bluuebunny/crossref_metadata_2025 huggingface dataset:
Section 718 (Telemedicine): Virtual Health Outcomes From Regional Health Command Europe
Authors: Waibel Kirk H , Cain Steven M , Huml-VanZile Michelle , Kreciewski Nicolette , Hall Todd E , Nelson Keely , Everitt-Johnson Lauren , Black Irma , Keen Ronald S
Published: March 2019

Background

Section 718 of the Fiscal Year 2017 (FY17) National Defense Authorization Act (NDAA) outlines many reportable telemedicine outcomes. While the Military Health System Data Repository (MDR) and the Management and Reporting Tool M2 provide some telemedicine analyses, there are many outcomes that neither the MDR nor M2 provide. Understanding patient and provider attitudes towards telehealth and specialty-specific usage may assist initial or ongoing telehealth lines of effort within Defense Health Agency Medical Treatment Facilities (DHA MTFs).

Methods

A retrospective descriptive analysis of synchronous virtual health (VH) encounters and results from three internally developed telehealth surveys for calendar year (CY) 2016 was conducted.

Results

Three thousand seven hundred and seventy-eight synchronous VH visits for 2,962 unique patients were completed by 142 providers located within 27 distinct specialty clinics. 89.8% of patients were adults and 75.9% were Active Duty. Skill type I and II medical providers conducted 1,827 new consultations, 1,187 follow-up visits, and 371 readiness exams. Overall, specialty-specific VH use ranged from less than 1% to 39.9%. Patient satisfaction was 98% while provider satisfaction ranged from 91% to 93%. Additionally, significant intangible savings were recognized.

Conclusion

Regional medical centers conducting synchronous VH will require both internal and external data sources to report Section 718 outcomes required by Congress. As the anticipated demand for direct provider-to-patient telehealth increases, understanding these outcomes may aid initial and ongoing efforts in other military treatment facilities conducting synchronous VH.
More Than Just Counting Deaths: The Evolution of Suicide Surveillance in the Canadian Armed Forces
Authors: Rolland-Harris Elizabeth
Published: March 2019

Suicide prevention and surveillance are of primary concern to the Canadian Armed Forces (CAF) and to the CAF Health Services (CFHS). Suicide surveillance has been conducted on behalf of the CFHS by the Directorate of Force Health Protection for nearly 30 years. Over time, multiple changes have occurred within CAF: changes in its military role (from a primarily peacekeeping role to one also involving active combat), changes in operational tempo, temporal changes in at-risk subpopulations, as well as increased awareness and concern with suicide and suicide prevention. This has resulted in the annual reporting of CAF suicide rates and the evolution of the report’s content to respond to the needs of its end users.

More recently, Regular Force Army and Combat Arms males have been identified as being at significantly higher risk of suicide, relative to their counterparts, as well as to the Canadian general population. However, this trend has been fairly stable.

To optimize the use of limited epidemiologic resources and to shift the focus from the rates themselves towards a better understanding of what they represent and how they can be modified, the suicide surveillance portfolio is evolving to include complementary data sources and elements.

This paper describes the different data sources that constitute the CAF’s enhanced suicide surveillance portfolio, the value-added evidence generated by the use of complementary data collection methods and sources, and how this evidence is used by CAF leadership in their efforts to prevent suicide amongst those who serve.
Comparison of AR, ITS, CBT, and Didactic Training and Evaluation of Retinopathy-Based Diagnosis
Authors: Bergeron Bryan , Hagen Michael , Peterson Lars , Dworkin Ross , Bono Charles , Graham Todd , Williams Mary
Published: March 2019

Research objective

To test the relative efficacy of adaptive and fixed simulator training vs. adaptive and fixed computer-based training (CBT) vs. traditional lecture.

Methods

Ninety-two board certified Family Physicians were given a pretest, followed by training under one of five randomly assigned training conditions: (i) adaptive CBT; (ii) non-adaptive CBT; (iii) adaptive simulator; (iv) non-adaptive simulator; and (v) lecture. Subjects were given a post-test immediately after training and again in 6 weeks. In the adaptive groups, the content presented to subjects was a function of the subjects’ knowledge and performance, under control of a MOODLE LMS. In the lecture component, a physician projected images identical to the images in the CBT component of the study.

Results

No significant differences (p = 0.89 for ANOVA) in baseline knowledge between the five groups, based on pretest scores; In each of the five groups, our intervention resulted in immediate changes in knowledge (95% CI), based on analysis of pretest and PostTest1 scores; and, with the exception of subjects with non-adaptive, simulator intervention, all groups had significant decay in knowledge between the first and second post-tests (95% CI).

Conclusion

Periodic simulator intervention could result in significant knowledge retention over extended periods of time.
Human Papillomavirus Vaccination Rates of Military and Civilian Male Respondents to the Behavioral Risk Factors Surveillance System Between 2013 and 2015
Authors: Collins Mary K , Tarney Christopher , Craig Eric R , Beltran Thomas , Han Jasmine
Published: March 2019

Objective

To evaluate human papillomavirus (HPV) vaccination rates among men in the USA and to compare vaccination rates among men who had served in the military to those reporting no previous military service.

Methods

We performed a cross-sectional analysis using Behavioral Risk Factor Surveillance System (BRFSS) data from the 2013 to 2015 to analyze HPV vaccination rates for vaccine eligible adult men. The BRFSS is a multistage, cross-sectional telephone survey conducted nationally by state health departments. Univariable and logistic regression analyses were performed to examine the relationship between military service and HPV vaccination status was assessed as well as the number of HPV vaccination doses received.

Results

A total of 5,274 participants were analyzed representing a weighted estimate of 1.5 million HPV vaccine eligible men in the USA. The vaccination rate among veterans was 25.3% (95% confidence interval (CI), 18.8–33.3%) compared to 15.9% (95% CI, 14.3–17.6%) for civilians (p < 0.01). Veterans were more likely to report having received at least one dose of the HPV vaccine compared to civilian men (adjusted odds ratios [aOR] = 2.7, 95% CI, 1.7%-4.1%, p < 0.001).

Conclusions

Veteran men are more likely to have received HPV vaccination than similarly aged civilian men. However, for both civilians and veterans, the HPV vaccination coverage remains low when compared to their female counterparts.
Percutaneous Peripheral Nerve Stimulation to Control Postoperative Pain, Decrease Opioid Use, and Accelerate Functional Recovery Following Orthopedic Trauma
Authors: Ilfeld Brian M , Ball Scott T , Cohen Steven P , Hanling Steven R , Fowler Ian M , Wongsarnpigoon Amorn , Boggs Joseph W
Published: March 2019

Orthopedic trauma is a significant military problem, causing several of the most disabling conditions with high rates of separation from duty and erosion of military readiness. The objective of this report is to summarize the findings of case series of a non-opioid therapy—percutaneous peripheral nerve stimulation (PNS) – and describe its potential for postoperative analgesia, early opioid cessation, and improved function following orthopedic trauma. Percutaneous PNS has been evaluated for the treatment of multiple types of pain, including two case series on postoperative pain following total knee replacement (n = 10 and 8, respectively) and a case series on postamputation pain (n = 9). The orthopedic trauma induced during TKR is highly representative of multiple types of orthopedic trauma sustained by Service members and frequently produces intense, prolonged postoperative pain and extended opioid use following surgery. Collectively, the results of these three clinical studies demonstrated that percutaneous PNS can provide substantial pain relief, reduce opioid use, and improve function. These outcomes suggest that there is substantial potential for the use of percutaneous PNS following orthopedic trauma.
Impact of Multi-Disciplinary Care and Clinical Coach Coordinators on Participant Satisfaction and Retention in TBI Clinical Trials: A TEAM-TBI Study
Authors: Mesley Matthew S , Edelman Kathryn , Sharpless Jane , Borrasso Allison , Billigen Julia B , Puffer Ross , Williams Dana , Benso Steven , Puccio Ava M , Schneider Walt , Soose Ryan , Beers Sue , Kontos Anthony , Collins Michael , Okonkwo David O
Published: March 2019

Background

Targeted Evaluation Action and Monitoring of Traumatic Brain Injury (TEAM-TBI) is a monitored, multiple interventional research identifying clinical profiles and assigns individualized, evidence-based treatment program. The objective of the current study was to assess overall participant satisfaction of the multi-disciplinary care team and approach.

Methods

Between 2014 and 2017, 90 participants completed the 4-day TEAM-TBI clinical intake evaluation resulting in individualized treatment recommendations followed by a six-month intervention phase follow-up. Inclusion criteria were: age 18–60, history of chronic TBI (>6 months post-injury) with refractory clinical sequelae at screening (Post-Concussion Symptom Scale [PCSS] score >30).

Results

A total of 85/90 (94%) participants completed the survey at baseline focusing on intake evaluation and approach; 90% of eligible participants also completed the follow-up time-point. Hundred percent of participants had a mean score of >4 across all questions at the initial time point.”

Conclusions

The multi-disciplinary care approach and individualized treatment plans of the TEAM-TBI study yielded high participant retention and satisfaction scores. The Clinical Coach component of the trial was one of the highest rated aspects of the program and was associated with participant motivation and high retention rates.
Comparison of a Novel Trainer to a Traditional Swine Model for Training Providers in Lateral Canthotomy and Cantholysis
Authors: Herder Penelope Anne P , Lu Michelle M , LaPorta Anthony J , Ross David W , Calvano Christopher J , Enzenauer Robert W
Published: March 2019

Research Objective

Military personnel are at greater risks of head and facial traumas and permanent blindness from orbital compartment syndrome in modern warfare. Rapid treatment must be implemented with a low-risk surgical remedy: lateral canthotomy and cantholysis (LCC). Traditional training of LCC is primarily performed using an animal tissue trainer (ATT); however, limitations to these types of trainers exist. Therefore, our research objectives were focused on highlighting the effectiveness, benefits, and vision-saving potential of learning LCC on a synthetic trainer.

Methods

Participants included 22 second-year medical students and 6 healthcare professionals. A pre-quiz assessed baseline knowledge. Next, an experienced ophthalmologist provided an overview and instruction. Subjects were randomized to either the synthetic trainer or the ATT and then switched to the other model for comparison. After performing LCC procedures on both models, a post-quiz and survey were administered.

Results

Participants found the synthetic trainer easier to use than the ATT model (p < 0.01). There was no statistically significant preference (p = 0.23), or preference of practical eye anatomy (p = 0.26) between the trainers. Post-quiz results demonstrated an overall improvement from pre-quiz scores for participants (p < 0.001).

Conclusions

The synthetic trainer is comparable to the traditional swine model for training LCC procedures, and should be considered as a future training platform.
A Prospective Cohort Study of Vitamin D Supplementation in AD Soldiers: Preliminary Findings
Authors: McCarthy Mary S , Elshaw Evelyn B , Szekely Barbara M , Raju Dheeraj
Published: March 2019

Purpose

To explore response to vitamin D supplementation in active duty (AD) warfighters and translate findings into evidence-based health policy.

Background

Soldiers are at risk for musculoskeletal injuries and metabolic dysfunction that impact physical performance and military readiness; the link with low vitamin D status is unclear.

Methods

This prospective trial enrolled 152 soldiers; baseline 25 hydroxyvitamin (OH) D level determined assignment to a no-treatment control (CG) or treatment group (TG) receiving a vitamin D3 supplement for 90 days. Symptoms, diet, sun exposure, and blood biomarkers obtained at baseline (T1) and 3 months (T2).

Results

Cohort was predominantly white (58%) with a significant difference in racial distribution for vitamin D status. Mean (SD) 25(OH)D levels were 37.8 (5.6) ng/mL, 22.2 (5.0) ng/mL, and 22.9 (4.7) ng/mL for the CG, low dose TG, and high-dose TG at T1, respectively. Following three months of treatment, one-way ANOVA indicated a statistically significant difference between groups (F5,246 = 44.37; p < 0.0001). Vitamin D intake was 44% of Recommended Dietary Allowance throughout the first phase of the trial. Patient-Reported Outcomes Measurement Information System scores improved in TG for fatigue and sleep, p < 0.01.

Conclusions

Vitamin D deficiency is widespread in AD soldiers. Clinicians must intervene early in preventable health conditions impacting warfighter performance and readiness and recommend appropriate self-care strategies.
An Exploratory Pilot Study to Describe Shared Decision-Making for PTSD Treatment Planning: The Provider Perspective
Authors: Etingen Bella , Hill Jennifer N , Miller Laura J , Schwartz Alan , LaVela Sherri L , Jordan Neil
Published: March 2019

Objective

To describe current practices used by Veterans Administration (VA) mental health (MH) providers involved in post-traumatic stress disorder (PTSD) treatment planning to support engagement of veterans with PTSD in shared decision-making (SDM).

Methods

Semi-structured interviews with MH providers (n = 9) were conducted at 1 large VA, audio-recorded, and transcribed verbatim. Transcripts were analyzed deductively, guided by a published account of the integral SDM components for MH care.

Results

While discussing forming a cohesive team with patients, providers noted the importance of establishing rapport and assessing treatment readiness. Providers’ clinical knowledge/expertise, knowledge of the facility’s treatment options, knowledge of how to navigate the VA MH care system, and patient factors (goals/preferences, factors influencing treatment engagement) were noted as important to consider when patients and providers exchange information. When negotiating the treatment plan, providers indicated that conversations should include treatment recommendations and concurrent opportunities for personalization. They also emphasized the importance of discussions to finalize a mutually agreeable patient- and provider-informed treatment plan and measure treatment impact.

Conclusion

These results offer a preliminary understanding of VA MH providers’ facilitation of SDM for PTSD care. Findings may provide insights for MH providers who wish to engage patients with PTSD in SDM.
Aggregates and Quasi-Aggregates: A Study of Dodecaphony in Schnittke’s Music
Authors: Honarmand Amin
Published: March 2019

After practicing Schoenbergian dodecaphony for a short period of time, Alfred Schnittke began to employ the pitch-class aggregate in a free and personal way. In his music, aggregates occur melodically, harmonically, and in a combination of the two, and are often unrelated by traditional row transformations. While Schnittke’s approach to the aggregate changes throughout his oeuvre, three features remain consistent: symmetry, chromatic motions, and diatonic/tertian elements. In addition to an in-depth study of these properties, the uses of interval classes 1, 2, 3, and 5 will be examined in relation to the three features. Moreover, the concept of quasi-aggregates will be studied in relation to complete aggregates. The examples in this article were chosen from analyses of 100 passages taken from 54 works in all genres, spanning over 30 years of Schnittke’s mature oeuvre. Finally, an analysis of the first movement of the Piano Sonata No. 1 will examine aggregates in a broader context.
We can’t afford to turn a blind eye to myopia
Authors: Bourke C M , Loughman J , Flitcroft D I , Loskutova E , O’Brien C
Published: March 2019

Background

Myopia is becoming increasingly prevalent throughout the world. It is an overlooked but leading cause of blindness, particularly among the working aged population. Myopia is often considered benign because it is easily corrected with glasses, contact lenses or refractive surgery. Traditionally myopia has been classified into physiological and pathological subtypes based on the degree of myopia present. Higher levels of myopia are associated with increased risk of pathological complications but it is important to note that there is no safe level of myopia. Even low levels of myopia increase the risk of retinal detachment and other ocular comorbidities which will be discussed in detail later. The most serious complication, myopic maculopathy, is the only leading cause of blindness without an established treatment and therefore leads to inevitable loss of vision in some myopes, even at a young age.

Aim

To highlight the current myopia epidemic and the sight threatening complications associated with it.

Design

This is a commissioned review article. Data were gathered by performing a literature review, searching the PubMed database for recent articles regarding myopia.

Conclusions

Myopia is a potentially blinding disease. By identifying at risk individuals and intervening before they become myopic, eye care practitioners can prevent or delay spectacle use, reduce the risk of the myriad of myopic complications, thereby improve the patient’s quality of life and positively impact its socio-economic effects.
Immigration Status and Substance Use Disorder-related Mortality in Sweden: A National Longitudinal Registry Study
Authors: Lundgren Lena , Padyab Mojgan , Lucero Nancy M. , Blom-Nilsson Marcus , Nyström Siv , Carver-Roberts Tabitha , Sandlund Mikael
Published: March 2019

Objectives:

First-generation immigrants, in many countries, are healthier than their native counterparts. This study examined the association between first- and second-generation immigrant status and alcohol- or drugs other than alcohol-related (primarily opioids) mortality for those with risky substance use.

Methods:

A Swedish longitudinal, 2003 to 2017, registry study combined Addiction Severity Index (ASI) assessment data with mortality data (n = 15 601). Due to missing data, the analysis sample for this study was 15 012. Multivariate models tested the relationship between immigration status and drugs other than alcohol or alcohol-related mortality, controlling for demographics and the 7 ASI composite scores (CS).

Results:

Age, a higher ASI CS for alcohol, a lower ASI CS family and social relationship, a lower ASI CS for drug use and a higher ASI CS for health significantly predicted mortality because of alcohol-related causes. Higher ASI CS for drugs other than alcohol, employment, and health, age, male sex, and immigration status predicted drugs other than alcohol, related mortality. Individuals born in Nordic countries, excluding Sweden, were 1.76 times more likely to die of drugs other than alcohol compared with their Swedish counterparts. Individuals born outside a Nordic country (most common countries: Iran, Somalia, Iraq, Chile) were 61% less likely to die of drugs other than alcohol compared with their Swedish counterparts. Those with parents born outside Nordic countries were 54% less likely to die of drugs other than alcohol.

Discussion:

Research is needed on why people with risky substance use from Nordic countries (not Sweden) residing in Sweden, have higher mortality rates because of drugs other than alcohol (primarily opioids drugs other than alcohol compared with the other population groups in our study). Findings indicate that ASI CSs are strong predictors of future health problems including mortality due to alcohol and other drug-related causes.
Brief Interventions for Cannabis Use in Healthcare Settings: Systematic Review and Meta-analyses of Randomized Trials
Authors: Imtiaz Sameer , Roerecke Michael , Kurdyak Paul , Samokhvalov Andriy V. , Hasan Omer S. M. , Rehm Jürgen
Published: March 2019

Objectives:

The efficacy of brief interventions for cannabis use was assessed in a systematic review and meta-analyses.

Methods:

Systematic searches in academic databases were conducted, and reference lists of included studies were reviewed. Randomized trials were included that compared brief interventions with minimal control interventions for improving cannabis-specific outcomes among participants recruited from healthcare settings. Mean differences (MDs) based on change-from-baseline measurements were pooled using random-effects meta-analyses, with stratification by short term (≤3 months) and long term (>3 months).

Results:

Ten reports from 9 studies were included. Most studies were conducted in the United States, including participants who were adults and were recruited from primary care or emergency departments. There were no significant effects of brief interventions on cannabis-specific Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores in the short term (MD −1.27 points; 95% confidence interval [CI] −3.75, 1.21; I
2 84.40%). The null pattern of findings was also observed for number of days of cannabis use in the past 30 days in the short term (MD −0.22 days; 95% CI −2.27, 1.82; I
2 60.30%) and long term (MD −0.28 days; 95% CI −2.42, 1.86; I
2 60.50%). The evidence base for other outcomes not subjected to meta-analyses was limited and mixed.

Conclusions:

Brief interventions did not result in reductions in cannabis-specific ASSIST scores or number of days of cannabis use, whereas the evidence base for other outcomes was limited and mixed. As such, brief interventions in healthcare settings may not be efficacious for cannabis use.
A Community Hospital NICU Developmental Care Partner Program
Authors: Clubbs Brooke Hildebrand , Barnette Alan R. , Gray Natallia , Weiner Lauren , Bond April , Harden Jane , Pineda Roberta
Published: March 2019

Background:

Volunteers can provide staff-directed sensory inputs to infants hospitalized in the NICU, but research on volunteer programs is limited.

Purpose:

To evaluate the feasibility of a developmental care partner (DCP) program in a level III NICU and determine its relationship with provider burnout and infant infection rates.

Methods:

DCPs were trained to provide sensory input to infants, based on the behavioral cues observed by the occupational therapists and nursing staff, in medically stable infants. Feasibility was assessed by documenting the process of training and utilizing volunteers, as well as tracking duration and frequency of DCP visits. Staff burnout measures were assessed using the Maslach Burnout Inventory Human Services Survey (MBI-HSS) before and after implementation. Infant infection rates before and after the introduction of volunteers were compared. Results: Seventy-two volunteers were interested, and 25 (35%) completed the DCP competencies and provided sensory exposures to 54 neonates, who were visited an average of 8 times (range 1-15). Twelve (48%) DCPs did once-per-week visits, and 9 (36%) did at least 50 contact hours. MBI-HSS scores for staff emotional exhaustion (P < .001) and depersonalization (P < .006) were lower after DCP implementation. There were no differences in infant infection rates before and after DCP implementation (Fisher exact P = 1.000).

Implications for Practice:

Volunteer-based DCP programs may be feasible to implement in community hospitals and could help reduce staff emotional exhaustion and depersonalization without increasing the incidence of infant infections.

Implications for Research:

Future research on NICU volunteer programs with larger sample sizes and different infant populations is warranted.
What Is the Impact of NICU-Dedicated Lactation Consultants? An Evidence-Based Practice Brief
Authors: Mercado Kathryn , Vittner Dorothy , McGrath Jacqueline
Published: March 2019

Background:

Benefits of exclusive human milk diets for preterm and low birth-weight infants are well established. Despite known benefits, supporting mothers in the provision of mother's own milk for high-risk infants is challenging. Lactation support in the neonatal intensive care unit (NICU) is highly variable. Lactations consultants (LCs) are often shared between postpartum units and the NICU, potentially increasing LC workload with less time spent with high-risk mothers. Furthermore, less than half of NICUs in the United States staff an international board-certified lactation consultant. Limited understanding exists regarding impacts of NICU-specific lactation support on breastfeeding outcomes.

Purpose:

The purpose of this evidence-based practice brief is to synthesize the literature on the impact of NICU-specific lactation support, LCs who work exclusively in the NICU, and provide guidance about how NICU staffing with LCs solely focused on supporting mothers of high-risk infants impacts breastfeeding outcomes for low birth-weight infants.

Search Strategy:

CINAHL PLUS, PubMed, Cochrane Library, and OVID databases were searched using key words and restricted to English language.

Findings:

During hospitalization, NICUs staffed with dedicated board-certified LCs have increased potential to yield improved breastfeeding rates through hospital discharge, increased proportion of infants who receive mother's own milk, and increased duration of breastfeeding or human milk expression through hospital discharge.

Implications for Practice:

Human milk nutrition is related to improved outcomes for high-risk infants. Neonatal intensive care unit–specific lactation support can potentially optimize maternal breastfeeding practices and improve outcomes for high-risk infants.

Implications for Research:

There is a need for further studies pertaining to NICU-specific lactation consultants and influences on breastfeeding outcomes.
Disparities in Care: Do Children with Autism Spectrum Disorder Experience Differential Medication Receipt In The Emergency Department?
Authors: Friedlaender Eron , Griffis Heather , Faerber Jennifer , Quarshie William , Ely Beth
Published: March 2019

Objective:

The primary objective of this study was to describe analgesia administration between neurotypical (NT) individuals and those with autism spectrum disorder (ASD) diagnosed with appendicitis or long bone fractures in the emergency department (ED). A secondary objective was to compare the rates of complicated appendicitis as a proxy for delayed diagnosis between the groups.

Methods:

This is a retrospective cohort study using the Pediatric Health Information System database. Study participants were children aged 6 to 18 years with ASD and with an ED visit for appendicitis or fracture between 2004 and 2015 who were matched to demographically similar NT children. Children with a developmental disorder and/or complex chronic condition were excluded. Coarsened exact matching and logistic regression were used to investigate the association between ASD status and opioid and non-opioid medication receipt. Comparison of the rates of complicated appendicitis in children with ASD and NT children was conducted before matching.

Results:

From 2004 to 2015, 126,412 children with appendicitis and 392,151 children with long bone fractures were identified. Of these, 889 children had a diagnosis of ASD and were matched to 35,672 NT controls with appendicitis. In addition, 2117 children with ASD were matched to 200,635 NT controls with long bone fractures. Receipt of opioids or nonsteroidal anti-inflammatory drugs was not found to be significantly different between the 2 groups. However, a larger proportion of children with ASD presented with complicated appendicitis compared with NT controls (37.1% vs 29.9%, respectively; p < 0.001).

Conclusion:

Receipt of analgesia did not differ significantly between populations of ASD and NT peers. Children with ASD have increased rates of complex appendicitis, possibly suggesting limited access to care or provider difficulty in evaluating this patient population.
Practical Computed Tomography Scan Findings for Distinguishing Metopic Craniosynostosis from Metopic Ridging
Authors: Birgfeld Craig B. , Heike Carrie L. , Al-Mufarrej Faisal , Oppenheimer Adam , Kamps Shawn E. , Adidharma Widya , Siebold Babette
Published: March 2019

Background:

Premature fusion of the metopic suture (ie, metopic craniosynostosis) can be difficult to discriminate from physiological closure of the metopic suture with ridging (MR). Yet, MCS is treated surgically, whereas MR is treated nonsurgically. Often, the diagnosis can be made by physical examination alone, but in difficult cases, a computed tomography (CT) scan can add additional diagnostic information.

Methods:

We de-identified, randomized, and analyzed the CT scans of patients with MCS (n = 52), MR (n = 20) and age-matched normative controls (n = 52) to identify specific findings helpful in distinguishing between MCS and MR. Four expert clinicians were blinded to the clinical diagnosis and assessed each CT for features of the orbits, frontal bones, and inner table of calvaria.

Results:

Although no single feature was diagnostic of MCS, we identified several signs that were correlated with MCS, MR, or controls. Features such as “posteriorly displaced frontal bone” and “frontal bone tangent to mid-orbit or medial” demonstrated higher correlation with MCS than MR and the addition of other features improves the accuracy of diagnosis as did inclusion of the interfrontal divergence angle.

Conclusion:

The presence of a closed metopic suture in addition to other CT scan findings may improve the accuracy of diagnosing MCS, MR, and normocephaly.
Public Perception of Plastic Surgery in Saudi Arabia
Authors: Almarghoub Mohammed A. , Almarzouq Sawsan F. , Alissa Sami I.
Published: March 2019

Background:

The general public perceives plastic surgeons as cosmetic surgeons. This study aimed to assess the general public’s awareness of the field of plastic and reconstructive surgery in Saudi Arabia.

Methods:

A short, anonymous, web-based survey was distributed to the public using SurveyMonkey as a platform. Participants were asked to choose the surgeon for managing 16 case scenarios, 11 of which were commonly managed by plastic surgeons.

Results:

In total, 2,116 participants completed the survey. The participants correctly chose plastic surgery as the specialty for managing 3 of the 11 listed plastic surgery case scenarios.

Conclusion:

More efforts are needed from plastic surgeons and media to educate the public about the scope of plastic and reconstructive surgery.
Biota Dose Assessment of Small Rodents Sampled Near Breccia Pipe Uranium Mines in the Grand Canyon Watershed
Authors: Minter Kelsey M. , Jannik G. Timothy , Hinck Jo Ellen , Cleveland Danielle , Kubilius Walter P. , Kuhne Wendy W.
Published: March 2019

The biotic exposure and uptake of radionuclides and potential health effects due to breccia pipe uranium mining in the Grand Canyon watershed are largely unknown. This paper describes the use of the RESRAD-BIOTA dose model to assess exposure of small rodents (n = 11) sampled at three uranium mine sites in different stages of ore production (active and postproduction). Rodent tissue and soil concentrations of naturally occurring uranium (234U, 235U, and 238U), thorium (228Th, 230Th, and 232Th), and radium (226Ra) radioisotopes were used in the dose model. The dose assessment results indicated that the potential internal, external, and total doses to rodents were below the US Department of Energy’s biota dose standard of 1 mGy d−1. As expected, tissue concentrations of 238U, 234U, and 230Th were in approximate equilibrium; however, 226Ra results in tissue were 1.25 to 5.75 times greater than 238U, 234U, and 230Th tissue results for 10 out of 11 samples. Soil at the three sites also displayed 226Ra enrichment, so it is likely that the 226Ra enrichment in the rodents was from soil via typical activities (i.e., burrowing, incidental ingestion, bathing, etc.) or by dietary uptake of translocated 226Ra. The results suggest that 226Ra is more mobile in this environment and bioaccumulates in these rodent species (e.g., in bones via the bloodstream). Internal dose accounting suggests that 226Ra is the radionuclide of most concern for rodent exposure and health.
Study of Primordial 226Ra, 228Ra, and 40K Concentrations in Dietary Palm Dates and Concomitant Radiological Risk
Authors: Khandaker Mayeen Uddin , Shuaibu Hauwau Kulu , Alklabi Farida Assghir Amar , Alzimami Khalid S. , Bradley D.A.
Published: March 2019

The presence of natural radionuclides in the food chain point to a need to assess concentration levels and concomitant radiological risk. Highly popular and forming a staple part of the diet in North Africa, the Arabian Peninsula, and West Asia, palm dates growing naturally there have even greater marketability than simple satisfaction of domestic demand, the palm dates representing a valuable export item. Accurate knowledge of the levels of natural radioactivity in the fruit is thus of importance. In this study, using high-purity germanium gamma-ray spectrometry, quantification has been made of natural radionuclide concentrations in imported dates originating from Iran, Saudi Arabia, and Tunisia. Sample analyses reveal respective mean activity concentrations of 1.4 ± 0.3, 0.8 ± 0.4, and 186 ± 9 Bq kg−1 dry weight for 226Ra, 228Ra, and 40K. For each nuclide, the mean concentration varies little between the dates of the three represented regions. The estimated committed effective dose resulting from the consumption of date fruits for a typical adult was found to be 29.9 μSv y−1, well below the global internal dose of 290 μSv y−1 assessed by the United Nations Scientific Committee on the Effects of Atomic Radiation to be due to food and water intake. Similarly, the excess lifetime cancer risk due to naturally occurring radioactive material exposure via date fruit consumption is seen to be below the International Commission on Radiological Protection cancer risk factor of 2.5 × 10−3 based on the additional annual dose limit of 1 mSv for a member of the general public. The results show no significant uptake in the analyzed date fruits.
Immunohistochemical Analysis of the Lacrimal Sac Mucopeptide Concretions
Authors: Ali Mohammad Javed , Heichel Jens , Paulsen Friedrich
Published: March 2019

Fibronectin and vWF are present in the core of the dacryoliths. Blood components may act as a nidus in the evolution of lacrimal sac mucopeptide concretions.

Purpose:

To investigate the presence and distribution patterns of proteins in the lacrimal sac mucopeptide concretions.

Methods:

The study was performed on 10 mucopeptide concretions obtained from the lacrimal sac during an endoscopic dacryocystorhinostomy. Immunohistochemical labeling was performed for assessing the presence and distribution of von Willebrand factor, fibronectin, collagen I, collagen III, human beta-defensin 2, beta-defensin 3, lysozyme, prolactin, cytokeratin (CK)—CK4, CK7, CK18, immunoglobulin M (IgM), immunoglobulin G (IgG), psoriasin (S100-A7), and migration inhibitory factor-related protein (MRP14/S100-A9). The results were then scored as positive or negative and the distribution pattern, if any, within the sectioned concretions was assessed.

Results:

Immunohistochemical labeling was strongly positive for von Willebrand factor and fibronectin in the core areas of the concretions. Collagen I was widely dispersed both in the peripheral and core areas whereas collagen III was mostly limited to only few areas of the core. Strong immunoreactivity was noted for lysozyme, which was abundantly distributed, whereas prolactin receptors were positive on the surface and also the dispersed cells within the concretion matrices. Very few peripheral areas of concretions showed MRP14 or S100-A9 positivity in a noncontiguous fashion. Immunoreactivity was uniformly negative for CK-18, IgM, IgG, and psoriasin.

Conclusions:

The presence of fibronectin and von Willebrand factor in the core of the concretions strengthens the earlier hypothesis that blood components may act as a nidus for subsequent mucopeptide deposition. The study also provides possible clues to the lacrimal defenses mounted during dacryolithiasis.
Further Evidence of the Relationship Between Cochlear Implant Electrode Positioning and Hearing Outcomes
Authors: Chakravorti Srijata , Noble Jack H. , Gifford René H. , Dawant Benoit M. , O’Connell Brendan P. , Wang Jianing , Labadie Robert F.
Published: March 2019

Background:

Postoperative imaging studies by numerous groups have revealed that final cochlear implant (CI) electrode position impacts audiological outcomes with scalar location consistently shown to be a significant factor. Modiolar proximity has been less extensively studied, and findings regarding the effect of insertion depth have been inconsistent.

Methods:

Using previously developed automated algorithms, we determined CI electrode position in an Institutional Review Board-approved database of 220 CI ears. Generalized linear models (GLM) were used to analyze the relationship between audiological outcomes and factors including age, duration of CI use, device type, and electrode position.

Results:

For precurved arrays, GLM revealed that scalar position, modiolar proximity, base insertion depth, and sex were significant factors for Consonant-Nucleus-Consonant (CNC) words (R = 0.43, p < 0.001, n = 92 arrays), while scalar position, modiolar proximity, age, and postlingual onset of deafness were significant for Bamford-Kawal-Bench Sentences in Noise (BKB-SIN) (R = 0.51, p < 0.001, n = 85) scores. Other factors were not significant in the final model after controlling for these variables. For straight arrays, we found the insertion depth, postlingual deafness, and length of CI use to be highly significant (R = 0.47, p < 0.001) factors for CNC words (91 arrays), while for BKB-SIN scores the most significant (R = 0.47, p < 0.001) factors were insertion depth, younger age, and postlingual deafness (89 arrays).

Conclusion:

Our results confirm the significance of electrode positioning in audiological outcomes. The most significant positional predictors of outcome for precurved arrays were full scala tympani (ST) insertion and the modiolar distance, while for the lateral wall arrays the depth of insertion was the most significant factor.
Parental Perceptions of Displayed Patient Data in a PICU: An Example of Unintentional Empowerment*
Authors: Asan Onur , Scanlon Matthew C. , Crotty Bradley , Holden Richard J. , Flynn Kathryn E.
Published: March 2019

Objectives:

To explore the perceptions of parents of pediatric patients in a PICU regarding real-time open electronic health record data displayed in patient rooms.

Design:

Cross-sectional qualitative interview study.

Setting:

PICU in a large Midwestern tertiary-care children’s hospital.

Subjects:

Parents of patients in a PICU (n = 33).

Measurements and Main Results:

Qualitative data were collected through in-person semi-structured, individual, and small-group interviews. Data were collected from March 2016 to July 2016, with approval from the study hospital’s institutional review board. Data were analyzed using inductive thematic analysis. Results included positive effects of accessing real-time open electronic health record data on family empowerment, situation awareness, potential error detection, understanding of medical data, and facilitating discussions during rounds. Concerns were reported regarding privacy of information as well as potential misinterpretation of displayed data. We identified several ways to improve this collaborative technology to make it more family-centered.

Conclusions:

This study suggests that a new health information technology system providing continuous access to open electronic health record data may be an effective way to empower and engage parents in the PICU, but potential drawbacks were also noted. The results also provide insights into the collaborative use of health information technology in the PICU setting.
Cardiopulmonary Exercise Test Using Arm Ergometry in Children With Spina Bifida: A Prediction Model for VO2peak
Authors: Tuijtelaars Jana A. M. , Leonardi-Figuiredo Marisa Maia , Crescencio Julio , Gallo Lourenço , Martinez Edson Zangiacomi , Bloemen Manon , Takken Tim , Mattiello-Sverzut Ana Claudia
Published: March 2019

Purpose:

This study aimed to develop a prediction model for peak oxygen uptake (

JOURNAL/ppyty/04.03/00001577-201904000-00015/15FSM1/v/2023-08-23T235932Z/r/image-gif

O2peak) in children with spina bifida (SB), considering peak workload (W
peak), peak heart rate, age, sex, anthropometric measures, walking level, physical activity level, and level of the lesion.

Methods:

Data of 26 participants with SB performing a graded arm crank test were used to develop the prediction model. An unrelated data set of participants with SB was used for validation.

Results:

The following equation was developed to predict

JOURNAL/ppyty/04.03/00001577-201904000-00015/15FSM1/v/2023-08-23T235932Z/r/image-gif

O2peak of participants with SB:

JOURNAL/ppyty/04.03/00001577-201904000-00015/15FSM1/v/2023-08-23T235932Z/r/image-gif

O2peak (mL/min) = 194+18 × W
peak – 110 × sex (adjusted R
2 = 0.933, SEE = 96 mL/min). Bland-Altman analysis showed a nonsignificant mean difference between the measured and predicted values of

JOURNAL/ppyty/04.03/00001577-201904000-00015/15FSM1/v/2023-08-23T235932Z/r/image-gif

O2peak (−0.09 L/min) and limits of agreement of −0.4036 and 0.2236 L/min.

Conclusions:

The prediction model shows promising results; however, further validation using the same protocol is warranted before implementation in clinical practice.
Relationship Between Torticollis and Gastroesophageal Reflux Disorder in Infants
Authors: Bercik Deborah , Diemer Susan , Westrick Stephanie , Worley Sarah , Suder Ryan
Published: March 2019

Purpose:

Although pediatric physical therapists may evaluate and treat infants with both congenital muscular torticollis (CMT) and gastroesophageal reflux disorder (GERD), a literature review found only 1 article suggesting a connection between these diagnoses. This study investigates a correlation between CMT and GERD.

Methods:

A retrospective chart review spanning 5 years including 2519 infants younger than 12 months examined the correlation between CMT, GERD, and other comorbidities including developmental dysplasia of the hip, oligohydramnios, multiparity, and breech positioning.

Results:

The CMT cohort had a significantly higher rate of GERD versus the general population. For all age groups, the GERD rate was significantly higher in the CMT population than in the reference population. The rate of developmental dysplasia of the hip, oligohydramnios, and breech positioning was higher in infants with both CMT and GERD.

Conclusions:

The increased likelihood of infants with CMT also having GERD has clinical implications for the pediatric physical therapist.
Assessment of Spinal Curvatures in Children With Upper Trunk Obstetrical Brachial Plexus Palsy
Authors: Acaröz Candan Sevim , Fırat Tüzün , Livanelioğlu Ayşe
Published: March 2019

Purpose:

Effects of upper trunk obstetrical brachial plexus palsy (OBPP) on the spinal curvature and relationship between the curvature degrees and upper limb movements have not been reported.

Methods:

Spinal Mouse was used to assess spinal curvature characteristics in the sagittal and frontal planes. Upper limb movements were assessed with using the Active Movement Scale in only study group.

Results:

The degree of frontal plane curvatures was higher in the study group. In the OBPP group, 11 of 25 (44%) children had thoracal C-shaped scoliosis. Nine of these children had contralateral side scoliosis. Shoulder external rotation was inversely correlated with scoliosis angle. Moreover, shoulder external rotation and elbow flexion were lower in children with scoliosis in the OBPP group.

Conclusions:

Upper trunk OBPP may affect frontal plane alignment. Especially insufficient shoulder external rotation scores may lead to constitute thoracal scoliosis as a result of trunk compensation.
Examining Causes and Prevention Strategies of Adverse Events in Deceased Hospital Patients: A Retrospective Patient Record Review Study in the Netherlands
Authors: Smits Marleen , Langelaan Maaike , de Groot Janke , Wagner Cordula
Published: March 2019

Objective

To improve patient safety and possibly prevent mortality from adverse events (AEs) in hospitals, it is important to gain insight in their underlying causes. We aimed to examine root causes and potential prevention strategies of AEs in deceased hospital patients.

Methods

Data on 571 AEs were used from two retrospective patient record review studies of patients who died during hospitalization in the Netherlands. Trained reviewers assessed contributing factors and potential prevention strategies. The results were analyzed together with data on preventability of the AE and the relationship of the AE with the death of the patient.

Results

In 47% of the AEs, patient-related causes were identified, in 35% human causes, in 9% organizational causes, and in 3% technical causes. Preventable AEs were caused by technical, organizational, and human causes (78%, 74%, and 74%, respectively) more often than by patient-related causes (33%). In addition, technical factors caused AEs leading to preventable death (78%) relatively often. Recommended strategies to prevent AEs were quality assurance/peer review, evaluation of safety behavior, improving procedures, and improving information and communication structures.

Conclusions

Human failures played an important role in the causation of AEs in Dutch hospitals, because they occurred frequently and they were frequently the cause of preventable AEs. To a lesser extent, latent organizational and technical factors were identified. Patient-related factors were often identified, but the preventability of the AEs with these causes was low. For future research into causes of AEs, we recommend combining record review with interviewing.