bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Human Articular Cartilage Tissue and Chondrocytes Isolated from Peripheral versus Central Regions of Traumatic Lesions
Authors: Acevedo Lina , Iselin Lukas , Berkelaar Majoska H. M. , Salzmann Gian M. , Wolf Francine , Feliciano Sandra , Vogel Nicole , Pagenstert Geert , Martin Ivan , Pelttari Karoliina , Barbero Andrea , Arnold Markus P. 
Published: September 2020

Objective Cellular and molecular events occurring in cartilage regions close to injury are poorly investigated, but can possibly compromise the outcome of cell-based cartilage repair. In this study, key functional properties were assessed for cartilage biopsies collected from the central part of traumatic joint lesions ( central) and from regions surrounding the defect ( peripheral). These properties were then correlated with the quality of the initial cartilage biopsy and the inflammatory state of the joint. Design Cartilage samples were collected from knee joints of 42 patients with traumatic knee injuries and analyzed for cell phenotype (by reverse transcriptas-polymerase chain reaction), histological quality, cellularity, cell viability, proliferation capacity, and post-expansion chondrogenic capacity of chondrocytes (in pellet culture). Synovium was also harvested and analyzed for the expression of inflammatory cytokines. Results Cartilage quality and post-expansion chondrogenic capacity were higher in peripheral versus central samples. Differences between these 2 parameters were more pronounced in joints with high inflammatory features characterized by >100-fold difference in the mRNA levels of IL6 and IL8 in the corresponding synovium. Peripheral chondrocytes isolated from good- versus bad-quality biopsies expressed higher levels of collagen II/I and aggrecan/versican and lower levels of MMP13 and ADAMTS5. They also exhibited reduced proliferation and enhanced cartilage-forming capacity. Conclusions Chondrocytes at the periphery of traumatic lesions better maintain properties of healthy cartilage compared to those isolated from the center, even when derived from bad-quality tissues harvested from highly inflamed joints. Future studies are necessary to investigate the change of functional properties of peripheral chondrocytes over time.
A retrospective study on end-of-life care in the emergency department of a tertiary hospital in Singapore
Authors: Goh Jia Ling , Jaffar Julia Li Yan , Xu Hanxing , Lum Vincent Wei Ming 
Published: September 2020

Introduction: The emergency department receives a whole breadth of patient types. Those who are imminently dying may attend the emergency department in the hours or days leading up to their demise, necessitating the initiation of end-of-life care in the emergency department. Aim: The aim of our study was to describe the characteristics and management of imminently dying patients who had presented to our emergency department to identify opportunities for improvement in the provision of end-of-life care in the emergency department. Methods: A retrospective study involving patients who died in the emergency department within 48 hours of registration presenting between 1 January 2018 and 31 December 2018 was carried out. Results: Out of 59 included patients, 91.5% had pre-existing medical conditions; 25.4% had end-stage organ failure of which renal and cardiac were most common. Only 15.3% had preferred care plans documented and among these, only a minority (33.3%) had undergone formal advance care planning. The most common presenting symptom among patients who died within 48 hours was dyspnoea (44.1%). The most common investigation done was capillary blood glucose (84.7%) and the most common procedure was an intravenous peripheral cannula insertion (84.7%). Antibiotics were given in 30.5% of the patients and fentanyl was administered in 20.3% for symptom control. Conclusion: The majority of patients presenting to the emergency department within hours or days of their demise had pre-existing chronic or terminal conditions but only a few had specified their preferences for end-of-life care. Investigations and procedures that do not affect patient comfort or outcomes should be minimised.
Clinical and imaging outcomes after intermediate‐ or high‐risk pulmonary embolus
Authors: Lachant Daniel , Bach Christina , Wilson Bennett , Chengazi Vaseem , Goldman Bruce , Lachant Neil , Pietropaoli Anthony , Cameron Scott , James White R. 
Published: September 2020

Long‐term outcomes after acute pulmonary embolism vary from complete resolution to chronic thromboembolic pulmonary hypertension (CTEPH). Guidelines after acute pulmonary embolism are generally limited to anticoagulation duration. We assessed patients with estimated prognosis >1 year in our pulmonary hypertension clinic 2–4 months after treatment for intermediate‐ or high‐risk acute pulmonary embolism. At follow‐up, ventilation–perfusion scan and echocardiogram were offered. The aim of this study was to assess for recurrent symptomatic disease, residual imaging defects or right ventricular dysfunction, and functional disability after acute management of pulmonary embolism. After treatment for acute intermediate‐ or high‐risk pulmonary embolism, 104 patients followed up in pulmonary hypertension clinic. Of those, 55% of patients had self‐reported limitation in activity. No patients had symptomatic recurrence of pulmonary embolism. Forty‐eight percent of patients had residual perfusion defects on perfusion imaging, while 91% of patients had either normal or only mildly enlarged right ventricles. We identified heart failure preserved ejection fraction, iron deficiency, and obstructive sleep apnea as significant contributors to breathlessness. Treatment of these conditions was associated with improvement. Surprisingly, we diagnosed CTEPH in nine patients; for some, chronic thrombus may already have been present at the time of index evaluation. Our findings suggest that follow‐up in a dedicated pulmonary hypertension clinic 2–4 months after acute intermediate‐ or high‐risk pulmonary embolism may add value to patient care. We identified treatable comorbidities that could be contributing to post‐pulmonary embolism syndrome as well as CTEPH.
Evaluating appropriateness and diagnostic stewardship opportunities of multiplex polymerase chain reaction gastrointestinal testing within a hospital system
Authors: O’Neal Melissa , Murray Hanna , Dash Sangita , Al-Hasan Majdi N. , Justo Julie Ann , Bookstaver P. Brandon 
Published: September 2020

Objective: This single-center, retrospective, observational cohort study evaluates the appropriateness of the BioFire® FilmArray® Gastrointestinal (GI) multiplex PCR panel testing at a community-teaching hospital. Methods: All adult, hospitalized patients at Prisma Health Richland Hospital with a documented GI multiplex PCR panel from 1 April 2015 through 28 February 2018 were included in the analysis. Inappropriate use of the GI panel was defined as a test obtained without documented diarrhea, greater than 2 days of hospitalization, redundant use with other diagnostic tests (e.g. Clostridioides difficile PCR), or laxative use in the preceding 48 h. Antibiotic use and host variables were compared between groups with positive and negative results. Results: During the study period, 442 GI panels were obtained, among which 268 (61%) were deemed inappropriate. Primary reasons for inappropriate testing were lack of documented diarrhea ( n = 92), greater than 2 days of hospitalization ( n = 116), having a duplicate C. difficile PCR test ordered ( n = 118), or laxative use in the 48 h before testing ( n = 36). A total of 141 (32%) GI panels were positive. The most frequently identified pathogens were C. difficile (51.1%, n = 72), Enteropathogenic Escherichia coli (17.7%, n = 25), and Norovirus GI/GII (12.1%, n = 17). Patients with negative GI panel results were initiated on antibiotics significantly less frequently than those with positive GI panels (62.5% versus 80.2%, p < 0.00001). Conclusion: Stewardship opportunities exist to optimize the diagnostic application of the GI multiplex PCR panel.
Automated vs. manual pain coding and heart rate estimations based on videos of older adults with and without dementia
Authors: Castillo Louise IR , Browne M Erin , Hadjistavropoulos Thomas , Prkachin Kenneth M , Goubran Rafik 
Published: September 2020

Introduction Technological advances have allowed for the estimation of physiological indicators from video data. FaceReader™ is an automated facial analysis software that has been used widely in studies of facial expressions of emotion and was recently updated to allow for the estimation of heart rate (HR) using remote photoplethysmography (rPPG). We investigated FaceReader™-based heart rate and pain expression estimations in older adults in relation to manual coding by experts. Methods Using a video dataset of older adult patients with and without dementia, we assessed the relationship between FaceReader’s™ HR estimations against a well-established Video Magnification (VM) algorithm during baseline and pain conditions. Furthermore, we examined the correspondence between the Facial Action Coding System (FACS)-based pain scores obtained through FaceReader™ and manual coding. Results FaceReader’s™ HR estimations were correlated with VM algorithm in baseline and pain conditions. Non-verbal FaceReader™ pain scores and manual coding were also highly correlated despite discrepancies between the FaceReader™ and manual coding in the absolute value of scores based on pain-related facial action coding of the events preceding and following the pain response. Conclusions Compared to expert manual FACS coding and optimized VM algorithm, FaceReader™ showed good results in estimating HR values and non-verbal pain scores.
The Rise of Supplementary Education in Sweden: Arguments, Thought Styles, and Policy Enactment
Authors: Hallsén Stina 
Published: September 2020

Purpose: This article focuses on the development of supplementary education, evolving under the label “homework support,” in Sweden between 2006 and 2018. Particular attention is paid to the significance of the private market for national policy. Design/Approach/Methods: Through a theoretical model on policy enactment, the interaction between national policy and local practice is highlighted. By analyzing how the local practice appears in documents related to state-regulated decision-making, the study gains further insights in the development of homework support in Sweden. Findings: This article argues that when private companies, offering supplementary tutoring, were established on the outskirts of the educational landscape in Sweden, the political educational discourse changed. Even though homework support became a given part of the political discussion about the school, the situation became difficult for private companies. Originality/Value: The article adds to the international field of shadow education. It describes the establishment of the private tutoring market’s entry into the Swedish educational landscape, which in the long term has provided a basis for a further Scandinavian development. Furthermore, the article contributes to theory development by a model that focuses on the interaction between policy formulation and local enactment.
The Adaptation of Pediatric Exercise Testing Programs to the Coronavirus/COVID-19 Pandemic
Authors: Powell Adam W. , Mays Wayne A. , Curran Tracy , Knecht Sandra K. , Rhodes Jonathan 
Published: September 2020

Objective: Response to the coronavirus/COVID-19 pandemic has resulted in several initiatives that directly impact hospital operations. There has been minimal information on how COVID-19 has affected exercise testing in pediatric patients. Design: A web-based survey was designed and sent to pediatric exercise testing laboratories in the United States and Canada. Questions were designed to understand the initial and ongoing adaptations made by pediatric exercise testing laboratories in response to COVID-19. Results were analyzed as frequency data. Results: There were responses from 42% (35/85) of programs, with 68% (23/34) of laboratories discontinuing all exercise testing. Of the 23 programs that discontinued testing, 15 (65%) are actively working on triage plans to reopen the exercise laboratory. Personal protective equipment use include gloves (96%; 25/26), surgical masks (88%; 23/26), N-95 masks (54%; 14/26), face shields (69%; 18/26), and gowns (62%; 16/26). Approximately 47% (15/32) of programs that typically acquire metabolic measurements reported either ceasing or modifying metabolic measurements during COVID-19. Additionally, 62% (16/26) of the programs that previously obtained pulmonary function testing reported either ceasing or modifying pulmonary function testing. Almost 60% of respondents expressed a desire for additional guidance on exercise laboratory management during COVID-19. Conclusions: Pediatric exercise testing laboratories largely closed during the early pandemic, with many of these programs either now open or working on a plan to open. Despite this, there remains heterogeneity in how to minimize exposure risks to patients and staff. Standardization of exercise testing guidelines during the COVID-19 pandemic may help reduce some of these differences.
Vascularised bone graft is an effective technique for extracortical bone bridging to combat cemented megaprosthesis loosening at the bone–implant junction
Authors: Luk Michelle Hilda , Yee Andy Hon-Fai , Yau Raymond , Ho Kenneth Wai-Yip , Lam Ying-Lee 
Published: September 2020

Introduction: The bone–implant junction is a potential site for aseptic loosening. Extracortical bone bridging at the bone–implant junction is advocated to improve implant fixation by forming a biological seal. We propose a novel technique with vascularised bone graft (VBG) to form an extracortical bone bridge at the bone–implant junction to enhance implant stability. We compared the clinical and radiological outcomes for tumour megaprostheses performed (1) with and without bone graft and (2) with non-vascularised versus VBG technique. Methods: Forty-six tumour megaprosthesis procedures from 1 June 2007 to 31 October 2017 were identified from hospital records. Twenty-eight operations incorporated bone graft at the bone–implant junction, and 18 did not. Of these 28 bone graft procedures, 13 involved VBG, and 15 did not (non-VBG). The VBG technique involves resecting a short segment of healthy bone beyond the oncological margin with its preserved blood supply, splitting it, then securing it over the junction. Clinical outcomes assessed included loosening, fracture and recurrence. Extracortical bone growth at the bone–implant junction was quantified radiologically at intervals 0–24 months post-operatively. The mean follow-up was 4.27 years. Results: There were five incidences (27.8%) of loosening in the non-bone graft group compared to zero in the bone graft group ( p = 0.03). There was a higher radiological score of extracortical bone growth in the bone graft group compared to no bone graft at 3–24 months post-operatively ( p < 0.05). Within the bone graft group, the VBG group fared superior at 6 and 12 months post-operatively compared to non-VBG ( p < 0.05), as well as a lower rate of radiological junctional resorption ( p = 0.04). Conclusions: We recommend bone grafting for its merits of less implant loosening. We propose the VBG technique to combat early aseptic loosening in megaprosthesis replacement as there was a higher radiological score compared to non-VBG.
At what point during total knee arthroplasty operations are gloves most frequently torn?
Authors: Karakus Ozgun , Sarı Ahmet Sinan 
Published: September 2020

Purpose: The aim of this study was to determine the time points during a total knee arthroplasty operation when there is the greatest possibility of tearing a surgical glove and thus the stage of the operation at which there is the greatest risk of infection. Methods: The study included 300 total knee arthroplasty cases performed by 10 orthopedic surgeons. Using a chronometer during the operation, the upper layer of each surgical glove was removed and inflated with sterile saline at 10-min intervals. When a tear was determined, a record was made of the time it occurred, the stage of the operation, the finger that was torn, and the side (right or left hand). Results: The mean time of the glove perforation was 40.74 ± 10.69 min. Glove tears occurred at the rate of 28.9% ( n = 39) in the thumb, 63.7% ( n = 86) in the index finger, 2.2% ( n = 3) in the middle finger, and 5.2% ( n = 7) in the ring finger. The tears occurred after the femoral cut in 8.1% ( n = 11), after the tibial cut in 14.8% ( n = 20), at the stage of trial component reduction in 52.6% of cases ( n = 71), after placement of the prosthesis in 7.4% ( n = 10), and at the closure stage in 17% ( n = 23) ( p < 0.001). Conclusion: The fingers requiring the most care during total knee arthroplasty are the thumb and index finger. The stages of the operation with the greatest risk for glove tears are trial component reduction and wound closure. Changing gloves after these high-risk surgical stages would help to decrease the risk of periprosthetic infections. Level of Evidence: Level IV/Case series
Morphological Features of the Ulnar Collateral Ligament of the Elbow and Common Tendon of Flexor-Pronator Muscles
Authors: Ikezu Masahiro , Edama Mutsuaki , Matsuzawa Kanta , Kaneko Fumiya , Shimizu Sohei , Hirabayashi Ryo , Kageyama Ikuo 
Published: September 2020

Background: The anterior bundle (AB) of the ulnar collateral ligament is the most important structure for valgus stabilization of the elbow. However, anatomic relationships among the AB, posterior bundle (PB) of the ulnar collateral ligament, and common tendon (CT) of the flexor-pronator muscles have not been fully clarified. Purpose: To classify the AB, PB, and CT and to clarify their morphological features. Study Design: Descriptive laboratory study. Methods: This investigation examined 56 arms from 31 embalmed Japanese cadavers. The CT investigation examined 34 arms from 23 embalmed Japanese cadavers with CTs remaining. Type classification was performed by focusing on positional relationships with surrounding structures. Morphological features measured were length, width, thickness, and footprint for the AB and PB and attachment length, thickness, and footprint for the CT. Results: The AB was classified as type I (44 elbows; 78.6%), can be separated as a single bundle, or type II (12 elbows; 21.4%), cannot be separated from the PB and joint capsule. The PB was classified as type I (28 elbows; 50.0%), can be separated as a single bundle; type IIa (6 elbows; 10.7%), posterior edge cannot be separated; type IIb (7 elbows; 12.5%), anterior edge cannot be separated; or type III (15 elbows; 26.8%), cannot be separated from the joint capsule. The CT was classified as type I (18 elbows; 52.9%), can be separated from the AB, or type II (16 elbows; 47.1%), cannot be separated from the AB. Significant differences in frequencies of AB, PB, and CT types were identified between men and women. Morphological features were measured only for type I of each structure, and reliability was almost perfect. Conclusion: These results suggest that the AB, PB, and CT each can be classified into an independent form and an unclear form. Presence of the unclear form was suggested as one factor contributing to morphological variation. Clinical Relevance: This study may provide basic information for clarifying functional roles of the AB, PB, and CT.
Self-Efficacy as an Indicator for Success in a Premedical Curriculum for Underrepresented Minority High School Students
Authors: Roche Rosellen , Manzi Joel , Ndubuizu Terra , Baker Samantha 
Published: September 2020

Context: The Aspiring DOctors PreCollege Program at the Ohio University Heritage College of Osteopathic Medicine Cleveland Campus is unique among other precollege pipeline and mini-medical school programs in that it engages learners from urban underserved communities for an entire academic year as a cocurricular adjunct to their high school course load. One day per month, students are brought to the medical college campus and introduced to the field of osteopathic medicine. Students also participate in activities related to preparing for college admissions, diversity in higher education, mental health and wellness, and financial stewardship. All these activities are done with the goal of increasing the number of underrepresented minority (URM) students in the health care professions. Objective: Self-efficacy has been identified as a measure of internal motivation and belief in one’s ability to succeed in the face of challenges. The purpose of this study is to determine what effect, if any, participation in this program has on URM student self-efficacy. Methods: Students were asked to complete a validated self-efficacy questionnaire at the start and end of this program to determine their levels of self-efficacy and if there were changes after participating in this program. Results: Ten of the 12 seniors completed pre- and post-self-efficacy surveys. Two main discoveries were made through this pilot. First, when tested at the beginning of the program, all students had high levels of self-efficacy (mean score, 4.45 of 5). Second, 2 items were specifically increased by a statistically significant amount. The students increased in self-efficacy concerning the responses “I can learn what is being taught in class this year” ( P = .024) and “My ability grows with effort” ( P = .015). Conclusions: With the competitive standards of acceptance into the Aspiring DOctors PreCollege Program, students enrolled in this program had high levels of self-efficacy from the onset. While there was modest increase across the board, many of these indicators remained consistently high after the program. Using self-efficacy as a screening tool for premedical students may be helpful in identifying candidates likely to succeed in a future medical career.
Endogenous Endophthalmitis: Recommendation for Empiric Dual Antibacterial and Antifungal Therapy
Authors: Amarasekera Sohani , Doss Mallika , Banaee Touka , Kowalski Regis P. , Eller Andrew W. 
Published: September 2020

Purpose: This work compares clinical presentation and course of bacterial and fungal causes of endogenous endophthalmitis (EE). Methods: A single-institutional study of consecutive patients diagnosed with EE was conducted at the University of Pittsburgh Medical Center between September 2015 and September 2018. Exclusion criteria included history of ocular trauma, intraocular surgery or injection 6 months before presentation, or primary external ocular infection. Data included demographics, medical and ocular history, clinical examination, culture data, therapeutic interventions, final corrected visual acuity (VA), and mortality. Results: Thirty-six eyes of 26 patients were diagnosed with EE during a 3-year period. Median age at diagnosis was 55.5 years (range, 19-86 years). Based on ocular and systemic cultures, 19 patients had bacterial EE and 6 patients had fungal EE; findings from all cultures remained negative in 1 patient. All patients had risk factors for EE. Presenting VA, subjective symptom report, and objective measures of intraocular inflammation were similar between bacterial and fungal causes. Overall, EE presented indolently and was initially misdiagnosed in 19% of cases. Complications including final VA less than 20/200, retinal detachment, enucleation, or death within 6 months of diagnosis were equivalent between bacterial and fungal cases. Conclusions: The presentation of EE is remarkably different from that of exogenous endophthalmitis. Without a high index of suspicion, the indolent presentation of EE may lead to misdiagnosis. No clinical features reliably differentiated bacterial and fungal sources. This highlights the importance of considering empiric therapy for antibacterial and antifungal coverage on initial presentation.