bluuebunny/crossref_metadata_2025 huggingface dataset:
Status Update on Infection Prevention and Control at Deployed Medical Treatment Facilities
Authors: Barsoumian Alice E , Solberg Steffanie L , Hanhurst Ashley S , Roth Amanda L , Funari Tamara S , Cruz-Fehr Maria Cristina E , Crouch Helen , Florez Christopher , Murray Clinton K
Published: November 2019

Introduction

Infections with multidrug resistant organisms that spread through nosocomial transmission complicate the care of combat casualties. Missions conducted to review infection prevention and control (IPC) practices at deployed medical treatment facilities (MTFs) previously showed gaps in best practices and saw success with targeted interventions. An IPC review has not been conducted since 2012. Recently, an IPC review was requested in response to an outbreak of multidrug resistant organisms at a deployed facility.

Materials and Methods

A Joint Service team conducted onsite IPC reviews of MTFs in the U.S. Central Command area of operations. Self-assessments were completed by MTF personnel in anticipation of the onsite assessment, and feedback was given individually and at monthly IPC working group teleconferences. Goals of the onsite review were to assist MTF teams in conducting assessments, review practices for challenges and successes, provide on the spot education or risk mitigation, and identify common trends requiring system-wide action.

Results

Nine deployed MTFs participated in the onsite assessments, including four Role 3, three Role 2 capable of surgical support, and two Role 1 facilities. Seventy-eight percent of sites had assigned IPC officers although only 43% underwent required predeployment training. Hand hygiene and healthcare associated infection prevention bundles were monitored at 67% and 29% of MTFs, respectively. Several challenges including variability in practices with turnover of deployed teams were noted. Successes highlighted included individual team improvements in healthcare associated infections and mentorship of untrained personnel.

Conclusions

Despite successes, ongoing challenges with optimal deployed IPC were noted. Recommendations for improvement include strengthening IPC culture, accountability, predeployment training, and stateside support for deployed IPC assets. Variability in IPC practices may occur from rotation to rotation, and regular reassessment is required to ensure that successes are sustained through times of turnover.
Asymptotic kinematics of globular clusters: The emergence of a Tully–Fisher relation
Authors: Hernandez X , Lara-D I A J
Published: November 2019

Using a recent homogeneous sample of 40 high-quality velocity dispersion profiles for Galactic globular clusters, we study the regime of low gravitational acceleration relevant to the outskirts of these systems. We find that a simple empirical profile having a central Gaussian component and a constant large-radius asymptote, σ∞, accurately describes the variety of observed velocity dispersion profiles. We use published population synthesis models, carefully tailored to each individual cluster, to estimate mass-to-light ratios from which total stellar masses, M, are inferred. We obtain a clear scaling, reminiscent of the galactic Tully–Fisher relation of $\sigma _{\infty }[\, \mathrm{km \, s}^{-1}]= 0.084^{+0.075}_{-0.040} (\mathrm{{\it M}/M}_{\odot })^{0.3 \pm 0.051}$, which is interesting to compare to the deep modified Newtonian dynamics (MOND) limit of $\sigma _{\infty } [\mathrm{km \, s}^{-1}]=0.2(\mathrm{{\it M}/M}_{\odot })^{0.25}$. Under a Newtonian interpretation, our results constitute a further restriction on models where initial conditions are crafted to yield the outer flattening observed today. Within a modified gravity scheme, because the globular clusters studied are not isolated objects in the deep MOND regime, the results obtained point towards a modified gravity where the external field effect of MOND does not appear, or is significantly suppressed.
Variability in extragalactic class I methanol masers: new maser components towards NGC 4945 and NGC 253
Authors: McCarthy T P , Ellingsen S P , Breen S L , Voronkov M A , Chen X , Qiao H-h
Published: November 2019

We have used the Australia Telescope Compact Array (ATCA) to make new observations of the 36.2-GHz (4−1 → 30E) methanol transition towards NGC 4945 and NGC 253. These observations have revealed the presence of new maser components towards these galaxies, and have provided the first clear evidence for variability in extragalactic class I methanol masers. Alongside the new observations of NGC 4945 and NGC 253, we present the results of recent 36.2-GHz methanol maser searches towards 12 galaxies, placing upper limits on the emission from the 36.2-GHz class I transition and the 37.7-GHz (72 → 81E) class II maser line towards these sources. Flux density values for the 7-mm continuum emission towards these sources are also reported where applicable. A re-analysis of the published 36.2-GHz methanol observations of Arp 220 undertaken as part of the search revealed some issues with previous imaging procedures. The re-analysis, combined with non-detections in independent follow-up observations, suggests that there is no 36.2-GHz methanol emission towards Arp 220 stronger than 3.5 mJy in a 10 km s−1 channel (5σ upper limit).
Disentangling magnification in combined shear-clustering analyses
Authors: Thiele Leander , Duncan Christopher A J , Alonso David
Published: November 2019

We investigate the sensitivity to the effects of lensing magnification on large-scale structure analyses combining photometric cosmic shear and galaxy clustering data (i.e. the now commonly called ‘3 × 2-point’ analysis). Using a Fisher matrix bias formalism, we disentangle the contribution to the bias on cosmological parameters caused by ignoring the effects of magnification in a theory fit from individual elements in the data vector, for Stage-III and Stage-IV surveys. We show that the removal of elements of the data vectors that are dominated by magnification does not guarantee a reduction in the cosmological bias due to the magnification signal, but can instead increase the sensitivity to magnification. We find that the most sensitive elements of the data vector come from the shear-clustering cross-correlations, particularly between the highest redshift shear bin and any lower redshift lens sample, and that the parameters ΩM, $S_8=\sigma _8\sqrt{\Omega _\mathrm{ M}/0.3}$, and w0 show the most significant biases for both survey models. Our forecasts predict that current analyses are not significantly biased by magnification, but this bias will become highly significant with the continued increase of statistical power in the near future. We therefore conclude that future surveys should measure and model the magnification as part of their flagship ‘3 × 2-point’ analysis.
LINCS Data Portal 2.0: next generation access point for perturbation-response signatures
Authors: Stathias Vasileios , Turner John , Koleti Amar , Vidovic Dusica , Cooper Daniel , Fazel-Najafabadi Mehdi , Pilarczyk Marcin , Terryn Raymond , Chung Caty , Umeano Afoma , Clarke Daniel J B , Lachmann Alexander , Evangelista John Erol , Ma’ayan Avi , Medvedovic Mario , Schürer Stephan C
Published: November 2019

The Library of Integrated Network-Based Cellular Signatures (LINCS) is an NIH Common Fund program with the goal of generating a large-scale and comprehensive catalogue of perturbation-response signatures by utilizing a diverse collection of perturbations across many model systems and assay types. The LINCS Data Portal (LDP) has been the primary access point for the compendium of LINCS data and has been widely utilized. Here, we report the first major update of LDP (http://lincsportal.ccs.miami.edu/signatures) with substantial changes in the data architecture and APIs, a completely redesigned user interface, and enhanced curated metadata annotations to support more advanced, intuitive and deeper querying, exploration and analysis capabilities. The cornerstone of this update has been the decision to reprocess all high-level LINCS datasets and make them accessible at the data point level enabling users to directly access and download any subset of signatures across the entire library independent from the originating source, project or assay. Access to the individual signatures also enables the newly implemented signature search functionality, which utilizes the iLINCS platform to identify conditions that mimic or reverse gene set queries. A newly designed query interface enables global metadata search with autosuggest across all annotations associated with perturbations, model systems, and signatures.
RiboVIEW: a computational framework for visualization, quality control and statistical analysis of ribosome profiling data
Authors: Legrand Carine , Tuorto Francesca
Published: November 2019

Recently, newly developed ribosome profiling methods based on high-throughput sequencing of ribosome-protected mRNA footprints allow to study genome-wide translational changes in detail. However, computational analysis of the sequencing data still represents a bottleneck for many laboratories. Further, specific pipelines for quality control and statistical analysis of ribosome profiling data, providing high levels of both accuracy and confidence, are currently lacking. In this study, we describe automated bioinformatic and statistical diagnoses to perform robust quality control of ribosome profiling data (RiboQC), to efficiently visualize ribosome positions and to estimate ribosome speed (RiboMine) in an unbiased way. We present an R pipeline to setup and undertake the analyses that offers the user an HTML page to scan own data regarding the following aspects: periodicity, ligation and digestion of footprints; reproducibility and batch effects of replicates; drug-related artifacts; unbiased codon enrichment including variability between mRNAs, for A, P and E sites; mining of some causal or confounding factors. We expect our pipeline to allow an optimal use of the wealth of information provided by ribosome profiling experiments.
A heterodimer of evolved designer-recombinases precisely excises a human genomic DNA locus
Authors: Lansing Felix , Paszkowski-Rogacz Maciej , Schmitt Lukas Theo , Schneider Paul Martin , Rojo Romanos Teresa , Sonntag Jan , Buchholz Frank
Published: November 2019

Site-specific recombinases (SSRs) such as the Cre/loxP system are useful genome engineering tools that can be repurposed by altering their DNA-binding specificity. However, SSRs that delete a natural sequence from the human genome have not been reported thus far. Here, we describe the generation of an SSR system that precisely excises a 1.4 kb fragment from the human genome. Through a streamlined process of substrate-linked directed evolution we generated two separate recombinases that, when expressed together, act as a heterodimer to delete a human genomic sequence from chromosome 7. Our data indicates that designer-recombinases can be generated in a manageable timeframe for precision genome editing. A large-scale bioinformatics analysis suggests that around 13% of all human protein-coding genes could be targetable by dual designer-recombinase induced genomic deletion (dDRiGD). We propose that heterospecific designer-recombinases, which work independently of the host DNA repair machinery, represent an efficient and safe alternative to nuclease-based genome editing technologies.
Cognitive impairment after cytotoxic chemotherapy
Authors: Huehnchen Petra , van Kampen Antonia , Boehmerle Wolfgang , Endres Matthias
Published: November 2019

Background

Neurotoxicity is a frequent side effect of cytotoxic chemotherapy and affects a large number of patients. Despite the high medical need, few research efforts have addressed the impact of cytotoxic agents on cognition (ie, postchemotherapy cognitive impairment; PCCI). One unsolved question is whether individual cytotoxic drugs have differential effects on cognition. We thus examine the current state of research regarding PCCI. Neurological symptoms after targeted therapies and immunotherapies are not part of this review.

Methods

A literature search was conducted in the PubMed database, and 1215 articles were reviewed for predefined inclusion and exclusion criteria. Thirty articles were included in the systematic review.

Results

Twenty-five of the included studies report significant cognitive impairment. Of these, 21 studies investigated patients with breast cancer. Patients mainly received combinations of 5-fluorouracil, epirubicin, cyclophosphamide, doxorubicin, and taxanes (FEC/FEC-T). Five studies found no significant cognitive impairment in chemotherapy patients. Of these, 2 studies investigated patients with colon cancer receiving 5-fluorouracil and oxaliplatin (FOLFOX). Independent risk factors for PCCI were patient age, mood alterations, cognitive reserve, and the presence of apolipoprotein E e4 alleles.

Conclusions

There is evidence that certain chemotherapy regimens cause PCCI more frequently than others as evidenced by 21 out of 23 studies in breast cancer patients (mainly FEC-T), whereas 2 out of 3 studies with colon cancer patients (FOLFOX) did not observe significant changes. Further studies are needed defining patient cohorts by treatment protocol in addition to cancer type to elucidate the effects of individual cytotoxic drugs on cognitive functions.
Wearable Egocentric Camera as a Monitoring Tool of Free-Living Cigarette Smoking: A Feasibility Study
Authors: Imtiaz Masudul H , Hossain Delwar , Senyurek Volkan Y , Belsare Prajakta , Tiffany Stephen , Sazonov Edward
Published: November 2019

Introduction

Wearable sensors may be used for the assessment of behavioral manifestations of cigarette smoking under natural conditions. This paper introduces a new camera-based sensor system to monitor smoking behavior. The goals of this study were (1) identification of the best position of sensor placement on the body and (2) feasibility evaluation of the sensor as a free-living smoking-monitoring tool.

Methods

A sensor system was developed with a 5MP camera that captured images every second for continuously up to 26 hours. Five on-body locations were tested for the selection of sensor placement. A feasibility study was then performed on 10 smokers to monitor full-day smoking under free-living conditions. Captured images were manually annotated to obtain behavioral metrics of smoking including smoking frequency, smoking environment, and puffs per cigarette. The smoking environment and puff counts captured by the camera were compared with self-reported smoking.

Results

A camera located on the eyeglass temple produced the maximum number of images of smoking and the minimal number of blurry or overexposed images (53.9%, 4.19%, and 0.93% of total captured, respectively). During free-living conditions, 286,245 images were captured with a mean (±standard deviation) duration of sensor wear of 647(±74) minutes/participant. Image annotation identified consumption of 5(±2.3) cigarettes/participant, 3.1(±1.1) cigarettes/participant indoors, 1.9(±0.9) cigarettes/participant outdoors, and 9.02(±2.5) puffs/cigarette. Statistical tests found significant differences between manual annotations and self-reported smoking environment or puff counts.

Conclusions

A wearable camera-based sensor may facilitate objective monitoring of cigarette smoking, categorization of smoking environments, and identification of behavioral metrics of smoking in free-living conditions.

Implications

The proposed camera-based sensor system can be employed to examine cigarette smoking under free-living conditions. Smokers may accept this unobtrusive sensor for extended wear, as the sensor would not restrict the natural pattern of smoking or daily activities, nor would it require any active participation from a person except wearing it. Critical metrics of smoking behavior, such as the smoking environment and puff counts obtained from this sensor, may generate important information for smoking interventions.
Parental Unemployment and the Transition into Tertiary Education: Can Institutions Moderate the Adverse Effects?
Authors: Lindemann Kristina , Gangl Markus
Published: November 2019

We examine how parental unemployment affects children’s transition to postsecondary education in different institutional contexts. Drawing on theoretical perspectives in intergenerational mobility research and sociology of higher education, we estimate the extent to which these intergenerational effects depend on social and education policies. We use data from five longitudinal surveys to analyze the effects of parental unemployment on entry to postsecondary education in 21 countries. The results of multilevel regression analysis show that in contexts that provide better insurance against unemployment, in terms of generous earnings replacement, the adverse effect of parental unemployment is alleviated. Moreover, entry gaps between youth from unemployed and employed households are smaller in tertiary education systems with more opportunity-equalizing education policies that provide more financial support to students and reduce the role of private expenditure. Some evidence also indicates that policies are more relevant for children of less-educated unemployed parents.
Impossibility Results on Stability of Phylogenetic Consensus Methods
Authors: Delucchi Emanuele , Hoessly Linard , Paolini Giovanni
Published: November 2019

We answer two questions raised by Bryant, Francis, and Steel in their work on consensus methods in phylogenetics. Consensus methods apply to every practical instance where it is desired to aggregate a set of given phylogenetic trees (say, gene evolution trees) into a resulting, “consensus” tree (say, a species tree). Various stability criteria have been explored in this context, seeking to model desirable consistency properties of consensus methods as the experimental data are updated (e.g., more taxa, or more trees, are mapped). However, such stability conditions can be incompatible with some basic regularity properties that are widely accepted to be essential in any meaningful consensus method. Here, we prove that such an incompatibility does arise in the case of extension stability on binary trees and in the case of associative stability. Our methods combine general theoretical considerations with the use of computer programs tailored to the given stability requirements. [Associative stability; consensus; extension stability; phylogeny.]
Reticulate Evolution Helps Explain Apparent Homoplasy in Floral Biology and Pollination in Baobabs (Adansonia; Bombacoideae; Malvaceae)
Authors: Karimi Nisa , Grover Corrinne E , Gallagher Joseph P , Wendel Jonathan F , Ané Cécile , Baum David A
Published: November 2019

Baobabs (Adansonia) are a cohesive group of tropical trees with a disjunct distribution in Australia, Madagascar, and continental Africa, and diverse flowers associated with two pollination modes. We used custom-targeted sequence capture in conjunction with new and existing phylogenetic comparative methods to explore the evolution of floral traits and pollination systems while allowing for reticulate evolution. Our analyses suggest that relationships in Adansonia are confounded by reticulation, with network inference methods supporting at least one reticulation event. The best supported hypothesis involves introgression between Adansonia rubrostipa and core Longitubae, both of which are hawkmoth pollinated with yellow/red flowers, but there is also some support for introgression between the African lineage and Malagasy Brevitubae, which are both mammal-pollinated with white flowers. New comparative methods for phylogenetic networks were developed that allow maximum-likelihood inference of ancestral states and were applied to study the apparent homoplasy in floral biology and pollination mode seen in Adansonia. This analysis supports a role for introgressive hybridization in morphological evolution even in a clade with highly divergent and geographically widespread species. Our new comparative methods for discrete traits on species networks are implemented in the software PhyloNetworks. [Comparative methods; Hyb-Seq; introgression; network inference; population trees; reticulate evolution; species tree inference; targeted sequence capture.]
Orogeny, sympatry and emergence of a new genus of Alpine subterranean Trechini (Coleoptera: Carabidae)
Authors: Delić Teo , Kapla Andrej , Colla Andrea
Published: November 2019

Despite two centuries of research in European subterranean habitats, which resulted in descriptions of numerous obligate subterranean beetle species, the role of ecological differentiation in speciation of subterranean beetles remains understudied. Discovery of a new genus and a species of Alpine subterranean Trechini beetles, Petraphaenops unguiculatus gen. & sp. nov., enables us to question the reasons for its morphological and ecological divergence. Multilocus, time-calibrated phylogeny and extensive morphological analyses were used to place the evolution of the species in a temporal and palaeogeographical framework. Set within the phylogeny of Alpine Trechini, the new genus is shown to have split from its sister-genus, Aphaenopidius, by the end of the Pliocene. The timeline of the split between these closely related genera corresponds to the onset of major orogenetic events in the southern Calcareous Alps. The orogeny dynamics, coupled with simultaneous diversification of subterranean habitats, presumably initiated ecological speciation and morphological diversification of this highly troglomorphic subterranean trechine genus.
Natural Variation in Portuguese Common Bean Germplasm Reveals New Sources of Resistance Against Fusarium oxysporum f. sp. phaseoli and Resistance-Associated Candidate Genes
Authors: Leitão Susana T. , Malosetti Marcos , Song Qijan , van Eeuwijk Fred , Rubiales Diego , Vaz Patto Maria Carlota
Published: November 2019

Common bean (Phaseolus vulgaris) is one of the most consumed legume crops in the world, and Fusarium wilt, caused by the fungus Fusarium oxysporum f. sp. phaseoli, is one of the major diseases affecting its production. Portugal holds a very promising common bean germplasm with an admixed genetic background that may reveal novel genetic resistance combinations between the original Andean and Mesoamerican gene pools. To identify new sources of Fusarium wilt resistance and detect resistance-associated single-nucleotide polymorphisms (SNPs), we explored, for the first time, a diverse collection of the underused Portuguese common bean germplasm by using genome-wide association analyses. The collection was evaluated for Fusarium wilt resistance under growth chamber conditions, with the highly virulent F. oxysporum f. sp. phaseoli strain FOP-SP1 race 6. Fourteen of the 162 Portuguese accessions evaluated were highly resistant and 71 intermediate. The same collection was genotyped with DNA sequencing arrays, and SNP–resistance associations were tested via a mixed linear model accounting for the genetic relatedness between accessions. The results from the association mapping revealed nine SNPs associated with resistance on chromosomes Pv04, Pv05, Pv07, and Pv08, indicating that Fusarium wilt resistance is under oligogenic control. Putative candidate genes related to phytoalexin biosynthesis, hypersensitive response, and plant primary metabolism were identified. The results reported here highlight the importance of exploring underused germplasm for new sources of resistance and provide new genomic targets for the development of functional markers to support selection in future disease resistance breeding programs.
New medication adverse reaction education
Authors: Price Jordan B.
Published: November 2019

Increasing patient satisfaction scores
Implementation of chlorhexidine gluconate bathing to reduce HAIs
Authors: DePrez Bernadette , Schreeder Carolyn , Davidson Susan
Published: November 2019

A nurse leader-led evidence-based practice change
Common Types of Gender-Based Microaggressions in Medicine
Authors: Periyakoil Vyjeyanthi S. , Chaudron Linda , Hill Emorcia V. , Pellegrini Vincent , Neri Eric , Kraemer Helena C.
Published: November 2019

Purpose

Microaggressions are subtle verbal or nonverbal everyday behaviors that arise from unconscious bias, covert prejudice, or hostility. They may contribute to the persistent disparities faced by women in medicine. In this study, the authors sought to identify common microaggressions experienced by women faculty in medicine and to determine if specific demographic characteristics affect the reported frequencies of these microaggressions.

Method

The authors used chain referral sampling to collect real-life anecdotes about microaggressions from women faculty across the nation. Thirty-four unique experiences from those reported were identified and scripted then reenacted using professional actors to create 34 videos of the real-life microaggressions and 34 corresponding fictional “control” versions of the same situations. The videos, presented in a random order, were evaluated by faculty from 4 academic medical centers from 2016 to 2018.

Results

A total of 124 faculty (79 women, 45 men) participated. Women reported higher frequencies of microaggressions than men in 33 of the 34 videos depicting microaggressions (P value range: < .001 to .042, area under the curve range: 0.60–0.69). No such differences were seen with the control videos. Women identified 21 microaggressions as occurring frequently. No significant differences were found with respect to participants’ age, race/ethnicity, academic rank, or years in medicine. Post hoc analyses showed that the microaggressions fell into 6 themes: encountering sexism, encountering pregnancy- and child care–related bias, having abilities underestimated, encountering sexually inappropriate comments, being relegated to mundane tasks, and feeling excluded/marginalized.

Conclusions

Privilege is often invisible to those who have it, whereas bias and discrimination are readily apparent to those who experience it. Knowledge of common microaggressions will allow for targeted individual, interpersonal, and institutional solutions to mitigate disparities in medicine.
Evidence of Vowel Discrimination Provided by the Acoustic Change Complex
Authors: Cheek Diane , Cone Barbara
Published: November 2019

Objectives:

The objectives of this study were to measure the effects of level and vowel contrast on the latencies and amplitudes of acoustic change complex (ACC) in the mature auditory system. This was done to establish how the ACC in healthy young adults is affected by these stimulus parameters that could then be used to inform translation of the ACC into a clinical measure for the pediatric population. Another aim was to demonstrate that a normalized amplitude metric, calculated by dividing the ACC amplitude in the vowel contrast condition by the ACC amplitude obtained in a control condition (no vowel change) would demonstrate good sensitivity with respect to perceptual measures of vowel-contrast detection. The premises underlying this research were that: (1) ACC latencies and amplitudes would vary with level, in keeping with principles of an increase in neural synchrony and activity that takes place as a function of increasing stimulus level; (2) ACC latencies and amplitudes would vary with vowel contrast, because cortical auditory evoked potentials are known to be sensitive to the spectro-temporal characteristics of speech.

Design:

Nineteen adults, 14 of them female, with a mean age of 24.2 years (range 20 to 38 years) participated in this study. All had normal-hearing thresholds. Cortical auditory evoked potentials were obtained from all participants in response to synthesized vowel tokens (/a/, /i/, /o/, /u/), presented in a quasi-steady state fashion at a rate of 2/sec in an oddball stimulus paradigm, with a 25% probability of the deviant stimulus. The ACC was obtained in response to the deviant stimulus. All combinations of vowel tokens were tested at 2 stimulus levels: 40 and 70 dBA. In addition, listeners were tested for their ability to detect the vowel contrasts using behavioral methods.

Results:

ACC amplitude varied systematically with level, and test condition (control versus contrast) and vowel token, but ACC latency did not. ACC amplitudes were significantly larger when tested at 70 dBA compared with 40 dBA and for contrast trials compared with control trials at both levels. Amplitude ratios (normalized amplitudes) were largest for contrast pairs in which /a/ was the standard token. The amplitude ratio metric at the individual level demonstrated up to 97% sensitivity with respect to perceptual measures of discrimination.

Conclusions:

The present study establishes the effects of stimulus level and vowel type on the latency and amplitude of the ACC in the young adult auditory system and supports the amplitude ratio as a sensitive metric for cortical acoustic salience of vowel spectral features. Next steps are to evaluate these methods in infants and children with hearing loss with the long-term goal of its translation into a clinical method for estimating speech feature discrimination.
Family Environment in Children With Hearing Aids and Cochlear Implants: Associations With Spoken Language, Psychosocial Functioning, and Cognitive Development
Authors: Holt Rachael Frush , Beer Jessica , Kronenberger William G. , Pisoni David B. , Lalonde Kaylah , Mulinaro Lindsay
Published: November 2019

Objectives:

To examine differences in family environment and associations between family environment and key speech, language, and cognitive outcomes in samples of children with normal hearing and deaf and hard-of-hearing (DHH) children who use hearing aids and cochlear implants.

Design:

Thirty families of children with normal hearing (n = 10), hearing aids (n = 10), or cochlear implants (n = 10) completed questionnaires evaluating executive function, social skills, and problem behaviors. Children’s language and receptive vocabulary were evaluated using standardized measures in the children’s homes. In addition, families were administered a standardized in-home questionnaire and observational assessment regarding the home environment.

Results:

Family environment overall was similar across hearing level and sensory aid, although some differences were found on parental responsivity and physical environment. The level of supportiveness and enrichment within family relationships accounted for much of the relations between family environment and the psychosocial and neurocognitive development of DHH children. In contrast, the availability of objects and experiences to stimulate learning in the home was related to the development of spoken language.

Conclusions:

Whereas broad characteristics of the family environments of DHH children may not differ from those of hearing children, variability in family functioning is related to DHH children’s at-risk speech, language, and cognitive outcomes. Results support the importance of further research to clarify and explain these relations, which might suggest novel methods and targets of family-based interventions to improve developmental outcomes.
Comparison of Locked Plating of Varus Displaced Proximal Humeral Fractures With and Without Fibula Allograft Augmentation
Authors: Davids Stephen , Allen Dexter , Desarno Michael , Endres Nathan K. , Bartlett Craig , Shafritz Adam
Published: November 2019

Objective:

To compare the clinical and radiographic outcomes between patients treated with fibula allograft-augmented locking compression fixation and patients treated with locking compression fixation alone for 2- and 3-part proximal humeral fractures with varus displacement.

Design:

Retrospective review.

Setting:

Level 1 trauma center.

Patients/Participants:

One hundred two patients treated with locking plate fixation ± fibular allograft augmentation confirmed intraoperatively by visual inspection to have varus-angulated, 2- and 3-part proximal humerus fractures with at least 45 degrees of varus angulation at the neck/shaft and at least 1 cm of displacement.

Intervention:

Proximal humerus locking plate (PHILOS; Synthes, Paoli, PA) with or without fibula allograft augmentation.

Main Outcome Measurements:

Statistical analysis to determine the differences between fractures treated with locking compression fixation ± fibula allograft augmentation regarding complications, shoulder reported outcome measures, and patient ROMs (Visual Analog Score (VAS), Disabilities of the Arm, Shoulder and Hand, and Simple Shoulder Test scores). Medical comorbidities as potential risk factors for complication from surgery were also evaluated.

Results:

Of 102 surgical cases, 27 were augmented with fibula allograft and 75 were not. Postoperatively, there were 16 noncatastrophic varus collapses of the fracture, 6 catastrophic varus collapses, and 5 deaths. Addition of fibula allograft did not significantly affect postoperative varus collapse, shoulder ROM, pain, or PROMs.

Conclusion:

Addition of fibula allograft to patients sustaining varus-angulated, 2- and 3-part proximal humeral fractures conferred no benefit to patient outcomes at our institution.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Early Operative Treatment of Acetabular Fractures Does Not Increase Blood Loss: A Retrospective Review
Authors: Parry Joshua A. , Nino Samanatha , Khosravani Nima , Weber Lee , Haidukewych George J. , Koval Kenneth J. , Langford Joshua R.
Published: November 2019

Objectives:

To compare cell salvage (CS) volume, intraoperative blood loss, intraoperative blood transfusions, and operative time for acetabular fractures undergoing early (≤48 hours from admission) versus delayed fixation (>48 hours from admission).

Design:

Retrospective.

Setting:

Level one trauma center.

Patients:

One hundred thirty-one patients with unilateral acetabular fractures involving at least one column.

Intervention:

Open reduction and internal fixation performed through the anterior intrapelvic approach or posterior approach.

Main Outcome Measurements:

CS volume, estimated blood loss (EBL), intravenous fluids (IVFs), intraoperative packed red blood cells (PRBCs), and operative time.

Results:

Early versus delayed fixation through the posterior approach was associated with shorter operative times and less intraoperative PRBCs (140 vs. 301 mL, MD −161 mL, 95% confidence interval −25 to −296 mL) with no differences in CS, EBL, or IVF. Early versus delayed fixation through an anterior intrapelvic approach was more common in less severe fracture patterns with no differences in PRBCs, CS, EBL, or IVF. CS, through either approach, was successful in returning blood to 77% of patients for an average of 267 ± 168 mL (range, 105–900 mL).

Conclusions:

Fixation of acetabular fractures within 48 hours of admission did not increase blood loss or intraoperative transfusions. CS was successful in returning an average of one unit of blood to a majority of patients.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Reamed Versus Unreamed Intertrochanteric Femur Fractures, Is It Time?
Authors: Pitts Charles C. , Montgomery Tyler P. , Hess Matthew C. , Smith Walter R. , Quade Jonathan H.
Published: November 2019

Objectives:

This study compares the intraoperative and postoperative outcomes of the traditional technique of femoral canal reaming to placement of an unreamed 10-mm nail.

Design:

Retrospective cohort study.

Setting:

Academic Level I Trauma Center, Southeastern US.

Patients/Participants:

Intertrochanteric femur fractures treated with a CMN (January 2016–December 2018) were retrospectively identified. Inclusion criteria were as follows: low-energy mechanism, at least 60 years of age, and long CMN. Exclusion criteria were as follows: short CMN, polytrauma, and subtrochanteric fractures.

Outcome Measurements:

Records were reviewed for demographics, hematologic markers, transfusion rates, operative times, and postoperative complications. Variables were assessed with a χ2 or Student T-test. Significance was set at 0.05.

Results:

Sixty-five patients were included (37 reamed and 28 unreamed), with a mean age of 76.2 years and mean body mass index of 25.1. Between the reamed and unreamed groups, respectively, mean nail size was 11.0 (SD 1.1) and 10.0 (SD 0.0), P < 0.001; mean blood loss was 209.1 mL (SD 177.5) and 195.7 mL (SD 151.5), P = 0.220; 55% (21/38), and 43% (12/28) were transfused, P = 0.319; operative time was 98.2 (SD 47.3) and 81.5 minutes (SD 40.7); P = 0.035. Changes in hemoglobin/hematocrit were not significant between the study groups. Two patients from the reamed group experienced implant failure due to femoral head screw cut out and returned to the operating room. Two patients from the unreamed group returned to operating room for proximal incision infection, without implant removal. One reamed patient and 2 unreamed patients died before 6-month follow-up.

Conclusions:

Unreamed CMNs for geriatric intertrochanteric femur fractures provide shorter operative times with no difference in perioperative complications. Both reamed and unreamed techniques are safe and effective measures for fixation of these fractures.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
True Cost of Operating Room Time: Implications for an Orthopaedic Trauma Service
Authors: Moody Alastair E. , Gurnea Taylor P. , Shul Craig P. , Althausen Peter L.
Published: November 2019

Objective:

To derive an accurate estimate of the operating cost per minute for an orthopaedic trauma room.

Study Design:

Retrospective economic analysis.

Setting:

Level II Trauma Center.

Intervention:

Hospital cost-accounting system query.

Main Outcome Measurements:

Direct fixed costs, direct variable costs, and hospital overhead.

Results:

Operating room per minute costs include direct variable costs of $2.77, direct fixed costs of $2.47, and hospital overhead costs of $10.97. Total per minute costs amounted to $16.21. This does not include professional fees of anesthesiology or surgeons or the costs of soft goods or implants.

Conclusions:

This is the first published study to document the true per minute cost of an orthopaedic trauma operating room. Such information is valuable when defining the value of a dedicated operating room, negotiating employment contracts, defining call stipends, and brokering capital purchases for the orthopaedic trauma service.

Level of Evidence:

Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Regenerative Medicine and Cell Therapy in Orthopedics—Health Policy, Regulatory and Clinical Development, and Market Access
Authors: Spinner Daryl S. , Faulkner Eric C. , Carroll Marissa C. , Ringo Moira C. , Joines John W.
Published: November 2019

Orthopedic indications collectively represent a large clinical and economic burden, especially given the aging world population. To meet this area of unmet need, a wave of regenerative medicine therapies, including stem cells and other cell-based therapies, is currently in clinical development and anticipated to inundate the global market over the next few years. Although intended to be transformative, orthopedic cell therapies face several practical opportunities and challenges. Such therapies could reduce the health care burden, in part by replacing traditional drug therapies and highly-invasive surgical interventions with single-dose treatments. However, therapy developers and providers must address hurdles from regulatory to reimbursement to commercial challenges before successful orthopedic cell therapies are available to patients. Regulatory policies, reimbursement processes, and commercial requirements for orthopedic cell therapies differ across markets, and key health care stakeholders must address these differences well before a product launch. Pricing and reimbursement models for innovative therapies, like cell-based therapies in orthopedics, grow unclear, especially how health care systems will absorb potentially transformative and highly-needed, but costly, therapies. Single administration therapies with relatively high upfront cost require more evidence to support their value for pricing and reimbursement than other health care products, and orthopedic cell therapies must do so based on patient quality of life and health care resource use, as opposed to improved survival, which is especially challenging. In addition, alternative financing and reimbursement models may be needed to support ongoing patient access and innovation. In the current article, we discuss global health policy issues and considerations for orthopedic cell therapy development and adoption.
Along the Axes of Difference: Setting Scholarship and Practice Agendas for Faculty Development
Authors: Reedy Gabriel , Bearman Margaret
Published: November 2019

The rise of academic clinical education programs underlines the growing influence of faculty development on how health care is taught and therefore practiced. Research to date has outlined the rapid rise of these postgraduate qualifications and their impact on their graduates' professional identities. Given the scale and nature of the change, it is worth considering these programs from a broader perspective. “Axes of difference” are invoked to chart the tensions and intersections between various social identities that form distinctive features of clinical education. Six axes are described: patients–clinicians, trainees–trainers, classrooms–clinics, uniprofessional–interprofessional, local–global, and teachers–clinicians. These reveal a range of complexities about faculty development, which can inform both practice and scholarship agendas.
Nurses' Use and Ways of Understanding Web-Based National Guidelines for Child Healthcare
Authors: Tell Johanna , Olander Ewy , Anderberg Peter , Sanmartin Berglund Johan
Published: November 2019

The national Rikshandboken for child healthcare is both a Web-based guideline containing knowledge and methodological guidance and a national child healthcare program in the process of being implemented in Sweden. The aim of this study was to examine child healthcare nurses' use and ways of understanding the national Web-based Rikshandboken. A mixed-methods study with sequential explanatory design in two phases was used; a Web survey with descriptive statistics was followed with telephone interviews with phenomenographic analysis. The study showed variations in use and contributed deeper knowledge of child healthcare nurses' ways of understanding the unit Rikshandboken whose varied parts interact with each other. To be reliable, useful, and relevant for nurses in their specific contexts, Rikshandboken must be kept updated and involve the end users in the development process. With access to technical devices and optimal use of the possibilities of information and communication technology, Rikshandboken can be a resource for continuing learning, a tool in everyday work, and a possible determinant to equality in child healthcare. The study contributes valuable knowledge for the design of Web-based national guidelines for healthcare, making them useful and relevant for the end users.
Nurses' Perceptions of Implant Barcode Scanning in Surgical Services
Authors: Wilson Natalia , Jehn Megan , Kisana Haroon , Reimer Donada , Meister Diane , Valentine Kimberly , Reiser Mark , Clarke Henry
Published: November 2019

The US Food and Drug Administration's 2013 Unique Device Identification System Rule requires manufacturers to label devices with unique identifiers. Implantable devices are now shipped with unique identifiers, and many electronic health records have fields to incorporate them. Health policy changes have prompted hospital systems to assess implementation of implant barcode scanning systems to capture unique device identifiers. Project aims were to assess predictors of operating room nurses' acceptance of a new implant barcode scanning system, describe operating room nurses' perceptions of the system value, and identify operating room nurses' perceived gaps in system implementation. An online survey was disseminated to operating room nurses, and focus groups were conducted with orthopedic operating room nurses in an academic medical center that had recently implemented an implant barcode scanning system in surgical services. Predictors of barcode scanning acceptance included perceived usefulness for patient care, perceived ease of use, and perceived usefulness (self). Nurses perceived the system to be more accurate and valuable for patient safety. Perceived gaps in system implementation related to communication, completeness of the system, consistency in process, and training. Understanding nurse perceptions of new barcode scanning systems and engaging them in the implementation process are key areas for success and optimization of these systems.
What Is the Normal Ulnar Bow in Adult Patients?
Authors: Hreha Jeremy , Congiusta Dominick V. , Ahmed Irfan H. , Vosbikian Michael M.
Published: November 2019

Background

Rotation of the forearm is a result of the complex interaction among the radius, ulna, and interosseous membrane. Although the radius is recognized as curved, the ulna is generally thought of as a “straight bone.” To better describe normal anatomy, which may lead to more successful anatomic fixation of forearm fractures, we aimed to apply a method of measuring the normal ulnar bow and determine the mean ulnar bow in adults.

Questions/purposes

(1) To what degree is the ulna bowed in the coronal and sagittal planes in normal adult forearms? (2) To what degree is the radius bowed in the coronal plane in normal adult forearms?

Methods

Radiographs of the forearms of adults taken during a 1-year period were initially obtained retrospectively. These radiographs were performed for various reasons, including forearm pain and routine radiographic follow-up. Radiographs were excluded if evidence of a fracture or post-fracture fixation was found, if a patient had missing AP or lateral images, or if a suboptimal technique was used. The coronal and sagittal bow of the ulna was measured with a method adapted from previous studies that assessed radial bow using AP and lateral radiographs, respectively. Similar measurements were made in the coronal plane for the radius. All measurements were performed independently by the four authors. There was excellent interobserver reliability for ulnar bow in the coronal and sagittal planes (interclass correlation coefficient = 0.96 and 0.97, respectively) and for radial bow in the coronal plane (interclass correlation coefficient = 0.90).

Results

The mean maximal coronal ulnar bow was 7 ± 2 mm and was located at 75% of the ulnar length, measured proximally to distally. The location of coronal bow was consistently distal to the radial bow location. The mean maximal sagittal ulnar bow was 6 ± 3 mm and was located at 39% of the ulnar length. The mean maximal coronal bow of the radius was 14 ± 2.0 mm and was 59% of the total length of the radius from proximal to distal.

Conclusions

The ulna is not a “straight bone,” as is commonly thought, but rather has a bow in both the coronal and sagittal planes.

Clinical Relevance

Knowledge of the standard ulnar bow may be pivotal to prevent malunion of the ulna during surgery. Future research using these data in preoperative planning may lead to changes in plate contouring and clinical outcomes in forearm fracture management.