bluuebunny/crossref_metadata_2025 huggingface dataset:
Searching for hot subdwarf stars from the LAMOST Spectra. II. Pure spectroscopic identification method for hot subdwarfs
Authors: Lei Zhenxin , Bu Yude , Zhao Jingkun , Németh Péter , Zhao Gang
Published: January 2019

Employing a new machine-learning method, named the hierarchical extreme learning machine (HELM) algorithm, we identified 56 hot subdwarf stars in the first data release (DR1) of the Large Sky Area Multi-Object Fibre Spectroscopic Telescope (LAMOST) survey. The atmospheric parameters of the stars are obtained by fitting the profiles of hydrogen (H) Balmer lines and helium (He) lines with synthetic spectra calculated from non-local thermodynamic equilibrium (NLTE) model atmospheres. Five He-rich hot subdwarf stars were found in our sample with their log (nHe/nH) > −1, while 51 stars are He-poor sdB, sdO and sdOB stars. We also confirmed the two He sequences of hot subdwarf stars found by Edelmann et al. (2003, A&A, 400, 939) in a Teff–log(nHe/nH) diagram. The HELM algorithm works directly on the observed spectroscopy and is able to filter out spectral properties without supplementary photometric data. The results presented in this study demonstrate that the HELM algorithm is a reliable method to search for hot subdwarf stars after suitable training is performed, and it can also be used to search for other objects which have obvious features in their spectra or images.
A categorical reconstruction of crystals and quantum groups at q = 0
Authors: Smith Craig
Published: January 2019

The quantum co-ordinate algebra Aq(g) associated to a Kac–Moody Lie algebra g forms a Hopf algebra whose comodules are direct sums of finite-dimensional irreducible Uq(g) modules. In this paper, we investigate whether an analogous result is true when q=0. We classify crystal bases as coalgebras over a comonadic functor on the category of pointed sets and encode the monoidal structure of crystals into a bicomonadic structure. In doing this, we prove that there is no coalgebra in the category of pointed sets whose comodules are equivalent to crystal bases. We then construct a bialgebra over Z whose based comodules are equivalent to crystals, which we conjecture is linked to Lusztig’s quantum group at v=∞.
A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia
Authors: Warren Chastity , Medei Mary Kathryn , Wood Brooke , Schutte Debra
Published: January 2019

Purpose: The purpose of this evidence-based quality improvement (QI) project was to implement an oral care protocol in the adult in-patient care areas of a level 1 trauma hospital and to evaluate its impact on the incidence of hospital-acquired pneumonia (HAP).

Methods: A standardized, evidence-based oral care protocol was implemented depending on the level of care required by each ventilated, at-risk, or short-term care patient. The QI project included the introduction of a new suction toothbrush kit for at-risk patients and, for short-term patients, a new short-term oral care kit that featured a more ergonomically appropriate toothbrush, a baking soda toothpaste, and an alcohol-free antiseptic mouthwash; the project also supported the continued use of the then current suction toothbrush kit for patients receiving mechanical ventilation. We examined medical records retrospectively and used International Classification of Diseases (ICD) 9 and ICD 10 codes for pneumonia not present on admission to determine the incidence of HAP, including nonventilator hospital-acquired pneumonia (NV-HAP) and ventilator-associated pneumonia (VAP), in two seven-month periods: the baseline and intervention periods. Both periods were in the same seven calendar months of two different years to control for seasonal differences in pneumonia rates. Documentation of oral care interventions were compared with oral care supply use reports to measure protocol adherence in the intervention group.

Results: There were 202 patients in the baseline group and 215 in the intervention group. A χ2 analysis of NV-HAP incidence showed a statistically significant decrease in occurrences of NV-HAP from 52 in the baseline group to 26 in the intervention group (χ2 = 12.8, df = 1, P < 0.001). The number of patient deaths from NV-HAP also differed significantly between groups, with 20 in the baseline group and four in the intervention group (χ2 = 4.33, df = 1, P = 0.037). NV-HAP incidence per 1,000 discharges was calculated at 2.84 in the baseline group and 1.41 in the intervention group. Among patients on a ventilator, there were 56 ventilatorassociated events (VAEs) with 12 cases of VAP in the baseline group and 49 VAEs and three cases of VAP in the intervention group. Infection rates in the baseline group were calculated as 12.53 VAEs per 1,000 ventilator days and 2.87 cases of VAP per 1,000 ventilator days. The intervention group yielded a VAE rate of 14.29 per 1,000 ventilator days and a VAP rate of 1.26 per 1,000 ventilator days. Overall, nurses' adherence to the new oral care protocol ranged from 36% to 100% per month, with an average adherence to protocol of 76% as evidenced by oral care documentation and supply use.

Implications: Nurses improved pneumonia outcomes by providing oral health interventions to all adult patients admitted to the hospital, which reduced overall hospital costs, length of stay, and patient mortality.
Integrating Peer Review into Nursing Practice
Authors: Pinero Maria , Bieler Jennifer , Smithingell Rochelle , Andre-Jones Cassie , Hughes Alexandra , Fischer-Cartlidge Erica
Published: January 2019

Clinical nurses develop a program to strengthen professional relationships and practice.
Teaching Q Methodology to Prelicensure Nursing Students
Authors: Opsahl Angela , Judge Deborah , Hensel Desiree
Published: January 2019

Prelicensure nursing student exposure to undergraduate research education may have a significant effect on their research skills and use of evidence-based practice. There are potential benefits to introducing Q methodology to prelicensure nursing research students. Utilizing Q methodology principles and techniques, a class on Q methodology was integrated into a prelicensure nursing research and evidence-based practice course. The interactive classroom format and active student engagement in the step-by-step mock study were positive aspects of the class.
Meeting Texas Nursing Workforce Needs Through Recruitment and Retention Initiatives
Authors: Gary Jodie C. , Gosselin Kevin , Mulcahy Abigail , Wise Matthews Debra
Published: January 2019

Evidence demonstrates health inequities can be ameliorated by a workforce whose diversity reflects the population served. The diversity of the Texas nursing workforce, however, is not reflective of the Texas population. This article reports on a project to recruit and retain minority nurses in Texas. The project goals were to improve enrollment for minority students, specifically Hispanic students, in an online South Texas baccalaureate nursing program (traditional BSN, second-degree BSN, and RN to BSN); facilitate student success; and promote student satisfaction. These goals were successfully achieved at one academic institution.
Population Health in Childbearing Family Education in Nursing
Authors: Dzubaty Dolores
Published: January 2019

Population health principles can be introduced in the undergraduate nursing curriculum during a course providing education about the childbearing family. Information regarding fertility and all stages of pregnancy and childbearing is discussed throughout the course. Knowledge regarding client resources, needs, risk factors, and health practices as related to client population is explored. Population health does not limit the clients' defining characteristics to only identified ethnicity or geographic area; clients may be members of more than one population. Introducing population health through the unfolding case study method stimulates a more thorough exploration of differing populations the student may not generally encounter.
Nurse Practitioner Role Transition and Identity Development in Rural Health Care Settings: A Scoping Review
Authors: Owens Rhoda A.
Published: January 2019

AIM

The purpose of this scoping review was to explore the literature regarding the nurse practitioner (NP) role transition and professional identity development at rural health care settings.

BACKGROUND

Because of the shortage of primary care providers, NPs are meeting the demand for primary care in rural areas.

METHOD

Arksey and O'Malley's six-stage methodological framework for scoping reviews guided this systematic literature review, which resulted in selection of 145 sources.

RESULTS

Three major themes emerged: NPs in rural clinical practice, defining NP professional identity, and role transition to an NP identity.

CONCLUSION

Further research is needed to guide education program leaders on curriculum development. Rural health care facilities and nursing programs should partner in the orientation and continuing education needs of NPs to prepare and support their role transition and professional identity development. NPs will be instrumental in providing access to quality primary health care in rural communities.
High-Fidelity Simulation in the Classroom for Clinical Judgment Development in Third-Year Baccalaureate Nursing Students
Authors: Klenke-Borgmann Laura
Published: January 2019

High-fidelity simulation-based experience (HFSBE) in the laboratory setting is an evidence-based teaching strategy that engenders clinical judgment among students. There is very little literature on the use of HFSBE as a teaching strategy in the traditional classroom setting. This article describes an innovative approach using a prerecorded HFSBE and debriefing with third-year, baccalaureate, undergraduate students. Results of this strategy were positive, including student feedback such as, “Any way to visually integrate pathophysiology in the clinical setting is the best form of teaching yet.”
Highlights From an English-as-an-Additional-Language Nursing Support Program
Authors: Choi Liza Lai Shan
Published: January 2019

English-as-an-additional-language nursing students are more likely to experience academic challenges than nursing students whose primary language is English. In an attempt to improve the learning environment for this group of students, a novel support group was established to address both academic and nonacademic issues. The impact and effectiveness of this support group are explored using an interpretative analytic approach. The findings suggest that English-as-an-additional-language support programs based on the principles of academic safety, purposeful design, curriculum relevance, positive faculty influence, and proactive enrollment have the most potential to facilitate student success.
Aquaporin 5 –1364A/C Promoter Polymorphism Is Associated with Pulmonary Inflammation and Survival in Acute Respiratory Distress Syndrome
Authors: Rahmel Tim , Rump Katharina , Peters Jürgen , Adamzik Michael
Published: January 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

The aquaporin-5 (AQP5) –1364A/C promoter single-nucleotide polymorphism is associated with an altered AQP5 expression and mortality in sepsis. Because AQP5 expression alters neutrophil cell migration, it could affect pulmonary inflammation and survival in bacterially evoked acute respiratory distress syndrome. Accordingly, the authors tested the hypotheses that the AC/CC genotype in patients with bacterially evoked pneumonia resulting in acute respiratory distress syndrome is associated with (1) attenuated pulmonary inflammation and (2) higher 30-day survival.

Methods

In this prospective, observational study, bronchoalveolar lavage and blood sampling were performed within 24 h of intensive care unit admission. In 136 Caucasian patients with bacterially evoked acute respiratory distress syndrome, genotype of the AQP5 –1364A/C promoter polymorphism, bronchoalveolar lavage total protein, albumin, white cell concentrations, and lactate dehydrogenase activity were measured to evaluate the relationship between genotypes and survival.

Results

AC/CC patients as well as survivors showed lower bronchoalveolar lavage protein (0.9 mg/ml vs. 2.3 mg/ml, P < 0.001 and 1.6 mg/ml vs. 2.6 mg/ml, P = 0.035), albumin (0.2 mg/ml vs. 0.6 mg/ml, P = 0.019 and 0.3 mg/ml vs. 0.6 mg/ml, P = 0.028), leukocytes (424 /ml vs. 1,430/ml; P = 0.016 and 768 /ml vs. 1,826/ml; P = 0.025), and lactate dehydrogenase activity (82 U/l vs. 232 U/l; P = 0.006 and 123 U/l vs. 303 U/l; P = 0.020). Thirty-day survival was associated with AQP5 –1364A/C genotypes (P = 0.005), with survival of 62% for AA genotypes (58 of 93) but 86% for C-allele carriers (37 of 43). Furthermore, multiple proportional hazard analysis revealed the AA genotype was at high risk for death within 30 days (hazard ratio, 3.53; 95% CI, 1.38 to 9.07; P = 0.009).

Conclusions

In acute respiratory distress syndrome attributable to bacterial pneumonia, the C-allele of the AQP5 –1364A/C promoter polymorphism is associated with an attenuated pulmonary inflammation and higher 30-day survival. Thus, the AQP5 genotype impacts on inflammation and prognosis in acute respiratory distress syndrome.
Nitric Oxide Story
Authors: Zapol Warren M.
Published: January 2019

Inhaled Nitric Oxide in Persistent Pulmonary Hypertension of the Newborn. By Roberts JD, Polaner DM, Lang P, and Zapol WM. Lancet 1992; 130:435–40. Reprinted with permission.

NO has vasodilatory effects on the pulmonary vasculature in adults and animals. We examined the effects on systemic oxygenation and blood pressure of inhaling up to 80 parts per million by volume of NO at fraction of inspired oxygen 0.9 for up to 30 min by six infants with persistent pulmonary hypertension of the newborn. In all infants, this treatment rapidly and significantly increased preductal oxygen saturation; in five infants, postductal oxygen saturation and oxygen tensions also increased. Inhalation of NO did not cause systemic hypotension or raise methemoglobin. These data suggest that low levels of inhaled NO have an important role in the reversal of hypoxemia due to persistent pulmonary hypertension of the newborn.
Operating Room Fires
Authors: Jones Teresa S. , Black Ian H. , Robinson Thomas N. , Jones Edward L.
Published: January 2019

Operating room fires are rare but devastating events. Guidelines are available for the prevention and management of surgical fires; however, these recommendations are based on expert opinion and case series. The three components of an operating room fire are present in virtually all surgical procedures: an oxidizer (oxygen, nitrous oxide), an ignition source (i.e., laser, “Bovie”), and a fuel. This review analyzes each fire ingredient to determine the optimal clinical strategy to reduce the risk of fire. Surgical checklists, team training, and the specific management of an operating room fire are also reviewed.
Propofol TCI Reductions Do Not Attenuate Significant Falls in Cardiac Output Associated With Anesthesia Induction and Knee-Chest Positioning in Spinal Surgery
Authors: Chaló Daniela , Pedrosa Sara , Amorim Pedro , Gouveia Sónia , Sancho Consuelo
Published: January 2019

Background:

Induction of anesthesia and the knee-chest position are associated with hemodynamic changes that may impact patient outcomes. The aim of this study was to assess whether planned reductions in target-controlled infusion propofol concentrations attenuate the hemodynamic changes associated with anesthesia induction and knee-chest position.

Materilas and Methods:

A total of 20 patients scheduled for elective lumbar spinal surgery in the knee-chest position were included. In addition to standard anesthesia monitoring, bispectral index and noninvasive cardiac output (CO) monitoring were undertaken. The study was carried out in 2 parts. In phase 1, target-controlled infusion propofol anesthesia was adjusted to maintain BIS 40 to 60. In phase 2, there were 2 planned reductions in propofol target concentration: (1) immediately after loss of consciousness—reduction calculated using a predefined formula, and (2) before positioning—reduction equal to the average percentage decrease in CO after knee-chest position in phase 1. Changes from baseline in CO and other hemodynamic variables following induction of anesthesia and knee-chest positioning were compared.

Results:

Induction of anesthesia led to decreases of 25.6% and 19.8% in CO from baseline in phases 1 and 2, respectively (P<0.01). Knee-chest positioning resulted in a further decrease such that the total in CO reduction from baseline to 10 minutes after positioning was 38.4% and 46.9% in phases 1 and 2, respectively (P<0.01). There was no difference in CO changes between phases 1 and 2, despite the planned reductions in propofol during phase 2. There was no significant correlation between changes in CO and mean arterial pressure.

Conclusions:

Planned reductions in propofol concentration do not attenuate anesthesia induction and knee-chest position-related decreases in CO. The knee-chest position is an independent risk factor for decrease in CO. Minimally invasive CO monitors may aid in the detection of clinically relevant hemodynamic changes and guide management in anesthetized patients in the knee-chest position.
Effects of Reverberation on the Relation Between Compression Speed and Working Memory for Speech-in-Noise Perception
Authors: Reinhart Paul , Zahorik Pavel , Souza Pamela
Published: January 2019

Objectives:

Previous study has suggested that when listening in modulated noise, individuals benefit from different wide dynamic range compression (WDRC) speeds depending on their working memory ability. Reverberation reduces the modulation depth of signals and may impact the relation between WDRC speed and working memory. The purpose of this study was to examine this relation across a range of reverberant conditions.

Design:

Twenty-eight older listeners with mild-to-moderate sensorineural hearing impairment were recruited in the present study. Individual working memory was measured using a Reading Span test. Sentences were combined with noise at two signal to noise ratios (2 and 5 dB SNR), and reverberation was simulated at a range of reverberation times (0.00, 0.75, 1.50, and 3.00 sec). Speech intelligibility was measured in listeners when listening to the sentences processed with simulated fast-acting and slow-acting WDRC conditions.

Results:

There was a significant relation between WDRC speed and working memory with minimal or no reverberation. Consistent with previous research, this relation was such that individuals with high working memory had higher speech intelligibility with fast-acting WDRC, and individuals with low working memory performed better with slow-acting WDRC. However, at longer reverberation times, there was no relation between WDRC speed and working memory.

Conclusions:

Consistent with previous studies, results suggest that there is an advantage of tailoring WDRC speed based on an individual’s working memory under anechoic conditions. However, the present results further suggest that there may not be such a benefit in reverberant listening environments due to reduction in signal modulation.
Garden 1 and 2 Femoral Neck Fractures Collapse More Than Expected After Closed Reduction and Percutaneous Pinning
Authors: Cronin Patrick K. , Freccero David M. , Kain Michael S. , Marcantonio Andrew J. , Horwitz Daniel S. , Tornetta Paul
Published: January 2019

Objectives:

To report on the final displacement after in situ percutaneous pinning for Garden type 1 and 2 fractures in height, femoral neck fracture collapse, and loss of offset.

Design:

Retrospectively reviewed case series.

Setting:

Three Academic Medical Centers. Boston University Medical Center (Level 1 Trauma Center), Lahey Hospital and Medical Center (Level 2 Trauma Center), and Geisinger Medical Center (level 2 Trauma Center).

Patients/Participants:

One hundred thirty skeletally mature patients with 130 fractures (78 garden 1 and 52 garden 2) who were treated between January 2000 and January 2014 at participating hospitals with percutaneous pinning with a cannulated screw system to successful union after sustaining an intracapsular femoral neck fracture without complete displacement.

Intervention:

In situ percutaneous pinning with 3 cannulated, partially threaded screws in an inverted triangle orientation.

Main Outcome Measurements:

Femoral neck fracture collapse (mm), femoral height shortening (mm), and femoral offset shortening (mm).

Results:

A total of 130 patients (81F, 49M), average age 72 years, sustained 78 Garden 1 and 52 Garden 2 femoral neck fractures. Maximal collapse occurred in the plane of the femoral neck. Thirty-three of 78 (42%) Garden 1 fractures and 33/52 (63%) Garden 2 fractures demonstrated >10 mm fracture collapse. The range of displacements was 0–39 mm as measured along the plane of the femoral neck.

Conclusions:

Garden 1 fractures collapse less frequently than Garden 2 fractures, but both have high rates of fracture collapse when treated to union with in situ percutaneous pin fixation.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Autograft, Allograft, and Bone Graft Substitutes: Clinical Evidence and Indications for Use in the Setting of Orthopaedic Trauma Surgery
Authors: Baldwin Paul , Li Deborah J. , Auston Darryl A. , Mir Hassan S. , Yoon Richard S. , Koval Kenneth J.
Published: January 2019

Bone grafts are the second most common tissue transplanted in the United States, and they are an essential treatment tool in the field of acute and reconstructive traumatic orthopaedic surgery. Available in cancellous, cortical, or bone marrow aspirate form, autogenous bone graft is regarded as the gold standard in the treatment of posttraumatic conditions such as fracture, delayed union, and nonunion. However, drawbacks including donor-site morbidity and limited quantity of graft available for harvest make autograft a less-than-ideal option for certain patient populations. Advancements in allograft and bone graft substitutes in the past decade have created viable alternatives that circumvent some of the weak points of autografts. Allograft is a favorable alternative for its convenience, abundance, and lack of procurement-related patient morbidity. Options include structural, particulate, and demineralized bone matrix form. Commonly used bone graft substitutes include calcium phosphate and calcium sulfate synthetics—these grafts provide their own benefits in structural support and availability. In addition, different growth factors including bone morphogenic proteins can augment the healing process of bony defects treated with grafts. Autograft, allograft, and bone graft substitutes all possess their own varying degrees of osteogenic, osteoconductive, and osteoinductive properties that make them better suited for different procedures. It is the purpose of this review to characterize these properties and present clinical evidence supporting their indications for use in the hopes of better elucidating treatment options for patients requiring bone grafting in an orthopaedic trauma setting.
Fracture Pattern and Periosteal Entrapment in Adolescent Displaced Distal Tibial Physeal Fractures: A Magnetic Resonance Imaging Study
Authors: Park Jinhee , Cha Yunsik , Kang Michael Seungcheol , Park Soo-Sung
Published: January 2019

Objectives:

To investigate the fracture pattern and periosteal entrapment in adolescent distal tibial physeal fractures.

Design:

Retrospective case series.

Setting:

Level I academic trauma center.

Patients/Participants:

Fifty patients (10–16 years of age) with displaced Salter–Harris type II, III, or IV distal tibial physeal fractures were retrospectively reviewed.

Intervention:

Periosteal involvement, fracture pattern.

Main Outcome Measurements:

We investigated the incidence and location of periosteal entrapment in those fractures and the angle of the fracture plane of metaphyseal fragments on axial plane by using magnetic resonance imaging.

Results:

Of the 15 type II, 12 type III (4 malleolar and 8 Tillaux), and 23 type IV (2 malleolar and 21 triplane) fractures, 72.0% (36/50) presented with periosteal entrapment. Among all type II and triplane fractures, periosteal entrapment was observed in the anterolateral corner when there was any displacement on that corner. By contrast, only 1 of 8 Tillaux fractures presented with periosteal entrapment. In almost all supinated foot injuries of type II and triplane fractures, the metaphyseal fracture line was parallel to the intermalleolar axis on axial plane.

Conclusions:

Salter–Harris type II and triplane fractures have a high risk of periosteal entrapment especially in the anterolateral corner. Therefore, even without preoperative magnetic resonance imaging, surgical repositioning of entrapped periosteum should be considered after failed closed reduction. In cases of supinated foot injuries of type II or triplane fractures requiring surgical fixation, a metaphyseal fracture plane parallel to the oblique coronal plane connecting the medial and lateral malleoli may assist surgeons in achieving appropriate metaphyseal fixation.

Level of Evidence:

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Effect of Elbow Position on Load to Failure in Olecranon Fracture Fixation: A Biomechanical Cadaveric Study
Authors: Lindeman Robert W. , Morris Randal , Weatherby Paul , Neustein Adam , Maassen Nicholas H.
Published: January 2019

Objectives:

This study evaluates if relative flexion or extension of the ulnohumeral joint affects the strength of repair in olecranon fractures treated with a precontoured locking plate.

Methods:

A cadaveric study was performed in matched pair cadaveric elbows. All soft tissue was dissected from the radius, ulna, and elbow of each specimen, leaving interosseous ligaments and joint capsules intact. Soft tissue from the humerus was dissected away, leaving only the triceps tendon and ulnar insertions intact. An oblique proximal to distal olecranon osteotomy was created in each specimen 1 cm from the tip of the olecranon. Internal fixation with standard precontoured locking plates and a Krackow augmentation suture with #2 FiberWire followed. Specimens were randomized to elbow position of 90 or 20 degrees° and loaded to failure via axial pull through the triceps. Load at failure, displacement at the time of failure, peak load, stiffness, and mechanism of failure was recorded and compared. The study was repeated a second time with the osteotomy more proximal, 0.6 cm creating a smaller fragment with less opportunities for locking screw fixation. This small fragment group was then tested as the large fragment group had.

Results:

There were no significant differences in load at failure, peak load, or stiffness between the elbow position in the large fragment group. Displacement at time of failure was significantly different, although not clinically relevant. Failure of fixation in this group was a mix of triceps avulsion and failure through fracture site. The smaller fragment group with less points of fixation demonstrated no statistically significant differences in any parameters. A majority of the failures were at the fracture site.

Conclusions:

Ulnohumeral position does not significantly affect overall construct strength even in olecranon fractures with small proximal fragments with limited points of fixation.
Risk Factors That Influence Subsequent Recurrent Instability in Terrible Triad Injury of the Elbow
Authors: Jung Sung-Weon , Kim Dong-Hee , Kang Seung-Hoon , Eho Yil-Ju , Yang Seong-Wook , Lee Gwang-Eun
Published: January 2019

Objective:

To identify risk factors associated with subsequent recurrent instability and to identify predictors of poor outcomes in terrible triad injury of the elbow.

Design:

Retrospective cohort study.

Setting:

University trauma center.

Patients/Participants:

Seventy-six patients who were surgically treated for terrible triad injury of the elbow.

Intervention:

Review of charts and standardized x-ray images before surgery and 2 years after surgery. Patients were categorized into 2 groups: recurrent instability (group A) or concentric stability (group B).

Main Outcome Measurement:

Primary outcome measures were injury mechanism, time between injury and operation, fracture type, ligament injury, radial head fixation, coronoid fixation, ligament repair, period of postoperative immobilization, joint space restoration, healing progress, secondary operation, functional outcomes, and complications. Secondary outcome measures were age, sex, height, body mass index, bone mineral density, and comorbidities (hypertension and diabetes). Outcomes were measured before surgery and 2 years after surgery and were compared between groups.

Results:

Recurrent instability occurred in 19.7% of cases; revision surgeries were performed in 12 cases (80%). High-energy trauma (P = 0.012), time between injury and operation (P = 0.001), radial head comminution (P = 0.001), medial collateral injury (P = 0.041), and coronoid nonrepair (P = 0.030) were associated with recurrent instability. Posttraumatic arthritis developed more often in group A (P = 0.001).

Conclusions:

Recurrent instability was associated with high-energy trauma, time between injury and operation, Mason type III radial head fracture, medial collateral injury, and coronoid nonrepair. Patients with recurrent instability were more likely to require secondary surgery and develop posttraumatic arthritis than those with concentric stability.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Orthogonal Plating With a 95-Degree Blade Plate for Salvage of Unsuccessful Cephalomedullary Nailing of Atypic Femur Fractures: A Technical Trick
Authors: Rollick Natalie C. , Bear Jessica , Diamond Owen , Wellman David S. , Helfet David L.
Published: January 2019

Atypical femur fractures secondary to bisphosphonate use are often complicated by nonunion, which often results in progressive varus collapse, femoral head and neck bone loss, and eventual implant failure. We present a technique that uses orthogonal, dual plating of the proximal femur in addition to biologic augmentation for the management of these challenging fractures.
Are Geriatric Patients Who Sustain High-Energy Traumatic Injury Likely to Return to Functional Independence?
Authors: Shah Jason , Titus Alexander J. , O'Toole Robert V. , Sciadini Marcus F. , Boulton Christina , Castillo Renan , Breazeale Stephen , Schoonover Carrie , Berger Peter , Gitajn I. Leah
Published: January 2019

Objectives:

To evaluate physical function and return to independence of geriatric trauma patients, to compare physical function outcomes of geriatric patients who sustained high-energy trauma with that of those who sustained low-energy trauma, and to identify predictors of physical function outcomes.

Design:

Retrospective.

Setting:

Urban Level I trauma center.

Patients:

Study group of 216 patients with high-energy trauma and comparison group of 117 patients with low-energy trauma.

Intervention:

Injury mechanism (high- vs. low-energy mechanism).

Main Outcome Measurement:

Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) patient-reported outcome measure, and change in living situation and mobility.

Results:

Physical function outcomes and return to independence differed between patients with high-energy and low-energy injuries. High-energy geriatric trauma patients had significantly higher PROMIS PF scores compared with low-energy geriatric trauma patients (PROMIS PF score 42.2 ± 10.4 vs. 24.6 ± 10.4, P < 0.001). High-energy geriatric trauma patients were able to ambulate outdoors without an assistive device in 67% of cases and were living independently 74% of the time in comparison with 28% and 45% of low-energy geriatric trauma patients, respectively (P < 0.001, P < 0.001). Multivariate linear regression analysis demonstrated that low-energy mechanism injury was independently associated with a 13.2 point reduction in PROMIS PF score (P < 0.001).

Conclusions:

Geriatric patients greater than 1 year out from sustaining a high-energy traumatic injury seem to be functioning within the expected range for their age, whereas low-energy trauma patients seem to be functioning substantially worse than both age-adjusted norms and their high-energy cohorts.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Ability of a Risk Prediction Tool to Stratify Quality and Cost for Older Patients With Operative Ankle Fractures
Authors: Lott Ariana , Egol Kenneth A. , Lyon Thomas , Konda Sanjit R.
Published: January 2019

Objectives:

To investigate the ability of a validated geriatric trauma risk prediction tool to stratify hospital quality metrics and inpatient cost for middle-aged and geriatric patients admitted from the emergency department for operative treatment of an ankle fracture.

Design:

Prospective cohort study.

Setting:

Single Academic Medical Center.

Patients:

Patients 55 years of age and older who sustained a rotational ankle fracture and who were treated operatively during their index hospitalization.

Intervention:

Calculation of validated trauma triage score, Score for Trauma Triage in Geriatric and Middle Aged (STTGMA), using patient demographics, injury severity, and functional status. Patients were stratified into groups based on scores to create a minimal-, low-, moderate-, and high-risk cohort.

Main Outcome Measurements:

Length of stay, complications, need for intensive care unit–/step-down unit–level care, discharge location, and index admission costs.

Results:

Fifty ankle fracture patients met inclusion criteria. The mean length of stay was 7.8 ± 5.2 days with a significant difference among the 4 risk groups (4.6-day difference between low and high risk). 73.1% of minimal-risk patients were discharged home compared with 0% of high-risk patients. There was no difference in complication rate or in need for intensive care unit–level care between groups. However, high-risk patients had a mean total inpatient cost 2 times greater than that of minimal-risk patients.

Conclusion:

The Score for Trauma Triage in Geriatric and Middle-Aged tool is able to meaningfully stratify older patients with ankle fracture who require operative fixation regarding hospital quality metrics and cost. This information may allow for efficient targeted reductions in costs while optimizing outcomes.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Effects of body weight on the clinical and radiological outcomes of children with flexible flatfeet managed with the ‘calcaneo-stop’ procedure
Authors: Pavone Vito , Vescio Andrea , Canavese Federico , Costa Danilo , Sessa Giuseppe , Testa Gianluca
Published: January 2019

This study aimed to evaluate the clinical and radiological outcomes of normal, overweight, and obese children with symptomatic flexible flatfeet managed with the ‘calcaneo-stop’ procedure (CSP), and to determine whether any correlation exists between patient weight and outcome. One hundred and seventy-four symptomatic flexible flatfeet were managed with CSP during the study period. The patients were divided into three groups according to their BMI and weight Z-scores: normal, overweight, and obese. Their clinical and radiographic outcomes were assessed preoperatively, and at 1 and 5 years after the index procedure. Although the radiographic criteria were comparable between the three groups, the clinical outcome was worse in obese children than in normal and overweight patients (P<0.05). BMI and the Z-score affected the outcomes of obese patients treated with CSP for symptomatic flexible flatfeet. Although the radiographic outcome was similar irrespective of BMI and Z-scores, obese patients had significantly lower clinical scores than the other patients.
Health-related Quality of Life After Fractures of the Lateral Third of the Clavicle in Children and Adolescents
Authors: Liebs Thoralf R. , Ryser Basil , Kaiser Nadine , Slongo Theddy , Berger Steffen , Ziebarth Kai
Published: January 2019

Introduction:

The health-related quality of life after pediatric fractures of the lateral third of the clavicle is unknown. Given the trend in the literature toward surgical management of clavicular fractures in adults, we frequently receive referrals for surgical management of lateral clavicular fractures in children.

Therefore, we examined (1) the health-related quality of life of patients who sustained a fracture of the lateral third of the clavicle in childhood and who were treated at a large regional pediatric trauma center, (2) if the health-related quality of life was associated with the age at the time of the injury, and (3) whether fracture and displacement patterns were associated with health-related qualify of life.

Methods:

This is a retrospective case series. We were able to identify 69 patients (21 girls and 48 boys) who sustained a fracture of the lateral third of the clavicle between the period spanning from January 2004 to June 2015. These patients were asked to fill in a questionnaire that included the Quick version of the Disability of Arm, Shoulder, and Hand (DASH) (primary outcome) and the Pediatric Quality of Life Inventory (Peds-QL). Until July 2017, we were able to get a response from 56 of these patients, resulting in a follow-up of 81%.

Results:

Treatment was conservative in all cases but one. In these cases, after a mean follow-up of 6.5 years (range, 1 to 13.2 y), the mean Quick-DASH was 1.2 (SD, 4.4) at a scale of 0 to 100, with lower values representing better quality of life. The mean physical function score of the Peds-QL was 97.8 (SD, 4.4), and the mean psychosocial function score was 91.8 (SD, 10.8), both at a scale of 0 to 100, with higher values representing better quality of life.

There was no statistically significant association of age at the time of injury on the primary outcome Quick-DASH.

There were no statistically significant associations between fracture or displacement patterns with regard to health-related quality of life.

Conclusions:

Conservative treatment of lateral clavicular fractures in children and adolescents is associated with excellent health-related quality of life, as measured with the disease-specific Quick-DASH and the non–disease-specific Peds-QL at a mean follow-up of 6.5 years (range, 1 to 13.2 y). There was no effect of age at the time of injury, and we were unable to identify associations to commonly analyzed risk factors, such as displacement patterns.

As the conservative treatment of this type of fracture in children and adolescents is associated with such a good health-related quality of life, it is unlikely that these results could be further improved by surgical interventions.

Level of evidence:

Level IV—case series.
Risk Factors for Rapidly Progressive Neurological Deterioration in Cervical Spondylotic Myelopathy
Authors: Takasawa Eiji , Sorimachi Yasunori , Iizuka Yoichi , Tsunoda Daisuke , Mieda Tokue , Iizuka Haku , Chikuda Hirotaka
Published: January 2019

Study Design.

A retrospective single-center study.

Objective.

This study sought to clarify the risk factors and to evaluate the surgical outcome in patients with rapidly progressive cervical spondylotic myelopathy (rp-CSM).

Summary of Background Data.

CSM is a degenerative spine disease presenting a slow development of myelopathy. Some patients, however, show rapidly progressive neurological deterioration (especially gait disturbances) without any trauma. At present, there is little information about this condition.

Methods.

We studied 71 consecutive CSM patients (52 men, 19 women) with a mean age of 67.1 years, and the follow-up period was 1 year. Patients were divided into two groups: rp-CSM and chronic-CSM (c-CSM) groups. The Japanese Orthopaedic Association score and various clinical differences, including age, sex, comorbidity, the waiting period from symptomatic onset to surgery, cervical range of motion, and intramedullary MR T2-hyperintensity were analyzed, and independent risk factors were determined using a logistic regression analysis.

Results.

Eighteen of 71 patients (25.4%) were diagnosed with rp-CSM. There were no significant differences between the two groups with regard to age, sex, or cervical range of motion. In the rp-CSM group, the preoperative upper/lower extremities and bladder functions were worse, and the waiting period for surgery was shorter (rp-CSM 1.2 mo, c-CSM 25.7 mo). Patients with rp-CSM had a history of cardiovascular event (CVE) (rp-CSM 44.4%, c-CSM 15.1%) and presented with MR T2-hyperintensity (rp-CSM 94.4%, c-CSM 58.5%), especially at the C4/5 disc level. Independent risk factors were a history of CVE (odds ratio = 4.7) and MR T2-hyperintensity (odds ratio  = 12.5). The rp-CSM group showed a better neurological recovery after decompression surgery (the Japanese Orthopaedic Association recovery rate: rp-CSM 64.5%, c-CSM 40.7%).

Conclusion.

A history of CVE and MR T2-hyperintensity were risk factors for rp-CSM. Despite rapid neurological deterioration, rp-CSM patients showed a good neurological recovery after surgery, and thus indicating that rp-CSM is a reversible condition.

Level of Evidence: 4
Long-term Tumor Control With Radiotherapy for Symptomatic Hemangioma of a Vertebral Body
Authors: Parekh Akash Dipak , Amdur Robert J. , Mendenhall William M. , Morris Christopher G. , Zlotecki Robert A.
Published: January 2019

Study Design.

Retrospective outcomes review.

Objective.

To analyze and report long-term outcomes in a cohort of patients treated with radiotherapy (RT) for symptomatic hemangioma of a vertebral body.

Summary of Background Data.

Data are scarce on the rate of tumor control with long-term (>5 yr) follow-up after RT for symptomatic hemangioma of a vertebral body.

Methods.

We retrospectively reviewed the medical records of patients treated at our institution between 1971 and 2008 for symptomatic hemangioma of a vertebral body, updated their follow-up, analyzed complications, and calculated the tumor control rate. Tumor control by imaging was defined as no increase in tumor size on computed tomography (CT) or magnetic resonance (MR) scan. Clinical tumor control was defined as no symptoms of recurrent tumor.

Results.

Ten patients were eligible for analysis. All patients had pain from visible hemangioma at the time of radiotherapy for which surgical resection or interventional radiology procedures were likely to result in high morbidity. Tumors were located in the lumbar (40%), thoracic (50%), or cervical (10%) areas of the spine. The mean radiotherapy dose delivered was 47 Gy.

Mean imaging follow-up after completion of radiotherapy was 8.1 years; mean clinical follow-up was 21.2 years. The tumor control rate was 90% (9/10). One patient who may have developed a tumor recurrence had radiographic and clinical evidence of tumor progression 30 years after radiotherapy. The actuarial rate of tumor control was 100% at 5, 10, 20, and 25 years. There was no grade more than or equal to three treatment toxicities, no evidence of malignant transformation, and no evidence of second tumors in treatment area (with the possible exception of the one tumor recurrence).

Conclusion.

RT for symptomatic hemangioma of the spine provides long-term tumor control with a low risk of serious complications. Radiotherapy is a good option when surgery or an interventional radiology procedure is high-risk. Our preferred dose is 45 Gy at 1.8 Gy/fraction.

Level of Evidence: 4
Artificial Intelligence Based Hierarchical Clustering of Patient Types and Intervention Categories in Adult Spinal Deformity Surgery
Authors: Ames Christopher P. , Smith Justin S. , Pellisé Ferran , Kelly Michael , Alanay Ahmet , Acaroğlu Emre , Pérez-Grueso Francisco Javier Sánchez , Kleinstück Frank , Obeid Ibrahim , Vila-Casademunt Alba , Shaffrey Christopher I. , Burton Douglas , Lafage Virginie , Schwab Frank , Shaffrey Christopher I. , Bess Shay , Serra-Burriel Miquel
Published: January 2019

Study Design.

Retrospective review of prospectively-collected, multicenter adult spinal deformity (ASD) databases.

Objective.

To apply artificial intelligence (AI)-based hierarchical clustering as a step toward a classification scheme that optimizes overall quality, value, and safety for ASD surgery.

Summary of Background Data.

Prior ASD classifications have focused on radiographic parameters associated with patient reported outcomes. Recent work suggests there are many other impactful preoperative data points. However, the ability to segregate patient patterns manually based on hundreds of data points is beyond practical application for surgeons. Unsupervised machine-based clustering of patient types alongside surgical options may simplify analysis of ASD patient types, procedures, and outcomes.

Methods.

Two prospective cohorts were queried for surgical ASD patients with baseline, 1-year, and 2-year SRS-22/Oswestry Disability Index/SF-36v2 data. Two dendrograms were fitted, one with surgical features and one with patient characteristics. Both were built with Ward distances and optimized with the gap method. For each possible n patient cluster by m surgery, normalized 2-year improvement and major complication rates were computed.

Results.

Five hundred-seventy patients were included. Three optimal patient types were identified: young with coronal plane deformity (YC, n = 195), older with prior spine surgeries (ORev, n = 157), and older without prior spine surgeries (OPrim, n = 218). Osteotomy type, instrumentation and interbody fusion were combined to define four surgical clusters. The intersection of patient-based and surgery-based clusters yielded 12 subgroups, with major complication rates ranging from 0% to 51.8% and 2-year normalized improvement ranging from −0.1% for SF36v2 MCS in cluster [1,3] to 100.2% for SRS self-image score in cluster [2,1].

Conclusion.

Unsupervised hierarchical clustering can identify data patterns that may augment preoperative decision-making through construction of a 2-year risk–benefit grid. In addition to creating a novel AI-based ASD classification, pattern identification may facilitate treatment optimization by educating surgeons on which treatment patterns yield optimal improvement with lowest risk.

Level of Evidence: 4