bluuebunny/crossref_metadata_2025_split huggingface dataset:
Submental Area Treatment with ATX-101: Relationship of Mechanism of Action, Tissue Response, and Efficacy
Authors: Humphrey Shannon , Munavalli Girish S. , Yoelin Steven G. , Friedmann Daniel P. , Kavali Carmen M. , Sangha Sara 
Published: May 2022

Background:
ATX-101 is an injectable, synthetically derived formulation of deoxycholic acid used for submental fat reduction.

Methods:
A narrative review of references relevant to the mechanism of action of ATX-101 and its relationship to efficacy and inflammatory adverse events was conducted.

Results:
When injected into subcutaneous fat, deoxycholic acid physically disrupts adipocyte cell membranes, leading to local adipocytolysis, cell death, and a mild, local inflammatory reaction consisting of macrophage infiltration and fibroblast recruitment. At Day 28 postinjection, inflammation largely resolves, and key histologic features include fibrotic septal thickening, neovascularization, and atrophy of fat lobules. Based on the mechanism of action of ATX-101 and the demonstrated inflammatory response, localized inflammation and swelling are expected following treatment. Indeed, postinjection swelling and other local injection-site events, including pain, erythema, and bruising, are common during and after treatment. Because of inflammatory sequelae following injection, reduction in submental fat is gradual and may require months before the full response is apparent. Patients may also require multiple treatment sessions to achieve their treatment goals. Repeated treatments may result in less pain and swelling over time owing to a combination of factors, including less target tissue allowing for lower doses/injection volumes, persistent numbness, and greater tissue integrity from thickened fibrous septa.

Conclusions:
Physicians can manage expectations by counseling patients that, based on the mechanism of action of ATX-101 and data from pivotal clinical trials, ATX-101 treatment results in localized inflammation/swelling and gradual submental fat reduction. Patient education about common local adverse events is critical.
Health-related Quality of Life Measurement Tools for Lymphedema: A Review of the Literature
Authors: Lim Pelicia , Li Henry , Neoh Derek , Ng Sally Kiu-Huen 
Published: May 2022

Background:
Lymphedema can significantly affect patients’ health-related quality of life (HRQoL). Various quality of life scales have been developed to assess the extent of the disease burden. The purpose of this study is to review various HRQoL instruments that have been used in lymphedema studies and compare their qualities against the COSMIN checklist.

Methods:
A systematic literature review search was conducted for clinical lymphedema studies published between January 1, 1984, and February 1, 2020, using Pubmed database. All clinical lymphedema studies which used HRQoL instruments as outcome measures were identified.

Results:
One thousand seventy-six studies were screened—of which, 288 studies were individually assessed. Thirty-nine HRQoL instruments were identified in these clinical lymphedema studies. Of these, there are eight lymphedema-specific questionnaires that cover all HRQoL domains, all of which have been validated for use in lymphedema. We contrasted the two most popular questionnaires [LYMQOL and Upper Limb Lymphedema (ULL)-27] and compared their features.

Conclusion:
There is currently no ideal lymphedema HRQoL measurement tool available based on the COSMIN criteria. However, our review suggested that LYMQOL and ULL-27 are the most used and most validated instruments at present, but each has their own limitations. We recommend the use of LYMQOL and ULL-27 for future studies to allow direct HRQoL comparison to current literature. Further research is required to develop an optimal HRQoL questionnaire that can ultimately become the gold standard HRQoL instrument for lymphedema.
Use of Private, Parochial, and Public Schools in Baccalaureate Nursing Programs for Pediatric Practicum
Authors: Schultz Celeste M. , Krassa Teresa J. 
Published: May 2022

Background:
Clinical sites are increasingly difficult to secure due to shorter hospital stays, increased clinical site competition, and limited practicum sites. Little is known about the use of schools for pediatric clinical practicum.

Purpose:
To explore utilization of private, parochial, and public primary and secondary schools for pediatric clinical practicum sites.

Methods:
Faculty (n = 108) completed a 38-item online survey.

Results:
Twenty-seven faculty members (25%) reported using schools for pediatric practicum. Most nursing students (85.1%) spent 23 total hours or less in schools obtaining anthropometric measurements, reviewing immunizations, and providing health education to children, parents, and teachers.

Conclusion:
Using schools for the pediatric practicum is thought to be a common practice; our findings suggest otherwise. School-based practicums provide students with skills beyond acute care competencies. Nursing faculty need to seriously consider which pediatric clinical settings provide the best experience to prepare future nurses.
An Interprofessional Yearlong Geriatrics Fellowship Program for Advanced Practice Nursing and Social Work Students
Authors: Glassburn Susan , Frank Kathryn , Fulton Jan , Westmoreland Glenda , Garrison Emilie , Roth Sarah , Litzelman Debra K. 
Published: May 2022

Background:
The care of older adults with complex medical conditions requires effective team-based care.

Problem:
Nursing and social work students need a curriculum that provides them with immersive experiences in geriatrics to prepare them for competent practice.

Approach:
This Geriatric Workforce Enhancement Program supported 5 advanced practice nursing (APN) and 5 master of social work (MSW) student fellows in a 2-semester program, with 3 cohorts completing the fellowship over 3 years (N = 30).

Outcomes:
By the completion of the fellowship, students had (1) demonstrated increased knowledge of age-related changes and health problems experienced by older adults, (2) developed clinical competencies in providing patient-centered health care for older adults, and (3) assessed the fellowship as helpful in preparing for interprofessional team care.

Conclusions:
An interprofessional gerontology fellowship for APN and MSW students can develop knowledge and skills in team-based care for older adults. Recommendations for creating a fellowship curriculum are provided.
Exploration of Online Doctor of Nursing Practice Students' Perceptions of Effective Teaching Methods Using the Critical Incident Technique
Authors: Robb Meigan , Spadaro Kathleen C. 
Published: May 2022

Background:
The online learning environment presents unique challenges for engaging students in the learning process. Current research is limited regarding online doctor of nursing practice (DNP) students' perceptions of effective faculty involvement related to their engagement in learning.

Purpose:
This qualitative study explored DNP students' perceptions of effective methods used by faculty to help them learn and be engaged in the asynchronous online classroom.

Methods:
The Community of Inquiry (COI) framework provided the theoretical support for this study. The critical incident technique was used to explore DNP students' perceptions of effective methods used by faculty teaching in an asynchronous online program. Perceptions of effective methods were analyzed using the inductive approach of thematic analysis.

Results:
Three themes emerged from the data analysis: providing clarity, staying on track, and making it personalized.

Conclusions:
Findings suggest nurse educators should follow the COI framework to establish teacher presence and promote student engagement in online courses.
Impact of distress screening and referral on health care utilization and cost among breast cancer patients: a retrospective cohort study ∗
Authors: Miller Melissa F. , Zaleta Alexandra K. , Allen Melyssa L. , Nichols Helen M. , Robinson Diane C. 
Published: May 2022

Abstract

Background:
Addressing cancer patient distress and unmet needs may reduce health care costs and enhance care utilization. This study examined the impact of a distress screening program CancerSupportSource™ (CSS) on health care utilization and costs for breast cancer patients.

Methods:
In a retrospective cohort study with 2 years’ follow-up, breast cancer patients receiving care at a community cancer center in Orlando, FL, between 2016 and 2019 were categorized according to exposure status: screened using CSS and acted by using supportive care services (SA); screened only (SO); and not screened (NS). Patients were matched on breast tumor location and age; screened patients were additionally matched on referral need. Outcomes abstracted from medical records included utilization and cost of emergency department (ED) services, hospital inpatient admissions, and outpatient services; and utilization of integrative medicine department, patient/family counseling, and allied health services.

Results:
SA patients (n = 36), compared to NS (n = 37), had significantly lower rates of ED visits in negative binomial regression analysis (incidence rate ratio [IRR] 0.43; 95% confidence interval [CI] 0.20–0.93; P = .031). There were significantly higher rates of integrative medicine department visits in SA (IRR 4.20; 95% CI 1.63–10.9; P = .003) and SO (IRR 3.71; 95% CI 1.49–9.24; P = .005) groups compared to NS, and higher rates of patient/family counseling visits in SA (IRR 6.21; 95% CI 1.52–25.3; P = .011). There were no significant differences in 2-year health care costs between groups, controlling for age and race/ethnicity.

Conclusions:
These findings highlight the potential value of distress screening and referral for health care utilization, shifting use of higher cost services to lower cost nonemergent and preventive care in cancer, and can inform future prospective research on cost outcomes.
Versatility of Medial Sural Artery Islanded Pedicled Perforator Flap for Resurfacing Areas Around the Knee
Authors: Suba Santanu , Giri Sanjay Kumar , Pant Priyanka , Kanungo Aparna 
Published: May 2022

Abstract
Soft tissue defects with exposed tendon, bones, and joints around the knee are difficult and challenging to treat because of its location over a joint, requires a stable cover that is supple and stretchable. For any knee defects, the gastrocnemius muscle flap is the first choice for the reconstruction, although it causes less functional deficit; however, because of its less reach, it is difficult to cover the defect in the superolateral aspect of knee joint and anterior to the tibial tuberosity with the other disadvantage being the bulkiness. The medial sural artery perforator flap (MSAPF) provides thin fasciocutaneous tissue similar to the adjacent normal soft tissue in the knee and so, its use leads to an improved reconstruction of contour and eliminating the need of a skin graft over the primary defect. Here, we will be discussing a case series using MSAPF to cover the defects around the knee.
Cannabinoids and Pain for the Plastic Surgeon
Authors: Stephens Kristen L. , Heineman John T. , Forster Grace L. , Timko Michael P. , DeGeorge Brent R. 
Published: May 2022

Background
Since the passage of the 2018 Farm Bill, practitioners have encountered more patients self-treating pain with over-the-counter topical cannabidiol (CBD) derived from hemp—Cannabis sativa with less than 0.3% delta-9-tetrahydrocannabinol—with reported improvements in pain control and activities of daily living. Cannabidiol has been touted for its capacity to improve inflammatory, arthritic, and neuropathic pain conditions, and increasing numbers of patients are exploring its use as potential replacement for opioids. However, limited rigorous clinical trials have been performed evaluating the safety and efficacy of cannabinoids for the treatment of pain.

Methods
A systematic search of PubMed was performed using the Medical Subject Headings (MeSH) terms “cannabinoid” or “CBD” or “cannabidiol” or “cannabis” or “medical marijuana” and “pain.” It yielded 340 article titles. Twelve full-text primary studies of oral or topical CBD for chronic pain were selected for review, including 6 animal (2 randomized clinical trial and 4 prospective trials) and 6 human (4 randomized clinical trial and 2 prospective trials) studies.

Results
With respect to the safety and efficacy of oral and topical CBD for treating pain, animal and human studies have shown early positive results with limited minor side effects. However, all human studies may be underpowered with small sample sizes.

Conclusions
With respect to the safety and efficacy of oral and topical CBD for treating pain, the evidence remains inconclusive in that we have a paucity of data to share with our patients who are considering the use of these products, which may be associated with significant costs.
Trapezius Perforator Flaps Based on Superficial Cervical Artery and Dorsal Scapular Artery
Authors: Wang Qianwen , Li Zhiqiang , Xu Xiaohuan , Zhou Xu , Wang Tailing 
Published: May 2022

Background
The flaps in the trapezius region are routinely elevated as musculocutaneous flaps. The anatomy of trapezius perforators and their clinical application are unclear.

Methods
The number and distribution of superficial cervical artery perforators (SCAPs) and dorsal scapular artery perforators (DSAPs) were studied on 8 cadavers. The clinical usage of SCAP and DSAP flaps was investigated through a systematic literature review.

Results
A total of 27 SCAPs and 28 DSAPs were found in the 16 hemibacks. The mean calibers of SCAP and DSAP were 0.9 ± 0.2 and 0.8 ± 0.2 mm, respectively. The vascular length to the takeoff of the source artery was 7.3 ± 2.0 cm (range, 4.7–9.7 cm) for SCAPs and was 8.1 ± 2.8 cm (range, 3.2–13.6 cm) for DSAPs. Contour and density heat maps showed that the SCAPs were clustered within approximately 3 to 5 cm above the horizontal line through the medial point of the scapular spine (x-axis) and 5 to 8 cm from the midline (y-axis, P = 0.001) and clustered DSAPs located in approximately 4 to 9 cm below the x-axis and 4 to 10 cm from the y-axis (P = 0.002). Four SCAP and 19 DSAP flaps were found in literature. The mean sizes of SCAP flaps and DSAP flaps were 18.5 × 7.8 and 16.5 × 8.7 cm, respectively.

Conclusions
Both SCAP and DSAP flaps can be elevated with a relatively long pedicle. The anatomical knowledge of the location of major clusters of perforators contributes to the application of these flaps.
One-Stage Reconstruction of Large Upper Vermillion Defects Using a Lower to Upper Bipedicle Axial Cross-Lip Vermillion Flap
Authors: Qiu Yajing , Gao Bowen , Chen Hui , Lin Xiaoxi 
Published: May 2022

Background
Vermilion deformities after intralesional bleomycin A5 injections for hemangiomas of the upper lip have not been rare during the past 2 decades in China. In this article, we summarized our 10 years of experience using a lower to upper axial cross-lip musculomucosal flap with bipedicle lower labial coronary arteries for 1-stage reconstruction of large upper vermillion defects. Based on several years of experience, we also created some modified approaches to achieve satisfactory cosmetic outcomes.

Patients and Methods
From July 2006 to July 2016, a total of 25 patients with moderate and severe vermilion defects of the upper lip were treated with this method at the Department of Plastic and Reconstructive Surgery in Shanghai Ninth People’s Hospital. The cosmetic outcomes and complications were reviewed.

Results
The overall mean follow-up time was 14.9 months. No patients had infection or hematoma. All the flaps survived, and all the patients were satisfied with the postoperative appearance.

Conclusions
Our experience has proven that a lower to upper axial cross-lip musculomucosal flap with bipedicle lower labial coronary arteries is a safe and effective approach for correcting large upper vermillion defects. It is a 1-stage operation for the overall length of upper vermillion reconstruction. This method could improve upper-lip aesthetics and achieve reconstructive goals while avoiding lower-lip deformities.
Bilateral Transverse Upper Gracilis Flaps for Unilateral Breast Reconstruction
Authors: Christopoulos Georgios , Khoury Alexandra , Sergentanis Theodoros N. , Mackey Simon P. , Jones Martin E. 
Published: May 2022

Introduction
The transverse upper gracilis (TUG) flap is a reliable alternative to abdominally based breast reconstruction because of its advantageous anatomy. However, the limited tissue volume prevents reconstruction of large breasts. The bilateral TUG flaps for unilateral breast reconstruction can overcome this problem.

Methods
A retrospective analysis was performed regarding unilateral breast reconstruction with bilateral TUGs at the Queen Victoria Hospital from 2015 to 2019. Associations between categorical variables were examined with Fisher exact test, and any differences in continuous variables by complication status were evaluated with Mann-Whitney-Wilcoxon test for independent samples. A relevant systematic review was conducted with a meta-analysis of proportions using the Freeman-Tukey arcsine transformation for the estimation of the overall survival rates.

Results
Ten cases were identified with 6 having a delayed reconstruction. Median age and body mass index were 50.8 years and 23.9 kg/m2, respectively, and average flap weight was 268.3 g. One flap was placed superiorly with its pedicle anastomosed to the retrograde internal mammary vessels, except of half of the cases where a second anterograde vein was used. The mean follow-up was 21.4 months, and all flaps survived. Two patients returned to theater, and 4 experienced donor-site problems. The presence of complications was not associated with age, ever smoking, body mass index, TUG weight, or anastomosis to retrograde internal mammary vein. The systematic review resulted in 8 eligible articles with a total sample of 156 flaps. The overall survival rate was 96.8%. In 6 cases, the indication was Poland syndrome (7.7%), and in 48.7%, axillary vessels were also used as recipient vessels. The estimated overall flap survival rate was 100% (95% confidence interval, 99%–100%), and no significant heterogeneity was noted (I
2 = 0%, P = 0.71).

Conclusions
The “2-in-1” technique can lead to symmetrical aesthetically pleasant results for both recipient and donor sites. Our case series and the conducted systematic review reiterate the reliability of this approach.
Vaccine Stockpile Sharing For Selfish Objectives
Authors: Shivam Shashwat , Weitz Joshua S. , Wardi Yorai 
Published: May 2022

AbstractThe COVAX program aims to provide global equitable access to life-saving vaccines. However, vaccine protectionism by wealthy nations has limited progress towards vaccine sharing goals. For example, as of April 2022 only ∼20% of the population in Africa has received at least one COVID-19 vaccine dose. Here we use a two-nation coupled epidemic model to evaluate optimal vaccine-sharing policies given a selfish objective: in which countries with vaccine stockpiles aim to minimize fatalities in their own populations. Despite the selfish objective, we find it is often optimal for a donor nation to share a significant fraction of its vaccine stockpile. Mechanistically, sharing a vaccine stockpile reduces the intensity of outbreaks in the recipient nation, in turn reducing travel-associated incidence in the donor nation. This effect is intensified as vaccination rates decrease and epidemic coupling increases. Despite acting selfishly, vaccine sharing by a donor nation significantly reduces transmission and fatalities in the recipient nation. Moreover, we find that there are hybrid sharing policies that have a negligible effect on fatalities in the donor nation compared to the optimal policy while significantly reducing fatalities in the recipient nation. Altogether, these findings provide a rationale for nations with extensive vaccine stockpiles to share with other nations.
Data-driven Identification of Total RNA Expression Genes (TREGs) for Estimation of RNA Abundance in Heterogeneous Cell Types
Authors: Huuki-Myers Louise A. , Montgomery Kelsey D. , Kwon Sang Ho , Page Stephanie C. , Hicks Stephanie C. , Maynard Kristen R. , Collado-Torres Leonardo 
Published: May 2022

AbstractNext-generation sequencing technologies have facilitated data-driven identification of gene sets with different features including genes with stable expression, cell-type specific expression, or spatially variable expression. Here, we aimed to define and identify a new class of “control” genes called Total RNA Expression Genes (TREGs), which correlate with total RNA abundance in heterogeneous cell types of different sizes and transcriptional activity. We provide a data-driven method to identify TREGs from single cell RNA-sequencing (RNA-seq) data, available as an R/Bioconductor package at https://bioconductor.org/packages/TREG. We demonstrated the utility of our method in the postmortem human brain using multiplex single molecule fluorescent in situ hybridization (smFISH) and compared candidate TREGs against classic housekeeping genes. We identified AKT3 as a top TREG across five brain regions, especially in the dorsolateral prefrontal cortex.
Prevalence and Genotypic Characterization of Extended Spectrum Beta-Lactamase Uropathogens Isolated from Refugees with Urinary Tract Infections in Nakivale Refugee Settlement camp, Southwestern Uganda
Authors: Hussein Ayan Ahmed , Kassaza Kennedy , Mwesigye James , Mwamibi Bashir , Kabanda Taseera , Bazira Joel 
Published: May 2022

ABSTRACTBackgroundWorld Health Organization approximates that one in four individuals have had at least one UTI episode requiring treatment with an antimicrobial agent by the teen age. At Nakivale refugee camp, the overwhelming number of refugees often associated with poor living conditions such as communal bathrooms and toilets and multiple sex partners do predispose the refuges to urinary tract infections.AimTo determine the prevalence of bacterial community-onset urinary tract infections among refugees in Nakivale refugee settlement and determine the antimicrobial susceptibility patterns of the isolated pathogens.MethodsThis study was a cross-sectional study, that included 216 outpatients attending Nakivale Health Centre III between July and September 2020.ResultsPrevalence of UTI was 24.1% (52/216). The majority 86(39.81%) of the refugees were from DR Congo, followed by those from Somalia 58(26.85%). The commonest causative agent was Staphylococcus aureus 22/52 (42.31%) of total isolates, followed by Escherichia coli 21/52(40.38%). Multidrug resistant isolates accounted for 71.15% (37/52) and mono resistance was 26.92% (14/52). Out of the 52 bacterial isolates, 30 (58%) were Extended-Spectrum Beta-Lactamase organisms (ESBLs). Twenty-one (70.0%) isolates were ESBL producers while 9(30%) were non-ESBL producers. Both blaTEM and blaCTX-M were 62.5% each while blaSHV detected was 37.5%.ConclusionsThe prevalence of UTI among refugees in Nakivale settlement is high with Staphylococcus aureus and Escherichia coli as the commonest causes of UTI. There is a high rate of multidrug resistance to common drugs used to treat UTI. The prevalence of ESBL-producing Enterobacteriaceae is high and the common ESBL genes are blaTEM and blaCTX-