bluuebunny/crossref_metadata_2025_split huggingface dataset:
Classified and Secret: Understanding the Literature on Diversity in the Intelligence Sector
Authors: Stephenson Elise , Rimmer Susan Harris 
Published: July 2023

Abstract
Intelligence services are important sites of contestation, often the foci of reform and calls for greater transparency. Yet, while growing attention has been paid to intersectionality, gender equality reform, and progress in other areas of international affairs, little of this same transparency and attention has been paid to diversity in the intelligence sector. This paper seeks to bridge the gap, comprising a systematic review of the literature on diversity in the intelligence sector to improve our understanding of what is known and what can be known about the history and current make-up of the intelligence sector—and those who “do intelligence work”. By identifying strengths and gaps in the literature and setting an agenda for future research within these “secret institutions”, this paper argues that the lack of transparency, data, and knowledge on the interplay of gender, race, and sexuality, among other aspects of diversity in intelligence, is deeply troubling. It hampers our knowledge of how the sector may be “gendered” or otherwise experienced, as well as how this particular area of the security sector may or may not be integrating gender and other perspectives into their work. This paper finds that diversity in the intelligence and national security sectors is both an asset and a liability to be managed. Diversity is seen as a source of intelligence gathering and analysis strength, as well as a potential threat to hegemonic masculinity in intelligence practice. Further, language and processes for promoting diversity in intelligence can reinforce stereotyped knowledge of marginalized groups that ultimately hamper calls for greater representation, diversity, inclusion, access, and opportunities in the intelligence sector.
On the Decoupling of Evolutionary Changes in mRNA and Protein Levels
Authors: Jiang Daohan , Cope Alexander L , Zhang Jianzhi , Pennell Matt 
Published: July 2023

Abstract
Variation in gene expression across lineages is thought to explain much of the observed phenotypic variation and adaptation. The protein is closer to the target of natural selection but gene expression is typically measured as the amount of mRNA. The broad assumption that mRNA levels are good proxies for protein levels has been undermined by a number of studies reporting moderate or weak correlations between the two measures across species. One biological explanation for this discrepancy is that there has been compensatory evolution between the mRNA level and regulation of translation. However, we do not understand the evolutionary conditions necessary for this to occur nor the expected strength of the correlation between mRNA and protein levels. Here, we develop a theoretical model for the coevolution of mRNA and protein levels and investigate the dynamics of the model over time. We find that compensatory evolution is widespread when there is stabilizing selection on the protein level; this observation held true across a variety of regulatory pathways. When the protein level is under directional selection, the mRNA level of a gene and the translation rate of the same gene were negatively correlated across lineages but positively correlated across genes. These findings help explain results from comparative studies of gene expression and potentially enable researchers to disentangle biological and statistical hypotheses for the mismatch between transcriptomic and proteomic data.
Identification and molecular characterization of Culex flavivirus in Culex quinquefasciatus (Diptera: Culicidae): first report from India
Authors: Anakha A , Shah Harish Kumar , Fathima P A , Aiswarya R S , Ajithlal P M , Kumar N Pradeep , Kumar Ashwani , Saini Prasanta 
Published: July 2023

ABSTRACT

Background
Culex quinquefasciatus is a notorious vector known to transmit pathogens such as Wuchereria bancrofti (causing Lymphatic filariasis) and flaviviruses such as West Nile virus in India and St. Louis Encephalitis virus in the USA. It is the vector of the Rift Valley Fever virus, also on the African continent. Mosquitoes also harbor other non-pathogenic insect-specific flaviviruses (ISFs), such as Culex flavivirus (CxFV) and Aedes flavivirus. Recent studies have implicated ISFs interfering with the vectorial efficiency of the pathogenic arbo-viruses.

Methods
One hundred specimens of the Cx. quinquefasciatus population in two urban areas in Kerala State, India, were screened to have an understanding of the prevalence of these flaviviruses in this vector species. Viral RNA was extracted from individual specimens and was subjected to RT-PCR towards amplification of the CxFV non-structural protein 5 (NS5) gene.

Results
Among the 100 specimens, 7.0% were found to be harboring CxFV infection. The phylogenetic analysis of the gene sequences showed that the virus isolates were genetically related to Kenya, with 98–99% sequence similarities.

Conclusion
This is the first report on the occurrence of CxFV from Cx. quinquefasciatus from India. The occurrence of these viruses in mosquitoes could play a critical role in disease vector management.
Ovarian preservation in gynecologic oncology: current indications and techniques
Authors: Bizzarri Nicolò , Pavone Matteo , Loverro Matteo , Querleu Denis , Fagotti Anna , Scambia Giovanni 
Published: July 2023

Purpose of review
Early menopause represents a relevant clinical issue for women. Nevertheless, this issue should be balanced with the risks of ovarian metastasis, ovarian recurrence, and the risk of recurrence in hormone-sensitive gynecological cancers. The purpose of this review was to provide an overview on current indications and techniques of ovarian preservation in patients with gynecological cancers.

Recent findings
The potential discussion about ovarian conservation could be proposed to patients with FIGO-stage IA grade 1-2 endometrioid endometrial cancer aged 40 years or less, FIGO-stage IB1-IB2 node-negative cervical cancer with squamous cell carcinoma and HPV-associated adenocarcinoma, FIGO-stage IA-IC grade 1-2 serous, endometrioid, mucinous expansile pattern ovarian cancer, any stage germ cell ovarian tumors, and FIGO-stage IA sex cord-stromal tumors. Technique to perform ovarian transposition in cervix cancer is also reported.

Summary
Ovarian conservation is a surgical approach that involves preserving one or both ovaries during the treatment of gynecologic cancers. This approach has gained popularity in recent years, as it offers several benefits to the patient, including the preservation of hormonal function and fertility. The decision to perform ovarian conservation depends on several factors, such as the stage and type of cancer, the patient's age, fertility desire, and should be carefully discussed with patients.
New boundaries for fertility sparing management in endometrial cancer
Authors: Rodolakis Alexandros , Pergialiotis Vasilis , Thomakos Nikolaos 
Published: July 2023

Purpose of review
The increasing rates of endometrial cancer in premenopausal women that accompanies modern lifestyle options that enhance the prevalence of obesity as well as the trend of delayed childbearing are expected to increase the need for fertility sparing techniques. Currently, the cornerstone of fertility sparing treatment is hormonal handling with progestin treatment and is reserved for women with well differentiated endometrioid lesions that are limited in the myometrial layer.

Recent findings
Innovative approaches in the surgical treatment of patients with the use of operative hysteroscopy seem to offer decreased intervals to remission of lesions and longer progression free survival. Recent small case series also dictate that patients with endometrioid lesions of medium differentiation as well as those with superficial myometrial invasion may be adequately treated with the use of operative hysteroscopy. Moreover, the novel classification system may help better understand patients that will likely respond better to hormonal treatment.

Summary
In the near future, further data from clinical trials will be available that will help optimize patient selection as well select surgical and medical options that will help establish a personalized approach of fertility preservation in endometrial cancer patients.
A Systematic Review of Artificial Intelligence Applications in Plastic Surgery: Looking to the Future
Authors: Spoer Daisy L. , Kiene Julianne M. , Dekker Paige K. , Huffman Samuel S. , Kim Kevin G. , Abadeer Andrew I. , Fan Kenneth L. 
Published: July 2023

Background:
Artificial intelligence (AI) is presently employed in several medical specialties, particularly those that rely on large quantities of standardized data. The integration of AI in surgical subspecialties is under preclinical investigation but is yet to be widely implemented. Plastic surgeons collect standardized data in various settings and could benefit from AI. This systematic review investigates the current clinical applications of AI in plastic and reconstructive surgery.

Methods:
A comprehensive literature search of the Medline, EMBASE, Cochrane, and PubMed databases was conducted for AI studies with multiple search terms. Articles that progressed beyond the title and abstract screening were then subcategorized based on the plastic surgery subspecialty and AI application.

Results:
The systematic search yielded a total of 1820 articles. Forty-four studies met inclusion criteria warranting further analysis. Subcategorization of articles by plastic surgery subspecialties revealed that most studies fell into aesthetic and breast surgery (27%), craniofacial surgery (23%), or microsurgery (14%). Analysis of the research study phase of included articles indicated that the current research is primarily in phase 0 (discovery and invention; 43.2%), phase 1 (technical performance and safety; 27.3%), or phase 2 (efficacy, quality improvement, and algorithm performance in a medical setting; 27.3%). Only one study demonstrated translation to clinical practice.

Conclusions:
The potential of AI to optimize clinical efficiency is being investigated in every subfield of plastic surgery, but much of the research to date remains in the preclinical status. Future implementation of AI into everyday clinical practice will require collaborative efforts.
Ultrasound as an Educational Tool in Facial Aesthetic Injections
Authors: Schelke Leonie , Farber Nimrod , Swift Arthur 
Published: July 2023

Summary:
Injection therapies for cosmetic enhancement, particularly antiaging treatments, are increasingly popular. However, once the needle has penetrated the skin, the injector is “blind” to the depth and exact location of the needle tip. Duplex ultrasound use before and after treatment can allow the injector to visualize in real time the individual anatomy, thereby improving and confirming the accuracy of the injections through visualization of both the target layer and the vital structures to be avoided. Previously injected permanent filler treatments can also be visualized. In this way, ultrasound use becomes an important educational tool in promoting “safer” facial injection therapy. It shifts static anatomy to mobile real-time facial anatomy, thereby establishing itself as an invaluable learning tool through follow-up imaging, with subsequent optimization in techniques and patient outcomes.
Venous Thromboembolism Risk Assessment Models in Plastic Surgery: A Systematic Review and Meta-Analysis
Authors: Mrad Mohamed Amir , Al Qurashi Abdullah A. , Shah Mardan Qutaiba N. M. , Al Ghamdi Abdulrahman Abdulaziz , Al Jabr Faisal Ali , Almenhali Ahmed Abdullah , AlMansour Abdullah , Al Maghrabi Aroub , Allhybi Abdulaziz Khalid , Merdad Reyan Hatem , Alaa'adeen Abdulqader 
Published: July 2023

Background:
Postoperative venous thromboembolism (VTE) is the most common complication of plastic surgery procedures. Diverse risk assessment models (RAMs) exist to stratify patients by VTE risk, but due to a lack of high-quality evidence and heterogeneity in RAM data, there is no recommendation regarding RAM that can be used for plastic surgery patients. This study compares the reliability and outcomes of Caprini and American Society of Anesthesiologists (ASA) physical status classification RAMs used in plastic surgery to help surgeons stratify the risk of VTE.

Methods:
MEDLINE and Embase databases were searched between February 2010 and December 2021. All published English articles that report the incidence of VTE stratified by a RAM among patients who underwent plastic surgery were included. The results of the presented meta-analysis were pooled using a random-effects model.

Results:
The database search revealed 809 articles, out of which eight studies (n = 1,348,606) were eligible. Out of the eight studies, six utilized the Caprini score, and three utilized ASA score. Super-high-risk patients were significantly more likely to present with VTE than their high-risk [odds ratio (OR), 2.92; 95% confidence interval (CI), 1.26–6.78], medium-risk (OR, 5.29; 95% CI, 2.38–11.79), or low-risk counterparts (OR, 10.00; 95% CI, 2.32–43.10) at Caprini score. High-risk patients in ASA score showed significant increase in VTE incidents (OR, 2.72; 95% CI, 1.10–6.72).

Conclusions:
Both Caprini and ASA RAMs showed compelling evidence of efficacy in our study. However, the Caprini RAM is more predictive of postoperative VTE incidents in high-risk plastic surgery patients than the ASA grading system.
Obesity and Complications in Mammoplasty: A Retrospective Review in an Obese Patient Population
Authors: Hinson Chandler , Alford Hayden , Huett Wilson , Zeidan Melody , Moore Rachel , Lee Yann-Leei , Quang Kenny , Brooks Ronald 
Published: July 2023

Background:
With trends of obesity increasing, plastic surgeons are resecting larger weights from larger patients. Published literature has demonstrated the association between body mass index (BMI) and resection weight to postsurgical complications; however, these relationships are unclear in a population that is primarily overweight or obese. Our study examines these relationships to assist plastic surgeons in identifying high-risk patients and discussing preoperative measures to decrease the likelihood of surgical complications.

Methods:
We performed a retrospective electronic medical record review of a cohort of 182 bilateral reduction mammoplasty procedures performed at a single institution over a four-year period. Patient data were obtained and correlated with postoperative complications.

Results:
Within our identified patient cohort, 95% were classified as either overweight or obese. Incidence of complications was 51%, with wound dehiscence having the highest incidence of 36.26%. Using a multivariate regression, our analysis found statistical significance between surgical complications and both smoking status and BMI (P = 0.042 and P = 0.025, respectively). Smokers had an increased risk of complications with an odds ratio of 5.165. For every additional 1 kg/m2 increase in BMI, the odds for surgical complication increased by 1.079. In a subanalysis focusing on wound dehiscence, the use of postoperative drains was a protective factor (P = 0.0065).

Conclusions:
Our study population, with a high average BMI and smoking status, demonstrated a statistically significant increase in postsurgical complications. These findings will help counsel obese patients preoperatively on their increased risk of complications.
Utilization of the Free Fibular Flap for First Metatarsal Reconstruction
Authors: Gupta Rohun , Pfennig Mitchell , Gannon James , Young Devin , Gupta Rushil , Hart Justin , Kissel Brian G. , Kissel Erik C. , Fortin Paul , Chaiyasate Kongkrit 
Published: July 2023

Summary:
Beyond being aesthetically unpleasing, metatarsal defects have been known to lead to several patient concerns such as intermetatarsal malpositioning and metatarsalgia. There are several reconstructive techniques that have been utilized for reconstruction of bony defects in the foot, including the free dorsal toe flap and dorsal metatarsal perforator flap. Our institution has utilized the free fibular flap for surgical management pertaining to tarsal reconstruction. Our study looks to evaluate the work of a single plastic surgeon and identify patient postoperative outcomes. A retrospective chart review was conducted at Beaumont Health System, Royal Oak for patients who underwent first metatarsal reconstruction with a free fibular flap between the years 2015 and 2022. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively gathered and analyzed. A total of two patients were isolated after chart review. Both patients were found to have tolerated the procedure well and had no intraoperative complications. In addition, all patients had clinically viable flaps and were satisfied with their surgical results. The free fibular flap may be used effectively in the management of metatarsal defects that have failed prior therapy. In our study, both patients who underwent surgical management with a free fibular flap were noted to have successful long-term results. With the right expertise and patient population, a free fibular flap can be highly successful in the repair of metatarsal defects.
Tuberous Breast Management: A Review of Literature and Novel Technique Refinements
Authors: Grella Roberto , D’Andrea Francesco , Nicoletti Giovanni Francesco , Lanzano Giuseppe 
Published: July 2023

Background:
The tuberous breast is a rare malformation that can affect psychosocial well-being in young women. Its management represents a great challenge to plastic surgeons. Many surgical procedures have been described to correct different grades of tuberous breast deformity (TBD). The authors describe their one-stage technique for correcting grade 2 TBD.

Methods:
Sixteen women affected by grade 2 TBD treated with glandular flaps, silicone gel prosthesis, and only an hemiperiareolar incision between January 2018 and January 2019 were reviewed. The age range was 19–27 years (mean age was 25). Follow-up average was 25 months (range 16–33 months). To evaluate the results, we used two analogic scales with values from 1 to 3, where the lower value was the worst result. First, an independent medical team of three plastic surgeons evaluated two parameters: correction of deformity and symmetry. Then, patients were asked to judge the result obtained.

Results:
The resulting breast has a normal-shaped areola without bulging, a natural shape, a volume matching the contralateral breast, and no evidence of “double-bubble” deformity or irregularities of the lower pole shape.

Conclusion:
We propose this one-stage approach with hemiperiareolar incision, to minimize time interval to obtain final results in TBD correction, with reduced scar dimensions to avoid all the possible complications related to the round block suture.
Down with the Bean Bag: A Multi-institutional Experience with Total Latissimus Muscle Free Flap Harvest in the Supine Position
Authors: Shuck John W. , Felder John A. , Shammas Ronnie L. , Chang Edward I. , Selber Jesse C. , Phillips Brett T. 
Published: July 2023

Summary:
The latissimus muscle continues to be a head to toe workhorse in free tissue transfer for coverage of large defects. Traditional full muscle harvest is performed in the lateral decubitus position which is frequently suboptimal or requires position change based on the recipient site and laterality. We present a multi-institutional case series of full muscle flap harvest from the supine position for a range of defects in 32 patients. The relevant operative setup and technique are described. In our experience, supine harvest has become the preferred open harvest technique compared to lateral positioning for both optimal exposure of the pedicle and reduction in operating time.
Trade-offs in locational choices for care coordination resources in accountable care organizations
Authors: Tsuei Sian Hsiang-Te , Alcusky Matthew , Florio Collen , Kerrissey Michaela June 
Published: July 2023

Background
Care coordination is central to accountable care organizations (ACOs), especially in Medicaid where many patients have complex medical and social needs. Little is known about how to best organize care coordination resources in this context, particularly whether to centralize them. We examined how care coordinators’ location, management, and colocation of both (within ACO headquarters, practice sites, or other organizations) relate to care quality and coordination.

Methods
We conducted a cross-sectional analysis of surveys administered to a sample of practice sites covering all 17 Medicaid ACOs in Massachusetts (n = 225, response rate = 64%). We applied controlled, cluster-robust regressions, adjusting the significance threshold for the number of ACO clusters, to assess how clinical information sharing across settings, care quality improvement, knowledge of social service referral, and cross-resource coordination (i.e., the ability of multiple resources to work well together) relate to where care coordinators were physically located and/or managed.

Results
Centralizing care coordinators at ACO headquarters was associated with greater information sharing. Embedding care coordinators in practices was associated with greater care quality improvement. Embedding coordinators at other organizations was associated with less information sharing and care quality improvement. Managing coordinators at practice sites and other organizations were associated with better care quality improvement and cross-resource coordination, respectively. Colocating the two functions showed no significant differences.

Practice Implications
Choosing care coordinators’ locations may present trade-offs. ACOs may strategically choose embedding care coordinators at practice sites for enhanced care quality versus centralizing them at the ACO to facilitate information sharing.
An Open-Label Study of Adjunctive Dextromethorphan/Quinidine in Treatment-Resistant Depression
Authors: Wang Philip R. , Yavi Mani , Lee Holim , Kotb Yasmine , Shora Lorie , Park Lawrence T. , Zarate Carlos A. 
Published: July 2023

Abstract

Background
Approximately one third of individuals with major depressive disorder have treatment-resistant depression (TRD). Glutamatergic modulators such as the N-methyl-d-aspartate receptor antagonist ketamine have rapid and robust antidepressant effects, but their use has been limited by accessibility and route of administration. This open-label pilot study assessed the adjunctive antidepressant efficacy of dextromethorphan/quinidine (DM/Q) in TRD.

Methods
Inpatients with TRD (n = 17, 40.8 ± 12.3 years; 9 females/8 males) received adjunctive open-label DM/Q (20 mg/10 mg) up to 3 times daily. The study had no set endpoint; participants were followed until they discontinued DM/Q or were discharged. Montgomery-Asberg Depression Rating Scale (MADRS) scores were obtained at baseline (before DM/Q administration) and regularly during hospitalization. Full response was defined as a ≥50% reduction in baseline MADRS score, partial response as a 25% to 50% decrease in baseline MADRS score, and nonresponse as a <25% reduction or an increase in baseline MADRS score.

Results
The 17 inpatients received open-label DM/Q for 5.1 ± 2.7 weeks. Forty-seven percent of participants responded to DM/Q—12% achieved a full response and 35% achieved a partial response. The largest MADRS difference observed at any time point was −6.4 ± 8.4 (−21.0% ± 29.9%), and the MADRS difference observed at time of DM/Q discontinuation or hospital discharge was −4.8 ± 8.4 (−15.9% ± 29.7%). Twenty-four percent of participants experienced a nonserious adverse event; none experienced a serious adverse event.

Conclusions
In this open-label pilot study, 47% of participants responded to adjunctive DM/Q, which was well tolerated. Larger placebo-controlled trials are needed to determine the real-world efficacy of DM/Q.