bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stakeholder Perspectives on MAPS
Authors: Sanchez Amanda L. , Hoskins Katelin , Pettit Amy R. , Momplaisir Florence , Gross Robert , Brady Kathleen A. , Hoffacker Carlin , Zentgraf Kelly , Beidas Rinad S. 
Published: June 2022

Background:
Managed problem solving (MAPS) is an evidence-based intervention that can boost HIV medication adherence and increase viral suppression, but it is not widely used in community clinics. Deploying community health workers to deliver MAPS could facilitate broader implementation, in support of the Ending the HIV Epidemic (EHE) initiative's goal of reducing new HIV infections in the US by 90% by 2030.

Setting:
Ryan White-funded clinics in Philadelphia, 1 of 48 US counties prioritized in the EHE.

Methods:
Semistructured stakeholder interviews were conducted with 13 clinics and 4 stakeholder groups: prescribing clinicians, nonprescribing clinical team members (eg, medical case managers), clinic administrators, and policymakers. Interviews were based on the Consolidated Framework for Implementation Research and investigated perceived barriers to and facilitators of MAPS delivery by community health workers. Rapid qualitative analytic techniques were used to synthesize interview data and identify key categories along an implementation pathway. Core determinants (ie, barriers and facilitators) of MAPS implementation were grouped within each category.

Results:
Stakeholders were receptive to CHW-delivered MAPS and offered critical information on potential implementation determinants including preferences for identification and referral of patients, and the importance of integration and communication within the care team.

Conclusions:
This study elucidates insights regarding barriers and facilitators to delivering an evidence-based behavioral intervention in clinics serving people with HIV (PWH) and extends a rapid qualitative approach to HIV care that rigorously incorporates stakeholder data into the development of implementation strategies. It also offers insights for national implementation efforts associated with EHE.
Exergames to Improve Rehabilitation for Shoulder Injury: Systematic Review and GRADE Evidence Synthesis
Authors: Fernandes Carla Sílvia , Magalhães Bruno , Gomes José Augusto , Santos Célia 
Published: June 2022

Introduction
The use of exergames has become an increasingly frequent intervention in rehabilitation, referred to as a fun and motivating activity that involves patients. This systematic review aimed to evaluate the effectiveness of exergames in the rehabilitation of the shoulder joint compared to other types of care.

Methods
We performed a systematic review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) evidence synthesis. The search was conducted using the following databases: MEDLINE, CINAHL, SPORTDiscus, SCOPUS, SciELO, Psychology and Behavioral Sciences Collection, Cochrane Central Register of Controlled Trials, and PEDRo. Databases were searched from the first record until July 2021. Randomized controlled trials using exergames as an intervention were included.

Results
The search resulted in 1,048 records. A total of 10 articles published between 2013 and 2020 met inclusion criteria and were reviewed for this study. A positive impact was observed in using exergames to increase shoulders’ range of motion, namely, extension, flexion, abduction, internal and external rotation, and functionality postinjury.

Conclusions
The results of this review provide evidence of the benefits of exergames in shoulder joint rehabilitation. However, more robust clinical trials need to be developed that assess the effectiveness of using exergames as a complement to traditional rehabilitation and assess participants’ degree of satisfaction, motivation, and adherence.
Three-Dimensional Z-Epicanthoplasty Retains the Depth of the Medial Canthus With Scars That Are Less Visible
Authors: Su Zhiguo , Liu Liqiang , Fan Jincai , Tian Jia , Gan Cheng , Jiao Hu , Yang Zengjie , Zhang Tiran , Chen Yihua 
Published: June 2022

Background
Traditional coronal Z-epicanthoplasty usually generates visible scars, and V-Y advancement or skin redraping can damage the normal shape of the lower eyelid. In addition, these methods usually lead to loss of the medial canthus depth, which is important for the natural appearance of East Asians. This report aims to describe a 3-dimensional Z-epicanthoplasty that can maintain the depth of the medial canthus with fewer visible scars.

Methods
Patients who underwent 3-dimensional Z-epicanthoplasty from January 2016 to December 2019 were included. In our method, excess skin in the horizontal direction was first rotated to the vertical position and then turned inward from a coronal to a sagittal orientation to supplement the skin deficiency of the medial canthus in the sagittal orientation. The skin flap turned in the sagittal orientation and maintained the depth of the medial canthus and the natural appearance of the eye.

Results
In total, 138 patients were included, and the follow-up interval ranged from 6 to 36 months. After the surgery, the epicanthi were removed, and the shapes of the patients' eyes were significantly improved and appeared natural. The surgical scars were hidden in the sagittal orientation rather than in the coronal orientation, which cannot be seen easily. The depth of the medial canthus was well preserved without any lower eyelid destruction. Patients were satisfied with the natural appearance of the medial canthus.

Conclusions
This method could not only correct the epicanthal fold effectively with scars that are less visible but also maintain the depth of the medial canthus and make the appearance of the eye look more natural.
Effects of Preconditioning With Transcutaneous Electrical Nerve Stimulation Monitored by Infrared Thermography on the Survival of Pedicled Perforator Flaps in a Rat Model
Authors: Zheng Yinhua , Chang Kun , Gong Xu 
Published: June 2022

Objective
Pedicled perforator partial or complete necrosis with a rate of 13.7%. This study was undertaken to test whether preconditioning with transcutaneous electrical nerve stimulation (TENS) monitored by infrared thermography protect against partial necrosis by converting the choke anastomoses to the true anastomoses via inducing heme oxygenase-1 (HO-1) in a rat pedicled perforator flap model.

Methods
Seventy-two Sprague-Dawley rats were randomly assigned to the control, the TENS, the TENS + SnPP (tin protoporphyrin; HO-1 activity inhibitor; 50 μmol/kg) and the TENS +0.9% saline groups. On the unilateral dorsum of the rats, a rectangular flap donor site of 11 × 3 cm was marked out, which contained three perforator angiosomes and two choke zones. On days 1, 3 and 4, 1 hour of TENS (biphasic pulses, 25 mA, 80 Hz, 200 μs) was applied to the flap donor sites, respectively. On day 5, after the flap donor sites were assessed by infrared thermography, the flaps were harvested based on the deep circumflex iliac artery perforator.

Results
Infrared thermography showed that the choke zones in the flap donor sites presented white in the TENS and the TENS +0.9% saline groups, whereas they presented red in the control and the TENS + SnPP groups. Postmortem arteriography showed that the number of arterioles across each choke zone significantly increased in the TENS and the TENS +0.9% saline groups compared with the control and the TENS + SnPP groups. Immunohistochemistry and western blot showed a significant increase in HO-1 in the choke zones after TENS preconditioning. The necrotic area percentage of the flaps was significantly decreased in the TENS (4.3% ± 2.6%) and the TENS +0.9% saline groups (4.5% ± 2.3%) compared with the control (24.8% ± 5.0%) (P < 0.001); there was no significant difference between the TENS and the TENS + SnPP (24.4% ± 7.3%) groups.

Conclusions
These data show that TENS preconditioning monitored by infrared thermography might be a promising strategy to prevent pedicled perforator flaps from partial necrosis.
Direct-to-Implant Versus 2-Stage Breast Reconstruction
Authors: Piper Merisa L. , Rios-Diaz Arturo J. , Kimia Rotem , Cunning Jessica , Broach Robyn , Wu Liza , Serletti Joseph , Fosnot Joshua 
Published: June 2022

Background
Two-stage (TS) implant-based reconstruction is the most commonly performed method of reconstruction after mastectomy. A growing number of surgeons are offering patients direct-to-implant (DTI) reconstruction, which has the potential to minimize the number of surgeries needed and time to complete reconstruction, as well as improve health care utilization. However, there are conflicting data regarding the outcomes and complications of DTI, and studies comparing the 2 methods exclusively are lacking.

Methods
Patients undergoing implant-based reconstruction after mastectomy within a large interstate health system between 2015 and 2019 were retrospectively identified and grouped by reconstruction technique (TS and DTI). The primary outcomes were a composite of complications (surgical site occurrences), health care utilization (reoperations, unplanned emergency department visits, and readmissions), and time to reconstruction completion. Risk-adjusted logistic and generalized linear models were used to compare outcomes between TS and DTI.

Results
Of 104 patients, 42 underwent DTI (40.4%) and 62 underwent TS (59.6%) reconstruction. Most demographic characteristics, and oncologic and surgical details were comparable between groups (P > 0.05). However, patients undergoing TS reconstruction were more likely to be publicly insured, have a smoking history, and undergo skin-sparing instead of nipple-sparing mastectomy. The composite outcome of complications, reoperations, and health care utilization was higher for DTI reconstruction within univariate (81.0% vs 59.7%, P = 0.03) and risk-adjusted analyses (odds ratio, 3.78 [95% confidence interval [CI], 1.09–13.9]; P < 0.04). Individual outcome assessment showed increased mastectomy flap necrosis (16.7% vs 1.6%, P < 0.01) and reoperations due to a complication (33.3% vs 16.1%; P = 0.04) in the DTI cohort. Although DTI patients completed their aesthetic revisions sooner than TS patients (median, 256 days vs 479 [P < 0.01]; predicted mean difference for TS [reference DTI], 298 days [95% CI, 71–525 days]; P < 0.01), the time to complete reconstruction (first to last surgery) did not differ between groups (median days, DTI vs TS, 173 vs 146 [P = 0.25]; predicted mean difference [reference, DTI], −98 days [95% CI, −222 to 25.14 days]; P = 0.11).

Conclusions
In this cohort of patients, DTI reconstruction was associated with higher complications, reoperations, and health care utilization with no difference in time to complete reconstruction compared with TS reconstruction. Further studies are warranted to investigate patient-reported outcomes and cost analysis between TS and DTI reconstruction.
A Transcriptomic Liquid Biopsy Assay for Predicting Resistance to Neoadjuvant Therapy in Esophageal Squamous Cell Carcinoma
Authors: Okuno Keisuke , Tokunaga Masanori , Kinugasa Yusuke , Baba Hideo , Kodera Yasuhiro , Goel Ajay 
Published: June 2022

Objective:
The aim of this study was to establish a liquid-biopsy assay to predict response to neoadjuvant therapy (NAT) in esophageal squamous cell carcinoma (ESCC) patients.

Summary Background Data:
Pretreatment prediction of resistance to NAT is of great significance for the selection of treatment options in ESCC patients. In this study, we comprehensively translated tissue-based microRNA (miRNA) and messenger RNA (mRNA) expression biomarkers into a liquid biopsy assay.

Methods:
We analyzed 186 clinical ESCC samples, which included 128 formalin-fixed paraffin-embedded and a matched subset of 58 serum samples, from 2 independent institutions. We performed quantitative reverse-transcription polymerase chain reaction, and developed a resistance-prediction model using the logistic regression analyses.

Results:
We first evaluated the potential of 4-miRNAs and 3-mRNAs panel, which robustly predicted resistance to NAT [area under the curve (AUC): 0.85]. Moreover, addition of tumor size to this panel increased predictive potential to establish a combination signature (AUC: 0.92). We successfully validated this signature performance in independent cohort, and our model was more accurate when the signature was combined with clinical predictors (AUC: 0.81) to establish a NAT resistance risk (NATRR) model. Finally, we successfully translated our NATRR model into a liquid biopsy assay (AUC: 0.78), and a multivariate regression analysis revealed this model as an independent predictor for response to NAT (odds ratio: 6.10; P < 0.01).

Conclusions:
We successfully developed a liquid biopsy-based assay that allows robust prediction of response to NAT in ESCC patients, and our assay provides fundamentals of developing precision-medicine.
Design and Implementation of a Career Development Program for Physician-Scientists: Lessons Learned
Authors: Kameny Rebecca R. , Amundsen Cindy L. 
Published: June 2022

Importance
Although skills in health services research and data science have great potential to advance the field of urogynecology, few clinical researchers obtain such training.

Objectives
The aim of the R25 UrogynCREST Program is to prepare the next generation of physician-scientists for a successful career in urogynecologic health services research through skilled mentoring and advanced training. The purpose of this report is to describe program implementation and lessons learned.

Study Design
Administered through the program institution and in partnership with the American Urogynecologic Society, this program provided junior faculty with advanced online training and, through a core facility, access to health care databases for research projects. Participants received individualized mentoring and biostatistical support. Anonymous surveys captured actionable, real-time feedback from participants as they moved through the program.

Results
Despite a limited budget, UrogynCREST maintained a core of excellent faculty, high-quality biostatistical support, and engaged, knowledgeable advisors and mentors. This allowed for similar experiences across cohorts while permitting program improvements between cohorts in faculty-participant interactions, team dynamics, and data and regulatory support. Administrative management by a single institution facilitated responses to fiscal and regulatory changes. Asynchronized learning and partnering with a society attracted a diverse group of physician-scientists.

Conclusions
Career development programs that incorporate online education, mentoring, database access, and biostatistical support must be prepared for midprogram changes. Regular communication among stakeholders was vital. Working with a core facility provided efficient database access, but evolving regulatory and administrative processes and costs presented challenges. Our experiences implementing this program can benefit similar programs that train early-career physician-scientists.
Patient Satisfaction, Provider Productivity, and Efficacy of a Standardized Preparatory Toolkit With Broad Telemedicine Adaptation in an Outpatient Urology Clinic
Authors: Overholt Tyler L. , Dutta Rahul , Smith Whitney R. , Velet Liliya P. , Xu Raymond , Matthews Catherine A. 
Published: June 2022

Importance
The COVID-19 pandemic prompted telemedicine adoption. In March 2020, we developed an implementation toolkit with a nursing protocol for patient preparation before tertiary care urology clinic visits.

Objectives
Our primary objective was to determine patient satisfaction after implementation of a telemedicine toolkit. Our secondary objective was to assess downstream productivity generated from telehealth visits.

Study Design
We prospectively conducted a postvisit survey that included the Telehealth Usability Questionnaire, a validated survey assessing patient satisfaction, for all patients with documented completion of the nursing protocol to assess patient experience and satisfaction. We then performed a retrospective chart review of all telemedicine visits to determine downstream outcomes, including imaging and procedure scheduling.

Results
Between April and May 2020, 1,422 visits were completed, of which 265 had complete nursing protocol documentation. Eighteen of 265 (6.8%) reported setup assistance. Four (1.8%) were unsuccessful and converted to a nonvisual phone visit. Overall, 186 (70.1%) completed the Telehealth Usability Questionnaire with a mean score of 118.31 ± 23.44. High satisfaction was reported regardless of race, marital status, income, education, employment status, or travel distance. Younger age (P = 0.017) and female sex (P = 0.017) were associated with greater satisfaction. Of 1,422 total visits, imaging was ordered in 29%, office procedures scheduled in 14%, and surgery scheduled in 14%. New visits were more likely to result in procedure and surgery scheduling than returns (P < 0.0001).

Conclusions
Our telemedicine toolkit designed to maximize patient engagement was successful in achieving patient-provider connectivity in 98% of patients with high satisfaction. Telemedicine visits are effective to provide comprehensive urologic care with implications beyond the pandemic.
Linguistic Differences by Gender in Letters of Recommendation for Female Pelvic Medicine and Reconstructive Surgery Fellowship Applicants From 2010 to 2020
Authors: Tappy Erryn , Pan Evelyn , Brown Larry Steven , Wang Angela , Verma Diksha , Florian-Rodriguez Maria 
Published: June 2022

Importance
Linguistic differences suggestive of gender bias have been detected in letters of recommendation (LOR) for female and male residency and fellowship program applicants within multiple medical specialties.

Objective
The aim of the study was to determine whether linguistic differences exist in LOR for female and male physicians applying to female pelvic medicine and reconstructive surgery (FPMRS) fellowship.

Study Design
A retrospective analysis of FPMRS fellowship applications submitted to a university-affiliated academic center from 2010 to 2020 was performed. Linguistic Inquiry and Word Count, a text analysis software, was used to characterize the linguistic content of letters. Multivariable analysis was used to compare letter characteristics with applicant and letter writer demographics.

Results
Of 306 applications reviewed, 221 (72.2%) applicants were female and 85 (27.8%) were male. Of the 1,062 letters analyzed, 457 (43.0%) were written by female letter writers, 586 (55.2%) by males, and 19 (1.8%) were a combination. Multivariable analysis controlling for race, Step 1 score, and letter writer gender demonstrated more frequent use of affiliation words for female applicants compared with males (3.1% ± 0.3 vs. 2.9% ± 0.3, P = 0.02). No additional differences were noted in average letter length or all other linguistic categories analyzed. Multiple differences were detected between writing styles of female and male letter writers, including average letter length, use of multiple word categories, and use of communal (relationship-oriented) language. Data were stratified into 2-year periods and no longitudinal trends in linguistic differences were detected.

Conclusions
No linguistic differences, suggestive of gender bias, were found between female and male applicants to FPMRS fellowship.
Patients With Better Outcome Have Higher ERP Response to Emotional Auditory Stimuli
Authors: Portnova Galina V. , Podlepich Vitaliy V. , Skorokhodov Ivan V. 
Published: June 2022

Purpose:
Accuracy of outcome prognosis is one of the most important tasks of coma arousal therapy. Reactions toward sensory stimuli are the most significant predictor of conscience and cognitive functions restoration after a brain injury. A paradigm that includes ERP registration has the advantage of detailed stimuli processing visualization. The authors aimed to investigate perception and distinguishing of emotionally significant sounds (crying and laughter) in coma patients with different consciousness restoration prognosis.

Methods:
EEG was recorded in 24 comatose patients with different outcomes (scored with Glasgow Outcome Scale-Extended) and 32 healthy volunteers. The authors presented sounds of crying and laughter. ERPs for sound stimulation were calculated.

Results:
An analysis of the correlation of ERP components and Glasgow Outcome Scale-Extended score was performed. P200 (r = 0.6, P = 0.0014) and N200 amplitudes (r = −0.56, P = 0.0037) for emotional sounds correlated with the Glasgow Outcome Scale-Extended score. The significant differences of P300 and N400 amplitudes corresponded to differences of response between sounds of crying and laughter in subjects of the control group. Unlike the control group, comatose participants with good outcome produced similar electrical activity toward pleasant and unpleasant emotional stimuli.

Conclusions:
Comatose patients with good outcome produced more prominent ERP for emotional sounds. Even the good outcome participants were unable to distinguish emotional sounds of different moods, which indicate the preservation of solely robust mechanisms of sound processing. N200 and P200 amplitudes for emotional stimuli correlated significantly with outcome prognosis in coma patients.
Identifying Suspected Volume Conduction Contamination of External Anal Sphincter Motor Evoked Potentials in Lumbosacral Spine Surgery
Authors: Wilkinson Marshall , Ajoku Uchenna , Pederson Kristine , McIntrye Ian , Zarrabian Mohammad 
Published: June 2022

Purpose:
Iatrogenic injury to sacral nerve roots poses significant quality of life issues for patients. Motor evoked potential (MEP) monitoring can be used for intraoperative surveillance of these important structures. We hypothesized that volume conducted depolarizations from gluteus maximus (GM) may contaminate external anal sphincter (EAS) MEP results during lumbosacral spine surgery.

Methods:
Motor evoked potential from the EAS and medial GM in 40 patients were prospectively assessed for inter-muscle volume conduction during lumbosacral spine surgeries. Peak latency matching between the EAS and GM MEP recordings conditionally identified volume conduction (VC+) or no volume conduction (VC−). Linear regression and power spectral density analysis of EAS and medial GM MEP amplitudes were performed from VC+ and VC− data pairs to confirm intermuscle electrical cross-talk.

Results:
Motor evoked potential peak latency matching identified putative VC+ in 9 of 40 patients (22.5%). Mean regression coefficients (r
2) from peak-to-peak EAS and medial GM MEP amplitude plots were 0.83 ± 0.04 for VC+ and 0.34 ± 0.06 for VC− MEP (P < 0.001). Power spectral density analysis identified the major frequency component in the MEP responses. The mean frequency difference between VC+ EAS and medial GM MEP responses were 0.4 ± 0.2 Hz compared with 3.5 ± 0.6 Hz for VC− MEP (P < 0.001).

Conclusions:
Our data support using peak latency matching between EAS and GM MEP to identify spurious MEP results because of intermuscle volume conduction. Neuromonitorists should be aware of this possible cross-muscle conflict to avoid interpretation errors during lumbosacral procedures using EAS MEP.