bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integrating Financial Incentives for Viral Load Suppression into HIV Care Coordination Programs: Considerations for Development and Implementation
Authors: Gambone Gina F. , Feldman Matthew B. , Thomas-Ferraioli Anna Y. , Shubert Virginia , Ghose Toorjo 
Published: July 2019

Context:
Interventions that support durable viral load suppression (VLS) among people living with HIV (PLWH) who face barriers to treatment adherence are needed to maintain optimal individual health, prevent new HIV infections, and advance health equity. Efficacy trials indicate that financial incentives (FIs) are a promising strategy for promoting VLS, although less is known about their implementation in “real-world” settings. This article describes considerations for the development and implementation of FI interventions identified in existing literature, and how they informed the scale-up of a multilevel treatment adherence support program designed to increase VLS among PLWH in New York City.

Program:
The UndetectablesSM VLS Program comprises a social marketing campaign and a “tool kit” of evidence-based HIV treatment adherence strategies, including quarterly FIs ($100) that patients receive for achieving or maintaining an undetectable viral load (<200 copies/mL; also referred to as VLS). The intervention was developed and pilot tested by Housing Works Community Healthcare and the University of Pennsylvania from 2014 to 2016. Initial findings from the pilot evaluation showed a statistically significant positive effect on VLS.

Implementation:
The New York City Department of Health and Mental Hygiene contracted with 7 agencies across New York City to scale up The Undetectables Program over a 3-year period (2016-2019) by integrating the program into existing services for PLWH.

Evaluation Plans:
Quality indicators (eg, percentage of clients who received an FI each quarter; percentage of clients who were virally suppressed at 90 days postenrollment) will be used to measure program performance and impact over time.

Discussion:
Recommendations for implementing FIs for PLWH include packaging FIs with client-centered, evidence-based adherence strategies, incorporating FIs into existing service delivery systems, and obtaining organization-wide buy-in to facilitate their implementation. Implementation science research is needed to identify strategies to effectively implement and sustain evidence-based FI interventions.
Survival and Disease Recurrence Rates among Breast Cancer Patients following Mastectomy with or without Breast Reconstruction
Authors: Siotos Charalampos , Naska Androniki , Bello Ricardo J. , Uzosike Akachimere , Orfanos Philippos , Euhus David M. , Manahan Michele A. , Cooney Carisa M. , Lagiou Pagona , Rosson Gedge D. 
Published: July 2019

Background:
Concerns have been expressed about the oncologic safety of breast reconstruction following mastectomy for breast cancer. This study aimed to evaluate the association of breast reconstruction with breast cancer recurrence, and 5-year survival among breast cancer patients.

Methods:
The authors analyzed data from The Johns Hopkins Hospital comprehensive cancer registry, comparing mastectomy-only to postmastectomy breast reconstruction in breast cancer patients to evaluate differences in breast cancer recurrence and 5-year survival. Kaplan-Meier curves were used to compare unadjusted estimates of survival or disease recurrence. Data were modeled through Cox proportional hazards regression, using as outcomes time to death from any cause or time to cancer recurrence.

Results:
The authors analyzed data on 1517 women who underwent mastectomy for breast cancer at The Johns Hopkins hospital between 2003 and 2015. Of these, 504 (33.2 percent) underwent mastectomy only and 1013 (66.8 percent) underwent mastectomy plus immediate breast reconstruction. Women were followed up for a median of 5.1 years after diagnosis. There were 132 deaths and 100 breast cancer recurrences. A comparison of Kaplan-Meier survival estimates demonstrated a survival benefit among patients undergoing mastectomy plus reconstruction. After adjusting for various clinical and socioeconomic variables, there was still an overall survival benefit associated with breast reconstruction which, however, was not statistically significant (hazard ratio, 0.78; 95 percent CI, 0.53 to 1.13). Patients who underwent reconstruction had a similar rate of recurrence compared to mastectomy-only patients (hazard ratio, 1.08; 95 percent CI, 0.69 to 1.69).

Conclusion:
This study suggests that breast reconstruction does not have a negative impact on either overall survival or breast cancer recurrence rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Patterns and Correlates of Knowledge, Communication, and Receipt of Breast Reconstruction in a Modern Population-Based Cohort of Patients with Breast Cancer
Authors: Momoh Adeyiza O. , Griffith Kent A. , Hawley Sarah T. , Morrow Monica , Ward Kevin C. , Hamilton Ann S. , Shumway Dean , Katz Steven J. , Jagsi Reshma 
Published: July 2019

Background:
Disparities persist in the receipt of breast reconstruction after mastectomy, and little is known about the nature of communication received by patients and potential variations that may exist.

Methods:
Women with early-stage breast cancer (stages 0 to II) diagnosed between July of 2013 and September of 2014 were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries and surveyed to collect additional data on demographics, treatment, and decision-making experiences. Treating general/oncologic surgeons were also surveyed. Primary outcomes measures included self-reported communication-related measures on receipt of information on breast reconstruction and on the receipt of breast reconstruction.

Results:
The authors analyzed 936 women who underwent mastectomy for unilateral breast cancer. Four hundred eighty-four (51.7 percent) underwent mastectomy with reconstruction. Women who were older and for whom English was not their primary spoken language had lower odds of being informed by a doctor about breast reconstruction. Ultimately, women who were older, were Asian, had invasive disease, had bronchitis/emphysema, and had lower income were less likely to undergo breast reconstruction. Breast reconstruction was performed more often in patients undergoing bilateral mastectomies (OR, 3.27; 95 percent CI, 2.26 to 4.75). Women cared for by surgeons with higher volumes of breast cancer patients (≥51 patients per year) were more likely to undergo breast reconstruction (OR, 2.43; 95 percent CI, 1.40 to 4.20).

Conclusion:
To eliminate existing disparities, increased efforts should be made in consultations for surgical management of breast cancer to provide information to all patients regarding the option of breast reconstruction, the possibility of immediate reconstruction, and insurance coverage of all stages of reconstruction.
The Relationship between Hand Therapy and Long-Term Outcomes after Distal Radius Fracture in Older Adults: Evidence from the Randomized Wrist and Radius Injury Surgical Trial
Authors: Chung Kevin C. , Malay Sunitha , Shauver Melissa J. 
Published: July 2019

Background:
Older patients are frequently referred to hand therapy after distal radius fracture. Supervised therapy sessions place a transportation burden on patients and are costly on both the individual and systematic levels. Furthermore, there is little evidence that supervised therapy or home exercises improve long-term outcomes.

Methods:
Data were collected for the Wrist and Radius Injury Surgical Trial, a multicenter, international, pragmatic, randomized trial of distal radius fracture treatment in patients aged 60 years and older. Referral to therapy and therapy protocol were at the discretion of the treating surgeon and therapist. The authors examined outcomes between participants who underwent therapy and those who did not and assessed the duration of therapy. The authors also analyzed the effect of therapy on subgroups at risk for poor outcomes: older participants and those who had more comorbidities or lower baseline activity.

Results:
Eighty percent of participants underwent therapy; 70 percent participated in both supervised therapy and home exercises. Participants had a mean 9.2 supervised sessions over 14.2 weeks. There were no differences in patient-reported outcomes between participants who underwent therapy and those who did not. Participants who did not have therapy recovered more grip strength. Participants who engaged in therapy for a shorter time reported greater function, ability to work, and satisfaction. There were no relationships revealed in subgroup analyses.

Conclusions:
Hand therapy after distal radius fracture may not be necessary for older patients. Encouraging participants to resume activities of daily living as soon as possible may be as effective as formal therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Caprine Models of the Agonist-Antagonist Myoneural Interface Implemented at the Above- and Below-Knee Amputation Levels
Authors: Clites Tyler R. , Carty Matthew J. , Srinivasan Shriya S. , Talbot Simon G. , Brånemark Rickard , Herr Hugh M. 
Published: July 2019

Background:
Traditional approaches to amputation are not capable of reproducing the dynamic muscle relationships that are essential for proprioceptive sensation and joint control. In this study, the authors present two caprine models of the agonist-antagonist myoneural interface (AMI), a surgical approach designed to improve bidirectional neural control of a bionic limb. The key advancement of the AMI is the surgical coaptation of natively innervated agonist-antagonist muscle pairs within the residual limb.

Methods:
One AMI was surgically created in the hindlimb of each of two African Pygmy goats at the time of primary transtibial amputation. Each animal was also implanted with muscle electrodes and sonomicrometer crystals to enable measurement of muscle activation and muscle state, respectively. Coupled agonist-antagonist excursion in the agonist-antagonist myoneural interface muscles was measured longitudinally for each animal. Fibrosis in the residual limb was evaluated grossly in each animal as part of a planned terminal procedure.

Results:
Electromyographic and muscle state measurements showed coupled agonist-antagonist motion within the AMI in the presence of both neural activation and artificial muscle stimulation. Gross observation of the residual limb during a planned terminal procedure revealed a thin fibrotic encapsulation of the AMI constructs, which was not sufficient to preclude coupled muscle excursion.

Conclusions:
These findings highlight the AMI’s potential to provide coupled motion of distal agonist-antagonist muscle pairs preserved during below- or above-knee amputation at nearly human scale. Guided by these findings, it is the authors’ expectation that further development of the AMI architecture will improve neural control of advanced limb prostheses through incorporation of physiologically relevant muscle-tendon proprioception.
In the Eye of the Beholder: Changes in Perceived Emotion Expression after Smile Reanimation
Authors: Dusseldorp Joseph R. , Guarin Diego L. , van Veen Martinus M. , Jowett Nate , Hadlock Tessa A. 
Published: July 2019

Background:
Tools to quantify layperson assessments of facial palsy are lacking. In this study, artificial intelligence was applied to develop a proxy for layperson assessments, and compare sensitivity to existing outcome measures.

Methods:
Artificially intelligent emotion detection software was used to develop the emotionality quotient. The emotionality quotient was defined as the percentage probability of perceived joy over the percentage probability of perceived negative emotions during smiling, as predicted by the software. The emotionality quotient was used to analyze the emotionality of voluntary smiles of normal subjects and unilateral facial palsy patients before and after smile reanimation. The emotionality quotient was compared to oral commissure excursion and layperson assessments of facial palsy patients.

Results:
In voluntary smiles of 10 normal subjects, 100 percent joy and no negative emotion was detected (interquartile ranges, 0/1). Median preoperative emotionality quotient of 30 facial palsy patients was 15/−60 (interquartile range, 73/62). Postoperatively, median emotionality quotient was 84/0 (interquartile range, 28/5). In 134 smile reanimation patients, no correlation was found between postoperative oral commissure excursion and emotionality quotient score. However, in 61 preoperative patients, a moderate correlation was found between layperson-assessed disfigurement and negative emotion perception (correlation coefficient, 0.516; p < 0.001).

Conclusions:
Computer vision artificial intelligence software detected less joy and more negative emotion in smiles of facial palsy patients compared with normal subjects. Following smile reanimation, significantly more joy and less negative emotion were detected. The emotionality quotient was correlated with layperson assessments. The simplicity, sensitivity, and objectivity of the emotionality quotient render it an attractive tool to serve as a potential proxy for layperson assessment, an ideal outcome measure in facial palsy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
Paratesticular Paraganglioma
Authors: Gosavi Vikrant , Jadhav Swati , Shah Nalini S. , Shrivastava S. K. , Prakash Gagan , Shah Ravi 
Published: July 2019

Abstract
Paratesticular paragangliomas are a rare occurrence. We present the case of a 43-year-old man who presented with paresthesia and paraparesis and was found to have pathologic fracture involving D1 vertebra as a manifestation of metastasis from a nonsecretory right paratesticular paraganglioma.
Nivolumab-Associated Pulmonary and Bone Sarcoidosis in a Patient With Melanoma of Unknown Primary
Authors: Tulbah Rima I. , Rowe Steven P. , Solnes Lilja B. , Javadi Mehrbod S. 
Published: July 2019

Abstract
A 57-year-old man with stage IIIB malignant melanoma of unknown primary presented for pretherapy FDG PET/CT that demonstrated metastatic left cervical lymph node with no other site of involvement. Following left neck dissection, nivolumab was initiated. Follow-up FDG PET/CT 3 months after initiation of nivolumab demonstrated extensive radiotracer-avid chest lymphadenopathy and multiple bone lesions. Ultrasound-guided endobronchial biopsy of the mediastinal lymph nodes demonstrated sarcoidosis.
Concomitant Prostate Carcinoma and Follicular Lymphoma
Authors: Dhiantravan Nattakorn , Hovey Elizabeth , Bosco Annmarie , Wegner Eva Alina 
Published: July 2019

Abstract
We report a case of a 75-year-old man with concomitant metastatic prostate cancer and progressive follicular lymphoma and the utility of molecular imaging in differentiating these 2 conditions. 18F-FDG PET/CT can offer accurate staging in many cancers, although its role in prostate cancer is limited. The role of 18F-DCFPyL (PSMA) PET/CT in prostate cancer is evolving and has been demonstrated to have a higher sensitivity than conventional bone scan and CT scan. Together, FDG and PSMA PET/CT studies may offer a noninvasive approach to individually characterize concomitant malignancies, aiding optimization of management and follow-up.
Risk of Lymphedema Following Contemporary Treatment for Breast Cancer
Authors: Byun Hwa Kyung , Chang Jee Suk , Im Sang Hee , Kirova Youlia M. , Arsene-Henry Alexandre , Choi Seo Hee , Cho Young Up , Park Hyung Seok , Kim Jee Ye , Suh Chang-Ok , Keum Ki Chang , Sohn Joo Hyuk , Kim Gun Min , Lee Ik Jae , Kim Jun Won , Kim Yong Bae 
Published: July 2019

Objective:
The aim of this study was to identify the comprehensive risk factors for lymphedema, thereby enabling a more informed multidisciplinary treatment decision-making.

Summary Background Data:
Lymphedema is a serious long-term complication in breast cancer patients post-surgery; however, the influence of multimodal therapy on its occurrence remains unclear.

Methods:
We retrospectively collected treatment-related data from 5549 breast cancer patients who underwent surgery between 2007 and 2015 at our institution. Individual radiotherapy plans were reviewed for regional nodal irradiation (RNI) field design and fractionation type. We identified lymphedema risk factors and used them to construct nomograms to predict individual risk of lymphedema. Nomograms were validated internally using 100 bootstrap samples and externally using 2 separate datasets of 1877 Asian and 191 Western patients.

Results:
Six hundred thirty-nine patients developed lymphedema during a median follow-up of 60 months. The 3-year lymphedema incidence was 10.5%; this rate increased with larger irradiation volumes (no RNI vs RNI excluding axilla I–II vs RNI including axilla I–II: 5.7% vs 16.8% vs 24.1%) and when using conventional fractionation instead of hypofractionation (13.5% vs 6.8%). On multivariate analysis, higher body mass index, larger number of dissected nodes, taxane-based regimen, total mastectomy, larger irradiation field, and conventional fractionation were strongly associated with lymphedema (all P < 0.001). Nomograms constructed based on these variables showed good calibration and discrimination internally (concordance index: 0.774) and externally (0.832 for Asian and 0.820 for Western patients).

Conclusions:
Trimodality breast cancer treatment factors interact to promote lymphedema. Lymphedema risk can be decreased by deintensifying node dissection, chemotherapy regimen, and field and dose of radiotherapy. Deescalation strategies on a multidisciplinary basis might minimize lymphedema risk.
Frequency of Electrodiagnostically Measurable Berrettini Anastomosis
Authors: Seidel Geoffrey K. , Seidel Madeleine E. , Hakopian David , Alabdulkarim Moayad , Rahman Abir , Andary Michael T. , Millis Scott R. 
Published: July 2019

Purpose:
Ulnar sensory palmar crossover to digit three (D3), the Berrettini anastomosis, is measurable in routine electrodiagnostic nerve conduction studies. The crossover is reported as occurring in 60% of anatomic dissections, but the frequency of measurable ulnar crossover to D3 and its potential as a nerve conduction pitfall is not established. The purpose of this article was to present descriptive statistics regarding the frequency of measurable Berrettini anastomosis in nerve conduction studies.

Methods:
A retrospective chart review and data analysis was completed on 248 patients representing 411 extremities with a main outcome measure of ulnar sensory stimulated nerve conduction simultaneous waveform recording on D3 and digit four (D4). Consistent electrodiagnostic technique with waveform recording data analysis in a private practice and independent university waveform verification was completed on sequential patients referred for upper extremity electrodiagnostic testing.

Results:
Measurable ulnar stimulated D3 sensory nerve action potentials were demonstrated in 34% of patients with amplitudes of 27%, the simultaneously recorded corresponding ulnar D4 amplitudes representing electrophysiological evidence of ulnar sensory crossover.

Conclusions:
The Berrettini anastomosis can frequently be seen as a small amplitude sensory nerve action potential response, but at times can be observed with an amplitude greater than 10 μV. It is possible that patients with an absent or significantly delayed median nerve response may have simultaneous inadvertent spread of stimulus to ulnar axons measurable on D3 that may be interpreted as a falsely normal response. All electromyographers need to be aware of this potential pitfall.
Immune landscapes predict chemotherapy resistance and immunotherapy response in acute myeloid leukemia
Authors: Vadakekolathu Jayakumar , Minden Mark D. , Hood Tressa , Church Sarah E. , Reeder Stephen , Altmann Heidi , Sullivan Amy H. , Viboch Elena , Patel Tasleema , Ibrahimova Narmin , Warren Sarah E. , Arruda Andrea , Liang Yan , Muth John , Schmitz Marc , Cesano Alessandra , Pockley A. Graham , Valk Peter J.M. , Löwenberg Bob , Bornhäuser Martin , Tasian Sarah K. , Rettig Michael P. , Davidson-Moncada Jan , DiPersio John F. , Rutella Sergio 
Published: July 2019

AbstractThis study dissected the complexity of the immune architecture of acute myeloid leukemia (AML) at high resolution and assessed its influence on therapeutic response. Using 387 primary bone marrow samples from three discovery cohorts of children and adults with AML, we defined immune-infiltrated and immune-depleted disease subtypes and unraveled critical differences in immune gene expression across age groups and disease stages. Importantly, interferon (IFN)-γ-related mRNA profiles were predictive for both chemotherapy resistance and response of primary refractory/relapsed AML to flotetuzumab immunotherapy. Our compendium of microenvironmental gene and protein profiles sheds novel insights into the immuno-biology of AML and will inform the delivery of personalized immunotherapies to IFN-γ-dominant AML subtypes.
Regional Differences Following Partial Salivary Gland Resection
Authors: O’Keefe Kevin J. , DeSantis Kara A. , Altrieth Amber L. , Nelson Deirdre A. , Taroc Ed Zandro M. , Stabell Adam R. , Pham Mary T. , Larsen Melinda 
Published: July 2019

AbstractRegenerative medicine aims to repair, replace, or restore function to tissues damaged by aging, disease, or injury. Partial organ resection is not only a common clinical approach in cancer therapy, it is also an experimental injury model used to examine mechanisms of regeneration and repair in organs. We performed a partial resection, or partial sialodenectomy, in the murine submandibular salivary gland (SMG) to establish a model for investigation of repair mechanisms in salivary glands (SGs). After partial sialoadenectomy we performed whole gland measurements over a period of 56 days and found that the gland reached its maximum size 14 days after injury. We used microarray analysis and immunohistochemistry to examine mRNA and protein changes in glands over time. Microarray analysis identified dynamic changes in the transcriptome three days after injury that were largely resolved by day 14. At the 3 day time point, we detected gene signatures for cell cycle regulation, inflammatory/repair response, and extracellular matrix remodeling in the partially resected glands. Using quantitative immunohistochemistry, we identified a transient proliferative response throughout the gland, in which both secretory epithelial and stromal cells expressed Ki67 that was detectable at day 3 and largely resolved by day 14. IHC also revealed that while most of the gland underwent a wound healing response that resolved by day 14, a small region of the gland showed an aberrant sustained fibrotic response characterized by increased levels of ECM deposition and sustained Ki67 levels in stromal cells. The partial submandibular salivary gland resection model provides an opportunity to examine a normal healing response and an aberrant fibrotic response within the same gland to uncover mechanisms that prevent wound healing and regeneration in mammals. Understanding regional differences in the wound healing responses may ultimately impact regenerative therapies for patients.