bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Documentation in Low- and Middle-income Countries: Lessons Learned from Implementing Specialized Charting Software
Authors: Ferry Andrew M. , Davis Matthew J. , Rumprecht Ewa , Nigro Alexander L. , Desai Priya , Hollier Larry H. 
Published: June 2021

Background:
The implementation of electronic health record (EHR) software at healthcare facilities in low- and middle-income countries (LMICs) is limited by financial and technological constraints. Smile Train, the world’s largest cleft charity, developed a cleft treatment EHR system, Smile Train Express (STX), and distributed it to their partnered institutions. The purpose of this study was to investigate trends in medical documentation practices amongst Smile Train-partner institutions to characterize the impact that specialized EHR software has on medical documentation practices at healthcare facilities in LMICs.

Methods:
Surveys were administered electronically to 843 Smile Train-partnered institutions across 68 LMICs. The survey inquired about institutions’ internet connection, documentation methods used during patient encounters, rationale for using said methods, and documentation methods for cloud-based storage of healthcare data. Institutions were grouped by economic and geographic subgroups for analysis.

Results:
A total of 162 institutions (19.2%) responded to the survey. Most institutions employed paper charting (64.2%) or institutional EHR software (25.9%) for data entry during a patient encounter with the latter’s use varying significantly across geographical subgroups (P = 0.01). STX was used by 18 institutions (11.1%) during a patient encounter. Workflow was the most frequently cited reason for institutions to employ their entry method during a patient encounter (51.4%).

Conclusions:
The provision of STX to partnered institutions influenced medical documentation practices at several institutions; however, regulations and guidelines have likely limited its complete integration into clinical workflows. Further studies are needed to characterize trends in medical documentation in LMICs at a more granular level.
Planned and Unplanned Delayed Anterolateral Thigh Flap Phalloplasty
Authors: Santucci Richard A. , Linder Emma R. , Wachtman Galen S. , Crane Curtis N. 
Published: June 2021

Background:
Pedicled anterolateral thigh (ALT) flap phalloplasty can be limited by inadequate perfusion. Vascular delay increases perfusion, as delay causes blood vessel formation by limiting the blood supply available to a flap before transfer. We hypothesized that delayed ALT flap phalloplasty would decrease rates of partial flap or phallus loss and other postoperative complications when compared with previously reported complication rates of undelayed single-stage ALT phalloplasty in our practice.

Methods:
A retrospective medical record review was performed on all phalloplasty patients in our practice between January 2016 and September 2019. We found those patients who had completed delayed ALT flap phalloplasty with at least 6 months of delay and 12 months of follow-up. For these patients, we recorded postoperative complications, simultaneous surgeries, subsequent surgeries, and demographic characteristics.

Results:
Five female-to-male transsexuals underwent delayed ALT flap phalloplasty (two were unplanned procedures, three were planned). Planned delay: The average time between Stage 1 and Stage 2 was 6.5 months. Complications for the planned delay cohort were as follows: partial loss of the neophallus not requiring repair (33%), urethral stricture requiring surgical repair (33%). Unplanned delay: The average time between Stage 1 and Stage 2 was 9.1 months. The following complication was seen in the unplanned delay cohort: urethral stricture requiring surgical repair (50%).

Conclusions:
Vascular delay of ALT flap phalloplasty is a successful emergency salvage procedure. Planned delay of ALT flaps provided similar results compared with those previously reported by our practice with standard single-stage approach.
Impact of COVID-19 on Elective Cleft Surgery in Low- and Middle-income Countries
Authors: Vander Burg Richard , Agrawal Karoon , Desai Priya , Desalu Ibironke , Donkor Peter 
Published: June 2021

Background:
The COVID-19 pandemic disrupted health systems worldwide, including in low- and middle-income countries (LMICs). Many countries limited the delivery of elective surgery. To date, COVID-19’s impact on elective surgery in LMICs has been unquantified. We use operative data from a large international non-government cleft organization to compare case volume for 2019 and 2020 to quantify the impact of COVID-19.

Methods:
Smile Train supports a partner network of over 1100 partners globally to deliver treatment to children with cleft lip and cleft palate (CLP). Treatment data is documented into a proprietary digital platform, Smile Train Express. We compared monthly treatment data for 2019 to 2020, by country, and by World Bank Income group to describe the effect that the COVID-19 pandemic has had on CLP surgery in LMICs.

Results:
Our analysis shows 25,444 (31.4%) fewer primary operations performed between January and December 2020 than in the same period in 2019 with the most significant decline in procedures observed in April 2020. Many countries resumed elective surgery for CLP procedures from May onward and volume approximated that of pre-pandemic baseline by November of 2020.

Conclusions:
The emergence of the COVID-19 pandemic had a large impact on health systems and service delivery across the world. We find that this is evident in the delivery of CLP surgery in LMICs. The impact is characterized by a dramatic decrease in surgery rates in April of 2020 with a recovery of surgical volume from July 2020 onwards. The rate of surgical rate recovery is consistent across World Bank Income groups.
Do Triphasic Waves and Nonconvulsive Status Epilepticus Arise From Similar Mechanisms? A Computational Model
Authors: Ligtenstein Sophie , Song Jiangling , Jin Jin , Sun Haoqi , Paixao Luis , Zafar Sahar , Westover M. Brandon 
Published: June 2021

Purpose:
Triphasic waves arising in patients with toxic metabolic encephalopathy (TME) are often considered different from generalized periodic discharges (GPDs) in patients with generalized nonconvulsive status epilepticus (GNCSE). The primary objective of this study was to investigate whether a common mechanism can explain key aspects of both triphasic waves in TME and GPDs in GNCSE.

Method:
A neural mass model was used for the simulation of EEG patterns in patients with acute hepatic encephalopathy, a common etiology of TME. Increased neuronal excitability and impaired synaptic transmission because of elevated ammonia levels in acute hepatic encephalopathy patients were used to explain how triphasic waves and GNCSE arise. The effect of gamma-aminobutyric acid-ergic drugs on epileptiform activity, simulated with a prolonged duration of the inhibitory postsynaptic potential, was also studied.

Results:
The simulations show that a model that includes increased neuronal excitability and impaired synaptic transmission can account for both the emergence of GPDs and GNCSE and their suppression by gamma-aminobutyric acid-ergic drugs.

Conclusions:
The results of this study add to evidence from other studies calling into question the dichotomy between triphasic waves in TME and GPDs in GNCSE and support the hypothesis that all GPDs, including those arising in TME patients, occur via a common mechanism.
Atypical or Typical Triphasic Waves—Is There a Difference? A Review
Authors: Fernández-Torre José L. , Kaplan Peter W. 
Published: June 2021

Summary:The entity of triphasic waves (TWs) and TW encephalopathy has derived from the subjective art of EEG interpretation. Indeed, there are few if any guidelines regarding many different aspects of TWs. The authors seek to shed light on the nature and the diagnostic characteristics of various types of TWs, differentiating “typical” from “atypical” forms. The authors conclude that morphologies in the form of bursts of well-formed, smoothly contoured, negative–positive–negative, bilateral, symmetrical and synchronous, regular, reactive, periodic or rhythmic, 1.5 to 2.0 Hz, fronto-central, triphasic complexes with fronto-occipital lag meet the criteria for typical TWs and are highly suggestive of toxic–metabolic encephalopathies. These are most frequently hepatic, uremic, or sepsis-associated encephalopathies with multi-organ failure. In such cases, atypical TWs (frontopolar or parieto-occipital maximum, negative–positive or negative–positive–negative, asymmetric and asynchronous, unreactive, irregular, multifocal, continuous with spatiotemporal evolution, sharper and without fronto-occipital/occipito-frontal lag, or triphasic delta waves) are rarely seen. Atypical TWs are encountered in Angelman syndrome, toxic encephalopathies, hyperthyroidism/hypothyroidism, Hashimoto encephalopathy, nonconvulsive status epilepticus, dementia, sepsis-associated encephalopathy, cerebrovascular disorders, and certain boundary syndromes. Investigations describing TWs with uncommon etiologies revealed few with typical TWs, suggesting that the term “TWs” has been overused in the past. Triphasic waves arise from the interaction of multiple factors including toxic, metabolic, infectious, and structural disorders that affect circuits between thalamus and cortex. The patient's metabolic status, presence of potentially neurotoxic drugs, cerebral atrophy, white matter disease, dementia, or seizures help differentiate typical from typical TWs. Future studies will determine whether this dichotomy is heuristically and clinically helpful.
REPAIR OF ABDOMINAL WALL DEFECTS WITH ACELLULAR BOVINE PERICARDIUM MATRIX A MULTICENTRE PROSPECTIVE STUDY
Authors: Frascino Luiz Fernando , De Campos Severi Jonas Dias , Funes Lorenzzato Fernanda Ribeiro , Xavier Funes Hamilton Luiz 
Published: June 2021

ABSTRACTBackgroundThe association of prosthetic meshes in the abdominal wall repair, reducing the recurrence rates in an impactful way, has become an almost mandatory routine for the success of these surgeries. After decades using non-biological synthetic implants, from the 90s onwards biological membranes of animal or human origin were introduced – the so called acellular biological matrices - beginning a new era in abdominal wall defects correction.MethodsThirty patients underwent repair for different abdominal wall deformities, with acellular matrices of bovine pericardium, in a total of 40 anatomically individualized implants. The median follow-up was 22 months, with patients evaluated clinically and radiologically. In three cases, biopsies of the implanted areas were performed, allowing histological analysis of the material.ResultsThere was no recurrence of hernias in any of the cases, both clinically and radiologically. There was also no record of hematomas, infections or any phenomenon of a local or systemic reaction nature. Radiologically, it was not possible to visualize the matrices at the implantation site in any of the analysed postoperative periods. Biopsies showed important tissue neoformation replacing the implanted membranes, with important deposition of collagen, normal-looking cellularized tissue, and absence of foreign body reactions.ConclusionsThe analysed matrices showed similarity to other biological membranes described in the international literature. Representing an important update and conceptual evolution, biological matrices must be incorporated into the therapeutic arsenal in abdominal wall repairs.
Impact of vaccination in reducing Hospital expenses, Mortality and Average length of stay among COVID-19 patients – a retrospective cohort study from India
Authors: Ramakrishnan Madhumathi , Subbarayan Prakash 
Published: June 2021

Background & AimWHO listed vaccine hesitancy among the top 10 global threats to health and there are very few reports highlighting vaccine benefits against COVID-19. The aim of this study was to study the impact of vaccination on reducing the average length of stay (ALOS), intensive care unit (ICU) requirement, mortality and cost of the treatment among COVID-19 patients.MethodsIn this retrospective cohort study all the patients above 45 years who underwent treatment for COVID-19 were included. The data of patients treated pan India during the period March & April 2021 with the diagnosis of COVID-19, under health insurance cover, were extracted to study parameters like the ALOS, mortality, ICU requirement, total hospital expenses incurred and the vaccination status.ResultsAmong 3820 patients with COVID-19, 3301 (86.4%) were unvaccinated while 519 (13.6%) were vaccinated. Among the unvaccinated the mean (s.d) ALOS was 7 days. Fourteen days after second dose of vaccination this was significantly less (p=0.01) at 4.9. The mean total hospital expense among the unvaccinated was Rs. 277850. Fourteen days after second dose of vaccination this was further less (p=0.001) at Rs. 217850. Among the unvaccinated population 291/3301 (8.8%) required ICU and this was significantly less (p=0.03) at 31/519 (6%) among the vaccinated. Among those who received two doses of vaccination it was further less at 1/33 (3%). The mortality among unvaccinated patients was 16/3301 (0.5%) while there was no mortality among the vaccinated. Among those who received two doses of vaccination there was a 66% relative risk reduction in ICU stay and 81% relative risk reduction in mortality.ConclusionsThere was a significant reduction in ALOS, ICU requirement, mortality & treatment cost in patients who had completed two doses of vaccination. These findings may be used in motivating public and promoting vaccination drive.
Factors affecting the transmission of SARS-CoV-2 in school settings
Authors: Yuan Haokun , Reynolds Connor , Ng Sydney , Yang Wan 
Published: June 2021

AbstractBackgroundSeveral studies have reported SARS-CoV-2 outbreaks in schools, with a wide range of secondary attack rate (SAR; range: 0-100%). We aimed to examine key risk factors to better understand SARS-CoV-2 transmission in schools.MethodsWe collected records of 39 SARS-CoV-2 school outbreaks globally published through July 2021 and compiled information on hypothesized risk factors. We utilized the directed acyclic graph (DAG) to conceptualize risk mechanisms, used logistic regression to examine each risk-factor group, and further built multi-risk models.ResultsThe best-fit model showed that the intensity of concurrent community transmission (adjusted odds ratio [aOR]: 1.2, 95% CI: 1.17 – 1.24, for each increase of 1 case per 10,000 persons per week), individualism (aOR: 1.72, 95% CI: 1.19 – 2.5, above vs. below the median) were associated higher risk, whereas preventive measures (aOR: 0.22, 95% CI: 0.17 – 0.29, distancing and masking vs. none) and higher population immunity (aOR: 0.28, 95% CI: 0.22 – 0.35) were associated with lower risk of SARS-CoV-2 transmission in schools. Compared to students in pre-schools, the aOR was 0.35 (95% CI: 0.23 – 0.54) for students in primary schools and 1.3 (95% CI: 0.9 – 1.88) for students in high schools.ConclusionsPreventive measures in schools (e.g. social distancing and mask-wearing) and communal efforts to lower transmission and increase vaccination uptake (i.e. vaccine-induced population immunity) in the community should be taken to collectively reduce transmission and protect children in schools. Flexible reopening policies may be considered for different levels of schools given their risk differences.
New insights from the combined discrimination of modern/ancient genome-wide shared alleles and haplotypes: Differentiated demographic history reconstruction of Tai-Kadai and Sinitic people in South China
Authors: Wang Mengge , He Guanglin , Zou Xing , Chen Pengyu , Wang Zheng , Tang Renkuan , Yang Xiaomin , Chen Jing , Yang Meiqing , Li Yingxiang , Liu Jing , Wang Fei , Zhao Jing , Guo Jianxin , Hu Rong , Wei Lan-Hai , Chen Gang , Yeh Hui-Yuan , Wang Chuan-Chao 
Published: June 2021

AbstractSouthern China was a region with mixed rice-millet farming during the Middle Neolithic period and also suggested to be the homeland of Tai-Kadai-speaking (TK) people. The archaeological evidence of animal and plant domestication has demonstrated that southern Chinese rice agriculturalists dispersed from the Yangtze River basin with the dissemination of TK, Austroasiatic (AA), Austronesian (AN) and Hmong-Mien (HM) languages. However, the formations of the inland TK-speaking people, central/southern Han Chinese and their relationships with Neolithic farmers from the Yangtze and Yellow Rivers (YR) basins are far from clear due to the limited sampling of South China. Here, we revealed the spatiotemporal demographic history of southern China by analyzing newly generated genome-wide data of 70 southeastern mainland TK speakers including Dong, Gelao and Bouyei and 45 southwestern Han Chinese together with comprehensive modern/ancient reference datasets. Southwest Han Chinese and Gelao demonstrated a closer genomic affinity to Neolithic YR farmers, while inland TKs (Dong and Bouyei) demonstrated a closer genomic affinity to coastal TK/AN-speaking islanders and Neolithic Yangtze farmers and their descendants. The shared genetic drift between inland TK/AN speaker highlighted a common origin of AN/TK groups, which may be descended from Tanshishan people or their predecessors (Xitoucun). Additionally, we found that inland TK/Sinitic could be modelled as an admixture of ancestral northern East Asian (ANEA) and ancestral southern East Asian (ASEA) sources with different proportions, in which the ANEA was phylogenetically closer to Neolithic millet farmers deriving from the YR Basin and the ASEA was phylogenetically closer to Coastal Neolithic-to-modern southern East Asians. Finally, we discovered genetic differentiation among TK people from southern China and Southeast Asia and obvious substructures between northern and southern inland Chinese TK people. The observed patterns of the spatiotemporal distribution of the northern and southern East Asian lineages in Central/southern China were also compatible with the scenario of bi-directional gene flow events from ANEA and ASEA. Conclusively, multiple lines of genomic evidence indicated millet farmers deriving from the YR basin and rice farmers deriving from the Yangtze River basin substantially contributed to the present-day mainland TK speakers and Central/southern Han Chinese, and formed the modern dual genetic admixture profile.
Dysphagic disorder in a cohort of COVID-19 patients: evaluation and evolution
Authors: Glotta Andrea , Galli Anna , Biggiogero Maira , Bona Giovanni , Saporito Andrea , Mauri Romano , Ceruti Samuele 
Published: June 2021

ABSTRACTBackgroundCOVID-19 is a multisystem disease complicated by respiratory failure requiring sustanined mechanical ventilation (MV). Prolongued oro-tracheal intubation is associated to an increased risk of dysphagia and bronchial aspiration. Purpose of this study was to investigate swallowing disorders in critically ill COVID-19 patients.MethodsThis was a retrospective study analysing a consecutive cohort of COVID-19 patients admitted to the Intensive Care Unit (ICU) of our Hospital. Data concerning dysphagia were collected according to the Gugging Swallowing Screen (GUSS) and related to demographic characteristics, clinical data, ICU Length-Of-Stay (LOS) and MV parameters.ResultsFrom March 2 to April 30 2020, 31 consecutive critically ill COVID-19 patients admitted to ICU were evaluated by speech and language therapists (SLT). Twenty-five of them were on MV (61% through endotracheal tube and 19% through tracheostomy); median MV lenght was 11 days. Seventeen (54.8%) patients presented dysphagia; a correlation was found between first GUSS severity stratification and MV days (p < 0.001), ICU LOS (p < 0.001), age (p = 0.03) and tracheostomy (p = 0.042). No other correlations were found. At 16 days, 90% of patients had fully recovered; a significant improvement was registered especially during the first week (p < 0.001).ConclusionCompared to non-COVID-19 patiens, a higher rate of dysphagia was reported in COVID-19 patients, with a more rapid and complete recovery. A systematic early SLT evaluation of COVID-19 patients on MV may thus be useful to prevent dysphagia-related complications.
Integration of molecular inflammatory interactome analyses reveals dynamics of circulating cytokines and extracellular vesicle long non-coding RNAs and mRNAs in heroin addicts during acute and protracted withdrawal
Authors: Zhang Zunyue , Wu Hongjin , Peng Qingyan , Xie Zhenrong , Chen Fengrong , Ma Yuru , Zhang Yizhi , Zhou Yong , Yang Jiqing , Chen Cheng , Li Shaoyou , Zhang Yongjin , Wang Yuan , Xu Yu , Luo Huayou , Zhu Mei , Kuang Yiqun , Yu Juehua , Wang Kunhua 
Published: June 2021

AbstractHeroin addiction and withdrawal influence multiple physiological functions, including immune responses, but the mechanism remains largely elusive. The objective of this study was to investigate the molecular inflammatory interactome, particularly the cytokines and transcriptome regulatory network in heroin addicts undergoing withdrawal, compared to healthy controls (HCs). Twenty-seven cytokines were simultaneously assessed in 41 heroin addicts, including 20 at the acute withdrawal (AW) stage and 21 at the protracted withdrawal (PW) stage, and 38 age- and gender-matched HCs. Disturbed T-helper(Th)1/Th2, Th1/Th17, and Th2/Th17 balances, characterized by reduced interleukin (IL)-2, elevated IL-4, IL-10, and IL-17A, but normal TNF-α, were present in the AW subjects. These imbalances were mostly restored to the baseline at the PW stage. However, the cytokines TNF-α, IL-2, IL-7, IL-10, and IL-17A remained dysregulated. This study also profiled exosomal long non-coding RNA (lncRNA) and mRNA in the plasma of heroin addicts, constructed co-expression gene regulation networks, and identified lncRNA- mRNA-pathway pairs specifically associated with alterations in cytokine profiles and Th1/Th2/Th17 imbalances. Altogether, a large amount of cytokine and exosomal lncRNA/mRNA expression profiling data relating to heroin withdrawal was obtained, providing a useful experimental and theoretical basis for further understanding of the pathogenic mechanisms of withdrawal symptoms in heroin addicts.
A Continuous Bayesian Model for the Stimulation COVID-19 Epidemic Dynamics
Authors: Xu Zhaobin , Zhang Hongmei , Niu Yonggang 
Published: June 2021

AbstractIt is of great theoretical and application value to accurately forecast the spreading dynamics of COVID-19 epidemic. We first proposed and established a Bayesian model to predict the epidemic spreading behavior. In this model, the infection probability matrix is estimated according to the individual contact frequency in certain population group. This infection probability matrix is highly correlated with population geographic distribution, population age structure and so on. This model can effectively avoid the prediction malfunction by using the traditional ordinary differential equation methods such as SIR (susceptible, infectious and recovered) model and so on. Meanwhile, it would forecast the epidemic distribution and predict the epidemic hot spots geographically at different time. According to the results revealed by Bayesian model, the effect of population geographical distribution should be considered in the prediction of epidemic situation, and there is no simple derivation relationship between the threshold of group immunity and the virus reproduction number R0. If we further consider the virus mutation effect and the antibody attenuation effect, with a large global population spatial distribution, it will be difficult for us to eliminate Covid-19 in a short time even with vaccination endeavor. Covid-19 may exist in human society for a long time, and the epidemic caused by re-infection is characterized by a wild-geometric && low-probability distribution with no epidemic hotspots.