bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting Medical School Enrollment Behavior: Comparing an Enrollment Management Model to Expert Human Judgment
Authors: Burkhardt John C. , DesJardins Stephen L. , Teener Carol A. , Gay Steven E. , Santen Sally A.
Published: October 2018

Purpose

Medical school admissions committees are tasked with fulfilling the values of their institutions through careful recruitment. Making accurate predictions regarding enrollment behavior of admitted students is critical to intentionally formulating class composition and impacts long-term physician representation. The predictive accuracy and potential advantages of employing an enrollment predictive model in medical school admissions compared with expert human judgment have not been tested.

Method

The enrollment management-based predictive model previously generated using historical data was employed to provide a predicted enrollment percentage for each admitted student in the 2016–2017 application pool (N = 352). Concurrently, the human expert created a predicted enrollment percentage for each applicant while blinded to the values generated by the model. An absolute error for each applicant for both approaches was calculated. Statistical significance between approaches (expert vs. enrollment model) was assessed using t tests.

Results

The enrollment management approach was noninferior to expert prediction in all cases (P < .05) with a superior correct classification rate (77.7% vs. 71.2%). When considering subgroup analyses for specific populations of potential importance in recruiting (underrepresented in medicine, female, and in-state applicants), the enrollment management predictions were statistically more accurate (P < .05).

Conclusions

Examining a single admitted class, the enrollment predictions using the enrollment management model were at least as accurate as the expert human estimates, and in specific populations of interest more accurate. This information can be readily exported for a real-time dashboard system to drive recruitment behaviors.
Evaluation of Autologous Blood in Pterygium Surgery With Conjunctival Autograft
Authors: Zeng Weijuan , Dai Hanjun , Luo Hong
Published: October 2018

Purpose:

Autologous blood has been used exploratively with conjunctival autograft in pterygium surgery. However, it is controversial whether autologous blood performed better than other fixation methods, including fibrin glue and sutures. This meta-analysis was conducted to evaluate the effectiveness of using autologous blood in pterygium surgery with conjunctival autograft.

Methods:

The study was conducted according to the PRISMA guidelines. The MEDLINE, Cochrane library, and Embase databases were systematically searched from their establishment until April 1, 2018. Randomized controlled trials comparing autologous blood with fibrin glue/suture in pterygium surgery with conjunctival autograft were included. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. Outcome measurements were recurrence, graft displacement, graft retraction, and surgical duration. Review Manager 5.3 (Cochrane Community, Cochrane Collaboration, London, UK) was used to perform the statistical analysis. When I2 < 50%, statistical heterogeneity was considered acceptable, and a fixed-effects model was adopted; alternatively, the random-effects model was used.

Results:

Seven randomized controlled trials including 516 patients were finally included in the meta-analysis. Four studies with 379 patients compared autologous blood and fibrin glue. Autologous blood was inferior to fibrin glue with respect to surgical duration, graft retraction, and graft displacement. However, there was no statistical difference between the 2 groups in terms of the recurrence rate. Four studies with 152 patients compared autologous blood and traditional suturing. Autologous blood was superior to sutures in terms of surgical duration and inferior to sutures in terms of graft retraction. No difference was detected in terms of graft displacement and recurrence rate.

Conclusions:

In conclusion, autologous blood is an appropriate method for graft fixation in pterygium surgery. Current research suggests that autologous blood derivatives may be a promising approach after pterygium excision. However, this requires further confirmation.
Fractionated Stereotactic Radiotherapy for Cavernous Venous Malformations of the Orbital Apex
Authors: Ratnayake Gishan S. , McNab Alan A. , Dally Michael J. , Zajarski Catherine , Senthi Sashendra , Ruben Jeremy D.
Published: October 2018

Purpose:

The objective of this study was to investigate the efficacy and safety of fractionated stereotactic radiotherapy in the treatment of cavernous venous malformation of the orbital apex.

Methods:

The authors reviewed a prospective database from a single center of patients with cavernous venous malformation of the orbital apex who had treatment with fractionated stereotactic radiotherapy. The authors compared the symptoms, visual function and the size of the tumor pre- and posttreatment as well as reviewed the treatment details and the incidence of complications.

Results:

Six patients received treatment with fractionated stereotactic radiotherapy for cavernous venous malformation involving the orbital apex. The median age was 48 (range, 32–63), and 50% were female. Patients received a dose of 45 to 50.4 Gy in 1.8 to 2 Gy fractions. Median follow up was 33 months (range, 18–66 months). The average tumor volume reduction at posttreatment imaging after 12 months was 63%. All lesions reduced in size postradiotherapy and remained controlled for the duration of follow up. All patients who had proptosis or a visual field defect had an improvement in the symptoms posttreatment. There were no complications of the treatment.

Conclusion:

Fractionated stereotactic radiotherapy appears to be a safe and effective management option for cavernous venous malformation of the orbital apex and leads to a sustained reduction of the volume of the lesion with associated improvement in symptoms and visual function.
Anthropometric Analysis on the Ocular Region Morphology of Children and Young Adults in Chinese Han Population
Authors: Cai Xianxian , Chen Ying , Li Qian , Ma Huan , Tang Zhixin , Nie Cong , Lu Rong
Published: October 2018

Purpose:

The periocular features vary in different age groups and ethnic populations. In this study, the authors sought to determine whether age-related differences exist for certain periocular parameters between children and young adults of Chinese Han population.

Methods:

OU of 310 children (aged 7–10 years) and 301 young adults (aged 20–30 years) were evaluated by 2-dimensional photogrammetry. All the subjects were of Chinese Han population. The eyelid crease profiles were classified according to their morphology. Periocular measurements, including 11 linear and 3 angular parameters were acquired from standardized photographs, 3 indices were further derived. The presence of epicanthal fold was also recorded. Each of the parameters was compared between the age groups.

Results:

A statistical difference was found between the 2 age groups for the distribution of eyelid crease types. Statistical significances existed between the age groups for various parameters, these include palpebral fissure height and width, margin reflex distance, intercanthal and outercanthal width, distance from the medial end of the eyebrow to the medial canthus, distance from the lateral end of the brow to the lateral canthus, crease height and eyebrow height, angle of endocanthion and exocanthion, palpebral fissure inclination, palpebrae fissure index, canthal index, and angular index (p < 0.05). The incidence of epicanthal fold tended to decrease with increase of age.

Conclusions:

Age differences exist in periocular features between children and young adults of Chinese Han population. Standards of periocular measurements based on age and race could provide reliable guidelines for clinical examination and planning periocular surgery.
Effect of Vancomycin Versus Linezolid on Hospital Length of Stay in Patients With Suspected or Confirmed Influenza and Bacterial Pneumonia
Authors: Stoneman Carly E. , Winters Shauna D. , LaBeff Lauren L. , Heidel Robert E. , Hamilton Leslie A.
Published: October 2018

Introduction

Patients with influenza who then present with bacterial pneumonia often present with methicillin-resistant Staphylococcus aureus pneumonia. There is a paucity of literature about how antibiotic choice affects length of stay in these patients. The objective of this study was to assess if vancomycin or linezolid affects hospital length of stay in patients with bacterial pneumonia complicating influenza.

Methods

This was a single-center, retrospective cohort study conducted at the University of Tennessee Medical Center in Knoxville, Tenn. Inclusion criteria were adults 18 years or older who were admitted to the hospital with suspected postinfluenza pneumonia. In addition, these patients either received 24 hours of oseltamivir or had a positive influenza screen and received at least 24 hours of vancomycin or linezolid for empiric coverage of methicillin-resistant S. aureus pneumonia.

Results

A total of 186 patients were included in the study. There was no difference in overall length of stay between the linezolid and vancomycin groups (P = 0.937). Secondary outcomes included intensive care unit (ICU) length of stay and in-hospital mortality. The group treated with vancomycin had increased in-hospital mortality (P = 0.043) and longer ICU length of stay (P = 0.048).

Discussion

Although there was no difference in hospital length of stay between the 2 treatment groups, the vancomycin group had a longer ICU length of stay and increased mortality when compared with the linezolid group.
Recrudescence of Plasmodium falciparum Malaria in a Patient With Progressive Sarcoidosis
Authors: Allencherril Joseph , Hammond Allexa , Birnbaum Gilad , Gold Benjamin , Allencherril Ronan , Salciccioli Katherine , El Sahly Hana
Published: October 2018

Although endemic malaria has largely been eradicated in the United States, cases still occur, often as a result of travel-related exposure. Although nearly all cases of Plasmodium falciparum malaria occur within 3 months of exposure, in rare instances, symptoms manifest years after the sentinel infection because of compromise of immunity and parasite recrudescence. We describe a case of a 49-year-old woman with a history of childhood malaria and no recent travel history who presented with P. falciparum malaria in the setting of progressing pulmonary sarcoidosis. This case report highlights the role of advancing immune compromise status in malarial recrudescence. We also consider other potential avenues to explain how a patient might develop P. falciparum malaria in a nonendemic region in the absence of recent travel.
Divergent influences of the locus coeruleus on migraine pathophysiology
Authors: Vila-Pueyo Marta , Strother Lauren C , Kefel Malak , Goadsby Peter J. , Holland Philip R.
Published: October 2018

Migraine is a common disabling neurological condition that is associated with several premonitory symptoms that can occur days before the headache onset. The most commonly reported premonitory symptom is marked fatigue that has been shown to be highly predictive of an ensuing migraine attack. The locus coeruleus (LC) is a key nucleus involved in arousal that has also been shown to impact pain processing. It provides one of the major sources of noradrenaline to the dorsal horn of the spinal cord and neocortex. Given the clinical association between migraine, sleep–wake regulation, and fatigue, we sought to determine whether LC modulation could impact migraine-related phenotypes in several validated preclinical models of migraine. To determine its role in migraine-related pain, we recorded dural nociceptive-evoked responses of neurons in the trigeminocervical complex, which receives trigeminal primary afferents from the durovascular complex. In addition, we explored the susceptibility to cortical spreading depression initiation, the presumed underlying phenomenon of migraine aura. Our experiments reveal a potent role for LC disruption in the differential modulation of migraine-related phenotypes, inhibiting dural-evoked activation of wide dynamic neurons in the trigeminocervical complex while increasing cortical spreading depression susceptibility. This highlights the potential divergent impact of LC disruption in migraine physiology, which may help explain the complex interactions between dysfunctional arousal mechanisms and migraine.
What is the effect of alcohol consumption on the risk of chronic widespread pain? A Mendelian randomisation study using UK Biobank
Authors: Beasley Marcus , Freidin Maxim B. , Basu Neil , Williams Frances M.K. , Macfarlane Gary J.
Published: October 2018

Studies have shown that moderate alcohol consumption is strongly associated with reduced reporting of chronic widespread pain (CWP). The study designs used, however, are prone to confounding and are not able to establish the direction of causality. The current study overcomes these problems using the Mendelian randomisation design to determine the effect of alcohol consumption on the likelihood of reporting CWP. The UK Biobank recruited 500,000 participants aged between 40 and 69 years. Data collected included questions on chronic pain and alcohol consumption, and biological samples providing genotypic information. Alcohol consumption was categorised as “weekly consumption” or “nonfrequent or infrequent.” Participants were classified by genotype according to alleles of the rs1229984 single-nucleotide polymorphism, either “GG” or “AA/AG.” Chronic widespread pain was defined as pain all over the body for more than 3 months that interfered with activities. Associations between genotype, CWP, and alcohol consumption were tested by logistic regression. Instrumental variable analysis was used to calculate the causal effect of weekly alcohol consumption on CWP. Persons with “GG” genotype had an increased risk of CWP (odds ratio [OR] 1.17, 99% confidence interval 1.01-1.35) and were more likely to consume alcohol weekly (OR 1.76, 1.70-1.81) compared to those with “AA/AG” genotype. Weekly consumption of alcohol was associated with reduced risk of CWP (OR 0.33, 0.31-0.35), but instrumental variable analysis did not show a causal effect of alcohol consumption on reducing CWP (OR 1.29, 0.96-1.74). An interpretation of observational population studies as showing a protective effect of alcohol on CWP is not supported.
CACNG2 polymorphisms associate with chronic pain after mastectomy
Authors: Bortsov Andrey V. , Devor Marshall , Kaunisto Mari A. , Kalso Eija , Brufsky Adam , Kehlet Henrik , Aasvang Eske , Bittner Reinhard , Diatchenko Luda , Belfer Inna
Published: October 2018

Chronic postmastectomy pain (PMP) imposes a major burden on the quality of life of the ever-increasing number of long-term survivors of breast cancer. An earlier report by Nissenbaum et al. claimed that particular polymorphisms in the gene CACNG2 are associated with the risk of developing chronic PMP after breast surgery (Nissenbaum J, Devor M, Seltzer Z, Gebauer M, Michaelis M, Tal M, Dorfman R, Abitbul-Yarkoni M, Lu Y, Elahipanah T, delCanho S, Minert A, Fried K, Persson AK, Shpigler H, Shabo E, Yakir B, Pisante A, Darvasi A. Susceptibility to chronic pain following nerve injury is genetically affected by CACNG2. Genome Res 2010;20:1180–90). This information is important because in principle, it can inform the surgical, radiological, and chemotherapeutic decision-making process in ways that could mitigate the increased risk of chronic pain. In this study, we revisited this claim by independently evaluating the proposed marker haplotype using 2 different patient cohorts recruited in different research settings. Meta-analysis of these new postmastectomy cohorts and the original cohort confirmed significant association of the CACNG2 haplotype with PMP. In addition, we tested whether the same markers would predict chronic postsurgical pain in men who underwent surgery for inguinal hernia repair, and whether there is significant genetic association with cutaneous thermal sensitivity in postmastectomy and postherniotomy patients. We found that the biomarker is selective because it did not predict pain after laparoscopic hernia repair and was not associated with pain sensitivity to experimentally applied noxious thermal stimuli. We conclude that the A-C-C haplotype at the 3 single-nucleotide polymorphisms (rs4820242, rs2284015, and rs2284017) in the CACNG2 gene is associated with increased risk of developing PMP. This information may advance current knowledge on pathophysiology of PMP and serve as a step forward in the prediction of clinical outcomes and personalized pain management.
Evaluation of Allergic Diseases, Symptom Control, and Relation to Infections in a Group of Italian Elite Mountain Bikers
Authors: Perrotta Fabio , Simeon Vittorio , Bonini Matteo , Ferritto Luigi , Arenare Laura , Nigro Ersilia , Nicolai Ambra , Daniele Aurora , Calabrese Cecilia
Published: October 2018

Objectives:

This study estimates the prevalence of allergic diseases in a group of Italian elite mountain bikers, compares the prevalence of infectious episodes between allergic and nonallergic athletes, and evaluates asthma and rhinitis symptom control in allergic athletes.

Design:

Two hundred twenty-six Italian nonsmoking mountain bikers received by mail the Allergy Questionnaire for Athletes (AQUA) and completed it. The RhinAsthma Patient Perspective (RAPP) questionnaire was sent to the 108 participants with a positive AQUA score and 104 returned the questionnaire.

Methods:

Athletes with an AQUA score ≥5 or <5 were defined AQUA+ (allergic) or AQUA− (nonallergic), respectively. RhinAsthma Patient Perspective questionnaire total score ≥15 was indicative of a poor control of symptoms.

Results:

Of the 226 athletes, 47.8% were AQUA+, whereas 52.2% were AQUA−. A higher number of AQUA+ athletes reported frequent upper respiratory tract infections (URTIs) and herpes labialis than AQUA− athletes (P < 0.001), and the prevalence of URTI was greater in the subgroup of AQUA+ athletes who trained ≥3 hours per session. According to RAPP questionnaire score, 21.1% of AQUA+ mountain bikers had a poor control of asthma and rhinitis symptoms.

Conclusions:

Our study shows a high prevalence of allergy among Italian elite mountain bikers whose asthma and rhinitis symptoms are poorly controlled in about a fifth of the sample. Allergic athletes, mainly those training more than 3 hours per session, are at higher risk of URTI and herpes labialis. Screening programs to detect allergic diseases and to evaluate symptom control in athletes should be strongly encouraged.
Cold-Water Immersion Has No Effect on Muscle Stiffness After Exercise-Induced Muscle Damage
Authors: Pinto João , Rocha Pedro , Torres Rui
Published: October 2018

Objective:

To analyze the effect of cryotherapy on muscle stiffness after exercise-induced muscle damage.

Design:

A leg-to-leg comparison model.

Setting:

University research laboratory.

Participants:

Thirty (30) untrained men (21.1 ± 1.6 years, 177.6 ± 6.4 cm, 75.9 ± 10.0 kg, and 15.9 ± 2.9% fat mass) with no history of lower-limb injury and no experience in resistance training.

Intervention:

All participants underwent a plyometric exercise program to induce muscle damage; however, randomly, one leg was assigned to a treatment condition and subjected twice to cold-water immersion of the lower limb at 10°C (±1°C) for 10 minutes, while the other leg was assigned to control.

Main Outcomes Measures:

Longitudinal stiffness and passive transverse stiffness were evaluated on the soleus and gastrocnemius muscles at 4 moments: pre-exercise, immediately after exercise, 24 hours, and 72 hours after the damage protocol. Furthermore, pressure pain threshold (PPT) and maximal voluntary isometric contraction (MVIC) were also assessed in the same periods.

Results:

No significant differences between control and cryotherapy were observed in regard to MVIC (P = 0.529), passive longitudinal stiffness (P = 0.315), and passive transverse stiffness (P = 0.218). Only a significant decrease was observed in PPT on the soleus muscle in the cryotherapy compared with the control leg immediately after exercise (P = 0.040).

Conclusions:

The results show that cryotherapy had no influence on muscle stiffness. However, cryotherapy had a positive effect on PPT immediately after exercise.
Physical Activity and Liver Cancer Risk: A Systematic Review and Meta-analyses
Authors: Lin Zhan-Zhou , Xu Yong-Cheng , Liu Cai-Xia , Lu Xue-Lan , Wen Fan-Yuan
Published: October 2018

Objective:

Liver cancer is the second most common cause of death from cancer. Physical activity (PA) was found to be associated with lower risks of several types of cancer. However, the association between PA and the risk of liver cancer is still inconclusive. This systematic review and meta-analysis was aiming to summarize the association between PA and liver cancer risk.

Methods:

Literatures related were identified by searching PubMed, EMBASE, and Chinese Biomedical literature database from 1965 to 2017 without language limitation. Meta-analyses were performed using random effect model.

Results:

A total of 5 cohort studies involving 2 513 975 subjects were identified. The pooled relative risk of leisure-time PA with liver cancer risk was 0.92 [95% confidence interval (CI), 0.84-1.01]. There is no significant association between leisure-time PA and liver cancer risk. However, leisure-time PA significantly reduced liver cancer risk in never smokers. The pooled hazard ratio of daily total PA with liver cancer risk was 0.75 (95% CI, 0.66-0.86).

Conclusions:

Daily total PA significantly reduces liver cancer risk, whereas leisure-time PA significantly reduces liver cancer risk only in never smokers.
King-Devick Test Time Varies by Testing Modality
Authors: Clugston James R. , Chrisman Sara P. D. , Houck Zachary M. , Asken Breton M. , Boone Jonathan K. , Buckley Thomas A. , Hoffman Nicole L. , Schmidt Julianne D. , Kontos Anthony P. , Jaffee Michael S. , Harmon Kimberly G. , Broglio Steven P. , McCrea Michael A. , McAllister Thomas W. , Ortega Justus D.
Published: October 2018

Objective:

To explore differences in baseline King-Devick Test (KD) completion time between 2 testing modalities: (1) spiral-bound paper cards (cards) and (2) iPad application (iPad).

Design:

Cross-sectional cohort analysis.

Setting:

National Collegiate Athlete Association (NCAA) institutions.

Participants:

Student athletes from 13 women's and 11 men's collegiate sports who completed KD baseline testing as part of their first year in the Concussion Assessment, Research and Education (CARE) Consortium from 2014 to 2016 (n = 2003, 52.2% male).

Independent Variables:

King-Devick Test modalities; cards or iPad.

Main Outcome Measure:

Baseline KD completion time (seconds).

Results:

Mean baseline KD completion time of the iPad modality group [42.8 seconds, 95% confidence interval (CI), 42.1-43.3] was 2.8 seconds (95% CI, 2.1-3.4) greater than the cards group (40.0 seconds, 95% CI, 39.7-40.3) (t(1, 1010.7) = −8.0, P < 0.001, Cohen's d = 0.41).

Conclusions:

Baseline KD performance is slower when tested on an iPad than when tested on spiral-bound paper cards. The 2 KD modalities should not be used interchangeably in concussion assessments because differences in the modalities can lead to time differences similar in magnitude to those used to indicate concussion. From a research perspective, modality may influence interpretation and/or synthesis of findings across studies.
2017 Marathon of Rome: Anthropometry and Sport Profile in 350 Runners and Association With Achilles and Patellar Tendinopathy
Authors: Longo Umile Giuseppe , Berton Alessandra , Stelitano Giovanna , Madaudo Cristina , Perna Massiliano , Ciuffreda Mauro , Guarnieri Andrea , Papalia Rocco , Maffulli Nicola , Denaro Vincenzo
Published: October 2018

Background:

Achilles and patellar tendinopathy are common in runners. Despite the relevance of the problem, causative factors remain poorly understood. This cross-sectional study evaluated the association between Achilles and patellar tendinopathy and age, sex, weight, height, number of marathons, and impact profile in runners who participated in the 2017 Marathon of Rome.

Methods:

At the 2017 Marathon of Rome, 350 athletes (256 men and 94 women; mean age: 44.8 years, range 12-80 years) filled in the VISA-A and VISA-P questionnaires. A fully trained orthopedic surgeon made a diagnosis of Achilles and patellar tendinopathy according to clinical criteria.

Results:

Ninety-five participants were diagnosed with Achilles tendinopathy and 96 with patellar tendinopathy. There was evidence of a statistically significant positive association between age and Achilles and patellar tendinopathy, with no effect of sex, weight, and height on the presence of Achilles tendinopathy. There was no evidence of a statistically significant positive association between the number of marathons and impact profile and VISA-A score. There was a statistically significant association between VISA-P score and impact profile. Finally, there was evidence of a statistically significant positive association between VISA-A score and VISA-P score (P = 0.007).

Conclusions:

In marathon runners, there was no evidence of a statistically significant association between sex, weight, height, number of marathons, and Achilles and patellar tendinopathy. However, age was associated with Achilles and patellar tendinopathy, and impact profile was associated with patellar tendinopathy.
Onclarity Human Papillomavirus Extended Genotyping in the Management of Cervical Intraepithelial Neoplasia 2+ Lesions
Authors: Bottari Fabio , Iacobone Anna Daniela , Boveri Sara , Preti Eleonora Petra , Franchi Dorella , Mariani Luciano , Preti Mario , Landoni Fabio , Passerini Rita , Sandri Maria Teresa
Published: October 2018

Objective

Many methods are available today for human papillomavirus (HPV) testing; they differ for technology, targets, and information on the genotypes detected. In this study, we evaluated the performance of the Onclarity HPV assay in detection and follow-up of cervical preneoplastic lesions.

Materials and Methods

One hundred sixty-seven women referred to the European Institute of Oncology, Milan, for treatment of cervical lesions were enrolled. We investigated the utility of Onclarity extended genotyping HPV test in the management of cervical intraepithelial neoplasia (CIN) 2+ preneoplastic lesion.

Results

At baseline, the concordance was 92% (150/163) between Onclarity and Hybrid Capture 2 (HC2) and 93% (142/152) between Onclarity and linear array, respectively. At follow-up, the concordance between Onclarity and HC2 was 80%. Seven women relapsed: 6 had persistence of the same genotypes and 1 patient tested negative not only with Onclarity but also with HC2 for the presence of a low-risk genotype in the sample.

Conclusions

This study showed that the evaluation of the HPV genotype persistence may represent a valid option to monitor patients treated for CIN 2+ lesions, because relapses were detected only in patients with persistence of the same genotype detected at baseline.
Mapping and Sustaining Leadership Development
Authors: Patrician Patricia A. , Prapanjaroensin Aoyjai , Dawson Martha , White-Williams Connie , Miltner Rebecca S.
Published: October 2018

OBJECTIVE AND BACKGROUND

To improve leadership competency, academic and clinical partners planned and implemented a 2-day facilitated workshop that actively engaged nurse leaders in preparing for their current and future careers by focusing on “The Leader Within.” We anticipated that an emphasis on this particular dimension of leadership, that is, knowing oneself, would lead to improvements in the science and the art of leadership among nurse managers (NMs) and assistant NMs (ANMs).

METHODS

Using the Nurse Manager Skills Inventory (NMSI), we conducted precompetency and 8-month postcompetency surveys and interviews. Although 41 nurses completed the pretest, only 17 completed the posttest.

RESULTS

The sample of 50% NMs and 50% ANMs had an average age of 38.4 (SD, 8.2) years’ and 8.2 (SD, 6.3) years’ experience. Self-rated leadership competency scores were improved at the 8-month posttest period on all NMSI sections: the Science, the Art, and the Leader Within.

CONCLUSIONS

Actively cultivating “The Leader Within” facilitates reflective practice that may lead to more deliberate leadership competency attainment and career planning.
Increased Discrimination of Treponema pallidum Strains by Subtyping With a 4-Component System Incorporating a Mononucleotide Tandem Repeat in rpsA
Authors: Pillay Allan , Lee Min-Kuang , Slezak Tom , Katz Samantha S. , Sun Yongcheng , Chi Kai-Hua , Morshed Muhammad , Philip Susan , Ballard Ronald C. , Chen Cheng Y.
Published: October 2018

A guanine mononucleotide repeat in the rpsA (tp0279) gene was evaluated for improved strain discrimination using 72 Treponema pallidum–positive specimens. The tandem repeat combined with the enhanced Centers for Disease Control and Prevention typing system resulted in increased discrimination and should be useful for molecular epidemiologic studies on syphilis especially in outbreaks and among men who have sex with men.
The Incidence and Etiology of Previously Undiagnosed Hypoglycemic Disorders in the Emergency Department
Authors: White Kathryn , Truong Lisa , Aaron Kimberly , Mushtaq Nasir , Thornton Paul S.
Published: October 2018

Objective

The aim of this study was to determine the incidence and etiology of previously undiagnosed hypoglycemia in children (<18 years of age) seen in a hospital emergency department (ED).

Methods

A retrospective review of all emergency room visits over a 2-year period was conducted to identify patients younger than 18 years who had hypoglycemia (<50 mg/dL) not associated with a previously known cause. Evaluation of hypoglycemia was conducted during a spontaneous hypoglycemic event or during hypoglycemia induced by a fasting study. Insulin and counter-regulatory hormones were measured simultaneously when the blood glucose was less than 50 mg/dL.

Results

Of 224,125 children seen in the ED during the study, 160 (1:1400) were documented to have hypoglycemia not caused by a previously known condition. Eighty-five (53%) of the 160 hypoglycemic subjects underwent a diagnostic evaluation. Seventeen (20%) of the 85 were classified as having a high-risk disorder causing hypoglycemia, whereas 63 (74%) had a low-risk disorder. Seventy-five patients (47%) did not undergo a diagnostic evaluation during the ED visit or hospital admission.

Conclusions

Hypoglycemia of unknown etiology occurs in 1:1400 (0.07%) children who attended the ED during the study. Assuming that none of the children who failed to undergo a diagnostic evaluation had a high-risk disorder, 10.6% of the subjects with hypoglycemia were found to have a high-risk disorder. Because of the increased incidence of high-risk disorders causing hypoglycemia and the long-term health risk associated with hypoglycemia, we recommend that all children with hypoglycemia of unknown etiology have a critical blood sample drawn at the time of hypoglycemia (blood glucose <50 mg/dL) or be admitted for a diagnostic evaluation.
Predicting Perceived Disfigurement from Facial Function in Patients with Unilateral Paralysis
Authors: Lyford-Pike Sofia , Helwig Nathaniel E. , Sohre Nick E. , Guy Stephen J. , Hadlock Tessa A.
Published: October 2018

Background:

Clinical rating tools such as the electronic, clinician-graded facial function (eFACE) scale provide detailed information about aspects of facial functioning relevant to the assessment and treatment of facial paralysis. Past research has established that eFACE scores significantly relate to expert ratings of facial disfigurement. However, no studies have examined the extent to which eFACE scores relate to casual observers’ perceptions of disfigurement in facial paralysis.

Methods:

Casual observers (n = 539) were recruited at the 2016 Minnesota State Fair, and were shown short videos of facial expressions made by patients (n = 61) with unilateral facial paralysis. Observer ratings of disfigurement were recorded and related to eFACE scores (total and subscores) using mixed-effect regression models.

Results:

Patients’ eFACE scores were significantly related to observers’ disfigurement ratings, such that improved function (as indicated by a higher eFACE score) corresponded to a decreased perception of disfigurement. The resting face of patients, their total movement capability, and their involuntary movement through synkinesis all played a significant role in predicting the casual observers’ ratings.

Conclusions:

The results establish a clear connection between clinician eFACE ratings of facial function and casual observer judgments of disfigurement. In addition, the findings provide insight into which clinical aspects of facial dysfunction are most salient for casual observers’ perceptions of disfigurement. Such insights can help both patients and clinicians better understand the expected social implications of different clinical aspects of facial dysfunction.
Ergonomics in the Operating Room: The Cervicospinal Health of Today’s Surgeons
Authors: Fisher Sean M. , Teven Chad M. , Song David H.
Published: October 2018

In its many forms, operating can lead surgeons to adopt postures that have damaging long-term effects on physical health through imparting musculoskeletal fatigue. One area that is particularly susceptible is the cervical spine, as surgeons are forced into positions that require sustained cervical hyperflexion. The repercussions of resultant injuries can be steep, as they have the potential to adversely affect one’s operative capacity. The purpose of this article is to assess the spinal health of today’s surgeons by evaluating available research in various surgical subspecialties. By focusing on the ergonomic principles that govern the surgical arena and identifying unifying themes between plastic surgery and other surgical subspecialties, it is the goal of this article to enhance the understanding of cervical spine health as it pertains to the plastic and reconstructive surgeon.
Getting the Most Out of Augmentation-Mastopexy
Authors: Sarosiek Konrad , Maxwell G. Patrick , Unger Jacob G.
Published: October 2018

Learning Objectives:

After reviewing the article, the participant should be able to: 1. Understand the tenets of proper patient selection. 2. Be familiar with the assessment of patients for augmentation-mastopexy. 3. Be able to plan an operative approach and execute the critical steps. 4. Be able to recognize common complications and have a basic understanding of their management. 5. Be aware of emerging adjunctive techniques and technologies with respect to augmentation-mastopexy.

Despite being a multivariable and complex procedure, augmentation-mastopexy remains a central and pivotal component of the treatment algorithm for ptotic and deflated breasts among plastic surgeons. Careful preoperative planning, combined with proper selection of approach and implant, can lead to success. Physicians need to understand that there is a high frequency of reoperation cited in the literature with regard to this procedure, and discussions before the initial operation can help alleviate common misunderstandings and challenges inherent in this operation.
Longitudinal Associations Between Inflammation and Depressive Symptoms in Chronic Dialysis Patients
Authors: Haverkamp Gertrud L.G. , Loosman Wim L. , Schouten Robbert W. , Franssen Casper F. M. , Kema Ido P. , van Diepen Merel , Dekker Friedo W. , Chandie Shaw Prataap K. , Smets Yves F.C. , Vleming Louis-Jean , van Jaarsveld Brigit C. , Honig Adriaan , Siegert Carl E.
Published: October 2018

Objective

Patients undergoing chronic dialysis often display sustained elevations of inflammation markers and also have a high prevalence of depressive symptoms. Although multiple studies demonstrated cross-sectional associations between inflammation markers and depressive symptoms in this patient group, longitudinal associations have not been examined. We therefore investigated whether longitudinal associations exist between inflammation markers and depressive symptoms in chronic dialysis patients.

Methods

Data of three consecutive measurements of an observational, prospective cohort study among chronic dialysis patients were used. At baseline, 6-month, and 12-month follow-up, patients completed the Beck Depression Inventory, and inflammation markers (high-sensitivity C-reactive protein [HsCRP], interleukin (IL)-1β, IL-6, IL-10, and tumor necrosis factor α) were measured. We examined cross-sectional associations between inflammation markers and depressive symptoms using linear regression models. The longitudinal association between inflammation and depressive symptoms was assessed using a linear mixed model analyses.

Results

A total of 513 patients were included. Cross-sectional associations were found between HsCRP and depressive symptoms at baseline (β = 0.9, confidence interval [CI] = 0.4–1.4) and 6-month follow-up (β = 1.1, CI = 0.3–2.0), and between IL-1β and depressive symptoms at 6-month follow-up (β = 1.3, CI = 0.8–1.8) and 12-month follow-up (β = 1.2, CI = 0.4–1.9). Inflammation makers (HsCRP, IL-6, IL-1β, IL-10, and tumor necrosis factor α) at baseline were not associated with depressive symptoms at follow-up and vice versa.

Conclusions

We confirmed the presence of cross-sectional associations between inflammation markers and depressive symptoms in chronic dialysis patients, but with our longitudinal data, we found no longitudinal associations. This supports an associative instead of a causal relationship between inflammation and depressive symptoms.
Individual and Network Factors Associated With Racial Disparities in HIV Among Young Men Who Have Sex With Men: Results From the RADAR Cohort Study
Authors: Mustanski Brian , Morgan Ethan , D'Aquila Richard , Birkett Michelle , Janulis Patrick , Newcomb Michael E.
Published: October 2018

Background:

Individual sexual risk behaviors have failed to explain the observed racial disparity in HIV acquisition. To increase understanding of potential drivers in disparities, we assessed differences across individual, network, and social determinants.

Methods:

Data come from RADAR (N = 1015), a longitudinal cohort study of multilevel HIV-risk factors among young men who have sex with men (YMSM) aged 16–29 years in Chicago, IL. Data collection includes biological specimens; network data, including detailed information about social, sexual, and drug-use networks; and psychosocial characteristics of YMSM.

Results:

Compared to white YMSM (24.8%) and Hispanic YMSM (30.0%), black YMSM (33.9%) had a higher prevalence of both HIV (32%; P < 0.001) and rectal sexually transmitted infections (26.5%; P = 0.011) with no observed differences in pre-exposure prophylaxis use. Black YMSM reported lower rates of sexual risk behaviors and more lifetime HIV tests (P < 0.001) compared with all other YMSM; however, they were also significantly less likely to achieve viral suppression (P = 0.01). Black YMSM reported the highest rate of cannabis use (P = 0.03) as well as greater levels of stigma (P < 0.001), victimization (P = 0.04), trauma (P < 0.001), and childhood sexual abuse (P < 0.001). White YMSM reported higher rates of depression (P < 0.001) and alcohol use (P < 0.001). In network analyses, significant differences existed across network characteristics with black YMSM having the lowest transitivity (P = 0.002), the highest density (P < 0.001), and the highest homophily (P < 0.001).

Conclusions:

Black YMSM do not report higher rates of HIV-risk behaviors, but social and network determinants are aligned toward increased HIV risk. These results suggest that network interventions and those addressing social determinants may help reduce disparities.
Implementation of an Sexually Transmitted Disease-Screening Protocol in an Emergency Department
Authors: Yoo Binnara , Vangrafeiland Brigit
Published: October 2018

Urinary symptoms, such as dysuria, urinary urgency, frequency, and suprapubic pain, are frequent complaints made in the emergency department (ED; M. D. Wilbanks, J. W. Galbraith, & W. M. Geisler, 2014). Although it is easy to relate urinary symptoms with a urinary tract infection (UTI), both UTI and sexually transmitted disease (STD) can share same urinary symptoms that mask each other from detection. It presents challenges for ED clinicians to precisely distinguish between two infections, causing misdiagnosis and mistreatment, resulting in patient morbidity and high health care costs. Clinician adherence to clinical guidelines for the treatment of urinary symptoms with presumed STD remains inconsistent in terms of culturing urine to rule out UTI but not for chlamydial and gonorrheal infections. Given the increasing prevalence of gonorrheal and chlamydial infections, an evidence-based education on STD-screening guideline among clinicians was implemented. A retrospective chart was reviewed before and after the implementation to compare improvement on STD screening among young adults with urinary complaints in the ED. When education was given to the clinicians, more patients with urinary symptoms were screened for chlamydia and gonorrhea (p ≤ 0.001) and more chlamydial and gonorrheal infections were detected (p = 0.042). Patients with a positive STD had concurrent positive urine cultures, which shows that patients can have both a UTI and an STD at the same time and urinary symptoms are imprecise in distinguishing between the two. An ongoing STD-screening education is essential in ensuring successful detection, treatment, and prevention of transmission.
Emergency Patients' and Family Members' Experiences of Nonconveyance Situations and Counseling Received From Care Providers
Authors: Leikkola Päivi , Mikkola Riitta , Salminen-Tuomaala Mari , Paavilainen Eija
Published: October 2018

Making nonconveyance decisions can be demanding for care providers in prehospital emergency services. Studies have found homecare instructions and counseling of patients and family members partly insufficient. A descriptive cross-sectional design was applied for this pilot study to explore emergency patients' and family members' experiences of nonconveyance situations and counseling. Data were collected by questionnaires from acutely ill patients (n = 97) treated on-site and not transported to hospital and from their family members (n = 72) in 2015–2016. Responses to quantified statements were analyzed statistically, whereas responses to open questions were analyzed using qualitative inductive content analysis. Patients and family members had mostly received verbal home care instructions. Just more than 10% of patients found the instructions insufficient for their coping at home. Male patients were slightly more satisfied with counseling than female patients. One-fifth of female patients but only 6% of male patients were dissatisfied with nonconveyance decisions. In family members, the proportion of dissatisfied respondents was 14%. Older patients were more often dissatisfied than younger patients. Although the majority of the respondents were satisfied with the emergency medical services in general, patients suggested that home care instructions, staff competence, and availability of ambulances should be improved and resources and attention given to patients' opinions increased. Family members proposed more careful assessment of conveyance needs, increased resources, and attention given to the patient. The results highlight the importance of developing a more family-centered approach to emergency care.
Emergency Department Presentation of a New-Onset Seizure
Authors: Miller Benjamin J.
Published: October 2018

A seizure is a symptom of brain dysfunction, resulting in 1.6 million emergency department visits each year. The evaluation of new seizures in the emergency department is a process looking for triggers of seizures such as toxins, mass lesions, or metabolic derangements. Maintaining a broad differential diagnosis is essential to prevent premature closure of the diagnostic evaluation. Timing of neurologic imaging and electroencephalogram depends on the clinical situation. In this case, a young woman presents with a “new-onset” seizure with subsequent elevation of white blood cells and serum lactate levels. Neurologic imaging identified a large dermoid cyst in the frontal lobe. We review how seizures can elevate the serum lactate distinguishing a general tonic–clonic seizure from pseudoseizures and how dermoid cysts can be implicated in seizures.
Everolimus and Long-term Clinical Outcomes in Kidney Transplant Recipients: A Registry-based 10-year Follow-up of 5 Randomized Trials
Authors: Ying Tracey , Wong Germaine , Lim Wai H. , Clayton Philip , Kanellis John , Pilmore Helen , Campbell Scott , O’Connell Philip J. , Russ Graeme , Chadban Steven
Published: October 2018

Background.

Data regarding the long-term efficacy of everolimus-based immunosuppression for kidney transplantation are lacking. Existing randomized controlled trials are limited by short follow-up duration which limits capacity to assess impact on graft and patient survival.

Methods.

We linked individual trial participants to the Australian and New Zealand Dialysis and Transplant Registry. Using a 1-step meta-analysis approach, we investigated the 10-year risk of graft loss, mortality and graft function in 349 participants from 5 randomized trials of everolimus-based immunosuppression.

Results.

Two hundred forty-two patients randomized to everolimus and 107 control patients were followed for a median of 9 years (interquartile range, 7.1, 9.8 y). There were no significant differences in the risk of all-cause graft loss (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.69-1.94), mortality (adjusted HR, 1.51; 95% CI, 0.78-2.93) and death-censored graft loss in everolimus versus control (adjusted HR, 1.00; 95% CI, 0.50-2.01). For patients in the early initiation (de novo or <6-month conversion) everolimus trials (n = 279), decline in estimated glomerular filtration rate did not significantly differ with control (mean difference in the slope of estimated glomerular filtrate rate, 0.01 mL/min per 1.73 m2 [−0.06 to +0.09]).

Conclusions.

This registry-based analysis with long-term follow-up found no differences in graft and recipient survival or graft function for everolimus over current standard of care.