bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gut microbiota in relation to frailty and clinical outcomes
Authors: D’Amico Federica , Barone Monica , Brigidi Patrizia , Turroni Silvia 
Published: March 2023

Purpose of review
The gut microbiota is involved in several aspects of host health and disease, but its role is far from fully understood. This review aims to unveil the role of our microbial community in relation to frailty and clinical outcomes.

Recent findings
Ageing, that is the continuous process of physiological changes that begin in early adulthood, is mainly driven by interactions between biotic and environmental factors, also involving the gut microbiota. Indeed, our gut microbial counterpart undergoes considerable compositional and functional changes across the lifespan, and ageing-related processes may be responsible for – and due to – its alterations during elderhood. In particular, a dysbiotic gut microbiota in the elderly population has been associated with the development and progression of several age-related disorders.

Summary
Here, we first provide an overview of the lifespan trajectory of the gut microbiota in both health and disease. Then, we specifically focus on the relationship between gut microbiota and frailty syndrome, that is one of the major age-related burdens. Finally, examples of microbiome-based precision interventions, mainly dietary, prebiotic and probiotic ones, are discussed as tools to ameliorate the symptoms of frailty and its overlapping conditions (e.g. sarcopenia), with the ultimate goal of actually contributing to healthy ageing and hopefully promoting longevity.
Heterogeneity in the response to n-3 polyunsaturated fatty acids
Authors: Shaikh Saame Raza , Bazinet Richard P. 
Published: March 2023

Purpose of review
A central goal in the study of long chain n-3 polyunsaturated fatty acids (PUFA) is to translate findings from the basic sciences to the population level to improve human health and prevent chronic diseases. A tenet of this vision is to think in terms of precision medicine and nutrition, that is, stratification of individuals into differing groups that will have different needs across the lifespan for n-3 PUFAs. Therefore, there is a critical need to identify the sources of heterogeneity in the human population in the dietary response to n-3 PUFA intervention.

Recent findings
We briefly review key sources of heterogeneity in the response to intake of long chain n-3 PUFAs. These include background diet, host genome, composition of the gut microbiome, and sex. We also discuss the need to integrate data from newer rodent models (e.g. population-based approaches), multi -omics, and analyses of big data using machine learning and data-driven cluster analyses.

Summary
Accounting for vast heterogeneity in the human population, particularly with the use of big data integrated with preclinical evidence, will drive the next generation of precision nutrition studies and randomized clinical trials with long-chain n-3 PUFAs.
Intraoral flaps for oral cavity and oropharyngeal reconstruction
Authors: Sandilands Jessica , Somers Miles , Winters Ryan 
Published: March 2023

Purpose of review
Oral cavity reconstruction using local flaps is an area of head and neck surgery that has been overshadowed since the introduction of free flaps. Here, we discuss new developments, predominantly modifications to existing techniques for intraoral reconstruction, the utility of different local flaps and a review of functional outcomes.

Recent findings
The facial artery musculomucosal (FAMM) flap has seen the greatest number of modifications to technique, most notably the extended double-pedicled, kite-shaped tunnelized and osseous myomucosal approaches. The tunnelled buccal fat pad flap has gained popularity as well as the use of combining two flaps such as the buccal fat pad and palatal island flap to reconstruct oral cavity defects with good effect. There is still a paucity of literature surrounding functional outcomes post reconstruction. Despite this, the complication rate for local flaps remains low.

Summary
The value of intraoral flaps for oral cavity reconstruction is undisputed. However, they are potentially underutilised in the modern era of expanding availability and indications for free tissue transfer. As many practices see greater numbers of aging patients, often with multisystem comorbidities, local flaps are an important tool that can provide the surgeon with a greater number of reconstructive options.
Use of a Rubric for Pediatric Emergency Medicine Fellowship Application Review
Authors: Ruscica Alice , Dessie Almaz , Jamal Nazreen , Roskind Cindy 
Published: March 2023

Background
There is a need to review a large number of applications for pediatric emergency medicine fellowship in a holistic and systemic, unbiased manner. There exists a need to restructure the application process. We sought to develop and implement a rubric screening rubric for initial evaluation of pediatric emergency medicine fellowship applications that avoided traditionally used metrics that may be biased against racially underrepresented groups who are historically excluded from medicine.

Methods
An interactive process was used by key program leadership with review of prior literature and input from Diversity, Equity, and Inclusivity departmental chair to develop a holistic screening rubric with consensus reached around key factors that aligned with our fellowship program mission. All applications were reviewed with the rubric by the program director or the associate program director. A subset of applications being considered for review were additionally scored by members of the fellowship selection committee.

Results
Numerical scores ranged from 2 to 14, with the maximum potential score being 14. Seventy percent of those applicants invited for interview scored 9 or higher. Reliability of scores between the program director and the associate program director was high (intraclass coefficient, 0.89); however, reliability between the program director or associate program director and the selection committee members was low to moderate (intraclass coefficient, 0.46).

Conclusions
Developmental and use of a rubric screening allowed our institution to reflect on our priorities, as well as avoid potential bias. The use of the tool allowed us to communicate about applications in an objective and consistent manner. As we continue to iterate on the rubric, we hope to incorporate additional criteria to better identify highly qualified applicants who may otherwise be overlooked in a traditional screening process and gain familiarity in reviewers use.
Weaving and Layering Funding: A Territorial Health Agency's Guide to Effective Health Financing
Authors: Cruz Casierra , Wheatley Alex , Ensign Karl , Fraser Michael R. , Gilmartin Sharon , Bailey Amy , Mendiola Amber 
Published: March 2023

Context:
State and territorial health agencies can optimize programmatic funding through braiding and layering strategies.

Implementation:
The Commonwealth Healthcare Corporation, a territorial health agency located on the Pacific Island of Saipan, Commonwealth of the Northern Mariana Islands (CNMI), restructured its Non-Communicable Disease Bureau into 4 new units. Existing funding streams were braided and layered to support the restructuring. A shared vision of strengthening crosscutting connections to improve population health outcomes helped guide the restructuring process. Vision planning with leaders and funding partners, establishing buy-in within agency and external partners, and assessing immediate impacts were a few of the steps taken by the agency to ensure a successful restructuring.

Impact:
The immediate impact of the restructure has been positive. In both the CNMI and select states that have undertaken similar efforts, braiding and layering funding has facilitated more streamlined processes, coordinated approaches across programs and funding partners, and provided deeper levels of trust in partnerships. Although it is still too early to draw long-term assessments in the CNMI, the agency projects that coordinated funds will strengthen its foundational capabilities and promote a more community-centered, collaborative, and effective approach to public health. Restructuring the Non-Communicable Disease Bureau through braiding and layering funds gives the agency the flexibility it needs to more effectively address the social determinants of health and local population health priorities through a client-centered approach, ultimately improving health outcomes for the commonwealth.

Lessons Learned and Implications:
The agency experienced several challenges throughout the restructuring process that offer lessons learned for addressing effective health financing. For example, ample time is needed at the beginning of the braiding and layering process to establish policies and procedures for efficient accounting, documenting, and reporting. In addition, ongoing support and training opportunities for programmatic teams can smooth out the transition from siloed to braided and layered funding structures. These lessons, in addition to key elements mapped out by experienced state health agencies, can guide and prepare other agencies interested in implementing innovative funding mechanisms.
Lengthening Phalloplasty with division of the suspensory ligament and distally based fat flaps in Penis Enlargement operations.
Authors: Deskoulidi Parthena I. , Caminer David 
Published: March 2023

Background:
Small penile size is worrying for most men and leads to poor self-esteem, anxiety and depression. A penis can be enlarged in two ways: by increasing the length and by increasing the circumference. The purpose of this article is to present a new procedure of augmentation phalloplasty which combines these two parts in the same operation with a new technique to fill in the dead space created by the suspensory ligament division.

Methods:
The lengthening of the penis is achieved with an inverted V-Y plasty followed by a division of the suspensory ligament of the penis all the way down the pubic symphysis. Two distally based fat flaps are advanced into this area to fill in the dead space. The widening of the circumference is performed with fat injections.

Results:
The penile length gain postoperatively is 2-4 cm in the flaccid state and the widening component with the fat grafting technique gives an approximate circumference increase of 1cm with excellent natural results. Sexual self-esteem and functioning improvement was reported by the patients, 75 in total. Three patients returned after the operation for revision of fat injections 6-12 months after the operation.

Conclusion:
The literature regarding the long-term results after augmentation phalloplasty is poor and it is difficult to compare results with other techniques. Penile enlargement when performed for the appropriate reasons, can have a positive effect on the lives of many men.
After fifteen years of experience this procedure gives very pleasing results with minimal complications.
CranioRate TM: An Image-Based, Deep-Phenotyping Analysis Toolset and Online Clinician Interface for Metopic Craniosynostosis
Authors: Beiriger Justin W. , Tao Wenzheng , Bruce Madeleine K , Anstadt Erin , Christensen Cameron , Smetona John , Whitaker Ross , Goldstein Jesse 
Published: March 2023

Introduction:
The diagnosis and management of metopic craniosynostosis involves subjective decision-making at the point of care. The purpose of this work is to describe a quantitative severity metric and point-of-care user interface to aid clinicians in the management of metopic craniosynostosis and to provide a platform for future research through deep phenotyping.

Methods:
Two machine-learning algorithms were developed that quantify the severity of craniosynostosis – a supervised model specific to metopic craniosynostosis (Metopic Severity Score) and an unsupervised model used for cranial morphology in general (Cranial Morphology Deviation). CT imaging from multiple institutions were compiled to establish the spectrum of severity and a point-of-care tool was developed and validated.

Results:
Over the study period (2019-2021), 254 patients with metopic craniosynostosis and 92 control patients who underwent CT scan between the ages of 6 and 18 months were included. Scans were processed using an unsupervised machine-learning based dysmorphology quantification tool, CranioRate TM. The average Metopic severity score (MSS) for normal controls was 0.0±1.0 and for metopic synostosis was 4.9±2.3 (p<0.001). The average Cranial Morphology Deviation (CMD) for normal controls was 85.2±19.2 and for metopic synostosis was 189.9±43.4 (p<0.001). A point-of-care user interface (craniorate.org) has processed 46 CT images from 10 institutions.

Conclusion:
The resulting quantification of severity using MSS and CMD has shown an improved capacity, relative to conventional measures, to automatically classify normal controls versus patients with metopic synostosis. We have mathematically described, in an objective and quantifiable manner, the distribution of phenotypes in metopic craniosynostosis.
Effect of Dolutegravir and Multimonth Dispensing on Viral Suppression Among Children With HIV
Authors: Mugo Cyrus , Zubayr Bashir , Ezeokafor Nnenna , Oyawola Babatunde , Ekele David Ochedomi , Madueke Leila , Kpamor Zipporah , Semo Bazghina-werq 
Published: March 2023

Background:
Few studies in sub-Saharan Africa have assessed the impact of multimonth dispensing (MMD) of antiretroviral therapy (ART) and dolutegravir (DTG) beyond clinical trials among children with HIV (CWHIV). We assessed the effect of the 2 interventions on achieving undetectable viral load (VL) among CWHIV in the age group of 0–15 years in Nigeria.

Methods:
We used longitudinal routine records and cross-sectional survey data from caregivers of a subsample of children. VLs were considered suppressed at <1000 copies/mL and undetectable at <50 copies/mL. Multimonth dispensing (MMD) was defined as ART refill for >84 days. The effect of MMD and DTG on VL levels and associations between social factors and VL were estimated using generalized linear models, reporting adjusted relative risks/prevalence ratios and 95% confidence intervals (CIs).

Results:
Of 2490 CWHIV, 52% were male, with a median age of 10 years (interquartile ranges: 6–13) and a median duration on ART of 4.6 years (interquartile ranges: 2.8–7.1). Overall, 73% were on DTG and 55% received MMD. At baseline, 63% were suppressed, while 79% and 56% were suppressed and undetectable in their last VL, respectively. We found no differences in undetectable VL between those on MMD and not on MMD (adjusted relative risks: 1.05 [95% CI: 0.94–1.18]) and between those on DTG and not on DTG (1.07 [0.92–1.25]). In secondary analyses, poor adherence and being in a support group were associated with a lower likelihood of undetectable VL (adjusted prevalence ratios: 0.85 [95% CI: 0.74–0.96] and 0.81 [0.68–0.96], respectively).

Conclusion:
MMD did not compromise treatment outcomes for CWHIV. Poor adherence, however, remains a barrier to achieving treatment targets.
Combination Use of Compressed Sensing and Deep Learning for Shoulder Magnetic Resonance Imaging With Various Sequences
Authors: Shiraishi Kaori , Nakaura Takeshi , Uetani Hiroyuki , Nagayama Yasunori , Kidoh Masafumi , Kobayashi Naoki , Morita Kosuke , Yamahita Yuichi , Miyamoto Takeshi , Hirai Toshinori 
Published: March 2023

Objective
For compressed sensing (CS) to become widely used in routine magnetic resonance imaging (MRI), it is essential to improve image quality. This study aimed to evaluate the usefulness of combining CS and deep learning–based reconstruction (DLR) for various sequences in shoulder MRI.

Methods
This retrospective study included 37 consecutive patients who underwent undersampled shoulder MRIs, including T1-weighted (T1WI), T2-weighted (T2WI), and fat-saturation T2-weighted (FS-T2WI) images. Images were reconstructed using the conventional wavelet-based denoising method (wavelet method) and a combination of wavelet and DLR-based denoising methods (hybrid-DLR method) for each sequence. The signal-to-noise ratio and contrast-to-noise ratio of the bone, muscle, and fat and the full width at half maximum of the shoulder joint were compared between the 2 image types. In addition, 2 board-certified radiologists scored the image noise, contrast, sharpness, artifacts, and overall image quality of the 2 image types on a 4-point scale.

Results
The signal-to-noise ratios and contrast-to-noise ratios of the bone, muscle, and fat in T1WI, T2WI, and FS-T2WI obtained from the hybrid-DLR method were significantly higher than those of the conventional wavelet method (P < 0.001). However, there were no significant differences in the full width at half maximum of the shoulder joint in any of the sequences (P > 0.05). Furthermore, in all sequences, the mean scores of the image noise, sharpness, artifacts, and overall image quality were significantly higher in the hybrid-DLR method than in the wavelet method (P < 0.001), but there were no significant differences in contrast among the sequences (P > 0.05).

Conclusions
The DLR denoising method can improve the image quality of CS in T1-weighted images, T2-weighted images, and fat-saturation T2-weighted images of the shoulder compared with the wavelet denoising method alone.
Factors Contributing to Computed Tomography Trauma Scan Times at a Tertiary Center: Improving Emergency Department Trauma Imaging Workflow Through Targeted Interventions
Authors: Wood Erika J. , Stabo Nicholas , Garrett John W. , Rose Sean , Bartels Carrie , Szczykutowicz Timothy P. , Avey Greg , Mao Lu , Lubner Meghan G. 
Published: March 2023

Purposes
The aims of the study are to identify factors contributing to computed tomography (CT) trauma scan turnaround time variation and to evaluate the effects of an automated intervention on time metrics.

Methods
Throughput metrics were captured via picture archiving and communication system from January 1, 2018, to December 16, 2019, and included 17,709 CT trauma scans from our institution. Initial data showed that imaging technologist variation played a significant role in trauma imaging turnaround time. In December 2019, we implemented a 2-pronged intervention: (1) educational intervention to techs and (2) modified trauma CT abdomen/pelvis to autogenerate and autosend reformats to picture archiving and communication system. A total of 13,169 trauma CT scans were evaluated from the postintervention period taking place from January 2020 to March 2021. Throughput metrics such as last image to first report interval and emergency department length of stay were captured and compared with performing technologist, time of day, and weekday versus weekend scans.

Results
Substantial variability among trauma CT scans was observed. For CT trauma abdomen/pelvis, the interval from last image to initial report decreased from 26.4 to 24.0 minutes (P = 0.001) while the interval between first and last image time decreased from 11.4 to 4.2 minutes (P < 0.001). Emergency department length of stay also decreased from 3.9 to 3.7 hours (P < 0.0001) in the postintervention period. Variation among imaging technologist was statistically significant and became less significant after intervention (P = 0.09, P = 0.54)

Conclusions
Factors such as imaging technologist variability, time of day, and day of the week of trauma scans played a significant role in CT trauma turnaround time variability. Automation interventions can help with efficiency in image turnaround time.
Rapid Response Team Activation Triggers in Adults and Children: An Integrative Review
Authors: Feroz Ali Naheed , Amir Asma , Punjwani Aleena , Bhimani Rozina 
Published: March 2023

Abstract

Purpose
This integrative review aims to identify the triggers for rapid response team (RRT) activation and their outcomes in pediatric patients and to compare them with those of adult patients. In addition, this integrative review synthesizes the outcomes of cardiopulmonary resuscitation (CPR), intensive care unit (ICU) admission, length of hospital stay, and mortality following RRT activation.

Method
An integrative review using the Whittemore and Knafl methodology was undertaken with a search of three large databases (PubMed, Ovid MEDLINE, and CINAHL) and found 25 relevant studies published in the years 2017 through 2022.

Results
Tachypnea, decreased oxygen saturation, tachycardia, changes in blood pressure, and level of consciousness were the most common triggers in both populations. However, specific activation triggers differed between children and adults.

Conclusions
The most common triggers for RRT are detectable through vital signs monitoring; therefore, vigilant tracking of patients’ vital signs is critical and can provide early clues to clinical deterioration.
Comparison of Magnetic Resonance-Based Elastography and Ultrasound Shear Wave Elastography in Patients With Suspicion of Nonalcoholic Fatty Liver Disease
Authors: Tahmasebi Aylin , Wessner Corinne E. , Guglielmo Flavius F. , Wang Shuo , Vu Trang , Liu Ji-Bin , Civan Jesse , Lyshchik Andrej , Forsberg Flemming , Li Hongbo , Qu Enze , Eisenbrey John R. 
Published: March 2023

Abstract
This study investigated the correlation between magnetic resonance elastography (MRE) and shear wave ultrasound elastography (SWE) in patients with clinically diagnosed or suspected nonalcoholic fatty liver disease (NAFLD). Subjects with or at risk of NAFLD identified by magnetic resonance imaging (MRI) proton density fat fraction (PDFF) were prospectively enrolled. For each patient, 6 valid 2-dimensional SWE measurements were acquired using a Logiq E10 scanner (GE HealthCare, Waukesha, WI). A reliability criterion of an interquartile range to median ratio of ≤15% was used for SWE to indicate quality dataset. Magnetic resonance elastography, and MR-fat quantification data were collected the same day as part of the patient's clinical standard of care. Magnetic resonance imaging PDFF was used as a reference to quantify fat with >6.4% indicating NAFLD. Pearson correlation and t-test were performed for statistical analyses. A total of 140 patients were enrolled, 112 of which met SWE reliability measurement criteria. Magnetic resonance elastography and 2-dimensional SWE showed a positive correlation across all study subjects (r = 0.27; P = 0.004). When patients were grouped according to steatosis and fibrosis state, a positive correlation was observed between MRE and SWE in patients with fibrosis (r = 0.30; P = 0.03), without fibrosis (r = 0.27; P = 0.03), and with NAFLD (r = 0.28; P = 0.02). No elastography technique correlated with liver fat quantification (P > 0.52). Magnetic resonance elastography was significantly different between patients with and without fibrosis (P < 0.0001). However, this difference was not apparent with SWE (P = 0.09). In patients with suspected or known NAFLD, MRE, and SWE demonstrated a positive correlation. In addition, these noninvasive imaging modalities may be useful adjunct techniques for monitoring NAFLD.