bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative Assessment of Surgical Ergonomics in Otolaryngology
Authors: Rodman Cole , Kelly Natalie , Niermeyer Weston , Banks Laura , Onwuka Amanda , Mason Eric , Chiang Tendy 
Published: June 2020

ObjectivesObjective evaluation of the ergonomic risk of common otolaryngology procedures and assessment of work‐related musculoskeletal pain and injury.Study DesignCross‐sectional intraoperative assessment and survey.SettingDepartment of Otolaryngology at a tertiary children’s hospital.Subjects and MethodsSixteen otolaryngology attendings, fellows, and residents participated in a blinded study. Intraoperative ergonomics was assessed for tonsillectomies, adenoidectomies, and tympanostomy tube insertions using the Rapid Upper Limb Assessment (RULA). Follow‐up surveys were sent to all participating surgeons to determine the prevalence of musculoskeletal pain and formal ergonomic training.ResultsZero percent (N = 0/275) of intraoperative observations were found to have a negligible level of ergonomic risk, with 47% low risk, 37% high risk, and 16% very high risk. Tympanostomy tube insertions conferred less risk than tonsillectomy and adenoidectomy, while the use of headlamp or loupes conferred increased risk. Eighty percent of respondents reported having musculoskeletal pain and 40% reported experiencing pain while operating within the past year. The most common area of pain was the cervical spine. No surgeons reported formal ergonomic training.ConclusionsOur study demonstrates an unacceptable level of ergonomic risk for common procedures in otolaryngology. Furthermore, most participants reported experiencing musculoskeletal pain despite the duration of examined procedures being relatively short. The high prevalence of work‐related musculoskeletal pain and the lack of ergonomic training in our cohort highlight the need for increased awareness of ergonomics as well as the development of formal ergonomic curricula.
Familial Aggregation in Idiopathic Subglottic Stenosis
Authors: Drake Virginia E. , Gelbard Alexander , Sobriera Nara , Wohler Elizabeth , Berry Lynne L. , Hussain Lena L. , Hillel Alexander 
Published: June 2020

ObjectiveTo evaluate inheritance patterns and define the familial clustering rate of idiopathic subglottic stenosis (iSGS).Study DesignRetrospective observational study.SettingInternational multicenter collaborative of >30 tertiary care centers.MethodsPatients with a clinically confirmed iSGS diagnosis within the North American Airway Collaborative’s iSGS1000 cohort consented between 2014 and 2018 were eligible for enrollment. Patient demographics and disease severity were abstracted from the collaborative’s iSGS longitudinal registry. Pedigrees of affected families were created.ResultsA total of 810 patients with iSGS were identified. Positive family history for iSGS was reported in 44 patients in 20 families. The rate of familial clustering in iSGS is 2.5%. Mean age of disease onset is 42.6 years. Of the 44 patients with familial aggregation of iSGS, 42 were female and 2 were male; 13 were mother‐daughter pairs and 2 were father‐daughter pairs. There were 3 sister‐sister pairs. There was 1 niece‐aunt pair and 2 groups of 3 family members. One pedigree demonstrated 2 affected mother‐daughter pairs, with the mothers being first‐degree paternal cousins. Inheritance is non‐Mendelian, and anticipation is present in 11 of 13 (84%) parent‐offspring pairs. The mean age of onset between parents (48.4 years) and offspring (36.1 years) was significantly different (P =. 016).ConclusionThis study quantifies the rate of familial clustering of iSGS at 2.5%. Inheritance is non‐Mendelian, and disease demonstrates anticipation. These data suggest that there may be a genetic contribution in iSGS.
Machine Learning Prediction of Extracapsular Extension in Human Papillomavirus–Associated Oropharyngeal Squamous Cell Carcinoma
Authors: Hatten Kyle M. , Amin Julian , Isaiah Amal 
Published: June 2020

ObjectiveTo determine whether machine learning (ML) can predict the presence of extracapsular extension (ECE) prior to treatment, using common oncologic variables, in patients with human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC).Study DesignRetrospective database review.SettingNational Cancer Database study.MethodsAll patients with HPV‐associated OPSCC treated surgically between January 1, 2010, and December 31, 2015, were selected from the National Cancer Database. Patients were excluded if surgical pathology reports did not include information regarding primary tumor stage, number of metastatic regional lymph nodes, size of largest metastatic regional lymph node, and tumor grade. The data were split into a random distribution of 80% for training and 20% for testing with ML methods.ResultsA total of 3753 adults with surgically treated HPV‐associated OPSCC met criteria for inclusion in the study. Approximately 38% of these patients treated with surgical management demonstrated ECE. ML models demonstrated modest accuracy in predicting ECE, with the areas under the receiver operating characteristic curves ranging from 0.58 to 0.68. The conditional inference tree model (0.66) predicted the metastatic lymph node number to be the most important predictor of ECE.ConclusionDespite a large cohort and the use of ML algorithms, the power of clinical and oncologic variables to predict ECE in HPV‐associated OPSCC remains limited.
Sleep problems worsen health-related quality of life and participation during the first 12 months of stroke rehabilitation
Authors: Fulk George , Duncan Pamela , Klingman Karen J 
Published: June 2020

Objective: Evaluate the impact of self-reported sleep problems on post-stroke recovery. Design: Cross-sectional secondary analysis of longitudinal data from the Locomotor Experience Applied Post-Stroke (LEAPS) rehabilitation and recovery study (phase-III single-blind randomized controlled clinical trial). Group medians were compared for three sleep problem groups across three time points. Setting: Outpatient and in-home physical therapy. Subjects: Adults during the first year following stroke ( n = 408, 380, 360 at 2, 6, 12 months, respectively). Interventions: The original study compared effects of locomotor training with body weight support in the year post-stroke. This analysis evaluated function in three sleep/functional-impact groups: no sleep problems, sleep problems with no-to-minimal-impact and sleep problems with moderate-to-quite-a-bit of impact. Main measures: Participants’ responses regarding if they had “a sleep problem, such as insomnia” and, if so, what the impact was on their function. Stroke Impact Scale subscales for strength, hand function, mobility, ADLs, memory, communication, emotion, participation, and percent recovery. Results: About 25% of people with stroke reported sleep difficulty, 10% perceived sleep problems negatively impact function. Groups self-reporting worse sleep performed worse in all functional subscales (except self-perceived percent recovery) during the first year post-stroke. Conclusion: Self-reported poor sleep adversely effects post-stroke functional recovery.
Morphological and functional assessment of the uterus: “one-stop shop imaging” using a compressed-sensing accelerated, free-breathing T1-VIBE sequence
Authors: Hausmann Daniel , Kreul Diana , Klarhöfer Markus , Nickel Dominik , Grimm Robert , Kiefer Berthold , Riffel Philipp , Attenberger Ulrike I , Zöllner Frank G , Kubik-Huch Rahel A 
Published: June 2020

Background The combination of motion-insensitive, high-temporal, and spatial resolution imaging with evaluation of quantitative perfusion has the potential to increase the diagnostic capabilities of magnetic resonance imaging (MRI) in the female pelvis. Purpose To compare a free-breathing compressed-sensing VIBE (fbVIBE) with flexible temporal resolution (range = 4.6–13.8 s) with breath-hold VIBE (bhVIBE) and to evaluate the potential value of quantifying uterine perfusion. Material and Methods A total of 70 datasets from 60 patients (bhVIBE: n = 30; fbVIBE: n = 40) were evaluated by two radiologists. Only temporally resolved reconstruction (fbVIBE) was performed on 30 of the fbVIBE datasets. For a subset (n = 10) of the fbVIBE acquisitions, a time- and motion-resolved reconstruction (mrVIBE) was evaluated. Image quality (IQ), artifacts, diagnostic confidence (DC), and delineation of uterine structures (DoS) were graded on Likert scales (IQ/DC/DoS: 1 (non-diagnostic) to 5 (perfect); artifacts: 1 (no artifacts) to 5 (severe artifacts)). A Tofts model was applied for perfusion analysis. Ktrans was obtained in the myometrium (Mm), junctional zone (Jz), and cervix (Cx). Results The median IQ/DoS/DC scores of fbVIBE (4/5/5 κ >0.7–0.9) and bhVIBE (4/4/4; κ = 0.5–0.7; P > 0.05) were high, but Artifacts were graded low (fbVIBE/bhVIBE: 2/2; κ = 0.6/0.5; P > 0.05). Artifacts were only slightly improved by the additional motion-resolved reconstruction (fbVIBE/mrVIBE: 2/1.5; P = 0.08); fbVIBE was preferred in most cases (7/10). Significant differences of Ktrans values were found between Cx, Jz, and Mm (0.12/0.21/0.19; P < 0.05). Conclusion The fbVIBE sequence allows functional and morphological assessment of the uterus at comparable IQ to bhVIBE.
Mid-term outcomes of uncemented or cemented arthroplasty revision following metal-on-metal total hip arthroplasty failure: a retrospective observational study
Authors: Chen Zhao , Chen Wenli , Yu Weiguang , Zhao Mingdong , lin Jinluan , Zhou Chaoming , Chen Hui , Ye Junxing , Zeng Xianshang , Zhuang Jintao 
Published: June 2020

Objective To retrospectively compare the mid-term outcomes of uncemented or cemented total hip arthroplasty (THA) revision for prior primary metal-on-metal (MoM) THA failure. Methods Data from 278 patients (278 hips) who underwent uncemented THA (UTHA) or cemented THA (CTHA) for prior primary MoM-THA failure from 2006 to 2016 were retrospectively analysed. Follow-up was performed 6 months, 1 year, 2 years, and then every 2 years after conversion. The mean follow-up time was 96 months (range, 64–128 months). The primary endpoint was the modified Harris hip score (HHS). The secondary endpoint was the major orthopaedic complication rate. Results The HHS showed significantly greater differences in the CTHA than UTHA group 12 months after conversion. From the 12th month after conversion to the final follow-up, CTHA yielded better functional outcomes than UTHA. There were significant differences between the UTHA and CTHA groups in the rates of re-revision (14.4% vs. 4.9%, respectively), aseptic loosening (17.3% vs. 6.8%, respectively), and periprosthetic fracture (11.5% vs. 3.9%, respectively). Conclusion CTHA has more advantages than UTHA in terms of improving functional outcomes and decreasing the major orthopaedic complication rate.
Therapeutic frames – exploring the relationship between psychiatry and visual art
Authors: Selikowitz Anne 
Published: June 2020

Objectives: While mental illness has long been associated with states of heightened creativity, the intersection between psychiatry and art warrants further exploration. This paper seeks to examine some fundamental concerns common to both disciplines, highlighting the therapeutic potential of visual art within psychiatric practice. Conclusions: Psychiatry and art are both concerned with the visual embodiment of abstract internal states, compelling us to deconstruct surface appearances in the pursuit of deeper meaning. Both also offer a window into the manifold ways in which others perceive the world. In a practical sense, art has significant therapeutic value, providing patients and clinicians with novel ways of processing emotions and fostering self-expression and agency.
Patient Risk Factor Profiles Associated With the Timing of Goals-of-Care Consultation Before Death: A Classification and Regression Tree Analysis
Authors: Starr Lauren T. , Ulrich Connie M. , Junker Paul , Huang Liming , O’Connor Nina R. , Meghani Salimah H. 
Published: June 2020

Background: Early palliative care consultation (“PCC”) to discuss goals-of-care benefits seriously ill patients. Risk factor profiles associated with the timing of conversations in hospitals, where late conversations most likely occur, are needed. Objective: To identify risk factor patient profiles associated with PCC timing before death. Methods: Secondary analysis of an observational study was conducted at an urban, academic medical center. Patients aged 18 years and older admitted to the medical center, who had PCC, and died July 1, 2014 to October 31, 2016, were included. Patients admitted for childbirth or rehabilitationand patients whose date of death was unknown were excluded. Classification and Regression Tree modeling was employed using demographic and clinical variables. Results: Of 1141 patients, 54% had PCC “close to death” (0-14 days before death); 26% had PCC 15 to 60 days before death; 21% had PCC >60 days before death (median 13 days before death). Variables associated with receiving PCC close to death included being Hispanic or “Other” race/ethnicity intensive care patients with extreme illness severity (85%), with age <46 or >75 increasing this probability (98%). Intensive care patients with extreme illness severity were also likely to receive PCC close to death (64%) as were 50% of intensive care patients with less than extreme illness severity. Conclusions: A majority of patients received PCC close to death. A complex set of variable interactions were associated with PCC timing. A systematic process for engaging patients with PCC earlier in the care continuum, and in intensive care regardless of illness severity, is needed.
Embryologically Based Classification Specifies Gender Differences in the Prevalence of Orofacial Cleft Subphenotypes
Authors: Pool Shariselle M. W. , der Lek Lisanne M. van , de Jong Kim , Vermeij-Keers Christl , Mouës-Vink Chantal M. 
Published: June 2020

Background: A recently published validated classification system divides all orofacial cleft (OFC) subphenotypes into groups based on underlying developmental mechanisms, that is, fusion and differentiation, and their timing, that is, early and late periods, in embryogenesis of the primary and secondary palates. Aims: The aim of our study was to define gender differences in prevalence for all subphenotypes in newborns with OFC in the Netherlands. Methods: This was a retrospective cross-sectional study on children with OFC born from 2006 to 2016. Clefts were classified in early (E-), late (L-), and early/late (EL-) embryonic periods, in primary (P-), secondary (S-), and primary/secondary (PS-) palates, and further divided into fusion (F-), differentiation (D-), and fusion/differentiation (FD-) defects, respectively. Results: A total of 2089 OFC children were analyzed (1311 males and 778 females). Orofacial cleft subphenotypes in females occurred significantly more frequent in the L-period compared to males (66% vs 55%, P = .000), whereas clefts in males occurred significantly more in the EL-periods (40% vs 27%, P = .000). Females had significantly more S-palatal clefts (42% vs 23%, P = .000), while males had significantly more PS-palatal clefts (44% vs 30%, P = .000). Furthermore, the clefts in females were significantly more frequent the result of an F-defect (60% vs 52%, P = .000). Conclusions: Orofacial cleft in females mainly occur in the L-period are mostly S-palatal clefts, and are usually the result of an F-defect. Orofacial cleft in males more commonly occur in the EL-periods, are therefore more often combined PS-palatal clefts, and are more frequent D- and FD-defects.
Progressive fatigue behavior of single-lap bolted laminates under different tightening torque magnitudes
Authors: Feyzi M , Hassanifard S , Varvani-Farahani A 
Published: June 2020

The present paper studies fatigue damage and life of single-lap bolted joints tightened with different torque magnitudes subjected to uniaxial load cycles. The adherends were constructed from E-glass/epoxy layers using a hand layup technique and assembled by 1.5, 3, and 8 N m of applied torques. Increasing the torque magnitude benefitted the final fatigue life of the joints so that the high-cycle fatigue life of the joint sample tightened with 8 N m was as high as 10 times that of the joint tightened with 1.5 N m. In the numerical section of this study, a three-dimensional finite element analysis was employed, and the impacts of applied torques were included in the progressive damage model to assess damage and failure in the bolted joints. For the joints tightened with higher torque levels, numerical results revealed higher fatigue lives but at the cost of more delamination at the vicinity of the hole. Laminate fracture surface was investigated through scanning electron microscopy and more cracking/damage progress was evidenced in matrix, fiber, and matrix–fiber interface as composite joints experienced fatigue cycles. Experimental life data of tested joints agreed with those anticipated through the use of finite element analyses indicating the developed model as an appropriate tool in evaluating the effects of applied torques on the fatigue fracture behavior of bolted laminates.
Workplace Reflection in the Age of AI: Materiality, Technology, and Machines
Authors: Yorks Lyle , Rotatori Denise , Sung SeoYoon , Justice Sean 
Published: June 2020

The Problem This article explores the nature of reflection within the workplace during the fourth industrial revolution (4IR), a period characterized by the proliferation of cognitive technologies—like artificial intelligence (AI)—which are changing the nature of work. This piece explores the manner in which individuals and teams learn through reflective practice as a result of increased human–machine collaboration in the 4IR since it has not been extensively researched. The Solution Through an analysis of Anand Rao’s three-tiered model of AI— assisted intelligence, augmented intelligence, and autonomous intelligence—and by using data collected through a semi-structured interview process that situated the article within a particular sector of the economy—the health care industry—this article provides a framework for understanding the workplace, and human-machine collaboration, during the 4IR. The Stakeholders Human resource development practitioners and researchers interested in the role of cognitive technologies within the workplace and their impact on human reflection.
The iArmS Robotic Armrest Prolongs Endoscope Lens–Wiping Intervals in Endoscopic Sinus Surgery
Authors: Okuda Hideki , Okamoto Jun , Takumi Yutaka , Kakehata Seiji , Muragaki Yoshihiro 
Published: June 2020

Objective. Fouling of the endoscope lens is a major problem in endoscopic sinus surgery (ESS). We examined whether the use of the intelligent arm support system (iArmS), a robotic armrest, could prolong endoscope lens–wiping intervals in ESS and thus allow for continuously clear endoscopic images. Study Design. This study is a prospective, nonrandomized crossover study. Methods. Three surgeons who performed ESS at 2 centers each conducted 3 operations with the iArmS and 3 operations without the iArmS; thus, 18 operations were assessed. To blind the assessments, we performed them prospectively without informing subjects of the endpoints. We recorded the operations and observed the recordings at a later date; endoscope lens–wiping times were noted in seconds to determine the endoscope lens–wiping intervals. Our examination was based on the null hypothesis that endoscope lens–wiping intervals would not differ according to the use or nonuse of the iArmS. Results. The median endoscope lens–wiping intervals with and without using the iArmS were 361 seconds and 135 seconds, respectively. Based on the Wilcoxon rank-sum test, this difference was significant ( P = 0.001); thus, the null hypothesis was rejected. This result indicated that endoscope lens–wiping intervals are greatly prolonged by the use of the iArmS. Conclusion. The iArmS robotic armrest is suitable for ESS, prolongs endoscope lens–wiping intervals, and facilitates obtaining continuous clear endoscopic images.
Acquired multiple mutations ALK I1171N, L1196M and G1202R mediate lorlatinib resistance in EML4-ALK-rearranged malignant pleural mesothelioma: a case report
Authors: Hu Jia , Zhang Baoshi , Yao Fangfang , Fu Yan , Chen Dianjun , Li Donghui , Du Nan , Lizaso Analyn , Song Jinlei , Zhang Lu , Li Xiaosong 
Published: June 2020

EML4-ALK rearranged malignant pleural mesothelioma (MPM) is rare and its responses to anaplastic lymphoma kinase (ALK) inhibitors, including alectinib and lorlatinib, remain unexplored. In this case report, we describe a patient with EML4-ALK-rearranged stage IIIB MPM who was administered with alectinib and lorlatinib as first-line and fourth-line therapy, respectively. He had remarkable response evaluated as partial response on both regimens lasting approximately 3.5 months on each regimen. His plasma samples were collected during the treatment course and submitted for targeted sequencing to understand the molecular mechanisms of his therapeutic resistance. Sequencing analysis revealed the emergence of ALK I1171N and L1196M at alectinib progression. Meanwhile, ALK I1171N, L1196M, and G1202R mutations were identified at lorlatinib progression, wherein L1196M is confirmed to be in cis to G1202R. We speculate that these multiple mutations synergistically mediated his resistance to both alectinib and lorlatinib. Our report describes the detection of EML4-ALK rearrangement in a patient with MPM who had remarkable therapeutic response with ALK inhibitors. Moreover, our case also revealed acquired mechanisms of lorlatinib resistance mediated by multiple mutations ALK I1171N, L1196M, and G1202R, contributing an incremental step to our understanding of the complexity of acquired resistance mechanisms in sequential ALK inhibitor therapy. The reviews of this paper are available via the supplemental material section.
Cytological-energy analysis of pleural effusions with predominance of neutrophils
Authors: Matuchova Inka , Kelbich Petr , Kubalik Jan , Hanuljakova Eva , Stanek Ivan , Maly Vilem , Karpjuk Ondrej , Krejsek Jan 
Published: June 2020

Background: The predominance of neutrophils in pleural effusions of patients with different serious impairments of the pleural cavity organs is often found. The aim of this study was to identify the type of injury using the cytological-energy analysis of pleural effusions. Methods: We analysed 635 samples of pleural effusions with predominance of neutrophils. We compared the values of the coefficient of energy balance (KEB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) catalytic activities in the following subgroups of patients: with transudative effusions, purulent pneumonia, chest empyema and after chest surgery with and without purulent complications. Statistical analysis was performed using the ANOVA Kruskal–Wallis test ( p < 0.05 was considered as significant). Results: We found the lowest KEB values in pleural effusions of patients with chest empyema and their gradual increases in patients with purulent pneumonia and with transudative effusions. We observed the highest LDH and AST enzymes activity in patients with chest empyema and their gradual decrease in patients with purulent pneumonia and with transudative effusions. LDH and AST enzymes activity was significantly higher in pleural effusions of patients after chest surgery with purulent complications compared with non-purulent cases. Conclusion: The most intensive inflammation and the most extensive tissue destruction in the pleural cavity were found in patients with chest empyema. Significantly better parameters were observed in patients with purulent pneumonia. The absence of serious inflammation and the absence of tissue destruction were typical for patients with transudative effusions. Finally, our results confirmed an anticipated higher tissue destruction in patients after chest surgery. Significantly worse injury was found in surgical patients with purulent complications compared with non-purulent ones. The reviews of this paper are available via the supplemental material section.