bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring changes in soil salinity and sodicity to depth, at a decadal scale, in a semiarid irrigated region of Australia
Authors: Filippi Patrick , Cattle Stephen R. , Bishop Thomas F. A. , Pringle Matthew J. , Jones Edward J.
Published: October 2018

Soil salinity and sodicity are two of the most limiting constraints for agriculture in arid and semiarid landscapes, but long-term studies are scarce, and most solely focus on the topsoil. This study monitors the change in soil electrical conductivity (EC) and exchangeable sodium percentage (ESP) to 1.2 m depth with bivariate linear mixed models between 2002 and 2015 in a semiarid, irrigated cotton-growing region of south-west New South Wales, Australia. In this work, the impacts of shifts in rainfall, variability of irrigation water quantity and quality, and agricultural land uses, on soil salinity and sodicity are analysed. The study area possessed generally low levels of soil salinity, and shifts in EC were detected over time, but only isolated areas of the various sampling depths experienced statistically significant changes in EC. Some areas under irrigated cotton production experienced a desalination trend, whereas soil EC under irrigated perennial horticulture increased over time. This increase was attributed to the use of fertilisers that contain salts, and the varying quantity and quality of applied irrigation water. Sodicity was low to moderate in the upper 0.5 m of the soil profile but high in deeper layers, with a trend of increasing soil sodicity through time. Most of the statistically significant increases in ESP occurred in areas under irrigated cotton and horticulture, with this likely due to the continued addition of sodium to the soil system. This study also demonstrates that visible near infrared spectroscopy can be used in to predict soil ESP values to reasonable accuracy.
Model of bacterial toxin-dependent pathogenesis explains infective dose
Authors: Rybicki Joel , Kisdi Eva , Anttila Jani V.
Published: October 2018

The initial amount of pathogens required to start an infection within a susceptible host is called the infective dose and is known to vary to a large extent between different pathogen species. We investigate the hypothesis that the differences in infective doses are explained by the mode of action in the underlying mechanism of pathogenesis: Pathogens with locally acting mechanisms tend to have smaller infective doses than pathogens with distantly acting mechanisms. While empirical evidence tends to support the hypothesis, a formal theoretical explanation has been lacking. We give simple analytical models to gain insight into this phenomenon and also investigate a stochastic, spatially explicit, mechanistic within-host model for toxin-dependent bacterial infections. The model shows that pathogens secreting locally acting toxins have smaller infective doses than pathogens secreting diffusive toxins, as hypothesized. While local pathogenetic mechanisms require smaller infective doses, pathogens with distantly acting toxins tend to spread faster and may cause more damage to the host. The proposed model can serve as a basis for the spatially explicit analysis of various virulence factors also in the context of other problems in infection dynamics.
Language style in the negotiation of class identity in translated contemporary Spanish fiction
Authors: Espunya Anna , Pavić Pintarić Anita
Published: October 2018

In the early novels of the Carvalho detective series by Manuel Vázquez Montalbán, set in the years of Spain’s transition to democracy, the negotiation of identities and political stance are paramount characterization resources. Given the role of speech in the construction of identity, translations may vary in the readings they afford beyond the detective aspects. We apply the sociolinguistic concepts of identity work and language style (albeit mediated by fictive orality), and the discourse analysis tools of Appraisal Theory, to analyse two working-class characters inLos mares del sur(1979) and in its English (1986) and Croatian (2007) translations.

In Spanish the language style of both characters reflects class allegiance, involvement and tenacity, intense feelings, a direct interpersonal approach and a rejection of altercasting. Their vocabulary and quotations from external sources index their ideology. The English translation is the least aware of identity work through language style and interaction. The characters’ standardized speech shows less involvement, tenacity and intensity. The Croatian translation follows the source text literally; involvement is maintained within a fictive colloquial spoken variety. Both translations maintain directness and a contractive dialogic style, and both make references to class and ideology more explicit.
China’s language services as an emerging industry
Authors: Luo Huifang , Meng Yongye , Lei Yalin
Published: October 2018

Languages play an essential role in China’s drive for modernization and in its interactions with the rest of the world. Discussions in this paper are designed to offer an overview of China’s language services, which have grown into a sizable industry with more than 70,000 businesses. In addition to its growth in size, the language services industry has also been a leader in introducing CAT technology in translation and adopting advanced technologies such as cloud computing, artificial intelligence, etc. Language service providers (LSPs) have also worked with institutions of higher learning in various forms of collaboration to provide internship opportunities to students of translation and other forms of support to universities. In order to promote the healthy development of the industry, the Translators Association of China (TAC) has done a huge amount of work in organizing industry efforts to develop guidelines for different kinds of language services, and help the industry to exercise self-regulation. This paper also discusses the challenges that the industry faces today and offers recommendations to the industry as it moves forward.
Exploring the effects of instruction on L2 French learner pronunciation, accentedness, comprehensibility, and
fluency
Authors: Inceoglu Solène
Published: October 2018

This study investigates the effects of a 16-week course on the development of second language French pronunciation. The course
targeted segmental and suprasegmental features and fluency development, and was administered entirely online. Pre- and post-test
tasks (i.e., picture narration, reading-aloud, and conversation simulation) were used to analyze learners’ pronunciation
development in terms of segmental errors, connected speech (use of liaisons and enchaînements), and fluency
(including pauses and mean length of run). Participants’ accentedness, comprehensibility, and fluency were also judged by five
native listeners. Findings revealed a significant decrease in segmental errors and unfilled pause frequency in all the tasks, and
improvement in fluency in the reading and conversation tasks. Results also showed a positive trend but no significant improvement
in the use of liaisons and enchaînements. There was, however, no significant improvement in the measures of
listeners’ ratings. The results are discussed in light of previous research on pronunciation instruction.
Differential GAP requirement for Cdc42-GTP polarization during proliferation and sexual reproduction
Authors: Gallo Castro Daniela , Martin Sophie G.
Published: October 2018

The formation of a local zone of Cdc42 GTPase activity, which governs cell polarization in many cell types, requires not only local activation but also switch-off mechanisms. In this study, we identify Rga3, a paralog of Rga4, as a novel Cdc42 GTPase-activating protein (GAP) in the fission yeast Schizosaccharomyces pombe. Contrary to Rga4, Rga3 localizes with Cdc42-GTP to sites of polarity. Rga3 is dispensable for cell polarization during mitotic growth, but it limits the lifetime of unstable Cdc42-GTP patches that underlie cell pairing during sexual reproduction, masking a partly compensatory patch-wandering motion. In consequence, cells lacking rga3 hyperpolarize and lose out in mating competition. Rga3 synergizes with the Cdc42 GAPs Rga4 and Rga6 to restrict Cdc42-GTP zone sizes during mitotic growth. Surprisingly, triple-mutant cells, which are almost fully round, retain pheromone-dependent dynamic polarization of Cdc42-GTP, extend a polarized projection, and mate. Thus, the requirement for Cdc42-GTP hydrolysis by GAPs is distinct during polarization by intrinsic or extrinsic cues.
The Usefulness of Main Prayer Hall of Masjid Agung Islamic Center of Lhokseumawe, Aceh - Indonesia
Authors: Karsono Bambang , Gregory Zayn Al-Abideen , Amer Koesmeri Dona Rose , Awang Sulong Awang Hashim bin , Zaini Atta Idrawani
Published: October 2018

Spatial design of masjids is typically the result of duplicating or replicating typology considered appropriate by the Muslim community. Often, this approach results in a massive centralized main prayer space that is underutilized and may contradict fundamental Islamic principles derived from the Quran and Hadith (canonical sayings of Prophet Muhammad

) This article attempts to reveal the utilization of the main praying hall at Masjid Agung Islamic Center (MAIC) of Lhokseumawe. Further, this study challenges the MAIC in light of the Islamic principle of ‘avoiding exaggeration’. Observation was conducted over 30 days alongside an exploration of values and principles guiding Islamic Architecture according to Quran and Hadith. Findings show the utilization of the main prayer hall of MAIC averaged 3.24% on a daily basis and 3.26% for Shalah (ritual prostration performed five times a day); clearly, a sign of wasted space. Results of this study are expected to stimulate discussion in the area of design and planning of Islamic Architecture toward a wiser design, particularly in Aceh Province of Indonesia.
MetaPGN: a pipeline for construction and graphical visualization of annotated pangenome networks
Authors: Peng Ye , Tang Shanmei , Wang Dan , Zhong Huanzi , Jia Huijue , Cai Xianghang , Zhang Zhaoxi , Xiao Minfeng , Yang Huanming , Wang Jian , Kristiansen Karsten , Xu Xun , Li Junhua
Published: October 2018

Pangenome analyses facilitate the interpretation of genetic diversity and evolutionary history of a taxon. However, there is an urgent and unmet need to develop new tools for advanced pangenome construction and visualization, especially for metagenomic data. Here, we present an integrated pipeline, named MetaPGN, for construction and graphical visualization of pangenome networks from either microbial genomes or metagenomes. Given either isolated genomes or metagenomic assemblies coupled with a reference genome of the targeted taxon, MetaPGN generates a pangenome in a topological network, consisting of genes (nodes) and gene-gene genomic adjacencies (edges) of which biological information can be easily updated and retrieved. MetaPGN also includes a self-developed Cytoscape plugin for layout of and interaction with the resulting pangenome network, providing an intuitive and interactive interface for full exploration of genetic diversity. We demonstrate the utility of MetaPGN by constructing Escherichia coli pangenome networks from five E. coli pathogenic strains and 760 human gut microbiomes,revealing extensive genetic diversity of E. coli within both isolates and gut microbial populations. With the ability to extract and visualize gene contents and gene-gene physical adjacencies of a specific taxon from large-scale metagenomic data, MetaPGN provides advantages in expanding pangenome analysis to uncultured microbial taxa.
A randomized controlled trial to improve engagement of hospitalized patients with their patient portals
Authors: Greysen S Ryan , Harrison James D , Rareshide Charles , Magan Yimdriuska , Seghal Neil , Rosenthal Jaime , Jacolbia Ronald , Auerbach Andrew D
Published: October 2018

Objectives

To test a patient-centered, tablet-based bedside educational intervention in the hospital and to evaluate the efficacy of this intervention to increase patient engagement with their patient portals during hospitalization and after discharge.

Materials and Methods

We conducted a randomized controlled trial of adult patients admitted to the hospitalist service in one large, academic medical center. All participants were supplied with a tablet computer for 1 day during their inpatient stay and assistance with portal registration and initial login as needed. Additionally, intervention group patients received a focused bedside education to demonstrate key functions of the portal and explain the importance of these functions to their upcoming transition to post-discharge care. Our primary outcomes were proportion of patients who logged into the portal and completed specific tasks after discharge. Secondary outcomes were observed ability to navigate the portal before discharge and self-reported patient satisfaction with bedside tablet use to access the portal.

Results

We enrolled 97 participants (50 intervention; 47 control); overall 57% logged into their portals ≥1 time within 7 days of discharge (58% intervention vs. 55% control). Mean number of logins was higher for the intervention group (3.48 vs. 2.94 control), and mean number of specific portal tasks performed was higher in the intervention group; however, no individual comparison reached statistical significance. Observed ability to login and navigate the portal in the hospital was higher for the intervention group (64% vs. 60% control), but only 1 specific portal task was significant (view provider messaging tab: 92% vs. 77% control, P = .04). Time needed to deliver the intervention was brief (<15 min for 80%), and satisfaction with the bedside tablet to access the portal was high in the intervention group (88% satisfied/very satisfied).

Conclusion

Our intervention was highly feasible and acceptable to patients, and we found a highly consistent, but statistically non-significant, trend towards higher inpatient engagement and post-discharge use of key portal functions among patients in the intervention group.
AMIA Board White Paper: AMIA 2017 core competencies for applied health informatics education at the master’s degree level
Authors: Valenta Annette L , Berner Eta S , Boren Suzanne A , Deckard Gloria J , Eldredge Christina , Fridsma Douglas B , Gadd Cynthia , Gong Yang , Johnson Todd , Jones Josette , Manos E LaVerne , Phillips Kirk T , Roderer Nancy K , Rosendale Douglas , Turner Anne M , Tusch Guenter , Williamson Jeffrey J , Johnson Stephen B
Published: October 2018

This White Paper presents the foundational domains with examples of key aspects of competencies (knowledge, skills, and attitudes) that are intended for curriculum development and accreditation quality assessment for graduate (master’s level) education in applied health informatics. Through a deliberative process, the AMIA Accreditation Committee refined the work of a task force of the Health Informatics Accreditation Council, establishing 10 foundational domains with accompanying example statements of knowledge, skills, and attitudes that are components of competencies by which graduates from applied health informatics programs can be assessed for competence at the time of graduation. The AMIA Accreditation Committee developed the domains for application across all the subdisciplines represented by AMIA, ranging from translational bioinformatics to clinical and public health informatics, spanning the spectrum from molecular to population levels of health and biomedicine. This document will be periodically updated, as part of the responsibility of the AMIA Accreditation Committee, through continued study, education, and surveys of market trends.
Equal North: how can we reduce health inequalities in the North of England? A prioritization exercise with researchers, policymakers and practitioners
Authors: Addison M , Kaner E , Johnstone P , Hillier-Brown F , Moffatt S , Russell S , Barr B , Holland P , Salway S , Whitehead M , Bambra C
Published: October 2018

Background

The Equal North network was developed to take forward the implications of the Due North report of the Independent Inquiry into Health Equity. The aim of this exercise was to identify how to reduce health inequalities in the north of England.

Methods

Workshops (15 groups) and a Delphi survey (3 rounds, 368 members) were used to consult expert opinion and achieve consensus. Round 1 answered open questions around priorities for action; Round 2 used a 5-point Likert scale to rate items; Round 3 responses were re-rated alongside a median response to each item. In total, 10 workshops were conducted after the Delphi survey to triangulate the data.

Results

In Round 1, responses from 253 participants generated 39 items used in Round 2 (rated by 144 participants). Results from Round 3 (76 participants) indicate that poverty/implications of austerity (4.87 m, IQR 0) remained the priority issue, with long-term unemployment (4.8 m, IQR 0) and mental health (4.7 m, IQR 1) second and third priorities. Workshop 3 did not diverge from findings in Round 1.

Conclusions

Practice professionals and academics agreed that reducing health inequalities in the North of England requires prioritizing research that tackles structural determinants concerning poverty, the implications of austerity measures and unemployment.
Investigation of Fungi Causing Twig Blight Diseases on Peach Trees in South Carolina
Authors: Froelich Martha H. , Schnabel Guido
Published: October 2018

A survey of fungal pathogens causing twig blight on commercial peach trees was conducted in South Carolina in the fall of 2016. Shoots with cankers, pycnidia, and dieback were collected from six locations around the state. Isolates obtained from these samples were identified as Botryosphaeria obtusa, Phomopsis amygdali, Leucostoma persoonii, and Cytospora sp., based on colony morphology, conidia size and shape, and ribosomal DNA sequence analysis. L. persoonii was the most prevalent species and was isolated in five of the six locations, followed by P. amygdali and B. obtusa. The sensitivity of representative isolates of B. obtusa, P. amygdali, and L. persoonii to fungicides of different FRAC codes was evaluated. All species tested were sensitive to thiophanate-methyl (FRAC 1) and pyraclostrobin and azoxystrobin (both FRAC 11), whereas all species were resistant to boscalid and fluopyram (both FRAC 7). P. amygdali and B. obtusa were sensitive to difenoconazole and propiconazole (both FRAC 3), whereas L. persoonii was moderately resistant. L. persoonii was the most virulent species based on expansion of mycelium in the cambium layer of 2-year-old, detached twig pieces. Bacterial spot (BS)-sensitive cultivar ‘O’Henry’ was most susceptible to B. obtusa compared with BS-sensitive ‘Summerprince’, brown rot (BR)-resistant ‘Contender’, and BR-sensitive ‘Coronet’ but was least susceptible to L. persoonii. Coronet was most susceptible to L. persoonii. There were no significant differences between susceptibility of the cultivars to P. amygdali. This study established that L. persoonii is currently the most frequent twig blight pathogen in South Carolina, perhaps owing to its superior fitness. Some fungicides were effective in controlling all twig blight pathogens and may therefore be useful for chemical management strategies. Our study also provides the first evidence that the genetic basis of resistance to BS and BR in peach trees is not necessarily linked to tolerance to wood pathogens.
Primary Cardiac Angiosarcoma: Authors' Perspective Following Synthesis of Available Literature
Authors: Doherty Deb , Arena Sara , Claucherty Emma , Moore Sheena
Published: October 2018

Why are malignant primary cardiac tumors so rare? Is it because of the specialized cardiac muscle cells or the large number of mitochondria per cell? Is it because cardiac muscle is the most aerobic organ of the body and its myocardial capillary density is at a 1:1 ratio, which is 10-fold higher than that of the skeletal muscle? There is overwhelming evidence regarding the benefits of aerobic exercise in prevention of many types of cancer and their associated sequelae. However, there appears to be an evidence gap that needs to be filled. Is there a link between the rare occurrence of primary cardiac cancers in terms of the oxygenation of cardiac muscle tissue and the benefits of aerobic exercise that could provide a new area of research for the primary prevention of cancer? Discussion of these questions was the impetus for the authors to conduct a literature search and then synthesize the review findings. This perspective aims to explore currently available knowledge and gaps in available evidence to understand areas in which physical therapists may impact the varied levels of preventive intervention on primary malignant cardiac cancers. The 35 presenting symptoms and medical history reported in the literature may provide a basis for correlation with other genetic and epigenetic factors to explore along our journey for answers. The physical therapy profession is well positioned to promote healthy behaviors and provide patient education to reduce risk factors and prevent and treat noncommunicable diseases consistent with a biopsychosocial paradigm.
Sentinel Emotional Events: The Nature, Triggers, and Effects of Shame Experiences in Medical Residents
Authors: Bynum William E. , Artino Anthony R. , Uijtdehaage Sebastian , Webb Allison M.B. , Varpio Lara
Published: October 2018

Purpose

This study explores an under-investigated topic, how medical residents experience shame within clinical learning environments, by asking residents to reflect on (1) the nature of their shame experiences; (2) the events that triggered, and factors that contributed to, those shame experiences; and (3) the perceived effects of those shame experiences.

Method

In this hermeneutic phenomenology study, the authors recruited 12 (self-nominated) residents from an internal medicine residency at a large teaching hospital in the United States. Data collection from each participant in 2016–2017 included (1) a written reflection about an experience during medical training in which the participant felt “flawed, deficient, or unworthy,” and (2) a semi-structured interview that explored the participant’s shame experience(s) in depth. The data were analyzed according to hermeneutic traditions, producing rich descriptions about participants’ shame experiences.

Results

Participants’ shame experiences ranged from debilitating emotional and physical reactions to more insidious, fleeting reactions. Participants reported shame triggers relating to patient care, learning processes, and personal goals; numerous factors contributed to their shame experiences. The effects of shame reactions included social isolation, disengagement from learning, impaired wellness, unprofessional behavior, and impaired empathy. Positive effects of shame reactions included enhanced learning, increased willingness to reach out for help, and improved relationships.

Conclusions

Shame reactions can be sentinel emotional events with significant physical and/or psychological effects in medical learners. This study has implications for learners, educators, and patients, and it may pave the way toward open, honest conversations about the role shame plays in medical education.
Knee Stiffness After Tibial Plateau Fractures: Predictors and Outcomes (OTA-41)
Authors: Kugelman David N. , Qatu Abdullah M. , Strauss Eric J. , Konda Sanjit R. , Egol Kenneth A.
Published: October 2018

Objectives:

What patient characteristics and injury factors predict decreased knee range of motion (ROM) after operative management of tibial plateau fractures?

Design:

Prospective cohort study.

Setting:

Academic medical center.

Patients:

Over 11 years, tibial plateau fractures at a single academic institution were prospectively followed. A total of 266 patients were included in this study.

Intervention:

Surgical repair of tibial plateau fractures and secondary interventions due to arthrofibrosis.

Main outcome measure:

Clinical outcomes were evaluated using the Short Musculoskeletal Function Assessment and ROM at 3-month, 6-month, and long-term follow-up. Secondary outcomes were considered as the need for a subsequent procedure due to arthrofibrosis.

Results:

At 3-month follow-up, the mean ROM was 113 degrees. By long-term follow-up (mean = 17 months), the mean ROM improved to 125 degrees. Independent predictors of decreased knee ROM were the following: at 3-month follow-up, open fractures (P= 0.047), application of a knee-spanning external fixator (P= 0.026), orthopaedic polytrauma (P= 0.003), and tibial spine involvement (P= 0.043); and at long-term follow-up, nonwhite ethnicity (P= 0.003), increasing age (P= 0.003), and a deep infection (P= 0.002). Ten patients (3.7%) required a secondary procedure for arthrofibrosis. There was a significant improvement in the knee ROM (P< 0.001) and functional outcomes (P= 0.004) following the intervention.

Conclusions:

At long-term follow-up, independent predictors of decreased knee ROM were nonwhite ethnicity, increasing age, and sustaining a postoperative complication of a deep infection. Secondary interventions were reliable treatments for arthrofibrosis.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Variations in the Organisms Causing Deep Surgical Site Infections in Fracture Patients at a Level I Trauma Center (2006–2015)
Authors: Montalvo Ryan N. , Natoli Roman M. , O'Hara Nathan N. , Schoonover Carrie , Berger Peter Z. , Reahl G. Bradley , Shirtliff Mark E. , Manson Theodore T. , Torbert Jesse T. , O'Toole Robert V. , Joshi Manjari
Published: October 2018

Objectives:

To quantify the current bacteriology of deep surgical site infections (SSIs) after fracture surgery at 1 institution and to compare those data with historical controls at the same institution, assessing variations in infecting organisms over the past decade.

Design:

Retrospective review.

Setting:

Level I trauma center.

Patients/Participants:

Two hundred forty-three patients requiring surgical intervention for deep SSI between January 2011 and December 2015 were compared with 211 patients requiring surgical intervention for deep SSI between December 2006 and December 2010.

Intervention:

None.

Main Outcome Measurements:

Bacteria were categorized as Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus, Enterococcus, gram-negative rods (GNR), gram-positive rods, anaerobes, or negative cultures. The proportion of each bacterial type was determined and compared with previously published data from the same trauma center (December 2006 to December 2010).

Results:

Patients most commonly had S. aureus infections (48%), followed by GNR (40%) and CoNS (19%). The proportion of CoNS species (26% vs. 12%, P < 0.01) in infected patients was significantly higher during the current study period compared with historical controls. The proportion of S. aureus species in infected patients was significantly less during the current study period (39% vs. 56%, P < 0.01). The reduction in the proportion of S. aureus species in infected patients was driven by a decrease in the proportion of methicillin-resistant S. aureus (MRSA) in the overall sample.

Conclusions:

Bacteriology of deep SSI of fractures has changed substantially over the past decade at our center, specifically the proportions of GNR, CoNS, and MRSA.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Comparison of the Open Semi-extended Parapatellar Versus Standard Entry Tibial Nailing Techniques and Knee Pain: A Randomized Controlled Trial
Authors: Rothberg David L. , Stuart Ami R. , Presson Angela P. , Haller Justin M. , Higgins Thomas F. , Kubiak Erik N.
Published: October 2018

Objective:

To determine if an open, semi-extended, parapatellar tibial nailing technique (SEK) imparts any undue knee symptoms/pain compared with the traditional infrapatellar tibial nailing technique (FK).

Design:

Randomized controlled trial.

Setting:

Level 1 trauma center.

Patients:

Forty-seven patients with OTA/AO 42A-C tibial shaft fractures were included in the study.

Intervention:

Patients were randomized to treatment with either a SEK or an FK technique.

Main Outcome:

The main outcome was a symptoms subset of the International Knee Documentation Committee (SS-IKDC) pertaining to knee symptoms/pain.

Results:

Final follow-up was collected at 1 year for 24 SEK and 23 FK patients. No significant differences were found between the groups in regards to demographics, injury, or surgery-related variables. The 2 techniques did have equivalent symptoms scores [mean for the difference (SEK − FK): 0.29, 90% confidence interval: −4.16 to 4.75] but did not have equivalent pain scores [mean for the difference (SEK − FK): 0.2, 90% confidence interval: −3.18 to 3.59]. When comparing demographic and injury-related variables to the SS-IKDC, only Kellgren–Lawrence classification was statistically significant (P = 0.026), where increasing presence of osteoarthritis was associated with lower scores.

Conclusions:

The results of this single-center randomized controlled trial show that SEK and FK techniques for tibial nailing are equivalent in regards to knee symptoms (defined as ±5 points on the SS-IKDC) but not specifically pain that showed trends toward decreasing knee pain with the open SEK technique. This randomized controlled trial demonstrates that the use of the open semi-extended, parapatellar technique for tibial nailing should not be associated with any higher likelihood of knee pain/symptoms than the traditional flexed knee, infrapatellar technique.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Operative Setup to Improve Sagittal Syndesmotic Reduction: Technical Tip
Authors: Boszczyk Andrzej , Kordasiewicz Bartłomiej , Kiciński Maciej , Fudalej Marcin , Rammelt Stefan
Published: October 2018

We analyzed the operative measures that may be used to reduce the likelihood of sagittal syndesmotic malreduction. Hence, we propose a simple technical tip to avoid sagittal plane malreduction of the fibula within the syndesmosis in ankle fractures. Supporting the leg under the heel should be avoided when performing syndesmotic reduction for unstable malleolar fractures, and support under the calf should be used instead. Our observations have been confirmed in 6 cadaver specimens. We observed that there was a significant anterior subluxation of the fibula when the leg was supported under the heel. No significant difference between the intact and unstable state was present when the leg was supported under the calf. In conclusion, during syndesmotic reduction and fixation in supine position, supporting the foot under the heel should be avoided.
Use of Inherent Anteversion of an Intramedullary Nail to Avoid Malrotation in Comminuted Femur Fractures: A Prospective Case– Control Study
Authors: Vaidya Rahul , Dimovski Radomir , Cizmic Zlatan , Vaidya Anshul , Gheraibeh Petra , Hudson Ian
Published: October 2018

Objectives:

To (1) evaluate using the inherent anteversion of a second or third generation femoral nail to set the version of the femur during locked intramedullary nailing of comminuted femoral shaft fractures (Espinosa Technique [ET]) and compare it with our traditional method (traditional group [TG]) and (2) assess the variation of anteversion because of the inherent play in the nail itself.

Design:

A prospective IRB-approved study.

Setting:

Academic US Level 1 Trauma Center.

Patients:

Fifty-two consecutive patients with comminuted femur fractures all completed the study.

Intervention:

The first 27 patients had the anteversion determined using the patellar shadow and lesser trochanter (TG), and the next 25 patients were treated by ET.

Main Outcome Measure:

Computed tomography scanogram for femoral anteversion and length in the normal versus operated femur.

Results:

A >15 degree difference from native to operated legs was found in 8/27 TG (29%, 95% CI 15.3%–54.2%), with a mean difference of 11.6 ± 10.2 degrees (95% CI 8.8–16.17) verses 1/25 in the ET group (2.5%, 95% CI 0%–15.3%), with a mean difference of 4.8 ± 6.2 degrees (95% CI 1.38–8.9) (P = 0.0068). There was a 5 degree variability in our ability to center the proximal locking screw in the femoral head and 5 degrees variation in distal locking.

Conclusions:

The inherent anteversion of a second generation nail can be used to minimize malrotation of the femur after comminuted fractures during locked intramedullary nailing in patients with normal anteversion and is superior to our present fluoroscopic technique.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Foot Function After Surgically Treated Intraarticular Calcaneal Fractures: Correlation of Clinical and Pedobarographic Results of 65 Patients Followed for 8 Years
Authors: Dürr Constanze , Apinun Jirun , Mittlmeier Thomas , Rammelt Stefan
Published: October 2018

Objectives:

To correlate functional deficits after surgical treatment of displaced intraarticular calcaneal fractures (DIACFs) as measured through dynamic pedobarography with clinical and radiographic long-term results.

Design:

Retrospective single-center study.

Setting:

Level 1 trauma center.

Patients:

Sixty-five patients with unilateral DIACFs, reexamined at an average of 8.1 years after surgery.

Intervention:

Internal fixation of DIACF with lateral plate or percutaneous screws.

Main Outcome Measurements:

Dynamic pedobarography, AOFAS, Zwipp, SF-36 scores, Foot Function Index, Böhler angle, and articular congruity.

Results:

When compared with the uninjured side, pedobarography of the operated foot revealed a significantly increased contact area of the hindfoot and midfoot, with a decreased contact area under first/second metatarsal (MT) and first/second toe after DIACF. Maximum pressure and pressure time integral were significantly increased at the midfoot and lateral MT with a decrease under the hindfoot and first to second MT/toe. Midfoot pressure time integral correlated with the range of plantarflexion. Fracture classification correlated with MT 1 contact time. Hindfoot and MT contact times were negatively correlated with Böhler angle. Patients with the smallest side-to-side differences in pedobarogaphy had overall highest scores and significantly greater ankle/hindfoot range of motion at follow-up.

Conclusions:

Significant correlations were found between clinical and pedobarographic results. Increased contact areas and time at the midfoot indicating a lateral load shift correlated with inferior outcome and decreased subtalar motion. These results support the importance of reconstruction of the subtalar joint and overall bony morphology of the calcaneus with preservation of subtalar motion as necessary for global foot function.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Prospective Study of the Effectiveness of Paroxetine on the Onset of Posttraumatic Stress Disorder, Depression, and Health and Functional Outcomes After Trauma
Authors: Borrelli Joseph , Starr Adam , Downs Dana L. , North Carol S.
Published: October 2018

Objectives:

To determine whether the administration of medication for posttraumatic stress disorder (PTSD) to injured trauma survivors prevents or mitigates PTSD.

Design:

Double-blinded, placebo-controlled.

Setting:

Level I trauma center.

Patients:

One hundred twenty patients admitted for traumatic orthopaedic injury.

Intervention:

Either paroxetine or placebo starting 2 weeks postinjury.

Main Outcome Measurements:

PTSD symptoms were measured with the PTSD Checklist for DSM-IV. The Quick Inventory of Depressive Symptomatology (QIDS) assessed the presence and severity of DSM-IV-TR major depressive symptoms. The SF-36 measured postinjury quality of life and social functioning. The Short Musculoskeletal Functional Assessment rated postinjury musculoskeletal function.

Results:

The paroxetine group did not differ from the placebo group in proportions with PTSD as assessed at the 6- or 12-month follow-up or in proportions with major depression symptoms since the injury as assessed at the 3-month follow-up. The groups also did not differ at the 8-week follow-up in the amount of change from baseline in QIDS scores. The paroxetine group had a marginally greater increase from baseline in SF-36 functioning score at the 12-month follow-up as compared with the placebo group and a marginally greater reduction from baseline in Short Musculoskeletal Functional Assessment musculoskeletal functioning at the 12-month follow-up as compared with the placebo group.

Conclusions:

These results suggest the potential for psychotropic medication to prevent or reduce posttraumatic stress symptoms and to improve the function and health of trauma patients. Further research is needed to confirm paroxetine's use for this purpose.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Vitamin D to Prevent Lung Injury Following Esophagectomy—A Randomized, Placebo-Controlled Trial*
Authors: Parekh Dhruv , Dancer Rachel C. A. , Scott Aaron , D’Souza Vijay K. , Howells Phillip A. , Mahida Rahul Y. , Tang Jonathan C. Y. , Cooper Mark S. , Fraser William D. , Tan LamChin , Gao Fang , Martineau Adrian R. , Tucker Olga , Perkins Gavin D. , Thickett David R.
Published: October 2018

Objectives:

Observational studies suggest an association between vitamin D deficiency and adverse outcomes of critical illness and identify it as a potential risk factor for the development of lung injury. To determine whether preoperative administration of oral high-dose cholecalciferol ameliorates early acute lung injury postoperatively in adults undergoing elective esophagectomy.

Design:

A double-blind, randomized, placebo-controlled trial.

Setting:

Three large U.K. university hospitals.

Patients:

Seventy-nine adult patients undergoing elective esophagectomy were randomized.

Interventions:

A single oral preoperative (3–14 d) dose of 7.5 mg (300,000 IU; 15 mL) cholecalciferol or matched placebo.

Measurements and Main Results:

Primary outcome was change in extravascular lung water index at the end of esophagectomy. Secondary outcomes included Pao
2:Fio
2 ratio, development of lung injury, ventilator and organ-failure free days, 28 and 90 day survival, safety of cholecalciferol supplementation, plasma vitamin D status (25(OH)D, 1,25(OH)2D, and vitamin D-binding protein), pulmonary vascular permeability index, and extravascular lung water index day 1 postoperatively. An exploratory study measured biomarkers of alveolar-capillary inflammation and injury. Forty patients were randomized to cholecalciferol and 39 to placebo. There was no significant change in extravascular lung water index at the end of the operation between treatment groups (placebo median 1.0 [interquartile range, 0.4–1.8] vs cholecalciferol median 0.4 mL/kg [interquartile range, 0.4–1.2 mL/kg]; p = 0.059). Median pulmonary vascular permeability index values were significantly lower in the cholecalciferol treatment group (placebo 0.4 [interquartile range, 0–0.7] vs cholecalciferol 0.1 [interquartile range, –0.15 to –0.35]; p = 0.027). Cholecalciferol treatment effectively increased 25(OH)D concentrations, but surgery resulted in a decrease in 25(OH)D concentrations at day 3 in both arms. There was no difference in clinical outcomes.

Conclusions:

High-dose preoperative treatment with oral cholecalciferol was effective at increasing 25(OH)D concentrations and reduced changes in postoperative pulmonary vascular permeability index, but not extravascular lung water index.
Beyond Low Tidal Volume Ventilation: Treatment Adjuncts for Severe Respiratory Failure in Acute Respiratory Distress Syndrome
Authors: Fielding-Singh Vikram , Matthay Michael A. , Calfee Carolyn S.
Published: October 2018

Objectives:

Despite decades of research, the acute respiratory distress syndrome remains associated with significant morbidity and mortality. This Concise Definitive Review provides a practical and evidence-based summary of treatments in addition to low tidal volume ventilation and their role in the management of severe respiratory failure in acute respiratory distress syndrome.

Data Sources:

We searched the PubMed database for clinical trials, observational studies, and review articles describing treatment adjuncts in acute respiratory distress syndrome patients, including high positive end-expiratory pressure strategies, recruitment maneuvers, high-frequency oscillatory ventilation, neuromuscular blockade, prone positioning, inhaled pulmonary vasodilators, extracorporeal membrane oxygenation, glucocorticoids, and renal replacement therapy.

Study Selection and Data Extraction:

Results were reviewed by the primary author in depth. Disputed findings and conclusions were then reviewed with the other authors until consensus was achieved.

Data Synthesis:

Severe respiratory failure in acute respiratory distress syndrome may present with refractory hypoxemia, severe respiratory acidosis, or elevated plateau airway pressures despite lung-protective ventilation according to acute respiratory distress syndrome Network protocol. For severe hypoxemia, first-line treatment adjuncts include high positive end-expiratory pressure strategies, recruitment maneuvers, neuromuscular blockade, and prone positioning. For refractory acidosis, we recommend initial modest liberalization of tidal volumes, followed by neuromuscular blockade and prone positioning. For elevated plateau airway pressures, we suggest first decreasing tidal volumes, followed by neuromuscular blockade, modification of positive end-expiratory pressure, and prone positioning. Therapies such as inhaled pulmonary vasodilators, glucocorticoids, and renal replacement therapy have significantly less evidence in favor of their use and should be considered second line. Extracorporeal membrane oxygenation may be life-saving in selected patients with severe acute respiratory distress syndrome but should be used only when other alternatives have been applied.

Conclusions:

Severe respiratory failure in acute respiratory distress syndrome often necessitates the use of treatment adjuncts. Evidence-based application of these therapies in acute respiratory distress syndrome remains a significant challenge. However, a rational stepwise approach with frequent monitoring for improvement or harm can be achieved.
Effects of Polyethylene Glycol-20k on Postresuscitation Myocardial and Cerebral Function in a Rat Model of Cardiopulmonary Resuscitation
Authors: Yang Jin , Xiao Yan , Quan Eugenie Y. , Hu Zhangle , Guo Qinyue , Miao Changqing , Bradley Jennifer L. , Peberdy Mary A. , Ornato Joseph P. , Mangino Martin J. , Tang Wanchun
Published: October 2018

Objectives:

Polyethylene glycol-20k is a hybrid cell impermeant that reduces ischemia injury and improves microcirculatory flow during and following low flow states through nonenergy-dependent water transfer in the microcirculation. We investigated the effects of polyethylene glycol-20k on postresuscitation microcirculation, myocardial and cerebral function, and duration of survival in a rat model of cardiopulmonary resuscitation.

Design:

Ventricular fibrillation was induced in 20 male Sprague Dawley rats and untreated for 6 minutes. Animals were randomized into two groups (n = 10 for each group): polyethylene glycol-20k and control. Polyethylene glycol-20k (10% solution in saline, 10% estimated blood volume) and vehicle (saline) were administered at the beginning of cardiopulmonary resuscitation by continuous IV infusion. Resuscitation was attempted after 8 minutes of cardiopulmonary resuscitation.

Setting:

University-Affiliated Research Laboratory.

Subjects:

Sprague Dawley Rats.

Interventions:

Polyethylene glycol-20k.

Measurements and Main Results:

Buccal microcirculation was measured at baseline, 1, 3, and 6 hours after return of spontaneous circulation using a side-stream dark-field imaging device. Myocardial function was measured by echocardiography at baseline and every hour postresuscitation for 6 hours. The animals were then returned to their cage and observed for an additional 72 hours. Neurologic Deficit Scores were recorded at 24, 48, and 72 hours after resuscitation. Postresuscitation ejection fraction, cardiac output, and myocardial performance index were significantly improved in animals treated with polyethylene glycol-20k (p < 0.05). Perfused buccal vessel density and microcirculatory flow index values were significantly higher at all time points in the polyethylene glycol-20k group compared with the control group. Postresuscitation cerebral function and survival rate were also significantly improved in animals that received polyethylene glycol-20k.

Conclusions:

Administration of polyethylene glycol-20k following cardiopulmonary resuscitation improves postresuscitation myocardial and cerebral function, buccal microcirculation, and survival in a rat model of cardiopulmonary resuscitation.
Peripherally Inserted Central Catheters in the ICU: A Retrospective Study of Adult Medical Patients in 52 Hospitals
Authors: Govindan Sushant , Snyder Ashley , Flanders Scott A. , Chopra Vineet
Published: October 2018

Objectives:

To quantify variation in use and complications from peripherally inserted central catheters placed in the ICU versus peripherally inserted central catheters placed on the general ward.

Design:

Retrospective cohort study.

Setting:

Fifty-two hospital Michigan quality collaborative.

Patients:

Twenty-seven–thousand two-hundred eighty-nine patients with peripherally inserted central catheters placed during hospitalization.

Measurements and Main Results:

Descriptive statistics were used to summarize patient, provider, and device characteristics. Bivariate tests were used to assess differences between peripherally inserted central catheters placed in the ICU versus peripherally inserted central catheters placed on the ward. Multilevel mixed-effects generalized linear models adjusting for patient and device factors with a logit link clustered by hospital were used to examine the association between peripherally inserted central catheter complications and location of peripherally inserted central catheter placement. Variation in ICU peripherally inserted central catheter use, rates of complications, and appropriateness of use across hospitals was also examined. Eight-thousand two-hundred eighty patients (30.3%) received peripherally inserted central catheters in the ICU versus 19,009 (69.7%) on the general ward. The commonest indication for peripherally inserted central catheter use in the ICU was difficult IV access (35.1%) versus antibiotic therapy (53.3%) on wards. Compared with peripherally inserted central catheters placed in wards, peripherally inserted central catheters placed in the ICU were more often multilumen (59.5% vs 39.3; p < 0.001) and more often associated with a complication (odds ratio, 1.30; 95% CI, 1.18–1.43; p < 0.001). Substantial variation in ICU peripherally inserted central catheter use and outcomes across hospitals was observed, with median peripherally inserted central catheter dwell time ranging from 3 to 38.5 days (p < 0.001) and complications from 0% to 40.2% (p < 0.001). Importantly, 87% (n = 45) of ICUs reported median peripherally inserted central catheter dwell times less than or equal to 14 days, a duration where traditional central venous catheters, not peripherally inserted central catheters, are considered appropriate by published criteria.

Conclusions:

Peripherally inserted central catheter use in the ICU is highly variable, associated with complications and often not appropriate. Further study of vascular access decision-making in the ICU appears necessary.