bluuebunny/crossref_metadata_2025 huggingface dataset:
A systematic review of the factors that influence the quality and effectiveness of telesupervision for health professionals
Authors: Martin Priya , Lizarondo Lucylynn , Kumar Saravana
Published: April 2017

Introduction

Whilst telesupervision (clinical supervision undertaken using communication technology) is being used more frequently, there is limited information on what factors influence its effectiveness and quality. We undertook this systematic review to address this gap.

Methods

Eligible telesupervision studies were identified following targeted search of electronic databases and the grey literature. Data were synthesised thematically, resulting in development of core themes.

Results

We identified 286 papers for initial relevancy screening by title and abstract. The full text of 36 papers were then retrieved and assessed for further relevance. A total of 11 papers were included in the final analysis. We identified eight themes that contribute to effective and high-quality telesupervision: supervisee characteristics, supervisor characteristics, supervision characteristics, supervisory relationship, communication strategies, prior face-to-face contact, environmental factors and technological considerations.

Conclusion

From the available evidence, telesupervision can be a feasible and acceptable form of clinical supervision if set up well. Further studies with robust designs are required to strengthen the existing evidence on what makes telesupervision effective, as well as to examine its cost-effectiveness.
Transition to work: Perspectives from the autism spectrum
Authors: Hedley Darren , Cai Ru , Uljarevic Mirko , Wilmot Mathilda , Spoor Jennifer R , Richdale Amanda , Dissanayake Cheryl
Published: April 2017

To improve employment outcomes for adults with autism spectrum disorder, it is necessary to identify factors associated with successful transition to work from the perspectives of the individual and from those who work with or support them. This study involved focus groups with adults with autism spectrum disorder ( n = 9) participating in a 3-year employment and training programme, as well as focus groups with family members ( n = 6), support staff ( n = 7) and co-workers ( n = 6). The aim was to gain better understanding of the experience of transition to work, barriers and also the factors that promote workplace success. Main themes included factors that facilitated success at work ( Enablers), barriers to success ( Challenges) and programme outcomes ( Outcomes). Organisation support, advice from co-workers, supportive leadership, allowance of environmental modifications and presence of a consultant were identified as enablers that most facilitated success at work. Challenges included task-related difficulties, individual factors, social difficulties and distractibility, not managing work-related stress, and being perceived to be too frank. Outcomes were rated as positive and encompassed work-related outcomes, as well as outcomes related to sense of purpose, achieving personal independence and improvements in social relationships, both with work colleagues and within families.
Spatial social polarization and birth outcomes: preterm birth and infant mortality – New York City, 2010–14
Authors: Huynh M. , Spasojevic J. , Li W. , Maduro G. , Van Wye G. , Waterman P.D. , Krieger N.
Published: April 2017

Aims: This study assessed the relationship between spatial social polarization measured by the index of the concentration of the extremes (ICE) and preterm birth (PTB) and infant mortality (IM) in New York City. A secondary aim was to examine the ICE measure in comparison to neighborhood poverty. Methods: The sample included singleton births to adult women in New York City, 2010–2014 ( n=532,806). Three ICE measures were employed at the census tract level: ICE − Income (persons in households in the bottom vs top 20th percentile of US annual household income), ICE −Race/Ethnicity (black non-Hispanic vs white non-Hispanic populations), and ICE – Income + Race/Ethnicity combined. Preterm birth was defined as birth before 37 weeks’ gestation. Infant mortality was defined as a death before one year of age. A two-level generalized linear model with random intercept was utilized adjusting for individual-level covariates. Results: Preterm birth prevalence was 7.1% and infant mortality rate was 3.4 per 1000 live births. Women who lived in areas with the least privilege were more likely to have a preterm birth or infant mortality as compared to women living in areas with the most privilege. After adjusting for covariates, this association remained for preterm birth (ICE – Income: Adjusted Odds Ratio (AOR) 1.16 (1.10–1.21); ICE – Race/Ethnicity: AOR 1.41 (1.34–1.49); ICE – Income + Race/Ethnicity: AOR 1.36 (1.29–1.43)) and IM (ICE – Race/Ethnicity (AOR 1.80 (1.43–2.28) and ICE – Income + Race/Ethnicity (AOR 1.54 (1.23–1.94)). High neighborhood poverty was associated with PTB only (AOR 1.09 (1.04–1.14). Conclusions: These results provide preliminary evidence for the use of the ICE measure in examining structural barriers to healthy birth outcomes.
Fuzzy logic model for the categorization of manual lighting control behaviour patterns based on daylight illuminance and interior layout
Authors: Cılasun Kunduracı Arzu , Kazanasmaz Z. Tuğçe
Published: April 2017

In considering total building energy consumption, lighting plays an important role in shaping energy consumption and use. Although key strategies (such as energy efficient lighting products, lighting control systems and energy simulation software) are developed so far, such attempts may be unsuccessful unless users are not taken into consideration. Users’ behaviours and their manual lighting control actions depend on various factors, though within the scope of this study manual lighting control behaviour was analysed only in terms of interior layout and daylight illuminance. Three private offices in Izmir Institute of Technology were monitored using illuminance metres and occupancy/light detectors under eight different interior layout conditions. In relation to change of interior layout and daylight penetrations, users’ manual lighting control behaviours were monitored. The obtained data were then used to construct a fuzzy logic model in MATLAB FIS editor. A fuzzy logic algorithm was applied to classify behaviour patterns about the tendency to turn on the lights. This kind of prediction of the light usage tendency regarding the occupancy is aimed to foresee the ‘possible’ manual lighting control behaviour within given conditions. The gathered classification can be used further in future studies of manual lighting control behaviour and energy-saving estimations/simulations.
Negative Pressure Wound Therapy for Treatment of Mesh Infection After Abdominal Surgery: Long-Term Results and Patient-Reported Outcome
Authors: Nobaek S. , Rogmark P. , Petersson U.
Published: April 2017

Background and Aims:

Treatment of synthetic mesh infections has previously often resulted in mesh explantation. Negative pressure wound therapy has been used in these situations with encouraging results. The aims of this study were to evaluate wound healing, mesh preservation, and patient-reported outcome after negative pressure wound therapy of mesh infections.

Material and Methods:

Medical records of patients treated with negative pressure wound therapy for mesh infection and age-matched mesh-operated controls without postoperative complications were scrutinized in a retrospective study. An abdominal wall complaints questionnaire was used to evaluate patient-reported outcome.

Results:

Of 722 mesh operations performed 2005–2012, negative pressure wound therapy was used for treating postoperative mesh infections in 48 patients. A total of 48 age-matched controls were recruited from patients without wound complications. No differences were found between groups regarding preoperative characteristics. The following peroperative characteristics were significantly more frequent in the negative pressure wound therapy group: emergency operation, dirty/infected surgical field, surgical techniques other than laparoscopic intraperitoneal onlay mesh repair, implantation of more than one mesh, larger mesh size, longer duration of surgery, and mesh not completely covered with anterior rectus fascia. The entire mesh was salvaged in 92%, while four meshes were partly excised. Wounds healed in 88% after a median of 110 (range 3–649) days. In total, 85% in the negative pressure wound therapy group and 75% in the control group answered the questionnaire. There were no significant differences regarding pain, other abdominal wall symptoms, and satisfaction with the final result in favor of the controls.

Conclusion:

No mesh had to be explanted and wound healing was achieved in the majority of patients when negative pressure wound therapy was used for treatment of mesh infections. However, time to healing was long, and numerous procedures were sometimes needed. Positive long-term outcome was more frequently reported among controls.
Outcome of Surgery for Pediatric Gastroesophageal Reflux: Clinical and Endoscopic Follow-up after 300 Fundoplications in 279 Consecutive Patients
Authors: Koivusalo A. I. , Pakarinen M. P.
Published: April 2017

Purpose:

Clinical and endoscopic assessment of the outcome after fundoplication for pediatric gastroesophageal reflux.

Basic procedures:

Hospital records of 279 consecutive patients who underwent fundoplication for gastroesophageal reflux from 1991 to 2014 were reviewed. Underlying disorders, clinical and endoscopic findings, imaging studies, pH monitoring, and surgical technique were assessed. Main outcome measures were patency of fundoplication, control of symptoms and esophagitis, complications, redo operations, and predictive factors of failures.

Main results:

A total of 279 patients underwent 300 fundoplications (277 primaries and 23 redos). Underlying disorders in 217 (72%) patients included neurological impairment (28%) and esophageal atresia (22%). Indications for fundoplication included recalcitrant gastroesophageal reflux symptoms (44%), failure to thrive (22%), respiratory symptoms (15%), esophageal anastomotic stricture (4%), apneic spells (2%), and regurgitation (2%). Preoperative endoscopy was performed in 92% and pH monitoring in 49% of patients. Median age at primary fundoplication was 2.2 ((IQR = 0.5–7.5)) years. Fundoplication was open in 205 (74%; Nissen n = 63, Boix-Ochoa n = 97, Toupet n = 39, and other n = 6), laparoscopic in 72 (24%; Nissen n = 67 and Toupet n = 5), and included hiatoplasty in 73%. Clinical follow-up was a median of 3.9 (IQR = 1.2–9.9) years. Mortality related to surgery was 0.3%. Symptom control was achieved in 87% of patients, and esophagitis rate decreased from 65% to 29% (p < 0.001). Fundoplication failed in 41 (15%) patients. Failure was predicted by esophageal atresia risk ratio = 3.9 (95% confidence interval = 1.3–11, p = 0.01), any underlying disorder risk ratio = 3.1 (95% confidence interval = 1.1–9.1, p = 0.04), and hiatoplasty risk ratio = 2.6 (95% confidence interval = 1.1–6.6, p = 0.03). Of the 23 redo-fundoplications, 32% failed.

Conclusion:

The majority of patients who underwent fundoplication had an underlying disorder. Primary fundoplication provided control of symptoms in almost 90% of patients and also reduced the rate of esophagitis. Failure of primary fundoplication occurred in 15% of patients, and an underlying disorder, esophageal atresia, and hiatoplasty increased the risk of failure.
Introduction of the Abbreviated Westmead Post-Traumatic Amnesia Scale and Impact on Length of Stay
Authors: Watson C. E. , Clous E. A. , Jaeger M. , D’Amours S. K.
Published: April 2017

Background and Aims:

Mild traumatic brain injury is a common presentation to Emergency Departments. Early identification of patients with cognitive deficits and provision of discharge advice are important. The Abbreviated Westmead Post-traumatic Amnesia Scale provides an early and efficient assessment of post-traumatic amnesia for patients with mild traumatic brain injuries, compared with the previously used assessment, the Modified Oxford Post-traumatic Scale.

Material and Methods:

This retrospective cohort study reviewed 270 patients with mild traumatic brain injury assessed for post-traumatic amnesia over a 2-year period between February 2011 and February 2013. It identified those assessed with Abbreviated Westmead Post-traumatic Amnesia Scale versus Modified Oxford Post-traumatic Scale, the outcomes of these post-traumatic amnesia assessments, the hospital length of stay for patients, and their readmission rates.

Results:

The Abbreviated Westmead Post-traumatic Amnesia Scale was used in 91% of patient cases (and the Modified Oxford Post-traumatic Scale in 7%), and of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 94% cleared post-traumatic amnesia testing within 4 h. Of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 56% had a shorter length of stay than had they been assessed with the Modified Oxford Post-traumatic Scale, resulting in 295 bed-days saved. Verbal and written discharge advice was provided to those assessed for post-traumatic amnesia to assist their recovery. In all, 1% of patients were readmitted for monitoring of mild post-concussion symptoms.

Conclusion:

The Abbreviated Westmead Post-traumatic Amnesia Scale provides an effective and timely assessment of post-traumatic amnesia for patients presenting to the Emergency Department with mild traumatic brain injury compared with the previously used assessment tool. It helps identify patients with cognitive impairment and the need for admission and further investigation, resulting in appropriate access to care. It also results in a decreased length of stay and decreased hospital admissions, with subsequent cost savings to the hospital.
Trauma in pregnancy: A review of the Pennsylvania Trauma Systems Foundation database
Authors: Schuster Meike , Becker Natasha , Young Amanda , Paglia Michael J , Mackeen A Dhanya
Published: April 2017

Objective

The goal of this study is to determine if injury severity score (ISS) of ≥9 and systolic blood pressure (SBP) predict poor maternal/pregnancy outcomes in blunt and penetrating trauma, respectively.

Methods

The Pennsylvania Trauma Systems Foundation database was used to identify pregnant trauma patients. Blunt trauma patients were analyzed with regard to ISS, while penetrating trauma patients were analyzed to determine whether SBP < 90 mmHg was predictive of poor maternal outcome.

Results

Patients with severe blunt injury (ISS ≥ 9) due to motor vehicle accident were less likely to wear seatbelts (51% vs. 63%, p = 0.005), and delivery was required in 17% of these patients as compared to 6% of the less severely injured, and only 6% of those were vaginal deliveries. Severely injured patients were discharged home 68% of the time and 6% died compared to less severely injured patients of which 83% were discharged home and <1% died; all other patients required discharge to a rehabilitation facility. Patients with penetrating trauma and SBP < 90 mmHg on arrival were more likely to require delivery (35% vs. 5%, p < 0.001) and were 14 times more likely to die (58% vs. 4%, p < 0.001) when compared to the normotensive group.

Conclusion

ISS ≥ 9 and SBP < 90 mmHg are predictors for poor outcomes after trauma during pregnancy. Severely injured blunt trauma patients often require surgery and delivery. Patients who present with SBP < 90 after penetrating trauma are more likely to deliver and are 14 times more likely to die.
Exploring science visually: Science and photography with pre-kindergarten children
Authors: Britsch Susan
Published: April 2017

This paper presents initial findings from a project that explored the use of digital cameras by preschool children in classroom science investigations. Children’s science experience was viewed through a multimodal, social semiotic lens. A qualitative approach to data analysis was used to track and codify the visual choices made by the child photographers. This paper characterizes the precise visual choice-making in which the children engaged to compose their photographs. Focusing on one investigation of mixture and separation, the paper contrasts case studies of two of the focal children, arguing that a series of child-composed photographs can be viewed as a visual structuring of perceptual experience. In fact, the photographs provided visual evidence of the children’s relationships to the investigation. These photographs are also compared with the children’s post-investigation drawings to demonstrate differences in the use of image-as-photograph and image-as-drawing to visually characterize their roles in the science investigation.
Voices of Spouses Living with Partners with Neuropsychiatric Symptoms Related to Dementia
Authors: Tyrrell Marie , Hillerås Pernilla , Skovdahl Kirsti , Fossum Bjöörn , Religa Dorota
Published: April 2017

Persons with dementia, who reside in their own homes, are often cared for by family members. The presence of a family career is said to have a protective effect, postponing admissions to residential care. The majority of persons with dementia develop behavioural and personality changes during the disease trajectory also known as neuropsychiatric symptoms. Quality of life for both the person with neuropsychiatric symptoms and their careers are affected, increasing suffering and risk for hospitalisation and admission to long-term residential care. Family careers to persons with dementia have identified behavioural changes as more distressing than cognitive impairment leading to increased burden of care and admissions to residential care. Knowledge gaps exist regarding how family careers living with persons with dementia experience neuropsychiatric symptoms in a community setting. The aim was to describe spouses’ experiences of living with partners who have developed neuropsychiatric symptoms related to dementia in a community setting. Semi-structured interviews were carried out with 14 spouses of partners with dementia. The interviews included completion of the neuropsychiatric inventory. Interview data were analysed using a content analysis approach. The results showed that spouses identified in the neuropsychiatric inventory that partners with dementia had on average five to eight co-existing symptoms. Frequency, severity and distress varied. From the narrative data, the theme living on the edge lacking support and time for self, emerged. The findings of this study suggest that support offered to persons with dementia and their spouses should have a person-centred approach meeting individual needs. Safety and welfare of persons with dementia and their spouses residing in their own homes may be jeopardised in the presence of neuropsychiatric symptoms. A greater awareness is required in the community regarding the well-being of these persons.
Rights in Mind: Thinking Differently About Dementia and Disability
Authors: Shakespeare Tom , Zeilig Hannah , Mittler Peter
Published: April 2017

The aim of this paper is to argue for the utility of a relational model of disability, as a way of conceptualizing dementia. We explore whether dementia should be considered as a disability, and whether people with dementia might consider themselves as disabled people. We review examples of, and issues raised by, the political activism of people with dementia. We consider how language constructs dementia negatively. We discuss how the environment influences the experience of dementia. In conclusion, we show that a relational model of dementia lays the basis for a human rights approach to the condition, based on collaborative partnerships between people with dementia and people from other disability communities.
Consuming popular songs online: Phoenix Legend’s audiences and Douban Music
Authors: Liu Chen , Yang Rong
Published: April 2017

This article explores the creative consumption of popular music and explains how audiences involve their place-based emotions within their representations of popular music in an everyday setting, drawing on a qualitative study on people’s interpretations of Phoenix Legend (a popular music duo in mainland China) and its music. We collected the texts created by Phoenix Legend’s audiences from Douban Music ( http://music.douban.com/ ), a Chinese online music forum. Our analysis focuses on how fans, non-fans and anti-fans interpret and re-write the meanings of Phoenix Legend and its songs emotionally and how these interpretations shape and are shaped by these audiences’ senses of self and place. The key finding of this article argues that through the consumer-to-consumer network provided by social media (Douban Music), the rural–urban division, ethnic cultures and the role of Chinese nationalism in the global marketplace are generated by audiences’ creative writings and their interactions with other consumers. Moreover, we suggest that anti-fans’ and non-fans’ emotional engagement within music consumption and their interactions should be paid more attentions to.
Rectus Abdominis Motor Nerves as Donor Option for Free Functional Muscle Transfer: A Cadaver Study and Case Series
Authors: Mull Aaron B. , Nicoson Michael C. , Moore Amy M. , Hunter Dan A. , Tung Thomas H.
Published: April 2017

Background: Current management of brachial plexus injuries includes nerve grafts and nerve transfers. However, in cases of late presentation or pan plexus injuries, free functional muscle transfers are an option to restore function. The purpose of our study was to describe and evaluate the rectus abdominis motor nerves histomorphologically and functionally as a donor nerve option for free functional muscle transfer for the reconstruction of brachial plexus injuries. Methods: High intercostal, rectus abdominis, thoracodorsal, and medial pectoral nerves were harvested for histomorphometric analysis from 4 cadavers from levels T3-8. A retrospective chart review was performed of all free functional muscle transfers from 2001 to 2014 by a single surgeon. Results: Rectus abdominis nerve branches provide a significant quantity of motor axons compared with high intercostal nerves and are comparable to the anterior branch of the thoracodorsal nerve and medial pectoral nerve branches. Clinically, the average recovery of elbow flexion was comparable to conventional donors for 2-stage muscle transfer. Conclusion: Rectus abdominis motor nerves have similar nerve counts to thoracodorsal, medial pectoral nerves, and significantly more than high intercostal nerves alone. The use of rectus abdominis motor nerve branches allows restoration of elbow flexion comparable to other standard donors. In cases where multiple high intercostal nerves are not available as donors (rib fractures, phrenic nerve injury), rectus abdominis nerves provide a potential option for motor reconstruction without adversely affecting respiration.
Using phase II data for the analysis of phase III studies: An application in rare diseases
Authors: Wandel Simon , Neuenschwander Beat , Röver Christian , Friede Tim
Published: April 2017

Background:

Clinical research and drug development in orphan diseases are challenging, since large-scale randomized studies are difficult to conduct. Formally synthesizing the evidence is therefore of great value, yet this is rarely done in the drug-approval process. Phase III designs that make better use of phase II data can facilitate drug development in orphan diseases.

Methods:

A Bayesian meta-analytic approach is used to inform the phase III study with phase II data. It is particularly attractive, since uncertainty of between-trial heterogeneity can be dealt with probabilistically, which is critical if the number of studies is small. Furthermore, it allows quantifying and discounting the phase II data through the predictive distribution relevant for phase III. A phase III design is proposed which uses the phase II data and considers approval based on a phase III interim analysis. The design is illustrated with a non-inferiority case study from a Food and Drug Administration approval in herpetic keratitis (an orphan disease). Design operating characteristics are compared to those of a traditional design, which ignores the phase II data.

Results:

An analysis of the phase II data reveals good but insufficient evidence for non-inferiority, highlighting the need for a phase III study. For the phase III study supported by phase II data, the interim analysis is based on half of the patients. For this design, the meta-analytic interim results are conclusive and would justify approval. In contrast, based on the phase III data only, interim results are inconclusive and require further evidence.

Conclusion:

To accelerate drug development for orphan diseases, innovative study designs and appropriate methodology are needed. Taking advantage of randomized phase II data when analyzing phase III studies looks promising because the evidence from phase II supports informed decision-making. The implementation of the Bayesian design is straightforward with public software such as R.
Treatment of missing data in follow-up studies of randomised controlled trials: A systematic review of the literature
Authors: Sullivan Thomas R , Yelland Lisa N , Lee Katherine J , Ryan Philip , Salter Amy B
Published: April 2017

Background/aims:

After completion of a randomised controlled trial, an extended follow-up period may be initiated to learn about longer term impacts of the intervention. Since extended follow-up studies often involve additional eligibility restrictions and consent processes for participation, and a longer duration of follow-up entails a greater risk of participant attrition, missing data can be a considerable threat in this setting. As a potential source of bias, it is critical that missing data are appropriately handled in the statistical analysis, yet little is known about the treatment of missing data in extended follow-up studies. The aims of this review were to summarise the extent of missing data in extended follow-up studies and the use of statistical approaches to address this potentially serious problem.

Methods:

We performed a systematic literature search in PubMed to identify extended follow-up studies published from January to June 2015. Studies were eligible for inclusion if the original randomised controlled trial results were also published and if the main objective of extended follow-up was to compare the original randomised groups. We recorded information on the extent of missing data and the approach used to treat missing data in the statistical analysis of the primary outcome of the extended follow-up study.

Results:

Of the 81 studies included in the review, 36 (44%) reported additional eligibility restrictions and 24 (30%) consent processes for entry into extended follow-up. Data were collected at a median of 7 years after randomisation. Excluding 28 studies with a time to event primary outcome, 51/53 studies (96%) reported missing data on the primary outcome. The median percentage of randomised participants with complete data on the primary outcome was just 66% in these studies. The most common statistical approach to address missing data was complete case analysis (51% of studies), while likelihood-based analyses were also well represented (25%). Sensitivity analyses around the missing data mechanism were rarely performed (25% of studies), and when they were, they often involved unrealistic assumptions about the mechanism.

Conclusion:

Despite missing data being a serious problem in extended follow-up studies, statistical approaches to addressing missing data were often inadequate. We recommend researchers clearly specify all sources of missing data in follow-up studies and use statistical methods that are valid under a plausible assumption about the missing data mechanism. Sensitivity analyses should also be undertaken to assess the robustness of findings to assumptions about the missing data mechanism.
It’s a family business!: Leadership texts as technologies of heteronormativity
Authors: Ferry Nicole C
Published: April 2017

This article contributes to the recent scholarship in Critical Leadership Studies by tracing several heteronormative logics entangled within contemporary leadership discourse. As a popular and profitable industry, mainstream leadership studies utilize the fields of psychology and business management to support their claims of successful practices. This situates leadership discourse as a natural, objective, and value-neutral science, rendering its inherently biased and exclusionary assumptions and applications largely unexamined from a critical lens. In response, this analysis illustrates how leadership serves as a technology of heteronormativity by describing prominent and interconnected themes in several of the bestselling leadership books in the United States. Using queer and poststructural theoretical frames in conjunction with critical discourse analysis, three themes are analyzed which illuminate how leadership discourses: rely on heteronormative familial logics, use generational paradigms that position leadership within heteronormative time and space, and promote and privilege (hetero)reproduction through ideas of legacy and role modeling. These themes within leadership coalesce to form decidedly heterosexist/heteronormative discursive practices, disrupting the notion of leadership as an ideologically neutral discourse.
Interpreting oblique impact data from an accelerometer-instrumented ice hockey helmet
Authors: Jorgensen Janelle K , Thoreson Andrew R , Stuart Michael B , Loyd Andre , Smith Aynsley M , Twardowski Casey , Gaz Daniel V , Hollman John H , Krause David A , Nan An Kai , Stuart Michael J
Published: April 2017

The purpose of this study was to assess the correlations of acceleration measurements between an instrumented hockey helmet and the Hybrid III headform and to determine whether collision with a broad surface affects the correlations between these data. A CCM Vector hockey helmet, instrumented with the Head Impact Telemetry System, was fitted onto an instrumented Hybrid III headform and dropped onto an inclined plate to simulate impacts in hockey. The helmet and headform were dropped from 0.15, 0.30, and 0.60 m at different orientations to create impacts to the vertex, occipital, right, left, and forehead surfaces. Peak linear and rotational acceleration magnitudes and head injury criteria were assessed for each system. Correlations were assessed with the Pearson correlation coefficient, and linear regression models were generated. Relative error was assessed, and results were compared with the Wilcoxon signed rank test. Peak acceleration magnitudes generally had strong mathematical correlations, although a 1:1 linear relationship for rotational acceleration data was not observed. Differences between helmet and head peak acceleration magnitudes were significant. The linear relationship varied according to the impact direction. Instrumented helmet and head data demonstrated a strong mathematical correlation, but measures of linear acceleration generally had better 1:1 agreement than rotational acceleration measures. There is some dependence in the relationship between the helmet and head data on the impact direction, with vertex strikes showing the weakest correlation. Although data generated from the helmet may be useful for interpreting head accelerations experienced by on-ice players, additional analysis of the time-series data should be performed to understand its full utility.
Asexual Reproduction to Propel Recovery Efforts of the Critically Endangered Håyun Lågu Tree (Serianthes nelsonii Merr.)
Authors: Marler Thomas E.
Published: April 2017

The natural distribution of the critically endangered tree Serianthes nelsonii (Håyun lågu) is restricted to 33 known individuals located on the islands of Rota and Guam, Mariana Islands. Major risks of extinction are a limited range, a minimal number of individuals, and a lack of recruitment. The potential for grafting and air-layering propagation was evaluated to reveal new approaches, by which species recovery efforts may be achieved. Root formation occurred on 100% of the air-layered S. nelsonii stems. Using Serianthes kanehirae as rootstock, graft success was 100% for approach graft and 25% for traditional veneer graft techniques. These results have shown that asexual reproduction is highly successful for this woody legume species and is available to address the restrictions on species recovery caused by limited seed availability. These propagation strategies open up new prospects for conserving contemporary genetic diversity and reversing the failures in S. nelsonii recovery efforts, since the 1994 recovery plan was published.
Predictors and characteristics of angioectasias in patients with obscure gastrointestinal bleeding identified by video capsule endoscopy
Authors: Nennstiel Simon , Machanek Annkathrin , von Delius Stefan , Neu Bruno , Haller Bernhard , Abdelhafez Mohamed , Schmid Roland M , Schlag Christoph
Published: April 2017

Background

In obscure gastrointestinal bleeding, angioectasias are common findings in video capsule endoscopy (VCE).

Objective

The objective of this study was to identify predictors and characteristics of small bowel angioectasias.

Methods

Video capsule examinations between 1 July 2001 and 31 July 2011 were retrospectively reviewed. Patients with obscure gastrointestinal bleeding were identified, and those with small bowel angioectasia were compared with patients without a definite bleeding source. Univariate and multivariable statistical analyses for possible predictors of small bowel angioectasia were performed.

Results

From a total of 717 video capsule examinations, 512 patients with obscure gastrointestinal bleeding were identified. Positive findings were reported in 350 patients (68.4%) and angioectasias were documented in 153 of these patients (43.7%). These angioectasias were mostly located in the proximal small intestine (n  = 86, 56.6%). Patients’ age >65 years (odds ratio (OR) 2.15, 95% confidence interval (CI) 1.36–3.38, p  = .001) and overt bleeding type (OR 1.89, 95% CI 1.22–2.94, p  = .004) were identified as significant independent predictors of small bowel angioectasia.

Conclusion

Angioectasias are the most common finding in VCE in patients with obscure gastrointestinal bleeding. They are mostly located in the proximal small bowel and are associated with higher age and an overt bleeding type.
A scoping review of Finnish doctoral dissertations in older people nursing science
Authors: Stolt Minna , Eloranta Sini , Elo Satu , Isola Arja , Suhonen Riitta
Published: April 2017

Scientific research is important in guiding the development of evidence-based, cost-effective and comprehensive healthcare. The purpose of this scoping review was to analyse the current stage of research in the field of older people nursing science based on doctoral dissertations completed in Finnish universities. Altogether 418 doctoral dissertations in nursing science were published (1990–2015), and 44 of these (11%) represented older people nursing. The majority of the dissertations focused on patient and family or nursing activities. Usual topics were care procedures and clinical nursing (36%); self-care ability, independence (23%) and existence, being and feeling as an individual person (18%). Only one randomised controlled trial was conducted. The main informants were older people (78%) who were typically interviewed or surveyed. Research in older people nursing science in Finland is focusing on traditional clinical nursing settings. More innovative research is necessary from the perspective of health promotion and technological solutions.
Traumatic Cervical Unilateral and Bilateral Facet Dislocations Treated With Anterior Cervical Discectomy and Fusion Has a Low Failure Rate
Authors: Anissipour Alireza K. , Agel Julie , Baron Matthew , Magnusson Erik , Bellabarba Carlo , Bransford Richard J.
Published: April 2017

Study Design:

Retrospective radiographic and chart review.

Objective:

To define the rate and associated risk factors of treatment failure of anterior cervical fusion for treatment of cervical facet dislocations.

Methods:

Between 2004 and 2014, a retrospective review at a single level 1 trauma center identified 38 patients with unilateral or bilateral dislocated facet(s) treated with anterior cervical discectomy and fusion (ACDF). Two patients were eliminated due to less than 30-day follow-up. Demographic data, initial neurological exams, surgical data, radiographic findings, and follow-up records were reviewed.

Results:

Of the 36 patients with facet dislocations treated with ACDF using a fixed locking plate, 16 were unilateral and 20 were bilateral. The mean age was 35 years (range 13-58). Mean follow-up was 323 days (range 30-1998). There were 3 treatment failures (8%). Three of 7 (43%) endplate fractures failed ( P < .01), and 1/28 (4%) facet fractures failed ( P = .13). The mean time to failure was 4 weeks (1-7 weeks). One treatment failure had a facet fracture, and all 3 failures had an associated endplate fracture.

Conclusion:

Treatment failure occurred in 3 out of 36 (8%) patients with facet fracture dislocations treated with anterior cervical discectomy, fusion, and plating. Rates of failure are lower than has been previously reported. Endplate fractures of the inferior level in jumped facets appears to be a major risk factor of biomechanical failure. However, a facet fracture may not be a risk factor for failure. In the absence of an endplate fracture, ACDF is a reasonable treatment option in patients with single-level cervical facet dislocation.
Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution
Authors: Tseng Chia-Lin , Eppinga Wietse , Charest-Morin Raphaele , Soliman Hany , Myrehaug Sten , Maralani Pejman Jabehdar , Campbell Mikki , Lee Young K. , Fisher Charles , Fehlings Michael G. , Chang Eric L. , Lo Simon S. , Sahgal Arjun
Published: April 2017

Study Design:

A broad narrative review.

Objectives:

The objective of this article is to provide a technical review of spine stereotactic body radiotherapy (SBRT) planning and delivery, indications for treatment, outcomes, complications, and the challenges of response assessment. The surgical approach to spinal metastases is discussed with an overview of emerging minimally invasive techniques.

Methods:

A comprehensive review of the literature was conducted on the techniques, outcomes, and developments in SBRT and surgery for spinal metastases.

Results:

The optimal management of patients with spinal metastases is complex and requires multidisciplinary assessment from an oncologic team that is familiar with the shifting paradigm as a consequence of evolving techniques in surgery and stereotactic radiation, as well as new developments in systemic agents. The Spinal Instability Neoplastic Score and the epidural spinal cord compression (Bilsky) grading system are useful tools that facilitate communication among oncologic team members and can direct management by providing a baseline assessment of risks prior to therapy. The combined multimodality approach with “separation surgery” followed by postoperative spine SBRT achieves thecal sac decompression, improves tumor control, and avoids complications that may be associated with more extensive surgery.

Conclusion:

Spine SBRT is a highly effective treatment that is capable of delivering ablative doses to the target while sparing the critical organs-at-risk, chiefly the critical neural tissues, within a short and manageable schedule. At the same time, surgery occupies an important role in select patients, particularly with the expanding availability and expertise in minimally invasive techniques. With rapid adoption of spine SBRT in centers outside of the academic setting, it is imperative for the practicing oncologist to understand the relevance and application of these evolving concepts.
Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle–Sparing Decompression With Segmental Instrumentation and Interbody Fusion
Authors: Carr Daniel A. , Volkov Andrey A. , Rhoiney David L. , Setty Pradeep , Barrett Ryan J. , Claybrooks Roderick , Bono Peter L. , Tong Doris , Soo Teck M.
Published: April 2017

Study Design:

Retrospective consecutive case series.

Objective:

The objective of this case series was to demonstrate the safety of a modified transfacet pedicle–sparing decompression and instrumented fusion in patients with thoracic disc herniations (TDHs).

Methods:

Consecutive patients undergoing operative management of TDH from July 2007 to December 2011 using a posterior unilateral modified transfacet pedicle–sparing approach were identified. All patients underwent open or minimally invasive modified transfacet pedicle–sparing discectomy and segmental instrumentation with interbody fusion, performed by four different surgeons. Pre- and postoperative visual analog scale (VAS) pain scores, Nurick grade, and American Spinal Injury Association Impairment Scale (AIS) were analyzed from a retrospective chart review. Estimated blood loss and complications were also obtained.

Results:

Fifty-one patients were included that had operations for TDH. Thirty-nine patients had single level decompression and 12 had multilevel decompression. The total number of levels operated on was 64. Five patients were treated with minimally invasive surgery. A herniated disc level of T11-12 (n = 17) was treated most often. One major complication of epidural hematoma occurred. Minor complications such as malpositioned hardware, postoperative hematoma, wound infection, pseudoarthrosis, and pulmonary complications occurred in a few patients. Follow-up ranged from 1 to 46 months with 1 patient lost to follow-up. From preoperative to final postoperative: mean VAS scores improved from 8.31 to 4.05, AIS in all patients remained stable or improved, and Nurick scores improved from 3 to 2.6 on average. No intraoperative or permanent neurological deficit occurred.

Conclusion:

In our surgical series, 51 consecutive patients underwent modified transfacet pedicle–sparing approach to TDHs and experienced improvement of functional status as well as improvement of objective pain scales with no neurological complications. The posterior unilateral modified transfacet pedicle–sparing decompression and instrumented fusion approach to the thoracic spine is a safe and reproducible procedure for the treatment of TDHs.
Use of Bivector Traction for Stabilization of the Head and Maintenance of Optimal Cervical Alignment in Posterior Cervical Fusions
Authors: Karikari Isaac O. , Bumpass David B. , Gum Jeffrey , Sugrue Patrick , Chapman Todd M. , Elsamadicy Aladine A. , Riew K. Daniel
Published: April 2017

Study Design:

Retrospective analysis of consecutive case series.

Objective:

To introduce a novel method of stabilizing the cranium using bivector traction in posterior cervical fusions.

Methods:

A retrospective review of 50 consecutive patients undergoing instrumented posterior cervical arthrodesis was performed. All patients had at least 3 levels of subaxial fusion using the bivector traction apparatus. Patients’ demographic data was recorded for the following: pre- and postoperative cervical lordosis, pre- and postoperative cervical sagittal vertical alignment (cSVA), and intraoperative complications from pin placements.

Results:

A total of 50 patients were studied. There were 31 females and 19 males. The mean age at the time of surgery was 49 years (range 35-79). A mean 5.8 levels were fused. The most common levels fused were C2-T3 in 14 patients followed by C2-T2 in 7 patients. In no case did the surgeon or assistant have to scrub out to adjust the alignment. The mean pre- and postoperative cervical lordosis was −6.0° and −10°, respectively ( P = .04). The mean pre-and postoperative cSVA was 30.5 mm and 32 mm, respectively ( P = .6). There were no complications related to placement of the Gardner-Well tongs.

Conclusion:

The bivector traction is an easy, safe, and effective method of stabilizing the head and obtaining adequate cervical sagittal alignment.
Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013
Authors: Bernstein David N. , Brodell David , Li Yue , Rubery Paul T. , Mesfin Addisu
Published: April 2017

Study Design:

Retrospective database analysis.

Objective:

The impact of the 2008-2009 economic downtown on elective lumbar spine surgery is unknown. Our objective was to investigate the effect of the economic downturn on the overall trends of elective lumbar spine surgery in the United States.

Methods:

The Nationwide Inpatient Sample (NIS) was used in conjunction with US Census and macroeconomic data to determine historical trends. The economic downturn was defined as 2008 to 2009. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), were used in order to identify appropriate procedures. Confidence intervals were determined using subgroup analysis techniques.

Results:

From 2003 to 2012, there was a 19.8% and 26.1% decrease in the number of lumbar discectomies and laminectomies, respectively. Over the same time period, there was a 56.4% increase in the number of lumbar spinal fusions. The trend of elective lumbar spine surgeries per 100 000 persons in the US population remained consistent from 2008 to 2009. The number of procedures decreased by 4.5% from 2010 to 2011, 7.6% from 2011 to 2012, and 3.1% from 2012 to 2013. The R2 value between the number of surgeries and the S&P 500 Index was statistically significant ( P ≤ .05).

Conclusions:

The economic downturn did not affect elective lumbar fusions, which increased in total from 2003 to 2013. The relationship between the S&P 500 Index and surgical trends suggests that during recessions, individuals may utilize other means, such as insurance, to cover procedural costs and reduce out-of-pocket expenditures, accounting for no impact of the economic downturn on surgical trends. These findings can assist multiple stakeholders in better understanding the interconnectedness of macroeconomics, policy, and elective lumbar spine surgery trends.
Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America
Authors: Buser Zorica , Ortega Brandon , D’Oro Anthony , Pannell William , Cohen Jeremiah R. , Wang Justin , Golish Ray , Reed Michael , Wang Jeffrey C.
Published: April 2017

Study Design:

Retrospective database study.

Objective:

Low back and neck pain are among the top leading causes of disability worldwide. The aim of our study was to report the current trends on spine degenerative disorders and their treatments.

Methods:

Patients diagnosed with lumbar or cervical spine conditions within the orthopedic subset of Medicare and Humana databases (PearlDiver). From the initial cohorts we identified subgroups based on the treatment: fusion or nonoperative within 1 year from diagnosis. Poisson regression was used to determine demographic differences in diagnosis and treatment approaches.

Results:

Within the Medicare database there were 6 206 578 patients diagnosed with lumbar and 3 156 215 patients diagnosed with cervical degenerative conditions between 2006 and 2012, representing a 16.5% (lumbar) decrease and 11% (cervical) increase in the number of diagnosed patients. There was an increase of 18.5% in the incidence of fusion among lumbar patients. For the Humana data sets there were 1 160 495 patients diagnosed with lumbar and 660 721 patients diagnosed with cervical degenerative disorders from 2008 to 2014. There was a 33% (lumbar) and 42% (cervical) increases in the number of diagnosed patients. However, in both lumbar and cervical groups there was a decrease in the number of surgical and nonoperative treatments.

Conclusions:

There was an overall increase in both lumbar and cervical conditions, followed by an increase in lumbar fusion procedures within the Medicare database. There is still a burning need to optimize the spine care for the elderly and people in their prime work age to lessen the current national economic burden.