bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adopting Graduate Competencies in Opioid Prescribing for Massachusetts Physician Assistant Programs: A Statewide Public Health Response
Authors: White Susan E. , Altongy-Magee Kristy , Cooper Christopher , Hixon Jennifer , Honda Trenton , Milch Charles , Murphy Richard , Riethle Theresa , Walker Lisa , Berkowitz Oren 
Published: November 2019

Abstract
Opioid addiction has become a national epidemic. Morbidity and mortality from prescription and synthetic opioid use and abuse have increased at an alarming rate in recent years. Ensuring that physician assistant (PA) graduates have the knowledge to become safe prescribers of medications, including opiates, is a goal of PA training programs. Achieving that goal requires fostering PA student competence regarding current issues in pain control, drug use and misuse, polypharmacy, diversion, self-medication, and substance use disorder. We present a public health approach to addressing that need. Our approach involved developing consensus among the 9 PA programs in Massachusetts concerning the adoption and implementation of statewide, graduate core competencies for the prevention and management of prescription drug misuse. The process implemented in Massachusetts could be used as a model in other states and might be relevant to addressing other public health crises. We present the adopted competencies as well as individual PA programs' curricular approaches.
Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population
Authors: Fan Lei , Ou Dingqiang , Huang Xuna , Pang Mao , Chen Xiu-Xing , Yang Bu , Wang Qi-You 
Published: November 2019

Abstract

Background:
It is unclear whether surgery or conservative treatment is more suitable for elderly patients with type II and type III odontoid fractures. We performed this meta-analysis to compare the efficacy of surgical and conservative treatments for type II and type III odontoid fractures.

Methods:
A literature search was performed in PubMed, Embase, Web of Science, and Cochrane Library in January 2017. Only articles comparing surgery with conservative treatment in elderly patients with type II and type III odontoid fractures were selected. After 2 authors independently assessed the retrieved studies, 18 articles were included in this meta-analysis, and the primary endpoints were the nonunion rate and mortality rate. The secondary outcomes were patient satisfaction, complications, and the length of the hospital stay. The quality of the included studies was evaluated using the modified Newcastle–Ottawa scale. Sensitivity analyses were performed for high-quality studies, and the publication bias was evaluated using a funnel plot.

Results:
Lower nonunion (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.18–0.40, P < .05) and mortality rates (OR: 0.52, 95% CI: 0.34–0.79, P < .05) confirmed the superiority of surgery in treating type II and type III fractures. The secondary outcomes differed. Patients in the surgery group felt more satisfied with the outcome (OR: 3.44, 95% CI: 1.19–9.95, P < .05), and the complications were similar in the 2 groups (OR: 1.14, 95% CI: 0.78–1.68, P = .5), whereas patients in conservative groups spent less time in the hospital (OR: 5.10, 95% CI: 2.73–7.47, P < .05). The results of the subgroup analyses and sensitivity analysis were similar to the original outcomes, and no obvious publication bias was observed in the funnel plot.

Conclusion:
Most elderly (younger than 70 years) patients with type II or type III odontoid fractures should be considered candidates for surgical treatment, due to the higher union rate and lower mortality rate, while statistically significant differences were not observed in the population with an advanced age (older than 70 years). Therefore, the selection of the therapeutic approach for elderly patients with odontoid fractures requires further exploration. Simultaneously, based on our meta-analysis, a posterior arthrodesis treatment was significantly superior to the anterior odontoid screw treatment.
Rare presentation of an isolated bilateral cerebral peduncular infarction
Authors: Fu Xiaoxue , Li Hongyu , Tian Xiaoquan , Wang Wei , Liu Hong 
Published: November 2019

Abstract

Rationale:
Due to the rarity of bilateral cerebral peduncular infarction (BCPI), its symptoms and prognosis are not clear. It is necessary to collect cases of pure cerebral peduncular infarction, explore the etiology and anatomy of midbrain infarction in depth, and develop meaningful tools for explaining clinical symptoms and predicting prognosis of patients.

Patient concerns:
We here provide a case of isolated BCPI with uncommon symptoms of ataxia, dysarthria, sensory disturbance, normal muscular strength, and full eye movements.

Diagnoses:
Diffusion weighted images and apparent diffusion coefficient map of our patient revealed acute and isolated bilateral peduncle cerebrum infarction.

Interventions:
Drugs that could improve circulation and antiplatelet were used in therapy.

Outcomes:
The infarct size was enlarged and new infarction was identified in the splenium of the corpus callosum and pons. The patient developed progressed disorder of consciousness and died at the eleventh day.

Lessons:
We inferred that the symptoms of ataxia, dysarthria, sensory disturbance, and mild paresis of the extremities could be prominent features of patients with pure cerebral peduncular infarction. We hypothesize that pure BCPI is also related to severe basilar artery stenosis or occlusion and there is no collateral circulation from PCA. This may explain the corresponding distribution of cerebral peduncular infarction and its poor prognosis. For these reasons, exploring etiology and anatomy of midbrain infarction in depth would have clinical value for predicting symptoms and prognosis.
Association between prenatal exposure to bisphenol a and birth outcomes
Authors: Zhou Zhitong , Lei Yuyang , Wei Wei , Zhao Yuxin , Jiang Yizhou , Wang Ningning , Li Xiaofeng , Chen Xin 
Published: November 2019

Abstract

Background:
Previous studies investigated the relation of prenatal exposure to bisphenol A (BPA) and birth outcomes, but these results were inconsistent. The aim of this study was to investigate the relation of prenatal exposure to BPA and birth outcomes, provide comprehensive results based on current studies.

Methods:
The PubMed, Cochrane databases, and Web of Science databases were searched systematically by two researchers respectively from their inceptions to Oct. 2018, using the following keywords “bisphenol A, birth weight, birth length, head circumference, gestational age, birth outcomes”. We extracted β coefficient and 95% confidence interval (CI) or β coefficient and standard deviation (SD) from included study. The subgroup analysis was performed to evaluate the potential heterogeneity between studies. We conducted sensitivity analysis by excluding the each individual study to assess the results whether were stable. Finally, the publication bias was performed by accumulative forest plot.

Results:
Seven studies with 3004 participants met the inclusion criteria. BPA had significant positively association with birth weight (β = 21.92, 95%CI: 1.50–42.35, P = .04). No significant associations were found between BPA and birth length, head circumference and gestational age (All of P > .05).

Conclusion:
This meta-analysis demonstrated that the BPA was positively associated with birth weight. Therefore, further studies are needed to investigate the critical sensitive period of influencing fetal development and to investigate the difference on gender.
Psychosocial dimensions of hand transplantation: lessons learned from solid organ transplantation
Authors: Smith Patrick J. , Cendales Linda C. 
Published: November 2019

Purpose of review
The present review examines psychosocial factors emerging as predictive of clinical outcomes among solid organ transplant (SOT) recipients, with possible extensions to vascular composite allograft (VCA) and hand transplantation, in particular. The Chauvet Workgroup report and International Society of Heart and Lung Transplantation consensus guidelines are used to delineate areas of commonality between SOT and VCA, as well as unique features contributing to post-VCA psychosocial risk.

Recent findings
Increasing evidence suggests that depression, cognitive function, and other posttransplant psychosocial factors consistently associate with clinical risk in SOT. However, the mechanisms precipitating these psychosocial risk factors are likely diverse in their cause, with large individual differences across SOT and VCA. Transdiagnostic dimensions may serve as mechanistic factors, increasing the risk of adverse clinical outcomes and suggesting potential treatment strategies for risk mitigation. Psychosocial dimensions including psychological flexibility, self-efficacy, and posttraumatic growth are discussed as potential contributory factors.

Summary
Psychosocial factors hold importance in predicting posttransplant clinical outcomes. Emerging transdiagnostic factors may provide insight into mechanisms and potential treatments.
Racial Differences in the Incidence and Survival of Patients With Neuroendocrine Tumors
Authors: Shen Chan , Gu Dian , Zhou Shouhao , Xu Ying , Sarshekeh Amir Mehrvarz , Halperin Daniel , Shih Ya-Chen T. , Yao James C. , Dasari Arvind 
Published: November 2019

Objectives
The incidence of neuroendocrine tumors (NETs) has been steadily increasing. Racial differences in the incidence and survival are mostly unknown. This study examines the racial differences and the underlying causes.

Methods
We conducted a retrospective, population-based study using datasets from Surveillance, Epidemiology, and End Results (SEER) cancer registry and SEER data linked with Medicare claims (SEER-Medicare). We examined the incidence rates and the effects of patient demographics, clinical characteristics, and socioeconomic factors on survival.

Results
Of the 15,786 and 1731 cases from SEER and SEER-Medicare, 1991 and 163 were blacks, respectively. We found that blacks had higher NET incidence for all stages, with the largest difference noted in the local stage (4.3 vs 2.6 per 100,000 in whites). We found worse survival for distant-stage black patients, although they more often had clinical factors typically associated with better prognosis in NETs. However, they were also found to have significant unfavorable differences in socioeconomic and sociodemographic factors.

Conclusions
Blacks have higher incidence of NETs and worse survival compared with other races, especially whites. The influences of neighborhood socioeconomic, sociodemographic, and marital status suggest that social determinants, support mechanisms, and access to health care may be contributing factors.
A Quality Improvement Intervention to Decrease Postoperative Opioid Prescriptions in Pediatric Oncology Patients
Authors: Mansfield Sara A. , El Gohary Yousef , Kimble Amy , Wynn Lynn , Hall Elizabeth A. , Anghelescu Doralina L. , Davidoff Andrew M. , Murphy Andrew J. 
Published: November 2019

Purpose:
This quality improvement initiative aimed to minimize opioid prescribing after oncologic pediatric surgery.

Methods:
Retrospective surgical data collected at a pediatric cancer hospital from July 2016 to June 2018 included hospitalization details, oral morphine equivalents prescribed, unplanned visits/calls because of pain, and parental/patient satisfaction with pain control. The quality improvement initiative promoted opioid prescription at discharge on the basis of prior inpatient requirements and education regarding nonopioid analgesia. Upon commencing this project in July 2018, we collected data prospectively.

Results:
The retrospective and the prospective cohorts included 271 and 99 patients, respectively. Mean (SD) oral morphine equivalents (mg/kg) prescribed upon discharge was significantly reduced in the prospective (0.75±1.34) versus retrospective cohorts (5.48±6.94, P<0.001). The unplanned visits/calls regarding pain were 23 (retrospective, 8.5%) and 2 (prospective, 2.0%). In total, 44 patients (44.4%) received an opioid prescription at discharge in the prospective cohort, significantly fewer than retrospective cohort (251, 92.6%, P<0.001), and used a mean of 34.3 of 159.8 (21.5%) doses dispensed. Length of stay was comparable (P=0.88) between cohorts. Prospective satisfaction rate was 96.2%, leaving 3 patients (3.8%) not satisfied with their pain control regimen.

Conclusions:
Dramatic reduction of opioid prescriptions after oncologic surgery can be achieved without detriment to patient satisfaction or readmissions.

Level of Evidence:
Level V.
Investigating Multiple-Reported Bacterial Sexually Transmitted Infection Hot Spot Counties in the United States: Ordered Spatial Logistic Regression
Authors: Owusu-Edusei Kwame , Chang Brian A. 
Published: November 2019

PurposeTo identify and examine the correlates of multiple bacterial sexually transmitted infection (STI) hot spot counties in the United States.MethodsWe assembled and analyzed 5 years (2008–2012) of cross-sectional STI morbidity data to identify multiple bacterial STI (chlamydia, gonorrhea, and syphilis) hot spot counties using hot spot analysis. Then, we examined the association between the multi-STI hot spots and select multiyear (2008–2012) sociodemographic factors (data obtained from the American Community Survey) using ordered spatial logistic regression analyses.ResultsOf the 2935 counties, the results indicated that 85 counties were hot spots for all 3 STIs (3-STI hot spot counties), 177 were hot spots for 2 STIs (2-STI hot spot counties), and 145 were hot spots for only 1 STI (1-STI hot spot counties). Approximately 93% (79 of 85) of the counties determined to be 3-STI hot spots were found in 4 southern states––Mississippi (n = 25), Arkansas (n = 22), Louisiana (n = 19), and Alabama (n = 13). Counties determined to be 2 STI hot spots were found in 7 southern states––Arkansas, Louisiana, Mississippi, Alabama, Georgia, and North and South Carolina had at least ten 2-STI hot spot counties each. The multi-STI hot spot classes were significantly (P< 0.05) associated with percent black (non-Hispanic), percent Hispanics, percent American Indians, population density, male-female sex ratio, percent aged 25 to 44 years, and violent crime rate.ConclusionsThis study provides information on multiple STI hot spot counties in the United States and the associated sociodemographic factors. Such information can be used to assist planning, designing, and implementing effective integrated bacterial STI prevention and control programs/interventions.
Prevalence of Risk and Protective Factors for Tick Exposure and Tick-Borne Disease Among Residents of Indiana
Authors: Omodior Oghenekaro , Kianersi Sina , Luetke Maya 
Published: November 2019

Objective:
To determine the prevalence of risk and protective factors for tick exposure and tick-borne disease (TBD) based on gender and living in urban or rural areas (urbanicity) among a cross section of Indiana adults.

Methods:
Data were collected from 3003 adults (81% response rate) spread across all 92 Indiana counties. Study participants were recruited from existing online panels maintained by Qualtrics. We calculated prevalence ratio (PR) and 95% confidence interval (CI) of 8 primary outcomes for 2 different exposures: (1) gender (male/female) and (2) urbanicity.

Results:
Female participants were 10% less likely to find a tick on themselves than male participants (PR = 0.90; 95% CI, 0.74-0.99) and significantly more likely to worry about their health and safety because of ticks, whereas males avoided the outdoors less because of worry about ticks. Female participants were significantly more likely to adopt various personal protective measures, specifically because of concern for ticks. Female participants were also less likely to have been told by a health care provider that they have a TBD (PR = 0.53; 95% CI, 0.38-0.75). Rural participants were significantly more likely to report seeing a tick at their residential property (PR = 2.40; 95% CI, 2.11-2.76), report finding ticks on themselves (PR = 1.90; 95% CI, 1.68-2.23), and report finding a tick on a child at their residential property within the past 6 months than urban dwellers (PR = 1.37; 95% CI, 1.06-1.77). In addition, we found that 62% of participants have very high trust in government sources of information on TBD and tick prevention.

Conclusions:
In Indiana, the area around people's residences may constitute an important source of tick exposure for humans. Being exposed to ticks is most prevalent in those living in rural areas of Indiana. Finally, risk factors for TBD are higher among males than among females.
The Fragility of Statistically Significant Randomized Controlled Trials in Plastic Surgery
Authors: Chin Brian , Copeland Andrea , Gallo Lucas , Wakeham Scott , Coroneos Christopher J. , Walsh Michael , Thoma Achilleas , Voineskos Sophocles 
Published: November 2019

Background:
The fragility index has been proposed as a metric to evaluate the robustness of statistically significant findings in randomized controlled trials. It measures the number of events that a trial result relies on to maintain statistical significance. This study examines the robustness of statistically significant results from randomized controlled trials in the plastic surgery literature.

Methods:
A systematic literature search of the 15 highest impact plastic surgery journals was conducted to identify randomized controlled trials published between 2000 and 2017 that reported a statistically significant dichotomous outcome (p < 0.05). The fragility index of each study was calculated using Fisher’s exact test. Multiple linear regression was used to determine trial characteristics associated with the fragility index.

Results:
The 90 eligible randomized controlled trials had a median sample size of 73.5 patients (25th to 75th percentile, 50 to 115) and a median of 20 events (25th to 75th percentile, 11 to 33.5) for the chosen outcome. The median fragility index was 1 (25th to 75th percentile, 0 to 4), indicating that statistical significance would be lost in half of the randomized controlled trials if a single patient had a change in event status. The fragility index was 0 in 24 of 90 (27 percent) randomized controlled trials, meaning the outcome immediately lost statistical significance on recalculation of the p value using Fisher’s exact test.

Conclusions:
The results of randomized controlled trials in plastic surgery demonstrate substantial fragility, as statistically significant results were found to hinge on a small number of events. The fragility index offers an intuitive and simple metric to complement the p value and determine the confidence in the results of randomized controlled trials.
Extrapelvic Sciatic Nerve Endometriosis, the Role of Magnetic Resonance Imaging: Case Report and Systematic Review
Authors: Lomoro Pascal , Simonetti Igino , Nanni Annalisa , Cassone Rosario , Di Pietto Francesco , Vinci Giorgia , Prevedoni Maria Sole , Romano Stefania , Sammarchi Luigi 
Published: November 2019

Abstract
Endometriosis (EN) is a common gynecological condition characterized by the presence of functional endometrium located outside the uterine cavity. Sciatic nerve (SN) is rarely affected by EN. Magnetic resonance imaging allows a direct visualization of the spinal and SN, and it is the modality of choice for the study of SN involvement in extrapelvic EN. We report a case of an endometrioma located in the right SN with a systematic review of the literature.
Defining the surgical critical care research agenda: Results of a gaps analysis from the Critical Care Committee of the American Association for the Surgery of Trauma
Authors: Kim Dennis Y. , Lissauer Matt , Martin Niels , Brasel Karen 
Published: November 2019

BACKGROUND
There has been an unprecedented increase in critical care research recently, and there is a need for an organized and systematic approach to surgical critical care research planning. The purpose of this article was to establish a surgical critical care research agenda via a systematic review of the literature and needs assessment.

METHODS
A systematic review of the literature was performed to identify high-impact critical care articles since 1999 on the basis of citation data. Using a standardized data abstraction tool, surgical representation in the literature was analyzed. A needs assessment was performed using a modified Delphi approach in three rounds to obtain consensus among members of the Critical Care Committee of the American Association for the Surgery of Trauma (n = 30) regarding research priorities in surgical critical care.

RESULTS
Of 1,019 articles screened, 645 underwent full-text review, and 276 articles were included in the final analysis. Surgical patients were identified in 177 studies (64.1%), whereas trauma patients were identified in 82 (31.7%). Key categories identified during the first round of the Delphi included end of life care, traumatic brain injury (TBI), delirium, post-intensive care syndrome (PICS), hemodynamic monitoring, and volume/fluid balance. During the second and third rounds, 10 topics were classified as high priority. The three highest ranked topics were: addressing goals of care in the acute care setting (4.44 ± 0.70); improving prognostic indicators in patients with severe TBI (4.38 ± 0.85); and interventions to mitigate PICS (4.22 ± 0.65). There was a strong positive correlation in ratings (R
s value = 0.90, p = 0.001) between rounds 2 and 3.

CONCLUSION
The results of this study highlight the recent surgical critical care research literature and may serve as a platform for future research endeavors in surgical critical care.
Startle and the StartReact Effect: Physiological Mechanisms
Authors: Carlsen Anthony N. , Maslovat Dana 
Published: November 2019

Summary:
It has been well documented that a prepared response can be triggered at short latency following the presentation of a loud acoustic stimulus that evokes a reflexive startle response. Different hypotheses have been proposed for this so-called “StartReact” effect, although there is still much debate surrounding the physiological mechanisms involved in the observed reduction in reaction time (RT). In this review, we outline the various neurophysiological explanations underlying the StartReact effect and summarize the data supporting, and at times opposing, each possibility. Collectively, the experimental results do not unequivocally support a single explanation and we suggest the most parsimonious mechanism may involve a hybrid framework involving a distribution of neural pathways. Specifically, we propose that multiple node networks at the cortical, brainstem, and spinal levels are involved in response preparation and initiation, and the relative contributions of these structures depends on the type of stimulus delivered and the type of movement required. This approach may lead to greater understanding of the pathways involved in response preparation, initiation, and execution for both healthy and motor disordered populations.