bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obesity and kidney transplantation
Authors: Chang Jae-Hyung , Mushailov Vladimir , Mohan Sumit 
Published: February 2023

Purpose of review
Obesity has reached epidemic proportions in the United States. It is a risk factor for developing, among others, heart disease, stroke, type 2 diabetes, and chronic kidney disease (CKD), and thus a major public health concern and driver of healthcare costs. Although the prevalence of obesity in the CKD/end-stage kidney disease population is increasing, many obese patients are excluded from the benefit of kidney transplant based on their BMI alone. For this reason, we sought to review the experience thus far with kidney transplantation in obese patients and associated outcomes.

Recent findings
Obesity is associated with a lower rate of referral and waitlisting, and lower likelihood of kidney transplantation. Despite increased risk for early surgical complications and delayed graft function, experience from multiple centers demonstrate a clear survival benefit of transplantation over dialysis in most obese patients, and comparable graft and patient survival rates to nonobese recipients.

Summary
Data suggest that long-term transplant outcomes among obese recipients are similar to those among nonobese. Strategies to achieve pretransplant weight reduction and minimally invasive surgical techniques may further improve results of kidney transplantation in obese recipients.
Analyzing the Effects of Family Presence and Visitation Restrictions During the COVID-19 Pandemic Among Nurse Leaders and Non–Nurse Leaders
Authors: Brewer Katherine C. , Horning Melanie A. , Walker Mark S. , Ness Michelle M. 
Published: February 2023

AIM
This analysis seeks to identify the effect of family presence and visitation during COVID-19 pandemic among nurses and nurse leaders.

BACKGROUND
Visitation restrictions were widespread during the initial months of the COVID-19 pandemic and were a potential source of distress for nurses. Few studies have examined sources of distress, such as visitation restrictions, among nurse leaders and non–nurse leaders.

METHODS
Secondary analysis was performed using a national survey of nurses conducted by the American Nurses Foundation.

RESULTS
More nurse leaders than nonleaders reported that nurses were involved in policy decisions/discussions and that visitation restrictions created additional burdens. There was similar level of agreement among nurse leaders and nonleaders that restrictions were not in the best interest of the patients. Many nurses reported the restrictions impacted their own well-being.

CONCLUSION
Visitation restrictions were a likely source of distress. Improvements to communication, planning, and transparency should be considered in preparation for future emergencies that may require visitation restrictions.
Physical Activity in Multiple Sclerosis: Meeting the Guidelines at the Time of the COVID-19 Pandemic
Authors: Pedullà Ludovico , Santoyo-Medina Carme , Novotna Klara , Moumdjian Lousin , Smedal Tori , Arntzen Ellen Christin , van der Linden Marietta L. , Learmonth Yvonne , Kalron Alon , Güngör Feray , Nedeljkovic Una , Kos Daphne , Jonsdottir Johanna , Coote Susan , Tacchino Andrea 
Published: February 2023

Background and Purpose:
Regular physical activity (PA) helps to reduce the severity of physical and mental symptoms and improves quality of life in people with multiple sclerosis (PwMS). Based on current evidence and expert opinion, the recent multiple sclerosis guidelines recommend at least 150 minutes/week of PA. This study presents the results of a survey analyzing whether and how PwMS met the guidelines before and during the pandemic.

Methods:
We developed and disseminated an international online survey between December 2020 and July 2021, investigating changes in self-reported PA type, duration, frequency, and intensity due to the COVID-19 outbreak in PwMS with differing disability levels.

Results:
Among respondents (n = 3810), 3725 were eligible. The proportion of those who conducted at least one activity decreased with increasing disability level at both time points (pre and during). Overall 60% of respondents met the guidelines before the pandemic (mild: 64.43%; moderate: 51.53%; severe: 39.34%; χ2
(2) = 109.13, P < 0.01); a reduction of approximately 10% occurred during the pandemic in all disability groups (mild: 54.76%; moderate: 42.47%; severe: 29.48%; χ2
(2) = 109.67, P < 0.01). Respondents with higher disability participated more in physical therapy and less in walking, cycling, and running at both time points. Most respondents reported practicing PA at a moderate intensity at both time points; frequency and duration of sessions decreased as disability level increased.

Discussion and Conclusions:
The percentage of those meeting the guidelines reduced with increasing disability level and during the pandemic. PA type and intensity varied widely across the disability categories. Interventions accounting for disability level are required to enable more PwMS to reap the benefits of PA.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A415).
The sustained impact of a virtual disability education curriculum with fourth year medical students in a mandatory physical medicine and rehabilitation clerkship
Authors: Hartsgrove Caitlin , Delauter Gabrielle , Kirshblum Steven 
Published: February 2023

Abstract

Objective
To measure the short and long-term impact of a virtual disability education curriculum associated with a two-week mandatory physical medicine and rehabilitation (PM&R) clerkship for fourth-year medical students.

Design
A prospective pre-post intervention survey-based study measuring the impact of a virtual disability education series at 1-week and 6-month timepoints following a mandatory PM&R clerkship including eight hours of virtual didactics with an emphasis on physical disabilities. The surveys assessed the overall virtual curriculum, perceived benefit of a virtual encounter, and the long-term applicability of the information learned from the clerkship.

Results
The PM&R clerkship was effective in improving medical students’ perceived comfort and clinical knowledge regarding treatment of persons with disabilities (PWD) (p < 0.01). There were no statistical differences at the six-month timepoint, indicating sustained benefit and integration of knowledge in the long-term (p > 0.05). Additionally, 84% of students reported using the information in clinical experiences at six months.

Conclusion
The PM&R clerkship including a virtual disability education curriculum improved long-term perceived medical student comfort and knowledge of treating PWD, with a focus on those with physical disabilities. Virtual encounters with PWD are viable and impactful avenues to provide this education.
Reoperative Microsurgical Free Flap Surgery
Authors: Pu Lee L. Q. , Song Ping 
Published: February 2023

Abstract
Microsurgical free flap surgery has revolutionized reconstructive surgery at most academic centers worldwide. However, free flap failures still occur even in the hands of the most experienced microsurgeon. Although we have achieved a great deal of success performing microsurgical free flap reconstruction for various indications, complications from initial free flap surgery that result in reoperation remain a small, but steady percentage. Venous flap congestion is one of the most challenging conditions that result in free flap failure if not resolved promptly. It can be caused by several conditions, and salvage for venous congestion is often difficult and time consuming. Over 20 years, the senior author has encountered 2 unique situations that resulted in venous congestion of the flap requiring reoperative surgery for flap salvage or a second free flap. Several medical conditions can compromise free flap surgery and result in total flap loss. The senior author has also encountered 2 medical conditions resulting in total flap loss. However, both patients received successful second free tissue transfers when combined with unique perioperative management strategies. It is our hope that this review will highlight some unique management strategies for reoperative microsurgical free tissue transfer and serve as “lessons learned” for initial salvage procedures and a second free tissue transfer. We also hope our reoperative approach demonstrated in this review will help the future generation of microsurgeons to avoid such complications altogether so that overall outcome after microsurgical free flap surgery can further be improved.
The Impact of Breast Cancer Type, Staging, and Treatment on Vascular Complications of Immediate Free-Flap Breast Reconstruction
Authors: Talwar Ankoor A. , Mazzaferro Daniel , Morris Martin P. , Davis Harrison , Hitchner Michaela , Shulkin Jared , Christopher Adrienne N. , Broach Robyn B. , Brooks Ari D. , Serletti Joseph M. 
Published: February 2023

BackgroundPatients with advanced cancer staging have a greater risk of developing venous thromboembolism than noncancer patients. The impact of breast cancer stage and treatment on outcomes after autologous free-flap breast reconstruction (ABR) is not well-established. The objective of this retrospective study is to determine the impact of breast cancer characteristics, such as cancer stage, hormone receptor status, and neoadjuvant treatments, on vascular complications of ABR.MethodsA retrospective review was conducted examining patients who underwent ABR from 2009 to 2018. Breast cancer stage, cancer types, hormone receptor status, and treatments were collected in addition to demographic data. Intraoperative vascular concerns, postoperative vascular concerns, and flap loss were analyzed. Univariate analysis and fixed-effects models were used to associate breast cancer characteristics with outcomes.ResultsNeoadjuvant hormone therapy was associated with increased risk for intraoperative vascular concern (odds ratio, 1.059 [P= 0.0441]). Neoadjuvant trastuzumab was associated with decreased risk of postoperative vascular concern (odds ratio, 0.941 [P= 0.018]). Breast cancer stage, somatic genetic mutation, receptor types, neoadjuvant chemotherapy, and neoadjuvant radiation had no effect on any vascular complications of ABR.ConclusionAutologous free-flap breast reconstruction is a reliable reconstructive option for patients with all stages and types of breast cancer. There is potentially increased risk of intraoperative microvascular compromise in patients who have neoadjuvant hormone therapy. Trastuzumab is potentially protective against postoperative microvascular compromise. Patients should feel confident that, despite higher stage cancer, they can pursue their desired reconstructive option without fear of vascular compromise.
Outcomes Using Two Unique Methods of Immediate Implant-Based Breast Reconstruction After Nipple-Sparing Mastectomy in Ptotic Patients
Authors: Erlichman Zachary , Buro Justin , Waraich Minah , Veeramachaneni Haritha 
Published: February 2023

Objective
After nipple-sparing mastectomy (NSM) and immediate implant-based reconstruction, patients with significant ptosis are at increased risk for nipple-areolar complex (NAC) necrosis. Attempts to salvage the nipple using inferior dermal pedicles have yielded unsatisfactory results. This study aims to evaluate complications using 2 unique methods of breast reconstruction using either a Wise incision with dermal infolding or batwing incision after NSM.

Materials and Methods
A retrospective chart review was conducted on all patients who underwent NSM and immediate implant reconstruction using the methods described by a single surgeon between 2016 and 2022. Outcomes were assessed by comparing average complications rates.

Result
Seventy-three reconstructions were performed after NSM in patients with ptosis. Sixteen reconstructions used a prior technique, Wise pattern with inferior dermal flap. Thirty reconstructions used the Wise incision with dermal infolding, while 27 other reconstructions used a batwing incision. For the Wise with inferior dermal flap technique, NAC necrosis occurred in 43.8%. In the cases in which the newer techniques were used, NAC necrosis occurred in 11.1% in the batwing group and 10% in the dermal infolding group. Other complications measured were within acceptable percentiles between both groups. Aesthetic outcomes were acceptable for most of the cases involving NAC necrosis.

Conclusions
A batwing pattern incision or a Wise pattern with a broad, infolded dermal pedicle is a more effective method of immediate reconstruction after NSM in patients with ptosis according to these findings. Nipple-areolar complex necrosis continues to be a major complication that is important to discuss with patients. However, these methods offer patients with ptosis the benefit of preserving a native NAC while allowing for simultaneous skin reduction during an immediate reconstruction.
Prediction of American Society of Anesthesiologists Physical Status Classification from Preoperative Clinical Text Narratives Using Natural Language Processing
Authors: Chung Philip , Fong Christine T. , Walters Andrew M. , Yetisgen Meliha , O’Reilly-Shah Vikas N. 
Published: February 2023

AbstractImportanceLarge volumes of unstructured text notes exist for patients in electronic health records (EHR) that describe their state of health. Natural language processing (NLP) can leverage this information for perioperative risk prediction.ObjectivePredict a modified American Society of Anesthesiologists Physical Status Classification (ASA-PS) score using preoperative note text, identify which model architecture and note sections are most useful, and interpret model predictions with Shapley values.DesignRetrospective cohort analysis from an EHR.SettingTwo-hospital integrated care system comprising a tertiary/quaternary academic medical center and a level 1 trauma center with a 5-state referral catchment area.ParticipantsPatients undergoing procedures requiring anesthesia care spanning across all procedural specialties from January 1, 2016 to March 29, 2021 who were not assigned ASA VI and also had a preoperative evaluation note filed within 90 days prior to the procedure.ExposuresEach procedural case paired with the most recent anesthesia preoperative evaluation note preceding the procedure.Main Outcomes and MeasuresPrediction of a modified ASA-PS from preoperative note text. We compared 4 different text classification models for 8 different input text snippets. Performance was compared using area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (AUPRC). Shapley values were used to explain model predictions.ResultsFinal dataset includes 38566 patients undergoing 61503 procedures. Prevalence of ASA-PS was 8.81% for ASA I, 31.4% for ASA II, 43.25% for ASA III, and 16.54% for ASA IV-V. The best performing models were the BioClinicalBERT model on the truncated note task (macro-average AUROC 0.845) and the fastText model on the full note task (macro-average AUROC 0.865). Shapley values reveal human-interpretable model predictions.Conclusions and RelevanceText classification models can accurately predict a patient’s illness severity using only free-form text descriptions of patients without any manual data extraction. They can be an additional patient safety tool in the perioperative setting and reduce manual chart review for medical billing. Shapley feature attributions produce explanations that logically support model predictions and are understandable to clinicians.
Assessment of a 60-biomarker health surveillance panel (HSP) on whole blood from remote sampling devices by targeted LC/MRM-MS and discovery DIA-MS analysis
Authors: Whelan Stephen A. , Hendricks Nathan , Dwight Zachary L. , Fu Qin , Moradian Annie , Van Eyk Jennifer E. , Mockus Susan M. 
Published: February 2023

SummaryTelehealth, accessing healthcare and wellness remotely, should be a cost effective and efficient way for individuals to receive care. The convenience of having a robust remote collection device for blood tests will facilitate access to precision medicine and healthcare. Herein, we tested a 60-biomarker health surveillance panel (HSP), containing 35 FDA/LDT assays and covering at least 14 pathological states, on 8 healthy individuals’ ability to collect their own capillary blood from a lancet finger prick and directly compared to the traditional phlebotomist venous blood and plasma collection methods. Samples were quantitatively analyzed by a liquid chromatography-multiple reaction monitoring-mass spectrometry method targeting 114 peptides representing 60 HSP proteins and by a data-independent acquisition mass spectrometry discovery method, resulting in up to 3,811 protein identifications including 122 FDA approved biomarkers. The >90% similarity between the three biofluids indicate that remote collection devices are a viable option for personal blood proteome biosignature stratification and health analysis.
Longitudinal changes in IgG-type SARS-CoV-2 antibody titers after COVID-19 vaccination and, prominent increase in antibody titers when infected after vaccination
Authors: Kusunoki Hiroshi , Ohkusa Michiko , Iida Rie , Saito Ayumi , Kawahara Mikio , Ekawa Kazumi , Kato Nozomi , Yamasaki Keita , Motone Masaharu , Shimizu Hideo 
Published: February 2023

Abstract[Objective]Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody titers level and duration of elevated levels are considered important indicators for confirming the efficacy of coronavirus disease 2019 (COVID–19) vaccines. The objective of this study was to demonstrate the changes in antibody titers after the second and third doses of the COVID–19 vaccine, and to determine the antibody titers in cases of spontaneous infection with SARS-CoV-2 after vaccination.[Materials and Methods]From June 2021 to February 2023, IgG-type SARS-CoV-2 antibody titers were measured in 127 participants, including 74 outpatients and 53 staffs, at the Osaka Dental University Hospital (65 males and 62 females, mean age 52.3 ± 19.1 years).[Results]Consistent with previous reports, the SARS-CoV-2 antibody titer decreased with time, not only after the second dose, but also after the third dose of the vaccine if there is no spontaneous COVID–19 infection. We also confirmed that the third booster vaccination was effective in increasing the antibody titer.21 cases of natural infections were observed after administering two or more doses of the vaccine. 13 of these patients had post-infection antibody titers exceeding 40,000 AU/mL, and some cases continued to maintain antibody titers in the tens of thousands of AU/mL even after more than 6 months had passed since infection.[Conclusion]The rise in and duration of antibody titers against SARS-CoV-2 are considered important indicators for confirming the efficacy of novel COVID–19 vaccines. A longitudinal follow-up of antibody titers after vaccination in larger studies is warranted.
A qualitative exploration of the psychosocial factors affecting antiretroviral therapy adherence among HIV infected young adults in Eastern Uganda
Authors: Twekambe Easton , Epuitai Joshua , Kawala Enid Kagoya , Namanya Vian , Ayikobua Emmanuel Tiyo , Obakiro Samuel Baker , Napyo Agnes , Kiyimba Kenedy 
Published: February 2023

ABSTRACTBackgroundThe use of anti-retroviral therapy (ART) in management and prevention of HIV/AIDS epidemic is a globally accepted strategy. In Uganda, despite the efforts to increase uptake of ART, adherence remains a huge challenge. This study, therefore, was conducted to explore psychosocial factors which influenced non-adherence to ART among young adults in Eastern Uganda.MethodsThis was an exploratory qualitative study conducted at the ART clinic of Mbale Regional Referral Hospital. A total of 35 in-depth interviews with young adults who had defaulted from taking ART drugs were conducted. Also, five key-informant interviews were conducted among the healthcare workers in the hospital. Thematic analysis approach was followed to analyze the data using NVIVO software (version 11).ResultsNon-adherence to ART was perceived to result from poor social support, poor coping mechanisms, unpredictable and busy work schedules, poverty, incompatible religious beliefs and practices. The poor social support factors included poor caregiver support, non-disclosure of HIV status, stigma and discrimination while factors linked to poor coping mechanisms included alcohol and substance abuse, psychosocial stress, depression, forgetfulness and feelings of self-hatred. Poverty limits access to treatment and basic needs including transportation to health facilities. Long waiting time at the ART clinic was the healthcare system factor which was thought to cause non-adherence among young adults.ConclusionNon-adherence to ART at Mbale Regional Referral Hospital in Eastern Uganda is attributed to various psychosocial factors such as stigma and discrimination, mental health problems, work-related problems and low socio-economic status, religious beliefs and poor knowledge, long waiting time in ART clinic and poor family support. Psychosocial counselling should therefore target the perceived causes of ART non-adherence so as to improve the adherence /compliance to ART.
Distribution of Obesity-related Health Outcomes Across the Urban-Rural Commuting Area in Mississippi, Alabama, Louisiana, and Georgia
Authors: Ahmmad Roungu , Faruque Fazlay 
Published: February 2023

AbstractObesity-related chronic diseases are still major public health concerns in the United States, particularly in the south. The purpose of this study is to examine the association between obesity-related chronic diseases and rurality/urbanicity in the four Deep South states-Mississippi, Alabama, Louisiana and Georgia. We used publicly available Zip Code level approximations of USDA-developed RUCA Code for rurality designation and Zip Code level PLACES data developed by CDC for selected obesity-related health outcomes-Asthma, Obesity, Chronic Obstructive Pulmonary Disease, Coronary Heart Disease, Diabetes, High Cholesterol, Stroke and High Blood Pressure. This study employed the random forest method, partial least squares discriminant analysis and multinomial logistic regression to investigate the association between selected health outcomes and degrees of rurality. There are significant differences in the prevalence of Asthma, Obesity, COPD and Stroke between Metropolitan and small towns or complete rural areas. On the other hand, while considering Micropolitan and small towns or complete rural areas, Asthma, Obesity, COPD, Diabetes, High Cholesterol and Stroke show significant differences in prevalence. This study revealed disparities in health outcomes per RUCA Codes, which can be useful to target specific geographic areas for appropriate interventions.