bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic accuracy of a new clinical test (resisted internal rotation) for detection of gluteus medius tears
Authors: Ortiz-Declet Victor , Chen Austin W , Maldonado David R , Yuen Leslie C , Mu Brian , Domb Benjamin G 
Published: November 2019

Abstract
The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination for detection of gluteus medius (GM) tears. A case group of 50 patients undergoing arthroscopy with GM repair was compared with a control group of 50 patients undergoing arthroscopy who had no peritrochanteric symptoms. Both groups were examined clinically, had magnetic resonance imaging studies performed and underwent arthroscopic surgery. Recorded clinical examinations included abnormal gait (Trendelenburg), tenderness to palpation of the greater trochanter, resisted abduction and the test being studied, resisted internal rotation. For all clinical tests, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rates were calculated and compared with the arthroscopic and MRI data for the case group, and the MRI data for the control group. The resisted internal rotation test had a sensitivity of 92%, specificity of 85% and diagnostic accuracy of 88% in the detection of GM tears, with a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of Trendelenburg gait, showed inferior rates. Trendelenburg gait had a higher specificity, but much lower sensitivity. The resisted internal rotation test aides in the detection of GM pathology. Due to the good results of the resisted internal rotation test in all the diagnostic parameters, we recommend incorporating it on the physical exam of patients with hip pain.
Job Hopping and Adverse Selection in the Labor Market
Authors: Fan Xiaodong , DeVaro Jed 
Published: November 2019

AbstractA model of employer learning (both symmetric and asymmetric) about worker ability from job histories is constructed, and testable implications are derived to detect asymmetric learning empirically. The model predicts that early-career bad job matches are particularly damaging when learning is asymmetric. Analysis of NLSY79 data reveals that job hopping is associated with lower wages for college graduates, controlling for measured ability, labor market experience, and current job tenure. Suggestive of asymmetric learning, the effect is strongest for job tenures less than one year and for early-career workers, and mitigated when job hopping severs matches that were formed during economic downturns. (JEL D82, J31, J63)
The polarized signal from broad emission lines in AGNs
Authors: Lira P , Goosmann R W , Kishimoto M , Cartier R 
Published: November 2019

ABSTRACT
Using the stokes Monte Carlo radiative transfer code, we revisit the predictions of the spectropolarimetric signal from a disc-like broad emission line region (BLR) in type I active galactic nuclei due to equatorial scattering. We reproduce the findings of previous works, but only for a scatterer that is much more optically and geometrically thick than previously proposed. We also find that when taking into account the polarized emission from all regions of the scatterer, the swing of the polarization position angle (PA) is in the opposite direction to that originally proposed. Furthermore, we find that the presence of outflows in the scattering media can significantly change the observed line profiles, with the PA of the scattering signal being enhanced in the presence of radially outflowing winds. Finally, a characteristically different PA profile, shaped like an ‘M’, is seen when the scatterer is co-spatial with the BLR and radially outflowing.
On the road to per cent accuracy – III. Non-linear reaction of the matter power spectrum to massive neutrinos
Authors: Cataneo M , Emberson J D , Inman D , Harnois-Déraps J , Heymans C 
Published: November 2019

ABSTRACT
We analytically model the non-linear effects induced by massive neutrinos on the total matter power spectrum using the halo model reaction framework of Cataneo et al. In this approach, the halo model is used to determine the relative change to the matter power spectrum caused by new physics beyond the concordance cosmology. Using standard fitting functions for the halo abundance and the halo mass–concentration relation, the total matter power spectrum in the presence of massive neutrinos is predicted to per cent-level accuracy, out to $k=10 \,{ h}\,{\rm Mpc}^{-1}$. We find that refining the prescriptions for the halo properties using N-body simulations improves the recovered accuracy to better than 1 per cent. This paper serves as another demonstration for how the halo model reaction framework, in combination with a single suite of standard Λ cold dark matter (ΛCDM) simulations, can recover per cent-level accurate predictions for beyond ΛCDM matter power spectra, well into the non-linear regime.
Stereotactic Radiation as Salvage Therapy for Recurrent Rathke Cleft Cysts
Authors: Agarwalla Pankaj K , Koch Matthew J , Royce Trevor J , Redjal Navid , Bussière Marc R , Loeffler Jay S , Swearingen Brooke 
Published: November 2019

Abstract

BACKGROUND
Rathke cleft cysts (RCCs) are sellar-based cystic lesions that are often found incidentally but occasionally become symptomatic with significant visual and/or endocrine deficits. The standard of treatment is surgery, but rare cases of multiply recurrent RCCs can be refractory to surgical drainage, leading to significant morbidity.

OBJECTIVE
To demonstrate the safety and feasibility of fractionated stereotactic radiotherapy (SRT) as salvage therapy in multiply recurrent RCCs refractory to surgical drainage.

METHODS
An IRB-approved retrospective review at a single institution was conducted to identify and describe patients with multiply recurrent RCCs refractory to surgical drainage who underwent SRT.

RESULTS
From 1994 to 2015, 6 patients (5 female) who underwent SRT for recurrent RCCs were identified. A total of 4 presented with visual deficits, and 2 presented with endocrine dysfunction and severe headaches prior to their initial drainage. All patients had initial postoperative improvement but then developed multiple, symptomatic recurrences. Median number of surgical drainage procedures prior to radiotherapy was 3. A total of 3 patients underwent LINAC-based SRT, and 3 had proton-based SRT. Treatment doses were 45 Gy over 25 fractions (n = 5) and 50.4 Gy over 28 fractions (n = 1). Median follow-up after radiation therapy was 69 mo (range 24-154 mo). In the follow-up period, stabilization of the RCC was achieved, although 2 patients required additional drainage procedures. Only 1 patient developed new hypothyroidism and hypoadrenalism after SRT.

CONCLUSION
In rare cases of multiply recurrent RCCs refractory to repeat surgical drainage, stereotactic fractionated radiation therapy is a safe and effective salvage therapy.
Identification of measures predictive of age of puberty onset in gilts
Authors: Graves Kody L , Mordhorst Bethany R , Wright Elane C , Hale Benjamin J , Stalder Kenneth J , Keating Aileen F , Ross Jason W 
Published: November 2019

Abstract
A potential indicator of female lifetime productivity in swine is age of puberty, when a gilt achieves her first behavioral estrus. Follicular activity, as determined by tertiary follicle development, in prepubertal gilts begins during postnatal day (PND) 75 to 115. The central hypothesis of this study is that gilts demonstrating tertiary follicle development earlier in life, assessed using vulva size as a proxy, achieve puberty earlier in life compared with counterparts of a similar age and weight that lack tertiary follicle development. The objectives of this project were to identify a developmental time point when variation in ovarian development exists and to determine whether a relationship between the age prepubertal ovarian development and the age at onset of puberty exists. To accomplish this, 155 gilts of similar age (± 2 d) were weighed and vulva size measured on PND 75, 85, 95, 105, and 115. Vulva measures, including vulva width (VW), vulva length (VL), and vulva area (VA), were utilized as developmental proxies for follicular activity. At each time point, gilts (n = 10) were sacrificed and ovarian follicular activity recorded. In a subset of gilts (n = 105), estrus detection was conducted daily on PND days 126 to 200. Mean VA on PND 75, 85, 95, 105, and 115 was 596 ± 206, 683 ± 190, 864 ± 212, 1014 ± 228, and 1265 ± 252 mm2, respectively. Of the gilts demonstrating behavioral estrus, 28 were within PND 140 to 160, 36 between PND 161 to 180, 15 between PND 181 to 200, and 26 did not demonstrate estrus behavior within 200 d of age. All gilts euthanized at PND 75 lacked follicular activity as defined by having a minimum of 2 antral follicles per ovary, whereas 60%, 80%, 90%, and 100% demonstrated follicular activity on PND 85, 95, 105, and 115, respectively. Body weight at PND 75 and VW at PND 115 were correlated to age at first estrus (P &lt; 0.05). Of the gilts whose VA was less than 1 SD from the mean on PND 95 (i.e., &lt;652 mm2), 31% and 50% demonstrated their first behavioral estrus by PND 180 and 200, respectively. However, of gilts whose VA was within or greater than 1 SD of the mean (i.e., ≥652 mm2), 66% and 79% exhibited estrus prior to PND 180 and 200, respectively. These data support utilization of VA changes between 95 and 115 d of age as a useful tool to identify replacement gilts prior to puberty for inclusion into the sow herd.
Postoperative Pain and Analgesic Requirements in the First Year after Intraoperative Methadone for Complex Spine and Cardiac Surgery
Authors: Murphy Glenn S. , Avram Michael J. , Greenberg Steven B. , Shear Torin D. , Deshur Mark A. , Dickerson David , Bilimoria Sara , Benson Jessica , Maher Colleen E. , Trenk Gregory J. , Teister Kevin J. , Szokol Joseph W. 
Published: November 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Methadone is a long-acting opioid that has been reported to reduce postoperative pain scores and analgesic requirements and may attenuate development of chronic postsurgical pain. The aim of this secondary analysis of two previous trials was to follow up with patients who had received a single intraoperative dose of either methadone or traditional opioids for complex spine or cardiac surgical procedures.

Methods
Preplanned analyses of long-term outcomes were conducted for spinal surgery patients randomized to receive 0.2 mg/kg methadone at the start of surgery or 2 mg hydromorphone at surgical closure, and for cardiac surgery patients randomized to receive 0.3 mg/kg methadone or 12 μg/kg fentanyl intraoperatively. A pain questionnaire assessing the weekly frequency (the primary outcome) and intensity of pain was mailed to subjects 1, 3, 6, and 12 months after surgery. Ordinal data were compared with the Mann–Whitney U test, and nominal data were compared using the chi-square test or Fisher exact probability test. The criterion for rejection of the null hypothesis was P < 0.01.

Results
Three months after surgery, patients randomized to receive methadone for spine procedures reported the weekly frequency of chronic pain was less (median score 0 on a 0 to 4 scale [less than once a week] vs. 3 [daily] in the hydromorphone group, P = 0.004). Patients randomized to receive methadone for cardiac surgery reported the frequency of postsurgical pain was less at 1 month (median score 0) than it was in patients randomized to receive fentanyl (median score 2 [twice per week], P = 0.004).

Conclusions
Analgesic benefits of a single dose of intraoperative methadone were observed during the first 3 months after spinal surgery (but not at 6 and 12 months), and during the first month after cardiac surgery, when the intensity and frequency of pain were the greatest.
Two-Level Osteotomy for the Corrective Surgery of Severe Kyphosis From Ankylosing Spondylitis
Authors: Zhong Woquan , Chen Zhongqiang , Zeng Yan , Sun Chuiguo , Li Weishi , Qi Qiang , Guo Zhaoqing 
Published: November 2019

Study Design.
Retrospective study.

Objective.
To describe the treatment results of patients with severe ankylosing spondylitis (AS) kyphosis who underwent two-level osteotomy and correction surgery.

Summary of Background Data.
The best solution for the fixed kyphotic deformity of AS is corrective osteotomy. Many osteotomy options are available: pedicle subtraction osteotomy (PSO), Smith-Peterson osteotomy (SPO), and vertical column resection (VCR). These procedures all provide multiplanar deformity correction. Nevertheless, when the AS deformity is severe, an additional osteotomy site to get more correction, achieve more ideal, and smooth curvature of the spine than single osteotomy.

Methods.
From May, 2008 to August, 2016, 19 patients of severe AS kyphosis underwent two-level spinal osteotomy and correction surgery. The patients had an average kyphosis angle greater than 90°. The radiological features and clinical evaluation, including Oswestry Disability Index (ODI), visual analog scale (VAS), and Scoliosis Research Society (SRS)-22 components were assessed before surgery and at follow-up. The patients underwent either one-level PSO combined with one-level SPO (n = 9) or two-level PSO (n = 10).

Results.
The height was increased after surgery in all patients (P < 0.05). The median follow-up was 24 months. The kyphosis angle improved from 92.0 ± 16.6° to 30.0 ± 17.2°. The chin-brow vertical angle improved from 37.6 ± 19.2° to –0.6 ± 2.5°. The sacral slope improved from 3.9 ± 11.8° to 21.7 ± 7.4°. Sagittal imbalance improved from 241.4 ± 115.3 mm to 74.6 ± 48.5 mm (P < 0.05). Lumbar lordosis improved from –3.9 ± 20.8° to 29.4 ± 14.1° (all P < 0.05). There were significant improvements in the ODI, VAS, and all components of SRS-22 (all P < 0.05). All patients with pseudarthrosis (n = 5) underwent PSO + SPO and achieved satisfactory results. Six complications were observed perioperatively, but without permanent sequelae.

Conclusion.
Two-level osteotomy and correction procedure can achieve satisfactory results in severe AS kyphosis. PSO + SPO could be a good option for patients with pseudarthrosis because of relatively easier and faster operation.

Level of Evidence: 4
Net Ultrafiltration Prescription and Practice Among Critically Ill Patients Receiving Renal Replacement Therapy: A Multinational Survey of Critical Care Practitioners
Authors: Murugan Raghavan , Ostermann Marlies , Peng Zhiyong , Kitamura Koichi , Fujitani Shigeki , Romagnoli Stefano , Di Lullo Luca , Srisawat Nattachai , Todi Subhash , Ramakrishnan Nagarajan , Hoste Eric , Puttarajappa Chethan M. , Bagshaw Sean M. , Weisbord Steven , Palevsky Paul M. , Kellum John A. , Bellomo Rinaldo , Ronco Claudio 
Published: November 2019

Objectives:
To assess the attitudes of practitioners with respect to net ultrafiltration prescription and practice among critically ill patients with acute kidney injury treated with renal replacement therapy.

Design:
Multinational internet-assisted survey.

Setting:
Critical care practitioners involved with 14 societies in 80 countries.

Subjects:
Intensivists, nephrologists, advanced practice providers, ICU and dialysis nurses.

Intervention:
A cross-sectional survey.

Measurement and Main Results:
Of 2,567 practitioners who initiated the survey, 1,569 (61.1%) completed the survey. Most practitioners were intensivists (72.7%) with a median duration of 13.2 years of practice (interquartile range, 7.2–22.0 yr). Two third of practitioners (71.0%; regional range, 55.0–95.5%) reported using continuous renal replacement therapy with a net ultrafiltration rate prescription of median 80.0 mL/hr (interquartile range, 49.0–111.0 mL/hr) for hemodynamically unstable and a maximal rate of 299.0 mL/hr (interquartile range, 200.0–365.0 mL/hr) for hemodynamically stable patients, with regional variation. Only a third of practitioners (31.5%; range, 13.7–47.8%) assessed hourly net fluid balance during continuous renal replacement therapy. Hemodynamic instability was reported in 20% (range, 20–38%) of patients and practitioners decreased the rate of fluid removal (70.3%); started or increased the dose of a vasopressor (51.5%); completely stopped fluid removal (35.8%); and administered a fluid bolus (31.6%), with significant regional variation. Compared with physicians, nurses were most likely to report patient intolerance to net ultrafiltration (73.4% vs 81.3%; p = 0.002), frequent interruptions (40.4% vs 54.5%; p < 0.001), and unavailability of trained staff (11.9% vs 15.6%; p = 0.04), whereas physicians reported unavailability of dialysis machines (14.3% vs 6.1%; p < 0.001) and costs associated with treatment as barriers (12.1% vs 3.0%; p < 0.001) with significant regional variation.

Conclusions:
Our study provides new knowledge about the presence and extent of international practice variation in net ultrafiltration. We also identified barriers and specific targets for quality improvement initiatives. Our data reflect the need for evidence-based practice guidelines for net ultrafiltration.
Self-Care
Authors: Spurlock Rachel 
Published: November 2019

ABSTRACT:
What does it mean to practice self-care? How do we care effectively and compassionately for our patients while maintaining our own physical and emotional health? Nursing associations have incorporated the importance of self-care into models for good nursing practice. The perspective on self-care can change from one of self-focus to one of stewardship. Self-care from a stewardship view reflects what God is already doing to take care of us.
PSEUDOMONAL CHOROIDAL ABSCESS AFTER ROUTINE PARS PLANA VITRECTOMY IN AN IMMUNOSUPPRESSED PATIENT
Authors: Wang Kendrick M. , Liu Tin Yan Alvin , Sein Julia , Arevalo J. Fernando 
Published: November 2019

Purpose:
To describe an unusual case of pseudomonal choroidal abscess which developed after a routine pars plana vitrectomy in an immunosuppressed patient.

Methods:
Case report. A 61-year-old woman with a history of rheumatoid arthritis and ulcerative colitis on abatacept underwent pars plana vitrectomy. A few days after the patient's operation, a partially serous choroidal detachment was identified. Her choroidal detachment increased in size despite prednisone therapy, and she was taken to the operating room for repeat vitrectomy and choroidal drainage. Intraoperatively, there was no significant intraocular inflammation, but purulent whitish material was expressed during external choroidal drainage which grew Pseudomonas aeruginosa.

Results:
The patient was given intravenous antibiotics. Systemic infectious workup was negative for blood and urine cultures. The patient was transitioned to oral antibiotics, but had persistent eye pain after discharge and vision remained at count fingers. A computed tomography orbit scan with contrast showed persistent choroidal abscess, and intravitreal ceftazidime injections were administered. The patient's subjective pain resolved within several days of the first intravitreal injection; repeat ultrasound also showed interval resolution of the choroidal elevation. One year after the resolution of her choroidal abscess, her visual acuity was Snellen 20/250 in the affected eye.

Conclusion:
Isolated choroidal bacterial abscess is a possible, but rare, complication of pars plana vitrectomy. Although visual prognosis is poor, especially for pseudomonal choroidal abscesses, aggressive treatment with timely choroidal drainage, systemic antibiotics, and intravitreal antibiotics may allow recovery of some ambulatory vision.
Evaluation of 99mTC-ECD SPECT/CT brain Imaging with NeuroGam analysis in Moyamoya disease after surgical revascularization
Authors: Lou Jingjing , Liu Zhuang , Xu Bin , Wang Yuan-Kai , Liu Cong-Jin , Liu Miao , Liu Xing-Dang 
Published: November 2019

Abstract
To evaluate the clinical value of NeuroGam software in assessing the brain foci perfusion changes by 99mTC-ECD single photon emission computed tomography/computed tomography (SPECT/CT) brain imaging in patients with Moyamoya Disease (MMD).
Seventy-two patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass combined with encephalo-duro-myo-synangiosis (EDMS) surgical revascularization were included. Baseline and follow-up 99mTC-ECD SPECT/CT brain scans were performed on all patients at least twice before and after operation. Pre- and post-SPECT dicom images were reoriented into Talairach space using NeuroGam Software package. Additional visual analysis was performed. Differences mean pixel value between pre- and post- operation brain perfusion were assessed with paired t test and McNemar test.
Significant differences in the number of hypoperfusion foci were found between visual assessment and NeuroGam aided assessment. More hypoperfusion foci were found by NeuroGam software aided assessment in the frontal, parietal, temporal, occipital lobe, thalamus, basal ganglia and cerebellum before and after surgery (P < .0001). According to NeuroGam software assessment, the perfusion of frontal, parietal, temporal lobe, anterior and middle cerebral regions on the operative side significantly improved before and after surgery (t = –3.734, t = –3.935, t = –5.099, t = –4.006, t = –5.170, all P < .001). However, no significant differences were found in the occipital lobe (t = –1.962, P = .054), thalamus (t = 1.362, P = .177), basal ganglia (t = –2.394, P = .019), and cerebellum (t = 1.383, P = .171) before and after surgery.
The NeuroGam software provides a quantitative approach for monitoring surgical effect of MMD in a variable time (3–12 months after surgery). It could discover the perfusion changes that are neglected in conventional visual assessment.
Overground exoskeletons may boost neuroplasticity in myotonic dystrophy type 1 rehabilitation
Authors: Portaro Simona , Naro Antonino , Leo Antonino , Cimino Vincenzo , Balletta Tina , Buda Antonio , Accorinti Maria , Calabrò Rocco Salvatore 
Published: November 2019

Abstract

Rationale:
Myotonic dystrophy type 1 (DM1) is a slowly progressive multisystem neuromuscular disease characterized by myotonia and muscle weakness and wasting of distal and axial muscles. People with DM1, due to the disease progression, are often concerned about their ability to carry out and participate in the activities of daily living. Rehabilitation approaches in DM1, including moderate-to-intense strength training, have shown not univocal efficacy to face such difficulties. Aim of this case-study was to demonstrate the effects of a combined approach by using conventional plus robotic training in rare neuromuscular diseases, such as DM1.

Patient concerns:
A 46-year-old woman came to our observation complaining of difficulty in opening fist after strong voluntary muscle contraction for about 20 years. Over the years, she referred swallowing difficulties for solid foods, balance impairment complicated by tendency to stumble and falls, fatigability, hand muscle weakness with difficulty to open bottles and lifting weights, and daytime sleepiness

Diagnosis:
Paraparesis in DM1.

Interventions:
The patient underwent 2 different trainings. The first period of treatment was carried out by using conventional physiotherapy, 6 times a week (twice a day) for 4 weeks. Then, she underwent a two-month specific task-oriented robotic rehabilitation training for the gait impairment using an overground exoskeleton, namely Ekso-GT, combined to the conventional therapy.

Outcomes:
The patient, after the EKSO training, gained a significant improvement in walking, balance and lower limbs muscle strength, as per 10-meter walking test and Left Lower Limb Motricity Index. Neurophysiological data (electroencephalography and surface electromyography) were also collected to more objectively assess the functional outcomes.

Lessons:
Rehabilitation approaches in DM1, including moderate-to-intense strength training, have shown not univocal efficacy. Emerging and advancing robotic technologies can enhance clinical therapeutic outcomes by allowing therapists to activate and/or modulate neural networks to maximize motor and functional recovery.