bluuebunny/crossref_metadata_2025_split huggingface dataset:
Skin Preparation Techniques for Orthopedic Foot and Ankle Surgery: A Current Concepts Review
Authors: Mehraban Nasima , Holmes George B. , Lin Johnny , Lee Simon , Hamid Kamran S. , Bohl Daniel D. 
Published: June 2020

Surgical site infection (SSI) following orthopedic foot and ankle surgery is associated with morbidity, mortality, and cost to the healthcare system. The local anatomy and physiology predispose patients undergoing procedures to elevated risk. In particular, sterilizing of the webspaces, nailfolds, and subungual areas presents challenges, and the preferred skin antisepsis technique for foot and ankle procedures has not yet been defined. Skin antiseptic solutions (SASs) consist of 3 main categories: alcohol, chlorhexidine, and iodine-based solutions. This review of the literature supports a combined chlorhexidine and alcohol preparation technique; however, there are a number of studies that suggest otherwise. In addition, there is variable evidence for the use of alternatives to the standard soft sponge application technique, including immersion, bristled brush, and cotton gauze application. These alternatives may have a particular advantage in the forefoot. Most studies to date use growth from skin swab cultures after skin preparation as the primary outcome. Higher-level studies with large subject populations and more meaningful clinical outcomes will be required to solidify guidelines for preoperative skin antisepsis prior to foot and ankle procedures. Level of Evidence: Level V, expert opinion.
Randomised clinical study of the impact of routine preoperative Doppler ultrasound for the outcome of autologous arteriovenous fistulas for haemodialysis
Authors: Lopes Jocefábia Reika Alves , Marques Ana Lígia de Barros , Correa João Antonio 
Published: June 2020

Background: Arteriovenous fistulas are the gold standard of vascular accesses in haemodialysis; however, they have a considerable primary failure rate. This study evaluated the comparative reliability of routine preoperative Doppler ultrasound with an isolated physical examination of autologous arteriovenous fistulas within the Single Health System of Brazil and analysed the potential clinical benefit, improvement in primary failure rates and its economic impact. Methods: A non-blind randomised clinical study group of patients undergoing a vessel mapping with preoperative Doppler ultrasound (ultrasound group) and a control group who had undergone only a physical examination (clinical group) before the vascular procedures was performed. The role of the arteriovenous fistula in dialysis and possible alterations was evaluated in both the groups and followed up for 6 months. Results: Of the initial 248 eligible patients, there was a randomisation of 230 patients, 228 of whom were submitted for surgery, 114 in each group. In the clinical group, a significantly higher rate of primary failure was recorded, with 13.6% versus 4.4% in the ultrasound group ( p = 0.002). The Kaplan–Meier curve with log-rank analysis showed a significantly higher primary patency in the ultrasound group ( p = 0.042). Regarding the cost-effectiveness of the use of Doppler ultrasound, there was no increase in the final cost compared to the physical examination (US$1.28/fistula day × US$1.29/fistula day). Conclusion: It was concluded that Doppler ultrasound contributed to the reduction of primary failure, leading to a significantly superior primary patency of arteriovenous fistulas, and no increase in the final cost. This justifies its routine preoperative use in the Single Health System. Registration number RBR-474xhn ( http://www.ensaiosclinicos.gov.br ).
Atypical visual-auditory predictive coding in autism spectrum disorder: Electrophysiological evidence from stimulus omissions
Authors: van Laarhoven Thijs , Stekelenburg Jeroen J , Eussen Mart LJM , Vroomen Jean 
Published: June 2020

Autism spectrum disorder is a pervasive neurodevelopmental disorder that has been linked to a range of perceptual processing alterations, including hypo- and hyperresponsiveness to sensory stimulation. A recently proposed theory that attempts to account for these symptoms, states that autistic individuals have a decreased ability to anticipate upcoming sensory stimulation due to overly precise internal prediction models. Here, we tested this hypothesis by comparing the electrophysiological markers of prediction errors in auditory prediction by vision between a group of autistic individuals and a group of age-matched individuals with typical development. Between-group differences in prediction error signaling were assessed by comparing event-related potentials evoked by unexpected auditory omissions in a sequence of audiovisual recordings of a handclap in which the visual motion reliably predicted the onset and content of the sound. Unexpected auditory omissions induced an increased early negative omission response in the autism spectrum disorder group, indicating that violations of the prediction model produced larger prediction errors in the autism spectrum disorder group compared to the typical development group. The current results show that autistic individuals have alterations in visual-auditory predictive coding, and support the notion of impaired predictive coding as a core deficit underlying atypical sensory perception in autism spectrum disorder. Lay abstract Many autistic individuals experience difficulties in processing sensory information (e.g. increased sensitivity to sound). Here we show that these difficulties may be related to an inability to process unexpected sensory stimulation. In this study, 29 older adolescents and young adults with autism and 29 age-matched individuals with typical development participated in an electroencephalography study. The electroencephalography study measured the participants’ brain activity during unexpected silences in a sequence of videos of a handclap. The results showed that the brain activity of autistic individuals during these silences was increased compared to individuals with typical development. This increased activity indicates that autistic individuals may have difficulties in processing unexpected incoming sensory information, and might explain why autistic individuals are often overwhelmed by sensory stimulation. Our findings contribute to a better understanding of the neural mechanisms underlying the different sensory perception experienced by autistic individuals.
Perceptions of intensive care unit nurses of therapeutic futility: A scoping review
Authors: Vieira João V. , Deodato Sérgio , Mendes Felismina 
Published: June 2020

Introduction Intensive care units are contexts in which, due to the remarkable existence of particularly technological resources, interventions are promoted to extend the life of people who experience highly complex health situations. This ability can lead to a culture of death denial where the possibility of implementing futile care and treatment cannot be excluded. Objective To describe nurses’ perceptions of adult intensive care units regarding the therapeutic futility of interventions implemented to persons in critical health conditions. Method Review of the literature following the Scoping Review protocol of the Joanna Briggs Institute. The Population, Concept, and Context mnemonic was used to elaborate the research question and the research was performed using the EBSCOHost search engine in the CINAHL Complete databases, MEDLINE Complete, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews to identify studies published between 1990 and 2019. Seven studies were selected. Results Nurses consider that therapeutic futility, a current problem in adult intensive care units, may have a negative impact on persons in critical health conditions and that contributes directly to resource expenditure and moral conflicts and consequently leads to emotional exhaustion. Conclusion Due to the complexity of this concept, knowing and understanding people’s and families’ perceptions is crucial to the decision-making process, for which reason nurses can play a key role in managing these situations.
The odd malaise of democratic education: Horace Mann, Amy Gutmann and the inordinate influence of business
Authors: Ford Brian 
Published: June 2020

This article is the third of three on “Sources of Authority in Education.” All use the work of Amy Gutmann as a heuristic device to describe and explain the prevalence of market-based models of education reform in the US and the business-influenced Global Education Reform Movement. The other two are “Negating Amy Gutmann: Deliberative Democracy, Business Influence and Segmentation Strategies in Education” and “Neoliberalism and Four Spheres of Authority in American Education: Business, Class, Stratification and Intimations of Marketization.” All three are intended to be included together as chapters of my Democratic Education and Markets: Segmentation, Privatization and Sources of Authority in Education Reform. The “Negating Amy Gutmann” article looks primarily at deliberative democracy. The “Neoliberalism and Four Spheres of Authority” article, considers its main theme to be the promise of egalitarian democracy and how figures ‘such as Horace Mann, John Dewey and Gutmann’ have argued it is largely based on the promise of public education. It thus begins with a consideration of what might be called a partial historical materialist analysis – the growth of inequality in the US (and other countries) since the 1970s that correlates with much of the basis for changes in the justifications and substance of education reform. The present article, “The Odd Malaise of Democratic Education and the Inordinate Influence of Business,” continues the argument by offering some historical background and comparisons and ends by considering what happens to the philosophy of education when democracy and capitalism are at odds. It thus starts with recent history, looking at how the content and context of educational policy have changed in the US since Gutmann wrote in the 1980s. Specifically, it concerns itself with the increasing prevalence of twin notions: that our system of education must be reformed because of global competition and that the educational system should emulate the market. The article then goes back a little bit further, to the origins of the common school in the 1600s and Horace Mann’s articulation of the principles behind public education, which are shown to be in stark contrast to Education Reform. The narrative describes how the standards movement, variously, coalesced around George H. W. Bush’s America 2000 and Bill Clinton’s Goals 2000 programs, was reflected in a ‘21st-century schools’ discourse, found programmatic form in George W. Bush’s No Child Left Behind and it’s offspring, Arne Duncan’s Race to the Top. All of the preceding were, to a shocking degree, based on misleading and selective statistical analysis and sets goals that are unreachable even in the best of all possible worlds. The article concludes by considering paradigm change in education and its causes; I draw on both Peter Hall’s exposition of social learning 1 and Antonio Gramsci’s conceptualization of hegemony. 2
Evaluating an inpatient deprescribing initiative at a rural community hospital in Ontario
Authors: Gazarin Mohamed , Devin Brian , Tse Darren , Mulligan Emily , Naciuk Mary , Duncan Simon , Burnett Sean , Hall Lynn , Elbeddini Ali 
Published: June 2020

Background: Deprescribing is an effective means to reduce polypharmacy in elderly patients. However, geriatric day care deprescribing services are challenging to implement in rural regions. In this study, we examined whether a subacute care unit of a rural hospital could deliver a comprehensive and multidisciplinary intervention to promote deprescribing in patients and whether this intervention would succeed in achieving significant and lasting deprescribing results. Methods: We conducted a cross-sectional analysis of a deprescribing program at a rural hospital in Eastern Ontario, Canada. Participants were 11 patients, aged 65 or older, who were admitted to the hospital’s medical/surgical unit or who presented to the emergency department. Clinicians followed a structured, comprehensive and multidisciplinary approach designed to facilitate deprescribing, which concluded with an outcome evaluation at discharge and follow-up phone calls. Outcomes included the frequency and total number of medications successfully removed, reduced, substituted and restarted after discharge and emergency department visits and hospitalizations 6 months before and after the intervention. Results: Of a total 57 deprescribed medications, 38 were eliminated, 8 were switched to a safer alternative, and 11 were dose reduced. Postdischarge deprescribing reversal occurred in only 5 of 57 deprescribed medications. Among the study population, a 59.2% reduction was observed in the combined number of emergency department visits and hospitalizations 6 months after deprescribing. Conclusions: This feasibility study was successful in showing the potential added value for offering a rehabilitative, subacute care, inpatient, comprehensive and multidisciplinary approach toward patients with complex deprescribing needs. It also showed proof of concept in reducing polypharmacy-induced adverse health outcomes. Can Pharm J (Ott) 2020:153:xx-xx.
The landscape of gene mutations and clinical significance of tumor mutation burden in patients with soft tissue sarcoma who underwent surgical resection and received conventional adjuvant therapy
Authors: Xu Li-Bin , Zhao Zhen-Guo , Xu Song-Feng , Zhang Xin-Xin , Liu Ting , Jing Chang-You , Zhang Shu-Guang , Yu Sheng-Ji 
Published: June 2020

Background The aim of this study was to evaluate the landscape of gene mutations and the clinical significance of tumor mutation burden (TMB) in patients with soft tissue sarcoma who underwent surgical resection and received conventional adjuvant therapy. Methods A total of 68 patients with soft tissue sarcoma were included. Postoperative tumor tissue specimens from the patients were collected for DNA extraction. Targeted next-generation sequencing of cancer-relevant genes was performed for the detection of gene mutations and the analysis of TMB. Univariate analysis between TMB status and prognosis was carried out using the Kaplan–Meier survival analysis, and multivariate analysis was adjusted by the Cox regression model. Results No specific genetic mutations associated with soft tissue sarcoma were found. The mutation frequency of TP53, PIK3C2G, NCOR1, and KRAS of the 68 patients with soft tissue sarcoma were observed in 19 cases (27.94%), 15 cases (22.06%), 14 cases (20.59%), and 14 cases (20.59%), respectively. With regard to the analysis of TMB, the overall TMB of the 68 patients with soft tissue sarcoma was relatively low (median: 2.05 per Mb (range: 0∼15.5 per Mb)). Subsequently, TMB status was divided into TMB-Low and TMB-Middle according to the median TMB. Patients with TMB-Low and TMB-Middle were 37 cases (54.41%) and 31 cases (45.59%), respectively. Overall survival analysis indicated that the median overall survival of patients with TMB-Low and TMB-Middle was not reached, and 4.5 years, respectively ( P=0.015). Conclusion This study characterizes the genetic background of patients with STS soft tissue sarcoma. The TMB was of clinical significance for patients with soft tissue sarcoma who underwent surgical resection and received conventional adjuvant therapy.
Sonographers’ level of autonomy in communication in Australian obstetric settings: Does it affect their professional identity?
Authors: Thomas Samantha , O’Loughlin Kate , Clarke Jill 
Published: June 2020

Introduction Unlike the United Kingdom, policies in Australia prevent sonographers from exercising autonomy in their level of communication with pregnant patients in the event of adverse findings. The organisational structure makes the sonographer dependent on the sonologist because sonographers do not have the authority to provide the official report. The emotional labour on sonographers is increased as they struggle to provide patient-centred care, given the limits put on their communication during the ultrasound examination. The aim of this study was to explore Australian sonographers’ views on communicating adverse findings, including their level of autonomy in communicating with patients and how this influences their sense of professional identity. Methods Following a national survey, seven purposively selected participants, who were qualified to perform obstetric ultrasound examinations, completed follow-up interviews. The interviews were thematically analysed with iterative comparison to the survey results. Three case studies show sonographers differed in their ‘communicator type’ due to geographical location and workplace setting. Results The case studies illustrate a sonographer’s communication role, and level of autonomy is negotiated/renegotiated depending on the needs and expectations of each workplace. Their communication practices varied due to the sonologist (radiologist/obstetrician) policy on sonographer/patient communication, presence and support in the clinical setting. A strong professional identity and level of autonomy came from the construction of attributes that were built over time based on multiple factors, including previous experience, geographical location, critical incidents, training and supportive work environments. Conclusion The sonography profession demands autonomy and a strong professional identity free of hierarchical barriers within a collaborative model of care.
A novel combined anorectal biofeedback and percutaneous tibial nerve stimulation protocol for treating fecal incontinence
Authors: Mazor Yoav , Prott Gillian M. , Sequeira Carol , Jones Michael , Ejova Anastasia , Kellow John E. , Schnitzler Margaret , Malcolm Allison 
Published: June 2020

Background/Aims: Fecal incontinence (FI) is a common, debilitating condition that causes major impact on quality of life for those affected. Non-surgical treatment options include anorectal biofeedback therapy (BF) and percutaneous tibial nerve stimulation (PTNS), usually performed separately. The aims of the current study were to determine the feasibility, tolerability, safety, and efficacy of performing a combined BF and PTNS treatment protocol. Methods: Female patients with urge FI were offered a novel pilot program combining BF with PTNS. The treatment protocol consisted of 13 weekly sessions: an educational session, followed by 5 combined BF and PTNS sessions, 6 PTNS and a final combined session. Anorectal physiology and clinical outcomes were assessed throughout the program. For efficacy, patients were compared with BF only historical FI patients matched for age, parity, and severity of symptoms. Results: A total of 12/13 (93%) patients completed the full program. Overall attendance rate was 93% (157/169 sessions). Patient comfort score with treatment was rated high at 9.8/10 (SD 0.7) for PTNS and 8.6/10 (SD 1.7) for the BF component. No major side effects were reported. A reduction of at least 50% in FI episodes/week was achieved by 58% of patients by visit 6, and 92% by visit 13. No physiology changes were evident immediately following PTNS compared with before, but pressure during sustained anal squeeze improved by the end of the treatment course. Comparing outcomes with historical matched controls, reductions in weekly FI episodes were more pronounced in the BF only group at visit 6, but not week 13. Conclusions: In this pilot study, concurrent PTNS and anorectal biofeedback therapy has been shown to be feasible, comfortable, and low risk. The combined protocol is likely to be an effective treatment for FI, but future research could focus on optimizing patient selection.
Patient Controlled, Off-label Use of Continuous Glucose Monitoring: Real-World Medical Costs and Effects of Patient Controlled Sensor Augmented Pump Therapy in Adult Patients Type 1 Diabetes
Authors: Hidefjäll Patrik , Berg Lars 
Published: June 2020

Background: Continuous glucose monitoring (CGM) has shown promise to reduce glycated hemoglobin (HbA1c) levels, but its cost-effectiveness is seen as uncertain by reimbursement agencies. The aim of this study was to explore the impact of real-world, off-label, patient controlled CGM use in combination with continuous subcutaneous insulin infusion (CSII) on costs and effects in patients with type 1 diabetes in a Swedish clinic. Methods: A real-world, retrospective study with questionnaire on CGM use by adult patients with type 1 diabetes on CSII (Animas Vibe) were offered sensor augmented pump therapy (SAPT) (Dexcom G4) as part of hospital innovation funding program. Direct medical costs, HbA1c, and complications following switch from CSII with self-monitoring of blood glucose (SMBG) to SAPT were calculated. Results: Questionnaire data showed that CGM sensors were on average used 92% of the time for 22 days. One hundred and thirty-nine (95%) of 146 respondents used each sensor for longer than one week. Data analysis showed a statistically significant HbA1c decrease of 0.56% (6.1 mmol/mol) after change to SAPT. In patients using the sensor 100%, the decrease was 0.89% (9.8 mmol/mol). The analysis showed that SAPT led to higher costs (5500 USD/year) than CSII + SMBG (3680 USD/year), with incremental costs being 1815 USD per year to achieve an HbA1c decrease of 0.56% (6.1 mmol/mol). The incidence of all complications declined after switch to SAPT. Conclusion: The primary data analysis showed a decrease in HbA1c values following switch to SAPT, corresponding to previous cost-effectiveness studies, but at substantially lower costs due to longer sensor off-label use.
Whole-Body Metabolism, Carbohydrate Utilization, and Caloric Energy Balance After Sport Concussion: A Pilot Study
Authors: Walton Samuel R. , Malin Steven K. , Kranz Sibylle , Broshek Donna K. , Hertel Jay , Resch Jacob E. 
Published: June 2020

Background: Sport concussion (SC) causes an energy crisis in the brain by increasing energy demand, decreasing energy supply, and altering metabolic resources. Whole-body resting metabolic rate (RMR) is elevated after more severe brain injuries, but RMR changes are unknown after SC. The purpose of this study was to longitudinally examine energy-related changes in collegiate athletes after SC. Hypothesis: RMR and energy consumption will increase acutely after SC and will return to control levels with recovery. Study Design: Case-control study. Level of Evidence: Level 4. Methods: A total of 20 collegiate athletes with SC (mean age, 19.3 ± 1.08 years; mean height, 1.77 ± 0.11 m; mean weight, 79.6 ± 23.37 kg; 55% female) were compared with 20 matched controls (mean age, 20.8 ± 2.17 years; mean height, 1.77 ± 0.10 m; mean weight, 81.9 ± 23.45 kg; 55% female). RMR, percentage carbohydrate use (%CHO), and energy balance (EBal; ratio between caloric consumption and expenditure) were assessed 3 times: T1, ≤72 hours after SC; T2, 7 days after T1; and TF, after symptom resolution. A 2 × 2 × 3 (group × sex × time) multivariate analysis of variance assessed RMR, %CHO, and EBal. Changes in RMR, %CHO, and EBal (T1 to TF) were correlated with days to symptom-free and days to return to play in the concussed group. Results: Women reported being symptom-free (median, 6 days; range, 3-10 days) sooner than men (median, 11 days; range, 7-16 days). RMR and %CHO did not differ across time between groups or for group × sex interaction. SC participants had higher EBal than controls at T1 ( P = 0.016) and T2 ( P = 0.010). In men with SC, increasing %CHO over time correlated with days to symptom-free ( r = 0.735 and P = 0.038, respectively) and days to return to play ( r = 0.829 and P = 0.021, respectively). Conclusion: Participants with SC were in energy surplus acutely after injury. Although women recovered more quickly than men, men had carbohydrate metabolism changes that correlated with recovery time. Clinical Relevance: This pilot study shows that male and female student-athletes may have differing physiologic responses to SC and that there may be a role for dietary intervention to improve clinical outcomes after SC.