bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of Patient-Reported Outcomes After Breast Reconstruction: A Retrospective Study
Authors: Wang Yi , Li Guangxue , Yang Kai , Bi Ye , Liu, Yan , Mu Dali , Liu Chunjun , Xin Minqiang , Liu Yuanbo , Mu Lan 
Published: February 2023

Objective
This study aimed to investigate the effects of surgical timing, procedure, and age, on complication rates, health-related quality of life, and postoperative satisfaction, in patients who underwent breast reconstruction.

Methods
The data of 80 patients who underwent breast reconstruction surgery between August 2004 and June 2018 were reviewed. Patients were grouped according to surgical timing, procedure, and age. The evaluation indicators included complications and BREAST-Q scores. The statistical methods used included the Mann-Whitney U test and analyses of variance and covariance.

Results
The incidence of complications was 15.0% (12/80). The complication rates were similar in each group (P > 0.05). The postsurgical scores of patient satisfaction with breast, psychosocial well-being, and sexual well-being were higher than the presurgical scores (P < 0.05). The postoperative psychosocial and sexual well-being scores of patients in the immediate group were higher than those in the delayed group (P < 0.05). The satisfaction with the outcome in the abdominal flap group was higher than that in the other group, whereas the sexual well-being score of the abdominal flap group was lower than that of the other group (P < 0.05). The scores of the postoperative physical well-being of the chest and abdomen in the younger group were higher than that in the older group (P < 0.05).

Conclusions
Breast reconstruction can significantly improve patients' health-related quality of life and satisfaction. Immediate breast reconstruction can reduce the adverse psychological and physical effects that breast loss exerts on patients, leading to better postoperative satisfaction. Patients who underwent breast reconstruction with abdominal flaps had higher postoperative satisfaction. Breast reconstruction in elderly patients was associated with considerable postoperative satisfaction.
Application of Trapezoid Orbital Septum Membrane Flap in Double-Eyelid Blepharoplasty
Authors: Yang Zhenyu , Tan Xiaoyan , Bahadur Aneesh , Zitkovsky Helen , Zeng Pingying , Mi Zijing 
Published: February 2023

Background
For a long time, to achieve the natural shape of double-eyelid crease, multiple techniques of double-eyelid plastic surgery have been developed. We describe the trapezoid orbital septum membrane flap in blepharoplasty to achieve a dynamic double-eyelid crease and avoid a depressed static scar.

Methods
The authors developed a trapezoid orbital septum membrane flap in double-eyelid blepharoplasty. The flap base is fixed on the pretarsal plate with the distal end of the flap positioned between the superior and inferior edges of the incision. Layer-by-layer contraposition suturing is then performed.

Results
One hundred ninety-one cases of double-eyelid blepharoplasty were performed by a senior surgeon using the trapezoid orbital septum flap method. Patients were followed for 6 to 17 months. Twelve cases were revised secondarily. Patients were satisfied with the palpebral folds, which showed a dynamic crease followed with movements of the eyelids.

Conclusions
The authors introduce a trapezoid orbital septum flap in upper eyelid blepharoplasty. The flap relies on the elasticity of the orbital septum flap as the levator aponeurosis extension segment to produce a natural crease without a depressed static scar.
Static and Dynamic Stabilization of the Shoulder After Total Scapulectomy in an Electric Burn Patient
Authors: May Jessica M. , Pathak Abraham , Pientka William F. , Meade Anna E. , Duque Sofia , Farewell Jordyn T. , Zhang Andrew Y. 
Published: February 2023

Abstract
An otherwise healthy 49-year-old man experienced a high-voltage electrical injury to the left shoulder resulting in total scapulectomy, partial calviculectomy, and a substantial soft tissue defect. The majority of the muscles around his shoulder were debrided because of necrosis, with only the pectoralis and latissimus dorsi muscles remaining attached to the humerus. Surprisingly, the patient's brachial plexus remained intact, and his left elbow, wrist, and hand function were preserved. A novel combination of 3 static and dynamic suspension techniques were used to stabilize his shoulder and prevent traction injury to the brachial plexus. Postoperative follow-up at 1 year demonstrated excellent stability of his reconstructed shoulder, which allowed him to ambulate independently and return to employment.
Periumbilical Anatomy of Scarpa's Fascia
Authors: Amakiri Uchechukwu O. , Doo Florence Xini , Kuruvilla Annet , Ibelli Taylor J. , Jesús Gabrielle Hernaiz-De , Kagen Alexander , Henderson Peter W. 
Published: February 2023

Background
Intraoperative observation of Scarpa's fascia (SF) has suggested attenuation in the periumbilical region. This study's purpose was to objectively evaluate SF anatomy in the periumbilical region and assess clinical outcomes of a novel, modified SF closure technique of transverse abdominal wall incisions that only reapproximates SF where it is definitively present.

Methods
Women were identified who had undergone abdominal magnetic resonance (MR) angiography before their abdominal-based autologous breast reconstruction that used the modified SF closure technique. Statistical analysis of SF presentation on the MR images was performed. Intraoperative measurements from dissected panniculectomy specimens were used to validate MR analysis. Donor site complications were recorded in patients undergoing modified SF closure.

Results
Sixty-six patients were included in the retrospective MR imaging analysis; this revealed an average attenuation of SF of 4.7 cm (SEM = 0.25 cm), 4.5 cm (SEM = 0.23 cm), 4.6 cm (SEM = 0.23 cm), and 4.2 cm (SEM = 0.22 cm) to the left of, right of, cranial to, and caudal to the umbilicus, respectively. The mean surface area of radiologic SF absence was 56.3 cm2 (SEM = 3.57 cm2). There was a significant difference in SF presentation based on patient age (P = 0.013) and body mass index (P = 0.005). Five of the 66 patients (7.6%) experienced abdominal closure site complications.

Conclusions
This study objectively confirms that there is attenuation of SF in the periumbilical region, describes a novel SF closure technique, and provides evidence to support its adoption when closing transverse abdominal wall incisions.
Ballistic Facial Trauma Reconstruction
Authors: Lee Clara J. , Calvo Richard , Rosales Ricardo , Akhter Maheen , Sise Michael J. , Krzyzaniak Andrea , Lance Samuel 
Published: February 2023

Background
Management of nonfatal ballistic facial trauma is well described in the literature for wounds secondary to military combat. However, there is little literature describing such management in civilian practice. We aimed to describe nonmilitary patients with recent nonfatal facial injuries from ballistic trauma using the California Office of Statewide Health Planning and Development patient database.

Methods
A retrospective study was performed using the California Office of Statewide Health Planning and Development Ambulatory Surgery and Inpatient datasets. All adults with the International Classification of Diseases, 10th Revision codes of severe nonfatal facial trauma from firearms requiring emergent surgery during 2016–2018 were included. Outcomes assessed include number and type of facial procedures performed, hospital length of stay, number of admissions, timing of definitive management, and lifetime hospitalization costs.

Results
A total of 331 traceable patients were identified over this 3-year period. The average age was 35.4 years (SD, 15.2), and 87% were male. The median index admission length of stay was 8 days (interquartile range, 3–15 days). Subsequent readmission was required for 123 (37.2%) patients with 10% mortality in the index admission. Total median charges per patient for all admissions were $257,804 (interquartile range, $105,601–$531,916). A total of 215 patients (65%) had at least 1 facial repair performed. Of all 331 patients, 64.3% underwent musculoskeletal repair (n = 213), 31.4% underwent digestive system repair (n = 104), and 29.6% underwent respiratory system repair (n = 98). The average number of repairs per patient was 2.52 (SD, 3.38), with 35% not having any of the specified International Classification of Diseases, 10th Revision repair codes. A total of 27% of patients had 1 procedure performed, whereas 38% received 2 or more, for an average of 3.87 (SD, 3.5) repairs over the study duration.

Discussion
To our knowledge, this is the first assessment of civilian characteristics of nonfatal ballistic facial trauma in California. Nonfatal facial ballistic trauma results in complex injuries to multiple body systems, requiring long admissions, costly hospital stays, and coordination of care across several surgical specialties. Many patients require a variety of procedures over multiple admissions, highlighting the overall morbidity of these injuries. Future studies will look at how care for these patients differs between various hospitals and geographic regions and whether current civilian management aligns with well-defined military reconstructive protocols for facial ballistic injuries.
The Impact of Prior Infection With SARS-Cov-2 on Surgical Outcomes in Patients Undergoing Abdominal Body Contouring Procedures
Authors: Wang Fei , Rothchild Evan , Ricci Joseph A. 
Published: February 2023

Background
There is evidence of increased postoperative complications in patients who have recovered from SARS-CoV-2. However, previous studies have not examined this effect in abdominal contouring procedures.

Methods
A retrospective review was conducted for all patients who underwent abdominoplasty or panniculectomy at our institution from March 2020 to November 2021. Patients were separated into cohorts via preoperative history of SARS-CoV-2 infections. Variables collected include demographic data, concurrent comorbidities, postoperative complications, readmission/reoperation, and length of stay. Parametric, nonparametric, and multivariable regression modeling was used for analysis.

Results
Of the 181 patients included, 14 (7.7%) had a prior SARS-CoV-2 infection. Average time from infection to surgery was 250 days. The mean age and Charlson Comorbidity Index for nonexposed and exposed patients were 45.4 and 45.9 years, and 1.24 and 1.36 points. Patients with prior SARS-CoV-2 infection were more likely to have chronic kidney disease (odds ratio [OR], 6.79; P = 0.017) and undergo abdominoplasties compared with panniculectomies (OR, 4.43; P = 0.039). There were no other significant differences in patient or operative characteristics between the cohorts. Compared with those with no history of infection, patients with prior infections had increased odds of postoperative complications such as delayed wound healing (OR, 27.67; P < 0.001). No other significant associations were found between prior SARS-CoV-2 infection and perioperative outcomes.

Conclusion
Prior SARS-CoV-2 infections may be associated with increased incidence of delayed wound healing despite a significant time lag between the time of infection and operation. Further studies are needed to elucidate the exact relationship and mechanism of action behind these findings.
Severe Increase in Nursing Labor Cost and Effect on Surgical Department Financial Margins at an Academic, Tertiary Medical Center
Authors: Brinster Clayton J , Escousse G Thomas , Hayson Aaron , Sternbergh WC , Money Samuel R 
Published: February 2023

Background:
A pre-existing nationwide nursing shortage drastically worsened during the pandemic, causing a significant increase in nursing labor costs. We examined the financial impact of these changes on department of surgery financial margins.

Study Design:
Operating room, inpatient, and outpatient financial metrics were analyzed. Monthly averages from a 14-month control cohort, January 2019-February 2020 (Pre-COVID), were compared to a 21-month cohort, March 2020-November 2021 (COVID). True revenue and cost data from hospital accounting records, not estimates or administrative projections, were analyzed. Statistics were performed with standard student’s T-test and the Anderson-Darling normality test.

Results:
Monthly surgical nursing costs increased significantly, with concomitant significant decreases in departmental contribution to margin (Table 1). No significant change was observed in case volume per month, length of stay per case, or surgical acuity, as standardized by CMS Case Mix Index. In order to obviate insurance payor mix as a variable and standardize cost data, surgical nursing expense per RVU was analyzed, demonstrating a significant increase. Hospital-wide agency nursing costs increased from $5.1 to $13.5 million/month (+165%) in 2021.

Conclusions:
Our results demonstrate a significant increase in surgical nursing labor costs with a resultant erosion of department of surgery financial margins. Utilization of real-time accounting data instead of commonly touted administrative approximations or Medicare projections increases both the accuracy and generalizability of the data. The long-term impact of both direct costs from supply chain interruption and indirect costs, such as limited OR and ICU access, will require further study. Clearly this ominous trend is not viable, and fiscal recovery will require sustained, strategic workforce allocation.
Predicting COVID-19 case status from self-reported symptoms and behaviors using data from a massive online survey
Authors: Srivastava Mashrin , Reinhart Alex , Mejia Robin 
Published: February 2023

AbstractWith the varying availability of RT-PCR testing for COVID-19 across time and location, there is a need for alternative methods of predicting COVID-19 case status. In this study, multiple machine learning (ML) models were trained and assessed for their ability to accurately predict the COVID-19 case status using US COVID-19 Trends and Impact Survey (CTIS) data. The CTIS includes information on testing, symptoms, demographics, behaviors, and vaccination status. The best performing model was XGBoost, which achieved an F1 score of≈94% in predicting whether an individual was COVID-19 positive or negative. This is a notable improvement on existing models for predicting COVID-19 case status and demonstrates the potential for ML methods to provide policy-relevant estimates.
Effectiveness of a New Regional Network on STEMI Care in an Under-developed Area of Southwest China
Authors: Zhang Li Mei , Geater Alan Frederick , Luo Heng , Wang Yuan Zhang , Wen Shao Chang 
Published: February 2023

AbstractBackgroundST-elevation myocardial infarction (STEMI) is life-threatening and need time-critical care. A new prefecture-wide STEMI Network was implemented in Chuxiong, Yunnan, China, the first reported STEMI network in underdeveloped area. How the Network impacted STEMI care in the prefecture has not previously been evaluated. The study aims to estimate the efficacy of the STEMI Network.MethodsA longitudinal study including 5-years STEMI patients covering the pre-network, creation and post-network phase was conducted to assess the changes of STEMI care. Outcomes including timely presentation, reperfusion therapy, timely reperfusion, heart failure, inpatient mortality, length of hospital stay, in-hospital charge, and various intervals of ischemic time (total ischemic time, patient delay, system delay, diagnosis time, reperfusion delay, Z to N time, Z to W time) were compared among the three Network phases.ResultsA total of 1436 STEMI patients (380 in pre-network, 375 in creation and 681 in post-network phases) were included. Significantly increasing proportions of timely presentation (71.3%, 73.3%, 81.4%) and reperfusion (58.2%, 59.2%, 65.3%) were found over the 3 phases. Compared with pre-network patients, post-network patients had shorter medians of patient delay (193 vs. 215 minutes), total ischemic time (348 vs. 380 minutes) and system delay (152 vs. 174 minutes). A significant decreasing trend of heart failure was observed (11.1%, 8.8%, 7.0%) across network phases. After conditioning, post-network patients were more likely than pre-network patients to have timely presentation (OR=1.70 [1.26, 2.30]), receive reperfusion therapy (OR=1.33 [1.02, 1.73]), and have shorter patient delay (HR=1.23 [1.08,1.40]) and total ischemic time (HR=1.22 [1.03,1.44]), but were less likely to receive timely reperfusion (OR=0.55 [0.36, 0.84]), timely PCI (OR=0.55 [0.34, 0.86), and shorter Z to W time (HR=0.78 [0.65, 0.94).ConclusionImprovements of STEMI reperfusion care by the regional Network were evident in this under-developed area; however, timely reperfusion care still needs to be enhanced.
Factors associated with suffering domestic violence in women during the last semester of the pandemic in Honduras- Central America
Authors: Espinoza-Turcios Eleonora , Zambrano Lysien Ivania , Sosa-Mendoza Carlos , Castro Ramos Henry Noel , Arias-Chávez Dennis , Mejia Christian R. 
Published: February 2023

ABSTRACTIntroductionMental health deterioration had already been reported prior to the pandemic, resulting in domestic violence in women, but this has not yet been reported in the pandemic in Central America.AIMTo determine the Factors associated with suffering domestic violence in women in the last half year of the pandemic in Honduras.MethodologyAnalytical and retrospective cross-sectional study, carried out through a survey in 17 departments of Honduras, in hospitals and first level health care centers. The main variable was obtained through the question “if you suffered domestic violence in the last 6 months”, being the possible answer verbal, physical, psychological. Descriptive and analytical results were obtained.ResultsOf the 8442 Hondurans surveyed, 4.2% (352) perceived verbal violence, 1.9% (165) physical violence and 1.3% (113) psychological violence. In the multivariate analysis, it was found that women (p=0.001), those with a history of alcohol (p=0.002) or drug use (p=0.015), previous mental illness (p<0.001), mild (p<0.001), moderate (p<0.001) or severe (p=0.025) depression (p<0.001) had experienced more domestic violence; On the contrary, there was less perception of domestic violence at higher economic income (all p-values were <0.029), among single (p=0.003) and married people (p<0.001).DiscussionImportant Factors associated with suffering domestic violence in women, especially social factors and a history of mental illness, as well as alcohol and drug use in the home.
Intergenerational Persistence of Health: Evidence from India
Authors: Kumar Santosh , Nahlen Bernard 
Published: February 2023

AbstractUsing nationally representative data, we estimate intergenerational persistence in health in India. Results from the instrumental variable method show that children of anemic mothers are more likely to be anemic, with an intergenerational health correlation of 0.26. Results are robust to the inclusion of confounding factors including the mother’s height. We find that the correlation between mothers’ anemic status and children’s anemic status differs by wealth quintile, indicating that economic status may play a role in the persistence of poor health across generations in developing countries.JEL ClassificationI10, I14, O15
TheInternational Classification of Diseases, 10thEdition, Clinical Modification (ICD-10-CM)Code I16.0 Accurately Identifies Patients with Hypertensive Urgency
Authors: Kaiser Jed , Liao Vanessa , Kamel Hooman , Ng Catherine , Lappin Richard I. , Liberman Ava L. 
Published: February 2023

ABSTRACTObjectiveHypertensive urgency, defined as acutely elevated BP without target organ damage, is associated with an increased risk of adverse cardiovascular events and accounts for a substantial proportion of national emergency department (ED) visits. To advance research in this space, we sought to validate the newICD-10-CMdiagnostic code for hypertensive urgency within a single healthcare system.MethodsWe performed a retrospective chart-review study of ED encounters at Weill Cornell Medicine from 2016 – 2021. We randomly selected 25 encounters with theICD-10-CMcode I16.0 as the primary discharge diagnosis and 25 encounters with primaryICD-10-CMdischarge diagnosis codes for benign headache disorders. A single board-certified vascular neurologist reviewed all 50 encounters while blinded to the assignedICD-10-CMcodes to identify cases of hypertensive urgency. We calculated the sensitivity, specificity, and positive predictive values of theICD-10-CMcode I16.0 with 95% confidence intervals (CI).ResultsOut of 50 randomly selected ED encounters, 24 were adjudicated as hypertensive urgency. All encounters adjudicated as hypertensive urgency had been assigned theICD-10-CMdischarge diagnosis code of I16.0. All 25 of the encounters adjudicated as headache were assigned anICD-10-CMdischarge diagnosis code for a benign headache disorder. TheICD-10-CMcode for hypertensive urgency, I16.0, was thus found to have a sensitivity of 100% (95% CI: 86-100%), specificity of 96% (95% CI: 80-100%), and positive predictive value of 96% (95% CI: 78-99%).ConclusionWe found that the newICD-10-CMcode for hypertensive urgency, I16.0, can reliably identify patients with this condition.
Trends of Developmental Milestone Attainment in Israeli Children Between 2016-2020: A National Report
Authors: Girshovitz Irena , Amit Guy , Goldshtein Inbal , Zimmerman Deena R. , Baruch Ravit , Akiva Pinchas , Tsadok Meytal Avgil , Sadaka Yair 
Published: February 2023

AbstractBackgroundThe early years of children’s lives are critical for their healthy development. Although children’s growth and development rates may vary, a significant delay during early childhood could indicate a medical or a developmental disorder. Developmental surveillance is used worldwide by healthcare providers in routine encounters, as well as by educators and parents, to elicit concerns about child development. In this work, we used a national dataset of developmental assessments to describe temporal trends of milestone attainment rates and associations between milestone attainment and various sociodemographic factors.MethodsThe study included 1,002,700 children ages birth until 6 years with 4,441,689 developmental visits between the years 2016 and 2020. We used the Israeli developmental scale to assess the annual rates of failure to attain language, social and motoric milestones by the entire population, as well as by subgroups stratified by sociodemographic factors. We used multivariable logistic regression to analyze the impact of different sociodemographic factors on the odds of failure to attain milestones, while controlling for confounding.ResultsMilestone failure rates progressively increased over the examined years in all developmental domains, and most prominently in the language domain. Conversely, the rates of parental concern for developmental delay remained constant. In multivariable analysis, higher risk of milestone attainment failure was observed in children whose mothers were divorced, unemployed, immigrant, had lower education, of Bedouin origin or were over 40 years old when giving birth.ConclusionsThis report describes national trends of child development in the gross motor, fine motor, language, and social domains. An annual report of these trends may assist policy makers to objectively evaluate subgroups in need for intervention, and to assess the effectiveness of intervention programs in attempt to maximize the developmental potential of children in Israel.