bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inclusion of physical activity in nurse practitioner programs: A national perspective
Authors: Falcon Ashley , Vermeesch Amber , Stoutenberg Mark , Sampson Emma , Bender-Stephanski Meg , Webb Willow , Woo Yerin 
Published: March 2022

ABSTRACT

Background:
Physical activity (PA) provides a multitude of health benefits, creating an avenue for disease prevention and management. Health care providers play a crucial role in helping patients become more active, yet little is known about the preparation of primary care nurse practitioners (NPs) to aid in this effort.

Purpose:
To examine the amount and type of PA training offered in primary care NP programs in the United States.

Methodology:
A cross-sectional study design was used. Eligible programs' websites were reviewed, and an online survey of program leaders assessed details regarding the inclusion of PA training, barriers, and future plans.

Results:
Data extracted from 1,067 NP program websites revealed that 81.7% of websites (n = 264) with course descriptions contained one or more general health promotion keywords, whereas only 0.6% (n = 2) included a PA-specific keyword. Two-hundred institutions (53.2%) completed the program leader survey, of which 45.0% reported no inclusion of PA training. Among institutions providing PA training, 82.2% (n = 88) and 55.1% (n = 59) reported the inclusion of aerobic activity and strength training recommendations, respectively. Forty-one institutions (46.1%) felt that their institution prepared students to effectively counsel patients on starting a PA program.

Conclusions:
Although some NP programs include PA content, most provide no or less-than-adequate PA training.

Implications for practice:
The current state of PA training in NP programs may hinder health promotion and disease prevention efforts. Programs should dedicate sufficient time and attention to preparing future NPs to promote PA behaviors. A multifaceted, multistakeholder approach is needed to facilitate widespread adoption of PA inclusion.
Disseminated Gonorrhea Presenting as Liver Abscess in a Patient With Sickle Cell Disease
Authors: Kim Jani M. , Pervaiz Sarah , Sivasubramanian Geetha 
Published: March 2022

Abstract
Infection caused by Neisseria gonorrhoeae is a global health concern. Occasionally, gonococcal infections may disseminate and cause clinical syndromes, such as arthritis, tenosynovitis, and skin lesions. Here, we report a very rare presentation of a liver abscess due to N. gonorrhoeae in a 29-year-old woman with sickle cell disease without prior genitourinary complaints. The patient was successfully treated using drainage and antimicrobial therapy. Evaluation did not reveal any inherited defects in complement deficiency. It is possible that the underlying immune defects from sickle cell disease and unknown bacterial virulence factors could have contributed to this dissemination. Further research is needed to understand the immunopathogenesis of disseminated gonococcal infections, and efforts to screen and prevent primary infections are ongoing.
Estimating the Association Between Public Health Spending and Sexually Transmitted Disease Rates in the United States: A Systematic Review
Authors: Lim Sungwon , Pintye Jillian , Seong Hohyun , Bekemeier Betty 
Published: March 2022

Abstract
Public health spending is important for managing increases in sexually transmitted diseases (STDs) in the United States. Although previous studies suggest that a beneficial link exists between public health spending and changes in STD rates, there have been no systematic reviews synthesizing existing evidence regarding the association for STDs at the population level. The objective of this study was to synthesize evidence from studies that assessed the associations between general and STD-specific public health spending and STD rates. We conducted a systematic review using Ovid-Medline, EMBASE, CINAHL, Cochrane Library, Web of Science, and EconLit for relevant studies that examined the association between public health spending and gonorrhea, syphilis, chlamydia, and chancroid rates following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 5 articles (2 regarding general public health spending and 3 regarding STD-specific public health spending) met our inclusion criteria. There was a significant decrease in gonorrhea, syphilis, chlamydia, and chancroid rates associated with increased public health spending. We also found that STD-specific public health spending has a greater effect on STD rates compared with general public health spending. Our review provides evidence that increases in general and STD-specific public health spending are associated with a reduction of STD rates. Such research regarding estimates of the impact of STD prevention spending can help policy makers identify priority funding areas and inform health resource allocation decisions.
Methylation Profiling Improves the Care of Pediatric Brain Tumor Patients
Authors: Jamshidi Pouya , McCord Matthew , Horbinski Craig , Jennings Lawrence , Santana dos Santos Lucas , Fudyma Iga Alicja , DeCuypere Michael , Yap Kai Lee , Rathbun Pamela , Wadhwani Nitin 
Published: March 2022

Abstract
We describe a pediatric patient with an intra-axial tumor; histopathologic examination of the resected specimen was unable to establish a precise diagnosis. While the initial targeted next-generation sequencing (NGS) panel was also nondiagnostic, genomic DNA methylation profiling indicated that the tumor was an astroblastoma, MN1-altered. A more comprehensive NGS panel was then run, which confirmed an MN1-BEND2 fusion. This case displays the limitations and pitfalls of a histological and immunohistochemical-based diagnosis in a case of an infrequently encountered pediatric brain tumor. Furthermore, it highlights the growing need for performing DNA methylation, paired with a comprehensive NGS panel, to ensure an accurate diagnosis in modern surgical neuropathology.
Standardized Letters of Recommendation in Plastic Surgery: The Impact of Gender and Race
Authors: Reghunathan Meera , Carbullido Mary Kristine , Blum Jessica , Wong Serena , Gosman Amanda A. 
Published: March 2022

Background:
In the last few decades, standardized letters of recommendation have seen increasing popularity among various medical specialties and have been shown to demonstrate score inflation and gender bias in some select specialties. Through analysis of standardized letter of recommendation scoring patterns, this study evaluated the impact of race and gender on performance in standardized letters of recommendation and provides suggestions for programs to optimally interpret standardized letters of recommendation and minimize bias when writing letters of recommendation.

Methods:
Available standardized letters of recommendation were those from interviewed applicants to the integrated plastic surgery program between 2015 and 2018 (82 total applicants) and all applicants in the year of 2019 (241 total applicants). Various standardized letters of recommendation component scores were analyzed by demographics of both applicants and letter writers, including descriptive statistics, analysis of variance, t testing, and Fleiss kappa for interrater reliability using SPSS software (IBM, Armonk, N.Y.).

Results:
No scoring category had an average score below the eighty-fifth percentile. Male letter writers scored male applicants significantly higher in Overall, Conscientiousness, Self-Initiative, and Academic Performance components, whereas female letter writers scored female applicants higher in Communication and Overall components. In the 2019 cohort, applicants of a minority race received lower scores on average in nine out of 10 categories, a difference that was significant in the Team Player category.

Conclusions:
Score inflation pervades standardized letters of recommendation scoring in plastic surgery. Work must be done by letter writers to help mitigate racial and gender biases that influence recommendations for resident selection in plastic surgery.
Hidradenitis Suppurativa: A Comparison of Institutional Experience and the Tracking Operations and Outcomes for Plastic Surgeons Registry
Authors: Steele Andrew W. , Miller Nathan F. , Wallace Sean J. , Hume Keith M. , Sommers Catherine A. , Simmons Christopher J. , Murphy Robert X. 
Published: March 2022

Background:
Hidradenitis suppurativa is a chronic inflammatory dermatologic condition occurring most commonly in areas with large numbers of apocrine sweat glands. Surgical excision and wound reconstruction are indicated for severe or refractory disease. This study aims to explore institutional reconstructive outcomes following hidradenitis suppurativa excision and compare these to the nationally recognized Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database to determine best-practice guidelines.

Methods:
A retrospective chart review of all patients with surgically treated hidradenitis suppurativa from January of 2004 to January of 2016 was performed. Data on patient characteristics, reconstructive methods, and outcomes were collected. Outcomes for each reconstructive method were analyzed and associations between reconstruction and complications were determined. These results were compared to TOPS data.

Results:
A total of 382 operative sites for 101 individual patients were reviewed. Overall complication rates were 80, 68.3, and 59.6 percent for simple, intermediate, and complex closure, respectively; 68.3 percent for adjacent soft-tissue rearrangement; and 100 percent for split-thickness skin grafts and perforator flaps. Statistical significance was identified between superficial wound dehiscence and adjacent tissue rearrangement compared to intermediate and complex closure (p = 0.0132). TOPS data revealed similar wound breakdown rates for primary closure methods but much lower rates with negative-pressure wound therapy, split-thickness skin grafts, and muscle flaps.

Conclusions:
Primary closure techniques for hidradenitis suppurativa wound reconstruction possess high complication rates, whereas improved outcomes are observed with negative-pressure wound therapy, split-thickness skin grafts, and muscle flaps. The correlation in outcomes between our experience and that reported in the TOPS database provides a level of validation to this national database.
Body Feminization Combining Large-Volume Fat Grafting and Gluteal Implants
Authors: del Vecchio Daniel , Bravo Miguel G. , Mandlik Veronika , Aslani Alexander 
Published: March 2022

Background:
With the increase in popularity of fat transfer to the buttocks in body contouring surgery, new patient subsets are emerging. The gender confirmation patient has specific characteristics that must be addressed to achieve the best outcomes.

Methods:
The authors performed an observational prospective study including 36 consecutive patients who underwent body feminization as a gender affirming operation using large-volume fat transplantation with or without gluteal implants.

Results:
Thirty-six consecutive male-to-female transgender patients have undergone large-volume fat transplantation to the buttocks performed by the authors, between July of 2016 and January of 2019. In 12 of these 36 cases, large-volume fat grafting was supplemented by intramuscular placement of silicone implants. The mean waist-to-hip ratio before surgery was 1.11, and this improved to 0.81 after surgery (fat transfer–only group, 0.88; fat transfer plus implants group, 0.75).

Conclusions:
The transgender patient is a unique patient requiring a specific set of surgeon’s skills and intraoperative strategies to achieve good outcomes. Composite solutions with both implants and lipofilling lead to better outcomes in terms of waist-to-hip ratio in these patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Potential Mediating Effects of Inflammation on the Association Between Type D Personality and Coronary Plaque Vulnerability in Patients With Coronary Artery Disease: An Optical Coherence Tomography Study
Authors: Yi Huijie , Li Ling , Wang Yini , Tao Hui , Yu Xi , Yu Bo , Gao Xueqin , Lin Ping 
Published: March 2022

ABSTRACT

Objective
Type D personality involves the interaction between negative affectivity with social inhibition and has been associated with an increased risk of coronary artery disease (CAD) progression and coronary plaque vulnerability. However, the underlying mechanisms in the relationship between type D personality and coronary plaque vulnerability remain indeterminate. The present study examined the potential mediating effects of inflammation biomarkers on the association between type D personality and coronary plaque vulnerability in patients with CAD.

Methods
A total of 347 patients (mean [standard deviation] age = 56.6 [11.2] years; 29.3% women) with CAD who had culprit coronary plaques were examined for type D personality. The inflammation biomarkers (high-sensitivity C-reactive protein, interleukin 6 [IL-6], and tumor necrosis factor α [TNF-α]) were evaluated. Each individual inflammation biomarker was standardized using z scores to calculate inflammation standardized sumscores. Plaque vulnerability of culprit lesions was measured in vivo using optical coherence tomography.

Results
The presence of type D personality (38%) was associated with TNF-α, IL-6, and inflammation standardized sumscores (t = 2.74, Cohen d = 0.32, p = .006; t = 4.03, Cohen d = 0.44, p ≤. 001; t = 4.16, Cohen d = 0.11, p = .001, respectively). In addition, the standardized inflammation sumscore was a mediator of the relationship between type D personality and lipid-rich plaques (effect sizes = 0.12, 95% confidence interval = 0.007–0.286, p = .064) and plaque rupture vulnerability (effect sizes = 0.16, 95% confidence interval = 0.043–0.365, p = .024). Analysis of continuous type D scores revealed that TNF-α, IL-6, and inflammation standardized sumscores also mediate the relationship between the primary effect of negative affectivity and plaque vulnerability.

Conclusions
Inflammation activation is a potential mediator of the association between type D personality and plaque vulnerability. The negative affectivity component of type D personality might be particularly relevant to the inflammatory aspects of plaque vulnerability.
Synergistic Associations of Depressive Symptoms and Executive Functions With Longitudinal Trajectories of Diabetes Biomarkers Among Urban-Dwelling Adults Without Diabetes
Authors: Khambaty Tasneem , Leibel Daniel K. , Katzel Leslie I. , Evans Michele K. , Zonderman Alan B. , Waldstein Shari R. 
Published: March 2022

ABSTRACT

Objective
Depressive symptoms and executive functions (EFs) have recently emerged as novel risk factors for type 2 diabetes, but it is unknown if these factors interact to influence diabetes pathophysiology across the life span. We examined the synergistic associations of depressive symptoms and EFs with longitudinal trajectories of diabetes diagnostic criteria among middle-aged and older adults without diabetes.

Methods
Participants were 1257 African American and White, urban-dwelling adults from the Healthy Aging in Neighborhoods of Diversity across the Life Span study who were assessed up to three times over a 13-year period (2004–2017). At baseline, participants completed the Center for Epidemiological Studies—Depression scale and measures of EFs—Trail Making Test Part B, verbal fluency, and Digit Span Backward—for a composite EFs score, and provided blood samples at each follow-up for glycated hemoglobin and fasting serum glucose.

Results
A total of 155 and 220 individuals developed diabetes or prediabetes at wave 3 and wave 4, respectively. Linear mixed-effects regression models adjusting for sociodemographic factors, diabetes risk factors, and antidepressant medications revealed significant three-way interactions of Center for Epidemiological Studies—Depression, EFs, and age on change in glycated hemoglobin (b = −0.0001, p = .005) and in fasting serum glucose (b = −0.0004, p < .001), such that among individuals with lower but not higher EFs, elevated depressive symptoms were associated with steeper age-related increases in diabetes biomarkers over time.

Conclusions
Depressive symptoms and lower EFs may interactively accelerate trajectories of key diagnostic criteria, thereby increasing the risk for earlier diabetes incidence. Identifying individuals in this high-risk group may be an important clinical priority for earlier intervention, which has the promise of preventing or delaying this debilitating disease.
A Pilot Study of a Patient Navigation Intervention to Improve HIV Pre-exposure Prophylaxis Persistence Among Black/African American Men Who Have Sex With Men
Authors: Goedel William C. , Coats Cassandra Sutten , Chan Philip A. , Sims-Gomillia Courtney E. , Brock James B. , Ward Lori M. , Mena Leandro A. , Nunn Amy S. 
Published: March 2022

Background:
Suboptimal HIV pre-exposure prophylaxis (PrEP) care outcomes among Black/African American men who have sex with men (MSM) limits its population-level effects on HIV incidence. We conducted a pilot study of a brief patient navigation intervention aimed at improving PrEP initiation and persistence among Black/African American MSM in the Southern United States.

Setting:
Community health center in Jackson, MS.

Methods:
We recruited 60 Black/African American MSM aged 18–34 years who were newly prescribed PrEP. Participants were randomized to receive the clinic's current standard of care or an intervention condition including a single patient navigation session to discuss and address perceived barriers to initiating and maintaining access to PrEP and biweekly check-ins. Participants were followed over 6 months using survey assessments, medical chart review, and pharmacy purchase records to ascertain PrEP initiation and persistence.

Results:
Participants in the intervention condition were more likely to pick up their initial PrEP prescription [RR: 1.47; 95% confidence interval (CI): 1.10 to 1.97], be retained in PrEP care at 3 months (RR: 1.62; 95% CI: 1.01 to 2.59) and 6 months (RR: 1.38; 95% CI: 0.64 to 2.93), and have access to PrEP medications greater than 80% of all study days based on pharmacy fill records (RR: 3.00; 95% CI: 1.50 to 5.98).

Conclusion:
A brief patient navigation intervention demonstrated proof-of-concept in improving PrEP initiation and persistence among Black/African American MSM in the Southern United States.
Evolution of the sex-determining region inGinkgo biloba
Authors: Gong Wei , Filatov Dmitry A. 
Published: March 2022

Sex chromosomes or sex-determining regions (SDR) have been discovered in many dioecious plant species, including the iconic ‘living fossil'Ginkgo biloba, though the location and size of the SDR inG. bilobaremain contradictory. Here we resolve these controversies and analyse the evolution of the SDR in this species. Based on transcriptome sequencing data from four genetic crosses we reconstruct male- and female-specific genetic maps and locate the SDR to the middle of chromosome 2. Integration of the genetic maps with the genome sequence reveals that recombination in and around the SDR is suppressed in a region of about 50 Mb in both males and females. However, occasional recombination does occur except a small, less than 5 Mb long region that does not recombine in males. Based on synonymous divergence between homologous X- and Y-linked genes in this region, we infer that theGinkgoSDR is fairly old—at least of Cretaceous origin. The analysis of substitution rates and gene expression reveals only slight Y-degeneration. These results are consistent with findings in other dioecious plants with homomorphic sex chromosomes, where the SDR is typically small and evolves in a region with pre-existing reduced recombination, surrounded by long actively recombining pseudoautosomal regions.This article is part of the theme issue ‘Sex determination and sex chromosome evolution in land plants’.
Direct estimates of absolute ventilation in primary health care clinics in South Africa
Authors: Beckwith Peter G , Karat Aaron S , Govender Indira , Deol Arminder , McCreesh Nicky , Kielmann Karina , Baisley Kathy , Grant Alison D , Yates Tom A 
Published: March 2022

AbstractBackgroundHealthcare facilities are important sites for the transmission of pathogens spread via bioaerosols, such as Mycobacterium tuberculosis (Mtb). Natural ventilation can play an important role in reducing this transmission. In primary health care (PHC) clinics in low and middle-income settings, susceptible people, including healthcare workers, are exposed to individuals with infectious pulmonary tuberculosis. We measured rates of natural ventilation in PHC clinics in KwaZulu-Natal and Western Cape provinces, South Africa.Methods and FindingsWe measured ventilation in clinic spaces using a tracer-gas release method. In spaces where this was not possible, we estimated ventilation using data on indoor and outdoor carbon dioxide levels, under reasonable assumptions about occupants’ metabolic rates. Ventilation was measured i) under usual conditions and ii) with all windows and doors fully open. We used these ventilation rates to estimate the risk of Mtb transmission using the Wells-Riley Equation. We obtained ventilation measurements in 33 clinical spaces in 10 clinics: 13 consultation rooms, 16 waiting areas and 4 other clinical spaces. Under usual conditions, the absolute ventilation rate was much higher in waiting rooms (median 1769 m3/hr, range 338–4815 m3/hr) than in consultation rooms (median 197 m3/hr, range 0–1451 m3/hr). Ventilation was better in permanent than in temporary structures. When compared with usual conditions, fully opening existing doors and windows resulted in a median two-fold increase in ventilation. Our Wells-Riley estimates show that, following sustained exposure, or contact with highly infectious index cases, some risk of Mtb infection may persist in the best ventilated clinical spaces unless other components of transmission risk are also addressed.ConclusionsAmong the clinical spaces studied, we observed substantial variation in natural ventilation. Ventilation interventions may have considerable impact on Mtb transmission in this setting. We recommend these form part of a package of infection prevention and control interventions.