bluuebunny/crossref_metadata_2025_split huggingface dataset:
A major outbreak of the COVID-19 on the Diamond Princess cruise ship: Estimation of the basic reproduction number
Authors: Chou Yu-Ching , Lin Yu-Ju , Shie Shian-Sen , Tsai Hung-Bin , Sheng Wang-Huei 
Published: October 2022

Background:
The COVID-19 pandemic, which broke out in Wuhan, China, in 2019, was declared an international public health emergency by the World Health Organization on January 31, 2020. The outbreak on the Diamond Princess cruise ship had appeared first as a cluster infection outside China during the early pandemic. The incident occurred on February 1, 2020, involved an 80-year-old Hong Kong man who was diagnosed with COVID-19. The cruise ship docked in Yokohama, Japan, for 14 days of onboard quarantine; however, cluster infection outbroke rapidly.

Methods:
We constructed a SIR mathematical model and conducted an epidemiological study of the COVID-19 outbreak on the Diamond Princess cruise ship, covering the period from February 5 (start of quarantine) to February 20 (completion of 14-day quarantine). We estimated the basic reproduction number (R0) using a novel method of nonlinear least-squares curve fitting under Microsoft Excel Solver. The 95% confidence interval (CI) values were estimated by the jackknife procedures.

Results:
Six hundred thirty-four (17.1%) cases were diagnosed in a total population of 3711 cruise passengers, and 328 (51.7%) cases were asymptomatic. As of April 24, 2020, 712 cases had been diagnosed and 14 (1.96%) deaths had occurred. The R0 with 95% CI of the COVID-19 outbreak was 3.04 (2.72–3.36). Without an evacuation plan for passengers and crew, we estimated the total number of cumulative cases would reach 3498 (CI, 3464–3541). If the R0 value was reduced by 25% and 50%, the cumulative cases would be reduced to 3161 (CI, 3087-3254) and 967 (CI, 729-1379), respectively. The abovementioned R0 value was estimated from the original Wuhan strain.

Conclusion:
Cruise conditions would accelerate the spread of infectious diseases and were not suitable for onboard quarantine. Early evacuation and isolation of all passengers and crew members would reduce the R0 value and avoid further infections.
Justice Denied: A Call to Action for Forensic Nurses
Authors: Glover Hilary Ashton 
Published: October 2022

ABSTRACT
Sexual violence is a major public health problem that negatively affects millions of Americans. Persons who have experienced sexual violence may choose to undergo a medical forensic examination and complete a sexual assault kit to collect and preserve evidence. DNA evidence is an impactful tool that has the potential to confirm an assailant's identity, reveal previously unknown offenders, connect serial predators to other crime scenes, exonerate the wrongly convicted, and prevent future acts of sexual violence. However, many of these kits have become “backlogged,” meaning that evidence was not submitted by law enforcement for testing or DNA analysis was not completed by the crime laboratory, thereby denying justice and closure for victims. The purpose of this article is to illustrate the backlog of untested sexual assault kits in the United States and describe a case in which a serial offender was apprehended because of the testing of backlogged kits. In addition, this call to action aims to raise awareness regarding kit processing and promote advocacy among forensic nurses.
Association Between Human Leukocyte Antigen Polymorphism and Human Papillomavirus Infection in Brazilian Women
Authors: de Araujo-Souza Patricia Savio , El-Zein Mariam , Bolpetti Aline do N. , Maciag Paulo Cesar , Rabachini Tatiana , Franco Eduardo L. , Villa Luisa L. 
Published: October 2022

Background
Human papillomavirus (HPV) infection is a necessary cause for cervical cancer, but a majority of genital HPV infections clear spontaneously. Human leukocyte antigen (HLA) polymorphism influences immune response and genetic susceptibility, and its association with cervical cancer was extensively investigated, but few reports focused on HPV infection.

Methods
We performed molecular typing of HLA-A, HLA-B, HLA-DQB1, and HLA-DRB1 genes as well as of HPV in 1226 women enrolled in the Ludwig-McGill cohort study and investigated the influence on cumulative HPV positivity. HPV types were grouped according to Alphapapillomavirus subgenera that exhibit similar tissue tropism and biological behavior concerning cancer risk. The associations between HLA polymorphisms and HPV infections were estimated using unconditional logistic regression analysis adjusted for age and race.

Results

HLA-B*08 and HLA-DRB1*15:01 were negatively associated with HPV positivity, and similar effects were observed for HPV subgenus 2 only, which includes HPV16. HLA-DRB1*08:07 was associated with overall HPV infection and subgenus 2 positivity. The haplotypes HLA-B*08-DRB1*03:01-DQB1*02:01 and HLA-DRB1*08:07-DQB1*04:02 were negatively and positively associated with cumulative HPV positivity, respectively.

Conclusions
Our data suggest that HLA class I and II polymorphism can influence HPV natural infection.
Dysplastic Pulmonary Valve Infective Endocarditis With an Atrial Septal Defect—A Black Swan Event
Authors: Desai Heena M. , Tapadia Ritika , Amonkar Gayathri P. 
Published: October 2022

Abstract
A case of infective endocarditis of a dysplastic pulmonic valve along with atrial septal defect has been described. Right-sided endocarditis has now increased in frequency because of cardiac invasive procedures and intravenous drug abuse. Although the tricuspid valve usually bears the brunt of right-sided endocarditis, there have now been increasing reports of pulmonary valve infective endocarditis.
Legal Needs, Health, and Health Care Utilization Among Patients Participating in the Delaware Medical Legal Partnership
Authors: Mapp Alexandra M. , Moore Christopher , Booker Erin , Santiago Cindy , Baker Dawn , Salvatore Alicia L. 
Published: October 2022

Context:
Unmet legal needs can exacerbate health disparities and contribute to a lack of adherence to treatment plans and medical recommendations for care. Medical legal partnerships (MLPs) are integrated health care and legal aid interventions offered by many health systems in the United States. Although much research has been published regarding the success of MLPs with specific patient groups, there is a gap in literature regarding the nature of MLPs in a more general, at-risk patient population.

Objective:
We aimed to better understand specific patient characteristics and health outcomes associated with different iHELP legal needs.

Design:
This is a cross-sectional study of patients who were enrolled in the Delaware MLP (DMLP) from November 2018 to June 2020 (N = 212).

Setting:
The DMLP is a collaboration between ChristianaCare, a Mid-Atlantic health system, and the Community Legal Aid Society, Inc (CLASI).

Participants:
Patients must be adults (ie, 18 years or older), below 200% of the federal poverty level (eg, ≤$53 000 for a household of 4 as of 2021), have at least one qualifying legal need, and live in the state.

Intervention:
The DMLP is designed to address unmet legal needs that fall under a framework called iHELP. iHELP legal domains are income and insurance (i), housing and utilities (H), education and employment (E), legal status (L), and personal and family stability (P).

Main Outcome Measures:
Outcomes of interest were iHELP legal needs, patient demographics, perceived stress and mental and physical health–related quality of life, comorbidities, and health care utilization.

Results:
Housing and utilities (46.2%) and income support (41.5%) were the highest reported legal needs. Perceived stress scores were significantly higher for those with income needs (P = .01) as well as those with housing and utilities needs (P = .01).

Conclusions:
MLP programs offer a value-added service that can address unmet legal needs in vulnerable, at-risk patients.
Evaluation of a Virtual Training to Enhance Public Health Capacity for COVID-19 Infection Prevention and Control in Nursing Homes
Authors: Penna Austin R. , Hunter Jennifer C. , Sanchez Guillermo V. , Mohelsky Romy , Barnes Laura E. A. , Benowitz Isaac , Crist Matthew B. , Dozier Tiffany R. , Elbadawi Lina I. , Glowicz Janet B. , Jones Heather , Keaton Amelia A. , Ogundimu Abimbola , Perkins Kiran M. , Perz Joseph F. , Powell Krista M. , Cochran Ronda L. , Stone Nimalie D. , White Katelyn A. , Weil Lauren M. 
Published: October 2022

Context:
Between April 2020 and May 2021, the Centers for Disease Control and Prevention (CDC) awarded more than $40 billion to health departments nationwide for COVID-19 prevention and response activities. One of the identified priorities for this investment was improving infection prevention and control (IPC) in nursing homes.

Program:
CDC developed a virtual course to train new and less experienced public health staff in core healthcare IPC principles and in the application of CDC COVID-19 healthcare IPC guidance for nursing homes.

Implementation:
From October 2020 to August 2021, the CDC led training sessions for 12 cohorts of public health staff using pretraining reading materials, case-based scenarios, didactic presentations, peer-learning opportunities, and subject matter expert–led discussions. Multiple electronic assessments were distributed to learners over time to measure changes in self-reported knowledge and confidence and to collect feedback on the course. Participating public health programs were also assessed to measure overall course impact.

Evaluation:
Among 182 enrolled learners, 94% completed the training. Most learners were infection preventionists (42%) or epidemiologists (38%), had less than 1 year of experience in their health department role (75%), and had less than 1 year of subject matter experience (54%). After training, learners reported increased knowledge and confidence in applying the CDC COVID-19 healthcare IPC guidance for nursing homes (≥81%) with the greatest increase in performing COVID-19 IPC consultations and assessments (87%). The majority of participating programs agreed that the course provided an overall benefit (88%) and reduced training burden (72%).

Discussion:
The CDC's virtual course was effective in increasing public health capacity for COVID-19 healthcare IPC in nursing homes and provides a possible model to increase IPC capacity for other infectious diseases and other healthcare settings. Future virtual healthcare IPC courses could be enhanced by tailoring materials to health department needs, reinforcing training through applied learning experiences, and supporting mechanisms to retain trained staff.
A novel approach to severe chronic neurogenic dysphagia using pharyngeal sensory electrical stimulation: a case report
Authors: Zhang Xue , Wang Xiaolu , Dou Zulin , Wen Hongmei 
Published: October 2022

Abstract
The treatment options for severe chronic neurogenic dysphagia are limited. A patient, after resection of medulla oblongata hemangioblastoma, who failed to respond to seven months of traditional dysphagia rehabilitation therapy, was treated with prolonged pharyngeal sensory electrical stimulation for 39 sessions over 57 days. For the first time, this case report showed improvement in hypopharyngeal peak pressure (9.1 mmHg vs. 90.8 mmHg) using high-resolution manometry. Reduction in the penetration and aspiration scale, secretion, and residue of the vallecular and pyriform sinus were verified by videofluoroscopic swallowing study and flexible endoscopic evaluation of swallowing. The Functional Oral Intake Scale score increased from 1 to 6. No adverse event was observed. This case report presented a potential therapeutic protocol for severe chronic neurogenic dysphagia, which might be instructive for clinical practice.
“Predicting Breast Reduction Resection Weights and Attainment of Insurance-Mandated Minimums: Sternal Notch-Nipple and Nipple-Inframammary Fold Distances Alone are Effective”
Authors: Zhu Xiao , Hall Jennifer A. , Gimbel Michael L. , Nguyen Vu T. 
Published: October 2022

Background:
Despite evidence that reduction mammaplasty alleviates macromastia symptoms independent of resection weights, resection minimums are commonly used to grant insurance coverage. Multiple formulas have been published to predict resection weights, but very few have evaluated predictive performance relative to attaining common insurance minimums.

Methods:
This was a retrospective single-center review of 268 patients from 2007-2020. Multiple linear regression (MLR) and exponential model (EM) were created to predict resection weights and attainment of the Schnur, 350g, and 500g minimums. Accuracy was compared against published Appel, Descamps, and Galveston equations. BMI subgroup analyses were performed.

Results:
EM possessed the lowest resection weight prediction error overall (172.8 ± 211.5g). All equations performed significantly better than surgeons in predicting attainment of the 500g minimum. None performed better than the surgeons’ predictive accuracy in attaining a 350g minimum. MLR and EM performed significantly better than surgeons in predicting attainment of the Schnur minimum. Only the EM performed significantly better than surgeons for both the Schnur (82% vs. 71%, p<0.01) and the 500g minimums (89% vs. 68%, p<0.01). On BMI subgroup analyses, all three minimums were biased in favor of obese women – the least egregious of which was the 350g minimum.

Conclusion:
All minimums were biased against non-obese women. Our EM equation based on pre-operative sternal notch-nipple (SN-N) and nipple-inframammary fold (N-IMF) distances accurately predicts resection weights and improves on our surgeons’ predictive accuracy in attaining the Schnur or 500g minimums. This may prove useful in the preoperative setting to better counsel patients.
The BREASTrial Stage III: Acellular Dermal Matrix Breast Reconstruction Outcomes from Three Months to Two Years Postoperative
Authors: Mendenhall Shaun D. , Moss Whitney , Graham Emily M. , Carter Gentry , Agarwal Jayant P. 
Published: October 2022

Background:
The Breast Reconstruction Evaluation of Acellular Dermal Matrix (ADM) as a Sling Trial is a blinded, randomized trial comparing the outcomes of tissue expander breast reconstruction using AlloDerm or DermaMatrix. In this final stage of the trial, outcomes three months to two years following definitive reconstruction are reported along with patient satisfaction data.

Methods:
A randomized trial was conducted to compare complication rates between groups reconstructed with AlloDerm and DermaMatrix. Regression models were used to analyze the impact of matrix type, age, chemotherapy, radiation therapy, and reconstructive type on complication rates. Pre- and postmastectomy questionnaires were used to assess patient satisfaction and were also analyzed using regression models.

Results:
Of the 128 patients (199 breasts) who were randomized in the trial, 108 patients (167 breasts) were available for analysis in stage III. There was no difference in the overall rates of complication between AlloDerm and DermaMatrix groups (6% vs. 13.2%, p=0.3) or the severity of those complications (p=0.7). Obesity was a positive predictor for complications, regardless of reconstruction group (p=0.02). Patient satisfaction was positive overall and did not grossly vary between AlloDerm and DermaMatrix groups.

Conclusion:
Findings from the BREASTrial conclude that AlloDerm and DermaMatrix exhibit similar histologic and clinical outcomes. Patient satisfaction is also similar between matrices. Obesity is a predictor of complications and acellular dermal matrices should be used with caution in these patients. As the largest head-to-head trial comparing two ADMs, the BREASTrial contributes to fund of knowledge regarding ADM supplementation in breast reconstruction.
Sensory restoration in abdominally-based free flap for breast reconstruction using nerve allograft
Authors: Djohan Risal , Scomacao Isis , Duraes Eliana FR , Knackstedt Rebecca , Mangan Rachel , Schwarz Graham 
Published: October 2022

Background:
Neurotization of the breast reconstruction can be performed with the aid of nerve grafts and conduits to decrease the tedious dissection and overcome size mismatch. However, there has yet to be a formal analysis of this approach. The goal of this study is to evaluate sensory recovery after neurotized abdominally-based free flap for breast reconstruction using our novel technique and analyze factors that could affect sensory recovery.

Methods:
A novel technique employing processed nerve allograft in combination with a nerve conduit was utilized. Dynamic and static sensation recovery tests were performed in patients who underwent neurotized or non-neurotized abdominally-based free flap reconstructions. Demographics, surgical details, and complications were analyzed. Statistical analyses were performed using Chi-Square and Mann-Whitney tests.

Results:
Fifty patients (78 breasts) were analyzed; 60 with neurotized reconstruction and 18 without. For patients with more than twelve months of follow up, the neurotized cohort demonstrated improved dynamic tests compared to the non-neurotized cohort (38±21.69 vs. 56.17±20.8, p=0.014, respectively). Factors associated with decreased sensory return in patients who underwent neurotized reconstruction were diabetes, higher BMI, skin-sparing mastectomy, higher ASA class and history of radiation, or hormonal therapy.

Conclusion:
This is the first study to report on outcomes of neurotized autologous breast reconstruction utilizing a nerve graft and conduit technique. Our approach resulted in improved sensory outcomes compared to those in patients who did not undergo sensory reconstruction. Importantly, factors that can interfere with sensory recovery were identified.
Reconstructive Burnout After Mastectomy: Implications for Patient Selection
Authors: Halani Sameer H. , Jones Kaitlin , Liu Yulun , Teotia Sumeet S. , Haddock Nicholas T. 
Published: October 2022

Background:
The reconstructive journey after mastectomy can be a long road with many hurdles to achieve an ideal aesthetic result. Cancer therapy, operative complications, and comorbidities impact patients, both physically and emotionally. Our study introduces the term ‘Reconstructive Burnout’ and aims to evaluate which factors predict and contribute to patients prematurely stopping reconstruction.

Methods:
We performed a retrospective review of patients undergoing breast reconstruction after skin-sparing mastectomy from 2014-2017 with two senior surgeons at a single institution. ‘Reconstructive Burnout’ is defined as either no breast mound creation or completion of the breast mound without completion of all major revisions

Results:
A total of 530 patients were included with 76.6% completing reconstruction. In patients undergoing delayed-immediate reconstruction, patients with wounds (p=0.004), infections (p=0.037), or a complication requiring operative intervention (p<0.001) were correlated with incomplete reconstruction; explantation of expanders were highly correlated with Reconstructive Burnout (p<0.001). Implant-based and autologous reconstruction had comparable burnout rates (17.1% vs 19.1%, p=0.58). Logistic regression models found high BMI, radiation therapy, any TE complication, and TE explantation to be significant predictors of burnout. Autologous reconstruction was the strongest predictor of completion of reconstruction in both univariable and multivariable models.

Conclusion:
Reconstructive Burnout in breast reconstruction is associated with TE complications, high BMIs, and radiation therapy. Overall rates of Burnout were comparable between autologous and implant-based reconstruction, with autologous reconstruction being the strongest predictor of completion of reconstruction. It is critical to tailor each patient’s reconstructive journey to meet both their emotional and physical needs to avoid Reconstructive Burnout.
Fold Flaps to the Rescue in Post-Mastectomy Breast Reconstruction
Authors: Brown Ciara A , Losken Albert 
Published: October 2022

Background:
Ischemic complications following post-mastectomy breast reconstruction are not uncommon and can lead to reconstructive failure especially with implant reconstruction. We propose a simple local flap for management of such complications. This flap is easily raised from the upper abdomen or lateral chest as a medially or laterally based fasciocutaneous flap while the donor site is hidden in the infra or lateral mammary fold. We present a case series of these “fold flaps” which were used to manage complications following implant-based breast reconstruction.

Methods:
All patients between 2007 and 2021 who underwent a fold flap for breast reconstruction salvage were queried from a prospectively maintained data. Demographic variables, clinical factors and surgical details were analyzed. Outcomes assessed included complications, appropriate wound healing, and reconstructive salvage.

Results:
14 patients underwent thoracoepigastric or thoracoabdominal fold flaps following breast reconstruction for soft tissue coverage with an underlying prosthesis. The mean age was 54 years; BMI, 30; and follow-up duration, 18.5 months. Fold flap indications included mastectomy skin flap necrosis (n=9), infection (n=4) and chronic seroma (n=1). 11 (79%) reconstructions were salvaged while 3 (21%) required eventual prosthesis explantation secondary to infection or delayed wound healing.

Conclusion:
Fold flaps are a reliable option to manage ischemic complications following post-mastectomy breast reconstruction. The benefits include improved soft tissue coverage with a high salvage rate. These flaps are simple to raise, and their donor site is concealed within the folds. Further, they provide a reliable early option to manage complications and potentially prevent reconstructive failure.
Frequency and Risk Factors for Air Embolism in Computed Tomography Fluoroscopy–Guided Biopsy of Lung Tumor With the Use of Noncoaxial Automatic Needle
Authors: Maehara Yosuke , Miura Hiroshi , Hirota Tatsuya , Asai Shunsuke , Okamoto Toshiyuki , Ohara Yu , Yamada Kei 
Published: October 2022

Purpose
The aim of the study is to analyze incidence and risk factors for air embolism during computed tomography (CT) fluoroscopy–guided lung biopsies using noncoaxial automatic needle.

Materials and Methods
Between February 2014 and December 2019, 204 CT fluoroscopy–guided lung biopsies (127 men; mean age, 70.6 years) using noncoaxial automatic needle under inspiratory breath holding were performed. We retrospectively evaluated the incidence of air embolism as presence of air in the systemic circulation on whole-chest CT images obtained immediately after biopsy. Risk factors of the patient, tumor and procedural factors (size, location and type of nodule, distance from the pleura, the level of the lesion relative to the left atrium, emphysema, patient position, penetration of a pulmonary vein, etc) were analyzed.

Results
The technical success rate was 97.1%. Air embolism was radiologically identified in 8 cases (3.92%, 7 males; size, 21.6 ± 18.2 mm; distance to pleura, 11.9 ± 14.5 mm). Two patients showed overt symptoms and the others were asymptomatic. Independent risk factors were needle penetration of the pulmonary vein (P = 0.0478) and higher location relative to left atrium (P = 0.0353). Size, location and type of nodule, distance from the pleura, emphysema, patient position, and other variables were not significant risk factors. As other complications, pneumothorax and alveolar hemorrhage were observed in 57.4% and 77.5%, respectively.

Conclusions
In CT fluoroscopy–guided lung biopsy using the noncoaxial automatic needles, radiological incidence of air embolism was 3.92%. Given the frequency of air embolism, it is necessary to incorporate this into postprocedure imaging and clinical evaluation.