bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brief Report: Point of Care Cryptococcal Antigen Screening: Pipetting Finger-Prick Blood Improves Performance of Immunomycologics Lateral Flow Assay
Authors: Wake Rachel M. , Jarvis Joseph N. , Harrison Thomas S. , Govender Nelesh P. 
Published: May 2018

Background:
Cryptococcal antigen (CrAg) screening at the point of care could improve cryptococcal meningitis prevention where laboratory resources are limited. We evaluated the accuracy of Immunomycologics (IMMY, Norman, OK) CrAg lateral flow assay (LFA) using different techniques at point of care.

Setting:
Two tertiary-level hospitals in Johannesburg and a community health clinic in Soweto, South Africa.

Methods:
A case–control diagnostic validation study and a prospective clinic-based implementation study using the IMMY CrAg LFA on finger-prick blood. Accuracy, using direct application of LFA to sample, or pipette to transfer sample to diluent, and reading after 10 and 20 minutes, was compared with laboratory-based plasma testing.

Results:
The validation study tested 64 CrAg-positive and 152 CrAg-negative patients with no symptoms or signs of meningitis, identified by routine laboratory screening, recruited by convenience sampling. Consecutively diagnosed HIV-infected adults (n = 654) were included in the implementation study. Sensitivity was 82% and 20% when the LFA was read 10 minutes after direct application to finger-prick blood in the validation and implementation studies, respectively. Using a pipette to transfer blood and reading after 20 minutes improved sensitivity to 100%, while retaining 100% specificity, in both studies.

Conclusions:
Although the IMMY CrAg LFA performs well when applied directly to finger-prick blood for diagnosing cryptococcal meningitis, this technique may not provide adequate volume to detect low concentrations of CrAg when screening asymptomatic patients. Using a pipette to transfer larger volumes of blood to diluent before CrAg LFA testing and reading results after 20 minutes is a more reliable point-of-care method.
Cytomegalovirus-Specific CD4+ T-cell Responses and CMV-IgG Levels Are Associated With Neurocognitive Impairment in People Living With HIV
Authors: Ballegaard Vibe , Pedersen Karin Kaereby , Pedersen Maria , Brændstrup Peter , Kirkby Nikolai , Buus Anette Stryhn , Ryder Lars P. , Gerstoft Jan , Nielsen Susanne Dam 
Published: May 2018

Background:
Mechanisms leading to neurocognitive impairment (NCI) in people living with HIV (PLWHIV) on stable combination antiretroviral therapy (cART) remain unknown. We investigated the association between immunity against cytomegalovirus (CMV), HIV-specific variables, and NCI in PLWHIV on stable cART and with low comorbidity.

Methods:
Fifty-two PLWHIV on stable cART and 31 HIV-uninfected controls matched on age, sex, education, and comorbidity were tested with a neurocognitive test battery, and CMV-immunoglobulin G (CMV-IgG) levels were measured. In PLWHIV, CMV-specific (CMV-pp65 and CMV-gB) CD4+ and CD8+ T-cell responses were measured using intracellular cytokine staining and flow cytometry. NCI was defined as a global deficit scale score (GDS score) ≥0.5. GDS scores and domain-specific scores defined severity of NCI. Logistic and linear multivariable regression analyses were used.

Results:
NCI was detected in 30.8% of PLWHIV, and HIV was associated with an adjusted odds ratio (aOR) of 5.18 [95% confidence interval (CI): 1.15 to 23.41, P = 0.033] for NCI. In PLWHIV, higher CMV-specific CD4+ T-cell responses increased the probability of NCI with an aOR of 1.68 (95% CI: 1.10 to 2.57) for CMV-pp65 or an aOR of 3.73 (95% CI: 1.61 to 16.98) for CMV-gB, respectively. Similar associations were not found with CMV-IgG or CMV-specific CD8+ T cells, but when assessing severity of NCI, higher CMV-IgG (per 100 U/mL) was associated with worse GDS scores (β = 0.08) (0.01–0.16), P = 0.044), specifically in the domain of speed of information processing (β = 0.20 (0.04–0.36, P = 0.019).

Conclusions:
PLWHIV had increased risk of NCI. Excess risk may be associated with CMV-specific CD4+ T-cell responses and CMV-IgG. Larger longitudinal studies investigating the impact of immunity against CMV on risk of NCI are warranted.
Extended-release Naltrexone Improves Viral Suppression Among Incarcerated Persons Living with HIV and Alcohol use Disorders Transitioning to the Community: Results From a Double-Blind, Placebo-Controlled Trial
Authors: Springer Sandra A. , Di Paola Angela , Barbour Russell , Azar Marwan M. , Altice Frederick L. 
Published: May 2018

Objective:
To determine whether extended-release naltrexone (XR-NTX) would improve or maintain viral suppression (VS) among incarcerated individuals with HIV and alcohol use disorders (AUDs) transitioning to the community.

Design:
A randomized, double-blind, placebo-controlled trial was conducted among incarcerated individuals with HIV and AUDs transitioning to the community from 2010 through 2016.

Methods:
Eligible participants (N = 100) were randomized 2:1 to receive 6 monthly injections of XR-NTX (n = 67) or placebo (n = 33) starting at release and continued for 6 months. The primary and secondary outcomes were the proportion that maintained or improved VS at <200 and <50 copies per milliliter from baseline to 6 months, respectively, using an intention-to-treat analysis.

Results:
Participants allocated to XR-NTX improved VS from baseline to 6 months for <200 copies per milliliter (48.0%–64.2%, P = 0.024) and for <50 copies per milliliter (31.0%–56.7%, P = 0.001), whereas the placebo group did not (<200 copies/mL: 64%–42.4%, P = 0.070; <50 copies/mL: 42.0%–30.3%, P = 0.292). XR-NTX participants were more likely to achieve VS than the placebo group at 6 months (<200 copies/mL: 64.2% vs. 42.4%; P = 0.041; <50 copies/mL: 56.7% vs. 30.3%; P = 0.015). XR-NTX independently predicted VS [<200 copies/mL: adjusted odds ratio (aOR) = 2.68, 95% confidence interval (CI) = 1.01 to 7.09, P = 0.047; <50 copies/mL: aOR = 4.54; 95% CI = 1.43 to 14.43, P = 0.009] as did receipt of ≥3 injections (<200 copies/mL: aOR = 3.26; 95% CI = 1.26 to 8.47, P = 0.010; <50 copies/mL: aOR = 6.34; 95% CI = 2.08 to 19.29, P = 0.001). Reductions in alcohol consumption (aOR = 1.43, 95% CI = 1.03 to 1.98, P = 0.033) and white race (aOR = 5.37, 95% CI = 1.08 to 27.72, P = 0.040) also predicted VS at <50 copies per milliliter.

Conclusions:
XR-NTX improves or maintains VS after release to the community for incarcerated people living with HIV and AUDs.
Willingness to Donate Organs Among People Living With HIV
Authors: Nguyen Anh Q. , Anjum Saad K. , Halpern Samantha E. , Kumar Komal , Van Pilsum Rasmussen Sarah E. , Doby Brianna , Shaffer Ashton A. , Massie Allan B. , Tobian Aaron A.R. , Segev Dorry L. , Sugarman Jeremy , Durand Christine M. 
Published: May 2018

Background:
With passage of the HIV Organ Policy Equity (HOPE) Act, people living with HIV (PLWH) can donate organs to PLWH awaiting transplant. Understanding knowledge and attitudes regarding organ donation among PLWH in the United States is critical to implementing the HOPE Act.

Methods:
PLWH were surveyed regarding their knowledge, attitudes, and beliefs about organ donation and transplantation at an urban academic HIV clinic in Baltimore, MD, between August 2016 and October 2016. Responses were compared using Fisher exact and χ2 tests.

Results:
Among 114 survey respondents, median age was 55 years, 47.8% were female, and 91.2% were African American. Most were willing to be deceased donors (79.8%) or living donors (62.3%). Most (80.7%) were aware of the US organ shortage; however, only 24.6% knew about the HOPE Act, and only 21.1% were registered donors. Respondents who trusted the medical system or thought their organs would function adequately in recipients were more likely to be willing to be deceased donors (P < 0.001). Respondents who were concerned about surgery, worse health postdonation, or need for changes in HIV treatment because of donation were less likely to be willing to be living donors (P < 0.05 for all). Most believed that PLWH should be permitted to donate (90.4%) and that using HIV+ donor organs for transplant would reduce discrimination against PLWH (72.8%).

Conclusions:
Many of the PLWH surveyed expressed willingness to be organ donors. However, knowledge about the HOPE Act and donor registration was low, highlighting a need to increase outreach.
Comparison of Adults With Polyarticular Juvenile Idiopathic Arthritis to Adults With Rheumatoid Arthritis
Authors: Feger Danielle M. , Longson Nicholas , Dodanwala Hiranda , Ostrov Barbara E. , Olsen Nancy J. , June Rayford R. 
Published: May 2018

Background/ObjectiveMany individuals with juvenile idiopathic arthritis (JIA) have persistent disease into adulthood. Polyarticular JIA (pJIA) is often mislabeled as rheumatoid arthritis (RA) in adult rheumatology clinics, and treatment for adult pJIA patients is not well defined. We aimed to describe clinical features and medication use in the adult pJIA population in relation to an RA control cohort.MethodsWe performed a cross-sectional study of 45 adults with pJIA and 94 with RA seen from 2013 to 2017. Clinical characteristics including RA classification criteria were compared using χ2and McNemar tests. Medication use was analyzed focusing on tumor necrosis factor inhibitor (TNFi) survival, and an accelerated failure-time model was developed for time to methotrexate initiation.ResultsPolyarticular JIA patients were less likely to be rheumatoid factor or cyclic citrullinated peptide antibody positive; fewer than half of pJIA subjects met the RA 2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria. Time from diagnosis to methotrexate initiation was associated with longer disease duration in both groups (p< 0.01). Current TNFi use was more prevalent in pJIA patients (49% vs. 18%,p< 0.01), and TNFi use, particularly for etanercept, was sustained longer with a median drug survival of 4.41 years compared with 0.70 years in RA patients (p< 0.01).ConclusionsAlthough often considered together in adult rheumatology practice, adults with pJIA are distinct from patients with RA. Medication use markedly differed between the 2 populations with greater prevalence and duration of TNFi use in pJIA patients. Further study is needed to improve outcomes in this unique population.
Quality and Safety in Health Care, Part XLIII
Authors: Harolds Jay A. 
Published: May 2018

Abstract
To compare outcome results from different institutions in a registry, it is necessary to have a way to take into account differences in the risk characteristics of the patients. This model has been constructed for the Implantable Cardioverter Defibrillator (ICD) Registry, and the most important variables have been identified. In another study, it has also been found that many of these patients have comorbidities, and the mortality rate 60 months after a replacement ICD was 41.2%. In a third study, it was determined that for individuals at least 65 years of age, 60 months after ICD placement, 50.9% of the recipients used hospice services or were dead.
Venous Anastomoses in Anterolateral Thigh Flaps for the Lower Extremity
Authors: Mattos David , Diamond Shawn , Chattha Anmol S. , Riesel Johanna N. , Iorio Matthew L. 
Published: May 2018

Background
Dual venous drainage for anterolateral thigh flaps has been proposed to protect against flap-related complications in head and neck applications. Here we report our experience with single vs dual venous anastomosis during lower extremity free-tissue transfer.

Methods
All free anterolateral thigh flaps for lower extremity reconstruction from 2011 to 2017 were retrospectively reviewed. An algorithm was used to determine the type and number of venous anastomoses, emphasizing patient anatomy, venous quality, and size match. Patients were divided into single- and dual-venous-anastomosis groups. Univariate analysis determined differences between the groups. A multivariable analysis identified independent risk factors.

Results
Fifty patients met the inclusion criteria. Patient demographics, recipient sites, wound type, and flap characteristics were similar in 1 and 2 vein groups. Average follow-up was 9.6 months. Forty-two percent underwent single venous drainage anastomoses. Mean age was 52.7 years, 78.0% were male, and 60% had defects of the foot and ankle. Increased flap area and early dangling did not increase flap demise. Thirty-three percent of single-drainage patients and 31.0% of dual-drainage patients had a complication. A body mass index of greater than 30 kg/m2 was a predictor for both flap complication (P = 0.025) and partial flap loss (P = 0.031) in univariate analysis. No independent predictors were found in multivariate analysis.

Conclusions
The number of venous anastomoses, area, and dangling protocol did not influence outcomes while using our lower extremity vein method. Thoughtful evaluation of venous egress should outweigh the routine use of multiple veins in perforator flap reconstructions of the lower extremity.
Complex Scalp and Calvarium Defects After Giant Basal Cell Carcinoma Excision: Management, Challanges, Outcomes
Authors: Ozcan Utku , Akyurek Mustafa , Arslan Emrah 
Published: May 2018

Abstract
Giant basal cell carcinoma (GBCC) is defined as a tumor ≥5 cm in diameter. GBCC of scalp usually requires extended resection of soft tissues, calvarium, and dura. In this study, we present 5 patients with GBCC of head, who underwent a single-stage combined scalp, calvarium, and dural reconstruction. Herein, we aim to discuss reconstruction methods, cerebrospinal fluid (CSF) leakage, duration of hospital stay, and tumor recurrency. Peroperative and postoperative follow-ups, defect areas, and performed calvarium reconstruction methods of 5 patients, who underwent complex scalp and calvarium reconstruction after GBCC between year 2010 and 2017, were retrospectively maintained. We studied reconstruction methods, CSF leakage, duration of hospital stay, and tumor recurrency. All patients undergone single-stage reconstruction. Avarge duration of hospital stay was 15 days. Titanium mesh was used in 3 patients and methyl methacrylate was used in 2 patients for calvarium reconstruction. CSF leakage was seen in patients who underwent calvarium reconstruction with titanium mesh. Tumor recurrence occured next to calvarium in 1 patient who undergone calvarium reconstruction with methyl methacrylate. CSF leakage and duration of hospital stay may induce morbidity of this oncoplastic procedure. The fact of longer hospital stay of patients reconstructed with titanium mesh might be a new data presented in this study. These parameters can be related with the method of calvarium reconstruction.
Pediatric Nasal Traumas: Contribution of Epidemiological Features to Detect the Distinction Between Nasal Fractures and Nasal Soft Tissue Injuries
Authors: Cakabay Taliye , Ustun Bezgin Selin 
Published: May 2018

Objectives:
Nasal bone is prone to injury due of its prominent position on the face. Epidemiologic surveys are necessary to investigate nasal traumas. The aim of the present study is to examine the distribution of trauma etiologies according to age, sex, and seasonality in pediatric patients who present with nasal trauma, and to classify the pathologies according to their etiology as nasal fractures or nasal soft tissue injuries.

Methods:
A total of 200 pediatric patients aged between 0 and 18 years who were admitted to the emergency room with sustained nasal trauma between September 1, 2015 and August 1, 2016 and who were diagnosed with an either nasal fracture or nasal soft tissue injury were retrospectively analyzed. The relationship between the nasal bone fractures and nasal soft tissue injuries and age, sex, admission date, and trauma etiology were investigated.

Results:
Of 200 patients, 70.5% were males and 29.5% were females with a mean age of 8.93 ± 5.50 years. Of these patients, 33.0% were in the 0 to 5 years age group, 24.0% were in the 6 to 10 years age group, 18.5% were in the 11 to 14 years age group, and 24.5% were in the 15 to 18 years age group. Of these, 82.5% had a nasal soft tissue injury and 17.5% had a nasal fracture. The etiology of trauma was most commonly fall from a height in 42.5% of the patients. Impact injuries and falls were the most common etiologies in the 0 to 5 age group, falls were the most common etiologies in the 6 to 10 age group, sports injuries were the most common etiologies in the 11 to 14 age group, and physical assault was the most common etiology in the 15 to 18 age group (P = 0.001; P < 0.01). According to the paired comparisons, the rate of nasal fracture in the 0 to 5 age group was significantly higher than the rates in the 11 to 14 (P = 0.001) and 15 to 18 (P = 0.001) age groups (P < 0.05). The rate of nasal soft tissue injuries was significantly higher in the patients presenting to the emergency room with sustained impact injury to the nose or falls. The majority of the patients presenting with physical assault and sports injuries were males. Nasal soft tissue injuries were mostly seen in girls, whereas the rate of nasal fractures was higher in boys, which was directly proportional to the trauma etiology and severity of injury. The patients often presented in the summer season.

Conclusion:
Our study results suggest that age, sex, time of trauma, and type of trauma guide the diagnosis of specific pathologies in pediatric patients presenting with sustained trauma. These characteristics must be specifically questioned and taken into consideration in the follow-up and treatment.
Results Following Adoption of a Modified Melbourne Technique of Total Scaphocephaly Correction
Authors: Sharma Julia D. , O’Hara Justine L. , Borghi Alessandro , Rodriguez-Florez Naiara , Breakey William , Ong Juling , Jeelani Nu Owase , Dunaway David J. , James Greg 
Published: May 2018

Abstract
The Melbourne technique was described in 2008 as a novel method for complete correction of scaphocephaly. Since 2015, it has become our operation of choice for children with sagittal synostosis who are too old at presentation for minimally invasive techniques. Our modifications were 2-position (initially supine then prone) technique and undertaking a formal fronto-orbital remodeling to correct forehead contour. Retrospective chart review was used to record demographics, blood transfusion frequency and volumes, operating time, length of stay, clinical outcome, and complications. Eleven underwent modified Melbourne procedure between July 2015 and March 2017; 9 of 11 were male. All had a diagnosis of nonsyndromic sagittal synostosis. Mean age at surgery was 29 months. Mean surgical time was 6 hours. All patients required blood transfusion with a mean volume transfused of 29 mL/kg (range 13–83 mL/kg). For those 5 patients where preoperative and postoperative measurements were available, there was an increase in mean cephalic index (CI) from 0.64 to 0.75. All postoperative patients had a CI of over 0.70. Three-dimensional shape analysis indicated head shape change addressing all phenotypic aspects of scaphocephaly. In the 5 patients in which analysis could be undertaken, the mean intracranial volume increased from 1481 cm3 preoperatively to 1671 cm3 postoperatively, a mean increase in intracranial volume of 14%. The postoperative intracranial volume was higher than preoperative in all 5 patients. There were 4 minor and no major complications. Modified Melbourne procedure is safe and effective for the treatment of severe scaphocephaly in sagittal synostosis.
The Many Faces of Patient-Centered Simulation
Authors: Arnold Jennifer L. , McKenzie Frederic (Rick) D. , Miller Jane Lindsay , Mancini Mary E. 
Published: May 2018

Introduction
Patient-centered simulation for nonhealthcare providers is an emerging and innovative application for healthcare simulation. Currently, no consensus exists on what patient-centered simulation encompasses and outcomes research in this area is limited. Conceptually, patient-centered simulation aligns with the principles of patient- and family-centered care bringing this educational tool directly to patients and caregivers with the potential to improve patient care and outcomes.

Methods
This descriptive article is a summary of findings presented at the 2nd International Meeting for Simulation in Healthcare Research Summit. Experts in the field delineated a categorization for better describing patient-centered simulation and reviewed the literature to identify a research agenda.

Results
Three types of patient-centered simulation patient-directed, patient-driven, and patient-specific are presented with research priorities identified for each.

Conclusions
Patient-centered simulation has been shown to be an effective educational tool and has the potential to directly improve patient care outcomes. Presenting a typology for patient-centered simulation provides direction for future research.
Early Impact of Medicare Accountable Care Organizations on Inpatient Surgical Spending
Authors: Nathan Hari , Thumma Jyothi R. , Ryan Andrew M. , Dimick Justin B. 
Published: May 2018

Objective:
To evaluate whether hospital participation in accountable care organizations (ACOs) is associated with reduced Medicare spending for inpatient surgery.

Background:
ACOs have proliferated rapidly and now cover more than 32 million Americans. Medicare Shared Savings Program (MSSP) ACOs have shown modest success in reducing medical spending. Whether they have reduced surgical spending remains unknown.

Methods:
We used 100% Medicare claims from 2010 to 2014 for patients aged 65 to 99 years undergoing 6 common elective surgical procedures [abdominal aortic aneurysm (AAA) repair, colectomy, coronary artery bypass grafting (CABG), hip or knee replacement, or lung resection]. We compared total Medicare payments for 30-day surgical episodes, payments for individual components of care (index hospitalization, readmissions, physician services, and postacute care), and clinical outcomes for patients treated at MSSP ACO hospitals versus matched controls at non-ACO hospitals. We accounted for preexisting trends independent of ACO participation using a difference-in-differences approach.

Results:
Among 341,675 patients at 427 ACO hospitals and 1,024,090 matched controls at 1531 non-ACO hospitals, patient and hospital characteristics were well-balanced. Average baseline payments were similar at ACO versus non-ACO hospitals. ACO participation was not associated with reductions in total Medicare payments [difference-in-differences estimate=-$72, confidence interval (CI95%): -$228 to +$84] or individual components of payments. ACO participation was also not associated with clinical outcomes. Duration of ACO participation did not affect our estimates.

Conclusion:
Although Medicare ACOs have had success reducing spending for medical care, they have not had similar success with surgical spending. Given that surgical care accounts for 30% of total health care costs, ACOs and policymakers must pay greater attention to reducing surgical expenditures.