bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burkitt lymphoma presenting with fever of unknown origin and isolated hypoglossal nerve palsy
Authors: Seneca Kathleen H. , Nahass Ronald G. , Adler Rachel H. 
Published: August 2019

ABSTRACT
Fever of unknown origin (FUO) continues to present a clinical conundrum for even expert practitioners. The syndrome of FUO has over 200 possible etiologies. Burkitt lymphoma (BL) is a highly aggressive B-cell non-Hodgkin lymphoma with only 1,200 US adult cases reported annually. Fever, night sweats, and weight loss, otherwise known as B symptoms, are common early symptoms of BL. Nerve palsy, especially isolated hypoglossal nerve palsy (IHNP), is rarely seen as a presenting sign in any pathological condition. A case report of FUO and IHNP as the presenting manifestations of BL is presented. The rarity of IHNP and its clinical features delayed the recognition of this syndrome and emphasizes the value of a thorough understanding of the physical examination and the association of unusual clinical findings with a readily identifiable clinical syndrome.
Breast cancer risk assessment: Evaluation of screening tools for genetics referral
Authors: Himes Deborah O. , Zaro Maren L. , Williams Mary , Freeborn Donna , Eggett Dennis L. , Kinney Anita Y. 
Published: August 2019

ABSTRACT

Background and purpose:
The United States Preventative Services Task Force (USPSTF) recommends breast cancer risk-screening tools to help primary care providers determine which unaffected patients to refer to genetic specialists. The USPSTF does not recommend one tool above others. The purpose of this study was to compare tool performance in identifying women at risk for breast cancer.

Methods:
Pedigrees of 85 women aged 40–74 years with first-degree female relative with breast cancer were evaluated using five tools: Family History Screen-7 (FHS-7), Pedigree Assessment Tool, Manchester Scoring System, Referral Screening Tool, and Ontario Family History Assessment Tool (Ontario-FHAT). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to describe each tool's ability to identify women with elevated risk as defined by Claus Model calculations (lifetime risk ≥15%). Receiver operating curves were plotted. Differences between areas under the curve were estimated and compared through logistic regression to assess for differences in tool performance.

Conclusions:
Claus calculations identified 14 of 85 women with elevated risk. Two tools, Ontario-FHAT and FHS-7, identified all women with elevated risk (sensitivity 100%). The FHS-7 tool flagged all participants (specificity 0%). The Ontario-FHAT flagged 59 participants as needing referral (specificity 36.2%) and had a NPV of 100%. Area under the curve values were not significantly different between tools (all p values > .05), and thus were not helpful in discriminating between the tools.

Implications for practice:
The Ontario-FHAT outperformed other tools in sensitivity and NPV; however, low specificity and PPV must be balanced against these findings. Thus, the Ontario-FHAT can help determine which women would benefit from referral to genetics specialists.
Avoiding missed opportunities to screen for HIV
Authors: O'Byrne Patrick , Orser Lauren 
Published: August 2019

ABSTRACT
HIV transmission is ongoing, primarily among men who have sex with men, injection drug users, and persons from HIV endemic regions. One prevention strategy has been prompt HIV diagnosis. Undermining these efforts is that some persons are diagnosed with HIV late in their infection because practitioners missed the diagnosis. In this article, the authors review the epidemiology and pathophysiology of HIV/AIDS, and provide a recommended clinical approach: (1) continue to screen persons who belong to the groups that are at-risk for HIV, and (2) appropriately rule out HIV infection in persons who present with HIV and AIDS-like symptoms.
Prefrontal Cortical Activation With Open and Closed-Loop Tactile Cueing When Walking and Turning in Parkinson Disease: A Pilot Study
Authors: Stuart Samuel , Mancini Martina 
Published: August 2019

Background and Purpose:
Gait and turning impairments are common in people with Parkinson disease (PwPD). Tactile cues delivered in open- or closed-loop modalities may improve gait and turning in PwPD, but underlying mechanisms are unclear. Attention stemming from the prefrontal cortex (PFC) may play a role in cue response, but PFC contributions to specific cue modalities are unclear. Examining how open- and closed-loop cueing influences PFC activity during walking and turning in PwPD may elucidate mechanisms involved in cue response, which could advance development of effective therapeutics. We examined PFC activity during walking and turning in response to open- and closed-loop cueing in PwPD, and explored relationships between PFC activity and behavioral measures.

Methods:
A mobile functional near-infrared spectroscopy device measured PFC activity during walking and turning in 25 PwPD (n = 13 freezers, n = 12 nonfreezers). Participants performed 180° and 360° turns while walking, and a 2-minute walk under single- and dual-task (AX-CPT) conditions with and without an open- (metronome-like vibration) or closed-loop (biofeedback vibration) tactile cue.

Results:
PFC activity did not change when walking or turning in PwPD; freezing status or task demands did not influence PFC activity. With both open- and closed-loop cueing dual-task cost of gait significantly improved, whereas turning slowed.

Discussion and Conclusions:
Our preliminary results indicate that both open- and closed-loop cueing can improve gait without additional burden to the PFC beyond usual walking. However, turning while walking slowed with cueing with no PFC activity change. Further investigations are necessary to establish these findings in a larger cohort.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, the Video, available at: http://links.lww.com/JNPT/A280).
Data to Care Opportunities: An Evaluation of Persons Living With HIV Reported to Be “Current to Care” Without Current HIV-Related Labs
Authors: Hart-Malloy Rachel , Shrestha Tarak , Pezzulo Molly C. , Patterson Wendy , Gunn Jayleen K. L. , Johnson Megan C. , Tesoriero James M. 
Published: August 2019

Background:
Data to care (D2C) is an effective strategy using HIV surveillance data to link/relink persons living with HIV into medical care. However, some appearing to be not in care (NIC) report being in care (persons “current to care”).

Setting:
New York State's Expanded Partner Services (ExPS) D2C program has identified many persons reported as “current to care.” This evaluation describes these persons after 24 months of follow-up and identifies HIV-related laboratory-based testing patterns and results to determine whether this cohort could benefit from further programmatic intervention.

Methodology:
Data from ExPS assignments from September 2013 to May 2016 were used. Persons “current to care” were compared with persons NIC on demographics, subsequent HIV-related laboratory-based testing, and viral load suppression status. Persons “current to care” receiving subsequent HIV-related laboratory-based testing were compared with those who did not receive HIV-related labs.

Results:
Persons “current to care” significantly differed from persons NIC on demographics and subsequent HIV-related laboratory-based testing (82% of persons “current to care” had subsequent HIV-related labs, versus 99% of those NIC who were relinked to care). Persons “current to care” were more likely to be virally suppressed at their subsequent lab than persons NIC who were relinked to care (72% vs. 47%). Minor differences were noted for persons “current to care” receiving subsequent HIV-related labs compared with those who did not.

Conclusions:
Persons “current to care” reflect a unique cohort who might benefit from further programmatic intervention. Although most received additional HIV-related labs, some were without labs for the duration of follow-up.
The Partnerships for Care Project in Massachusetts: Developing Partnerships and Data Systems to Increase Linkage and Engagement in Care for Individuals Living With HIV
Authors: Lewis Sophie , Morrison Monica , Randall Liisa M. , Roosevelt Kathleen 
Published: August 2019

Background:
Before implementation of the Massachusetts Partnerships for Care (MA P4C) project, Massachusetts did not routinely provide HIV partner services to newly diagnosed individuals. Identification of individuals disengaged from HIV care and assistance for re-engagement relied on community- and clinic-based HIV medical case management services. Processes to identify individuals out of HIV care used either surveillance or clinic data, but did not combine both.

Methods:
The Massachusetts Department of Public Health collaborated with 6 community health centers to implement HIV partner services and out-of-care re-engagement services. Implementation of these services required development of both health department and community health center capacity. Capacity development strategies included the following: development and implementation of operational protocols, establishment of communication strategies and processes, training and education for health department and health center staff, and enhancement of disease surveillance systems.

Results:
Development of operational protocols supported implementation of public health services and collaboration with health centers. Health department–facilitated meetings, training, and technical assistance enhanced communication with health centers and promoted buy-in for collaboration. A strategy for combining clinic and surveillance data to identify individuals out of HIV care was implemented. Surveillance data system enhancements improved efficiency of out-of-care identification, assignment of cases for public health follow-up, and provided quality improvement tools.

Conclusions:
Collaboration between health departments and community health centers to identify and support patient engagement in HIV medical care is feasible and supports improved continuity of care. Use of surveillance and clinic data to identify out-of-care patients promotes efficiency in Data to Care activities.
Short-Term Outcomes and Lessons Learned From the Federal HIV Health Improvement Affinity Group for State Medicaid/Children's Health Insurance Program Agencies and State Health Departments
Authors: Davies Cathleen , Klein Pamela W. , Okoye Ijeamaka D. , Heitgerd Janet , Shapatava Ekaterine , Ihiasota Ijeoma , Browne Michelle N. C. , Viall Abigail , Stockmann Deirdra , Hauck Heather 
Published: August 2019

Background:
Medicaid is the single largest source of health care coverage for people living with HIV (PLWH) in the United States. Therefore, high-quality HIV care and associated viral suppression among Medicaid beneficiaries have the potential to greatly impact the HIV epidemic. The HIV Health Improvement Affinity Group (HHIAG) supported state efforts to improve health outcomes for PLWH enrolled in Medicaid through new or enhanced collaborations between state public health departments and state Medicaid agencies.

Methods:
Supported by multiple federal health agencies for 1 year, state health department and Medicaid staff from 19 states participated in state-to-state learning and sharing of promising approaches. This evaluation assessed the HHIAG's processes, short-term outcomes, and lessons learned through review of state materials, a web survey, and telephone interviews.

Results:
Of the 19 states, 13 (68%) ultimately established new, or refined existing, data-sharing agreements between Medicaid and public health departments. Nearly all states with data-sharing agreements successfully matched the data or streamlined the data-matching process (n = 12/13). Two-thirds of states (67%, n = 8/12) with matched data generated an HIV care continuum for state Medicaid/Children's Health Insurance Program beneficiaries; 75% (n = 6/8) of these states also initiated quality improvement activities.

Conclusions:
The HHIAG created an unique opportunity for multiple federal agencies and states to collaborate and implement data-driven, state-specific solutions to improve care delivery and, ultimately, clinical outcomes for PLWH. The HHIAG model has the potential to be replicated to address other public health issues that cross agency and institutional boundaries, such as hepatitis C.
Improving HIV Surveillance Data by Using the ATra Black Box System to Assist Regional Deduplication Activities
Authors: Ocampo Joanne Michelle F. , Hamp Auntré , Rhodes Anne , Smart J. C. , Pemmaraju Raghu , Poschman Karalee , Hess Kristen L. , Bhattacharjee Reshma , Flynn Colin , Anderson Bridget J. , Dowling James E. , Maccormack Fred , Doshi Rupali , Lum Garret , Maddox Lorene , Moncur Brenda , Barnhart John E. , Maxwell Jason , Aurand Sahithi Boggavarapu , Hogan Vicki , Wills David , Prowell Stacy , Kassaye Seble G. , Karn Helen E. , Laffoon Benjamin T. , Collmann Jeff 
Published: August 2019

Background:
Focused attention on Data to Care underlines the importance of high-quality HIV surveillance data. This study identified the number of total duplicate and exact duplicate HIV case records in 9 separate Enhanced HIV/AIDS Reporting System (eHARS) databases reported by 8 jurisdictions and compared this approach to traditional Routine Interstate Duplicate Review resolution.

Methods:
This study used the ATra Black Box System and 6 eHARS variables for matching case records across jurisdictions: last name, first name, date of birth, sex assigned at birth (birth sex), social security number, and race/ethnicity, plus 4 system-calculated values (first name Soundex, last name Soundex, partial date of birth, and partial social security number).

Results:
In approximately 11 hours, this study matched 290,482 cases from 799,326 uploaded records, including 55,460 exact case pairs. Top case pair overlaps were between NYC and NYS (51%), DC and MD (10%), and FL and NYC (6%), followed closely by FL and NYS (4%), FL and NC (3%), DC and VA (3%), and MD and VA (3%). Jurisdictions estimated that they realized a combined 135 labor hours in time efficiency by using this approach compared with manual methods previously used for interstate duplication resolution.

Discussion:
This approach discovered exact matches that were not previously identified. It also decreased time spent resolving duplicated case records across jurisdictions while improving accuracy and completeness of HIV surveillance data in support of public health program policies. Future uses of this approach should consider standardized protocols for postprocessing eHARS data.
Role of Intraoperative Clean Surgical Margin Determined With Lesion Size and Duration to Obtain Apropriate Histological Clean Surgical Margin in High-Risk Basal Cell Carcinoma Patients, According to National Comprehensive Cancer Network Criteria
Authors: Kurt Ozkaya Nese , Yeldir Nese , Yilmaz Sarper 
Published: August 2019

Abstract
We aimed to elucidate the role of intraoperative clean surgical margin (iCSM) determined according to lesion size and duration to obtain appropriate histological clean surgical margin (hCSM) in high-risk basal cell carcinoma (BCC) patients evaluated according to National Comprehensive Cancer Network (NCCN) criteria considering the tumor size and/or location. The contribution of lesion area to determine iCSM was also evaluated. Patients with high-risk BCC requiring surgical management were included. iCSM, hCSM, and clinical variables including sec, age, longest edge, location and area, and follow-up duration were recorded. In total, 96 lesions were evaluated. Lesions were mostly located in the mask area and other face region (93.8%). Lesions located on the nose comprised 50%, 34.1%, and 26.3% in the BCC-5, BCC-7, and BCC-10 lesions, respectively. The hCSMs were positive in 11.5%, 9.1%, and 3.8% of the BCC-5, BCC-7, and BCC-10 lesions, respectively. The deep surgical margin was positive in 15.4%, 4.5%, and 7.7% of the BCC-5, BCC-7, and BCC-10 lesions, respectively. The calculated risk for the positive surgical margin if the BCC-10 lesions were done like the BCC-7 was 15.4%. No recurrence was during follow-up duration. As supported by the findings of the present study, to obtain an adequate hCSM in the high-risk BCC lesions, the iCSM determined according to NCCN recommendations may not be optimal. Nevertheless, after their categorization according to lesion size and disease duration for excision with 5-, 7-, and 10-mm iCSMs, it is possible to obtain a small but important improvement in the outcome of patients.
Enophthalmos: Exploration of Quantitative Treatment With Retro-Orbital Fat Globules Injection
Authors: Ye Lingxiao , Zhang Lu , Zhu Yijia , Zhang Yuguang , Wu Wei , Zhang Ying 
Published: August 2019

Abstract
Craniomaxillofacial and plastic surgeons are often confronted with patients who present with enophthalmos caused mainly by trauma. In many patients, one-stage reconstruction repairs only the bony orbit, leaving intact the disfiguring enophthalmos. Thus, some filler is needed to restore the normal volume of the orbit. The authors describe a technique to correct such deformation safely and effectively. Data were collected from 30 enophthalmic patients (average age 36.67 ± 11.66 years) who underwent retro-ocular injections of fat globules between August 2014 and July 2018. CT helped identify a safe injection site, and specific CT measurements quantified the volume of fat globules required. There was a significant difference between the preoperative and postoperative values for lateral orbital protrusion (P < .01), superior orbital protrusion (P < .01), and orbital volume (P < .01). Most patients were satisfied with the outcome. There were no significant complications. Injecting fat globules into the retro-orbital area is an effective technique for correcting enophthalmos deformity.
Comprehensive Application of Autologous Costal Cartilage Grafts in Rhino- and Mentoplasty
Authors: Zhang Lu , Ma Wen-Shu , Bai Ji-Ping , Li Xing-Xing , Li Hong-Dong , Zhu Tao , Sun Jian-Yu , Ge Hong-Gang , Pang Yun , Xue Feng , Cheng Li-Ying , Jin Rong , Zhang Ying , Sun Xiao-Ming , Zhang Yu-Guang 
Published: August 2019

Background:
Underdevelopment of nose and chin in East Asians is quite common. Rhinoplasty and mentoplasty are effective procedures to solve the above-depicted defects and can achieve remarkable cosmetic effects. An autologous costal cartilage graft has become an ideal material for rhinoplasty, especially for revision surgery. However, many problems in the clinical application of costal cartilage remain unresolved. This study is to investigate application strategies of autologous costal cartilage grafts in rhino- and mentoplasty.

Methods:
The methods involved are as follows: application of an integrated cartilage scaffold; comprehensive application of diced cartilage; and chin augmentation of an autologous costal cartilage graft.

Results:
In this study, satisfactory facial contour appearance was immediately achieved in 28 patients after surgery; 21 patients had satisfactory appearance of the nose and chin during the 6- to 18-month follow-up. Cartilage resorption was not observed. Two patients had nasal tip skin redness and were cured after treatment.

Conclusion:
This procedure can be used to effectively solve: curvature of the costal cartilage segment itself; warping of the carved costal cartilage; and effective use of the costal cartilage segment. The procedure has achieved satisfactory outcomes, and its application is worth extending to clinical practice.
Contemporary Characterization of Injury Patterns, Initial Management, and Disparities in Treatment of Facial Fractures Using the National Trauma Data Bank
Authors: Wasicek Philip J. , Gebran Selim G. , Ngaage Ledibabari M. , Liang Yuanyuan , Ottochian Marcus , Morrison Jonathan J. , Rasko Yvonne , Liang Fan , Grant Michael P. , Nam Arthur J. 
Published: August 2019

Background:
Contemporary description of facial fracture patterns and factors associated with early operative intervention at trauma centers is lacking. The purpose of this study was to characterize injuries and initial treatment patterns of patients suffering from facial fractures.

Methods:
Using the National Trauma Databank from 2007 to 2015, patients suffering from facial fractures were included. Demographics, injury characteristics, and outcomes including operative interventions were assessed.

Results:
Over 9 years, 626,270 patients were included: 74.5% were male, 39.0% suffered traumatic brain injury (TBI), and 23.3% severe noncraniofacial injuries (chest, abdomen, and/or extremity Abbreviated Injury Score ≥3). A total of 537,594 (85.8%) patients were admitted and 184,206 (34.3%) underwent operations for their facial injuries during the index hospitalization. The frequency and patterns of fractures varied by age, sex, race, and mechanism of injury. Operative intervention rates were highest for mandible (63.2%) and lowest for orbit fractures (1.0%). Multiple regression revealed that multiple factors were independently associated with the odds of early fracture repair including: female versus male (odds ratio [95% confidence interval]: 0.96 [0.94–0.98]), age >65 versus <18 years (0.62 [0.59–0.64]), non-white race (0.95 [0.94–0.97]), uninsured versus Medicaid (0.88 [0.86–0.90]), hospital bed size (>600 vs ≤200 beds, 1.67 [1.61–1.73]), TBI (0.70 [0.69–0.71]), and C-spine injury (0.93 [0.90–0.96]).

Conclusions:
Facial fractures are common among many demographic cohorts, and multiple patient and injury-specific factors influenced fracture patterns and management. Early operative intervention was highest for mandible fractures and lowest for orbit fractures. Multiple factors including age, sex, insurance status, hospital characteristics, and race/ethnicity were independently associated with early operative intervention, highlighting disparities in care.
Identifying Naturalistic Coaching Behavior Among Practicing Surgeons in the Operating Room
Authors: Pradarelli Jason C. , Delisle Megan , Briggs Alexandra , Smink Douglas S. , Yule Steven 
Published: August 2019

Objective:
The aim of this study was to identify examples of naturalistic coaching behavior among practicing surgeons operating together by analyzing their intraoperative discussion.

Background:
Opportunities to improve surgical performance are limited for practicing surgeons; surgical coaching is one strategy to address this need. To develop peer coaching programs that integrate with surgical culture, a better understanding is needed of how surgeons routinely discuss operative performance.

Methods:
As part of a “co-surgery” quality improvement program, 20 faculty surgeons were randomized into 10 dyads who performed an operation together. Discourse analysis was conducted on transcribed intraoperative discussions. Themes were coded using an existing framework of surgical coaching principles (self-identified goals, collaborative analysis, constructive feedback, peer learning support) and surgical coaching content (technical skills, nontechnical skills). Coaching principles were cross-referenced with coaching content; c-coefficient measured the strength of association between pairs of themes.

Results:
Overall, 44 unique coaching examples were identified in 10 operations. Of the 4 principles of surgical coaching, only self-identified goals and collaborative analysis were identified consistently. Self-identified goals were most associated with discussions regarding technical skills of “tissue exposure,” “flow of operation,” and “instrument handling” and the nontechnical skill “situation awareness.” Collaborative analysis was most associated with discussions regarding technical skills of “respect for tissue” and “flow of operation” and nontechnical skills of “communication and teamwork.”

Conclusions:
In naturalistic discussions between practicing surgeons in the operating room, numerous examples of unprompted coaching behavior were identified that target intraoperative performance. Prominent coaching gaps—constructive feedback and peer learning support—were also observed. Surgical coach trainings should address these gaps.