bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined Liposuction and Physiologic Treatment Achieves Durable Limb Volume Normalization in Class II–III Lymphedema
Authors: Brazio Philip S. , Nguyen Dung H. 
Published: January 2021

Introduction
Outcomes of surgical lymphedema treatment are currently suboptimal. Physiologic procedures including lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) reestablish lymphatic flow but cannot correct fibroadipose deposition, whereas liposuction alone cannot prevent disease progression. We propose a treatment algorithm combining liposuction with LVA or VLNT that can achieve normal limb volumes and prevent disease progression in stage II–III lymphedema.

Methods
We performed a retrospective chart review of patients undergoing liposuction and physiologic lymphedema operations at our institution between January 2016 and June 2019. Patients were assigned to treatment groups according to their clinical presentation: physiologic first, followed by no further treatment (physiologic only) or liposuction (physiologic then liposuction); liposuction then physiologic; or simultaneous. Preoperative patient characteristics and sequence of operations were recorded. Compression garment usage was self-reported. Limb volumes were approximated as a truncated cone.

Results
Twenty-one patients met the inclusion criteria. The liposuction then physiologic group had significantly higher stage and excess limb volume at baseline, whereas the physiologic first groups had lower excess volume. While the physiologic only group had predominantly stage I disease, the patients who later required liposuction (physiologic then liposuction group) all had stage II disease. All groups achieved 82% to 106% mean excess volume reduction, and volume reduction was maintained for up to 2.4 years. Compression garment class was not reduced, but mean postoperative compression duration decreased from 12.5 to 7.5 h/d (P = 0.003). Ten of 11 patients with history of cellulitis had no further recurrence.

Conclusion
Lymphedema represents a continuum of fluid and fibroadipose disease. Accurate staging and timely treatment with physiologic procedures and liposuction can normalize limb volume. We propose a treatment algorithm to optimize outcomes. Patients with predominantly nonpitting presentation benefit from liposuction to maximize removal of fibroadipose tissue and optimize postoperative compression, followed by LVA or VLNT to improve lymphatic drainage. Patients with primarily pitting edema are best treated with physiologic procedures initially, reserving selective liposuction as a second stage. Patients with mixed presentation are best served by single-stage combination procedures.
Limitations of Available Blood Products for Massive Transfusion During Mass Casualty Events at US Level 1 Trauma Centers
Authors: Williams James , Gustafson Michael , Bai Yu , Prater Samuel , Wade Charles E. , Guillamondegui Oscar D. , Khan Mansoor , Brenner Megan , Ferrada Paula , Roberts Derek , Horer Tal , Kauvar David , Kirkpatrick Andrew , Ordonez Carlos , Perreira Bruno , Priouzram Artai , Duchesne Juan , Cotton Bryan A. 
Published: January 2021

ABSTRACT

Introduction:
Exsanguination remains a leading cause of preventable death in traumatically injured patients. To better treat hemorrhagic shock, hospitals have adopted massive transfusion protocols (MTPs) which accelerate the delivery of blood products to patients. There has been an increase in mass casualty events (MCE) worldwide over the past two decades. These events can overwhelm a responding hospital's supply of blood products. Using a computerized model, this study investigated the ability of US trauma centers (TCs) to meet the blood product requirements of MCEs.

Methods:
Cross-sectional survey data of on-hand blood products were collected from 16 US level-1 TCs. A discrete event simulation model of a TC was developed based on historic data of blood product consumption during MCEs. Each hospital's blood bank was evaluated across increasingly more demanding MCEs using modern MTPs to guide resuscitation efforts in massive transfusion (MT) patients.

Results:
A total of 9,000 simulations were performed on each TC's data. Under the least demanding MCE scenario, the median size MCE in which TCs failed to adequately meet blood product demand was 50 patients (IQR 20–90), considering platelets. Ten TCs exhaust their supply of platelets prior to red blood cells (RBCs) or plasma. Disregarding platelets, five TCs exhausted their supply of O- packed RBCs, six exhausted their AB plasma supply, and five had a mixed exhaustion picture.

Conclusion:
Assuming a TC's ability to treat patients is limited only by their supply of blood products, US level-1 TCs lack the on-hand blood products required to adequately treat patients following a MCE. Use of non-traditional blood products, which have a longer shelf life, may allow TCs to better meet the blood product requirement needs of patients following larger MCEs.
Making Concepts Material
Authors: Cheung Jeffrey J. H. , Kulasegaram Kulamakan M. , Woods Nicole N. , Brydges Ryan 
Published: January 2021

Background
Simulation affords opportunities to represent functional relationships between conceptual (eg, anatomy) and procedural knowledge (eg, needle insertion technique) in ways that make them accessible to our many senses. Despite deprioritizing realism, such simulations may encourage trainees to create cognitive connections between these knowledge (ie, cognitive integration), which may improve transfer of learning. However, the impact of such “integrated instruction” has not been examined in simulation-based training. We developed integrated video- and simulator-based instructional modules for lumbar puncture training and compared their impacts on participants' retention, transfer, and conceptual knowledge.

Methods
During 1 hour of simulation-based training, we randomized 66 medical students to receive either (a) video-based procedural-only instruction, (b) integrated video-based instruction, or (c) integrated simulator-based instruction. One week later, we tested participants' retention and transfer performances and their conceptual knowledge on a written test.

Results
Simple mediation analyses revealed that compared with participants receiving procedural-only instruction, participants receiving integrated instruction had superior retention and transfer outcomes, mediated by gains in conceptual knowledge (all P < 0.01). We found no significant differences between the integrated groups for retention, transfer, or conceptual knowledge (all P > 0.01).

Conclusions
We extended previous findings, showing integrated instruction (video- or simulator-based) improved trainees' conceptual knowledge, which mediated their improved retention and transfer. As an innovation, we demonstrated how simulators can facilitate cognitive integration by making abstract conceptual-procedural relationships material. In suggesting how researchers might capitalize further on simulator-based integration, we offer an alternative framework for designing simulations that emphasizes cognitive processes rather than simulator fidelity.
Development and Validation of a Patient-reported Outcome Measure for Gastrointestinal Obstruction in the Setting of Advanced Malignancy
Authors: Badgwell Brian , Williams Loretta A. , Chen Tsun Hsuan , Cleeland Charles , Mendoza Tito 
Published: January 2021

Objective:
We sought to construct a valid and reliable patient-reported outcome measure for patients with advanced malignancy and GIO.

Background:
Bowel obstruction is the most common indication for palliative surgical consultation in patients with advanced cancer; however, no validated patient-reported outcome measures exist for this population.

Methods:
A total of 125 patients with GIO and 64 patients without GIO who underwent palliative surgical consultation completed the MDASI-GIO questionnaire and a single global quality-of-life question. Summary statistics were used to assess the symptom burden of GIO patients. Outcome measures were validity (construct and criterion) and reliability (internal and test-retest) for the MDASI-GIO.

Results:
The majority of patients rated the severity of each of the 5 following GIO-specific symptoms as moderate to severe (rating of ≥5 on a 0 to 10 scale): “being unable to eat’’ (72%), “being unable to have a bowel movement’’ (65%), “abdominal discomfort’’ (62%), “stomach feeling full’’ (55%), and “abdominal cramping’’ (54%). The MDASI-GIO subscale Cronbach coefficient alpha values were 0.80–0.91, and intraclass correlations were 0.72–0.84. Correlations between MDASI-GIO subscales and global quality of life were –0.39 to–0.49 (P < 0.001 for all comparisons). GIO patients had significantly worse symptoms and higher interference than did non-GIO patients (all P < 0.05) with effect-size differences of ≥0.36, supporting known-group validity.

Conclusions:
The MDASI-GIO shows initial validity and reliability for assessing the severity of symptoms of patients with GIO and the interference of these symptoms in patients’ daily functioning.
Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room
Authors: Yates Elizabeth F. , Bowder Alexis N. , Roa Lina , Velin Lotta , Goodman Andrea S. , Nguyen Louis L. , McClain Craig D. , Meara John G. , Cooper Zara 
Published: January 2021

Objective:
We review the existing research on environmentally sustainable surgical practices to enable SAO to advocate for improved environmental sustainability in operating rooms across the country.

Summary of Background Data:
Climate change refers to the impact of greenhouse gases emitted as a byproduct of human activities, trapped within our atmosphere and resulting in hotter and more variable climate patterns.1 As of 2013, the US healthcare industry was responsible for 9.8% of the country's emissions2; if it were itself a nation, US healthcare would rank 13th globally in emissions.3 As one of the most energy-intensive and wasteful areas of the hospital, ORs drive this trend. ORs are 3 to 6 times more energy intensive than clinical wards.4 Further, ORs and labor/delivery suites produce 50%–70% of waste across the hospital.5,6 Due to the adverse health impacts of climate change, the Lancet Climate Change Commission (2009) declared climate change “the biggest global health threat of the 21st century” and predicted it would exacerbate existing health disparities for minority groups, children and low socioeconomic patients.7

Methods/Results:
We provide a comprehensive narrative review of published efforts to improve environmental sustainability in the OR while simultaneously achieving cost-savings, and highlight resources for clinicians interested in pursuing this work.

Conclusion:
Climate change adversely impacts patient health, and disproportionately impacts the most vulnerable patients. SAO contribute to the problem through their resource-intensive work in the OR and are uniquely positioned to lead efforts to improve the environmental sustainability of the OR.
Patient Perceptions of Audio and Video Recording in the Operating Room
Authors: Gallant Jean-Nicolas , Brelsford Kathleen , Sharma Sahil , Grantcharov Teodor , Langerman Alexander 
Published: January 2021

Objective:
The goal of this study was to determine surgical patients’ perceptions of hypothetical continuous audio-video OR recording (ORR).

Summary of Background Data:
Continuous audio-video recording of the operating room (OR), akin to the aviation industry's black box, has been proposed as a means to enhance training, supplement the medical record, and allow large-scale analysis of surgical performance and safety. These recordings would include patients' bodies; yet, understanding of patient perceptions regarding such technology is limited.

Methods:
Semi-structured interviews were conducted during elective surgery preoperative appointments during a 2-week period in August 2018 at a quaternary care center. Deidentified transcripts were analyzed using thematic analysis.

Results:
Forty-nine subjects were interviewed. Subjects recognized the potential for recording to improve surgical quality, safety and training. Subjects also desired access to an objective record of their own surgery, for the purposes of future care, medical-legal evidence, and to satisfy their own curiosity and understanding. Subjects had mixed perceptions regarding OR decorum and thus, differing views on the potential effect of ORR on OR behavior; some imagined that ORR would discourage bad behavior and others worried that it would cause unnecessary anxiety to the surgical team.

Conclusions:
Patients have a diverse set of views about the potential benefits, risks, and uses for OR data and consider themselves to be important stakeholders. Our study identifies pathways and potential challenges to implementation of continuous audio/video recording in ORs.
Antibody Development in Patients Treated Long-Term With OnabotulinumtoxinA for Benign Essential Blepharospasm and Hemifacial Spasm
Authors: Czyz Craig N. , Burns John A. , Bergstrom Reece E. 
Published: January 2021

Background:
Report the development of onabotulinumtoxinA neutralizing antibodies in patients treated consecutively for 20 years or longer for benign essential blepharospasm (BEB), hemifacial spasm (HFS), and Meige Syndrome.

Methods:
Prospective, randomized, cross-sectional study of 12 randomly selected patients from a single clinical practice that have been treated consecutively for 20 or more years with onabotulinumtoxinA for BEB, HFS, or Meige Syndrome. Serum samples were collected from each subject and analyzed for neutralizing antibody formation using the Mouse Protection Assay.

Results:
None of the tested patients (0%) displayed neutralizing antibodies to onabotulinumtoxinA. The mean duration of treatment was 27.5 years (range 22.1–34.1, SD 3.1, 95% confidence interval 25.45–29.50). Nine of the patients had a diagnosis of BEB, 2 HFS, and one Meige. Eleven of the 12 patients were women. There was no statistically significant difference in treatment dosage or interval over the course of treatment.

Conclusions:
The data support previous studies showing low incidence of antibody formation for botulinum A toxins with this subset of long-term treated patients. The results also provide further evidence for studies that have suggested increased onabotulinumtoxinA treatment volumes and/or decreased intervals between treatments are not due to neutralizing antibody formation and secondary non-response, but rather study designs that do not consider the titration phase of initial treatments. This study is specific to long-term treated patients, and the results cannot be generalized to patients naive to treatment.
Delayed Interventions, Low Compliance, and Health Disparities Amplified the Early Spread of COVID-19
Authors: Jalali Aliea M. , Khoury Sumaia G. , See JongWon , Gulsvig Alexis M. , Peterson Brent M. , Gunasekera Richard S. , Buzi Gentian , Wilson Jason , Galbadage Thushara 
Published: January 2021

AbstractThe United States (US) public health interventions were rigorous and rapid, yet failed to arrest the spread of the Coronavirus Disease 2019 (COVID-19) pandemic as infections spread throughout the US. Many factors have contributed to the spread of COVID-19, and the success of public health interventions depends on the level of community adherence to preventative measures. Public health professionals must also understand regional demographic variation in health disparities and determinants to target interventions more effectively. In this study, a systematic evaluation of three significant interventions employed in the US, and their effectiveness in slowing the early spread of COVID-19 was conducted. Next, community-level compliance with a state-level stay at home orders was assessed to determine COVID-19 spread behavior. Finally, health disparities that may have contributed to the disproportionate acceleration of early COVID-19 spread between certain counties were characterized. The contribution of these factors for the disproportionate spread of the disease was analyzed using both univariate and multivariate statistical analyses. Results of this investigation show that delayed implementation of public health interventions, a low level of compliance with the stay at home orders, in conjunction with health disparities, significantly contributed to the early spread of the COVID-19 pandemic.
Invasive Mould Disease in Fatal COVID-19: A Systematic Review of Autopsies
Authors: Kula Brittany E. , Clancy Cornelius J. , Nguyen M. Hong , Schwartz Ilan S. 
Published: January 2021

BackgroundInvasive mould disease (IMD) – most commonly pulmonary aspergillosis - is reported to affect up to a third of critically ill COVID-19 patients. Most reported cases are diagnosed with probable/putative COVID-19 associated pulmonary aspergillosis (CAPA) based on a combination of non-specific clinical, radiographic, and mycological findings, but the clinical significance – and whether these cases represent true invasive disease – is unresolved.MethodsWe performed a systematic review of autopsy series of decedents with COVID-19 for evidence of IMD. We searched PubMed, Web of Science, OVID (Embase) and MedRxiv for English- or French-language case series published between January 1, 2019 to September 26, 2020. We included series describing lung histology of ≥3 decedents, and authors were contacted for missing information as necessary.FindingsWe identified 51 case series describing autopsies of 702 decedents. Individual-level data was available for 430 decedents. The median age was 72 (IQR 61 to 80) years. Diabetes mellitus, pre-existing lung disease, and immunocompromising conditions were reported for 129 (32%), 95 (22%), and 25 (6%) decedents, respectively. The median hospitalization length was 10 (IQR 5-22) days. 51.6% of decedents had received mechanical ventilation for a median of nine (IQR 5-20) days. Treatment included immunomodulation in 60 (most often steroids or tocilizumab) and antifungals in 41 decedents. Eleven decedents (1·6%) had autopsy-confirmed IMD (6 with CAPA, 4 with invasive pulmonary mycosis not specified and 1 with disseminated mucormycosis). Among 173 decedents who received mechanical ventilation, 5 had IMD (2·9%).InterpretationAutopsy-proven IMD, including CAPA, is uncommon in fatal COVID-19.FundingThis study is unfundedCategoryReview
Efficient Surveillance and Temporal Calibration of Disease Response
Authors: Najeebullah Kamran , Liebig Jessica , Darbro Jonathan , Jurdak Raja , Paini Dean 
Published: January 2021

AbstractBackgroundDisease surveillance and response are critical components of epidemic preparedness. The disease response, in most cases, is a set of reactive measures that follow the outcomes of the disease surveillance. Hence, efficient surveillance is a prerequisite for an effective response.Methodology/Principal FindingsWe introduce the principle of epidemiological soundness and utilize it to construct a disease spread network. The network implicitly quantifies the fertility (whether a case leads to secondary cases) and reproduction (number of secondary cases per infectious case) of the cases as well as the size and generations (of the infection chain) of the outbreaks. We empirically confirm that high morbidity relates positively with delay in disease response. Moreover, we identify what constitutes efficient surveillance by applying various thresholds of disease response delay to the network and report their impact on case fertility, reproduction, number of generations and ultimately, outbreak size. Lastly, we identify the components of the disease surveillance system that can be calibrated to achieve the identified efficiency thresholds.ConclusionWe identify practically achievable, efficient surveillance thresholds (on temporal scale) that lead to an effective response and identify how they can be satisfied. Our approach can be utilized to provide guidelines on spatially and demographically targeted resource allocation for public awareness campaigns as well as to improve diagnostic abilities and turn-around times for the doctors and laboratories involved.Author SummaryEfficient surveillance and effective response capabilities are pivotal to the prevention and control of the infectious diseases. The disease response is a set of reactive actions that follow the outcomes of the disease surveillance. Ergo, efficient surveillance is a perquisite for the deployment of an effective response. The quantification of the efficiency of a disease surveillance system largely depends on the epidemiological characteristics of the disease. In this paper, we introduce an approach that builds on these characteristics and measures the performance of a disease surveillance system through its impact on the incidence of the disease. Using this approach, we obtain quantitative (on a temporal scale) efficient surveillance thresholds, which if followed by a timely response, lead to a considerable reduction in the disease incidence. Furthermore, we show that these thresholds are practically achievable by identifying the obstacles that lead to less than efficient surveillance outcomes. Our approach can be applied to obtain guidelines on spatially, temporally and demographically targeted resource allocations for public awareness campaigns as well to improve diagnostic ability and turn-around times in treating doctors and pathology labs.
GCH1mutations in hereditary spastic paraplegia
Authors: Varghaei Parizad , Yoon Grace , Estiar Mehrdad A , Veyron Simon , Leveille Etienne , Dupre Nicolas , Trempe Jean-François , Rouleau Guy A , Gan-Or Ziv 
Published: January 2021

AbstractGCH1mutations have been associated with dopa-responsive dystonia (DRD), Parkinson’s disease (PD) and tetrahydrobiopterin (BH4)-deficient hyperphenylalaninemia B. Recently,GCH1mutations have been reported in five patients with hereditary spastic paraplegia (HSP). Here, we analyzed a total of 400 HSP patients (291 families) from different centers across Canada by whole exome sequencing (WES). Three patients with heterozygousGCH1variants were identified: monozygotic twins with a p.(Ser77_Leu82del) variant, and a patient with a p.(Val205Glu) variant. The former variant is predicted to be likely pathogenic and the latter is pathogenic. The three patients presented with childhood-onset lower limb spasticity, hyperreflexia and abnormal plantar responses. One of the patients had diurnal fluctuations, and none had parkinsonism or dystonia. Phenotypic differences between the monozygotic twins were observed, who responded well to levodopa treatment. Pathway enrichment analysis suggested that GCH1 shares processes and pathways with other HSP-associated genes, and structural analysis of the variants indicated a disruptive effect. In conclusion,GCH1mutations may cause HSP; therefore, we suggest a levodopa trial in HSP patients and includingGCH1in the screening panels of HSP genes. Clinical differences between monozygotic twins suggest that environmental factors, epigenetics, and stochasticity could play a role in the clinical presentation.