bluuebunny/crossref_metadata_2025_split huggingface dataset:
SECONDARY EPIRETINAL MEMBRANE AFTER LASER RETINOPEXY FOR RETINAL TEAR OR LOCALIZED RETINAL DETACHMENT
Authors: Israilevich Rachel , Salabati Mirataollah , Mahmoudzadeh Raziyeh , Cai Louis , Ammar Michael , Xu David , Cohen Michael N. , Garg Sunir J. , Hsu Jason , Klufas Michael A. , Khan M. Ali 
Published: August 2021

Purpose:
To assess visual acuity and optical coherence tomography outcomes after repair of secondary epiretinal membrane (ERM) after prior laser retinopexy for retinal tear with or without localized retinal detachment.

Methods:
Retrospective, consecutive series. A previously described optical coherence tomography grading scheme was used for imaging analysis.

Results:
Forty-two eyes of 42 patients were included, of which 16 (38.1%) had a concurrent localized retinal detachment. Mean logMAR visual acuity prelaser retinopexy was 0.15 ± 0.13 (Snellen 20/28), which worsened to 0.56 ± 0.42 (Snellen 20/72) before ERM surgery (P < 0.001). The mean visual acuity improved to 0.36 ± 0.30 (Snellen 20/45, P < 0.001) 3 months postsurgery and to 0.31 ± 0.32 (Snellen = 20/40, P < 0.001) at the final follow-up. Most eyes exhibited advanced ERM characteristics (n = 19 [45.2%] Stage 3 and n = 15 [35.7%] Stage 4 characteristics). The presence of inner microcystic changes (P = 0.008) and ellipsoid zone disruption (P = 0.009) at postoperative Month 3 were associated with worse final visual acuity. Eyes undergoing ERM surgery ≤180 days from laser retinopexy (n = 16, 38.1%) were younger (P = 0.024) and more likely to have Stage 4 ERM characteristics (P = 0.001).

Conclusion:
Secondary ERM after laser retinopexy may occur rapidly (<180 days) and exhibit significant anatomic alterations. The presence of inner microcystic changes and ellipsoid zone disruption postoperatively were optical coherence tomography features associated with worse final visual acuity.
A Quality Improvement Initiative Addressing Provider Prescription of Weight Management Follow-up in Primary Care
Authors: Kharofa Roohi Y. , Siegel Robert M. , Morehous John F. 
Published: August 2021

Introduction:
Few providers routinely comply with the American Academy of Pediatrics recommendations to prescribe weight management follow-up in-between well-child checks for children with obesity/overweight. This quality improvement (QI) project aimed to increase the percentage of patients prescribed weight management follow-up within three months of their well-child check.

Methods:
The project took place in 1 outpatient primary care clinic at a large, free-standing children’s hospital from May 2018 to April 2019. We grouped interventions in 4 Plan-Do-Study-Act ramps with the following themes: (1) provider education; (2) electronic health record note changes; (3) discharge order modifications; and (4) provider feedback. The primary outcome was the percent of patients ages 2–18 years with body mass index ≥ 85% that had an order placed to schedule a follow-up weight management appointment in primary care. We monitored attendance rates for scheduled follow-up visits as a balancing measure.

Results:
Mean prescription rates increased from 32% at baseline to 58%, with special cause analysis demonstrating improvement. Of patients prescribed follow-up, 40% returned for a weight management visit, compared to 13% before the QI initiative. The no-show rate was 35%.

Conclusions:
The utilization of QI methodology led to an increase in the percentage of patients appropriately prescribed weight management follow-up and a resultant increase in the number of patients seen for follow-up. The next steps include a re-examination of process failures to improve patient buy-in in follow-up prescriptions.
Confidence-weighted Testing as an Impactful Education Intervention within a Pediatric Sepsis Quality Improvement Initiative
Authors: Nathaniel Emma D. , Scott Halden F. , Wathen Beth , Schmidt Sarah K. , Rolison Elise , Smith Carter , Hays Matthew J. , Lockwood Justin M. 
Published: August 2021

Introduction:
Confidence-weighted testing assesses learners’ beliefs about their knowledge and skills. As part of a hospital-wide quality improvement initiative to enhance care for pediatric patients with suspected sepsis, we developed a novel intervention using confidence-weighted testing to identify institutional areas of misinformation and knowledge gaps while also providing real-time feedback to individual learners.

Methods:
We developed pediatric sepsis eLearning modules incorporating confidence-weighted testing. We distributed them to nurses, advanced practitioners, and physicians in emergency departments and acute care/non-intensive care unit inpatient settings in our hospital system. We analyzed completion and response data over 2 years following module distribution. Our outcomes included completion, confidently held misinformation (CHM; when a learner answers a question confidently but incorrectly), struggle (when a learner repeatedly answers a question incorrectly or with low confidence), and mastery (when a learner initially answers a question correctly and confidently).

Results:
Eighty-three percent of assigned learners completed the modules (1,463/1,754). Although nurses had significantly more misinformation and struggled more than physicians and advanced practitioners, learners of all roles achieved 100% mastery as part of module completion. The greatest CHM and struggle were found in serum lactate interpretation’s nuances and the hemodynamic shock states commonly seen in sepsis.

Conclusions:
Our novel application of confidence-weighted testing enhanced learning by correcting learners’ misinformation. It also identified systems issues and institutional knowledge gaps as targets for future improvement.
An Opioid-free Anesthesia Protocol for Pediatric Strabismus Surgery: A Quality Improvement Project
Authors: Chiem Jennifer L. , Donohue Laura D. , Martin Lynn D. , Low Daniel K. 
Published: August 2021

Introduction:
This quality improvement (QI) project tracks a series of 2 Plan-Do-Study-Act (PDSA) cycles as we standardized and refined an ambulatory pediatric anesthesia strabismus protocol. We aimed to provide effective pain relief, reduce postoperative nausea and vomiting (PONV) rates, and be cost-efficient while minimizing perioperative opioids over 5 years.

Methods:
We used statistical process control (SPC) charts to analyze real-world data captured from the medical record. We chose the following outcome and process measures to evaluate effectiveness: postoperative morphine rescue rate, maximum pain score in the postanesthesia care unit (PACU), and PONV rescue rate. We also used 2 balancing measures: postoperative length of stay (LOS) and total anesthesia time. We standardized our anesthesia protocol for our first PDSA cycle (April 2017) by removing intraoperative intravenous acetaminophen and utilizing fentanyl only. For the second PDSA cycle (January 2019), we replaced intraoperative fentanyl with dexmedetomidine.

Results:
There was a total of 325 pediatric strabismus repair surgeries performed between April 2015 and July 2020. There was no special cause variation detected in the SPC charts for the family of measures chosen to measure effectiveness: postoperative morphine rescue rate, maximum pain score in the PACU, or the PONV rescue rate. The PONV rescue rate was 0 with the removal of opioids. Also, there was no special cause variation for the balancing measures: postoperative LOS or total anesthesia time.

Conclusions:
Throughout 2 PDSA cycles, this QI project enabled our team to standardize an opioid-free and cost-efficient anesthesia protocol for pediatric strabismus surgery over 5 years.
Education and Visual Reminders Fail to Reduce Overuse and Waste in Interhospital Transfers to a Pediatric Intensive Care Unit
Authors: O’Neil Bernadette L. , Kane Jason M. 
Published: August 2021

Introduction:
As healthcare costs continue to rise, initiatives to reduce costs while maintaining high-quality care become a priority. Nonclinically indicated studies add to this cost, especially during interfacility transfers when studies are often repeated. Also, unnecessary evaluations add to nonmonetary costs such as pain, radiation exposure, and iatrogenic anemia. This study aimed to establish the frequency of redundant testing on interfacility transfers to the pediatric intensive care unit (PICU) and then implement an education-based quality improvement strategy for waste reduction.

Methods:
In the preintervention period (September 2018–February 2019), we collected data on patients transferred to the PICU from any outside facility. Investigators evaluated studies repeated within 6 hours and deemed them redundant or indicated. We then determined a rate of patients with redundant studies as the first aim. This result prompted an educational intervention focused on testing stewardship. Investigators then collected data in the postintervention period (July–December 2019) and compared the rate of redundant studies.

Results:
Study efforts identified 150 patients in the preintervention period and 131 in the postintervention period, establishing a 21%–25% frequency of redundant testing. Education and visual reminders failed to reduce this testing.

Conclusion:
This study established a baseline rate of redundant testing on transferred patients to the PICU. An educational intervention alone did not produce significant change.
Screening Tests in the Era of COVID-19: Implications for the Plastic Surgeon
Authors: Hamilton Kristy L. , Rohrich Rod J. 
Published: August 2021

Summary:
The novel coronavirus, severe acute respiratory syndrome coronavirus 2, responsible for the coronavirus disease of 2019 (COVID-19) pandemic, has claimed over 2 million lives to date and brought the global economy to a halt, including elective surgery. As the authors emerge from lockdown, new protocols must be implemented to minimize risk by means of appropriate screening of their patients, surgical adjustments to reduce viral transmission in case of undiagnosed infection, and the development of accurate severe acute respiratory syndrome coronavirus 2 tests while awaiting the distribution of an effective vaccine. Many serology and molecular tests have received emergency use authorization from the U.S. Food and Drug Administration, but they have not yet been independently verified. There are three main types of diagnostic tests available: (1) imaging studies, (2) molecular tests, and (3) serology tests. Imaging studies reveal bilateral lower lobe pneumonia and ground-glass opacities that are suggestive of disease. Quantitative reverse transcription polymerase chain reaction identifies specific segments of viral RNA, indicating the active presence of the virus in the test subject, which is most useful for elective surgery screening. Finally, serology studies detect the presence of immunoglobulin M and immunoglobulin G antibodies to the virus, indicating a current or past infection. Each test offers its own benefits and limitations.
Update on the Basic Science Concepts and Applications of Adipose-Derived Stem Cells in Hand and Craniofacial Surgery
Authors: Lynch Evan B. , Anderson W. Matthew , DeCoster Ryan C. , Bonaroti Alisha R. , Vyas Krishna S. , Bourne Debra A. , Vasconez Henry C. , Lin Kant Y. 
Published: August 2021

Summary:
Adipose-derived stem cell therapy offers plastic surgeons a novel treatment alternative for conditions with few therapeutic options. Adipose-derived stem cells are a promising treatment because of their broad differentiation potential, capacity for self-renewal, and ease of isolation. Over the past decade, plastic surgeons have attempted to harness adipose-derived stem cells’ unique cellular characteristics to improve the survival of traditional fat grafting procedures, a process known as cell-assisted lipotransfer. However, the full implications of cell-assisted lipotransfer in clinical practice remain incompletely understood, stressing the urgent need to assess the scientific evidence supporting adipose-derived stem cell–based interventions. Furthermore, with the strict regulatory climate surrounding tissue explantation therapies, reviewing the safety and efficacy of these treatments will clarify their regulatory viability moving forward. In this report, the authors provide a comprehensive, up-to-date appraisal of best evidence-based practices supporting adipose-derived stem cell–derived therapies, highlighting the known mechanisms behind current clinical applications in tissue engineering and regenerative medicine specific to plastic and reconstructive surgery. The authors outline best practices for the harvest and isolation of adipose-derived stem cells and discuss why procedure standardization will elucidate the scientific bases for their broad use. Finally, the authors discuss challenges posed by U.S. Food and Drug Administration oversight of these cell-based therapies and examine the role of adipose-derived stem cell–based applications in the future of plastic surgery.
Resilience and mental health in children and adolescents: an update of the recent literature and future directions
Authors: Mesman Esther , Vreeker Annabel , Hillegers Manon 
Published: August 2021

Purpose of review
In order to promote optimal development of children and adolescents at risk for psychiatric disorders, a better understanding of the concept resilience is crucial. Here, we provide an overview of recent work on clinical and epidemiological correlates of resilience and mental health in children and adolescents.

Recent findings
Our systematic literature search revealed 25 studies that unanimously show that higher levels of resilience are related to fewer mental health problems, despite the heterogeneity of study populations and instruments. Correlates of resilience included multisystem factors, such as social, cultural, family and individual aspects, which is in line with the multisystem approach as described by recent resilience theories. Longitudinal studies are scarce but confirm the dynamical character of resilience and mental health. The application of longitudinal studies and innovative measurement techniques will improve our understanding on the cascade effects of stressors on resilience and mental health outcomes.

Summary
Resilience is strongly associated with mental health in children and adolescents and deserves a more prominent role in research, prevention programs and routine clinical care. Including social, cultural and family context in the evaluation of resilience is of great value, as this can identify targets for early and preventive interventions.
Retrospective Exploratory Analysis of Task-Specific Effects on Brain Activity after Stroke
Authors: Demers Marika , Varghese Rini , Winstein Carolee J. 
Published: August 2021

AbstractBackgroundEvidence supports cortical reorganization in sensorimotor areas induced by constraint-induced movement therapy (CIMT). However, only a few studies examined the neural plastic changes as a function of task specificity. This retrospective exploratory analysis aims to evaluate the functional brain activation changes during a precision and a power grasp task in chronic stroke survivors who received two-weeks of CIMT compared to a no-treatment control group.MethodsFourteen chronic stroke survivors, randomized to CIMT (n=8) or non-CIMT (n=6), underwent functional MRI (fMRI) before and after a two-week period. Two behavioral measures, the 6-item Wolf Motor Function Test (WMFT-6) and the Motor Activity Log (MAL), and fMRI brain scans were collected before and after a two-week period. During scan runs, participants performed two different grasp tasks (precision, power). Pre to post changes in laterality index (LI) were compared by group and task for two predetermined motor regions of interest: dorsal premotor cortex (PMd) and primary motor cortex (MI).ResultsThe CIMT group showed significant improvements in both the WMFT-6 and the MAL post-intervention, whereas the non-CIMT group showed improvements in only the MAL. Two weeks of CIMT resulted in a relative increase in activity in a key region of the motor network, PMd of the lesioned hemisphere, under precision grasp task conditions compared to the non-treatment control group. No changes in LI were observed in MI for either task or group. Conclusions: These findings provide evidence for task-specific effects of CIMT in the promotion of recovery-supportive cortical reorganization in chronic stroke survivors.
An approach to quantifying the interaction between behavioural and transmission clusters: the case of Hepatitis C virus infections in HIV positive men who have sex with men
Authors: Salazar-Vizcaya Luisa , Kusejko Katharina , Günthard Huldrych F , Böni Jürg , Metzner Karin , Braun Dominique , Nicca Dunja , Bernasconi Enos , Calmy Alexandra , Darling Katharine EA , Wandeler Gilles , Kouyos Roger D , Rauch Andri ,   the Swiss HIV Cohort Study
Published: August 2021

ABSTRACTWe hypothesize that patterns of sexual behaviour play a role in the conformation of transmission networks. If that was the case, behavioural grouping might in turn correlate with transmission networks and have the potential to predict proximity in viral phylogenies. To address this hypothesis, we present an intuitive approach for quantifying interactions between clusters of sexual behaviour along a virus phylogeny. Data from the Swiss HIV Cohort Study on condom use and incident Hepatitis C virus (HCV) sequences served as proof-of-concept. A strict inclusion criteria contrasting with relatively low HCV prevalence hindered our ability to identify significant relationships. This manuscript intends to serve as guide for studies aimed at characterizing interactions between behavioural patterns and transmission networks. Large transmission networks such as those of HIV or COVID-19 are prime candidates for applying this methodological approach.
All-cause excess mortality in the State of Gujarat, India, during the COVID-19 pandemic (March 2020-April 2021)
Authors: Acosta Rolando J , Patnaik Biraj , Buckee Caroline , Kiang Mathew V , Irizarry Rafael A , Balsari Satchit , Mahmud Ayesha S 
Published: August 2021

AbstractOfficial COVID-19 mortality statistics are strongly influenced by local diagnostic capacity, strength of the healthcare and vital registration systems, and death certification criteria and capacity, often resulting in significant undercounting of COVID-19 attributable deaths. Excess mortality, which is defined as the increase in observed death counts compared to a baseline expectation, provides an alternate measure of the mortality shock – both direct and indirect – of the COVID-19 pandemic. Here, we use data from civil death registers from a convenience sample of 90 municipalities across the state of Gujarat, India, to estimate the impact of the COVID-19 pandemic on all-cause mortality. Using a model fit to weekly data from January 2019 to February 2020, we estimated excess mortality over the course of the pandemic from March 2020 to April 2021. We estimated 21,300 [95% CI: 20,700, 22,000] excess deaths across these municipalities in this period, representing a 44% [95% CI: 43%, 45%] increase over the expected baseline. The sharpest increase in deaths in our sample was observed in late April 2021, with an estimated 678% [95% CI: 649%, 707%] increase in mortality from expected counts. The 40 to 65 age group experienced the highest increase in mortality relative to the other age groups. We found substantial, yet similar, increases in mortality for males and females. Our excess mortality estimate for these 90 municipalities, representing approximately 5% of the state’s population, exceeds the official COVID-19 death count for the entire state of Gujarat, even before the delta wave of the pandemic in India peaked in May 2021. Prior studies have concluded that true pandemic-related mortality in India greatly exceeds official counts. This study, using data directly from the first point of official death registration data recording, provides incontrovertible evidence of the high excess mortality in Gujarat from March 2020 to April 2021.
Genetic Influence underlying Brain Connectivity Phenotype: A Study on Two Age-Specific Cohorts
Authors: Cong Shan , Yao Xiaohui , Xie Linhui , Yan Jingwen , Shen Li ,   for the Alzheimer’s Disease Neuroimaging Initiative
Published: August 2021

AbstractBackgroundHuman brain structural connectivity is an important imaging quantitative trait for brain development and aging. Mapping the network connectivity to the phenotypic variation provides fundamental insights in understanding the relationship between detailed brain topological architecture, function, and dysfunction. However, the underlying neurobiological mechanism from gene to brain connectome, and to phenotypic outcomes, and whether this mechanism changes over time, remain unclear.MethodsThis study analyzes diffusion weighted imaging data from two age-specific neuroimaging cohorts, extracts structural connectome topological network measures, performs genome-wide association studies (GWAS) of the measures, and examines the causality of genetic influences on phenotypic outcomes mediated via connectivity measures.ResultsOur empirical study has yielded several significant findings: 1) It identified genetic makeup underlying structural connectivity changes in the human brain connectome for both age groups. Specifically, it revealed a novel association between the minor allele (G) of rs7937515 and the decreased network segregation measures of the left middle temporal gyrus across young and elderly adults, indicating a consistent genetic effect on brain connectivity across the lifespan. 2) It revealed rs7937515 as a genetic marker for body mass index (BMI) in young adults but not in elderly adults. 3) It discovered brain network segregation alterations as a potential neuroimaging biomarker for obesity. 4) It demonstrated the hemispheric asymmetry of structural network organization in genetic association analyses and outcome-relevant studies.DiscussionThese imaging genetic findings underlying brain connectome warrant further investigation for exploring their potential influences on brain-related diseases, given the significant involvement of altered connectivity in neurological, psychiatric and physical disorders.Impact StatementThe genetic architecture underlying brain connectivity, and whether this mechanism changes over time, remain largely unknown. To understand the inter-individual variability at different life stages, this study performed genome-wide association studies of brain network connectivity measures from two age-specific neuroimaging cohorts, and identified a common association between the minor allele (G) of rs7937515 and decreased network segregation measures of the left middle temporal gyrus. The mediation analysis further elucidated neurobiological pathway of brain connectivity mediators linking the genes FAM86C1/FOLR3 with body mass index. This study provided new insights into the genetic mechanism of inter-regional connectivity alteration in the brain.