bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical implementation of long-acting antiretroviral treatment in high-income countries: challenges and advantages
Authors: Waters Laura , Sparrowhawk Alex 
Published: April 2022

Purpose of review
Long-acting antiretroviral therapy (LA-ART) brings a paradigm shift to HIV care with injectable cabotegravir/rilpivirine (IM-CAB/RPV) in current or imminent use in several countries. This brings the usual opportunities and challenges of a new therapy, plus requirements to adapt services to reliably deliver injections and ensure patients understand advantages and limitations. We summarise key considerations for implementation in high-income countries.

Recent findings
Monthly IM-CAB/RPV is noninferior to oral ART and monthly IM-CAB/RPV to 1-monthly in carefully selected virally suppressed people. The numerically higher virological failure rate on two-monthly IM-CAB/RPV warrants close attention and careful monitoring. Implementation projects report positive experiences for patients and staff, but also barriers. Data is needed in younger people, pregnancy/breastfeeding, and in those with detectable viraemia secondary to suboptimal adherence.

Summary
We highlight a paucity of real-world data and key unanswered questions. Existing data on injection techniques may have implications for training; monitoring of outcomes is crucial to ensure clinical trial results are replicated in real-life. Better understanding of treatment failure, and individualised therapy, is crucial, and it is important to repeat patient preference surveys as new data emerges to ensure decisions are based on the most recent evidence of benefit vs risk.
An exploration of how broadly neutralizing antibodies might induce HIV remission: the ‘vaccinal’ effect
Authors: Tipoe Timothy , Fidler Sarah , Frater John 
Published: April 2022

Purpose of review
Broadly neutralizing antibodies (bNAbs) are a potential new therapeutic strategy to treat HIV infection. This review explores possible mechanisms of action of bNAbs and summarizes the current evidence supporting their immunomodulatory properties, which might lead to sustained virological remission – the ‘vaccinal effect’.

Recent findings
Antiretroviral therapy (ART) is required to confer lasting HIV suppression; stopping ART almost invariably leads to HIV recrudescence from a persistent pool of virally infected cells – the HIV reservoir. HIV-specific broadly neutralizing antibodies (bNAbs) may confer viral control after ART cessation predominantly through blockade of viral entry into uninfected target cells. In some human and animal studies, HIV bNAbs also conferred lasting viral suppression after therapeutic bNAb plasma levels had declined. Immune-modulatory mechanisms have been postulated to underlie this observation – the ‘vaccinal effect’. Hypothesized mechanisms include the formation of immune complexes between bNAbs and HIV envelope protein, thereby enhancing antigen presentation and uptake by immune cells, with boosted adaptive immune responses subsequently controlling the HIV reservoir.

Summary
There is emerging evidence for potent antiviral efficacy of bNAb therapy. Whether bNAbs can induce sustained viral suppression after dropping below therapeutic levels remains controversial. Mechanistic data from on-going and future clinical trials will help answer these questions.
Implementation of long-acting antiretroviral therapy in low-income and middle-income countries
Authors: Cresswell Fiona V. , Lamorde Mohammed 
Published: April 2022

Purpose of review
With oral antiretroviral therapy, HIV has become a manageable chronic illness. However, UNAIDS targets for virologic suppression have not yet been attained in many low-income and middle-income countries (LMICs). Long-acting drug formulations hold promise to improve treatment outcomes. In this rapidly evolving area of research, we aim to review recent literature on the treatment of HIV with long-acting agents and identify implementation considerations for LMICs.

Recent findings
Randomized controlled trials have shown that monthly long-acting injectable cabotegravir (CAB) and rilpivirine (RPV) is noninferior to oral ART, and 2-monthly CAB/RPV is noninferior to monthly injections. However, few people from LMICs were included. A modelling study predicts that in sub-Saharan Africa, injectable CAB/RPV is best targeted to those with poor adherence (HIV viral load >1000 copies/ml) in whom cost-effectiveness is greatest and risk of contributing to further resistance is no greater than continuation of oral ART. Other promising agents, such as lenacapavir are under investigation and may prove particularly useful in heavily treatment-experienced adults.

Summary
Long-acting regimens are a promising advance in HIV treatment. By extending the dosing interval, increasing convenience and being discreet these regimens may reduce HIV treatment challenges. However, there are multiple implementation considerations in LMICs including the need for exclusion of hepatitis B, cold chain, oral bridging in case of missed dosing and switching during tuberculosis therapy. Efficacy and safety data are also awaited for settings without routine access to baseline resistance testing or regular viral load monitoring and for special populations, such as pregnancy, children and the elderly.
Immigrant-Related Policies and the Health Outcomes of Latinx Adults in the United States: A Systematic Review
Authors: Crookes Danielle M. , Stanhope Kaitlyn K. , Suglia Shakira F. 
Published: April 2022

Background:
US federal and subfederal immigrant-related policy activity has increased in recent years. We hypothesize that these policies are structural determinants of health for Latinx communities, operating through access to resources, discriminatory enforcement, and stress.

Methods:
We searched seven databases for quantitative studies, published as of September 2021, examining the association between the presence of federal, state, or local immigrant-related policy(ies), over time or cross-sectionally, and mental or physical health outcomes among immigrant or US-born Latinx adults. We rated studies on methodologic quality.

Results:
Eleven studies were included. Policies included federal and state policies. Health outcomes included mental health (seven studies), self-rated health (n = 6), and physical disability (n = 1). Among immigrant, noncitizen, or Spanish-preferring Latinx adults, exclusionary policies were associated with poor self-rated health, physical disability, and poor mental health. Inclusive policies were associated with better health, although null findings were more common than among studies of exclusionary policies. Only three studies separately examined policy effects on US-born or citizen Latinx adults and these findings were often null. All studies received a weak overall study quality rating; among quality domains, studies were strongest in confounding control and weakest in outcome information bias and reporting missing data approaches.

Conclusions:
These results support the hypothesis that immigrant-related policies, especially exclusionary policies, are structural drivers of health for immigrant or noncitizen Latinx adults. However, evidence is scant among US-born or citizen Latinx adults. Studies of policies and physical health outcomes besides disability are lacking, as are results disaggregated by nativity and/or citizenship status.
Interprofessional Collaboration to Optimize Trauma-Informed Care in Pediatric Forensics
Authors: Morris Kristen A. , Glover Stephanie , Neff Samantha 
Published: April 2022

ABSTRACT
There are many challenges in providing trauma-informed healthcare to pediatric victims of sexual abuse and their families. We address this through collaborative interprofessional efforts within our hospital facility, located in a Midwestern adult Level 1 and pediatric trauma center. Our sexual assault nurse examiner team is composed of eight nurses and provides 24/7 coverage. The child abuse team located in our hospital includes one board-certified child abuse pediatrician, one certified pediatric nurse practitioner, and a licensed clinical social worker. The application of trauma-informed care using case scenarios involving both teams is described in this article.
Utilization of Improvement Methodologies by Healthcare Quality Professionals During the COVID-19 Pandemic
Authors: Pesch Lucie , Stafford Terry , Hunter Jaclyn , Stewart Glenda , Miltner Rebecca 
Published: April 2022

ABSTRACT

Introduction:
This study describes the work of healthcare quality professionals during the COVID-19 pandemic, highlighting the successes and challenges they faced when applying their expertise in performance and process improvement (PPI) to help manage the crisis.

Methods:
The researchers performed a descriptive analysis of anonymous survey data collected from members of the National Association for Healthcare Quality professional community who were asked about their improvement work during the pandemic response.

Results:
Most survey respondents used improvement methods to a great or moderate extent to measure what was happening (83%), rapidly review processes and practice (81%), and decide where to focus effort (81%). Fewer respondents used PPI methods to engage with patients and families (58% to a great or moderate extent). Looking to the future, respondents indicated that embedding systematic approaches to improvement within healthcare organizations (59%) and working in a more integrated way across teams (48%) should be prioritized in the post-pandemic recovery.

Conclusions:
The results from this study demonstrate why healthcare leaders should recognize the value that performance improvement approaches provide to everyday operations. They must empower PPI experts to lead this critical work and continue building workforce capacity in PPI methods to strengthen staff engagement and achieve better outcomes.
Mat Pilates training and blood pressure reactivity responses to psychological stress: comparison between normotensive and hypertensive postmenopausal women
Authors: Gonçalves Ludimila Ferreira , Batista Jaqueline Pontes , Tavares Julia Buiatte , de Souza Tállita Cristina Ferreira , Mariano Igor Moraes , Amaral Ana Luiza , Rodrigues Mateus de Lima , Puga Guilherme Morais 
Published: April 2022

Objectives
The aim of this study is to compare resting blood pressure and blood pressure reactivity responses to psychological stress in normotensive and hypertensive postmenopausal women after 12 weeks of Mat Pilates training.

Methods
Twenty-three hypertensive and 24 normotensive postmenopausal women, performed Mat Pilates training 3× a week for 12 weeks. Before and after the intervention, resting blood pressure, heart rate, and blood pressure reactivity to psychological stress through the electronic version of Stroop test protocol (3 minutes) were measured. We calculated the variation (Δ) of blood pressure (peak of blood pressure during the Stroop stress test minus resting blood pressure before test).

Results
The two-way ANOVA showed that the Δ of systolic blood pressure, diastolic blood pressure, and the mean blood pressure was reduced (P < 0.05) after training only in the hypertensive. The resting systolic, diastolic, and mean blood pressures decreased by (P < 0.05) over time in both groups with no interaction or difference.

Conclusion
Mat Pilates was able to reduce resting blood pressure in both hypertensive and normotensive, and blood pressure reactivity after psychological stress in hypertensive but not in normotensive postmenopausal women.
Pulmonary perfusion imaging and delayed imaging to measure pulmonary capillary permeability in pulmonary contusion
Authors: Xiong Kai , Li Shicong , Yu Yao , Duan Shuning , Zhang Peng , Wang Peng , Li Xin , Chen Yuan , Cui Yuantao , Wang Yuanguo , Shen Yiming , Yang Zhaoyu , Lu Chao , Tao Ziyou , Liu Yuxin , Zhang Peng , Meng Zhaowei 
Published: April 2022

Purpose
Explore the application value of pulmonary perfusion imaging and delayed imaging for evaluating pulmonary capillary permeability.

Materials and methods
After establishing a rat model of pulmonary contusion, changes in the metabolic index of technetium-99m macroaggregated albumin (99mTC-MAA) in the lungs of model rats were evaluated for two consecutive days. 99mTC-MAA metabolic indices of rat lungs with pulmonary contusion of varying severity (mild, moderate, and severe) were correlated with lung wet/dry weight ratio (W/D) and Evans blue extravasation. Finally, the method was validated in patients with pulmonary contusion and one healthy volunteer.

Results
The 99mTC-MAA metabolic index was 23.56% ± 2.44% in healthy control (HC) rat lung, 8.56% ± 3.42% immediately after lung contusion (d0), 8.35% ± 3.20% after 1 day (d1), and 17.45% ± 6.44% after 2 days (d2); indices at d0 and d1 were significantly higher than those at HC (P < 0.05). The metabolic index of 99mTC-MAA in lung had significant negative correlations with W/D (r = −0.8025; P = 0.0092) and Evans blue extravasation (r = −0.9356; P = 0.0002). Metabolic and oxygenation indices of 99mTC-MAA exhibited a significant positive linear correlation in patients with pulmonary contusion (r = 0.8925; P = 0.0416).

Conclusion
Pulmonary perfusion and delayed imaging of 99mTC-MAA have potential value for evaluating pulmonary capillary permeability.
Induced membrane technique for acute bone loss and nonunion management of the tibia
Authors: Chloros George D. , Kanakaris Nikolaos K. , Harwood Paul J. , Giannoudis Peter V. 
Published: April 2022

Abstract

Objectives:
To report our experience and clinical results of using the Masquelet technique for the treatment of tibial nonunions and acute traumatic tibial bone defects.

Design:
Retrospective study of prospectively collected data (Level IV).

Setting:
Level I trauma center in the UK.

Patients/Participants:
Consecutive patients with tibial nonunions and open fractures associated with bone loss.
Intervention: Two-stage Masquelet Procedure for the tibia.

Main Outcome Measurements:
Clinical and imaging assessment at 6 weeks, 3,6,9,12 months, or until pain-free mobilization and union.

Results:
There were 17 eligible patients, with a mean size of bone defect of 6 cm (range, 4–8 cm) and an 88.2% union rate at a mean of 8 months (range 5–18 months). Mean range of motion was 95 degrees of knee flexion (range 80°–130°). All patients but 2 returned to their previous occupation.

Conclusions:
The Masquelet technique is simple, effective, and has a high rate of success for the management of a variety of situations including acute bone loss or infected nonunions and is associated with a low incidence of complications.
Sensors and digital medicine in orthopaedic surgery
Authors: Merle Géraldine , Parent-Harvey Alexandre , Harvey Edward J. 
Published: April 2022

Abstract
Digital health principles are starting to be evident in medicine. Orthopaedic trauma surgery is also being impacted —indirectly by all other improvements in the health ecosystem but also in particular efforts aimed at trauma surgery. Data acquisition is changing how evidence is gathered and utilized. Sensors are the pen and paper of the next wave of data acquisition. Sensors are gathering wide arrays of information to facilitate digital health relevance and adoption. Early adaption of sensor technology by the nonlegacy health environment is what has made sensor driven data acquisition so palatable to the normal health care system. As it applies to orthopaedic trauma, current sensor driven diagnostics and surveillance are nowhere near as developed as in the larger medical community. Digital health is being explored for health care records, data acquisition in diagnostics and rehabilitation, wellness to health care translation, intraoperative monitoring, surgical technique improvement, as well as some early-stage projects in long-term monitoring with implantable devices. The internet of things is the next digital wave that will undoubtedly affect medicine and orthopaedics. Internet of things (loT) devices are now being used to enable remote health monitoring and emergency notification systems. This article reviews current and future concepts in digital health that will impact trauma care.
Assessing the Impact of Nasotracheal Intubation on Postoperative Neonates With Congenital Heart Disease: A Quality Improvement Project at a Single Heart Center
Authors: Marietta Jennifer , Glotzbach Kristi L. , Jones Courtney E. , Ou Zhining , Profsky Tiffany K. , Clegg Dave , Winder Melissa M. , Pribble Charles G. 
Published: April 2022

OBJECTIVES:
Nasotracheal intubation (NTI) is associated with fewer unplanned extubations and improved oral motor skills compared with orotracheal intubation (OTI). Our study aimed to implement a practice change from OTI to NTI for neonatal cardiac surgery and assess impact on postoperative outcomes.

DESIGN:
Single-center, prospective, quality improvement study.

SETTING:
Academic children’s hospital.

PATIENTS:
One hundred thirty neonates undergoing cardiac surgery with cardiopulmonary bypass.

INTERVENTIONS:
NTI during index cardiac surgery.

MEASUREMENTS AND MAIN RESULTS:
Data were collected between January 2019 and April 2021. The study was implemented in three phases: retrospective: OTI neonates (n = 43), I: safety and feasibility of NTI (n = 17), and II: speech language pathology (SLP) evaluation on postoperative day 1 facilitated by NTI (n = 70). Retrospective and phase I patients were combined for analysis. Groups were compared using Kruskal-Wallis test or Wilcoxon rank-sum test.
Ninety-one percent of eligible neonates were nasotracheally intubated. There were no clinically significant complications. Days to first SLP encounter decreased from a median 4.5 days (interquartile range [IQR], 3.8–6.2) to 1.1 days (IQR, 1.0–1.9; p < 0.001). Oral readiness time decreased from a median of 6.6 days (IQR, 5.4–8.9) to 4.3 days (IQR, 3.4–8.6; p < 0.001).

CONCLUSIONS:
NTI is feasible and safe in neonatal cardiac surgery. System-level engagement with stakeholders is necessary to change clinical practice. NTI facilitates early SLP evaluation and treatment and significantly affects oral readiness after neonatal cardiac surgery.
Contrast Media Reduction in Computed Tomography With Deep Learning Using a Generative Adversarial Network in an Experimental Animal Study
Authors: Haubold Johannes , Jost Gregor , Theysohn Jens Matthias , Ludwig Johannes Maximilian , Li Yan , Kleesiek Jens , Schaarschmidt Benedikt Michael , Forsting Michael , Nensa Felix , Pietsch Hubertus , Hosch René 
Published: April 2022

Objective
This feasibility study aimed to use optimized virtual contrast enhancement through generative adversarial networks (GAN) to reduce the dose of iodine-based contrast medium (CM) during abdominal computed tomography (CT) in a large animal model.

Methods
Multiphasic abdominal low-kilovolt CTs (90 kV) with low (low CM, 105 mgl/kg) and normal contrast media doses (normal CM, 350 mgl/kg) were performed with 20 healthy Göttingen minipigs on 3 separate occasions for a total of 120 examinations. These included an early arterial, late arterial, portal venous, and venous contrast phase. One animal had to be excluded because of incomplete examinations. Three of the 19 animals were randomly selected and withheld for validation (18 studies). Subsequently, the GAN was trained for image-to-image conversion from low CM to normal CM (virtual CM) with the remaining 16 animals (96 examinations). For validation, region of interest measurements were performed in the abdominal aorta, inferior vena cava, portal vein, liver parenchyma, and autochthonous back muscles, and the contrast-to-noise ratio (CNR) was calculated. In addition, the normal CM and virtual CM data were presented in a visual Turing test to 3 radiology consultants. On the one hand, they had to decide which images were derived from the normal CM examination. On the other hand, they had to evaluate whether both images are pathological consistent.

Results
Average vascular CNR (low CM 6.9 ± 7.0 vs virtual CM 28.7 ± 23.8, P < 0.0001) and parenchymal (low CM 1.5 ± 0.7 vs virtual CM 3.8 ± 2.0, P < 0.0001) CNR increased significantly by GAN-based contrast enhancement in all contrast phases and was not significantly different from normal CM examinations (vascular: virtual CM 28.7 ± 23.8 vs normal CM 34.2 ± 28.8; parenchymal: virtual CM 3.8 ± 2.0 vs normal CM 3.7 ± 2.6). During the visual Turing testing, the radiology consultants reported that images from normal CM and virtual CM were pathologically consistent in median in 96.5% of the examinations. Furthermore, it was possible for the examiners to identify the normal CM data as such in median in 91% of the cases.

Conclusions
In this feasibility study, it could be demonstrated in an experimental setting with healthy Göttingen minipigs that the amount of CM for abdominal CT can be reduced by approximately 70% by GAN-based contrast enhancement with satisfactory image quality.
Interobserver Agreement Rates on Fibroblast Activation Protein Inhibitor–Directed Molecular Imaging and Therapy
Authors: Serfling Sebastian E. , Hartrampf Philipp E. , Zhi Yingjun , Higuchi Takahiro , Rowe Steven P. , Bundschuh Lena , Essler Markus , Buck Andreas K. , Bundschuh Ralph Alexander , Werner Rudolf A. 
Published: April 2022

Objectives
Fibroblast activation protein (FAP) has emerged as a novel target for FAP inhibitor (FAPI)–directed molecular imaging and endoradiotherapy (ERT). We aimed to assess the interobserver agreement rates for interpretation of 68Ga-FAPI-4 PET/CT and decision for ERT.

Patients and Methods
A random order of 68Ga-FAPI-4 PET/CTs from 49 oncology patients were independently interpreted by 4 blinded readers. Per scan, visual assessment was performed, including overall scan impression, number of organ/lymph node (LN) metastases, and number of affected organs/LN regions. Moreover, a maximum of 3 target lesions, defined as largest in size and/or most intense, per organ compartment were identified, which allowed for an additional quantitative interobserver assessment of LN and organ lesions. To investigate potential reference tissues, quantification also included unaffected liver parenchyma and blood pool. Readers also had to indicate whether FAPI-directed ERT should be considered (based on intensity of uptake and widespread disease). Interobserver agreement rates were evaluated using intraclass correlation coefficients (ICCs) and interpreted according to Cicchetti (with 0.4–0.59 indicating fair, and 0.6–0.74 good, agreement).

Results
On a visual basis, the agreement rate for an overall scan impression was fair (ICC, 0.42; 95% confidence interval [CI], 0.27–0.57). The concordance rate for number of affected LN areas was also fair (ICC, 0.59; 95% CI, 0.45–0.72), whereas the number of LN metastases, number of affected organs, and number of organ metastases achieved good agreement rates (ICC, ≥0.63). In a quantitative analysis, concordance rates for LN were good (ICC, 0.70; 0.48–0.88), but only fair for organ lesions (ICC, 0.43; 0.26–0.60). In regards to background tissues, ICCs were good for unaffected liver parenchyma (0.68; 0.54–0.79) and fair for blood pool (0.43; 0.29–0.58). When readers should decide on ERT, concordance rates were also fair (ICC, 0.59; 95% CI, 0.46–0.73).

Conclusions
For FAPI-directed molecular imaging and therapy, a fair to good interobserver agreement rate was achieved, supporting the adoption of this radiotracer for clinical routine and multicenter trials.
Superiority of 11C-Choline PET/CT in the Delineation of a Rare Intracranial Diffuse Embryonic Tumor
Authors: Dong Ye , Zhou Wenlan , Han Yanjiang , Wu Hubing 
Published: April 2022

Abstract
Intracranial diffuse embryonal tumor in the adult is rare. We report a young woman with a diffuse embryonal malignancy in the saddle area, which was depicted well by 11C-choline PET/CT, superior to 18F-FDG PET/CT and contrast-enhanced MRI. Under the guiding of 11C-choline PET/CT, the biopsy was successfully performed and the diagnosis was established. This case highlights that11C-chione PET/CT may be useful to diagnose and delineate the intracranial diffuse embryonic tumors.