bluuebunny/crossref_metadata_2025 huggingface dataset:
When “Goal!” means ‘soccer’
Authors: Pascual Esther , Dornelas Aline , Oakley Todd
Published: February 2019

Autism is characterized by repetitive behavior and difficulties in adopting the viewpoint of others. We examine a communicative phenomenon resulting from these symptoms: non-prototypical direct speech for non-reports involving an actual utterance from previously produced discourse (e.g. quoting somebody’s words to refer to them,Pascual 2014). We video-recorded the naturalistic speech of five Brazilian children with autism, five typically developing children of the same mental age, and five of the same chronological age. They all used so-calledfictive speech(Pascual 2014,Dornelas & Pascual 2016) for narration, expressing needs, and referring to individuals and events (e.g. sayingGoal!for ‘playing soccer’). Such verbatim fictive speech originated in specific prior interactions or in socio-communicative or socio-cultural knowledge. We found considerable differences in the three groups in the frequency and degree of creativeness of fictive speech as opposed to it representing standard linguistic formulae or echoing previously produced speech word by word.
Using Bounds to Compare the Strength of Exchangeability Assumptions for Internal and External Validity
Authors: Breskin Alexander , Westreich Daniel , Cole Stephen R , Edwards Jessie K
Published: February 2019

In the absence of strong assumptions (e.g., exchangeability), only bounds for causal effects can be identified. Here we describe bounds for the risk difference for an effect of a binary exposure on a binary outcome in 4 common study settings: observational studies and randomized studies, each with and without simple random selection from the target population. Through these scenarios, we introduce randomizations for selection and treatment, and the widths of the bounds are narrowed from 2 (the width of the range of the risk difference) to 0 (point identification). We then assess the strength of the assumptions of exchangeability for internal and external validity by comparing their contributions to the widths of the bounds in the setting of an observational study without random selection from the target population. We find that when less than two-thirds of the target population is selected into the study, the assumption of exchangeability for external validity of the risk difference is stronger than that for internal validity. The relative strength of these assumptions should be considered when designing, analyzing, and interpreting observational studies and will aid in determining the best methods for estimating the causal effects of interest.
Opioid Use and Misuse and Suicidal Behaviors in a Nationally Representative Sample of US Adults
Authors: Samples Hillary , Stuart Elizabeth A , Olfson Mark
Published: February 2019

Prior research has shown associations between opioid misuse and suicidal behaviors, but the relationship between medical opioid use and suicidal behaviors is not known. We assessed associations of opioid use and misuse with suicidal ideation, suicide plans, and suicide attempts among adults aged 18–64 years (n = 86,186) using nationally representative cross-sectional data from the 2015 and 2016 administrations of the National Survey on Drug Use and Health. We used logistic regression to estimate associations between opioid use/misuse and suicidal behaviors and propensity score–weighted logistic regression analysis to examine the counterfactual scenario in which persons with misuse had instead not misused opioids. In propensity score–weighted analyses, compared with opioid misuse, opioid use without misuse was associated with lower odds of suicidal ideation (odds ratio (OR) = 0.57, 95% confidence interval (CI): 0.45, 0.72) and suicide plans (OR = 0.53, 95% CI: 0.35, 0.80), and no use was associated with lower odds of suicidal ideation (OR = 0.62, 95% CI: 0.49, 0.80), suicide plans (OR = 0.56, 95% CI: 0.39, 0.79), and suicide attempts (OR = 0.54, 95% CI: 0.33, 0.89). These findings suggest that opioid misuse is associated with greater odds of suicidal behaviors, but opioid use without misuse is not. Compared with persons with opioid misuse, similar persons without misuse have a reduced risk of suicidal behaviors. Clinical and public health interventions should focus on preventing misuse of opioids.
Social Work, Inter-Disciplinary Cooperation and Self-Neglect: Exploring Logics of Appropriateness
Authors: Mason Karl , Evans Tony
Published: February 2019

Working in a cooperative manner with other disciplines or agencies is often cited as an essential element of social work with adults who self-neglect. Cooperative working is now a legal requirement for agencies involved in adult social care in England. However, little is known about how social workers engage cooperatively with other disciplines in practice. This study sets out to explore this issue, employing the ‘Logic of Appropriateness’ perspective to theorise the ways in which social workers talked about working with other disciplines in self-neglect casework. The article presents a qualitative study, which was undertaken through semi-structured interviews with eleven social workers in an urban, adult social care team in an English local authority. Thematic analysis was not only used to draw out four key logics used by the social workers—leadership, joint-working, conflict and proxy—but also highlighted the ways in which social workers moved between different logics when talking about inter-disciplinary cooperation and working with adults who self-neglect. The results highlight the complex dynamics of cooperation and suggest that these dynamics need to be understood in assessing the implementation of integrated policies for social care in this area.
Directed random geometric graphs
Authors: Michel Jesse , Reddy Sushruth , Shah Rikhav , Silwal Sandeep , Movassagh Ramis
Published: February 2019

Many real-world networks are intrinsically directed. Such networks include activation of genes, hyperlinks on the internet and the network of followers on Twitter among many others. The challenge, however, is to create a network model that has many of the properties of real-world networks such as power-law degree distributions and the small-world property. To meet these challenges, we introduce the Directed Random Geometric Graph (DRGG) model, which is an extension of the random geometric graph model. We prove that it is scale-free with respect to the indegree distribution, has binomial outdegree distribution, has a high clustering coefficient, has few edges and is likely small-world. These are some of the main features of aforementioned real-world networks. We also empirically observed that word association networks have many of the theoretical properties of the DRGG model.
Evidence for a large strike-slip component during the 1960 Chilean earthquake
Authors: Kanamori Hiroo , Rivera Luis , Lambotte Sophie
Published: February 2019

The strainmeter record observed at Isabella (ISA), California, for the 1960 Chilean earthquake (Mw = 9.5) is one of the most important historical records in seismology because it was one of the three records that provided the opportunity for the first definitive observations of free oscillations of the Earth. Because of the orientation of the strainmeter rod with respect to the back azimuth to Chile, the ISA strainmeter is relatively insensitive to G (Love) waves and higher order (order ≥ 6) toroidal modes, yet long-period G waves and toroidal modes were recorded with large amplitude on this record. This observation cannot be explained with the conventional low-angle thrust mechanism typical of great subduction-zone earthquakes and requires an oblique mechanism with half strike-slip and half thrust. The strain record at Ogdenburg, New Jersey, the Press–Ewing seismograms at Berkeley, California, and the ultra-long period displacement record at Pasadena, California, also support the oblique mechanism. We tested the performance of the ISA strainmeter using other events including the 1964 Alaskan earthquake and found no instrumental problems. Thus, the ISA observation of large G/R and toroidal/spheroidal ratios most likely reflects the real characteristics of the 1960 Chilean earthquake, rather than an observational artefact. The interpretation of the large strike-slip component is not unique, but it may represent release of the strike-slip strain that has accumulated along the plate boundary as a result of oblique convergence at the Nazca–South American plate boundary. The slip direction of the 2010 Chilean (Maule) earthquake ( Mw = 8.8) is rotated by about 10° clockwise from the plate convergence direction suggesting that right-lateral strain comparable to that of an Mw = 8.3 earthquake remained unreleased and accumulates near the plate boundary. One possible scenario is that the strike-slip strain accumulated over several great earthquakes like the 2010 Maule earthquake was released during the 1960 Chilean earthquake. If this is the case, we cannot always expect a similar behaviour for all the great earthquakes occurring in the same subduction zone and such variability needs to be considered in long-term hazard assessment of subduction-zone earthquakes.
Structure of the zebrafish galectin-1-L2 and model of its interaction with the infectious hematopoietic necrosis virus (IHNV) envelope glycoprotein
Authors: Ghosh Anita , Banerjee Aditi , Amzel L Mario , Vasta Gerardo R , Bianchet Mario A
Published: February 2019

Galectins, highly conserved β-galactoside-binding lectins, have diverse regulatory roles in development and immune homeostasis and can mediate protective functions during microbial infection. In recent years, the role of galectins in viral infection has generated considerable interest. Studies on highly pathogenic viruses have provided invaluable insight into the participation of galectins in various stages of viral infection, including attachment and entry. Detailed mechanistic and structural aspects of these processes remain undetermined. To address some of these gaps in knowledge, we used Zebrafish as a model system to examine the role of galectins in infection by infectious hematopoietic necrosis virus (IHNV), a rhabdovirus that is responsible for significant losses in both farmed and wild salmonid fish. Like other rhabdoviruses, IHNV is characterized by an envelope consisting of trimers of a glycoprotein that display multiple N-linked oligosaccharides and play an integral role in viral infection by mediating the virus attachment and fusion. Zebrafish’s proto-typical galectin Drgal1-L2 and the chimeric-type galectin Drgal3-L1 interact directly with the glycosylated envelope of IHNV, and significantly reduce viral attachment. In this study, we report the structure of the complex of Drgal1-L2 with N-acetyl-d-lactosamine at 2.0 Å resolution. To gain structural insight into the inhibitory effect of these galectins on IHNV attachment to the zebrafish epithelial cells, we modeled Drgal3-L1 based on human galectin-3, as well as, the ectodomain of the IHNV glycoprotein. These models suggest mechanisms for which the binding of these galectins to the IHNV glycoprotein hinders with different potencies the viral attachment required for infection.
Is vacuum bell therapy effective in the correction of pectus excavatum?
Authors: Patel Akshay J , Hunt Ian
Published: February 2019

A best evidence topic in thoracic surgery was written in accordance to a structured protocol. The question addressed was: ‘In patients with a pectus excavatum deformity, is vacuum bell therapy (VBT) an effective treatment?’ Altogether, 19 papers were found using the reported search of which 7 represented the best evidence to answer the clinical questions. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Numerous groups have demonstrated the utility of VBT in pectus excavatum; the largest series has followed up patients over 13 years with sternal elevation of >1 cm being demonstrated in 105 patients. Initial age <11, initial chest wall depth <1.5 cm and chest wall flexibility have all been associated with better outcomes. The effects of VBT have been confirmed on computed tomography scanning and intraoperatively to lift the sternum to facilitate retrosternal soft tissue dissection during the Nuss procedure. There was significant heterogeneity in the studies reviewed, in terms of patient age, selection criteria, the VBT protocol, length of follow-up time following completion of VBT and the metrics used to assess success of therapy. VBT is a safe therapy for treating pectus excavatum in a non-surgical conservative manner with few complications reported. However, the success of VBT is largely dependent on patient compliance and motivation. Permanence of correction after completion of VBT needs to be properly assessed through rigorous follow-up, and currently the success of correction, i.e. permanence, remains in the hands of the patient.
Integrated approach for triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis is highly effective and cost-effective: an economic evaluation
Authors: Zhang Lei , Tao Yusha , Woodring Joseph , Rattana Kim , Sovannarith Samreth , Rathavy Tung , Cheang Kannitha , Hossain Shafiqul , Ferradini Laurent , Deng Serongkea , Sokun Chay , Samnang Chham , Nagai Mari , Lo Ying-Ru , Ishikawa Naoko
Published: February 2019

Background

The Regional Framework for Triple Elimination of Mother-to-Child Transmission (EMTCT) of HIV, Hepatitis B (HBV) and Syphilis in Asia and the Pacific 2018-30 was endorsed by the Regional Committee of WHO Western Pacific in October 2017, proposing an integrated and coordinated approach to achieve elimination in an efficient, coordinated and sustainable manner. This study aims to assess the population impacts and cost-effectiveness of this integrated approach in the Cambodian context.

Methods

Based on existing frameworks for the EMTCT for each individual infection, an integrated framework that combines infection prevention procedures with routine antenatal care was constructed. Using decision tree analyses, population impacts, cost-effectiveness and the potential reduction in required resources of the integrated approach as a result of resource pooling and improvements in service coverage and coordination, were evaluated. The tool was assessed using simulated epidemiological data from Cambodia.

Results

The current prevention programme for 370,000 Cambodian pregnant women was estimated at USD$2.3 ($2.0–$2.5) million per year, including the duration of pregnancy and up to 18 months after delivery. A model estimate of current MTCT rates in Cambodia was 6.6% (6.2–7.1%) for HIV, 14.1% (13.1–15.2%) for HBV and 9.4% (9.0–9.8%) for syphilis. Integrating HIV and syphilis prevention into the existing antenatal care framework will reduce the total time required to provide this integrated care by 19% for health care workers and by 32% for pregnant women, resulting in a net saving of $380,000 per year for the EMTCT programme. This integrated approach reduces HIV and HBV MTCT to 6.1% (5.7–6.5%) and 13.0% (12.1–14.0%), respectively, and substantially reduces syphilis MCTC to 4.6% (4.3–5.0%). Further introduction of either antiviral treatment for pregnant women with high viral load of HBV, or hepatitis B immunoglobulin (HBIG) to exposed newborns, will increase the total cost of EMTCT to $4.4 ($3.6–$5.2) million and $3.3 ($2.7–$4.0) million per year, respectively, but substantially reduce HBV MTCT to 3.5% (3.2–3.8%) and 5.0% (4.6–5.5%), respectively. Combining both antiviral and HBIG treatments will further reduce HBV MTCT to 3.4% (3.1–3.7%) at an increased total cost of EMTCT of $4.5 ($3.7–$5.4) million per year. All these HBV intervention scenarios are highly cost–effective ($64–$114 per disability-adjusted life years averted) when the life benefits of these prevention measures are considered.

Conclusions

The integrated approach, using antenatal, perinatal and postnatal care as a platform in Cambodia for triple EMTCT of HIV, HBV and syphilis, is highly cost-effective and efficient.
A systematic review of validated suicide outcome classification in observational studies
Authors: Swain Richard S , Taylor Lockwood G , Braver Elisa R , Liu Wei , Pinheiro Simone P , Mosholder Andrew D
Published: February 2019

Background

Suicidal outcomes, including ideation, attempt, and completed suicide, are an important drug safety issue, though few epidemiological studies address the accuracy of suicidal outcome ascertainment. Our primary objective was to evaluate validated methods for suicidal outcome classification in electronic health care database studies.

Methods

We performed a systematic review of PubMed and EMBASE to identify studies that validated methods for suicidal outcome classification published 1 January 1990 to 15 March 2016. Abstracts and full texts were screened by two reviewers using prespecified criteria. Sensitivity, specificity, and predictive value for suicidal outcomes were extracted by two reviewers. Methods followed PRISMA-P guidelines, PROSPERO Protocol: 2016: CRD42016042794.

Results

We identified 2202 citations, of which 34 validated the accuracy of measuring suicidal outcomes using International Classification of Diseases (ICD) codes or algorithms, chart review or vital records. ICD E-codes (E950-9) for suicide attempt had 2–19% sensitivity, and 83–100% positive predictive value (PPV). ICD algorithms that included events with ‘uncertain’ intent had 4–70% PPV. The three best-performing algorithms had 74–92% PPV, with improved sensitivity compared with E-codes. Read code algorithms had 14–68% sensitivity and 0–56% PPV. Studies estimated 19–80% sensitivity for chart review, and 41–97% sensitivity and 100% PPV for vital records.

Conclusions

Pharmacoepidemiological studies measuring suicidal outcomes often use methodologies with poor sensitivity or predictive value or both, which may result in underestimation of associations between drugs and suicidal behaviour. Studies should validate outcomes or use a previously validated algorithm with high PPV and acceptable sensitivity in an appropriate population and data source.
Connected through the force: mechanical signals in plant development
Authors: Landrein Benoit , Ingram Gwyneth
Published: February 2019

As multicellular organisms, plants acquire characteristic shapes through a complex set of biological processes known as morphogenesis. Biochemical signalling underlies much of development, as it allows cells to acquire specific identities based on their position within tissues and organs. However, as growing physical structures, plants, and their constituent cells, also experience internal and external physical forces that can be perceived and can influence key processes such as growth, polarity, and gene expression. This process, which adds another layer of control to growth and development, has important implications for plant morphogenesis. This review provides an overview of recent research into the role of mechanical signals in plant development and aims to show how mechanical signalling can be used, in concert with biochemical signals, as a cue allowing cells and tissues to coordinate their behaviour and to add robustness to developmental processes.
Good Reading for the Million: The ‘Paperback Revolution’ And the Co-Production of Academic Knowledge in Mid Twentieth-Century Britain and America*
Authors: Mandler Peter
Published: February 2019

The serious non-fiction paperback was one of the principal vehicles for the distribution of expert knowledge in the mid 20th century. This paper examines the market for serious non-fiction in both the US and the UK between the 1930s and the 1960s, by looking at the market leaders in the two countries, Pelican and Mentor Books, published by Penguin and New American Library respectively. It argues that novel modes of distribution and acts of selection by authors, publishers and readers constituted a process of the co-production of knowledge that problematizes views of mid-century expertise as expressions of governmentality. Different patterns of distribution and market demand in the two countries shed further light on who read, what they read and for what purpose.
Global analysis of protein expression in muscle tissues of dermatomyositis/polymyosisits patients demonstrated an association between dysferlin and human leucocyte antigen A
Authors: Xiao Yizhi , Zhu Honglin , Li Liya , Gao Siming , Liu Di , Dai Bingying , Li Qiuxiang , Duan Huiqian , Yang Huan , Li Quanzhen , Zhang Huali , Luo Hui , Zuo Xiaoxia
Published: February 2019

Objectives

DM and PM are characterized by myofibre damage with inflammatory cell infiltration due to the strong expressions of MHC class I HLA-A and monocyte chemoattractant protein-1 (MCP-1). Dysferlin (DYSF) is a transmembrane glycoprotein that anchors in the sarcolemma of myofibres. DYSF mutation is closely associated with inherited myopathies. This study aimed to determine the role of DYSF in the development of DM/PM.

Methods

Mass spectrometry was performed in muscle tissues from DM/PM patients and controls. The DYSF levels in muscle tissue, peripheral blood cells and serum were detected by Western blotting, IF, flow cytometry or ELISA. Double IF and co-immunoprecipitation were used to investigate the relationship between DYSF and HLA-A.

Results

Mass spectrometry and bioinformatics analysis findings suggested the dysregulated proteins in DM/PM patients participated in common biological processes and pathways, such as the generation of precursor metabolites and energy. DYSF was upregulated in the muscle tissue and serum of DM/PM patients. DYSF was mainly expressed in myofibres and co-localized with HLA-A and MCP-1. DYSF and HLA-A expressions were elevated in myocytes and endothelial cells after being stimulated by patient serum and IFN-β. However, no direct interactions were found between DYSF and HLA-A by co-immunoprecipitation.

Conclusion

Our study revealed the dysregulated proteins involved in common and specific biological processes in DM/PM patient samples. DYSF is upregulated and exhibits a potential role along with that of HLA-A and MCP-1 in inflammatory cell infiltration and muscle damage during the development of DM/PM.
Survey Results from the Gulf Region: NPUAP Changes in Pressure Injury Terminology and Definitions
Authors: Delmore Barbara , Ayello Elizabeth A. , Smart Hiske , Tariq Gulnaz , Sibbald R. Gary
Published: February 2019

Pressure injuries/ulcers are a global health issue, and there is a need for clinicians from many countries and continents to express their opinions on the terminology change (pressure ulcer to injury) and revised staging definitions. A convenience, opinion survey sample of clinicians from the Western Asia Gulf Region enrolled in a yearlong wound care course participated by expressing their opinion about these changes. Results reveal support for the pressure injury terminology and the revised staging definitions.
An uncommon cause of lower leg pain
Authors: Rohena Carla D. , Brown Trelena C.
Published: February 2019

This article describes a patient with intense pain originating from a benign tumor on her leg. After 7 years of enduring this painful condition with no correct diagnosis, the patient finally underwent a biopsy and excision, which revealed the growth was an angioleiomyoma.
High-Dose Antipsychotics and Unexpected Death in Children
Authors: Nelson Roxanne
Published: February 2019

Nurses and patients need better information about side effects and risks.
Clarifying the Confusion of Arterial Blood Gas Analysis: Is it Compensation or Combination?
Authors: Pompey Joyce , Abraham-Settles Betty
Published: February 2019

Arterial blood gas (ABG) analysis assesses the adequacy of ventilation, oxygenation, and the acid–base status of the body by measuring the levels of pH, oxygen, carbon dioxide, and bicarbonate in arterial blood. Interpretation of ABG results, which can play a major role in diagnosis and treatment of patients with pulmonary and other critical conditions, can sometimes be difficult. This article focuses on basic ABG analysis and interpretation, discusses the combinations of imbalances that may occur, and reviews the compensatory mechanisms that arise as a result.
RN Shortages Negatively Impact Patient Safety
Authors: Rosenberg Karen
Published: February 2019

According to this study:

Lower levels of RN staffing increase the risk of death during a hospital stay.

Increasing the number of nursing assistants cannot compensate for RN shortages.
Communication Intervention Improves Patient Safety
Authors: Rosenberg Karen
Published: February 2019

According to this study:

An intervention designed to improve communication between health care providers and family members may also decrease harmful medical errors and improve the family's experience.
What Are We Really Talking About? An Organizing Framework for Types of Consultation and Their Implications for Physician Communication
Authors: Hale Andrew J. , Freed Jason A. , Alston W. Kemper , Ricotta Daniel N.
Published: February 2019

Consultation amongst providers is a foundation of modern health care and one of the most frequent means of interdisciplinary communication. Accordingly, clear and efficient communication between providers and across medical specialties during consultation is essential to patient care and a collegial work environment. Traditionally, consultation requests are felt to require a clear question that falls within the purview of the consultant’s expertise. However, this narrow constraint is often lacking in the real-world clinical environment and may in fact be detrimental to physician communication and patient care. In this Perspective, the authors propose an organizing framework of seven specific consultation types, which apply broadly across disciplines: ideal, obligatory, procedural, S.O.S., confirmatory, inappropriate, and curbside. The authors describe what factors define each type and the benefits and pitfalls of each. The proposed framework may help providers have more productive, efficient, and collegial conversations about patient care, which may facilitate improved work satisfaction and an enhanced learning environment.
A Multi-Institution Collaboration to Define Core Content and Design Flexible Curricular Components for a Foundational Medical School Course: Implications for National Curriculum Reform
Authors: Chen Sharon F. , Deitz Jennifer , Batten Jason N. , DeCoste-Lopez Jennifer , Adam Maya , Alspaugh J. Andrew , Amieva Manuel R. , Becker Pauline , Boslett Bryn , Carline Jan , Chin-Hong Peter , Engle Deborah L. , Hayward Kristen N. , Nevins Andrew , Porwal Aarti , Pottinger Paul S. , Schwartz Brian S. , Smith Sherilyn , Sow Mohamed , Teherani Arianne , Prober Charles G.
Published: February 2019

Medical educators have not reached widespread agreement on core content for a U.S. medical school curriculum. As a first step toward addressing this, five U.S. medical schools formed the Robert Wood Johnson Foundation Reimagining Medical Education collaborative to define, create, implement, and freely share core content for a foundational medical school course on microbiology and immunology. This proof-of-concept project involved delivery of core content to preclinical medical students through online videos and class-time interactions between students and facilitators. A flexible, modular design allowed four of the medical schools to successfully implement the content modules in diverse curricular settings. Compared with the prior year, student satisfaction ratings after implementation were comparable or showed a statistically significant improvement. Students who took this course at a time point in their training similar to when the USMLE Step 1 reference group took Step 1 earned equivalent scores on National Board of Medical Examiners–Customized Assessment Services microbiology exam items. Exam scores for three schools ranged from 0.82 to 0.84, compared with 0.81 for the national reference group; exam scores were 0.70 at the fourth school, where students took the exam in their first quarter, two years earlier than the reference group. This project demonstrates that core content for a foundational medical school course can be defined, created, and used by multiple medical schools without compromising student satisfaction or knowledge. This project offers one approach to collaboratively defining core content and designing curricular resources for preclinical medical school education that can be shared.
Loss of Independence After Operative Management of Femoral Neck Fractures
Authors: Schemitsch Emil H. , Sprague Sheila , Heetveld Martin J. , Bzovsky Sofia , Heels-Ansdell Diane , Zhou Qi , Swiontkowski Marc , Bhandari Mohit ,   on behalf of the FAITH Investigators
Published: February 2019

Objectives:

The FAITH trial evaluated effects of sliding hip screws versus cancellous screws in femoral neck fracture patients. Using FAITH trial data, we quantified changes in living status, use of aids, and investigated factors associated with living and walking independently 12 months after fracture.

Methods:

We conducted a descriptive analysis to quantify patients' changes in living status, use of aids, and used multivariable Cox regression analyses to determine factors associated with living and walking independently after fracture.

Results:

Of patients who lived independently before hip fracture, 3.07% (50–80 years old) and 19.81% (>80 years old) were institutionalized 12 months after injury. Of patients who were walking independently before injury, 33.62% (50–80 years old) and 69.34% (>80 years old) required a walking aid 12 months after injury. Factors associated with higher chances of living independently included the following: being between 50 and 80 years, having a class I American Society of Anesthesiologists classification, not using a walking aid before fracture, being a nonsmoker or former smoker, and having an acceptable quality of implant placement. Factors associated with higher chances of walking without an aid included the following: being between 50 and 80 years, having a class I American Society of Anesthesiologists classification, living independently before fracture, being a nonsmoker or former smoker, having an undisplaced fracture, and not requiring revision surgery.

Conclusions:

Femoral neck fracture patients suffer great losses of independence. Identifying factors associated with living and walking independently after hip fracture may help surgeons better identify which patients are at risk and optimize care of patients with this injury.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Confirming the Clinical Safety and Feasibility of a Bundled Methodology to Improve Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest Compression Technique
Authors: Pepe Paul E. , Scheppke Kenneth A. , Antevy Peter M. , Crowe Remle P. , Millstone Daniel , Coyle Charles , Prusansky Craig , Garay Sebastian , Ellis Richard , Fowler Raymond L. , Moore Johanna C.
Published: February 2019

Objectives:

Combined with devices that enhance venous return out of the brain and into the thorax, preclinical outcomes are improved significantly using a synergistic bundled approach involving mild elevation of the head and chest during cardiopulmonary resuscitation. The objective here was to confirm clinical safety/feasibility of this bundled approach including use of mechanical cardiopulmonary resuscitation provided at a head-up angle.

Design:

Quarterly tracking of the frequency of successful resuscitation before, during, and after the clinical introduction of a bundled head-up/torso-up cardiopulmonary resuscitation strategy.

Setting:

9-1-1 response system for a culturally diverse, geographically expansive, populous jurisdiction.

Patients:

All 2,322 consecutive out-of-hospital cardiac arrest cases (all presenting cardiac rhythms) were followed over 3.5 years (January 1, 2014, to June 30, 2017).

Interventions:

In 2014, 9-1-1 crews used LUCAS (Physio-Control Corporation, Redmond, WA) mechanical cardiopulmonary resuscitation and impedance threshold devices for out-of-hospital cardiac arrest. After April 2015, they also 1) applied oxygen but deferred positive pressure ventilation several minutes, 2) solidified a pit-crew approach for rapid LUCAS placement, and 3) subsequently placed the patient in a reverse Trendelenburg position (~20°).

Measurements and Main Results:

No problems were observed with head-up/torso-up positioning (n = 1,489), but resuscitation rates rose significantly during the transition period (April to June 2015) with an ensuing sustained doubling of those rates over the next 2 years (mean, 34.22%; range, 29.76–39.42%; n = 1,356 vs 17.87%; range, 14.81–20.13%, for 806 patients treated prior to the transition; p < 0.0001). Outcomes improved across all subgroups. Response intervals, clinical presentations and indications for attempting resuscitation remained unchanged. Resuscitation rates in 2015–2017 remained proportional to neurologically intact survival (~35–40%) wherever tracked.

Conclusions:

The head-up/torso-up cardiopulmonary resuscitation bundle was feasible and associated with an immediate, steady rise in resuscitation rates during implementation followed by a sustained doubling of the number of out-of-hospital cardiac arrest patients being resuscitated. These findings make a compelling case that this bundled technique will improve out-of-hospital cardiac arrest outcomes significantly in other clinical evaluations.
Applying Clinical Decision Rules in a Patient With Venous Thromboembolism After an Elective Total Knee Arthroplasty: A Case Report
Authors: Heick John D.
Published: February 2019

Introduction:

Venous thromboembolism (VTE) includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease behind myocardial infarction and stroke, and is responsible for 10% of hospital deaths as a result of PE. The purposes of this case report are to (1) describe such an incident in a 63-year-old man status-post right total knee arthroplasty who is referred to physical therapy and (2) highlight the role of using clinical decision rules (CDRs) and the recently published VTE clinical practice guidelines.

Case presentation:

A 63-year-old man presented to an orthopedic surgeon for elective total knee arthroplasty of the right knee. The patient reported for his initial physical therapy session 3 weeks after surgery, and while warming up on a recumbent bicycle, he started having difficulty catching his breath. The patient was ultimately diagnosed with bilateral PE and a right lower extremity proximal DVT.

Conclusion:

This case illustrates the importance of using an evidence-based approach for determining the clinical probability of VTE by following clinical guidelines. This case also highlights the importance of using CDRs and communicating in a timely manner to ensure patient safety.
Anxiety and Fear of Exercise in Cardiopulmonary Rehabilitation
Authors: Farris Samantha G. , Abrantes Ana M. , Bond Dale S. , Stabile Loren M. , Wu Wen-Chih
Published: February 2019

Purpose:

One unexplored mechanism for poor outcomes in cardiovascular and pulmonary rehabilitation (CVPR) is fear about aerobic exercise. Patients in CVPR may tend to avoid aerobic exercise because of the fear of physical sensations associated with exertion. This study examined fear about exercise in patients enrolled in outpatient CVPR and practitioner beliefs and behaviors related to fear associated with exercise.

Methods:

Survey data were collected from patients (n = 117) enrolled in cardiac rehabilitation (n = 69) and pulmonary rehabilitation (n = 48) and practitioners (n = 16) who were exercise physiologists and nurses working in CVPR.

Results:

Fears about exercise and avoidance behaviors were common among patients. In pulmonary rehabilitation, fears and avoidance of exercise were correlated with higher levels of anxiety and depression (r values = 0.27-0.54), lower forced expiratory volume in the first second of expiration/forced vital capacity (r values = −0.13 to −0.39), lower health-related quality of life (r values = −0.13 to −0.62), and stronger beliefs about utility of anxiety treatment (r values = 0.21-0.36). In cardiac rehabilitation, fears about exercise were correlated with higher levels of anxiety (r values = 0.19-0.38), lower mental health quality of life (r values = −0.25 to −0.27), and stronger beliefs about utility of anxiety treatment (r values = 0.30-0.40), and avoidance of exercise was correlated with lower exercise tolerance and poorer physical health quality of life (r values = −0.22 to −0.24). Practitioners estimated that an average of 47 ± 20% of patients experience fear associated with exercise and reported low feelings of preparedness to address patient anxiety and fear.

Conclusions:

It may be beneficial to provide practitioners with skills to recognize and address anxiety and fear in their patients as it relates to exercise.
Recent Surgical Trends in Pediatric Corneal Transplantation: A 13-Year Review
Authors: Zhu Angela Y. , Prescott Christina R.
Published: February 2019

Purpose:

Corneal transplantation is the standard of care for pediatric corneal opacities, but little consensus exists on optimal surgical management. Our goal was to evaluate cross-sectional data of donor and recipient characteristics collected from eye banks providing tissue for pediatric corneal transplant cases to assess surgical trends in pediatric keratoplasty over the past 13 years.

Methods:

We performed a retrospective review of recipient data, collected from 4 major eye banks, for pediatric patients (<18 years) who underwent corneal transplantation between January 2005 and December 2017. We analyzed trends in surgical indications, types of keratoplasty, and donor/recipient characteristics.

Results:

Our database included 2620 total pediatric cases. Penetrating keratoplasty (PKP) remains the most common surgery performed (79.8%), but more partial-thickness transplant cases [eg, endothelial keratoplasty (EK)] have been performed since 2008. The most commonly reported transplant indication was ectasias/thinnings (34.1%) overall and congenital opacities (17.0%) in children less than 5 years. Average donor age was significantly lower for the youngest recipient age group of less than 5 years (P < 0.001); endothelial cell count was also higher, and death-to-surgery time was lower for PKP and EK cases versus other keratoplasties.

Conclusions:

Indications for transplant vary across age groups but are consistent with previous reports. Popularity of partial-thickness transplants has increased since 2008. Surgeons prefer younger donor tissue for younger patients and have higher thresholds for endothelial cell count for PKP and EK cases. Centralized tracking of pediatric keratoplasty cases is necessary for further investigation of long-term outcomes.
Evaluation of Dry Eye Disease in Children With Systemic Lupus Erythematosus and Healthy Controls
Authors: Ong Tone Stephan , Elbaz Uri , Silverman Earl , Levy Deborah , Williams Sara , Mireskandari Kamiar , Ali Asim
Published: February 2019

Purpose:

To compare the symptoms and signs of dry eye disease (DED) in children with systemic lupus erythematosus (SLE) with those in healthy children using common diagnostic tools.

Methods:

Prospective, observational, single-center cohort study. Thirty-four subjects with SLE and 15 healthy subjects were recruited from the Hospital for Sick Children in Toronto, Canada. Subjects underwent subjective and objective dry eye assessments using the Canadian Dry Eye Assessment (CDEA) questionnaire, tear film osmolarity, slit lamp examination, tear film break-up time, corneal fluorescein staining, Schirmer test 1, and conjunctival lissamine green staining.

Results:

No difference in symptoms was found between children with SLE and healthy children (CDEA score 6.4 ± 5.4 vs. 3.8 ± 3.2; P = 0.09). Corneal staining was more prevalent in children with SLE than in healthy children (58.8% vs. 20.0%; P = 0.01), and children with SLE had higher mean corneal fluorescein staining scores (1.7 ± 1.7 vs. 0.2 ± 0.4; P = 0.002). No statistically significant differences in tear osmolarity, inter-eye differences in tear osmolarity, tear film break-up time, Schirmer test 1, or lissamine green staining scores were observed between the 2 groups. In healthy children, CDEA scores weakly correlated with corneal fluorescein staining score (r = 0.53, P = 0.04). In children with SLE, no correlation between CDEA score and any of the diagnostic test outcomes was found.

Conclusions:

There is discordance between symptoms and signs of DED in children with SLE. Corneal fluorescein staining is essential for the diagnosis of DED in these children.
Using Electronic Clinical Decision Support in Patient-Centered Medical Homes to Improve Management of Diabetes in Primary Care
Authors: Gill James , Kucharski Kathrin , Turk Barbara , Pan Chunshen , Wei Wenhui
Published: February 2019

This prospective, randomized, real-world study aimed to examine the impact of electronic health record–based clinical decision support (CDS) tools on the management of diabetes in small- to medium-sized primary care practices participating in Delaware's patient-centered medical home project. Overall, use of CDS systems was associated with greater reductions from baseline in hemoglobin A1c and low-density lipoprotein cholesterol, and more patients achieving treatment goals. Physicians and staff reported that the CDS toolkit empowered them to be more involved in clinical decision-making, thereby helping to improve diabetes care. However, all cited significant barriers to fully implementing team-based CDS, predominantly involving time and reimbursement.
Planning for Active Learning in the Didactic Classroom
Authors: DeWitt Rachel D.
Published: February 2019

Driven by the convergence of the exponential growth of medical knowledge and the dated medical education delivery system, educators in physician assistant (PA) programs are striving to create teaching practices that actively engage students, improve knowledge retention, and prepare students for a career that requires lifelong learning and reflection. The emphasis on professor-directed teaching and learning activities is shifting toward a more learner-centered approach. To incorporate appropriate active learning exercises into the PA classroom, instructors must plan, design, and execute pedagogically sound practices. In addition, instructors must find a concrete way in which to reflect on and refine their classroom exercises so that they can expand their teaching skills even while educating their students.
Inadvertent epidural anesthesia associated with catheterization following continuous psoas compartment block in a patient with scoliosis
Authors: Kim Byung-Gun , Yang Chunwoo , Soh Sunghyun , Lee Kyungjoo
Published: February 2019

Rationale:

Psoas compartment block (PCB) is typically performed using surface anatomical landmarks and neurostimulation for guidance. However, anatomical anomalies, such as scoliosis, make this technique unreliable, posing a challenge for the anesthesiologist when inducing regional anesthesia.

Patient concerns:

A 69-year-old woman with lumbar scoliosis scheduled for total hip arthroplasty underwent PCB with catheterization.

Diagnoses:

Inadvertent epidural anesthesia with catheterization following PCB was diagnosed using a lumbar radiograph.

Interventions:

Due to hypotension induced by local anesthetic (LA) epidural diffusion, the patient received intravenous hydration and vasopressor. Since bilateral sensory block was noted at the T3 level, with an incomplete motor blockade in both legs, the surgery was performed under epidural anesthesia.

Outcomes:

The patient remained hemodynamically stable throughout the duration of the surgical procedure. The surgery was uneventful and without further complications.

Lessons:

Patients with lumbar scoliosis are highly at risk of LA epidural diffusion, following PCB using traditional landmark-based approach. Other nerve-localizing technique can minimize the risk of this complication.
A comparative analysis of clinicopathological factors between esophageal small cell and basaloid squamous cell carcinoma
Authors: Ishida Hirotaka , Kasajima Atsuko , Onodera Yu , Konno Takuro , Maruyama Shota , Okamoto Hiroshi , Sato Chiaki , Heishi Takahiro , Sakurai Tadashi , Taniyama Yusuke , Takahashi Masanobu , Fujishima Fumiyoshi , Jingu Keiichi , Ishioka Chikashi , Sasano Hironobu , Kamei Takashi
Published: February 2019

Esophageal small cell carcinoma (E-SmCC) and basaloid squamous cell carcinomas (BSCCs) are both highly aggressive malignancies, but their detailed differences in clinical behaviors have remained virtually unknown. In addition, treatment strategies of the patients with E-SmCC have not been established. 29 cases of E-SmCC and 39 with BSCC were examined in this study to clarify the clinical features and outcome of the patients with E-SmCC and to compare the findings with those of BSCC. E-SmCCs presented a more advanced status than BSCC (TNM Stage: P = .002). Esophagectomy was performed in 15 small cell carcinoma patients and 14 were treated with non-surgical/systemic therapy. The clinical outcome of the small cell carcinoma cases was significantly worse than those with BSCC (P = .001), but results of a stage-stratified analysis revealed that the Stage I small cell carcinoma patients presented favorable prognosis (3-year survival rate 100%, n = 4). In contrast, among those with Stage II–IV, clinical outcome tended to be better in the systemic therapy group (3-year survival rate 49%, n = 13) than the surgically treated group (3-year survival rate 0%, n = 12). E-SmCC was a more aggressive neoplasm than BSCC. However, early detection could possibly improve the clinical outcome of patients with E-SmCC. Systemic therapy could also benefit the patients with advanced disease (Stage II–IV).
Uterine size and volume are associated with a higher clinical pregnancy rate in patients undergoing assisted reproduction technology
Authors: Gao Hong , Liu Dong-e , Li Yumei , Tang Jing , Hu Shimin , Wu Xinrui , Tian Zhengwen , Tan Hongzhuan
Published: February 2019

The aim of this study was to investigate the relationships between uterine size and volume and clinical pregnancy rate.

This longitudinal study was conducted among patients undergoing assisted reproduction technology (ART) treatment at the Reproductive Medicine Center from January 2010 to May 2017, all of whom provided informed consent to participate in the study. The uterine size, for all patients, was measured by transvaginal ultrasonography before ovarian stimulation. Clinical pregnancy was diagnosed by ultrasound confirmation of at least an intrauterine gestational sac and fetal cardiac activity 4 weeks after embryo transfer.

A total of 11,924 patients were enrolled in this study. Compared to patients with uterine lengths of 50 to 59 mm (referent), patients with uterine lengths ≥60 mm had a lower clinical pregnancy rate. Compared to patients with uterine widths of 30 to 39 mm (referent), patients with uterine widths of 40 to 49 mm and those with uterine widths of ≥50 mm had a lower clinical pregnancy rate. Compared with those with a uterine anteroposterior diameter of <30 mm (referent), patients with uterine anteroposterior diameters of ≥50 mm had a lower clinical pregnancy rate. Compared with those with a uterine volume of 30 to 49 mL (referent), patients with a uterine volume ≥70 mL had a lower clinical pregnancy rate.

The patients with an optimal uterine length, width, anteroposterior diameter, and volume had a higher clinical pregnancy rate than those with suboptimal uterine measurements. Uterine sizes and volumes that were too large reduced the clinical pregnancy rate.