bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategy for Correction of the Whistling Deformity in Secondary Cleft Lip Reconstruction
Authors: Jian Xinchun , Jian Yu , Wu Xiaoshan , Li Hongyi 
Published: February 2021

Background:
Following primary repair of a cleft lip, patients present with many facial deformities. One of the commonly observed sequelae of cleft lip repair is a whistling deformity. This retrospective study was carried out to evaluate the outcomes following correction of whistling deformities in secondary cleft lip reconstruction.

Methods:
We retrospectively reviewed the hospital records of patients with various whistling deformities who underwent repair from April 1989 to March 2018; 2 surgeons performed the repair using either the double movable mucomuscular complex flaps technique, modified Abbe flap technique, or Abbe flap technique. The postoperative anatomical structure and aesthetic effects of the surgery were evaluated.

Results:
In total, 136 patients were included in this study. Among these patients, 60 (44.2%) had a grade I whistling deformity and 47 (34.5%) had a grade II deformity and repair was performed using the double movable mucomuscular complex flaps technique and modified Abbe flap transfer technique, respectively, whereas the Abbe flap transfer technique was used in 16 patients (11.8%) and 13 patients (9.5%) with a grade III and grade IV whistling deformity, respectively. All patients were found to have normal postoperative anatomical structures and aesthetic effects of the upper lip, with all patients experiencing mild to moderate postoperative edema of the upper lip, and 29 cases (21.3%) developed an inconspicuous scar.

Conclusion:
The repair technique should be chosen based on the type of whistling deformity.
A Safe and Effective Lip Augmentation Method: The Step-by-Step Φ (Phi) Technique
Authors: Keramidas Evangelos , Rodopoulou Stavroula , Gavala Maria-Ioanna 
Published: February 2021

Background:
The shape and fullness of the lips are essential in facial aesthetics. We describe a safe injection technique of hyaluronic acid (HA), based on the well-known golden number Φ (phi), for lip augmentation.

Methods:
The name given to that procedure is “the step-by-step Φ technique.” Firstly, “step-by-step” because we never inject more than 1–1.5 ml of HA in 1 session, and “phi” because we apply the golden ratio 1.618—broadly known as Φ—to identify the proper points for injection. Using a specific caliper, we identified 3–4 points in each upper half of the lip. We injected 0.01–0.05 ml of lower concentration (25 mg/g) HA in these particular areas of the upper lip, from the vermillion border into the vermillion. We took into consideration the existing lip volume to decide the proper amount of HA to be injected in every single site, as lips are often asymmetric. On the lower lip, we use the same caliper to identify again the proper injection points. If necessary, the next 2 sessions are performed at an interval of 15–30 days.

Results:
Our technique was performed in 833 patients. Mean age was 30.2 years (range: 18–72 years), and most patients were very satisfied. With this technique, we avoid severe complications such as arterial embolism or venous occlusion and unnatural results. The most common side effects were swelling, redness, and mild pain.

Conclusion:
The step-by-step Φ technique is safe, easy to learn and perform, and can provide natural results in lip augmentation.
A Workhorse Flap for Covering Moderate-sized Defects after Breast-conserving Surgery: Supercharged Lateral Thoracodorsal Flap
Authors: Kim Do Gon , Choi Dong Hun , Lee Joon Seok , Lee Jeong Woo , Lee Jeeyeon , Park Ho Yong , Yang Jung Dug 
Published: February 2021

Background:
The lateral thoracodorsal (LTD) flap technique is a type of oncoplastic breast surgery that involves transposition of tissue from the lateral aspect of a partial mastectomy defect. It is a relatively simple procedure and shows lower donor morbidity and good aesthetic outcomes. Complications, such as fat necrosis and wound dehiscence due to poor circulation, may occur at the distal part of the flap. We used a supercharged LTD flap to reduce this problem. In this study, the outcomes of the LTD flap over 13 years were reviewed.

Methods:
We performed a retrospective study of 86 patients who underwent an LTD flap procedure between 2007 and 2019. We analyzed patient information using medical chart review and classified patients into groups according to lateral thoracic artery perforator supercharging. The incidence of complications, such as fat necrosis and wound dehiscence, was also analyzed.

Results:
The mean tumor weight was 83.67 g, and defects had a moderate size, as they represented 25.02% of the total breast volume. Fat necrosis was noted in 19.4% of cases in the group without lateral thoracic artery perforator supercharging and 4% of cases in the group with supercharging, with a significantly lower rate in the supercharged group.

Conclusions:
Our findings show that the LTD flap could be used to cover moderate-sized defects after breast-conserving surgery. Careful dissection to preserve the lateral thoracic artery perforator resulted in the reduction of complications, such as fat necrosis, and excellent aesthetic results.
Association of long-term SBP with clinical outcomes and quality of life in heart failure with preserved ejection fraction: an analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial
Authors: Huang Peisen , Yu Yuan , Wei Fangfei , Zhu Wengen , Xue Ruicong , Dong Yugang , Liu Chen 
Published: February 2021

Aims:
To determine the associations of long-term SBP (LT-SBP) levels with clinical outcomes and health-related quality of life in heart failure with preserved ejection fraction (HFpEF).

Methods and results:
We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study with available different SBP measurements from different follow-ups (n = 3310). LT-SBP was the mean SBP value from 4-week measurement to the last one. The outcome measures are all-cause mortality and a composite of heart failure readmission or all-cause mortality and the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score. To determine the associations of LT-SBP and outcomes, we used adjusted Cox proportional hazards models and restricted cubic spline models. After multivariable adjustment, LT-SBP of 120–129 and 130–139 mmHg were associated with a lower risk of mortality (hazard ratio 0.66, 95% CI 0.51–0.87, P = 0.003; hazard ratio 0.68, 95% CI 0.51–0.90, P = 0.007, respectively); LT-SBP of 100–119 mmHg had similar risk of mortality (hazard ratio 0.96, 95% CI 0.72–1.28, P = 0.778) compared with LT-SBP of at least 140 mmHg. There was U-shaped relationship between LT-SBP and all-cause mortality (P < 0.001) with nadir risk occurring around 123 mmHg. Similar relationships were observed between LT-SBP and composite end point of heart failure readmission or all-cause mortality. The adjusted mean improvement in KCCQ score was significantly higher in the 120–129 mmHg group than in the at least 140 mmHg group beginning from the 12-month follow-up visit without significant differences in other groups.

Conclusion:
Among patients with HFpEF, long-term control of SBP level at 120–129 mmHg is independently associated with the highest risk reduction of all-cause mortality and improvement of KCCQ score. Future randomized clinical trials need to specifically evaluate optimal SBP treatment goals in patients with HFpEF.
A Case of Black Fungal Keratitis Caused by Biatriospora mackinnonii
Authors: Aoki Takanori , Fukuoka Hideki , Inatomi Tsutomu , Horiuchi Noriko , Kamei Katsuhiko , Sotozono Chie 
Published: February 2021

Purpose:
To report a novel case of fungal keratitis caused by Biatriospora mackinnonii (Pyrenochaeta mackinnonii), a dematiaceous fungus (black fungus) that rarely causes dermatological infection, in a patient treated for ocular cicatricial pemphigoid.

Methods:
An 81-year-old patient with ocular cicatricial pemphigoid was referred to our hospital because of persistent corneal epithelial defects in his left eye. On examination, a slightly elevated dark lesion in the middle of the erosion and hypopyon was observed in that eye, with smear examination of the obtained specimen revealed a filamentous fungal-like material. Initially, treatment included miconazole and fluconazole ophthalmic solution eye drops, natamycin ophthalmic ointment, and systemic voriconazole, followed surgical scraping of the mass, an anterior chamber lavage, and a subconjunctival injection of miconazole. However, the focus had resistance to the treatment and finally led to corneal perforation; hence, therapeutic penetrating keratoplasty (PKP) was subsequently performed.

Results:
Mycological testing revealed that the lesions were Candida parapsiliosis and black fungus, with the black fungus classified as B. mackinnonii via DNA sequencing of the internal transcribed spacer and the D1/D2 domains of the 28S rRNA gene. Fungal keratitis caused by B. mackinnonii was resistant to the antifungal drugs, yet was ameliorated by PKP, with no recurrence of fungal keratitis for more than 2 years postoperative.

Conclusions:
To the best of our knowledge, this is the first reported case of fungal keratitis caused by B. mackinnonii; however, in this case, PKP surgery resulted in a favorable outcome.
Discontinuation of Transmission Precautions for COVID-19 Patients
Authors: Jiwani Rahim A. , Mao Yuxuan , Pona Adrian , Bradner Evan , Hussain Jaffer , Stalls J. Stephen , Cook Paul , Burch Ashley , Afriyie Felix , Labbe Jonathan , Younes Ahmed , Badr Mai , Lee Elisabeth , Roper Rachel L. 
Published: February 2021

Background
The decision of when it is safe to discontinue transmission-based precautions for SARS-CoV-2 coronavirus disease 2019 (COVID-19) hospitalized patients has been controversial. The Centers for Disease Control and Prevention offered reverse transcriptase polymerase chain reaction (PCR) diagnostic test- or symptom-based guidelines.

Methods
A retrospective chart review of Vidant Health system, Eastern North Carolina, was conducted. Length of stay, days in isolation unit, and date appropriate for discharge or isolation discontinuation based on the symptom-based strategy were recorded.

Results
Of 196 COVID hospitalized patients, 34 had repeated COVID PCR tests 3 or more days from their first positive test result. Half of these patients experienced delays in release from transmission-based precautions because of repeated positive PCR test results and use of the test-based approach. This resulted in an additional 166 days of hospitalization, costing an estimated $415,000. Furthermore, 2 subjects had a combined 16-day delay in necessary medical procedures. Most of the COVID PCR platforms yield quantitative results in the form of cycle threshold (Ct) values, the number of cycles needed to detect the genome. These values have also been used to assess whether patients are likely to remain contagious. None of our patients who met the criteria for symptom-based strategy for transmission-based precaution discontinuation had positive PCR test results with Ct values lower than 25, but 4 had Ct values lower than 30.

Conclusions
Concerns surround immunocompromised patients and those treated with steroids who might be delayed or incapable of stopping viral replication and thus remain contagious. Our results suggest that clinicians use all available data including Ct values to evaluate the safety of discontinuation of transmission precautions.
Heightened pain facilitation rather than impaired pain inhibition distinguishes those with moderate/severe disability in work-related neck pain
Authors: Xie Yanfei , Thomas Lucy , Barbero Marco , Falla Deborah , Johnston Venerina , Coombes Brooke K. 
Published: February 2021

Abstract
To better understand the mechanisms underpinning work-related neck pain, this cross-sectional and single-blinded study compared somatosensory profiles among sonographers with varied neck disability levels. Based on K-mean cluster analysis of scores on the neck disability index (NDI), participants were classified into no (NDI ≤ 8%, n = 31, reference group), mild (NDI = 10%-20%, n = 43), or moderate/severe (NDI ≥ 22%, n = 18) disability groups. Data were collected on bodily pain distribution and severity and psychological measures including depression, anxiety, pain-catastrophizing, and fear-avoidance beliefs using validated scales. Participants attended 1 session of quantitative sensory testing performed according to a standardized protocol, including local and remote thermal and mechanical pain thresholds, temporal summation of pain (TSP), conditioned pain modulation, and an exercise-induced analgesia paradigm. Compared with participants with no and mild disability, those with moderate/severe disability showed more widespread pain, cold and mechanical hyperalgesia at a remote nonpainful site, and significantly higher TSP. Participants with mild disability demonstrated significantly higher TSP than those with no disability. These group differences were attenuated after adjusting for depression or anxiety, indicating these psychological factors may mediate the somatosensory changes associated with neck disability. Group differences were not found for conditioned pain modulation or exercise-induced analgesia. These findings suggest that heightened pain facilitation, rather than impaired pain inhibition may underpin nociplastic pain in participants with moderate/severe disability, and it may be associated with depression and anxiety. Clinicians should be aware that individuals with work-related neck pain presenting with moderate/severe disability display distinct somatosensory features and tailor management strategies accordingly.
Barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain: a systematic review and qualitative evidence synthesis
Authors: Ng Wendy , Slater Helen , Starcevich Cobie , Wright Anthony , Mitchell Tim , Beales Darren 
Published: February 2021

Abstract
A substantial evidence–practice gap exists between healthcare professionals learning about the biopsychosocial model of pain and adopting this model in clinical practice. This review aimed to explore the barriers and enablers that influence the application of a biopsychosocial approach to musculoskeletal pain in practice, from the clinicians' perspective. Qualitative evidence synthesis was used. Four electronic databases (CINAHL, EMBASE, MEDLINE, and PsycINFO) were searched. Primary qualitative studies were included if they investigated the experiences of primary healthcare professionals using a biopsychosocial model of musculoskeletal pain care in outpatient settings or their perceptions towards biopsychosocial-oriented clinical practice guidelines. After screening 6571 abstracts, 77 full-text articles were retrieved. Twenty-five studies met the eligibility criteria, reporting the experiences of 413 healthcare professionals (including general practitioners, physiotherapists, and others) spanning 11 countries. Three metathemes were identified that impact the adoption of the biopsychosocial model across the whole of health: (1) at the microlevel, healthcare professionals' personal factors, knowledge and skills, and their misconceptions of clinical practice guidelines, perception of patients' factors, and time; (2) at the mesolevel, clinical practice guideline formulation, community factors, funding models, health service provision, resourcing issues, and workforce training issues; and (3) at the macrolevel, health policy, organizational, and social factors. Synthesized data revealed multilevel (whole-of-health) barriers and enablers to health professionals adopting a biopsychosocial model of pain into practice. Awareness of these multilevel factors may help inform preimplementation preparedness and support more effective implementation of the biopsychosocial model of musculoskeletal pain into clinical practice.
Risk Factors for Reaching Core Body Temperature Thresholds in Florida Agricultural Workers
Authors: Mac Valerie , Elon Lisa , Mix Jacqueline , Tovar-Aguilar Antonio , Flocks Joan , Economos Eugenia , Hertzberg Vicki , McCauley Linda 
Published: February 2021

Background:
There is a compelling need to identify agricultural workers at risk for heat related illness (HRI).

Methods:
Data from Florida agricultural workers (N = 221) were collected over 3 summer workdays (2015 to 2017) to examine risk factors for exceeding NIOSH-recommended core temperature (Tc) thresholds (38 °C [Tc38] and 38.5 °C [Tc38.5]) using generalized linear mixed models.

Results:
On an average workday, 49% of participants exceeded Tc38 and 10% exceeded Tc38.5. On average, participants first exceeded both thresholds early in the day; the Tc38 threshold mid-morning (10:38 AM), and Tc38.5 about a half hour later (11:10 AM). Risk factors associated with exceeding Tc38 included years working in US agriculture, body mass index, time performing moderate-to-vigorous physical activity, increasing heat index, and field crop work.

Conclusions:
The high prevalence of core temperatures exceeding recommended limits emphasizes the serious need for mandated HRI prevention programs for outdoor workers.
Training Occupational and Environmental Medicine (OEM) Residents at the Uniformed Services University
Authors: Krahl Pamela L. , Thomas Richard J. , Gaydos Joel C. , Mallon Timothy M. 
Published: February 2021

Objective:
To develop an actionable plan to sustain and improve the quality of the Uniformed Services University of the Health Sciences (USU) Occupational and Environmental Medicine (OEM) Residency Program.

Methods:
Program metrics were collected and analyzed to assess strengths, weaknesses, opportunities, and threats (SWOT analysis).

Results:
Program strengths are stable funding, full-time faculty and large class size. Weaknesses are limited toxicology curriculum, and the lack of complex clinical cases. Opportunities include establishing an OEM referral clinic, collaborating with U.S. Department of Defense (DoD) toxicology programs, aligning OEM research priorities in DoD, and including DoD Civilian physicians in OEM residency training. Threats are Military Health System reorganization, budget, and personnel cuts.

Conclusions:
The USU OEM Residency is strong but must be flexible to adjust to personnel, fiscal, and organizational changes. Aggregating the SWOT analyses for all the OEM residency programs may help identify strategies to sustain OEM training in the United States.
COVID-19 Vaccine Acceptability Among US Firefighters and Emergency Medical Services Workers
Authors: Caban-Martinez Alberto J. , Silvera Carlos A. , Santiago Katerina M. , Louzado-Feliciano Paola , Burgess Jefferey L. , Smith Denise L. , Jahnke Sara , Horn Gavin P. , Graber Judith M. 
Published: February 2021

Objectives:
Estimate the point prevalence of COVID-19 vaccine acceptability among US firefighters and Emergency Medical Services (EMS) workers.

Methods:
A cross-sectional study design was used to administer an anonymous online survey to a national non-probabilistic sample of firefighter and EMS workers.

Results:
Among the 3169 respondents, 48.2% expressed high acceptability of the COVID-19 vaccine when it becomes available, while 24.2% were unsure and 27.6% reported low acceptability. Using the “high COVID-19 vaccine acceptability” group as the reference category, the groups with greater odds of reporting low acceptability included those: 30 to 39 years of age (odds ratio = 3.62 [95% confidence interval = 2.00 to 6.55]), Black race (3.60 [1.12 to 11.53]), Hispanic/Latinx ethnicity (2.39 [1.45 to 3.92]), with some college education (2.06 [1.29 to 3.27]), married (1.65 [1.03 to 2.65]), of current rank firefighter/EMS (2.21 [1.60 to 3.08]).

Conclusions:
Over half of US firefighters and EMS workers were uncertain or reported low acceptability of the COVID-19 vaccine when it becomes available.
The Economic Burden of Tenosynovial Giant Cell Tumors Among Employed Workforce in the United States
Authors: Lin Feng , Ionescu-Ittu Raluca , Pivneva Irina , Wynant Willy , Shi Sherry , Wu Eric Q. , Kwong Winghan J. , Abraham John A. 
Published: February 2021

Objective:
To assess the economic burden of tenosynovial giant cell tumor (TGCT) among US employed workforce.

Methods:
Patients with TGCT medical claims (N = 1395) and matched controls (1:10) without TGCT claims (N = 13,950) were identified from the OptumHealth Care Solutions, Inc. database (January 1, 1999 to March 31, 2017). Adjusted regression models were used to compare healthcare resource utilization, time lost from work, and associated costs between cohorts.

Results:
In patients with TGCT, the rates of inpatient admissions, emergency room visits, outpatient visits, and work loss days were 2.8, 1.5, 2.2, and 2.6 times those of matched controls, respectively (all P < 0.001). Total annual all-cause healthcare costs and work loss-related costs were $9368 and $2708 higher for TGCT patients than for matched controls, respectively (all P < 0.001).

Conclusions:
TGCT was associated with a significant healthcare and work loss burden on US employers.
Academic dishonesty: What impact does it have and what can faculty do?
Authors: Pittman Oralea A. , Barker Elizabeth 
Published: February 2021

ABSTRACT
Academic dishonesty occurs among nursing students at multiple levels of professional education programs. Studies have shown that students who commit dishonest acts in the educational setting may also commit dishonest acts as students in the clinical setting and as professionals in their practice setting. This lack of professional integrity may result in poor outcomes for patients as well as loss of trust from patients and from colleagues. Although multiple studies done among prelicensure nursing students explored academic dishonesty, there are few studies of academic integrity among nurse practitioner (NP) students. As advanced practice nurses, we need to understand the issues of academic dishonesty among NP students through further research. As faculty, we must act to prevent academic dishonesty and unethical behavior and to provide appropriate consequences when it occurs. It is also important that we consider ways to socialize students into ethical behavior to maintain trust in the profession. It is important that we respond to both students and colleagues who demonstrate a lack of integrity. All NPs must work to create a culture of professional integrity among students and members of the profession at every level.