bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evidence of Vowel Discrimination Provided by the Acoustic Change Complex
Authors: Cheek Diane , Cone Barbara 
Published: November 2019

Objectives:
The objectives of this study were to measure the effects of level and vowel contrast on the latencies and amplitudes of acoustic change complex (ACC) in the mature auditory system. This was done to establish how the ACC in healthy young adults is affected by these stimulus parameters that could then be used to inform translation of the ACC into a clinical measure for the pediatric population. Another aim was to demonstrate that a normalized amplitude metric, calculated by dividing the ACC amplitude in the vowel contrast condition by the ACC amplitude obtained in a control condition (no vowel change) would demonstrate good sensitivity with respect to perceptual measures of vowel-contrast detection. The premises underlying this research were that: (1) ACC latencies and amplitudes would vary with level, in keeping with principles of an increase in neural synchrony and activity that takes place as a function of increasing stimulus level; (2) ACC latencies and amplitudes would vary with vowel contrast, because cortical auditory evoked potentials are known to be sensitive to the spectro-temporal characteristics of speech.

Design:
Nineteen adults, 14 of them female, with a mean age of 24.2 years (range 20 to 38 years) participated in this study. All had normal-hearing thresholds. Cortical auditory evoked potentials were obtained from all participants in response to synthesized vowel tokens (/a/, /i/, /o/, /u/), presented in a quasi-steady state fashion at a rate of 2/sec in an oddball stimulus paradigm, with a 25% probability of the deviant stimulus. The ACC was obtained in response to the deviant stimulus. All combinations of vowel tokens were tested at 2 stimulus levels: 40 and 70 dBA. In addition, listeners were tested for their ability to detect the vowel contrasts using behavioral methods.

Results:
ACC amplitude varied systematically with level, and test condition (control versus contrast) and vowel token, but ACC latency did not. ACC amplitudes were significantly larger when tested at 70 dBA compared with 40 dBA and for contrast trials compared with control trials at both levels. Amplitude ratios (normalized amplitudes) were largest for contrast pairs in which /a/ was the standard token. The amplitude ratio metric at the individual level demonstrated up to 97% sensitivity with respect to perceptual measures of discrimination.

Conclusions:
The present study establishes the effects of stimulus level and vowel type on the latency and amplitude of the ACC in the young adult auditory system and supports the amplitude ratio as a sensitive metric for cortical acoustic salience of vowel spectral features. Next steps are to evaluate these methods in infants and children with hearing loss with the long-term goal of its translation into a clinical method for estimating speech feature discrimination.
Family Environment in Children With Hearing Aids and Cochlear Implants: Associations With Spoken Language, Psychosocial Functioning, and Cognitive Development
Authors: Holt Rachael Frush , Beer Jessica , Kronenberger William G. , Pisoni David B. , Lalonde Kaylah , Mulinaro Lindsay 
Published: November 2019

Objectives:
To examine differences in family environment and associations between family environment and key speech, language, and cognitive outcomes in samples of children with normal hearing and deaf and hard-of-hearing (DHH) children who use hearing aids and cochlear implants.

Design:
Thirty families of children with normal hearing (n = 10), hearing aids (n = 10), or cochlear implants (n = 10) completed questionnaires evaluating executive function, social skills, and problem behaviors. Children’s language and receptive vocabulary were evaluated using standardized measures in the children’s homes. In addition, families were administered a standardized in-home questionnaire and observational assessment regarding the home environment.

Results:
Family environment overall was similar across hearing level and sensory aid, although some differences were found on parental responsivity and physical environment. The level of supportiveness and enrichment within family relationships accounted for much of the relations between family environment and the psychosocial and neurocognitive development of DHH children. In contrast, the availability of objects and experiences to stimulate learning in the home was related to the development of spoken language.

Conclusions:
Whereas broad characteristics of the family environments of DHH children may not differ from those of hearing children, variability in family functioning is related to DHH children’s at-risk speech, language, and cognitive outcomes. Results support the importance of further research to clarify and explain these relations, which might suggest novel methods and targets of family-based interventions to improve developmental outcomes.
Comparison of Locked Plating of Varus Displaced Proximal Humeral Fractures With and Without Fibula Allograft Augmentation
Authors: Davids Stephen , Allen Dexter , Desarno Michael , Endres Nathan K. , Bartlett Craig , Shafritz Adam 
Published: November 2019

Objective:
To compare the clinical and radiographic outcomes between patients treated with fibula allograft-augmented locking compression fixation and patients treated with locking compression fixation alone for 2- and 3-part proximal humeral fractures with varus displacement.

Design:
Retrospective review.

Setting:
Level 1 trauma center.

Patients/Participants:
One hundred two patients treated with locking plate fixation ± fibular allograft augmentation confirmed intraoperatively by visual inspection to have varus-angulated, 2- and 3-part proximal humerus fractures with at least 45 degrees of varus angulation at the neck/shaft and at least 1 cm of displacement.

Intervention:
Proximal humerus locking plate (PHILOS; Synthes, Paoli, PA) with or without fibula allograft augmentation.

Main Outcome Measurements:
Statistical analysis to determine the differences between fractures treated with locking compression fixation ± fibula allograft augmentation regarding complications, shoulder reported outcome measures, and patient ROMs (Visual Analog Score (VAS), Disabilities of the Arm, Shoulder and Hand, and Simple Shoulder Test scores). Medical comorbidities as potential risk factors for complication from surgery were also evaluated.

Results:
Of 102 surgical cases, 27 were augmented with fibula allograft and 75 were not. Postoperatively, there were 16 noncatastrophic varus collapses of the fracture, 6 catastrophic varus collapses, and 5 deaths. Addition of fibula allograft did not significantly affect postoperative varus collapse, shoulder ROM, pain, or PROMs.

Conclusion:
Addition of fibula allograft to patients sustaining varus-angulated, 2- and 3-part proximal humeral fractures conferred no benefit to patient outcomes at our institution.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Early Operative Treatment of Acetabular Fractures Does Not Increase Blood Loss: A Retrospective Review
Authors: Parry Joshua A. , Nino Samanatha , Khosravani Nima , Weber Lee , Haidukewych George J. , Koval Kenneth J. , Langford Joshua R. 
Published: November 2019

Objectives:
To compare cell salvage (CS) volume, intraoperative blood loss, intraoperative blood transfusions, and operative time for acetabular fractures undergoing early (≤48 hours from admission) versus delayed fixation (>48 hours from admission).

Design:
Retrospective.

Setting:
Level one trauma center.

Patients:
One hundred thirty-one patients with unilateral acetabular fractures involving at least one column.

Intervention:
Open reduction and internal fixation performed through the anterior intrapelvic approach or posterior approach.

Main Outcome Measurements:
CS volume, estimated blood loss (EBL), intravenous fluids (IVFs), intraoperative packed red blood cells (PRBCs), and operative time.

Results:
Early versus delayed fixation through the posterior approach was associated with shorter operative times and less intraoperative PRBCs (140 vs. 301 mL, MD −161 mL, 95% confidence interval −25 to −296 mL) with no differences in CS, EBL, or IVF. Early versus delayed fixation through an anterior intrapelvic approach was more common in less severe fracture patterns with no differences in PRBCs, CS, EBL, or IVF. CS, through either approach, was successful in returning blood to 77% of patients for an average of 267 ± 168 mL (range, 105–900 mL).

Conclusions:
Fixation of acetabular fractures within 48 hours of admission did not increase blood loss or intraoperative transfusions. CS was successful in returning an average of one unit of blood to a majority of patients.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Reamed Versus Unreamed Intertrochanteric Femur Fractures, Is It Time?
Authors: Pitts Charles C. , Montgomery Tyler P. , Hess Matthew C. , Smith Walter R. , Quade Jonathan H. 
Published: November 2019

Objectives:
This study compares the intraoperative and postoperative outcomes of the traditional technique of femoral canal reaming to placement of an unreamed 10-mm nail.

Design:
Retrospective cohort study.

Setting:
Academic Level I Trauma Center, Southeastern US.

Patients/Participants:
Intertrochanteric femur fractures treated with a CMN (January 2016–December 2018) were retrospectively identified. Inclusion criteria were as follows: low-energy mechanism, at least 60 years of age, and long CMN. Exclusion criteria were as follows: short CMN, polytrauma, and subtrochanteric fractures.

Outcome Measurements:
Records were reviewed for demographics, hematologic markers, transfusion rates, operative times, and postoperative complications. Variables were assessed with a χ2 or Student T-test. Significance was set at 0.05.

Results:
Sixty-five patients were included (37 reamed and 28 unreamed), with a mean age of 76.2 years and mean body mass index of 25.1. Between the reamed and unreamed groups, respectively, mean nail size was 11.0 (SD 1.1) and 10.0 (SD 0.0), P < 0.001; mean blood loss was 209.1 mL (SD 177.5) and 195.7 mL (SD 151.5), P = 0.220; 55% (21/38), and 43% (12/28) were transfused, P = 0.319; operative time was 98.2 (SD 47.3) and 81.5 minutes (SD 40.7); P = 0.035. Changes in hemoglobin/hematocrit were not significant between the study groups. Two patients from the reamed group experienced implant failure due to femoral head screw cut out and returned to the operating room. Two patients from the unreamed group returned to operating room for proximal incision infection, without implant removal. One reamed patient and 2 unreamed patients died before 6-month follow-up.

Conclusions:
Unreamed CMNs for geriatric intertrochanteric femur fractures provide shorter operative times with no difference in perioperative complications. Both reamed and unreamed techniques are safe and effective measures for fixation of these fractures.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
True Cost of Operating Room Time: Implications for an Orthopaedic Trauma Service
Authors: Moody Alastair E. , Gurnea Taylor P. , Shul Craig P. , Althausen Peter L. 
Published: November 2019

Objective:
To derive an accurate estimate of the operating cost per minute for an orthopaedic trauma room.

Study Design:
Retrospective economic analysis.

Setting:
Level II Trauma Center.

Intervention:
Hospital cost-accounting system query.

Main Outcome Measurements:
Direct fixed costs, direct variable costs, and hospital overhead.

Results:
Operating room per minute costs include direct variable costs of $2.77, direct fixed costs of $2.47, and hospital overhead costs of $10.97. Total per minute costs amounted to $16.21. This does not include professional fees of anesthesiology or surgeons or the costs of soft goods or implants.

Conclusions:
This is the first published study to document the true per minute cost of an orthopaedic trauma operating room. Such information is valuable when defining the value of a dedicated operating room, negotiating employment contracts, defining call stipends, and brokering capital purchases for the orthopaedic trauma service.

Level of Evidence:
Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Along the Axes of Difference: Setting Scholarship and Practice Agendas for Faculty Development
Authors: Reedy Gabriel , Bearman Margaret 
Published: November 2019

Abstract:
The rise of academic clinical education programs underlines the growing influence of faculty development on how health care is taught and therefore practiced. Research to date has outlined the rapid rise of these postgraduate qualifications and their impact on their graduates' professional identities. Given the scale and nature of the change, it is worth considering these programs from a broader perspective. “Axes of difference” are invoked to chart the tensions and intersections between various social identities that form distinctive features of clinical education. Six axes are described: patients–clinicians, trainees–trainers, classrooms–clinics, uniprofessional–interprofessional, local–global, and teachers–clinicians. These reveal a range of complexities about faculty development, which can inform both practice and scholarship agendas.
What Is the Normal Ulnar Bow in Adult Patients?
Authors: Hreha Jeremy , Congiusta Dominick V. , Ahmed Irfan H. , Vosbikian Michael M. 
Published: November 2019

Abstract

Background
Rotation of the forearm is a result of the complex interaction among the radius, ulna, and interosseous membrane. Although the radius is recognized as curved, the ulna is generally thought of as a “straight bone.” To better describe normal anatomy, which may lead to more successful anatomic fixation of forearm fractures, we aimed to apply a method of measuring the normal ulnar bow and determine the mean ulnar bow in adults.

Questions/purposes
(1) To what degree is the ulna bowed in the coronal and sagittal planes in normal adult forearms? (2) To what degree is the radius bowed in the coronal plane in normal adult forearms?

Methods
Radiographs of the forearms of adults taken during a 1-year period were initially obtained retrospectively. These radiographs were performed for various reasons, including forearm pain and routine radiographic follow-up. Radiographs were excluded if evidence of a fracture or post-fracture fixation was found, if a patient had missing AP or lateral images, or if a suboptimal technique was used. The coronal and sagittal bow of the ulna was measured with a method adapted from previous studies that assessed radial bow using AP and lateral radiographs, respectively. Similar measurements were made in the coronal plane for the radius. All measurements were performed independently by the four authors. There was excellent interobserver reliability for ulnar bow in the coronal and sagittal planes (interclass correlation coefficient = 0.96 and 0.97, respectively) and for radial bow in the coronal plane (interclass correlation coefficient = 0.90).

Results
The mean maximal coronal ulnar bow was 7 ± 2 mm and was located at 75% of the ulnar length, measured proximally to distally. The location of coronal bow was consistently distal to the radial bow location. The mean maximal sagittal ulnar bow was 6 ± 3 mm and was located at 39% of the ulnar length. The mean maximal coronal bow of the radius was 14 ± 2.0 mm and was 59% of the total length of the radius from proximal to distal.

Conclusions
The ulna is not a “straight bone,” as is commonly thought, but rather has a bow in both the coronal and sagittal planes.

Clinical Relevance
Knowledge of the standard ulnar bow may be pivotal to prevent malunion of the ulna during surgery. Future research using these data in preoperative planning may lead to changes in plate contouring and clinical outcomes in forearm fracture management.
The Prognostic Value of Podoplanin Expression in Nonmelanoma Skin Cancers: Correlation With Lymphatic Vessel Density
Authors: Neinaa Yomna Mazid El-Hamd , El-Ashmawy Amal Ahmad , Alshenawy Hanan Al-Saeid , Dorgham Wesam Lotfy 
Published: November 2019

Background:
Podoplanin is one of the integral molecules controlling cellular motility and migration that is considered crucial in initiating tumor invasiveness and metastasis.

Objective:
This work aimed at studying the immunohistochemical expression of podoplanin in nonmelanoma skin cancers (NMSCs) and seborrheic keratosis (SK) in comparison to normal control skin and to evaluate its possible role in their pathogenesis.

Patients and Methods:
This study included 120 patients and paraffin blocks of epidermal tumors [30 SK, 30 basal cell carcinoma (BCC), 30 basosquamous carcinoma (BSC) and 30 squamous cell carcinoma (SCC)], in addition to 30 normal control skin specimens from age- and sex-matched healthy volunteers. All were examined for intratumoral and peritumoral immunohistochemical expression of podoplanin antibody (D2-40). In addition, morphometric measurement of lymphatic vessel density was evaluated in all studied specimens.

Results:
Podoplanin expression was significantly upregulated in all the studied epidermal tumor specimens in comparison to normal control skin specimens. The highest mean value of podoplanin expression (both intratumoral and peritumoral cells) was observed in SCC followed by BSC, then BCC, SK, and control skin in the same sequence. Positive correlations were detected between its expression in both BSC and SCC with the mean of lymphatic vessel density in the studied specimens and the presence of lymph node metastasis.

Conclusions:
Podoplanin plays an evident role in the development and progression of both benign and malignant skin neoplasms and may serve as a potential predictor of their clinical course and prognosis.
Caring for a Child with Phenylketonuria: Parental Experiences from a Eurasian Country
Authors: Zengin Akkus Pinar , Bilginer Gurbuz Berrak , Ciki Kismet , Ilter Bahadur Evin , Karahan Sevilay , Ozmert Elif Nursel , Coskun Turgay , Sivri Serap 
Published: November 2019

ABSTRACT

Objectives:
Phenylketonuria (PKU) and mild hyperphenylalaninemia (HPA) are characterized by increased blood phenylalanine concentrations varying from mild to severe. Management of PKU was reported to be time consuming and burdensome for caregivers. This study intended to explore the experiences of families caring for a child with PKU/HPA in a country with a high PKU rate. The aim of this study was to compare parental well-being between parents of children with and without dietary restrictions and to explore the factors associated with parental psychological well-being.

Methods:
Participants were interviewed about their experiences, concerns, and challenges related to the disease by using a semistructured questionnaire. After the interview, parents filled out the Beck Depression Inventory and State-Trait Anxiety Inventory-Trait.

Results:
This study highlighted the adverse psychological, financial, and social effects of the diagnosis and management of the disease regarding the lives of the families of children with PKU/HPA. Although parental anxiety scores of children with and without dietary restrictions were similar, depressive symptom scores were higher in parents of children with dietary restrictions. However, in multiple regression analysis, lower household income and absence of perceived social support were found to be independent factors associated with higher depressive symptom scores. Having a daughter diagnosed with PKU/HPA and lower household income were found to be factors associated with higher anxiety scores.

Conclusion:
This study revealed that income level, perceived social support, and gender of the child were factors associated with psychological well-being of parents caring for children with PKU/HPA. Health care professionals should identify the challenges faced by families and should be aware of risk factors associated with lower parental well-being to achieve better family adjustment and better health outcomes.
Extramammary Paget's Disease: A Review of the Literature Part II: Treatment and Prognosis
Authors: Morris Caroline R. , Hurst Eva A. 
Published: November 2019

BACKGROUND
Extramammary Paget's disease (EMPD) is a rare malignancy with unclear pathophysiology that occurs predominantly on apocrine-rich skin. Surgery is the treatment of choice; however, procedures tend to be extensive and associated with a high rate of recurrence.

OBJECTIVE
To review the current literature on EMPD regarding treatment and prognosis.

MATERIALS AND METHODS
Literature review using PubMed search for articles related to EMPD.

RESULTS
Extramammary Paget's disease classically presents as a slowly growing red plaque, which often mimics an inflammatory condition leading to significant delay in diagnosis. Diagnosis requires histopathologic examination and is often supported by immunohistochemical analysis. Once a diagnosis of EMPD is made, the patient must be risk-stratified and evaluated for an underlying malignancy.

CONCLUSION
Standard of treatment is surgery, with data suggesting that Mohs micrographic surgery may have superior clinical outcomes and lower recurrence rates. Alternatives such as photodynamic therapy and topicals have been explored and may be appropriate in certain situations. Patients with EMPD generally have a good prognosis with a 5-year overall survival rate of 75% to 95%.
The Force Required to Inject a Column of Filler Through Facial Arteries
Authors: Ramesh Sathyadeepak , Le Alan , Katsev Blake , Ugradar Shoaib 
Published: November 2019

BACKGROUND
Injectable fillers have become an integral part of facial rejuvenation, but vascular occlusion is a dreaded complication of such injections.

OBJECTIVE
To determine the force required by the fingertip onto the plunger of the syringe to cause retrograde migration.

METHODS
In this cadaver study, twelve 2-cm arterial segments and 4 fillers were tested. Injection pressure required to force a column of filler for 1 cm was measured. Five oculoplastics specialists were subsequently recruited and asked to inject the filler at a typical injection pressure.

RESULTS
The nonhyaluronic acid filler required significantly more pressure to cause propagation of the material compared with all other fillers (p < .01). None of the other fillers differed significantly from each other. Typical injection pressures generated by experienced injectors were significantly lower than that required to cause propagation of filler at the desired velocity and significantly lower than mean arterial pressure. Measured pressure required to cause filler propagation was well within the normal range of the finger strength that can be generated by humans.

CONCLUSION
Typical injection pressures from fingertip to plunger are lower than required to cause propagation of filler intravascularly.