised periods combined with immature gross and fine motor skills may lead to toddler injuries during toilet training. Our aim was to investigate toilet-related injuries (TIs) in children.

Methods
Data from the National Electronic Injury Surveillance System were used to evaluate emergency department encounters of children ages 0 to 6 years with TI from 2000 to 2019.

Results
There were an estimated 142,606 children (95% confidence interval, 115,599–168,613) who presented to the emergency department for TI. Toilets were involved in 95% of injuries, and other potty chairs (PCs) involved 5% of injuries. Children had higher odds of sustaining head injury while using a toilet versus PC (adjusted odds ratio = 1.91; 95% CI, 1.06–3.45).

Conclusions
Toilet-related injuries present a high burden of risk to young children. Our data support that the safest vessel for use in toilet training is a PC/training seat as opposed to the toilet.
A Legal Mapping Assessment of Cytomegalovirus-Related Laws in the United States
Authors: Yassine Brianne B. , Hulkower Rachel , Dollard Sheila , Cahill Eric , Lanzieri Tatiana 
Published: July 2021

Importance:
Congenital cytomegalovirus (CMV) infection is the leading infectious cause of birth defects in the United States, affecting approximately 1 out of 200 newborns. Increasing awareness of congenital CMV infection among policy makers and the public is critical for advancing the evidence base for prevention and intervention strategies, including behavioral interventions for pregnant women, newborn screening to enable timely interventions, and garnering support for vaccine development.

Objective:
To understand the current landscape of CMV-related statutes and regulations, we conducted a 50-state legal epidemiology study of laws expressly referencing “cytomegalovirus.”

Evidence Review:
Our search yielded 101 statutes and regulations from 35 jurisdictions (34 states and District of Columbia). We systematically reviewed and coded the texts for themes.

Findings:
Laws addressed 3 main themes: (1) CMV awareness and education; (2) testing and reporting; and (3) the provision of services.

Conclusions and Relevance:
State-level CMV laws have been enacted to increase CMV awareness and to implement CMV testing for infants at a higher risk for infection, such as those who do not pass newborn hearing screening. This study provides a complete legal assessment of existing ways law is used to address CMV infection in the United States.
Can HIV epidemics among MSM be eliminated through participation in preexposure prophylaxis rollouts?
Authors: Jijón Sofía , Molina Jean-Michel , Costagliola Dominique , Supervie Virginie , Breban Romulus 
Published: July 2021

Objective:
To study the conditions under which preexposure prophylaxis (PrEP) coverage can eliminate HIV among MSM in the Paris region.

Design:
Mathematical modeling.

Methods:
We propose an innovative approach, combining a transmission model with a game-theoretic model, for decision-making about PrEP use. Individuals at high risk of HIV infection decide to use PrEP, depending on their perceived risk of infection and the relative cost of using PrEP versus antiretroviral treatment (ART), which includes monetary and/or nonmonetary aspects, such as price and access model of PrEP, consequences of being infected and lifelong ART.

Results:
If individuals assessed correctly their infection risk, and the cost of using PrEP were sufficiently low, then the PrEP rollout could lead to elimination. Specifically, assuming 86% PrEP effectiveness, as observed in two clinical trials, a minimum PrEP coverage of 55% [95% confidence interval (CI) 43–64%] among high-risk MSM would achieve elimination in the Paris region. A complete condom drop by MSM using PrEP slightly increases the minimum PrEP coverage required for elimination, by ∼1%, whereas underestimation of their own HIV infection risk would require PrEP programs reduce the cost of using PrEP by a factor ∼2 to achieve elimination.

Conclusion:
Elimination conditions are not yet met in the Paris region, where at most 47% of high-risk MSM were using PrEP as of mid-2019. Further lowering the cost of PrEP and promoting a fair perception of HIV risk are required and should be maintained in the long-run, to maintain elimination status.
Inflammatory biomarkers and soft tissue changes among patients commencing second-line antiretroviral therapy after first-line virological failure
Authors: Mwasakifwa Gwamaka Eliudi , Amin Janaki , Kelleher Anthony , Boyd Mark A. 
Published: July 2021

Introduction:
We explored associations of inflammatory and immune activation biomarkers at baseline and percentage gain in peripheral and trunk fat and lean mass over 96 weeks in patients with confirmed virological failure initiating lopinavir-anchored second-line antiretroviral therapy (ART) regimens.

Method:
We measured baseline plasma concentration of interleukin (IL)-6, tumour necrosis factor (TNF), neopterin, IL-6, high-sensitivity C-reactive protein (hs-CRP), D-dimer, soluble cluster of differentiation 14 (sCD14), and soluble CD163 in 123 participants of the SECOND-LINE body composition substudy. Linear regression assessed the association between biomarkers and percentage gain in limb/trunk fat and lean mass, adjusting for age, nucleoside or nucleotide reverse transcriptase inhibitor (N(t)RTI) use, body mass index, ethnicity, smoking, viral load, CD4+ T-cell counts, smoking, duration of ART use, and cholesterol.

Results:
Mean (standard deviation) age was 38 (7.3) years, CD4+ T-cell count was 252 (185.9) cells/μl, human immunodeficiency virus viral load was 4.2 (0.9) log10 copies/ml, 47% (58/123) were in the N(t)RTI arm (vs. raltegravir [RAL] arm in 53%); 56.1% (69/123) were females. In adjusted analyses, for every log10 increase in baseline levels of IL-6, neopterin, and D-dimer, the percentage gain in peripheral fat over 96 weeks was 11.8% (95% confidence interval [CI]: 0.9–22.6, P = 0.033); neopterin, 11.2% (95% CI: 3.2–19.2, P = 0.007); D-dimer 9.6% (95% CI: 3.1–15.9, P = 0.004), respectively. The associations remained significant when analysis was stratified by N(t)RTI vs. RAL and included only patients with viral suppression at week 48. A significant gradient in lean mass gain was seen across quartiles of IL-6, TNF, neopterin, hsCRP, D-dimer, and sCD14.

Conclusion:
Inflammatory biomarkers provide important mechanistic insights into the pathogenesis of limb fat and lean mass changes independently of ART.
Evaluating Treatment Preferences and Perceptions of a Prosthetic Versus a Transplanted Hand
Authors: Shammas Ronnie L. , Huh Ji , Huber Joel , Mithani Suhail K. 
Published: July 2021

Introduction
This study used a conjoint analysis–based survey to assess which factors are most influential when considering treatment with a prosthesis or transplant after a unilateral hand amputation.

Methods
Overall, 469 respondents were recruited using Amazon Mechanical Turk and asked to assume that they experienced a hand amputation. To determine preferences for a prosthetic, respondents chose among 11 pairs of alternatives with variations in the following attributes: appearance, function, maintenance, and learning time. Respondents were then presented with descriptions of the risks and outcomes of hand transplantation. The most compelling reasons for and against a transplant were determined and characteristics predictive of support for a transplant were identified.

Results
The most important attributes for a prosthesis were “lifelike appearance” and “myolectric function.” For hand transplantation, respondents were most concerned about immunosuppression side effects (n = 323, 69%) and the intense nature of surgery (n = 275, 59%), whereas the most positive benefit was the concept of the transplant being “natural” (n = 339, 72%). When faced with the choice of a hand transplant or a prosthetic, approximately 50% of respondents chose a transplantation. Younger age, previous medical experiences, a perceived “familiarity with medical issues,” and the regular attendance of religious services were associated with strong support for a hand transplantation (P < 0.01).

Conclusions
When considering a hand prosthesis, respondents are motivated most by appearance and function. Meanwhile, with hand transplantation, the risks of immunosuppression and the intense nature of surgery and recovery are predominant concerns. These findings may help inform patient-physician discussions when considering treatment after unilateral hand amputation.
Rarely Seen Intradiploic Skull Hematoma in Infants
Authors: Malçok Ümit Ali , Akar Ali 
Published: July 2021

Abstract
Although the first intradiploic hematoma (IH) case was reported in 1934, only 7 infant cases were reported in the literature. The authors present 2 IH cases, without birth trauma or bleeding disorder, which were treated surgically. IH is also included in the differential diagnosis of babies with a skull deformity. Computed tomography and magnetic resonance imaging modalities should be used together in diagnosis and treatment. The authors believe that the surgery to treat skull deformity because of IH in babies should be planned in the early period.
3D-Printed Custom Cutting Guides Facilitate Frontal Cranioplasty in Gender Affirmation Surgery
Authors: Hohman Marc H. , Jastrzembski Meghan E. , Choe Nicholas , Nuara Michael J. , Teixeira Jeffrey C. , Vincent Aurora G. 
Published: July 2021

Abstract
Frontal cranioplasty in gender affirmation surgery requires precise identification of the borders of the frontal sinus in order to reduce brow prominence effectively and avoid complications. Several approaches to this have been described in the literature, but many techniques are imprecise or logistically cumbersome. Custom 3D-printing of cutting guides is an emerging modality that offers a method of identifying the frontal sinus accurately and rapidly. We herein present the results of 5 transgender woman who underwent type 3 frontal cranioplasty with the assistance of 3D-printed custom cutting guides. Our preliminary analysis suggests that the use of custom 3D-printed cutting guides is safe and would likely be cost-effective for many surgeons.
Enhanced Recovery After Surgery Patients Are Prescribed Fewer Opioids at Discharge
Authors: Maurer Lydia R. , El Moheb Mohamad , Cavallo Elena , Antonelli Donna M. , Linov Pamela , Bird Sarah , Faulkner Heather R. , del Carmen Marcela , Qadan Motaz , Ferrone Cristina R. , Kaafarani Haytham M. A. , Sisodia Rachel , Ellis Dan B. 
Published: July 2021

Objective:We aimed to compare discharge opioid prescriptions pre- and post-ERAS implementation.Summary of Background Data:ERAS programs decrease inpatient opioid use, but their relationship with postdischarge opioids remains unclear.Methods:All patients undergoing hysterectomy between October 2016 and November 2020 and pancreatectomy or hepatectomy between April 2017 and November 2020 at 1 tertiary care center were included. For each procedure, ERAS was implemented during the study period. PSM was performed to compare pre - versus post-ERAS patients on discharge opioids (number of pills and oral morphine equivalents). Patients were matched on age, sex, race, payor, American Society of Anesthesiologists score, prior opioid use, and procedure. Sensitivity analyses in open versus minimally invasive surgery cohorts were performed.Results:A total of 3983 patients were included (1929 pre-ERAS; 2054 post-ERAS). Post-ERAS patients were younger (56.0 vs 58.4 years;P <0.001), more often female (95.8% vs 78.1%;P <0.001), less often white (77.2% vs 82.0%;P <0.001), less often had prior opioid use (20.1% vs 28.1%;P <0.001), and more often underwent hysterectomy (91.1% vs 55.7%;P <0.001). After PSM, there were no significant differences between cohorts in baseline characteristics. Matched post-ERAS patients were prescribed fewer opioid pills (17.4 pills vs 22.0 pills;P <0.001) and lower oral morphine equivalents (129.4 mg vs 167.6 mg;P <0.001) than pre-ERAS patients. Sensitivity analyses confirmed these findings [open (18.8 pills vs 25.4 pills;P <0.001 \ 138.9 mg vs 198.7 mg;P <0.001); minimally invasive surgery (17.2 pills vs 21.1 pills;P <0.001 \ 127.1 mg vs 160.1 mg;P <0.001).Conclusions:Post-ERAS patients were prescribed significantly fewer opioids at discharge compared to matched pre-ERAS patients.
Conservative management of occult pneumothorax in mechanically ventilated patients: A systematic review and meta-analysis
Authors: Smith Jeremy Adam , Secombe Paul , Aromataris Edoardo 
Published: July 2021

BACKGROUND
The aim of this systematic review was to investigate the safety and effectiveness of conservative management versus prophylactic intercostal catheter (ICC) insertion for the management of occult pneumothoraces in mechanically ventilated patients.

METHODS
PubMed, Embase, CINAHL, Web of Science, Cochrane Central, and other trial registries were searched. Eligible studies were critically appraised using standardized instruments. Meta-analysis was performed with mixed-methods logistic regression where appropriate and sensitivity analyses were performed with alternative statistical methods (Stata™ 15 or RevMan 5.3) or summarized in narrative. Randomized controlled trials (RCTs) and cohort studies were analyzed separately.

RESULTS
Twelve studies with a total of 354 participants were included; three RCTs (178 participants) and nine cohort studies (176 participants). The majority of the included studies, particularly the cohort studies, were well conducted. Two of the RCTs were rated as low quality. Statistically significant differences were observed in the RCT analysis: ICC insertion (any reason) (odds ratio, 2.86; 95% confidence interval, 1.26–6.43, 2 RCTs) in favor of prophylactic ICC; ICC complications (odds ratio, 0.12; 95% confidence interval, 0.02–0.62, 2 RCTs) in favor of conservative management. Nonstatistically significant differences were observed for progression of pneumothorax, ICC insertion (progression to simple pneumothorax), and ICC insertion (nonpneumothorax reasons). Results of analyses showed high imprecision (wide confidence limits). Conservative management showed a low rate of tension pneumothorax (2.8%). Complications were higher in the ICC group (19.5% vs. 5.8%).

CONCLUSION
Available evidence suggests that conservative management is safe for the management of occult pneumothoraces in mechanically ventilated patients, especially when undergoing short-term (<4 days) ventilation. We recommend that patients undergoing mechanical ventilation for a procedure alone and patients suspected to be ventilated less than 4 days can be conservatively managed.

LEVEL OF EVIDENCE
Systematic review and meta-analysis, level III.
Platelet to erythrocyte transfusion ratio and mortality in massively transfused trauma patients. A systematic review and meta-analysis
Authors: Rijnhout Tim W.H. , Duijst Jeanette , Noorman Femke , Zoodsma Margreet , van Waes Oscar J.F. , Verhofstad Michael H.J. , Hoencamp Rigo 
Published: July 2021

BACKGROUND
Platelet transfusion during major hemorrhage is important and often embedded in massive transfusion protocols. However, the optimal ratio of platelets to erythrocytes (platelet-rich plasma [PLT]/red blood cell [RBC] ratio) remains unclear. We hypothesized that high PLT/RBC ratios, as compared with low PLT/RBC ratios, are associated with improved survival in patients requiring massive transfusion.

METHODS
Four databases (Pubmed, CINAHL, EMBASE, and Cochrane) were systematically screened for literatures published until January 21, 2021, to determine the effect of PLT/RBC ratio on the primary outcome measure mortality at 1 hour to 6 hours and 24 hours and at 28 days to 30 days. Studies comparing various PLT/RBC ratios were included in the meta-analysis. Secondary outcomes included intensive care unit length of stay and in-hospital length of stay and total blood component use. The study protocol was registered in PROSPERO under number CRD42020165648.

RESULTS
The search identified a total of 8903 records. After removing the duplicates and second screening of title, abstract, and full text, a total of 59 articles were included in the analysis. Of these articles, 12 were included in the meta-analysis. Mortality at 1 hour to 6 hours, 24 hours, and 28 days to 30 days was significantly lower for high PLT/RBC ratios as compared with low PLT/RBC ratios.

CONCLUSION
Higher PLT/RBC ratios are associated with significantly lower 1-hour to 6-hour, 24-hour, 28-day to 30-day mortalities as compared with lower PLT/RBC ratios. The optimal PLT/RBC ratio for massive transfusion in trauma patients is approximately 1:1.

LEVEL OF EVIDENCE
Systematic review and meta-analysis, therapeutic Level III.