bluuebunny/crossref_metadata_2025 huggingface dataset:
Fundamental statistical methods for prognosis research
Authors: Riley Richard D , Snell Kym IE , Moons Karel GM , Debray Thomas PA
Published: February 2019

This chapter introduces and describes the fundamental statistical measures, methods, and principles that form the bedrock of prognosis research. A major emphasis is given to linear regression for continuous outcomes, logistic regression for binary outcomes, and Cox regression and parametric survival models for time-to-event outcomes. It is shown how these models can be used to identify prognostic factors; obtain measures of prognostic value of such factors such as mean differences, odds ratios, and hazard ratios; and produce a model for predicting outcomes (and outcome risk) in new individuals. Details are provided on how the predictive performance of a prognostic model should be evaluated using a specific set of statistical techniques, including measuring and displaying overall fit, calibration, and discrimination. The importance of investigating non-linear prognostic associations (using methods such as fractional polynomials and cubic splines) are also covered. The chapter is designed to ensure that novice and experienced prognosis researchers have a firm grasp of the statistical principles underlying the four types of prognosis research discussed throughout the book.
Overgrowth
Authors: Clark Robin D. , Curry Cynthia J.
Published: February 2019

This chapter reviews information on disorders that cause large birth weight, macrosomia, and/or segmental overgrowth. The most common of these conditions is seen in infants of diabetic mothers. Abnormal dosage of growth regulating genes make chromosomal microarray abnormalities a relatively common cause of overgrowth. Particularly notable is the distinctive Pallister Killian syndrome (12p tetrasomy). Other common overgrowth syndromes include Beckwith-Wiedemann syndrome, Sotos, Malan, and Weaver syndromes. The RASopathy syndromes including Noonan syndrome* and Costello syndrome are also often large at birth. Segmental overgrowth syndromes including Proteus and Klippel Trenaunay as well as PIK3CA related overgrowth (PROS) are discussed as well as their somatic mosaic origin in affected tissues. Clinical guidelines for evaluation and surveillance are outlined. The clinical case presentation features an infant with Sotos syndrome.
Self-consistent redshift estimation using correlation functions without a spectroscopic reference sample
Authors: Hoyle Ben , Rau Markus Michael
Published: February 2019

We present a new method to estimate redshift distributions and galaxy-dark matter bias parameters using correlation functions in a fully data driven and self-consistent manner. Unlike other machine learning, template, or correlation redshift methods, this approach does not require a reference sample with known redshifts. By measuring the projected cross- and auto-correlations of different galaxy sub-samples, e.g. as chosen by simple cells in colour–magnitude space, we are able to estimate the galaxy-dark matter bias model parameters, and the shape of the redshift distributions of each sub-sample. This method fully marginalizes over a flexible parametrization of the redshift distribution and galaxy-dark matter bias parameters of sub-samples of galaxies, and thus provides a general Bayesian framework to incorporate redshift uncertainty into the cosmological analysis in a data-driven, consistent, and reproducible manner. This result is improved by an order of magnitude by including cross-correlations with the cosmic microwave background and with galaxy–galaxy lensing. We showcase how this method could be applied to real galaxies. By using idealized data vectors, in which all galaxy-dark matter model parameters and redshift distributions are known, this method is demonstrated to recover unbiased estimates on important quantities, such as the offset Δz between the mean of the true and estimated redshift distribution and the 68 per cent, 95 per cent, and 99.5 per cent widths of the redshift distribution to an accuracy required by current and future surveys.
Gamma-rays from SS433: evidence for periodicity
Authors: Rasul Kajwan , Chadwick Paula M , Graham Jamie A , Brown Anthony M
Published: February 2019

In this paper we present our study of the gamma-ray emission from the microquasar SS433. Integrating over 9 yr of Fermi-LAT Pass 8 data, we detect SS433 with a significance of ∼13σ in the 200 to 500 MeV photon energy range, with evidence for an extension in the direction of the w1 X-ray ‘hotspot’. A temporal analysis reveals evidence for modulation of SS433’s gamma-ray emission with the precession period of its relativistic jet. This suggests that at least some of SS433’s gamma-ray emission originates close to the object rather than from the jet termination regions.
Widespread star formation inside galactic outflows
Authors: Gallagher R , Maiolino R , Belfiore F , Drory N , Riffel R , Riffel R A
Published: February 2019

Several models have predicted that stars could form inside galactic outflows and that this would be a new major mode of galaxy evolution. Observations of galactic outflows have revealed that they host large amounts of dense and clumpy molecular gas, which provide conditions suitable for star formation. We have investigated the properties of the outflows in a large sample of galaxies by exploiting the integral field spectroscopic data of the large MaNGA-SDSS4 galaxy survey. We find evidence for prominent star formation occurring inside at least 30 per cent of the galactic outflows in our sample, whilst signs of star formation are seen in up to half of the outflows. We also show that even if star formation is prominent inside many other galactic outflows, this may have not been revealed as the diagnostics are easily dominated by the presence of even faint active galactic nucleus and shocks. If very massive outflows typical of distant galaxies and quasars follow the same scaling relations observed locally, then the star formation inside high-z outflows can be up to several 100 $\rm M_{\odot }~yr^{-1}$ and could contribute substantially to the early formation of the spheroidal component of galaxies. Star formation in outflows can also potentially contribute to establishing the scaling relations between black holes and their host spheroids. Moreover, supernovae exploding on large orbits can chemically enrich in situ and heat the circumgalactic and intergalactic medium. Finally, young stars ejected on large orbits may also contribute to the reionization of the Universe.
Fermi-LAT observations of extreme spectral variability in IC 310
Authors: Graham Jamie A , Brown Anthony M , Chadwick Paula M
Published: February 2019

We investigate the physical mechanisms of high-energy gamma-ray emission from the TeV-emitting misaligned active galactic nucleus IC 310. 8 yr of data from the Fermi Large Area Telescope (Fermi-LAT) between 100 MeV and 500 GeV are reduced and analysed to study the temporal and spectral characteristics of IC 310. Point spread function-partitioned instrument response functions are used to improve the resolvability of IC 310 from nearby NGC 1275. Systematic effects due to this choice of instrument response functions and the proximity of NGC 1275 are investigated. We find strong spectral variability and detect the hard flaring state of IC 310 along with a previously undiscovered soft state in quiescent periods, and the first detection with Fermi-LAT below 1 GeV. This represents a shift in peak Compton energy of more than 5 orders of magnitude. Possible interpretations are discussed, but we lack the instantaneous sensitivity with Fermi to probe the underlying physics.
A new method to probe the mass density and the cosmological constant using configuration entropy
Authors: Pandey Biswajit , Das Biswajit
Published: February 2019

We study the evolution of the configuration entropy for different combinations of Ωm0 and ΩΛ0 in the flat Λ cold dark matter universe and find that the cosmological constant plays a decisive role in controlling the dissipation of the configuration entropy. The configuration entropy dissipates at a slower rate in the models with higher value of ΩΛ0. We find that the entropy rate decays to reach a minimum and then increases with time. The minimum entropy rate occurs at an earlier time for higher value of ΩΛ0. We identify a prominent peak in the derivative of the entropy rate whose location closely coincides with the scale factor corresponding to the transition from matter to Λ domination. We find that the peak location is insensitive to the initial conditions and only depends on the values of Ωm0 and ΩΛ0. We propose that measuring the evolution of the configuration entropy in the Universe and identifying the location of the peak in its second derivative would provide a new and robust method to probe the mass density and the cosmological constant.
Plasticity of Promoter-Core Sequences Allows Bacteria to Compensate for the Loss of a Key Global Regulatory Gene
Authors: Lamrabet Otmane , Plumbridge Jacqueline , Martin Mikaël , Lenski Richard E , Schneider Dominique , Hindré Thomas
Published: February 2019

Transcription regulatory networks (TRNs) are of central importance for both short-term phenotypic adaptation in response to environmental fluctuations and long-term evolutionary adaptation, with global regulatory genes often being targets of natural selection in laboratory experiments. Here, we combined evolution experiments, whole-genome resequencing, and molecular genetics to investigate the driving forces, genetic constraints, and molecular mechanisms that dictate how bacteria can cope with a drastic perturbation of their TRNs. The crp gene, encoding a major global regulator in Escherichia coli, was deleted in four different genetic backgrounds, all derived from the Long-Term Evolution Experiment (LTEE) but with different TRN architectures. We confirmed that crp deletion had a more deleterious effect on growth rate in the LTEE-adapted genotypes; and we showed that the ptsG gene, which encodes the major glucose-PTS transporter, gained CRP (cyclic AMP receptor protein) dependence over time in the LTEE. We then further evolved the four crp-deleted genotypes in glucose minimal medium, and we found that they all quickly recovered from their growth defects by increasing glucose uptake. We showed that this recovery was specific to the selective environment and consistently relied on mutations in the cis-regulatory region of ptsG, regardless of the initial genotype. These mutations affected the interplay of transcription factors acting at the promoters, changed the intrinsic properties of the existing promoters, or produced new transcription initiation sites. Therefore, the plasticity of even a single promoter region can compensate by three different mechanisms for the loss of a key regulatory hub in the E. coli TRN.
Hearing Response Following Internal Auditory Canal Decompression in Neurofibromatosis Type 2
Authors: Bonne Nicolas-Xavier , Risoud Michaël , Hoa Michael , Lemesre Pierre-Emmanuel , Aboukais Rabih , Le Rhun Emilie , Dubrulle Frédérique , Baroncini Marc , Lejeune Jean-Paul , Vincent Christophe
Published: February 2019

BACKGROUND

Hearing response following an osteodural decompression of the internal auditory canal (IAC) is controversial.

OBJECTIVE

To evaluate the course of auditory brainstem responses (ABRs) and the early hearing response during the first year following IAC decompression for small to medium-sized vestibular schwannomas occurring in neurofibromatosis type 2 (NF2).

METHODS

Retrospective chart review of middle fossa craniotomy for IAC osteodural decompression in NF2-related vestibular schwannomas.

RESULTS

Twelve NF2 patients were operated on from 2011 to 2016 for IAC decompression. All had NF2 according to the Manchester criteria. All had a progressive change of their ABRs documented from the diagnosis of NF2 over a mean period of 6.25 [0.36;10.9] yr. Treatment was proposed to stop hearing progression based on the speech discrimination scores (SDSs; n = 4) or for hearing maintenance (n = 8). In patients with prior hearing progression, hearing responses were observed in 3 of the 4 patients during the first year. One patient kept on progressing. In the hearing maintenance group, the SDSs remained stable. SDSs improved from 85% [20-100] to 92.5% [60-100] on average (n = 12) and from 55% [20-80] to 77.5% [50-100] in the hearing progression group (n = 4). ABRs improved in 4 patients following decompression.

CONCLUSION

IAC decompression allows early objective hearing responses in select patients. We suggest that the procedure should be offered to patients with hearing progression based on their SDSs and/or associated progressive increases in their wave III and V latencies on ABRs.
The Continued Role and Value of Imaging for Acute Ischemic Stroke
Authors: Bonney Phillip A , Walcott Brian P , Singh Parampreet , Nguyen Peggy L , Sanossian Nerses , Mack William J
Published: February 2019

Advances in neuroimaging in the last 2 decades have revolutionized the management of acute ischemic stroke (AIS). Here we review the development of computed tomography (CT) and magnetic resonance imaging (MRI) modalities used to guide treatment of patients with AIS characterized by large vessel occlusion. In particular, we highlight recent randomized trials and their patient selection methodologies to detail the progression of these selection paradigms. With advanced imaging, distinction between at-risk penumbra and ischemic core in AIS may be performed using either CT or MRI. While limitations exist for methodologies to quantify core and penumbra, commercially available fully automated software packages provide useful information to guide treatment decisions. Randomized controlled trials implementing perfusion imaging to patient selection algorithms have demonstrated marked success in improving functional outcomes in patients with large vessel occlusions. As such, imaging has become a vital aspect of AIS treatment in selecting patients who may benefit from mechanical thrombectomy.
A systematic review of physical and psychological health and wellbeing of older women in Sub-Saharan Africa
Authors: Mangipudi Sowmya , Cosco Theodore , Harper Sarah
Published: February 2019

Background

Sub-Saharan Africa (SSA) has the fastest growing proportion of older adults in the world, the majority of whom are women. Global health agendas, however, continue to deprioritise older women’s health issues, including the incidence of and mortality from non-communicable disease (NCDs). This is the first systematic review to address the health, wellbeing and healthcare utilization of older SSA women.

Methods

Studies with primary analysis of health, wellbeing and/or healthcare utilization outcomes for women over the age of 50 from SSA countries were included. Databases searched include EMBASE, Scopus and Psycinfo.

Findings

About 26 studies from six SSA countries met inclusion criteria. Studies regarding NCDs predominated (n = 12), followed by healthcare utilization (n = 4), disability (n = 4), wellbeing (n = 2), depression (n = 2) and HIV (n = 2). Every study indicated significantly lower self-rated health and wellbeing, higher rates of depression, hypertension, obesity, disability or weakness for women compared with men. The studies also indicated that older women use healthcare more often, and choose public over private facilities more often.

Interpretation

The studies in the review had large, diverse samples. This review demonstrates the need for more gender-specific studies to better understand the unique challenges older women face in managing NCDs in particular.
Differences in identification of patients’ deterioration may hamper the success of clinical escalation protocols
Authors: De Bie A J R , Subbe C P , Bezemer R , Cooksley T , Kellett J G , Holland M , Bouwman R A , Bindels A J G H , Korsten H H M ,   Crisis Checklist Collaborative, Barach Paul , Beaugrand Helene , Breen Dorothy , Byrne Declan , Chalmers Catriona , Cleaver Hayley , Croke Eilish , Davis Elinor , Donnelly Peter , Dunne Eímhín , Durham Lesley , Ellis Bryn , Goel Rohan , Hancock Chris , Hartin Jillian , Hinge Denise , Hueske-Kraus Dirk , Kennelly Sean , Lighthall Geoffrey , Lunn Rebecca , Müller Michael , O’Dwyer Clodagh , O’Mahony Kerian
Published: February 2019

Background

Timely and consistent recognition of a ‘clinical crisis’, a life threatening condition that demands immediate intervention, is essential to reduce ‘failure to rescue’ rates in general wards.

Aim

To determine how different clinical caregivers define a ‘clinical crisis’ and how they respond to it.

Design

An international survey.

Methods

Clinicians working on general wards, intensive care units or emergency departments in the Netherlands, the United Kingdom and Denmark were asked to review ten scenarios based on common real-life cases. Then they were asked to grade the urgency and severity of the scenario, their degree of concern, their estimate for the risk for death and indicate their preferred action for escalation. The primary outcome was the scenarios with a National Early Warning Score (NEWS) ≥7 considered to be a ‘clinical crisis’. Secondary outcomes included how often a rapid response system (RRS) was activated, and if this was influenced by the participant’s professional role or experience. The data from all participants in all three countries was pooled for analysis.

Results

A total of 150 clinicians participated in the survey. The highest percentage of clinicians that considered one of the three scenarios with a NEWS ≥7 as a ‘clinical crisis’ was 52%, while a RRS was activated by <50% of participants. Professional roles and job experience only had a minor influence on the recognition of a ‘clinical crisis’ and how it should be responded to.

Conclusion

This international survey indicates that clinicians differ on what they consider to be a ‘clinical crisis’ and on how it should be managed. Even in cases with a markedly abnormal physiology (i.e. NEWS ≥7) many clinicians do not consider immediate activation of a RRS is required.
Local cooperation for innovation in ICT—Domestic groups with collaborations for innovation abroad and foreign subsidiaries
Authors: Holl Adelheid , Rama Ruth
Published: February 2019

On analysing a sample of Information and Communication Technology (ICT) firms, we ask whether domestic business groups that are engaged in international cooperation for innovation are likely to cooperate for innovation in the home market. We compare these companies with other types of ICT firms. The idea behind our inquiry is that domestic groups involved in international cooperation for innovation are exposed to international information, while they are also well embedded in the home economy. We find that these companies as well as foreign subsidiaries are more prone to cooperating for innovation with domestic partners than are other types of ICT companies, even when size and other characteristics of firms that may influence cooperation are taken into consideration. However, domestic groups with international cooperation for innovation show a systematically higher propensity than foreign subsidiaries to cooperate with domestic partners. These results may be useful regarding policies of foreign direct investment promotion and their alternatives.
Different Associations between Auditory Function and Cognition Depending on Type of Auditory Function and Type of Cognition
Authors: Danielsson Henrik , Humes Larry E , Rönnberg Jerker
Published: February 2019

Objectives:

Previous studies strongly suggest that declines in auditory threshold can lead to impaired cognition. The aim of this study was to expand that picture by investigating how the relationships between age, auditory function, and cognitive function vary with the types of auditory and cognitive function considered.

Design:

Three auditory constructs (threshold, temporal-order identification, and gap detection) were modeled to have an effect on four cognitive constructs (episodic long-term memory, semantic long-term memory, working memory, and cognitive processing speed) together with age that could have an effect on both cognitive and auditory constructs. The model was evaluated with structural equation modeling of the data from 213 adults ranging in age from 18 to 86 years.

Results:

The model provided good a fit to the data. Regarding the auditory measures, temporal-order identification had the strongest effect on the cognitive functions, followed by weaker indirect effects for gap detection and nonsignificant effects for threshold. Regarding the cognitive measures, the association with audition was strongest for semantic long-term memory and working memory but weaker for episodic long-term memory and cognitive speed. Age had a very strong effect on threshold and cognitive speed, a moderate effect on temporal-order identification, episodic long-term memory, and working memory, a weak effect on gap detection, and nonsignificant, close to zero effect on semantic long-term memory.

Conclusions:

The result shows that auditory temporal-order function has the strongest effect on cognition, which has implications both for which auditory concepts to include in cognitive hearing science experiments and for practitioners. The fact that the total effect of age was different for different aspects of cognition and partly mediated via auditory concepts is also discussed.
Desmoplastic fibroma of the tibia: review of the literature and case presentation of an unusual huge lesion
Authors: Abdel Rahman Mohamed , Elgebeily Mohamed , El Masry Ayman Mohammad , Ishak Shady Elia Anis
Published: February 2019

Desmoplastic fibroma is a benign, rare fibroblastic intraosseous neoplasm histologically resembling a desmoid soft-tissue tumor. Fewer than 300 such tumors have been reported in the literature worldwide. Radiographic differential diagnoses include tuberculosis, chondromyxoid fibroma, low-grade intramedullary osteosarcoma, and fibrosarcoma. Recurrence rate after curettage reaches up to 72%, thus en bloc resection with a wide margin of normal tissue is the treatment of choice. This article presents a case of an exceptionally large desmoplastic fibroma of the tibia, discussing the diagnosis and treatment as well as a review of the literature.
Primary pleomorphic liposarcoma of bone: a case report
Authors: Fajolu Olukemi , Wakely Paul E. , Scharschmidt Thomas J.
Published: February 2019

Primary pleomorphic liposarcoma of bone is an extremely rare tumor that is often challenging to diagnose. Radiographic characteristics are nonspecific and consistent with findings of other malignant bone tumors. In addition, debate exists as to whether or not it is actually a primary tumor. This tumor is aggressive and carries an overall poor prognosis. This manuscript reviews the presentation, imaging, and pathology findings of primary pleomorphic liposarcoma.
90/90 Bicortical, double-loop, interosseous wiring for fixation of transverse and short oblique metacarpal shaft fractures
Authors: Afifi Ahmed , Dobal M. Hussein , Mahmoud Mostafa , Moharram Ashraf N.
Published: February 2019

Background:

The purpose of this study was to determine the effectiveness of 90/90 interosseous wiring for fixation of transverse and short oblique metacarpal shaft fractures on early motion.

Methods:

This prospective study was conducted at an academic Level 1 trauma Center from 2015 to 2017. The study included 20 patients (16 males and 4 females). The mean age was 27.3 yr (range, 12 to 44 yr). The dominant hand was affected in 10 patients, and the nondominant hand was affected in the other 10 patients. Regarding the fracture pattern, 17 were transverse and three were short oblique fractures. The mean follow-up period was 6 mo (range, 4 to 8 mo). Patients were assessed for union (clinically and radiographically), range of motion (total active motion [TAM] and total active flexion [TAF]), hand grip strength, and patient-reported outcome using the quick-Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Results:

All patients achieved union after a mean of 7 wk (range, 6 to 8 wk). The mean TAF was 246 degrees (range, 150̊ to 260 degrees). TAM was excellent in 13 digits and good in seven digits. The mean grip strength was 90.20% (range, 61.53% to 100%) of the unaffected side. The mean quick-DASH score was 2.72 (range, 0 to 20.45).

Conclusions:

The interosseous wiring technique is an effective method of fixation that can be used alone for transverse or short oblique fractures of the metacarpal and can permit early hand mobilization postoperatively without loss of reduction.
Preoperative assessment of pediatric supracondylar humeral fractures by orthopaedic residents and orthopaedic surgeons: is there a difference?
Authors: Haruno Lee S. , Hill Jaclyn F. , Sanderson Cody J. , Browne Theodora , Zhu Huirong , McKay Scott D.
Published: February 2019

Background:

The urgency of pediatric supracondylar humeral (SCH) fracture treatment is influenced by preoperative evaluation and neurovascular integrity. This assessment often is completed by a resident. The purpose of this analysis was to determine differences in assessments made by orthopaedic residents and attending physicians in patients with supracondylar humeral fractures.

Methods:

Data were collected on 210 children with displaced supracondylar humeral fractures. A standardized 15-variable checklist was completed by an orthopaedic resident and attending physician. For each variable, Stuart-Maxwell and McNemar tests were used to determine significant differences (P<0.05) in marginal frequencies between the two cohorts. Cohen's kappa analysis (κ) quantified agreement between residents’ and attending physicians’ findings. Κ > 0.75 was considered excellent, 0.40-0.75 moderate, and < 0.40 marginal-poor.

Results:

The agreement between resident and attending physicians was 89%. Three variables had excellent agreement: hand temperature and color (κ~1), and Gartland fracture type (κ=0.81). Moderate agreement was observed for fracture direction (κ=0.68), pulse (κ=0.52), and radial nerve motor function (κ=0.49). The remaining variables: swelling, ecchymosis, motor function of the median, ulnar, anterior/posterior interosseous, and sensory function of the radial, median, and ulnar nerves had poor-marginal agreement (κ-range:−0.042-0.388). Only the attending physicians noted neurovascular abnormalities in 38/63 documented instances (60%). There was no significant association between agreement and evaluation time intervals or resident experience.

Conclusions:

Resident physicians and attending physicians agreed in 89% of the documentation; however, disparities were present in nearly 60% of patients with neurovascular abnormalities. Educational initiatives should target improvement of resident performance in upper extremity neurovascular examination in children. With accurate initial assessment, proper care can be provided according to published guidelines.
National access to pediatric care based on insurance type for children with buckle fractures
Authors: Marchenko Mikhail , Iobst Christopher A.
Published: February 2019

Background:

Previous studies have shown that there is a disparity between access to medical care for U.S. patients with Medicaid and patients with private insurance. This difference has been determined in previous studies of pediatric access to orthopaedic care, and in this study the access to pediatric care was analyzed.

Methods:

Five randomly selected pediatric offices from each state were called with a fictitious scenario to schedule an appointment for a child with a simple bone fracture called a buckle fracture. Once, the office was called with the child having private insurance and the second time the same office was called with the child having Medicaid.

Results:

Of the 250 offices that were contacted, 221/250 (88.4%) of the offices accepted private insurance, and 113/250 (45.2%) of the offices accepted Medicaid. There was a statistically significant difference between the two groups (P<0.0001). The percentage of offices that scheduled an appointment within 7 days was 95.5% for privately insured patients, and 83.6% for patients with Medicaid. This difference was also statistically significant (P=0.0005).

Conclusions:

Although earlier studies have shown that Medicaid patients are less likely to be accepted by specialty care providers, this study determined that pediatric patients will also have more difficulty in scheduling appointments with pediatricians if they are covered by Medicaid.
A novel technique to prevent distal anterior femoral cortical perforation
Authors: El Beaino Marc , Chen Jie , Hagedorn John C.
Published: February 2019

Background:

Anterograde femoral intramedullary nailing is a commonly used operative technique in orthopaedic surgery. Of its related complications, distal femoral anterior cortical breach is of special concern.

Methods:

We describe the steps of an anterograde femoral intramedullary nailing surgical technique performed on three patients to mitigate their risk of developing an anterior distal perforation of the femoral cortex.

Results:

All patients presented with a proximal intertrochanteric femoral fracture and underwent an intramedullary femoral nail placement. They all had an anatomic reduction radiographically. No complications intraoperatively or at last follow-up were recorded.

Conclusions:

By surgically redirecting the guidewire posteriorly before placing the nail in its desired position, our surgical technique prevents the anterior intramedullary nail abutment against the femoral cortex and the risk of anterior femoral cortical perforation.

Level of Evidence:

V.
Does orthopaedic resident efficiency improve with respect to decreased fluoroscopic times in tibial intramedullary nailing? A measure of an ACGME milestone
Authors: Bradburn Kayla , Patel Jay H. , Cannada Lisa K.
Published: February 2019

Background:

Intramedullary nailing of tibial fractures is a surgical milestone from the Accreditation Council for Graduate Medical Education (ACGME). Our purpose was to evaluate if fluoroscopic time decreased with increasing resident experience and could be used as a measure of this milestone.

Methods:

Current Procedural Terminology (CPT) codes were used to identify patients who underwent intramedullary nailing of tibial shaft fractures under the direction of fellowship-trained trauma attending staff. The data collected included patient demographics, fracture classification, fluoroscopic imaging total time, and the post-graduate years (PGY) of orthopaedic residency of the operating resident. Exclusions of patients included concomitant fluoroscopic procedures, inadequate records, or surgeries involving primary assisting residents with less than PGY-2 experience. We compared overall groups between half years and looked at individual resident years for each of the continuous variables.

Results:

When residents were grouped as senior (PGY-4 and PGY-5) or junior (PGY-2 and PGY-3), seniors used significantly less fluoroscopy than juniors (207.39 sec vs. 258.30 sec, P=0.018). In the first half of the academic year, PGY-2 residents completed tibial nailing slowest in terms of fluoroscopic usage (P=0.003). PGY-4 residents completed tibial nailing faster in terms of fluoroscopic usage than other years (P=0.031). In the second half of the academic year, PGY-5 residents used significantly less fluoroscopy than PGY-2 residents (P=0.035).

Conclusions:

As the ACGME currently has no measurement for resident progress and efficiency regarding tibial shaft intramedullary nailing, our data indicate that fluoroscopic measurements may be useful in assessing resident proficiency.
Nursing Value User Stories
Authors: Moon Lisa A. , Clancy Greg , Welton John , Harper Ellen
Published: February 2019

The use of nursing big data sets for value-based measurement is novel. Nursing value measurement depends on the availability of essential data attributes in the electronic health record related to nursing care delivered (what happened, when, and the result seen). Key in measuring value is a standardized structure and format of these attributes for enabling uniform consistent analysis, along with data sets that are sharable and comparable across individuals and groups, time, organization, and practice focus. The foundation of such sharable and comparable data sets would represent at a minimum individual essential nurse care actions and the resulting patient outcome(s). While nurses generate an extraordinary amount of health-related data, healthcare information systems are not designed to collect structured data that reflect the unique attributes of nursing care or support nursing analytic activities that would measure value. More important, the multidimensional features of the nursing process are difficult to untangle and differentiate from other healthcare workers and nonnursing care activities. The complexity of nursing knowledge work has limited the development of nursing data science methods like value measurement and discouraged value versus cost discussions. This article sets out to describe nursing value measurement and an approach that nurse scientists are maximizing through methods adapted from agile project management, including user stories, and business analysis processes to recognize nurses as primary contributors to patient outcomes and value generation. Nursing Value User Story methods deconstruct complex nursing scenarios into user stories that capture nursing actions as standardized data that can be mapped to a common nursing data model. Methods described here are being used in pilot research at Los Angeles Children's Hospital, and results will be available in 2019.
Treatment of Atrophic Facial Acne Scars With Microneedling Followed by Polymethylmethacrylate-Collagen Gel Dermal Filler
Authors: Biesman Brian S. , Cohen Joel L. , DiBernardo Barry E. , Emer Jason J. , Geronemus Roy G. , Gold Michael H. , Lehman Alayne S. , Pilcher Brian K. , Monheit Gary D. , Schlesinger Todd E. , Teller Craig F.
Published: February 2019

BACKGROUND

Microneedling and soft-tissue filler injections have been used independently to improve acne scarring. The effectiveness of a combined approach using microneedling followed by polymethylmethacrylate (PMMA)-collagen gel has not been carefully studied.

OBJECTIVE

The goal of this study was to assess the effectiveness and safety of microneedling alone versus microneedling followed by injection of PMMA-collagen gel filler for correction of atrophic facial acne scars.

METHODS

We conducted a multicenter, open-label, randomized, prospective study on subjects with distensible atrophic acne scars in the face to determine whether microneedling with PMMA-collagen gel is a superior acne scar treatment over microneedling alone. Forty-four subjects received 3 microneedling treatments over a 12-week period followed by randomization to treatments with PMMA-collagen gel (treatment group) or no further treatment (control group).

RESULTS

At 24 weeks, the treatment group achieved a statistically significant improvement in acne scores over microneedling alone. The improvement continued at 36 weeks. At 24 weeks, the treatment group showed a strong trend in improvement on the Physician Global Aesthetic Improvement Scale compared with microneedling alone.
Immunohistochemical Expression of Cyclooxygenases in Hypertrophic Scars and Keloids
Authors: Pavelecini Michel , Zettler Cláudio G. , Fernandes Marilda C. , Ely Pedro B.
Published: February 2019

Background:

There are studies demonstrating an increased expression of cyclooxygenase (COX) in keloids and hypertrophic scars, suggesting that anti-inflammatory drugs could be used in their treatment. However, a precise relationship between COX and pathological scarring has not been established in the literature yet. This study aims to evaluate the immunohistochemical expression of COXs in these scars.

Methods:

Prospective study, including 54 patients (aged 18–60 years) undergoing scar excision: 18 normal scars (group 1), 18 hypertrophic scar (group 2), and 18 keloids (group 3). The group classification was performed by clinical criteria. Scars samples were collected and anatomopathological examination (through hematoxylin-eosin method) was performed to confirm the scar type. Immunohistochemistry was performed to assess the expression of COX1 and COX2 in epidermis and dermis. Results were compared among all groups and between group I versus II and III together (abnormal scars).

Results:

For COX1, in the epidermis, there was no significant difference in the immunohistochemical expression when comparing the 3 groups. In the dermis, groups 2 and 3 had greater expression than group 1, with a significant difference being found when comparing all groups (P = 0.014), and in the comparison between normal versus abnormal scars (P = 0.004). For COX2, there was no significant difference between the groups in both the epidermis and dermis.

Conclusions:

The immunohistochemical expression of COX1 was greater in the dermis of abnormal scars when compared with normal scars. Future studies can be performed involving COX blockade as a perspective of these scars treatment.
Infectious Mononucleosis Caused by Dual Infection With Cytomegalovirus and Epstein-Barr Viruses
Authors: Dylewski Joe , Drummond Kenneth John
Published: February 2019

Mononucleosis syndromes are most commonly caused by infection with either Epstein-Barr virus or cytomegalovirus. There are differences in their clinical presentation and means of acquisition. Both viruses establish lifelong latency. They are associated with inducing some degree of immunosuppression potentially resulting in reactivation of the second “infecting” virus. There are few reports of suspected dual infections, and it is serologically difficult to prove. We wish to describe 2 cases of mononucleosis for which the serologic evidence for dual infection is presented. We also wish to review the serologic tests that help establish an acute infection with each virus.
High Hemoglobin Level As a Limiting Factor for Extracorporeal Membrane Oxygenation
Authors: Ursulet Lionel , Pierrakos Charalampos , Cudia Antonella , Velissaris Dimitrios , Janssenswillen Eddy , Devriendt Jacques , De Bels David
Published: February 2019

We report the case of a 47 year old male who developed acute respiratory distress syndrome after bariatric surgery, requiring a venovenous extracorporeal membrane oxygenation. An inadequate extracorporeal membrane oxygenation output flow was observed, possibly because of severe polycythemia and hyperviscosity. Management with acute normovolemic hemodilution corrected both the biologic and hemodynamic parameters. To our knowledge, this is the first reported case of acute normovolemic hemodilution to improve extracorporeal membrane oxygenation outflow. Clinicians should be aware that polycythemia and hyperviscosity may impair extracorporeal membrane oxygenation support and that acute normovolemic hemodilution may be a safe and efficient procedure to address such matter. The optimal hemoglobin level on extracorporeal membrane oxygenation deserves further investigation.
Successful Bridge to Transplant in a Pediatric Patient Using the SynCardia 50 cc Total Artificial Heart
Authors: Beasley Gary S. , Allen Kiona , Pahl Elfride , Jackson Lindsay , Eltayeb Osama , Monge Michael , Backer Carl , Thrush Philip
Published: February 2019

Pediatric heart transplant candidates have the highest wait-list mortality of all organ candidates. Mechanical circulatory support has improved survival for many patients awaiting transplant. Biventricular mechanical circulatory support remains a particular challenge for pediatric patients. We present the smallest patient (body surface area 0.9 m2) to date to receive the 50 cc SynCardia Total Artificial Heart, supported for 278 days before successful heart transplant.
Performance on the Plastic Surgery In-Service Examination Can Predict Success on the American Board of Plastic Surgery Written Examination
Authors: Girotto John A. , Adams Nicholas S. , Janis Jeffrey E. , Brandt Keith E. , Slezak Sheri S.
Published: February 2019

Background:

Originally developed for resident self-assessment, the Plastic Surgery In-Service Examination has been administered for over 45 years. The Accreditation Council for Graduate Medical Education requires that at least 70 percent of graduates pass the American Board of Plastic Surgery Written Examination on their first attempt. This study evaluates the role of In-Service Exam scores in predicting Written Exam success.

Methods:

In-Service Exam scores from 2009 to 2015 were collected from the National Board of Medical Examiners. Data included residency training track, training year, and examination year. Written Exam data were gathered from the American Board of Plastic Surgery. Multivariate analysis was performed and receiver operating characteristic curves were used to identify optimal In-Service Exam score cut-points for Written Exam success.

Results:

Data from 1364 residents were included. Residents who failed the Written Exam had significantly lower In-Service Exam scores than those who passed (p < 0.001). Independent residents were 7.0 times more likely to fail compared with integrated/combined residents (p < 0.001). Residents who scored above the optimal cut-points were significantly more likely to pass the Written Exam. The optimal cut-point score for independent residents was the thirty-sixth percentile and the twenty-second percentile for integrated/combined residents.

Conclusions:

Plastic Surgery In-Service Exam scores can predict success on the American Board of Plastic Surgery Written Exam. Residents who score below the cut-points are at an increased risk of failing. These data can help identify residents at risk for early intervention.
Facial Nerve Trauma: Clinical Evaluation and Management Strategies
Authors: Brown Stav , Isaacson Brandon , Kutz Walter , Barnett Samuel , Rozen Shai M.
Published: February 2019

The field of facial paralysis requires the reconstructive surgeon to apply a wide spectrum of reconstructive and aesthetic principles, using a comprehensive array of surgical tools, including microsurgery, peripheral nerve surgery, and aesthetic facial surgery on the road to optimize patient outcomes. The distinct deficits created by different anatomical levels of facial nerve injury require a fundamental understanding of facial nerve anatomy. Palsy duration, followed by location and mechanism, will determine mimetic muscle salvageability, by means of either direct repair, grafting, or nerve transfers, whereas longer palsy durations will necessitate introducing a new neuromuscular unit, whether by muscle transfer or free functional muscle transplant. A thorough history, physical examination, and basic understanding of ancillary studies, emphasizing palsy duration, location, and mechanism of injury, are critical in evaluation, prognostication, and treatment strategies in traumatic facial palsy patients. The importance of ancillary and aesthetic procedures cannot be overstated. Although these do not provide motion, they constitute essential tools in the treatment of facial paralysis, providing both protective and improved aesthetic outcomes, yielding the highest impact in final surgeon and patient satisfaction, bringing our patients to smile not only on the outside, but also on the inside.
Sparstolonin B: A Unique Anti-Inflammatory Agent
Authors: Yepuri Natesh , Dhawan Ravi , Cooney Mitchell , Pruekprasert Napat , Meng Qinghe , Cooney Robert N.
Published: February 2019

Toll-like receptors are transmembrane proteins which sense and transmit infectious and inflammatory responses to the cells expressing them. Therapeutic strategies for the blockade of excessive Toll-like receptor signaling are being actively pursued for several diseases. Recently, Sparstolonin B, isolated from Chinese herb, which suppresses selectively Toll-like receptors has been studied in various inflammatory models. The objective of this review is to summarize the current literature regarding the use of Sparstolonin B in various in vitro and in vivo studies and to provide an overview regarding the potential use of this agent in different inflammatory diseases. Additionally, the current knowledge regarding the role of Toll-like receptors in inflammatory disease and the usage of various Toll-like receptor antagonists will be summarized. Based on our review, we believe Sparstolonin B could serve as a potential therapeutic agent for treatment of Toll-like receptor-mediated inflammatory disorders.
Association of Urinary Phytoestrogens With Pelvic Organ Prolapse and Fecal Incontinence Symptoms in Postmenopausal Women
Authors: Cardenas-Trowers Olivia , Meyer Isuzu , Richter Holly E. , Addis Ilana , Markland Alayne D.
Published: February 2019

Objectives

The aim of this study was to investigate the association between urinary phytoestrogen levels with symptoms of pelvic organ prolapse (POP) and fecal incontinence (FI) in postmenopausal women.

Methods

This is a cross-sectional study using the National Health and Nutrition Examination Survey database from 2005 to 2010 including postmenopausal women 40 years or older who either had both ovaries removed and/or had no period in the past year due to hysterectomy and/or menopause. Urinary concentrations of 6 phytoestrogens were measured. Pelvic organ prolapse symptoms were defined as a positive response to the question, “Do you see or feel a bulge in the vaginal area?” Fecal incontinence was defined as leakage of mucus, liquid, or solid stool occurring at least monthly. Using appropriate sample weights, prevalence estimates and 95% confidence intervals were calculated. Logistic regression was performed assessing associations between pelvic floor symptoms and log-transformed phytoestrogen levels adjusting for appropriate covariates.

Results

Participants included 1341 postmenopausal women with phytoestrogen data; 1213 with or without POP symptoms and 1221 with or without FI symptoms. Multivariable analysis revealed no association of urinary phytoestrogen levels with POP symptoms. Higher urinary O-desmethylangolensin level was associated with decreased odds of FI symptoms in postmenopausal women (adjusted odds ratio, 0.92; 95% confidence interval, 0.86–0.99).

Conclusions

Increased urinary O-desmethylangolensin level was associated with lower odds of FI. Future research may be warranted to further investigate the potential of specific phytoestrogens as mediators of FI, as well as the role of phytoestrogens on POP symptoms.