bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of coronavirus disease 2019 on co-morbidities in HIV
Authors: Guaraldi Giovanni , Milic Jovana 
Published: February 2023

Purpose of review
This perspective paper offers some reflections on an hypothesized changing scenario of HIV comorbidities in the years to come and provides some insights on how to improve screening and management of people with HIV (PWH) in the coronavirus disease 2019 (COVID-19) era.

Recent findings
PWH may experience a higher burden of excess disease and mortality associated with noninfectious comorbidities in the COVID-19 era. HIV care must move beyond viral–immunological success to incorporate patient-centered outcomes based on the intrinsic characteristics of the individual and its environment, assessment and screening for comorbidities, evaluation of aging and geriatric syndromes and last but not least fight stigma, ageism and inequality to access to care.

Summary
COVID-19 is widening the gap between unmet needs of PWH and healthcare systems. An increasing burden of comorbidities, multimorbidity and frailty is affecting PWH which requires redesign of care delivery oriented around the diverse needs of individuals, rather than the prerequisites of providers, and must ensure health equity. In particular, any changes to care delivery must address existing disparities in access and care among PWH and fight stigma.
The importance of post marketing quality control
Authors: Buehler Philipp K. , Weiss Markus , Wendel-Garcia Pedro D. , Both Christian P. , Schmidt Alexander R. , Wehren Martin P. , Thomas Jörg 
Published: February 2023

BACKGROUND
A previously published study reported on the nonlinear behaviour for airway pressure and tidal volume of the adjustable pressure-limiting (APL) valve of the Aisys CS2 anaesthesia machine (GE Healthcare, Madison, Wisconsin, USA) during manual bag ventilation. In co-operation with the manufacturer, an adapted APL valve was developed.

OBJECTIVE
To test and characterise the performance of an adapted APL valve and assess its clinical usability.

DESIGN
Two-stage study, consisting of an in-vitro testing of an adapted APL valve in a baby and adolescent lung model, followed by a clinical experience survey of anaesthesia personnel after the official implementation of the new APL valve into clinical routine.

SETTING
Anaesthesia Department at the University Children's Hospital Zurich.

MAIN OUTCOME MEASURES
Airway pressures and inspiratory tidal volumes during opening and closure of the APL valve at different settings. Likert scale assessment of performance expectance, effort expectance, behavioural intention and safety of the APL valve during clinical use.

RESULTS
In contrast to the original APL valve of the GE Aisys CS2, the adapted APL valve showed a nearly linear increase in airway pressures as well as in the tidal volumes measured. Most importantly, the measured pressures never exceeded the set pressures. Based on the experimental findings, all original APL valves of the GE Aisys CS2 were replaced by the adapted APL valve. Two months later, an anonymised and standardised questionnaire was handed out to all employees working with the adapted APL valve. Analysis of the questionnaire indicated that the adapted APL valve is easier and more precise to handle in the daily routine than the original one.

CONCLUSION
The newly adapted APL valve for the GE Aisys CS2 has considerably improved its linearity at lower pressures and supports our institution's bag mask ventilation practices.
When Does Differential Outcome Misclassification Matter for Estimating Prevalence?
Authors: Edwards Jessie K. , Cole Stephen R. , Shook-Sa Bonnie E. , Zivich Paul N. , Zhang Ning , Lesko Catherine R. 
Published: February 2023

Background:
When accounting for misclassification, investigators make assumptions about whether misclassification is “differential” or “nondifferential.” Most guidance on differential misclassification considers settings where outcome misclassification varies across levels of exposure, or vice versa. Here, we examine when covariate-differential misclassification must be considered when estimating overall outcome prevalence.

Methods:
We generated datasets with outcome misclassification under five data generating mechanisms. In each, we estimated prevalence using estimators that (a) ignored misclassification, (b) assumed misclassification was nondifferential, and (c) allowed misclassification to vary across levels of a covariate. We compared bias and precision in estimated prevalence in the study sample and an external target population using different sources of validation data to account for misclassification. We illustrated use of each approach to estimate HIV prevalence using self-reported HIV status among people in East Africa cross-border areas.

Results:
The estimator that allowed misclassification to vary across levels of the covariate produced results with little bias for both populations in all scenarios but had higher variability when the validation study contained sparse strata. Estimators that assumed nondifferential misclassification produced results with little bias when the covariate distribution in the validation data matched the covariate distribution in the target population; otherwise estimates assuming nondifferential misclassification were biased.

Conclusions:
If validation data are a simple random sample from the target population, assuming nondifferential outcome misclassification will yield prevalence estimates with little bias regardless of whether misclassification varies across covariates. Otherwise, obtaining valid prevalence estimates requires incorporating covariates into the estimators used to account for misclassification.
Anatomical Study of the Penile Suspensory System: A Surgical Application to Micropenis
Authors: Danino Michel Alain , Benkahdra Mehdi , El Khatib Arij , Yafi Nazhat , Trouilloud Pierre , Danino Ruben Pierre , Laurent Romain 
Published: February 2023

Background:
Penile enlargement surgery is the second most desired cosmetic procedure in men worldwide. The mainstay of penile lengthening procedures is a partial release of the penile suspensory ligament system. Concerns regarding erect penis stability after this procedure have been raised by the surgical community. This study describes the anatomical features of the penile suspensory ligament system and explores the stability mechanisms of the penis.

Methods:
This study is subdivided in two parts: an anatomical analysis and a clinical analysis. The anatomical part consists of a dissection of eight male cadavers to describe the anatomy and test the stability after sectioning successively the suspensory ligaments. The clinical part consists of an analysis of 30 patients with micropenis operated on for penile lengthening by a penile suspensory ligament release and lipofilling.

Results:
The suspensory apparatus consists of four distinct ligamentous structures: fundiform, suspensory, dense vertical, and arcuate ligaments. These different structures are lax superficially but become firm and tense posteriorly. The section of the fundiform and suspensory ligaments did not destabilize the penis.

Conclusion:
Penile lengthening by way of cautious suspensory ligament release can be performed without erection instability.
Surgical Nipple Delay and its Expanded Indications for Nipple-sparing Mastectomy
Authors: Lee Phoebe L. , Ma Irene T. , Schusterman Mark Asher , Beiriger Justin , Ahrendt Gretchen , De La Cruz Carolyn , Diego Emilia J. , Steiman Jennifer G. , McAuliffe Priscilla F. , Gimbel Michael L. 
Published: February 2023

Background:
Necrosis of the nipple-areolar complex (NAC) or surrounding skin has been reported in 6%–30% of nipple-sparing mastectomy (NSM) patients, with higher rates associated with larger breasts, previous breast surgery, previous radiation, and active smoking. The nipple delay (ND) procedure is known to improve viability of the NAC in NSM patients with high-risk factors.

Methods:
A single-institution retrospective review was done of patients who underwent ND and NSM or NSM alone from 2012 to 2022. Patient demographics, risk factors, and outcomes were compared.

Results:
Forty-two breasts received ND-NSM and 302 breasts received NSM alone. The ND-NSM group had significantly more high-risk factors, including elevated BMI (26.3 versus 22.9; P < 0.001), elevated prior breast surgery (50% versus 25%; P < 0.001), and greater mastectomy specimen weight (646.6 versus 303.2 g; P < 0.001). ND-NSM was more likely to have undergone preparatory mammoplasty before NSM (27% versus 1%; P < 0.001). There was no delay in NSM treatment from decision to pursue NSM (P = 0.483) or difference in skin necrosis (P = 0.256), NAC necrosis (P = 0.510), hematoma (P = 0.094), seroma (P = 0.137), or infection (P = 0.437) between groups. ND-NSM and NSM patients differed in total NAC necrosis (0% versus 3%) and implant loss (0% vs 13%), but not significantly.

Conclusions:
We demonstrated no NAC necrosis and no significant delay of treatment in higher risk ND-NSM patients. ND may allow higher risk patients to undergo NSM with similar morbidity as lower risk patients.
The nonalcoholic steatohepatitis extended hepatocyte ballooning score: histologic classification and clinical significance
Authors: Gill Ryan M. , Allende Daniela , Belt Patricia H. , Behling Cynthia A. , Cummings Oscar W. , Guy Cynthia D. , Carpenter Daniela , Neuschwander-Tetri Brent A. , Sanyal Arun J. , Tonascia James , Van Natta Mark L. , Wilson Laura A. , Yamada Goro , Yeh Matthew , Kleiner David E. ,   for the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)
Published: February 2023

Background and Aims:
The NAFLD activity score was developed to measure histologic changes in NAFLD during therapeutic trials. Hepatocyte ballooning (HB) is the most specific feature in steatohepatitis diagnosis, yet the impact of variations in HB has not been incorporated.

Approach and Results:
Liver biopsies from patients enrolled in the NASH Clinical Research Network with an initial diagnosis of NASH or NAFL (n=1688) were evaluated to distinguish classic hepatocyte ballooning (cHB) from smaller, nonclassic hepatocyte ballooning (nHB), and also to designate severe ballooning and assign an extended hepatocyte ballooning (eB) score [0 points, no ballooning (NB); 1 point, few or many nHB; 2 points, few cHB; 3 points, many cHB; 4 points, severe cHB] to the biopsy assessment. The eB score was reproducible among NASH CRN liver pathologists (weighted kappa 0.76) and was significantly associated with older age (mean 52.1 y, cHB; 48.5 y, nHB, p<0.001), gender (72.3% female, cHB; 54.5% female, nHB, p<0.001), diabetes (49.8% diabetes, cHB; 28.2% diabetes, nHB, p<0.001), metabolic syndrome (68.5% metabolic syndrome, nHB; 50.2% metabolic syndrome, NB, p<0.001), and body mass index [33.2, 34.2, 35 mean body mass index (kg/m2); NB, nHB, and cHB, respectively, p<0.05]. Finally, fibrosis stage, as a marker of disease severity, was significantly correlated with the eB score (p<0.001).

Conclusions:
The eB score allows for a reproducible and more precise delineation of the range of ballooned hepatocyte morphology and corresponds with both clinical features of NASH and fibrosis stage.
Association between lung function and hypertension and home hypertension in a Japanese population: the Tohoku Medical Megabank Community-Based Cohort Study
Authors: Takase Masato , Yamada Mitsuhiro , Nakamura Tomohiro , Nakaya Naoki , Kogure Mana , Hatanaka Rieko , Nakaya Kumi , Chiba Ippei , Kanno Ikumi , Nochioka Kotaro , Tsuchiya Naho , Hirata Takumi , Hamanaka Yohei , Sugawara Junichi , Kobayashi Tomoko , Fuse Nobuo , Uruno Akira , Kodama Eiichi N. , Kuriyama Shinichi , Tsuji Ichiro , Hozawa Atsushi 
Published: February 2023

Background:
Although several studies have shown an inverse association between lung function and hypertension, few studies have examined the association between lung function and hypertension among never-smokers, and no study has investigated the association between lung function and home hypertension. We investigated the associations between lung function and hypertension in a Japanese population.

Individuals and methods:
We conducted a cross-sectional study of 3728 men and 8795 women aged 20 years or older living in Miyagi Prefecture, Japan. Lung function was assessed using forced expiratory volume at 1 s (FEV1) and forced vital capacity (FVC), measured by spirometry. Hypertension was defined as a casual blood pressure at least 140/90 mmHg and/or self-reported treatment for hypertension. Home hypertension was defined as morning home blood pressure at least 135/85 mmHg and/or self-reported treatment for hypertension. Multivariate logistic regression models adjusted for potential confounders were used to assess the association between lung function and hypertension.

Results:
The mean ages (±SD) of men and women were 60.1 (±14.0) years and 56.2 (±13.4) years, respectively, and 1994 (53.5%) men and 2992 (34.0%) women had hypertension. In the multivariable models, FEV1 and FVC were inversely associated with hypertension. Inverse associations between lung function and hypertension were observed even among never-smokers. Furthermore, reduced lung function was associated with higher prevalence of home hypertension in men and women.

Conclusion:
Reduced lung function was associated with higher prevalence of hypertension, independent of smoking status. Assessment of the lung function or blood pressure may be required in individuals with reduced lung function or hypertension.
Implications of Entrustable Professional Activities for Motivation and Learning
Authors: Sasek Cody A. 
Published: February 2023

Introduction
This study sought to explore the experience of entrustable professional activity-based assessment and its effect on self-determination, a well-supported measure of motivation. The goal was to understand EPA-based assessment's implications for student motivation, learning, and wellbeing.

Methods
A qualitative case study design was utilized through a standardized simulation activity with EPA-based assessment. An analysis of interviews and reflection journals was completed by the coding of emergent themes and significant statements with a subsequent thematic analysis framed in self-determination theory (SDT).

Results
Entrustment was found to be an affectively and interpersonally impactful metric that provided the learner with a clear understanding of clinical performance. Quality entrustment feedback supported participants' sense of competence and increased their confidence in their ability to be autonomous as well as a valuable part of the healthcare team.

Discussion
EPAs appeared to support learners' sense of competence and to provide a bridge to support autonomy and the ability to relate to others. To the extent that entrustment supported learners' sense of competence, other SDT propositions could be subsequently bolstered as well. Self-determination and intrinsic motivation were uniquely supported by EPA-based assessment, if implemented effectively. Further research is needed to better define effective implementation, faculty development, and feedback strategies.
The IOC Venue Ultrasound Program: A Pilot Study from Tokyo 2020 Olympic Games
Authors: Onishi Kentaro , Engebresten Lars , Budgett Richard , Soligard Torbjorn , Forster Bruce B. 
Published: February 2023

Abstract
The objective of this pilot investigation was to describe the novel use of venue ultrasound at the 2020 Tokyo Olympic Games. Portable laptop ultrasound machines were made available to cover seven Olympic sports at seven venues. The responses by both the National Olympic Committee personnel accompanying the medical room visits, and by the examining physicians were recorded. Athletes were followed up until the end of the Olympic Games and the ultrasound diagnostic accuracy was evaluated. Fourteen athletes were evaluated using venue ultrasound and the recorded injuries included seven soft tissue, five osseous, and two non-musculoskeletal injuries. From these, eight athletes were evaluated further by other imaging modalities, which indicated that the ultrasound provided an accurate diagnosis in all cases. All National Olympics Committee personnel reported increased diagnostic confidence and felt that venue ultrasound should be considered for future sports events. Further, all evaluating physicians felt ultrasound was helpful in refining the diagnosis. The average years of sports ultrasound experience was 8.4 years and the average years of clinical sports medicine experience was 9.3 years amongst the physicians. In conclusion, the International Olympic Committee Venue Ultrasound Pilot Program showed promise in improving venue triaging, suggesting its role at future sports events.
Development and validation of the Self-Management Assessment for the Residuum and prosThesis system designed for persons with limb loss (SMART)
Authors: Lee Daniel J. , Gailey Robert S. , Fernandez-Fernandez Alicia , Litwin Bini A. 
Published: February 2023

Objective:To develop a system of reliable and valid knowledge assessments of self-management in persons with lower limb loss, along with the accompanying targeted educational interventions (TEIs), known as the Self-Management Assessment for the Residuum and prosThesis (SMART) system.Design:This 2-phase study used mixed methodology. Phase 1 was development, face validation, and content validation of the 60-item knowledge assessment measure (SMART 60) and the TEI. Phase 2 assessed internal consistency reliability using Kuder-Richardson Formula 20 and the creation of the SMART system, consisting of modules developed from the SMART 60. Validity of the measures using known groups' comparison was analyzed by comparing clinicians (prosthetists and physical therapists) with persons with lower limb loss. Participants were recruited from the Amputee Coalition National Conference in 2018 and 2019.Results:A total of 140 participants completed this study. Four modules from the SMART 60 were created and designed to integrate as a system. Face validity survey average scores found that 9/10 participants either agreed or strongly agreed that the SMART system has high readability, perceived usefulness, and value for both new and experienced prosthetic users. Measure length ranged from 10 to 45 items with a reliability ranging from Kuder-Richardson Formula 20 = 0.70–0.82. The SMART system demonstrated known-groups validity (p< 0.05).Conclusion:The SMART system is an integrated series of self-management knowledge assessments with reasonable to good internal consistency reliability and known-groups validity. The TEIs provide directed solutions to identified knowledge gaps on the assessments.
Impact of sub-optimal HIV viral control on activated T cells
Authors: Arrigoni Francesca I.F. , Spyer Moira , Hunter Patricia , Alber Dagmar , Kityo Cissy , Hakim James , Matubu Allen , Olal Patrick , Paton Nicholas I. , Walker A. Sarah , Klein Nigel 
Published: February 2023

Objective:
HIV viral load (VL) monitoring is generally conducted 6–12 monthly in low- and middle-income countries, risking relatively prolonged periods of poor viral control. We explored the effects of different levels of loss of viral control on immune reconstitution and activation.

Design:
Two hundred and eight participants starting protease inhibitor (PI)-based second-line therapy in the EARNEST trial (ISRCTN37737787) in Uganda and Zimbabwe were enrolled and CD38+/HLA-DR+ immunophenotyping performed (CD8-FITC/CD38-PE/CD3-PerCP/HLA-DR-APC; centrally gated) in real-time at 0, 12, 48, 96 and 144 weeks from randomization.

Methods:
VL was assayed retrospectively on samples collected every 12–16 weeks and classified as continuous suppression (<40 copies/ml throughout); suppression with transient blips; low-level rebound (two or more consecutive VL >40, <5000 copies/ml); high-level rebound/nonresponse (two or more consecutive VL >5000 copies/ml).

Results:
Immunophenotype reconstitution varied between that defined by numbers of cells and that defined by cell percentages. Furthermore, VL dynamics were associated with substantial differences in expression of CD4+ and CD8+ cell activation markers, with only individuals with high-level rebound/nonresponse (>5000 copies/ml) experiencing significantly greater activation and impaired reconstitution. There was little difference between participants who suppressed consistently and who exhibited transient blips or even low-level rebound by 144 weeks (P > 0.2 vs. suppressed consistently).

Conclusion:
Detectable viral load below the threshold at which WHO guidelines recommend that treatment can be maintained without switching (1000 copies/ml) appear to have at most, small effects on reconstitution and activation, for patients taking a PI-based second-line regimen.
The impact of COVID-19 pandemic on the dynamic HIV care engagement among people with HIV: real-world evidence
Authors: Yang Xueying , Zhang Jiajia , Chen Shujie , Weissman Sharon , Olatosi Bankole , Li Xiaoming 
Published: February 2023

Introduction:
Existing studies examining the impact of the COVID-19 pandemic on engagement in HIV care often capture cross-sectional status, while lacking longitudinal evaluations. This study examined the impact of the pandemic on the longitudinal dynamic change of retention in care and viral suppression status.

Methods:
The electronic health record (EHR) data of this population-level cohort study were retrieved from the statewide electronic HIV/AIDS reporting system in South Carolina. The study population was people with HIV (PWH) who had at least one year's symmetric follow-up observation record before and after the pandemic. Multivariable generalized linear mixed regression models were employed to analyze the impact of the pandemic on these outcomes, adjusting for socio-demographic characteristics and preexisting comorbidities.

Results:
In the adjusted models, PWH had a lower likelihood of retention in care (adjusted odds ratio [aOR]: 0.806, 95% confidence interval [CI]: 0.769, 0.844) and a higher probability of virological failure (aOR: 1.240, 95% CI: 1.169, 1.316) during the peri-pandemic period than pre-pandemic period. Results from interaction effect analysis from each cohort revealed that the negative effect of the pandemic on retention in care was more severe among PWH with high comorbidity burden than those without any comorbidity; meanwhile, a more striking virological failure was observed among PWH who reside in urban areas than in rural areas.

Conclusion:
The COVID-19 pandemic has a negative impact on retention in care and viral suppression among PWH in South Carolina, particularly for individuals with comorbidities and residing in urban areas.