bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decomposition of socioeconomic inequalities in arboviral diseases in Brazil and Colombia (2007–2017)
Authors: Carabali Mabel , Harper Sam , Lima Neto Antonio S , dos Santos de Sousa Geziel , Caprara Andrea , Restrepo Berta Nelly , Kaufman Jay S 
Published: January 2022

Abstract

Background
We used surveillance data from Brazil and Colombia during 2007–2017 to assess the presence of socioeconomic inequalities on dengue, chikungunya and Zika at the neighborhood level in two Latin American cities.

Methods
To quantify the inequality, we estimated and decomposed the relative concentration index of inequality (RCI) accounting for the spatiotemporal distribution of the diseases.

Results
There were 281 426 arboviral cases notified in Fortaleza, Brazil, and 40 889 in Medellin, Colombia. The RCI indicated greater concentration of dengue cases among people living in low socioeconomic settings in both sites. The RCIs for chikungunya in Fortaleza covered the line of equality during their introduction in 2014, while the RCIs for Zika and chikungunya in Medellin indicated the presence of a small inequality. The RCI decomposition showed that year of notification and age were the main contributors to this inequality. In Medellin, the RCI decomposition showed that age and access to waste management accounted for 75.5%, 72.2% and 54.5% of the overall inequality towards the poor for dengue, chikungunya and Zika, respectively.

Conclusions
Our study presents estimates of the socioeconomic inequality of arboviruses and its decomposition in two Latin American cities. We corroborate the concentration of arboviral diseases in low socioeconomic neighborhoods and identify that year of occurrence, age, presence of healthcare facilities and waste management are key determinants of the heterogenous distribution of endemic arboviruses across the socioeconomic spectrum.
A Critical Analysis of Lateral Versus Central Endpoint in Distal Tibia Nailing: Does It Affect Alignment?
Authors: Brodke Dane J. , Upfill-Brown Alexander , Devana Sai K. , Eichenlaub Emily K. , Mahoney Jonathan M. , Orbach Mattan R. , Bucklen Brandon S. , Kelley Benjamin V. , Mayer Erik N. , Shi Brendan Y. , Lee Christopher 
Published: January 2022

Objectives:
To evaluate the effect of a traditional “center-center” end point for distal tibia nailing in comparison with a lateral-of-center end point on fracture malalignment in a cadaver model.

Methods:
Nine matched pairs of human cadaveric lower-extremity specimens were used to model the effect of nail end point on fracture alignment in extra-articular distal tibia fractures. After simulation of the fracture through a standardized osteotomy, 1 member of each pair was fixed with an intramedullary nail using a “center-center” end point, whereas a lateral-of-center end point was used for the other member of the pair. Specimens were stripped of soft tissue, and digital calipers were used to measure fracture translation and gap medially, laterally, anteriorly, and posteriorly. Coronal plane angulation at each fracture was measured on the final mortise image.

Results:
The average coronal angulation was 7.0 degrees of valgus (with a SD of 4.1) in central-end point specimens versus 0.2 degrees of valgus (SD = 1.5) in lateral-end point specimens (P < 0.001). Lateral-end point specimens also demonstrated significantly less fracture gap medially (mean 0.2 vs. 3.1 mm for central-end point specimens, P < 0.001), anteriorly (mean 0.1 vs. 1.3 mm, P = 0.003), and posteriorly (mean 0.3 vs. 2.2 mm, P = 0.003). Lateral-end point specimens also showed less lateral translation (mean 0.6 vs. 1.6 mm, P = 0.006).

Conclusions:
Lateral-of-center nail end points may help surgeons restore native alignment in extra-articular distal tibia fractures and avoid valgus malalignment.
Effect of a Multimodal Analgesic Protocol on Short-Term and Long-Term Opioid Use After Orthopaedic Trauma
Authors: Oyler Douglas R. , Slade Emily , Slavova Svetla , Matuszewski Paul E. , Lei Feitong , Herndon Brooke , Johnson Shannon , Moghadamian Eric S. 
Published: January 2022

Objective:
To determine whether the use of a multimodal analgesic protocol reduced short-term and long-term opioid use in patients hospitalized after orthopaedic trauma.

Design:
Retrospective pre–post intervention study.

Setting:
Regional, academic, Level 1 trauma center in Central Kentucky.

Patients/Participants:
Patients were hospitalized after orthopaedic injury before (n = 393) and after (n = 378) the implementation of a multimodal analgesic protocol.

Intervention:
The intervention involved a multimodal analgesic protocol consisting of acetaminophen, ibuprofen/ketorolac, gabapentinoids, skeletal muscle relaxants, and standardized doses of opioids plus standardized pain management education before hospital discharge.

Main Outcome Measurements:
End points included discharge opioid prescription, days' supply and daily morphine milligram equivalent (MME), and long-term opioid use after hospitalization. Opioid use in the 90 days before and after hospitalization was assessed using state prescription drug monitoring program data.

Results:
Discharge opioid prescription rates were similar in the intervention and control cohorts [79.9% vs. 78.4%, odds ratio (OR) 1.30 (0.83–2.03), P = 0.256]. Patients in the intervention cohort received a shorter days' supply [5.7 ± 4.1 days vs. 8.1 ± 6.2 days, rate ratio 0.70 (0.65–0.76), P < 0.001] and lower average daily MME [34.8 ± 24.9 MME vs. 51.5 ± 44.0 MME, rate ratio 0.68 (0.62–0.75), P < 0.001]. The incidence of long-term opioid use was also significantly lower in the intervention cohort [7.7% vs. 12.0%, OR 0.53 (0.28–0.98), P = 0.044].

Conclusions:
Implementation of a multimodal analgesic protocol was associated with reductions in both short-term and long-term opioid use, including long-term opioid therapy, after orthopaedic trauma.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Occurrence of Diastasis of the Rectus Abdominis Muscles in Patients with Medial Pectus Excavatum
Authors: Anger Jaime , de Campos Jose Ribas M. 
Published: January 2022

Background:
Since 1994, we have used soft silicone blocks sculpted intraoperatively to correct pectus excavatum in male patients. This technique involves a horizontal access incision in the region of the lower edge of the sternum. During the dissection to expose the sternum, we observed a constant diastasis of the rectus abdominis muscle and changes of the anatomy at its superior insertion. There is no report on this association.

Methods:
Male patients with untreated medial pectus excavatum with indication for silicone block correction were enrolled. Age, weight, height, and the presence of other associated conditions were noted. Ultrasound examination was performed. During the surgery, the width of the linea alba was evaluated and the anatomical positioning of the insertion of rectus abdominis muscle was noted.

Results:
From 2017 to 2019, 10 patients were submitted to surgery. The mean age was 27 years. All patients presented diastasis at the preoperative physical examination. Imaging examination reports showed diastasis of the rectus abdominis muscle: seven partial epigastric separations and three total separations, two of which were associated with umbilical hernia. The intraoperative findings showed the line alba with a minimum of 23 mm and a maximum of 45 mm width at 4 cm from the xiphoid process edge. The muscle borders presented a curved lateral deviation up to the insertion in the costal arches with a distance ranging from 35 mm to 60 mm.

Conclusions:
This study confirms the anatomical alterations of the superior portion of the rectus abdominis muscle. The authors discuss the surgical consequences and suggest that the semiology of rectus abdominis muscle is an important preoperative action in pectus excavatum patients.
Ready for Anything
Authors: Burton Candace W. , Carey Shannon , Draughon Moret Jessica E. 
Published: January 2022

ABSTRACT
Although numerous training options exist for sexual assault nurse examiner certification, most focus on specific certification-related content rather than on creating a holistic preparation for sexual assault nurse examiner (SANE) practice. Holistic preparation may be preferable for SANE trainees who are early in their nursing careers or who have practiced in limited clinical environments. This article describes a holistic training approach implemented at a SANE training site funded by the Advanced Nursing Education initiative of the Health Resources and Services Administration. Training covers hands-on pelvic and anal examinations, community education, underserved communities, self-care, and other topics that support newly trained SANEs in establishing and maintaining practice. This content has prepared trainees for a wide variety of patient encounters as well as for engaging with the community. With this approach, our trainees have the opportunity to enhance their ability to provide SANE care and to provide additional resources within their primary practice environments.
Functional Reach and Gait Speed Improvement in A Matter of Balance Participants
Authors: Hood Jessica , Sharrah Mark L. 
Published: January 2022

BACKGROUND:
Falls among older adults are the most common cause of hospital admissions. A Matter of Balance may reduce these falls by improving balance, flexibility, gait speed, and agility.

OBJECTIVE:
The study aimed to measure functional reach and gait speed among adults older than 65 years following A Matter of Balance. It was hypothesized that functional reach scores would increase and gait speed scores would decrease.

METHODS:
This was an interventional study with the primary outcomes of functional reach (measured by the Functional Reach test) and gait speed (measured by the Timed Up and Go test). A one-tailed paired t test was used to compare pre- and postprogram functional reach mean differences. A one-tailed Wilcoxon signed-rank test was used for comparing median differences of pre- and postprogram gait speed. Characteristics of participants who improved scores were compared with those who did not improve, using two-tailed independent-samples t tests and two-tailed Pearson's χ2. Effect sizes were computed for tests significant beyond p < .05.

RESULTS:
Mean functional reach increased by 0.6 inches (SD = 2.21, p = .002; d = 0.2). Median gait speed decreased by 1.25 s (interquartile range = 2.39, p < .001; r = .76). Improvement was not attributable to differences of age, sex, health status, preexisting conditions, or delivery site.

CONCLUSIONS:
Following A Matter of Balance, functional reach and gait speed improved. Adults older than 65 years should be encouraged to participate in the program, as it may reduce their fall risk.
Identification of Delayed Traumatic Diaphragmatic Injury: A Concise Review
Authors: Bartzak Patricia J. 
Published: January 2022

OBJECTIVE:
To provide a concise review of the literature on both the difficulty and subtly of identifying a traumatic diaphragmatic hernia in the delayed phase of injury.

DATA SOURCES:
Source data were obtained from PubMed and Open Access Journals.

STUDY SELECTION:
Studies addressing traumatic diaphragmatic injury in the delayed phase of diaphragmatic injury. PubMed was searched using the MeSH term “delayed diaphragmatic rupture.”

DATA EXTRACTION:
Relevant studies were reviewed and included on the basis of the preponderance of diaphragmatic injury cases that presented in the delayed phase. The following aspects of each study were identified, abstracted, and analyzed: study population, study design, methods, results, and relevant implications for practice. A few case studies were included to illustrate the importance of a careful medical history and patient evaluation necessary to identify a delayed diaphragmatic hernia presentation.

DATA SYNTHESIS:
Diaphragmatic herniation can occur days and weeks to decades after the initial trauma as a small diaphragmatic tear can evolve into a larger one over time. Follow-up after the acute phase is essential to assess for occult diaphragmatic injury and potential herniation. Meticulous patient history and evaluation are important considerations when the patient presents after the acute phase of injury with vague respiratory or abdominal complaints. During the triage phase of care, trauma nurses have an important role in assessing trauma history.

CONCLUSIONS:
The available evidence suggests that diaphragmatic injury should be on the differential list during and after trauma presentation for both providers and trauma nurses. Other critical injuries may portend a possible diaphragmatic injury. Diaphragmatic injury, though relatively rare, has high morbidity and mortality.
Educational Needs of U.S. Emergency Nurses Related to Forensic Nursing Processes
Authors: Wolf Lisa Adams , Perhats Cydne , Delao Altair 
Published: January 2022

BACKGROUND:
Forensic nursing is a specialty deployed in patient care areas, including emergency departments, intensive care units, labor and delivery suites, and psychiatric units treating persons who have suffered trauma from a violent or criminal act. The recognition of violence-related injuries in patients presenting to health care facilities is critical to an appropriate care trajectory. These patients require specialized resources beyond the treatment of physical injuries to include psychosocial and legal care that supports patient recovery and pursuit of criminal justice.

OBJECTIVE:
The purpose of this study is to obtain a broad view of current forensic knowledge and training for emergency nurses working in U.S. emergency departments and to identify gaps in nursing skills and practice such that appropriate education can be developed for this nursing specialty.

METHODS:
The study was conducted using a quantitative exploratory, descriptive approach via an emailed cross-sectional survey sent to a convenience sample of U.S. emergency nurses.

RESULTS:
A total of 43,775 emails were sent out to members of the Emergency Nurses Association. Of that group, 2,493 recipients opened the email, and 1,824 completed the survey, resulting in a total response rate of 4% and a 73% response rate from those who opened the email. Few respondents self-reported competence in the care of patients who experienced child abuse (13.1%), elder abuse (12.4%), interpersonal violence (17.6%), sexual assault (19.2%), human trafficking (7.4%), developmental challenges (7.2%), strangulation (12.5%), or who were suspected of committing a violent crime (11.4%).

CONCLUSIONS:
There is a compelling need to expand forensic education to advance knowledge and skill acquisition in emergency nursing practice and provide staff with additional resources that support a holistic trauma-informed approach to patient care.
Validation of the Trauma and Injury Severity Score for Prediction of Mortality in a Greek Trauma Population
Authors: Filippatos Georgios , Tsironi Maria , Zyga Sofia , Andriopoulos Panagiotis 
Published: January 2022

BACKGROUND:
Although the Trauma and Injury Severity Score (TRISS) has been extensively used for mortality risk adjustment in trauma, its applicability in contemporary trauma populations is increasingly questioned.

OBJECTIVE:
The study aimed to evaluate the predictive performance of the TRISS in its original and revised version and compare these with a recalibrated version, including current data from a Greek trauma population.

METHODS:
This is a retrospective cohort study of admitted trauma patients conducted in two tertiary Greek hospitals from January 2016 to December 2018. The model algorithm was calculated based on the Major Trauma Outcome Study coefficients (TRISSMTOS), the National Trauma Data Bank coefficients (TRISSNTDB), and reweighted coefficients of logistic regression obtained from a Greek trauma dataset (TRISSGrTD). The primary endpoint was inhospital mortality. Models' prediction was performed using discrimination and calibration statistics.

RESULTS:
A total of 8,988 trauma patients were included, of whom 854 died (9.5%). The TRISSMTOS displayed excellent discrimination with an area under the curve (AUC) of 0.912 (95% CI 0.902–0.923) and comparable with TRISSNTDB (AUC = 0.908, 95% CI 0.897–0.919, p = .1195). Calibration of both models was poor (Hosmer–Lemeshow test p < .001), tending to underestimate the probability of mortality across almost all risk groups. The TRISSGrTD resulted in statistically significant improvement in discrimination (AUC = 0.927, 95% CI 0.918–0.936, p < .0001) and acceptable calibration (Hosmer–Lemeshow test p = .113).

CONCLUSION:
In this cohort of Greek trauma patients, the performance of the original TRISS was suboptimal, and there was no evidence that it has benefited from its latest revision. By contrast, a strong case exists for supporting a locally recalibrated version to render the TRISS applicable for mortality prediction and performance benchmarking.
Teaching Mindfulness to Mitigate Burnout in a Pandemic
Authors: Tolouian Audrey , Wholeben Melissa , Rankin Diane 
Published: January 2022

BACKGROUND:
Posttraumatic stress syndrome has been on the rise across all nursing specialties. When dealing with high-stress situations in the workplace, it has become clear that health care providers require tools to maintain a healthy environment.

OBJECTIVE:
The purpose of this article is to describe an initiative to provide baccalaureate nursing students with mindfulness techniques to manage their internal reactions to day-to-day events during a pandemic.

METHODS:
This is an innovative classroom initiative reviewing nursing student engagement on a discussion board related to mindfulness reflection questions before and after implementing an 8-week mindfulness program conducted from August to October 2020 in a first-year undergraduate nursing program in Texas.

RESULTS:
A total of 124 student nurses participated in a mindfulness program. The majority of these were women (83.9%), aged 19–50 years, single (78.2%), and Hispanic or Latino (84.7%). Discussion board engagement increased from n = 1,001 posts over 16-week premindfulness program implementation to n = 4,191 over the first 10 weeks of the program implementation.

CONCLUSION:
Nursing implications include providing an atmosphere in which nurses can practice mindfulness skills, such as being in touch with their thoughts and bodies, which will help them transition into the position of trauma nurse. As nurse educators, it is our responsibility to assist in developing tools that students and patients may use to deal with their anxiety and foster an environment that promotes learning, understanding, and compassion.
Costs Associated With Incorporation of Network Approaches Into Sexually Transmitted Disease Program Activities
Authors: Williams Austin M. , Eppink Samuel T. , Guy Jalila N. , Seña Arlene C. , Berruti Andrés A. 
Published: January 2022

Background
Network approaches can be used to study sociosexual partnerships and identify individuals at high risk of infection. Little is known about the cost structure of these services and their association with STD diagnoses.

Method
We collected costs associated with using a peer network strategy to recruit men who have sex with men and transwomen of color in 4 counties in North Carolina: Guilford, Forsyth, Durham, and Wake from February through October 2019. We used a comprehensive costing approach to gather detailed retrospective information on the intervention cost, broken down by category and programmatic activity.

Results
The sociosexual networks collected consisted of 31 initial seeds (index cases) and 49 peers of those seeds. In peers, 5 cases of human immunodeficiency virus (HIV) and 10 cases of syphilis were identified. The cost per case (HIV or syphilis) identified was $7325. Personnel costs accounted for 80% of total expenditures, followed by laboratory expenses (12%). Personnel cost was distributed between disease intervention specialist patient navigators (51%), nonclinical (37%), and management (12%) staff. General administration was the costliest programmatic activity (37%), followed by case management and field services (37%), and study activities (11%). The estimated average cost per patient tested was $2242.

Conclusions
Finding positive peer cases in nonclinical settings is costly but may be crucial for limiting the spread of sexually transmitted diseases. The cost of staff was the major driver. This study demonstrates that using a network strategy can be a cost-effective way to identify, test, and refer patients at high risk of syphilis and HIV infections to care.
The Emergence of Hepatitis C Virus Genotype 4d Among Human Immunodeficiency Virus–Infected Patients in Mexico City: A Molecular Epidemiological Study
Authors: Lopez Luis Bruno Ali , Rodríguez-Díaz Roberto , Angulo-Medina Luis , Soto-Ramírez Luis Enrique 
Published: January 2022

Abstract
The recent detection of hepatitis C virus genotype 4 infection in human immunodeficiency virus–infected patients prompted performing molecular characterization of these isolates. All the Mexican isolates belonged to a subcluster within the 4d group and shared a common ancestor with a French isolate. The estimated timing of introduction in Mexico City was as recent as December 2015.
Case Report: Intracorneal Hemorrhages Seen with Scleral Contact Lens Wear and Netarsudil Therapy
Authors: Crum Amanda R. , Srikumaran Divya 
Published: January 2022

SIGNIFICANCE
Intracorneal hemorrhages are a rare finding generally associated with surgery or trauma. There is no consensus on preferred management except eliminating or addressing the causative mechanism in hopes of reducing the risk of corneal haze or scarring.

PURPOSE
This case highlights a rare adverse outcome of intracorneal hemorrhages occurring after recent initiation of netarsudil, possibly exacerbated by scleral contact lens wear in a patient with open-angle glaucoma and limbal stem cell deficiency.

CASE REPORT
A 77-year-old man using scleral contact lenses for therapeutic management of limbal stem cell deficiency started netarsudil for open-angle glaucoma. During an annual follow-up to adjust his scleral contact lenses, the patient developed peripheral intracorneal hemorrhages bilaterally. The intracorneal hemorrhages resolved over the course of 10 weeks after minor adjustments were made to the scleral contact lens fit and netasurdil was discontinued. Visual acuity and intraocular pressure remained stable throughout.

CONCLUSIONS
There are few reports of intracorneal hemorrhages associated with scleral contact lens use and even fewer associated with the use of netarsudil. This case proposes several possible causes of the intracorneal hemorrhages, including topical rho-associated kinase inhibitors, contact lens wear, and trauma. Further studies are needed to determine if netarsudil is associated with intracorneal hemorrhages, to understand the sequelae of intracorneal hemorrhages in netarsudil therapy, and to recommend management when intracorneal hemorrhages manifest with netarsudil use.