bluuebunny/crossref_metadata_2025_split huggingface dataset:
Progression of liver disease and portal hypertension in dyskeratosis congenita and related telomere biology disorders
Authors: Vittal Anusha , Niewisch Marena R. , Bhala Sonia , Kudaravalli Pujitha , Rahman Farial , Hercun Julian , Kleiner David E. , Savage Sharon A. , Koh Christopher , Heller Theo , Giri Neelam 
Published: May 2023

Background and Aims:
Dyskeratosis congenita (DC) and related telomere biology disorders (TBD) are characterized by very short telomeres and multisystem organ involvement including liver disease. Our study aimed to characterize baseline hepatic abnormalities in patients with DC/TBD and determine risk factors associated with liver disease progression.

Approach and Results:
A retrospective review was performed on a cohort of 58 patients (39 males) with DC/TBD who were prospectively evaluated at a single institute from 2002 to 2019. The median age at initial assessment was 18 (1.4–67.6) years, and median follow-up duration was 6 (1.4–8.2) years. Patients with autosomal or X-linked recessive inheritance and those with heterozygous TINF2 DC were significantly younger, predominantly male, and more likely to have DC-associated mucocutaneous triad features and severe bone marrow failure compared with autosomal dominant-non-TINF2 DC/TBD patients. Liver abnormality (defined at baseline assessment by laboratory and/or radiological findings) was present in 72.4% of patients with predominantly cholestatic pattern of liver enzyme elevation. Clinically significant liver disease and portal hypertension developed in 17.2% of patients during the 6-year follow-up; this progression was mainly seen in patients with recessive or TINF2-associated DC. Significant risk factors associated with progression included the presence of pulmonary or vascular disease.

Conclusions:
Our experience shows a high prevalence of cholestatic pattern of liver abnormality with progression to portal hypertension in patients with DC/TBD. Presence of pulmonary and/or vascular disease in patients with recessive or TINF2 DC was an important predictor of liver disease progression, suggesting the need for increased vigilance and monitoring for complications in these patients.
Rare case of multiple neurofibromas of the scalp and trunk in association with intradural extramedullary spinal tumor: a case report
Authors: Shah Aman K. , Dahal Alok , Thapa Nuppur 
Published: May 2023

Introduction and importance:
Neurofibromas are tumors of neural connective tissue composed of Schwann cells and fibroblasts. They can occur anywhere in the body, primarily as a solitary mass or as a component of neurofibromatosis. Only 1/4 of the intradural extramedullary spinal tumors are neurofibromas. While most of the neurofibromas are asymptomatic, the authors report a patient with symptomatic multiple neurofibromas of the scalp and trunk that lacked the salient features of neurofibromatosis-1.

Case presentation:
A 63-year-old male from Saptari, Nepal, with multiple insidious swellings in the scalp and trunk region, presented with complaints of weakness of the bilateral lower limb for 6–7 years resulting in difficulties in walking and bleeding from the most significant swelling that was in the occipital area.

Clinical findings and investigations:
Masses were present all over the scalp, averaging about 4×4 cm, with active bleeding from the two swellings. The authors performed the neurological assessment and histopathological and radiological investigations.

Interventions and outcomes:
A confirmed diagnosis of neurofibroma was made with myelography revealing an intradural extramedullary spinal tumor. A laminectomy with total excision of the tumor was performed.

Relevance and impact:
Meningiomas and nerve sheath tumors (schwannomas and neurofibromas) can both develop in the intradural extramedullary spinal compartment. Contrast-enhanced MRI is the most sensitive and specific imaging modality to evaluate possible spinal column lesions. Surgical excision, partial or complete, is the hallmark treatment of neurofibroma.
The Influence of Activities and Functional Social Support on Adult Cochlear Implant Outcomes
Authors: Casazza Julia A. , Yancey Kristen L. , Hunter Jacob B. 
Published: May 2023

Objective:
The objective of this study is to assess whether patient participation in specific activities and perceived social support correlate with speech perception following cochlear implantation.

Setting:
Tertiary referral hospital

Methods:
Adult cochlear implantation patients implanted in their poorer hearing ear between January 2019 and December 2020 completed the Functional Social Support Questionnaire (FSSQ) and a modified version of the Victoria Lifestyle Study-Activities Lifestyle Questionnaire (VLS-ALQ). Demographics, FSSQ score, and individual activities were correlated with implanted ear and binaural AzBio scores.

Results:
Twenty-three patients completed the survey and had at least 6 months of follow-up with appropriate speech perception testing. The average age at survey completion was 71.7 (SD, 9.1). Average pure-tone average in the contralateral ear was 70.1 (SD: 20) dB. The majority (N = 21, 91.3%) wore a hearing aid in the contralateral ear following cochlear implantation. Mean AzBioQuiet score improvement was 60.6% (range: 20%–99%) in the implanted ear and 42.6% (range: −2% to 67%) binaurally. Work-related social support correlated positively with improvement in the implanted ear (Pearson’s R = 0.473; 95% CI, 0.075-0.741; P = 0.023). Improvement in the implanted ear correlated positively with creative writing (R = 0.542; 95% CI, 0.167-0.780; P = 0.008), attending films (R = 0.448; 95% CI, 0.044-0.726; P = 0.032), going out with friends (R = 0.423; 95% CI, 0.013-0.711; P = 0.044) listening to audiobooks (R = 0.433; 95% CI, 0.025-0.717; P = 0.039), and public speaking (R = 0.468; 95% CI, 0.069-0.738; P = 0.024). Gains in binaural performance correlated positively with watching TV news (R = 0.819; 95% CI, 0.509-0.941; P < 0.001) and negatively with eating at restaurants (R = −0.532; 95% CI, −0.829 to −0.002; P = 0.05).

Conclusions:
Activities that provide intellectual stimulation and engage auditory faculties correlate with greater speech perception testing improvements in adult cochlear implantation patients.
Healthcare Value in Plastic Surgery Practice
Authors: Yang Alan Z. , Hyland Colby J. , Tsai Thomas C. , Broyles Justin M. 
Published: May 2023

Brief Summary:As value-based care gains traction in response to towering healthcare expenditures and issues of healthcare inequity, hospital capacity, and labor shortages, it is important to consider how a value-based approach can be achieved in plastic surgery. Value is defined as outcomes divided by costs across entire cycles of care. Drawing on previous studies and policies, this paper identifies key opportunities in plastic surgery to move the levers of costs and outcomes to deliver higher-value care. Specifically, outcomes in plastic surgery should include conventional measures of complication rates as well as patient-reported outcome measures in order to drive quality improvement and benchmark payments. Meanwhile, cost reduction in plastic surgery can be achieved through value-based payment reform, efficient workflows, evidence-based and cost-conscious selection of medical devices, and greater use of out-patient surgical facilities. Lastly, we discuss how the diminished presence of third-party payers in aesthetic surgery exemplifies the cost-conscious and patient-centered nature of value-based plastic surgery. To lead in future health policy and care delivery reform, plastic surgeons should strive for high-value care, remain open to new ways of care delivery, and understand how plastic surgery fits into overall health care delivery.
AN ANALYSIS OF TREATMENT CHOICES AMONG WHITE AND AFRICAN AMERICAN MEDICAID PATIENTS WITH CARPAL TUNNEL SYNDROME
Authors: Hooper Rachel C. , Tong Yanlin , Sanders Hayley M. , Wang Lu , Chung Kevin C. 
Published: May 2023

Introduction:Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and has severe long-term effects on hand function if surgery is delayed significantly following diagnosis. We investigated the timespan between diagnosis and surgical intervention for carpal tunnel syndrome among African American and White patients on Medicaid.Methods:Using the using the MarketScan Truven Database Medicaid Supplement 2009-2020, we identified patients with CTS. Demographic data and time intervals between diagnosis and treatment were collected and analyzed using Chi-squared test and regression models.Results:361,942 African American and White Medicaid patients with a diagnosis of CTS were included in the study. Overall, 21.4% of Whites compared to 13.6% of African Americans chose surgery as their first and only option, p<0.001. A greater proportion of Whites underwent surgery at < 6 months after diagnosis compared to African Americans, 75.5% and 67.7% respectively; p < 0.001. African American women underwent surgery at a significantly lower rate compared to White women, 13.8% and 21.8% respectively, p<0.001. Despite the increase in rates of surgery among both groups, the gap in utilization of surgery widened from a 6.6% difference in 2009 to a 9.5% in 2020 between racial groups.Conclusions:African American race and female sex are significantly correlated with choice of treatment and time to surgery among Medicaid patients with CTS. Identification of the relationship between healthcare disparities and the decision to undergo surgery is the first step in the development of strategies to mitigate underutilization of this quality of life improving procedure.
Modified Deep-Plane Face Lift and Lower Midface Lifting Using Deep Fat Compartment Mobilization and Zygomaticus Major Muscle Plication
Authors: Kim Sung Ho , Choi Bong Gyu , Chung Kyu-Jin 
Published: May 2023

Background:
Most face-lift techniques greatly improve the lower face; however, techniques for lifting the midface are limited and difficult. Original deep-plane face lift is a way to lift the superficial musculoaponeurotic system and skin as a compound unit. Although it minimizes tear of the superficial musculoaponeurotic system during dissection, damage to the vascular system, and the incidence of skin necrosis, and can be easily used in secondary cases, the deep-plane face lift does not adequately improve nasolabial fold. The authors perform a modified and enhanced deep-plane face lift to improve the midface. In this article, the authors explain the effects and procedures of the method.

Methods:
This retrospective study included patients (n = 632) on whom deep-plane face lift (DPF group; n = 299) and modified deep-plane face lift (M-DPF group; n = 333) was performed by a single surgeon from January of 2014 to January of 2017, and from February of 2017 to December of 2020, respectively, at a local clinic. The degree of improvement in wrinkles in the patients’ nasolabial fold was assessed using the five-grade Wrinkle Severity Rating Scale (WSRS).

Results:
The preoperative WSRS score was 2.95 ± 0.89 in the DPF group and 2.89 ± 0.92 in the M-DPF group. There was no significant difference in the preoperative WSRS score between the two groups (P = 0.058). The postoperative WSRS score was 1.81 ± 0.68 in the DPF group, which was significantly greater than the 1.65 ± 0.66 found in the M-DPF group.

Conclusion:
This method developed by the authors that combines deep-plane face lift with deep fat compartment mobilization and zygomaticus major muscle plication is safe and directly improves the nasolabial fold and promotes a smiling expression for rejuvenation effects.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Vibration-Assisted Volume Optimization Mammaplasty: An Alternative Approach for Large-Volume Fat Grafting to the Breast
Authors: Afifi Ahmed M. , Seitz Allison J. , Albano Nicholas J. 
Published: May 2023

Summary:
Fat grafting has become an integral part of aesthetic and reconstructive breast surgery. However, the ideal method for harvesting and injecting the fat remains unclear. The authors describe an alternative approach for large-volume fat grafting in the breast, vibration-assisted volume optimization mammaplasty, that builds on the experience of other authors with using the power-assisted liposuction machine for fat injection. The authors implemented this approach in 138 breasts over 2 years and found low rates of complications (4%). This new approach substantially reduces the time required to inject the fat graft and is simpler and faster to set up than previously described techniques. The authors believe vibration-assisted volume optimization mammaplasty can be used to perform large-volume fat grafting safely and efficiently in the breast with an acceptable rate of complications.
Initial report on special operations clinical training at a civilian academic medical center
Authors: Oury Jeffrey , Reed Benjamin L. , Donovan James , Abbas Kamil , Wilson Alison , Grabo Daniel 
Published: May 2023

BACKGROUND
Military-civilian partnerships for combat casualty care skills training have mostly focused on traditional, combat surgical team training. We sought to better understand US Special Forces (SF) Medics' training at West Virginia University in Morgantown, West Virginia, a Level 1 trauma center, via assessments of medical knowledge, clinical skills confidence, and technical performance.

METHODS
Special Forces Medics were evaluated using posttraining medical knowledge tests, procedural skills confidence surveys (using a 5-point Likert scale), and technical skills assessments using fresh perfused cadavers in a simulated combat casualty care environment. Data from these tests, surveys, and assessments were analyzed for 18 consecutive SF medic rotations from the calendar years 2019 through 2021.

RESULTS
A total of 108 SF Medics' tests, surveys, and assessments were reviewed. These SF Medics had an average of 5.3 years of active military service; however, deployed experience was minimal (73% never deployed). Review of knowledge testing demonstrated a slight increase in mean test score between the precourse (80% ± 14%; range, 50–100%) when compared with the postcourse (82% ± 14%; range, 50–100%). Skills confidence scores increased between courses, specifically within the point of injury care (p = 0.09) and prolonged field care (p < 0.001). Technical skills assessments included cricothyroidotomy, chest tube insertion, and tourniquet placement.

CONCLUSION
This study provides preliminary evidence supporting military-civilian partnerships at an academic Level 1 trauma center to provide specialty training to SF Medics as demonstrated by increase in medical knowledge and confidence in procedural skills. Additional opportunities exist for the development technical skills assessments.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Pre-exposure Prophylaxis with Tixagevimab-cilgavimab did not Reduce Severity of COVID-19 in Lung Transplant Recipients with Breakthrough Infection
Authors: Sindu Devika , Razia Deepika , Grief Katherine , Cherrier Lauren , Omar Ashraf , Walia Rajat , Tokman Sofya 
Published: May 2023

Background.
Lung transplant recipients (LTRs) have an increased risk of COVID-19–related morbidity and mortality. Tixagevimab-cilgavimab (tix-cil) is a long-acting monoclonal antibody combination granted Emergency Use Authorization approval by the US Food and Drug Administration for COVID-19 pre-exposure prophylaxis (PrEP) in immunocompromised patients. We sought to determine whether tix-cil 300–300 mg reduced the incidence and disease severity of severe acute respiratory syndrome coronavirus 2 infection in LTRs during the Omicron wave.

Methods.
We performed a retrospective, single-center cohort study of LTRs who had received a COVID-19 diagnosis between December 2021 and August 2022. We compared baseline characteristics and clinical outcomes after COVID-19 between LTRs who received tix-cil PrEP and those who did not. We then conducted propensity-score matching based on baseline characteristics and therapeutic interventions and compared clinical outcomes between the 2 groups.

Results.
Of 203 LTRs who received tix-cil PrEP and 343 who did not, 24 (11.8%) and 57 (16.6%), respectively, developed symptomatic COVID-19 (hazard ratio [HR], 0.669; 95% confidence interval [CI], 0.415-1.079; P = 0.099). The hospitalization rate of LTRs with COVID-19 during the Omicron wave trended lower in the tix-cil group than in the non–tix-cil group (20.8% versus 43.1%; HR, 0.430; 95% CI, 0.165-1.118; P = 0.083). In propensity-matched analyses, 17 LTRs who received tix-cil and 17 LTRs who did not had similar rates of hospitalization (HR, 0.468; 95% CI, 0.156-1.402; P = 0.175), intensive care unit admission (HR, 3.096; 95% CI, 0.322-29.771; P = 0.328), mechanical ventilation (HR, 1.958; 95% CI, 0.177-21.596; P = 0.583), and survival (HR, 1.015; 95% CI, 0.143-7.209; P = 0.988). COVID-19–related mortality was high in both propensity-score–matched groups (11.8%).

Conclusions.
Breakthrough COVID-19 was common among LTRs despite tix-cil PrEP, possibly due to reduced efficacy of monoclonal antibodies against the Omicron variant. Tix-cil PrEP may reduce the incidence of COVID-19 in LTRs, but it did not reduce disease severity during the Omicron wave.
A switch in jaw form–function coupling during the evolution of mammals
Authors: Tseng Z. Jack , Garcia-Lara Sergio , Flynn John J. , Holmes Emily , Rowe Timothy B. , Dickson Blake V. 
Published: May 2023

The evolutionary shift from a single-element ear, multi-element jaw to a multi-element ear, single-element jaw during the transition to crown mammals marks one of the most dramatic structural transformations in vertebrates. Research on this transformation has focused on mammalian middle-ear evolution, but a mandible comprising only the dentary is equally emblematic of this evolutionary radiation. Here, we show that the remarkably diverse jaw shapes of crown mammals are coupled with surprisingly stereotyped jaw stiffness. This strength-based morphofunctional regime has a genetic basis and allowed mammalian jaws to effectively resist deformation as they radiated into highly disparate forms with markedly distinct diets. The main functional consequences for the mandible of decoupling hearing and mastication were a trade-off between higher jaw stiffness versus decreased mechanical efficiency and speed compared with non-mammals. This fundamental and consequential shift in jaw form–function underpins the ecological and taxonomic diversification of crown mammals.
This article is part of the theme issue ‘The mammalian skull: development, structure and function’.
Ramlibacter paludis sp. nov., isolated from wetland
Authors: Lim Ji-Eun , Jo Jung-Hun , Im Wan-Taek 
Published: May 2023

A Gram-stain-negative, non-motile, rod-shaped, aerobic and white-coloured bacterium (designated XY19T) was isolated from a soil sample of wetland from Godeok Ecological Park, Gangdong-gu, Seoul, Republic of Korea. On the basis of 16S rRNA gene sequencing, strain XY19T clustered with species of the genus

Ramlibacter

and appeared closely related to

R

.

ginsenosidimutans

DSM 23480T (98.42 %),

R. alkalitolerans

JCM 32081T (97.68 %) and

R

.

monticola

JCM 31918T (97.66 %). The average nucleotide identity between strain XY19T and three strains (

R. ginsenosidimutans

DSM 23480T,

R. alkalitolerans

JCM 32081T and

R. monticola

JCM 31918T) were 80.7, 81.1 and 81.4 %. And the digital DNA–DNA hybridization (dDDH) calculated between strain XY19T and each of the three strains (

R. ginsenosidimutans

DSM 23480T,

R. alkalitolerans

JCM 32081T and

R. monticola

JCM 31918T) were 24.1, 24.4 and 24.5 %. ANI value and dDDH results were a novel species of the genus

Ramlibacter

. Growth occurs at 10–37 °C on R2A medium in the pressence of 0–1 % NaCl (w/v) and at pH 6.0–8.5. The DNA G+C content of the genomic DNA was 68.7 mol%, and ubiquinone-8 (Q-8) was the major respiratory quinone. The major cellular fatty acids (>5 %) were C16:1
ω7c and/or C16:1 ω6c (summed feature 3), C16 : 0, C17 : 0 cyclo and C18:1
ω7c and/or C18:1
ω6c (summed feature 8). The polar lipids consisted of diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, three unidentified lipids and unidentified aminophospholipid. Physiological and biochemical characteristics indicated that strain XY19T represents a novel species of the genus

Ramlibacter

, for which the name Ramlibacter paludis sp. nov. is proposed. The type strain is XY19T (= KACC 22220T = LMG 32190T).
INFLUENCE OF AVAILABILITY, BARRIERS TO ACCESSIBILITY, AND UTILIZATION OF MENTAL HEALTH SERVICES ON PSYCHOLOGICAL DISTRESS STATUS OF UNDERGRADUATE STUDENTS AT UNITED STATES INTERNATIONAL UNIVERSITY-AFRICA, KENYA
Authors: Wao Melvin A. , Omolo Calvin A. , Some Eliab , Kihara Michael , Njoroge Gladys 
Published: May 2023

ABSTRACTBackgroundPsychological distress is prevalent among university students worldwide. Research shows that there are inadequate efforts being made to improve the mental health of university students and there is low level of accessibility of university students to mental health services. This study aimed to determine the relationship between availability of mental health services, barriers to access to the services, and utilization of the services, on psychological distress status of undergraduate students at United States International University-Africa, KenyaMethodsThe research was conducted using a mixed methods research approach. Specifically, an exploratory sequential mixed methods research design was employed, including a cross-sectional survey and key informant interviews. The sample population was 249 undergraduate students at USIU-A, collected using cluster and stratified sampling procedure. Kessler Psychological Distress Scale (K10) was used to determine psychological distress status.ResultsThis study found 76.8% of undergraduate students suffer from psychological distress with highest prevalence among seniors. Majority of students were aware of available sources of mental health services with three most frequently cited sources by students including counselor (87%), social support (84%), and peer counselor (80%). It was found that psychological distress status varies by students’ awareness of availability of psychologists or personal coping strategist. Association between barriers of accessibility and utilization of mental health services to psychological distress status of students i.e., peer stigma, societal stigma, and self-sufficiency.ConclusionAt USIU-A, majority of students suffer from psychological distress. Whereas several sources of mental health services are available at the institution, a good number prefer to seek informal mental health services and two major barriers to mental health service accessibility include attitudinal barriers and stigma.GRAPHICAL ABSTRACT
Natural Language Processing Techniques to Identify Zoonosis Awareness
Authors: Gonzalez Roger Geertz 
Published: May 2023

AbstractIn this study, we incorporated several NLP techniques to identify the most important factors in the open-ended responses part of theKnowledge, Attitudes, and Practices: Survey of Zoonoses in Wildlife Trade (KAP)in Cambodia. These included: TF-IDF, ngrams, Latent Semantic allocation (LSA), k-means, Latent Dirichlet Allocation (LDA), and Top2Vec. The top topics participants identified included 1) stating that they handled wildlife by setting traps and mist nets, 2) stating they were bitten by bat or rat, 3) which zoonotic symptoms caused sickness, 4) describing how they would go to the hospital when they came down with zoonotic symptoms, and 5) saying that they were aware of avian flu and its symptoms.Based on our findings, recommendations for Cambodian public health officials include: 1) they need to educate participants to wear protective gear to prevent from being bitten by bats and rats during their jobs with these animals, and 2) they need to educate participants about the danger of different types of zoonotic diseases including Ebolavirus, Mojianvirus, etc., so that these participants can recognize the risks when handling bats and rats, and so they can take early action by seeking medical help as soon as they are bitten.