bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategies and Tools to Enhance Team Performance
Authors: Sucato Daniel J. 
Published: June 2020

Introduction:
The ability for teams to work together in a coordinated manner may be where the greatest improvements in health care occur in the next generation. To perform at the highest level there are several key principles that all teams must have no matter what playing field they are on, including health care.

Methods:
Several resources were used to identify the challenges we face in health care with respect to the delivery of quality care, improving outcomes and decreasing complications. A search of the lay press and scientific literature was evaluated to identify those key elements that lead to improvements in team performance. In addition, personal observations were accumulated with time and examples of strategies used at home institutions were identified.

Results:
The teams in our pediatric orthopaedic practices are many and include those in the clinic, the operating room, research, and our administrative office. The Institute of Medicine, in their influential article in 1999, defined the alarming rates of complications/harm occurring in the US health care system. In response, the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DOD) collaborated to create the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in 2006. This was implemented in military facilities and later civilian hospital settings with varied success in civilian hospital settings.

Discussion:
They defined key principles based around team structure, communication, leadership, situation monitoring, and mutual support. Other important foundational attributes of a successful team include identifying the vision of the team, hiring top-talent in the form of hard and soft skills, having open communication, being goal-focused, practicing accountability, and having an organized team. We can look to excellent examples in medicine, business, and sports to see where and how high-functioning teams have existed and to learn from them to implement similar successful teams.

Conclusions:
Team performance is a function of talented members who share a common vision, who have the opportunity to voice their thoughts/opinions, and have the ability to be accountable to each other. Surgeons need to lead by example, and provide each member of the team an opportunity to contribute in a meaningful way which ultimately will improve the lives of the patients we are honored to care for.
Building a Culture of Wellness in an Orthopaedic Group: Experiences at OrthoCarolina
Authors: Casey Virginia F. , Schenk Jennifer L. 
Published: June 2020

Introduction:
Physician wellness is a much broader concept than physician satisfaction, although physician satisfaction tends to be the predominant form of measurement. The purpose of this paper is to offer some key strategies for building a culture of physician wellness in the unique setting of a large, private group of orthopaedic surgeons.

Methods:
Organizational culture was assessed formally through validated physician satisfaction surveys and data gathered through the Patient Advocacy Reporting System (PARS program, and informally through organic, organizational initiatives, and responses. In addition, the authors continuously reviewed literature related to physician engagement, satisfaction and wellness, and organizational interventions designed to promote the same.

Results:
From 2014 to 2018, overall physician engagement improved and remained above the 90th percentile as compared with the vendor’s database of over 95,000 physicians surveyed nationally. Physician resilience, a measure of the predictors of physician burnout, also improved from 2014 to 2018 and is now above the national physician average. During the same time period, significant improvement was noted as it relates to a physician’s ability to disconnect and “recharge” outside of work (an important element of overall wellness). From 2016 to 2018, PARS interventions aimed at increasing professionalism and identifying at-risk physicians decreased by 23%.

Discussion:
At OrthoCarolina, we believe that developing a nurturing environment with good interpersonal connections is foundational to our success. Physicians within the group also report that supportive avenues such as mentor programs and organized activities outside of the workplace amplified the sense of connection and community within the physician group.

Conclusions:
Organizational culture of a physician group is a key determinant of physician wellness. It is imperative to have the full support of the physicians within the organization and its leaders to promote and support a culture of wellness. Data-driven programs create awareness and foster curiosity, which in turn allows for the development of specific initiatives including informal, organic initiatives that build connection and community.
ABCA1 Polymorphism Is Associated With the Warfarin-Induced Aortic Stiffness After Coronary Artery Bypass Surgery in the Chinese Population
Authors: Liao Shutan , Zhou Qing , Zhang Yang 
Published: June 2020

Abstract:
Warfarin is the most widely prescribed oral anticoagulant and is recommended for patients recovering from coronary artery bypass graft (CABG) with atrial fibrillation. Increasing evidence suggested that warfarin increased arterial stiffness in those patients. We aimed to examine the effect of warfarin therapy on aortic stiffness in patients who underwent CABG with or without postoperative warfarin treatment and explored the potential relationships of warfarin therapy with ABCA1 polymorphisms. This was a retrospect observational study of 24 patients who were continuously treated with warfarin were selected as the warfarin group and matched them by age (±3 years) and gender to 48 patients with nonuse of warfarin as the control group. The aortic stiffness, cholesterol efflux capacity, and plasma level of PIVKA-II were measured. Two ABCA1 polymorphisms were genotyped. Compared with baseline, treatment with warfarin for 1 year significantly increased the plasma level of PIVKA-II and aortic stiffness in pulse pressure and pulse wave velocity in patients after CABG. The increase of pulse wave velocity and plasma PIVKA-II level in the TT genotype was significantly greater than the CC genotype when comparing the −565C/T genotypes. The capacity of cholesterol efflux was significantly lower in the TT genotype at baseline and 1-year follow-up than the CC genotype. Postoperative treatment of warfarin for 1 year significantly increased aortic stiffness in patients who underwent CABG. ABCA1 −565C/T polymorphisms affected the cholesterol efflux capacity and were associated with the vitamin K status and the increased aortic stiffness after warfarin treatment in those patients.
Regenerative Peripheral Nerve Interfaces for the Management of Symptomatic Hand and Digital Neuromas
Authors: Hooper Rachel C. , Cederna Paul S. , Brown David L. , Haase Steven C. , Waljee Jennifer F. , Egeland Brent M. , Kelley Brian P. , Kung Theodore A. 
Published: June 2020

Summary:
Painful neuromas result from traumatic injuries of the hand and digits and cause substantial physical disability, psychological distress, and decreased quality of life among affected patients. The regenerative peripheral nerve interface (RPNI) is a novel surgical technique that involves implanting the divided end of a peripheral nerve into a free muscle graft for the purposes of mitigating neuroma formation and facilitating prosthetic limb control. The RPNI is effective in treating and preventing neuroma pain in major extremity amputations. The purpose of this study was to determine if RPNIs can be used to effectively treat neuroma pain following partial hand and digital amputations. We retrospectively reviewed the use of RPNI to treat symptomatic hand and digital neuromas at our institutions. Between November 2014 and July 2019, we performed 30 therapeutic RPNIs on 14 symptomatic neuroma patients. The average patient follow-up was 37 weeks (6–128 weeks); 85% of patients were pain-free or considerably improved at the last office visit. The RPNI can serve as a safe and effective surgical solution to treat symptomatic neuromas after hand trauma.
Corneal Blindness in Asia: A Systematic Review and Meta-Analysis to Identify Challenges and Opportunities
Authors: Tran Tu M. , Duong Huong , Bonnet Clemence , Kashanchi Ashkan , Buckshey Arjun , Aldave Anthony J. 
Published: June 2020

Purpose:
To describe the causes and prevalence of moderate-to-severe visual impairment (MSVI) and blindness from corneal diseases, as well as corneal transplantation across Asia.

Methods:
A meta-analysis of the published literature to identify population-based surveys conducted from 2008 to 2019 in 22 Asian countries regarding the prevalence and causes of MSVI and blindness from corneal disease, and a review of national corneal transplant data and eye bank statistics.

Results:
A total of 5307 records were screened to identify 57 reports that were used to estimate a prevalence of MSVI and blindness caused by corneal diseases in Asia of 0.38% (95% confidence interval, 0.29%–0.48%). The most frequent corneal diseases were infectious keratitis, trauma, and pseudophakic bullous keratopathy. As expected, these represented the most common indications for corneal transplantation, although the percentages in each country differed based on the level of economic development, with pseudophakic bullous keratopathy being the most common indication in countries with higher gross national income per capita. Despite this, endothelial keratoplasty is not the most commonly performed form of corneal transplantation in any Asian country and represents only a small percentage of keratoplasty procedures performed in most countries.

Conclusions:
The prevalence of MSVI and blindness from corneal disease in Asia is approximately 0.4%, with a nearly 20-fold difference in the national prevalence across the region. The indications for keratoplasty, reflective of the causes of corneal dysfunction, also vary, more so according to the gross national income than to geographic location, and only a few Asian countries have rates of corneal transplantation above international means.
Transcriptome Analysis of Deafness: Intracellular Signal Transduction Signaling Pathways Regulate Neuroplastic Changes in the Auditory Cortex
Authors: Lee Sang-Yeon , Lee Ho Sun , Park Min-Hyun 
Published: June 2020

Hypothesis and Background:Hearing loss leads to synaptic changes in auditory neurons and their networks, and functions as a consequence of the interplay between genes and proteins. However, cellular and molecular mechanisms leading to deafness-induced plasticity in the auditory cortex (AC) remain unclear. Here, we examined the changes in gene expression and key signaling pathways that regulate differentially expressed genes (DEGs) in the AC following auditory deafferentation using RNA-sequencing (RNA-Seq) analysis.Methods:Cochlear ablation-induced bilaterally deafened Sprague-Dawley rats were maintained for 12 weeks and their ACs were harvested. RNA-seq analysis was performed on each sample to identify which genes were expressed. This information was then used for comparative analysis of DEGs between samples. The statistical significance of DEGs was determined by fold change (|FC| > 1.5) and independentttest (p < 0.05).Results:RNA-seq analysis identified 72 DEGs, of which 19 were upregulated and 53 were down-regulated after bilateral deafening in the ACs. Gene ontology (GO) analysis revealed the potential involvement of mitogen-activated protein kinase, tumor necrosis factor, and cyclic adenosine 3′,5′-monophosphate (e.g.,Bdnf,Gli1, andc-Fos) signaling pathways in regulating changes in the expression of the genes listed herein. The DEGs of interest—includingc-Fos,Arc,Ntf3, andGli1—from the RNA-seq analysis were consistent with result of quantitative reverse transcriptase polymerase chain reaction.Conclusion:RNA-seq analysis revealed that auditory deprivation in adult rats elicited changes in gene expression, transcription factor levels, and their complex interaction at specific gene promoters in the AC. Particularly, activation of intracellular signal transduction signaling pathways may be key to neuronal plasticity in deafness.
The Relationship Between Vestibular Migraine and Motion Sickness Susceptibility
Authors: Abouzari Mehdi , Cheung Dillon , Pham Tiffany , Goshtasbi Khodayar , Sarna Brooke , Tajran Sarah , Sahyouni Sammy , Lin Harrison W. , Djalilian Hamid R. 
Published: June 2020

Objectives:
To determine the relationship between vestibular migraine (VM) and motion sickness (MoS) susceptibility and their comorbidity in a large student population, and to assess whether experiencing MoS is associated with higher susceptibility for VM.

Methods:
Surveys including Motion Sickness Susceptibility Questionnaire (MSSQ) and questions assessing migraine-related symptoms as well as family history of motion sickness and migraine headache were distributed to the university undergraduate students through Facebook and email. Diagnosis of definite VM (dVM) was based on the criteria of the International Classification of Headache Disorders.

Results:
Of 277 survey responders, 148 (53%) were found to be susceptible to MoS in which 74 (50%) met the criteria for dVM. Only childhood MSSQ score was significantly higher in participants with dVM compared with those without dVM (25.78 ± 15.89 versus 20.77 ± 14.28, p = 0.04); however, its significance faded out by regression analysis. Multivariate logistic regression showed having 1st degree relative with migraine headache (p = 0.02), neck stiffness (p = 0.001), and sinus pain, facial pressure, or headache with wind exposure (p = 0.02) to be independently associated with presence of dVM in MoS subjects.

Conclusions:
Though participants with MoS and dVM had significantly greater rates of migraine-related symptoms and family history of migraine headache compared with those with MoS only, childhood and adulthood MSSQ scores were similar. This and the high prevalence of dVM in our MoS cohort may suggest an existing association between MoS susceptibility and VM.
Incidence of and risk factors for tuberculosis among people with HIV on antiretroviral therapy in the United Kingdom
Authors: van Halsema Clare L. , Okhai Hajra , Hill Teresa , Sabin Caroline A. 
Published: June 2020

Objective:
The United Kingdom has a low tuberculosis incidence and earlier combination antiretroviral therapy (cART) is expected to have reduced incidence among people with HIV. Epidemiological patterns and risk factors for active tuberculosis were analysed over a 20-year period among people accessing HIV care at sites participating in the UK CHIC observational study.

Design:
Cohort analysis.

Methods:
Data were included for individuals over 15 years old attending for HIV care between 1996 and 2017 inclusive, with at least 3 months follow-up recorded. Incidence rates of new tuberculosis events were calculated and stratified by ethnicity (white/Black/other) as a proxy for tuberculosis exposure. Poisson regression models were used to determine the associations of calendar year, ethnicity and other potential risk factors after cART initiation.

Results:
Fifty-eight thousand seven hundred and seventy-six participants (26.3% women; 54.5% white, 32.0% Black, 13.5% other/unknown ethnicity; median (interquartile range) age 34 (29–42) years) were followed for 546 617 person-years. Seven hundred and four were treated for active tuberculosis [rate 1.3; 95% confidence interval (CI) 1.2–1.4/1000 person-years). Tuberculosis incidence decreased from 1.3 (1.2–1.5) to 0.6 (0.4–0.9)/1000 person-years from pre-2004 to 2011–2017. The decline among people of Black ethnicity was less steep than among those of white/other ethnicities, with incidence remaining high among Black participants in the latest period [2.1 (1.4–3.1)/1000 person-years]. Two hundred and eighty-three participants [191 (67%) Black African] had tuberculosis with viral load less than 50 copies/ml.

Conclusion:
Despite the known protective effect of cART against tuberculosis, a continuing disproportionately high incidence is seen among Black African people. Results support further interventions to prevent tuberculosis in this group.
Pushing the Limits in Cheek Reconstruction: The Sub-Superficial Musculo-Aponeurotic System “Deep Plane” Cervicofacial Flap for Reconstruction of Large Eyelid-Cheek Junction Defects
Authors: Purnell Chad A. , Bricker Jonathan T. , Alghoul Mohammed S. 
Published: June 2020

Abstract
The cervicofacial flap is a workhorse flap for reconstruction of moderate to large sized defects of the cheek. Defects that involve the eyelid-cheek junction are often the most challenging of these. While the ideal plane of dissection has been debated, it is our belief that dissection in the sub-superficial musculo-aponeurotic system (SMAS) plane provides better aesthetic and functional outcomes due to enhanced vascularity, fascial support, and additional bulk of the flap itself. The authors present a series of 9 patients who presented with heterogeneous defects of the eyelid-cheek junction after cancer resection and underwent reconstruction using a sub-SMAS cervicofacial flap. At a mean follow-up time of 20 months, the cohort had 2 patients who developed lower lid retraction requiring revision and 2 other minor complications. This series lends support to the versatility and reliability of the sub-SMAS cervicofacial flap for large defects of the eyelid-cheek junction.
Managing Isolated Symphyseal and Parasymphyseal Fractures in Pediatric Patients
Authors: Yesantharao Pooja S. , Lopez Joseph , Reategui Alvaro , Najjar Omar , Redett Richard J. , Manson Paul N. , Dorafshar Amir 
Published: June 2020

Background:
Isolated symphyseal or parasymphyseal mandibular fractures can confer significant morbidity in children. However, this mandibular injury pattern has not been well-characterized in children. This study investigated isolated symphyseal/parasymphyseal mandibular fractures in pediatric patients.

Methods:
This was a 29-year retrospective, longitudinal cohort study of pediatric patients who presented to a single institution with isolated symphyseal/parasymphyseal mandibular fractures. Patient data were abstracted from medical records and compared between patients of varying dentition stages.

Results:
Fourteen patients met inclusion criteria during the study period, of whom 2 (14.3%) had deciduous dentition, 7 (50.0%) had mixed dentition, and 5 (35.7%) had permanent dentition. Patients with deciduous dentition were significantly more likely to receive soft diet or closed treatment with mandibulomaxillary fixation than open reduction and internal fixation when compared to patients with mixed or permanent dentition (p = 0.04). The post-treatment complication rate was 40% among all patients treated with open reduction and internal fixation, 16.7% among patients who underwent closed treatment with mandibulomaxillary fixation, and 75% amongst patients treated with soft diet (though 2 patients who received soft diet had permanent dentition and thus were inappropriately managed). The most common complication overall was malocclusion (20%). A treatment algorithm was proposed based on study data; adherence to the algorithm significantly decreased odds of complications (odds ratio: 0.03, 95% confidence interval:0.001–0.6).

Conclusions:
The etiology, management, and outcomes of children with isolated symphyseal or parasymphyseal mandibular fractures at our institution varied by dentition stage. The authors proposed a treatment algorithm in order to optimize outcomes of symphyseal/parasymphyseal mandibular fractures in this patient population.
Impact of Physician Expertise on Probe Trajectory During Obstetric Ultrasound: A Quantitative Approach for Skill Assessment
Authors: Le Lous Maela , Despinoy Fabien , Klein Margaux , Fustec Elisa , Lavoue Vincent , Jannin Pierre 
Published: June 2020

Introduction
The objective of the study was to identify objective metrics to evaluate the significance of a sonographer's expertise on trajectories of ultrasound probe during obstetric ultrasound training procedures.

Methods
This prospective observational study was conducted at Rennes University Hospital, Department of Obstetrics and Gynecology. We evaluated a panel of sonographers (expert, intermediate, and novice) in performing 3 tasks (brain, heart, and spine) with an obstetric ultrasound simulator (Scantrainer; Medaphor, Cardiff, UK). The trajectories of the probe were logged and recorded by a custom data acquisition software. We computed metrics on the trajectories (duration, path length, average velocity, average acceleration, jerk, working volume) to compare the 3 groups and identify discriminating metrics.

Results
A total of 33 participants were enrolled: 5 experts, 12 intermediates, and 16 novices. Discriminatory metrics were observed among the 3 levels of expertise for duration, velocity, acceleration, and jerk for brain and spine tasks. Working volume was discriminatory for the brain and the heart task. Path length was discriminatory for the brain task.

Conclusions
Our results suggest a relationship between the sonographer's level of expertise and probe trajectory metrics. Such measurements could be used as an indicator of sonographer proficiency and contribute to automatic analysis of probe trajectory to evaluate the quality of sonography and the sonographer.
Topiramate-Responsive Tremor in a Novel Pathogenic Variant of SPG15 Patient
Authors: Ersen Atilla , Gençpınar Pınar , Arıcan Pınar , Bozkaya Yılmaz Sema , Aliyeva Nargiz , Özdemir Taha Reşid , Öztekin Özgür , Olgaç Dündar Nihal 
Published: June 2020

Abstract
Hereditary spastic paraplegia (HSP) is group of a rare neurodegenerative disorder with both genetically and clinically diverse neurologic features. Indeed, disease progression is varying greatly within the different forms and current treatment modalities are exclusively symptomatic for HSP. Tremor in HSP patients is only mentioned with rare case reports, so treatment option is lack in clinical ground. We reported a case of a HSP-15 girl with a previously reported novel mutation of SPG15 complained of a life disturbing tremor and topiramate as a drug therapy for tremor in our HSP patient.
Statistical Decision Properties of Imprecise Trials Assessing COVID-19 Drugs
Authors: Manski Charles F. , Tetenov Aleksey 
Published: June 2020

AbstractAs the COVID-19 pandemic progresses, researchers are reporting findings of randomized trials comparing standard care with care augmented by experimental drugs. The trials have small sample sizes, so estimates of treatment effects are imprecise. Seeing imprecision, clinicians reading research articles may find it difficult to decide when to treat patients with experimental drugs. Whatever decision criterion one uses, there is always some probability that random variation in trial outcomes will lead to prescribing sub-optimal treatments. A conventional practice when comparing standard care and an innovation is to choose the innovation only if the estimated treatment effect is positive and statistically significant. This practice defers to standard care as the status quo. To evaluate decision criteria, we use the concept of near optimality, which jointly considers the probability and magnitude of decision errors. An appealing decision criterion from this perspective is the empirical success rule, which chooses the treatment with the highest observed average patient outcome in the trial. Considering the design of recent and ongoing COVID-19 trials, we show that the empirical success rule yields treatment results that are much closer to optimal than those generated by prevailing decision criteria based on hypothesis tests.We have benefitted from the comments of Michael Gmeiner, Valentyn Litvin, Francesca Molinari, and John Mullahy. Tetenov has received funding from the Swiss National Science Foundation through grant number 100018-192580.