bluuebunny/crossref_metadata_2025_split huggingface dataset:
Menopause influences aortic pulse pressure and pressure wave responses to metaboreflex activation in women
Authors: Kang Yejin , Maharaj Arun , Dillon Katherine N. , Fischer Stephen M. , Figueroa Arturo 
Published: October 2022

Abstract

Objective
Postmenopausal women (post-MW) have greater risk of heart failure due to aortic pulsatile overload on the left ventricle associated with increased backward wave pressure (Pb). Post-MW have exaggerated peripheral blood pressure (BP) response to exercise mediated by metaboreflex (postexercise muscle ischemia [PEMI]) overactivation. Increased forward wave pressure (Pf) and Pb are determinants of aortic pulse pressure (PP) during isometric handgrip exercis (IHG) in young adults. We hypothesized that aortic PP and pressure wave responses to PEMI are augmented in nonhypertensive post-MW compared with premenopausal women (pre-MW).

Methods
Aortic BP, Pf, Pb, and reflection magnitude were assessed at rest and during IHG and PEMI by applanation tonometry in 15 pre-MW and 16 post-MW.

Results
Aortic systolic BP during PEMI similarly increased in both groups. The increase in diastolic BP was lower in post-MW (post-MW Δ6 ± 2 vs pre-MW Δ11 ± 2 mm Hg, P < 0.05). Aortic PP (post-MW Δ8 ± 2 vs pre-MW Δ3 ± 2), Pf (post-MW Δ6 ± 1 vs pre-MW Δ0 ± 1), and Pb (post-MW Δ5 ± 1 vs pre-MW Δ2 ± 1) augmented during PEMI in post-MW (P < 0.05 for all), but not in pre-MW. Reflection magnitude increased during PEMI only in pre-MW (pre-MW Δ7 ± 2 vs post-MW Δ-1 ± 2, P < 0.05) due to concurrent increases in Pf and Pb in post-MW.

Conclusions
Even in nonhypertensive postmenopausal women, increases in Pf and Pb and decrease in aortic DBP are important factors that contribute to the augmented aortic PP response to PEMI.
Chinese herbal medicine and COVID-19: quality evaluation of clinical guidelines and expert consensus and analysis of key recommendations
Authors: Zheng Qingyong , Gao Ya , Xiong Lu , Huang Hengyi , Li Junfen , OuYang Guoyuan , Saimire Wulayin , Yang Jingjing , Zhang Yu , Wang Xiaopeng , Luo Xiaofeng 
Published: October 2022

Objective:
To systematically review the clinical practice guidelines (CPGs) for the treatment of patients with coronavirus disease 2019 (COVID-19) using Chinese herbal medicine (CHM), assess the methodological quality as well as clinical credibility and implementability of specific recommendations, and summarize key recommendations.

Methods:
As of April 2022, we conducted a comprehensive search on major electronic databases, guideline websites, academic society websites, and government websites to assess the methodological quality and clinical applicability of the included CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and Evaluation-Recommendations EXcellence (AGREE-REX) instructions, respectively.

Results:
The search yielded 61 CPGs, which were mostly published in 2020; moreover, 98.4% of the CPGs were published in China. Only five CPGs achieved a high-quality AGREE II rating; further, six CPGs could be directly recommended, with most of the CPGs still showing much room for improvement. CPGs had a low overall score in the AGREE-REX evaluation, with the domains of clinical applicability, values and preferences, and implementability being standardized in 21.80% ± 12.56%, 16.00% ± 11.81%, and 31.33% ± 14.55% of the CPGs, respectively. Five high-quality CPGs mentioned 56 Chinese herbal formulas. Half of the recommendations had moderate or strong evidence level in the GRADE evaluation. The most frequently recommended herbal medicines were Lianhua Qingwen granule/capsule and Jinhua Qinggan granule; however, the strength of recommendation for each prescription varied across CPGs and populations.

Conclusions:
The overall quality of current CPGs for COVID-19 for CHM still needs to be improved; moreover, the strength of the evidence remains to be standardized across CPGs.

Graphical abstract:

http://links.lww.com/AHM/A34.
Effect of ultramarathon running on iron metabolism
Authors: Li Li-Hua , Hou Sen-Kuang , Chen Chung-Ting , Chang Yuan-I , Kao Wei-Fong , Chiu Yu-Hui , Juan Chi-Chang , How Chorng-Kuang 
Published: October 2022

Background:
Iron is a vital trace element for energy production and oxygen transportation; importantly, it is essential to athletic performance. Maintaining iron balance is tightly controlled at systemic and cellular levels. This study aimed to determine serum iron tests, hepcidin levels, and cellular iron import and export activities in peripheral blood mononuclear cells (PBMCs) in ultramarathon runners to elucidate the association of systemic inflammation response and iron metabolism.

Methods:
Sixteen amateur runners were enrolled. Blood samples were taken 1 week before, immediately, and 24 h after the run. Plasma hepcidin levels were measured by enzyme-linked immunosorbent assay. The expression levels of divalent metal iron transporter 1 (DMT1), ZRT/IRT-like protein 14 (ZIP14), transferrin receptor 1 (TfR1), and ferroportin (FPN) in PBMCs were measured using real-time quantitative reverse transcription-polymerase chain reaction.

Results:
Serum iron concentrations and transferrin saturation significantly decreased immediately after the race and dramatically recovered 24 h post-race. Serum ferritin levels had a statistically significant rise immediately after the race and remained high 24 h after the completion of the race. Ultramarathons were associated with increased plasma interleukin-6 concentrations corresponding to the state of severe systemic inflammation and therefore boosted plasma hepcidin levels. The expression levels of DMT1 and FPN mRNA were markedly decreased immediately and 24 h after the race. The ZIP14 and TfR1 mRNA expression in PBMCs significantly decreased immediately after the race and returned to the baseline level at 24 h post-race. Positive significant correlations were observed between plasma hepcidin and ferritin levels.

Conclusion:
Iron homeostasis and systemic inflammatory response are closely interconnected. Cellular iron import and export mRNA activities in PBMCs were acutely inhibited during an ultramarathon.
Using Personal Activity Intelligence With Patients in a Clinic Setting
Authors: Bean Glenn , Shaheen Sabrina , Lang Gregory R. , Kozu Pam , Boespflug Julie , Krishnan Uma 
Published: October 2022

Background
Personal Activity Intelligence (PAI) is a novel heart-rate–based metric used to assess cardiorespiratory fitness and quantify physical activity.

Objective
The aim of this study was to examine the feasibility, acceptability, and effectiveness of PAI with patients in a clinic setting.

Methods
Patients (n = 25) from 2 clinics underwent 12 weeks of heart-rate–monitored physical activity interfaced with aPAI Health phone app. We used a pre-post design with the Physical Activity Vital Sign and the International Physical Activity Questionnaire. Feasibility, acceptability, and PAI measures were used to evaluate the objectives.

Results
Twenty-two patients (88%) completed the study. There were significant improvements in International Physical Activity Questionnaire metabolic equivalent task minutes per week (P = .046) and a decrease in sitting hours (P = .0001). The Physical Activity Vital Sign activity increase in minutes per week was not significant (P = .214). Patients achieved a mean PAI score of 116 ± 81.1 and 100 or greater 71% of the days. Most patients (81%) expressed satisfaction with PAI.

Conclusions
Personal Activity Intelligence is feasible, acceptable, and effective when used with patients in a clinic setting.
Factors Associated With Additional Clinic Visits in the Treatment of Sports-Related Concussion
Authors: Hou Brian Q. , Yengo-Kahn Aaron M. , Hajdu Katherine , Tang Alan R. , Grusky Alan Z. , Zuckerman Scott L. , Terry Douglas P. 
Published: October 2022

Objective:
To evaluate the variables associated with additional concussion clinic visits before discharge to athletic trainer (AT).

Design:
Retrospective cohort study.

Setting:
Multidisciplinary Sports Concussion Center.

Patients:
Patients ages 12 to 23 years presenting with a sport-related concussion between January 11, 2017, and January 10, 2020, and were discharged to an AT.

Methodology:
Our main outcome variable was being discharged to AT after the initial clinic visit versus those who attended additional clinic visits before AT discharge. We examined the influence of age, sex, initial visit symptom score, family and personal history of psychiatric disorders and migraines, history of prior concussions, and other variables on this outcome.

Results:
Of 524 patients, 236 were discharged to AT after the initial clinic visit, while 288 patients required additional clinic visits. The additional visit group had higher initial visit symptom scores (P = 0.002), head imaging performed more frequently (P < 0.02), a family history of psychiatric disorders and/or migraines (P < 0.001, P < 0.001), more often reported a prior concussion (P = 0.02), and was younger (P = 0.014) compared with the one visit group. In a multiple variable model, the family history of psychiatric disorders [odds ratio (OR), 3.12 (95% CI, 1.531-6.343), P = 0.002], prior concussions [OR, 1.39 (95% CI, 1.020-1.892), P = 0.037], greater initial symptom score [OR, 1.05 (95% CI, 1.031-1.058), P < 0.001], and younger age [OR, 0.87 (95% CI, 0.773-0.979), P = 0.021] were strongly associated with additional visits.

Conclusions:
Among athletes treated at a regional sports concussion center, family history of psychiatric disorders, increased symptom score at initial visit, prior concussions, and younger age were each uniquely associated with needing additional clinic visits at the time of initial assessment. Understanding these variables may guide treatment protocols for optimal care.
Bereaved Caregiver Perspectives on the End of Life in Pediatric Patients With Ventricular Assist Devices
Authors: Bui Christine M. , Schneider Lauren M. , Brown Michelle R. , Char Danton S. , McIlvennan Colleen K. , Hollander Seth A. 
Published: October 2022

OBJECTIVES:
Ventricular assist devices (VADs) are increasingly used in pediatric heart failure as bridges to heart transplantation, although 25% will die with VADs. Family experiences in this population are not well-described. The objective is to understand bereaved families’ perspectives on VAD and end-of-life decision-making.

DESIGN:
Semistructured interviews with bereaved caregivers of pediatric VAD patients.

SETTING:
Tertiary children’s hospital.

PATIENTS:
Families of six pediatric VAD patients who died from 2014 to 2020.

INTERVENTIONS:
Not available.

MEASUREMENTS AND MAIN RESULTS:
Applying a grounded theory framework, interviews were coded by two independent readers using qualitative software. Themes were discussed in iterative multidisciplinary meetings. Participants were interviewed at a median 2.4 years after their child died. Three major themes emerged: 1) “lack of regret” for VAD implantation despite the outcome; 2) “caregiver-child accord” (via patient’s verbal assent or physical cues) at implantation and end-of-life was important in family decision-making; and 3) development of a “local surrogate family” (medical team and peer families) provided powerful support.

CONCLUSIONS:
Bereaved families’ perspectives provide insight into quality decision-making for major interventions and end-of-life care in pediatric patients with chronic illness who face decisions regarding technology dependence.
Centering Health Equity Within COVID-19 Contact Tracing: Connecticut's Community Outreach Specialist Program
Authors: Johnson Kelly , Diallo Kadijatou , Hennein Rachel , Shelby Tyler , Zhou Xin , Gupta Amanda J. , Ludomirsky Avital , Weiss June-Marie , Nunez-Smith Marcella , Soto Kristen , Davis J. Lucian 
Published: October 2022

Context:
The COVID-19 pandemic has disproportionately impacted vulnerable populations, including those who are non–English-speaking and those with lower socioeconomic status; yet, participation of these groups in contact tracing was initially low. Distrust of government agencies, anticipated COVID-19–related stigma, and language and cultural barriers between contact tracers and communities are common challenges.

Program:
The Community Outreach Specialist (COS) program was established within the Connecticut Department of Public Health (DPH) COVID-19 contact tracing program to encourage participation in contact tracing and address a need for culturally competent care and social and material support among socially vulnerable and non–English-speaking populations in 11 high-burden jurisdictions in Connecticut.

Implementation:
In partnership with state and local health departments, we recruited 25 COS workers with relevant language skills from target communities and trained them to deliver contact tracing services to vulnerable and non–English speaking populations.

Evaluation:
We conducted a cross-sectional analysis using data from ContaCT, DPH's enterprise contact tracing system. Overall, the COS program enrolled 1938 cases and 492 contacts. The proportion of residents reached (ie, called and interviewed) in the COS program was higher than that in the regular contact tracing program for both cases (70% vs 57%, P < .001) and contacts (84% vs 64%, P < .001). After adjusting for client age, sex, race and ethnicity, language, and jurisdiction, we found that the COS program was associated with increased reach for contacts (odds ratio [OR] = 1.52; 95% confidence interval [95% CI], 1.17-1.99) but not for cases (OR = 0.78; 95% CI, 0.70-0.88). Rapid qualitative analysis of programmatic field notes and meeting reports provided evidence that the COS program was feasible and acceptable to clients and contributed to COVID-19 education and communication efforts.

Conclusion:
A COS program employing a client-centered, community-engaged strategy for reaching vulnerable and non–English-speaking populations was feasible and more effective at reaching contacts than standard COVID-19 contact tracing.
First Responder Assertive Linkage Programs: A Scoping Review of Interventions to Improve Linkage to Care for People Who Use Drugs
Authors: Worthington Nancy , Gilliam Talayha , Mital Sasha , Caslin Sharon 
Published: October 2022

Context:
In response to the drug overdose crisis, first responders, in partnership with public health, provide new pathways to substance use disorder (SUD) treatment and other services for individuals they encounter in their day-to-day work.

Objective:
This scoping review synthesizes available evidence on first responder programs that take an assertive approach to making linkages to care.

Results:
Seven databases were searched for studies published in English in peer-reviewed journals between January 2000 and December 2019. Additional articles were identified through reference-checking and subject matter experts. Studies were selected for inclusion if they sufficiently described interventions that (1) focus on adults who use drugs; (2) are in the United States; (3) involve police, fire, or emergency medical services; and (4) assertively link individuals to SUD treatment. Twenty-two studies met inclusion criteria and described 34 unique programs, implementation barriers and facilitators, assertive linkage strategies, and linkage outcomes, including unintended consequences.

Conclusions:
Findings highlight the range of linkage strategies concurrently implemented and areas for improving practice and research, such as the need for more linkages to evidence-based strategies, namely, medications for opioid use disorder, harm reduction, and wraparound services.
COVID-19 Vaccine Acceptability Among People Experiencing Homelessness in Central Florida and Southern Nevada, March-June 2021
Authors: Meehan Ashley A. , Aarvig Kathleen , Kashani Mitra , Whitton Alaina , Mosites Emily 
Published: October 2022

Context:
Understanding COVID-19 vaccine acceptability among people experiencing homelessness is critical to improve vaccine coverage during the COVID-19 pandemic. Little is known about COVID-19 vaccine acceptability people experiencing unsheltered homelessness (PEUH).

Objective:
To identify and describe motivators for receiving a COVID-19 vaccine and reasons for hesitancy, information sources utilized and trusted for vaccine decision making, logistical barriers to receiving vaccination, and what might increase comfortability to receive a COVID-19 vaccination among PEUH.

Design:
Cross-sectional survey design, implemented from March to June 2021.

Setting:
Two US cities: Las Vegas and Nevada (urban), and Orlando, Florida (suburban).

Participants:
People experiencing predominantly unsheltered homelessness accessing handwashing stations and other wrap-around social services at program sites managed by Clean the World Foundation.

Main Outcome Measures:
The main outcome measures assessed included survey responses about current vaccine receipt (if participants have already received one or more doses of a COVID-19 vaccine), intention to receive a COVID-19 vaccine if not already received, motivators for receiving or wanting to receive a vaccine, reasons for hesitancy or uncertainty about receiving a vaccine, sources of information regarding COVID-19 vaccines, and actual or anticipated logistical barriers or challenges to receiving COVID-19 vaccines.

Results:
Among 864 participants, 465 (53.8%) were classified as “vaccine accepting,” and 399 were classified “vaccine hesitant or undecided.” The primary motivator to be vaccinated was to protect their health (212, 45.6%). Hesitant or undecided participants reported that vaccines were too new (269, 67.4%) or they needed more information (223, 55.9%) and were more likely to receive information from social media than accepting participants (80.0% vs 58.3%, P < .001). Logistical barriers to vaccination included distance to vaccination locations (85, 21.3%), lack of transportation (79, 19.8%), and limited time (64, 16%).

Conclusions:
Vaccination efforts to reach PEUH should consider how information and logistical needs may be addressed.
A comparative study of secondary procedures after sub-pectoral and pre-pectoral single-stage implant-based breast reconstruction
Authors: Abbas Abeera , Rizki Hirah , Tanska Aleksandra , Concepcion Mae , Tasoulis Marios Konstantinos , Gui Gerald 
Published: October 2022

Background:
Implant-based breast reconstruction (IBR) is the most commonly employed procedure to reconstruct the breast after mastectomy. The advantages and disadvantages of sub-pectoral versus pre-pectoral implant placement remain a matter of debate. This study compares the need for secondary aesthetic procedures between pre-pectoral and sub-pectoral IBR.

Methods:
This is a retrospective cohort study of consecutive patients who underwent sub-pectoral or pre-pectoral IBR between 2015-2018 under a single surgeon at a tertiary breast unit. The primary end-point was the number of secondary procedures performed to improve the aesthetic outcome. Secondary endpoints included the number of secondary procedures during the first year.

Results:
A total of 271 one-stage IBRs were performed (sub-pectoral n=128 in 74 patients, pre-pectoral n=143 in 84 patients). Overall, more patients required secondary procedures in the sub-pectoral group (36.5% vs 19%; P=0.014) although through longer follow-up. The commonest procedures were pocket revision and implant exchange (11.7% vs 3.5%, P=0.010; 11.7% vs 4.2%, P=0.021) while fat grafting was similar between the two groups (46% vs 40.5%, P=0.777). When adjusted for follow-up time, there was no significant difference in the number of secondary procedures undertaken in the sub-pectoral versus the pre-pectoral groups, (21% vs 16% respectively, P=0.288) at 1 year.

Conclusion:
The requirement for secondary procedures at one year was not different between groups. The need for fat grafting was not increased following pre-pectoral IBR.
Clinical Implications and Management of Non-ALCL Breast Implant Capsular Pathology
Authors: Vorstenbosch Joshua , Chu Jacqueline J. , Ariyan Charlotte E. , McCarthy Colleen M. , Disa Joseph J. , Nelson Jonas A. 
Published: October 2022

SUMMARY:
The breast implant capsule is a dynamic structure that forms following the implantation of a device. Although normally benign, increased awareness of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) highlights that disease may arise from the capsule. BIA-ALCL presents as a late seroma or mass but explains few of the late seromas found in breast implant patients. To date, many of these seromas lack a clear etiology and are often described as ”idiopathic.” Several benign and malignant breast implant capsular pathologies can cause a late seroma or mass. Similar to early reports of BIA-ALCL, these conditions are rare and largely limited to case reports or series.
The purpose of this special topic is to present a narrative review highlighting capsular pathologies that contribute to the formation of late seroma or mass in an attempt to broaden the differential diagnosis and help plastic surgeons identify the etiology. Specifically, we review the presentation and management of BIA-ALCL, synovial metaplasia, capsular epithelialization, late hematoma, double capsule, breast cancer, squamous cell carcinoma, mesenchymal tumor, and B-cell lymphoma. Although rare, plastic surgeons should consider these capsular conditions as causes of late seromas and masses. Usually, these conditions may be diagnosed by following the National Comprehensive Cancer Network (NCCN) screening guidelines for BIA-ALCL. Thorough evaluation and workup of late seromas and masses may lead to improved characterization of these rare breast implant capsular conditions and improve our understanding of their pathophysiology and management.
The Dual Plane Gluteal Augmentation. An Anatomical Demonstration of a New Pocket Design
Authors: Aslani Alexander , del Vecchio Daniel , Bravo Miguel G. , Zholtikov Vitaly , Palhazi Peter 
Published: October 2022

Background:
Fat grafting is the favored option for buttock augmentation by most surgeons and buttock implants are mostly regarded second choice. Accepted options for buttock implant pocket dissection are subfascial, intramuscular and submuscular. To overcome the limitations of both intramuscular and submuscular pockets, and combine the benefits that both of them have, we present a novel dual-plane pocket dissection. The dual plane pocket means a submuscular plane in the cranial half of the pocket and switching to an intramuscular plane in the caudal half. With this study we want to describe our experience with this technique and analyze the dissection of the pocket on human cadavers.

Methods:
We have reviewed 82 consecutive composite gluteal augmentation cases from March 2019 to November 2019. In all cases the implant has been placed “dual plane”. The clinical study has been supplemented by 10 hemigluteal dissections in 5 cadavers following the surgical technique, assessing afterwards the anatomical components of the implant pocket created.

Results:
Patients who underwent this technique showed excellent soft tissue coverage over the implants. Main complications observed were seroma formation (5 out of 82 patients) and temporary sciatic pain in 4 of the patients. The anatomical study confirmed double muscle coverage of both gluteus maximus and partial medius in the upper pocket pole, and intramuscular gluteus maximus implant position in the lower pole.

Conclusion:
We present the dual-plane dissection technique as a valuable innovation to improve soft tissue cover for the upper implant pole in buttock implant surgery.