bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Adding Motor Imagery to Early Physical Therapy in Patients with Knee Osteoarthritis who Had Received Total Knee Arthroplasty: A Randomized Clinical Trial
Authors: Briones-Cantero María , Fernández-de-las-Peñas César , Lluch-Girbés Enrique , Osuna-Pérez María C , Navarro-Santana Marcos J , Plaza-Manzano Gustavo , Martín-Casas Patricia 
Published: March 2020

AbstractObjectiveTo investigate the effects of the inclusion of motor imagery (MI) principles into early physical therapy on pain, disability, pressure pain thresholds (PPTs), and range of motion in the early postsurgical phase after total knee arthroplasty (TKA).MethodsA randomized clinical trial including patients with knee osteoarthritis who have received TKA was conducted. Participants were randomized to receive five treatment sessions of either physical therapy with or without MI principles in an early postsurgical phase after a TKA (five days after surgery). Pain intensity (visual analog scale [VAS], 0–100), pain-related disability (short-form Western Ontario McMaster Universities Osteoarthritis Index [WOMAC], 0–32), pressure pain thresholds (PPTs), and knee range of motion were assessed before and after five daily treatment sessions by an assessor blinded to the subject’s condition.ResultsTwenty-four participants completed data collection and treatment. The adjusted analysis revealed significant group*time interactions for WOMAC (F = 17.29, P = 0.001, η2 = 0.48) and VAS (F = 14.56, P &lt; 0.001, η2 = 0.45); patients receiving physiotherapy and MI principles experienced greater improvements in pain (Δ –28.0, 95% confidence interval [CI] = –43.0 to –13.0) and pain-related disability (Δ –6.0, 95% CI = –8.3 to –3.7) than those receiving physiotherapy alone. No significant group*time interactions for knee range of motion and PPTs were observed (all, P  &gt; 0.30).ConclusionsThe application of MI to early physiotherapy was effective for improving pain and disability, but not range of motion or pressure pain sensitivity, in the early postsurgical phase after TKA in people with knee osteoarthritis.
Heavy baryon production with an instanton interaction
Authors: Shim Sang-In , Hosaka Atsushi , Kim Hyun-Chul 
Published: March 2020

Abstract
We propose a new reaction mechanism for the study of strange and charmed baryon production. In this mechanism we consider the correlation of two quarks in baryons, so it can be called the two-quark process. As in the previously studied one-quark process, we find large production rates for charmed baryons in comparison with strange baryons. Moreover, the new mechanism causes the excitation of both the $\rho$ mode and the $\lambda$ mode. Using the wave functions for baryons from a quark model, we compute the production rates of various baryon states. We find that the production rates reflect the structure of the wave functions that imply the usefulness of the reactions for the study of baryon structures.
The Effects of Competition in Consumer Credit Markets
Authors: Gissler Stefan , Ramcharan Rodney , Yu Edison 
Published: March 2020

Abstract
This paper finds that banks and nonbanks respond differently to increased competition in consumer credit markets. Increased competition and a greater threat of failure induces banks to specialize in relationship business lending, and surviving banks are more profitable. However, nonbanks change their credit policy when faced with more competition and expand credit to riskier borrowers at the extensive margin, resulting in higher default rates. These results show how the effects of competition depend on the form of intermediation. They also suggest that increased competition can cause credit risk to migrate outside the traditional supervisory umbrella.
Naloxone Training From Nonmedical Personnel: Benefits Before, During, and After Overdose Events
Authors: Chichester Keith , Sisson Michelle L. , Schiavon Samantha P. , Hugley Mickeah J. , Hendricks Peter S. , Shelton Richard C. , Cropsey Karen L. 
Published: March 2020

Objectives:
Drug overdose death rates in the United States have increased exponentially over the past 2 decades, primarily driven by fatal opioid overdoses. To combat this epidemic, naloxone training programs have become prevalent, but still remain widely underutilized. The purpose of the current study was to assess the benefits of a brief training with differing educational approaches (individual training versus training in dyads) as well as the outcomes following overdose reversals.

Methods:
Persons who use opioids (N = 448) were recruited from 4 sites including treatment facilities, inpatient hospitals, and criminal justice locations over a 3-year period. Training was delivered by nonmedical personnel and focused on safe naloxone usage and recognizing overdose signs. Overdose and naloxone knowledge were assessed before and following training with a 10-item questionnaire. Participants were trained individually, in a dyad with a partner who used opioids (PO), or in a dyad with a partner who did not use opioids (PNO).

Results:
All training groups displayed an increased knowledge of naloxone and overdose situations following training. Approximately 11% of participants (n = 47) reported using their naloxone kit and 97.7% of those resulted in successful overdose reversals. Kits were primarily used by the trained participant on a third-party individual.

Conclusions:
The results of the current study substantiate the effectiveness of naloxone in reversing overdose symptoms. A brief, 15-minute naloxone training delivered by nonmedical personnel enhanced overdose knowledge and led to positive reversal outcomes. Training persons who use opioids in dyads may offer additional benefits and improve follow-up reporting.
Is posterolateral plating better for fixation of Weber B distal fibular fractures than lateral plating: A randomized controlled clinical trial and a review of the literature
Authors: Elwahab Mohammed Reda Abd , Salem Eid Ahmed , Kotb Ahmed , El-ghammaz Shady 
Published: March 2020

Background:
The overall outcomes of Weber B lateral malleolar fracture fixation are good. Fixation can be achieved using different methods; however, lag screw fixation combined with a lateral one-third tubular plate is the most popular option. The purpose of this randomized study was to assess clinical, radiographic, and functional outcomes in a cohort of patients who sustained unstable Weber B ankle fracture and were treated surgically with the technique using posterolateral plating and to compare this technique with the conventional lateral plating.

Methods:
Twenty patients were included in group 1 and managed with conventional lateral plating, and 20 patients (group 2) had posterolateral plating. Patients were evaluated clinically, radiographically, and at the end point according to the ankle module of the American College of Foot and Ankle Surgeons (ACFAS). Both groups were comparable in terms of age, sex, fracture side, and type of injury.

Results:
No statistically significant difference was noted between the groups in regard to individual scoring parameters and total score (P>0.05). Among all injury types, 80% of group 1 had well to excellent final outcomes compared with 95% of group 2 (P>0.05). Fifteen patients (37.5% of all patients) had complications.

Conclusions:
Excellent and good results obtainable with posterolateral plating without the problems commonly associated with lateral plating (short screws and intraarticular penetration) and antiglide plating (peroneal tendinitis) lead us to consider this technique as an option among the methods of choice for managing Weber B fractures.

Level of Evidence:
Level I.
The Frequency of Various “Myelopathic Symptoms” in Cervical Myelopathy
Authors: Niu Shuo , Anastasio Albert T. , Maidman Samuel D. , Faraj Razan R. , Rhee John M. 
Published: March 2020

Study Design:
A retrospective cohort of prospective data.

Objective:
Determine the frequency of various symptoms in a surgical cohort of cervical myelopathy (CM).

Summary of Background Data:
CM can be difficult to diagnose as there is no sine qua non “myelopathic symptom.” Despite extensive literature, the likelihood or frequency of symptoms at presentation remains unclear.

Materials and Methods:
A total of 484 patients treated at a single academic center were reviewed. Preoperative symptoms included: axial neck pain; upper extremity (UE) pain; UE sensory or motor deficit; lower extremity (LE) sensory or motor deficit; and sphincter dysfunction. It was noted whether a symptom was the chief complaint (CC) and/or one of a list of overall symptoms (OS) reported by the patient. Magnetic resonance imaging was assessed for the maximal cord compression level and T2 hyperintensity.

Results:
The most common CC was UE sensory deficit (46.5%), whereas the most common OS were UE and LE motor deficits (82.6% and 81.2%). Neck pain was significantly less common (32.6% CC, 55.4% OS), and sphincter dysfunction was rare (0.6% CC, 16.5% OS). UE pain as a CC was significantly higher when the maximal compression involved a more distal level. The presence of T2 hyperintensity was negatively associated with neck pain but positively associated with sensory and motor deficits of LE.

Conclusions:
The most common CC in CM related to UE sensation, whereas the most common OS related to upper and lower motor function. UE pain was more common with more distal cord compression. Those with T2 hyperintensity had worse myelopathy and were less likely to have neck pain, but more likely to have LE symptoms. To our knowledge, this study is the largest to quantify the frequency of myelopathic symptom presentation in a surgical population. These findings provide valuable insight into the symptomatic presentation of CM in clinical practice and can be used to better inform diagnosis and treatment in this complex patient population.

Level of Evidence:
Level II—retrospective study.
Patient Perceptions of Physician Ownership in Spine Care
Authors: Hirsch Brandon P. , Parrish James M. , Jenkins Nathaniel W. , Khechen Benjamin , Haws Brittany E. , Patel Dil V. , Yoo Joon S. , Lamoutte Eric H. , Karmarkar Sailee S. , Colman Matthew W. , Phillips Frank M. , Singh Kern 
Published: March 2020

Study Design:
This was a prospective study.

Objective:
This study aims to determine the perspectives of patients seeking spine care in regard to physician ownership of surgical facilities and to understand the importance of disclosing financial conflicts.

Summary of Background Data:
There has been limited investigation regarding patient perceptions of the proprietary structure of surgical facilities.

Methods:
Patients seeking treatment for spine pathology completed an 8-item survey. The questions assessed if patients acknowledged the owners of surgical facilities, if the patient thought knowledge of ownership is important, who they perceived as most qualified to own surgical facilities, preference of communication of ownership, and impact of facility ownership on care.

Results:
A total of 200 patients completed the survey. When patients were asked whom they thought owned the hospital, most reported private hospital corporations followed by universities/medical schools and insurance companies. With regard to whom patients thought owned an ambulatory surgical center, most reported physicians, followed by private hospital corporations and individual investors. When asked how important it is to know the financial stakeholders of a surgical facility, 73.5% of patients stated “very important” or “somewhat important.” Most patients reported they were not aware of who owned the facility. Regarding how facility owners should be communicated, 31.0% answered “written document,” whereas 25.0% preferred verbal communication with the staff/surgeon. When asked how much impact the owner of a surgical facility has on their care, 38.0% of patients responded, “strong impact,” followed by “moderate impact,” (43.0%), and “little or no impact” (19.0%). Patients thought that physicians were the most qualified to own an ambulatory surgical center, followed by universities/medical schools and private hospital corporations.

Conclusions:
The pretreatment perception of patients referred to a spine clinic favored the opinion that physicians were the most qualified to own and manage surgical facilities. Therefore, physicians should be encouraged to share disclosures with patients as their ownership of surgical facilities is viewed favorably.
Outcomes and Utilization of Adjuvant Chemotherapy for Stage II Colon Cancer in the Oxaliplatin Period
Authors: Jiao Xiayu , Hay Joel W. , Sadeghi Sarmad , Barzi Afsaneh 
Published: March 2020

Purpose:
Previous SEER (Surveillance, Epidemiology, and End Results)-Medicare analyses have shown no definitive survival benefit for adjuvant chemotherapy (AC) with fluoropyrimidines. Impact of oxaliplatin-containing regimens for elderly stage II patients in real-world setting is unknown. We explored the utilization and outcome of AC after the Food and Drug Administration (FDA) approval of oxaliplatin.

Patients and Methods:
Patients with stage II colon cancer (2004-2011) who underwent resection were selected for this analysis. Medicare claims data were used to ascertain the administration of AC within 120 days after surgery. The primary endpoint of the analysis was overall survival. We used the Cox proportional hazards model to estimate the effect of AC while adjusting for clinical and sociodemographic variables available in SEER. To adjust for referral pattern, a source of selection bias, we conducted an instrumental variable analysis using the surgeon of record and health service area.

Results:
A total of 16,468 patients were identified and 12.1% received AC. AC recipients were significantly younger, more likely to be male, nonwhite, married, and had lower comorbidity index. Their tumors had a more advanced stage, more likely to be left sided, and were less differentiated. The hazard ratio (HR) from the Cox model showed a statistically significant survival advantage for AC (HR=0.847, 95% confidence interval: 0.782-0.916). However, results from the instrumental variable analysis indicated that there was no definitive benefit of survival in AC recipients (HR=1.779, 95% confidence interval: 0.927-3.415). AC use decreased over time.

Conclusions:
After controlling for referral patterns, administration of AC provided no definitive survival benefit. Future studies may elucidate the elderly population who may benefit from AC.
Investigation of eNOS gene polymorphism exposes a genetic association between endothelial dysfunction and osteoporosis in postmenopausal women
Authors: Singh Puneetpal , Singh Monica , Valecha Srishti , Khinda Rubanpal , Kumar Nitin , Mastana Sarabjit , Singh Surinderpal , Juneja Pawan K. , Kaur Taranpal 
Published: March 2020

Abstract

Objectives:
To investigate the association of genetic polymorphisms of endothelial nitric oxide synthase (eNOS) gene with endothelial dysfunction associated osteoporosis in postmenopausal women of Punjab, India.

Methods:
The study involved 456 postmenopausal women having endothelial dysfunction categorized according to women with (n = 236) and without osteoporosis (n = 220). Bone mineral density (BMD) and reactive hyperemia index (RHI) were evaluated together with six single-nucleotide polymorphisms (SNPs) within the eNOS gene (rs2070744, rs1799983, rs1800780, rs3918181, rs891512, and rs1808593).

Results:
A moderate association between RHI and BMD at femoral neck (r
2 = 0.213, P = 0.002) and lumbar spine (r
2 = 0.267, P < 0.001) was observed. Minor alleles C and T of SNPs rs2070744 and rs1799983 were associated with chances of osteoporosis in both co-dominant (odds ratio [OR] 2.13, P = 0.017; OR 2.77, P = 0.009) and dominant (OR 2.10, P = 0.011; OR 2.45, P = 0.007) modes, whereas minor allele A of SNP rs891512 showed marginal probability in dominant model (OR 1.68, P = 0.047). A susceptibility haplotype (CTAAAT) was observed within the eNOS gene which conferred 2.32 times higher chances of osteoporosis (OR 2.32, 95% confidence interval 1.18-4.54, P = 0.021) after adjusting for the effect of confounders. Genetic model analysis revealed that each copy of susceptibility haplotype increased the possibility of osteoporosis by a factor of 2.11 ± 0.63 (P < 0.001). RHI was significantly associated with susceptibility haplotype CTAAAT in a dose-dependent manner, whereby the severity of endothelial dysfunction increased significantly in women having two copies over women having one copy or no copy (β = 2.13, P < 0.001) of susceptibility haplotype.

Conclusion:
A susceptibility haplotype CTAAAT within the eNOS gene is associated with double the possibility of endothelial dysfunction affiliated osteoporosis in postmenopausal women of Punjab, India.
Clinical Characteristics of Pediatric Pyelonephritis Without Pyuria or Bacteriuria
Authors: Yokoyama Tadafumi , Takemura Yuta , Irabu Hitoshi , Taniguchi Chihiro , Jinkawa Asumi , Yamamiya Mari , Obata Misato , Miyashita Kengo , Inoue Mika , Sakazume Shinobu , Ohta Kazuhide 
Published: March 2020

Background:
The gold standard for the diagnosis of acute pyelonephritis (APN) in children is the finding of both pyuria (P) and bacteriuria (B); however, some APN patients have neither of these findings [APN(P(−);B(−))].

Methods:
In this study, we investigated APN patients who visited our hospital over 14 years to identify specific clinical characteristics of APN(P(−);B(−)).

Results:
A total of 171 APN patients were included in the study, and of these 29 were APN(P(−);B(−)). Of the APN(P(−);B(−)) patients, 25.9% had vesicoureteral reflux (VUR), the same percentage as the APN(P(+);B(+)) patients, and 69.0% of APN(P(−);B(−)) patients had already taken antibiotics before diagnosis. APN(P(−);B(−)) patients were older and had a longer duration between onset of fever and diagnosis than the patients with pyuria and/or bacteriuria. In addition, they showed higher C-reactive protein levels. APN(P(−);B(−)) patients had high levels of urinary α-1 microglobulin and urinary β-2 microglobulin.

Conclusions:
APN is difficult to diagnose in febrile patients who display neither pyuria nor bacteriuria, but as these patients have the same risk for VUR as APN patients with pyuria and bacteriuria, a detailed history establishing the clinical course as well as urinary chemistry investigations, may assist in diagnosis.
Office-Based Buprenorphine Treatment
Authors: Noe Shelly R. , Keller Teresa 
Published: March 2020

Abstract
Opiate addiction is a serious global health issue that profoundly impacts the welfare of populations around the world. Opioid addiction affects an estimated 1.9 million individuals in the United States alone, stimulating a rise in treatment options such as medication-assisted treatment with buprenorphine. When combined with counseling and relapse prevention groups, medication-assisted treatment has proven to be an effective office-based opioid treatment for opiate dependence. Office-based opioid treatment has broadened access to treatment of opioid dependence, has decreased the risk for overdose, and is effective for reducing cravings and opioid use at proper dosing levels. However, treatment retention and relapse remain significant challenges. The purpose of this study was to identify characteristics predictive of retention in treatment time of opioid-dependent individuals receiving office-based buprenorphine treatment. The records of individuals enrolled in a public health office buprenorphine clinic (n = 350) were analyzed to determine retention time in treatment and whether retention time varied by selected individual variables. Participants in the study had a cumulative predicted retention time on buprenorphine of 65% at 30 days, 35% at 6 months, 25% at 12 months, and 18% at 18 months.
Reducing Student Nurse Stigmatization of the Patient Who Misuses Opioids
Authors: Maynard Kristi 
Published: March 2020

Abstract
The United States is in the midst of an opioid epidemic. The numbers of opioid-related deaths have been steadily climbing, magnifying the need for innovative intervention. Stigma is a set of preconceived, negative assumptions about a patient population or group. Stigma is a known deterrent to communication and the delivery of healthcare. Nurses serve as a primary contact for many marginalized patients within the healthcare system. The purpose of this scoping review is to gather known data on the use of educational interventions with nursing students to reduce stigmatizing tendencies. Inclusion criteria constituted an educational intervention involving student nurses and an effort to reduce stigmatizing attitudes toward patients who misuse opioids. The intervention must have taken place in an institute of higher learning between the years of 2003 and 2018. Exclusion criteria included community-wide studies. A single study was identified addressing nursing student reduction of stigmatization of the individual who uses opioids, and so, the search was expanded to include any student nursing intervention developed to reduce stigma toward any marginalized population. The following electronic databases were utilized in the search process: Cumulative Index of Nursing and Allied Health Literature, Google Scholar, Journal Storage, Microsoft Academic, and ScienceDirect. Reference pages of selected or related articles were reviewed in an attempt to identify additional pertinent literature through citation mapping. Fifteen studies were identified, each of which utilized a variable methodology for stigma reduction with varying levels of success.
Fluoro-deoxy-glucose uptake in the mylohyoid muscle: a common misconception
Authors: Pizzuto Daniele A. , Husmann Lars , Stolzmann Paul , Meerwein Christian , Orita Erika , von Schulthess Gustav K. , Huellner Martin W. 
Published: March 2020

Aim
The mylohyoid muscle is often believed to exhibit high physiologic fluoro-deoxy-glucose (FDG) uptake. Aim of this study was to use PET/MR for adequately assessing the normal FDG distribution in floor of the mouth (FOM) muscles and neighboring major salivary glands.

Materials and methods
Patients scanned with a simultaneous PET/MRI system for initial staging or follow-up of head and neck tumors, with no malignant lesions in salivary glands or in FOM, were included. Volumes-of-interest (VOIs) were positioned separately for bilateral mylohyoid, digastric, genioglossus, and geniohyoid muscles, based on T2-weighted and T1-weighted images, and for bilateral parotid, submandibular, and sublingual glands in the same way. SUVmax was measured for each VOI.

Results
Six hundred and ninety-two VOIs were positioned. FDG uptake in mylohyoid (SUVmax = 1.94 ± 0.37) and digastric muscles (SUVmax = 2.01 ± 0.37) were significantly higher compared to that in geniohyoid (SUVmax = 1.67 ± 0.53) and genioglossus muscles (SUVmax = 1.75 ± 0.54) (Friedman’s test; P < 0.001). FDG uptake in the sublingual glands (SUVmax = 3.77 ± 1.63) was significantly higher compared to the parotid glands (SUVmax = 2.34 ± 0.60) and submandibular glands (SUVmax = 2.51 ± 0.59) (Wilcoxon signed-ranks test; P < 0.001). FDG uptake in sublingual glands was significantly higher than FDG uptake in the mylohyoid muscles (P < 0.001). FDG uptake in the parotid, submandibular, and sublingual glands was inversely correlated to the age of subjects (Spearman’ rho coefficient: –0.397/P = 0.004; –0.329/P = 0.021; –0.535/P < 0.001, respectively).

Conclusion
The sublingual glands yield the highest physiologic FDG uptake in the FOM. High FDG uptake in the mylohyoid muscle is a common misconception.