bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spending on Children across Four Countries: Variation in the Role of Income and Women’s Labor Force Participation
Authors: Kornrich Sabino , Ruppanner Leah , Lappegård Trude 
Published: November 2019

Abstract
Scholars have recently documented inequalities in parents’ spending on children in the United States. This article situates these trends cross-nationally by using expenditure data from the United States, Australia, Spain, and Norway. The article investigates differences across countries in the links between household income, female labor force participation, and spending on children. The links between income, female labor force participation, and spending are largest in the United States and smallest in Norway, while Spain and Australia are intermediate cases, suggesting that public provision lessens inequalities in parental spending on children.
Accreditation of Canadian Undergraduate Medical Education Programs: A Study of Measures of Effectiveness
Authors: Blouin Danielle 
Published: November 2019

Purpose
Undergraduate medical education (UME) programs participate in accreditation with the belief that it contributes to improving UME quality and, ultimately, patient care. Linkages between accreditation and UME quality are incomplete. Previous studies focused on student performance on national examinations, medical school processes, medical school’s organizational culture types, and degree of implementation of quality improvement activities as markers of the effectiveness of accreditation. The current study sought to identify new indicators of accreditation effectiveness, to better understand the value and impact of accreditation.

Method
This qualitative study used an expert-oriented evaluation approach to identify novel markers of accreditation effectiveness. From March 2015 to March 2016, leaders and teachers at 16 of the 17 Canadian UME programs were invited to participate in interviews and focus group discussions aimed at identifying measures of accreditation effectiveness. Themes were extracted using the method of constant comparative analysis.

Results
Sixty-three individuals from 13 (81%) medical schools participated. Eight themes were formulated: Student/graduate performance, UME program processes, quality assurance and continuous quality improvement, stakeholder satisfaction, stakeholder expectations, engagement, research, and UME program quality. The latter 5 themes have not been previously studied as measures of accreditation effectiveness. All themes appear applicable to accreditation of graduate medical education as well. A framework is proposed to guide future research on the impact of accreditation.

Conclusions
Eight themes were generated, representing direct and indirect indicators of the impact of accreditation. The themes are integrated into a framework proposed to guide future research on the value of accreditation along the continuum of medical education.
Reporting Quality Analysis of Randomized Controlled Trials in Journal of Neurosurgical Anesthesiology: A Methodological Assessment
Authors: Kim Soo Yeon , Kim Kyu Nam , Kim Dong Won , Kang Mi Sun 
Published: November 2019

Background:
Randomized controlled trials (RCTs) are considered to provide high levels of evidence to optimize decision-making for patient care, although there can be a risk bias in their design, conduct, and analysis. Quality assessment of RCTs is necessary to assess whether they provide reliable results with little bias.

Materials and Methods:
We assessed the reporting quality of RCTs published in the Journal of Neurosurgical Anesthesiology (JNA) between January 1, 2000 and December 31, 2017 using the Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool (CCRBT).

Results:
We identified 130 RCTs and 570 original articles. Among the 130 RCTs, 92 (70.8%) presented an appropriate blinding method, and 70 (53.8%) described an appropriate allocation method. For the entire period, the percentages of high-quality reporting articles were 71.5%, 73.1%, and 13.8% in the Jadad scale, van Tulder scale, and CCRBT assessments, respectively. There was an improvement in the van Tulder scale over time (coefficients [95% confidence interval {CI}]=0.08 [0.01-0.15]; P=0.02). Appropriate reporting of allocation in the Jadad scale (coefficients [95% CI]=1.68 [1.28-2.07]; P<0.001) and van Tulder scale (coefficients [95% CI]=2.34 [1.97-2.70]; P<0.001), and reporting of blinding in the Jadad (coefficients [95% CI]=1.09 [0.66-1.52]; P<0.001) and van Tulder scores (coefficients [95% CI]=1.85 [1.45-2.25]; P<0.001), were associated with high-quality reporting.

Conclusions:
The ratio of high-quality reporting RCTs in JNA was consistently high compared with other journals. Thorough consideration of allocation concealment during the peer review process can further improve the reporting quality of RCTs in JNA.
Stillbirth Associated With Infection in a Diverse U.S. Cohort
Authors: Page Jessica M. , Bardsley Tyler , Thorsten Vanessa , Allshouse Amanda A. , Varner Michael W. , Debbink Michelle P. , Dudley Donald J. , Saade George R. , Goldenberg Robert L. , Stoll Barbara , Hogue Carol J. , Bukowski Radek , Conway Deborah , Reddy Uma M. , Silver Robert M. 
Published: November 2019

OBJECTIVE:To better characterize infection-related stillbirth in terms of pathogenesis and microbiology.METHODS:We conducted a secondary analysis of 512 stillbirths in a prospective, multisite, geographically, racially and ethnically diverse, population-based study of stillbirth in the United States. Cases underwent evaluation that included maternal interview, chart abstraction, biospecimen collection, fetal autopsy, and placental pathology. Recommended evaluations included syphilis and parvovirus serology. Each case was assigned probable and possible causes of death using the INCODE Stillbirth Classification System. Cases where infection was assigned as a probable or possible cause of death were reviewed. For these cases, clinical scenario, autopsy, maternal serology, culture results, and placental pathology were evaluated.RESULTS:For 66 (12.9%) cases of stillbirth, infection was identified as a probable or possible cause of death. Of these, 36% (95% CI 35–38%) were categorized as a probable and 64% (95% CI 62–65%) as a possible cause of death. Infection-related stillbirth occurred earlier than non–infection-related stillbirth (median gestational age 22 vs 28 weeks,P=.001). Fetal bacterial culture results were available in 47 cases (71%), of which 35 (53%) grew identifiable organisms. The predominant species wereEscherichia coli(19, 29%), group B streptococcus (GBS) (8, 12%), and enterococcus species (8, 12%). Placental pathology revealed chorioamnionitis in 50 (76%), funisitis in 27 (41%), villitis in 11 (17%), deciduitis in 35 (53%), necrosis in 27 (41%), and viral staining in seven (11%) cases. Placental pathology found inflammation or evidence of infection in 65 (99%) cases and fetal autopsy in 26 (39%) cases. In infection-related stillbirth cases, the likely causative nonbacterial organisms identified were parvovirus in two (3%) cases, syphilis in one (2%) case, cytomegalovirus (CMV) in five (8%) cases, and herpes in one (2%) case.CONCLUSION:Of infection-related stillbirth cases in a large U.S. cohort,E coli, GBS, and enterococcus species were the most common bacterial pathogens and CMV the most common viral pathogen.
Trends in Use and Effect on Survival of Simple Hysterectomy for Early-Stage Cervical Cancer
Authors: Sia Tiffany Y. , Chen Ling , Melamed Alexander , Tergas Ana I. , Khoury-Collado Fady , Hou June Y. , St. Clair Caryn M. , Ananth Cande V. , Neugut Alfred I. , Hershman Dawn L. , Wright Jason D. 
Published: November 2019

OBJECTIVE:
To identify use and outcomes of simple hysterectomy compared with radical hysterectomy for women with early-stage cervical cancer.

METHODS:
The National Cancer Database was used to review the cases of women with stage IA2 and IB1 (2 cm or less) cervical cancer from 2004 to 2015. Patients were classified based on whether they underwent simple or radical hysterectomy. Survival was examined after propensity score weighting.

RESULTS:
Simple hysterectomy was performed in 44.6% of women with stage IA2 (n=1,530) and 35.3% of those with stage IB1 (n=3,931) tumors. Rates of simple hysterectomy increased from 37.8% to 52.7% from 2004 to 2014 for stage IA2 cancers and from 29.7% to 43.8% between 2004 and 2013 for stage IB1 cancers. For stage IA2 cancers, younger women and those treated at an academic medical center were less likely to undergo simple hysterectomy. For stage IB1 cancers, black women were more likely to undergo simple hysterectomy, and those treated at an academic medical center were less likely to undergo simple hysterectomy. After propensity score weighting, there was no association between route of hysterectomy and survival for stage IA2 cancers (hazard ratio [HR] 0.70, 95% CI 0.41–1.20, 5-year survival 95.1% for radical hysterectomy vs 97.6% for simple hysterectomy). For stage IB1 cancers, patients who underwent simple hysterectomy were at 55% increased risk of death (HR 1.55, 95% CI 1.18–2.03, and 5-year survival was 95.3% for radical hysterectomy vs 92.4% for simple hysterectomy).

CONCLUSION:
Although there was no association between surgical radicality and survival for women with stage IA2 tumors, there was a 55% increase in mortality for women with stage IB1 neoplasms who underwent simple compared with radical hysterectomy. Radical hysterectomy is the treatment of choice for women with stage IB1 cervical cancer.
All Disclosure is Good Disclosure
Authors: Iyer Sravisht , Yoo Joon S. , Jenkins Nathaniel W. , Parrish James M. , Khechen Benjamin , Haws Brittany E. , Nolte Michael T. , Brundage Thomas S. , Hrynewycz Nadia M. , Phillips Frank M. , Singh Kern 
Published: November 2019

Study Design:
This was a prospective study.

Objective:
To determine patient awareness of surgeon-industry relationships, how these relationships affect patient perceptions of surgeons, and which relationships cause the greatest concern to patients.

Summary of Background Data:
The prevalence of orthopedic surgeon-industry relationships led to the establishment of a national database of physician-industry interaction [Open Payments Database (OPD)] as part of the Physician Payments Sunshine Act (PPSA).

Materials and Methods:
A 10-item questionnaire was administered to patients before their first evaluation. Two questions asked about awareness of the surgeon’s industry relationships and of the OPD. One question evaluated the importance of surgeon-industry relationships of patients when choosing a provider. Six questions assessed patient perception of specific types of surgeon-industry relationships. Lastly, each patient ranked specific types of surgeon-industry relationships (1—most concerning to 6—least/not concerning). The distribution of patient-perceptions was compared using a Friedman 2-way analysis of variance by Ranks test. Distributions across awareness were compared using a Kruskal-Wallis test.

Results:
A total of 205 patients completed the survey. A majority of patients were unaware of their surgeons’ relationships with industry and the existence of the OPD. However, most patients considered surgeon-industry relationships an important, very important or most important part of choosing their physician. There were significant differences in how industry relationships affected patient perceptions. Research funding had the most positive impact on perception. Financial ownership was reported to be the most concerning relationship followed by royalty payments and consulting.

Conclusions:
Our results suggest that despite a lack of awareness, most patients consider surgeon-industry relationships an important factor in choosing their doctor. Patients generally report a more positive view of surgeons that have active relationships with industry. These results emphasize the value of disclosure for surgeons; it provides transparency and improves their standing amongst a majority of their patients.
Prognostic Significance of Nuclear Factor Kappa B Expression in Locally Advanced Cervical Cancer Patients Treated Definitively With Concurrent Chemoradiation
Authors: Altoos Basel , Small Christina , Dalal Prarthana , Attieh Darlene , El Achy Samar , Parimi Vamsi , Wei Jian-Jun , Helenowski Irene , Donnelly Eric D. , Strauss Jonathan , Small William , Refaat Tamer 
Published: November 2019

Objectives:
Nuclear factor kappa B (NFkB) is a transcription factor shown to confer treatment resistance in tumors. A previous report suggested an association between pretreatment NFkB and poorer outcomes for cervical cancer patients treated with chemoradiation therapy (CRT). We aimed to validate their findings in a larger patient cohort.

Materials and Methods:
This Institutional Review Board approved study included patients with locally advanced cervical cancer patients treated with CRT. Evaluation of both nuclear and cytoplasmic immunoreactivity for NFkB was scored semiquantitatively by 3 pathologists. Cytoplasmic positivity incorporated both the intensity and percentage of immunoreactivity in invasive carcinoma (H-score), whereas nuclear positivity was assessed by percentage of positive cells. Outcomes were stratified by NFkB overexpression and tumor characteristics. Overall survival (OS), progression-free survival (PFS), distant metastases-free survival (DMFS), and local regional control (LC) were obtained using Kaplan-Meier and differences between groups were evaluated by the log-rank test. Hazard ratios were obtained using Cox regression for both univariate and multivariate analyses.

Results:
The mean age was 51 years old and most (78.57%) had locally advanced disease. Five-year OS, PFS, LC, and DMFS in the entire cohort were 57.18% (confidence interval [CI], 34.06%-74.82%), 48.07% (CI, 25.50%-67.52%), 72.11% (CI, 49.96%-85.73%), and 62.85% (CI, 36.33%-80.82%), respectively. There was no significant association between NFkB expression (H-index ≥180) and 3-year and 5-year OS (P-value=0.34), PFS (P-value=0.21), LC (P-value=0.86), or DMFS (P-value=0.18).

Conclusions:
Our study demonstrated that cytoplasmic NFkB-p65 expression (H-index ≥180) was associated with a nonstatistically significant trend toward poor clinical outcomes in locally advanced cervical cancer patients treated definitively with CRT.
Alterations in pronociceptive and antinociceptive mechanisms in patients with low back pain: a systematic review with meta-analysis
Authors: McPhee Megan E. , Vaegter Henrik Bjarke , Graven-Nielsen Thomas 
Published: November 2019

Abstract
Altered pronociceptive and antinociceptive mechanisms are often implicated in painful conditions and have been increasingly studied over the past decade. For some painful conditions, alterations are well-established, but in populations with low back pain (LBP), there remains considerable debate whether these mechanisms are altered. The present systematic review aimed to address this issue by identifying studies assessing conditioned pain modulation (CPM) and/or temporal summation of pain (TSP) in patients with LBP, comparing with either a healthy control group or using a method with reference data available. Qualitative synthesis and quantitative meta-analysis of group differences were performed. For CPM and TSP, 20 and 29 original articles were eligible, with data for meta-analysis obtainable from 18 (1500 patients and 505 controls) and 27 (1507 patients and 1127 controls) studies, respectively. Most studies were of poor-to-fair quality with significant heterogeneity in study size, population, assessment methodology, and outcome. Nonetheless, CPM was impaired in patients with LBP compared with controls (standardized mean difference = −0.44 [−0.64 to −0.23], P < 0.001), and the magnitude of this impairment was related to pain chronicity (acute/recurrent vs chronic, P = 0.003), duration (R
S = −0.62, P = 0.006), and severity (R
S = −0.54, P = 0.02). Temporal summation of pain was facilitated in patients with LBP compared with controls (standardized mean difference = 0.50 [0.29-0.72], P < 0.001), and the magnitude of this facilitation was weakly related to pain severity (R
S= 0.41, P = 0.04) and appeared to be influenced by test modality (P < 0.001). Impaired CPM and facilitated TSP were present in patients with LBP compared with controls, although the magnitude of differences was small which may direct future research on the clinical utility.
Biomarkers for predicting central neuropathic pain occurrence and severity after spinal cord injury: results of a long-term longitudinal study
Authors: Gruener Hila , Zeilig Gabi , Gaidukov Evgeni , Rachamim-Katz Orna , Ringler Erez , Blumen Nava , Engel-Haber Einat , Defrin Ruth 
Published: November 2019

Abstract
Central neuropathic pain (CNP) after spinal cord injury (SCI) is debilitating and immensely impacts the individual. Central neuropathic pain is relatively resistant to treatment administered after it develops, perhaps owing to irreversible pathological processes. Although preemptive treatment may overcome this shortcoming, its administration necessitates screening patients with clinically relevant biomarkers that could predict CNP early post-SCI. The aim was to search for such biomarkers by measuring pronociceptive and for the first time, antinociceptive indices early post-SCI. Participants were 47 patients with acute SCI and 20 healthy controls. Pain adaptation, conditioned pain modulation (CPM), pain temporal summation, wind-up pain, and allodynia were measured above, at, and below the injury level, at 1.5 months after SCI. Healthy control were tested at corresponding regions. Spinal cord injury patients were monitored for CNP emergence and characteristics at 3 to 4, 6 to 7, and 24 months post-SCI. Central neuropathic pain prevalence was 57.4%. Central neuropathic pain severity, quality, and aggravating factors but not location somewhat changed over 24 months. Spinal cord injury patients who eventually developed CNP exhibited early, reduced at-level pain adaptation and CPM magnitudes than those who did not. The best predictor for CNP emergence at 3 to 4 and 7 to 8 months was at-level pain adaptation with odds ratios of 3.17 and 2.83, respectively (∼77% probability) and a cutoff value with 90% sensitivity. Allodynia and at-level CPM predicted CNP severity at 3 to 4 and 24 months, respectively. Reduced pain inhibition capacity precedes, and may lead to CNP. At-level pain adaptation is an early CNP biomarker with which individuals at risk can be identified to initiate preemptive treatment.
Implementation of an educational program to improve precepting skills
Authors: Fincham Sarah J. , Smith Todd , Purath Janet 
Published: November 2019

ABSTRACT

Background:
Educating health care providers is dependent on developing high-quality clinical preceptors, yet preceptors face widespread challenges to precepting, such as time constraints and lack of formal preceptor training.

Local problem:
Our college of nursing conducted a needs assessment survey of our preceptors to better understand the barriers to and incentives for precepting. Formal preceptor training was identified as an intervention to support preceptors.

Methods:
Based on survey responses and a literature review of best practices, a preceptor training program was developed and delivered to local health care partners. Posttraining surveys were used to measure the effectiveness of the training.

Intervention:
We developed a one-hour formal preceptor training program. The main components included 1) orienting a student, 2) applying the Recorder/Reporter-Interpreter-Manager-Educator (RIME) framework for clinical evaluation, 3) One-Minute Preceptor (OMP) methodology for clinical teaching, 4) strategies for giving students feedback, and 5) communicating with the university.

Results:
Preceptor training was delivered to health care providers (N = 58) at eight clinics and one nurse practitioner (NP) professional group. Most participants (86%) had never received training in the RIME framework or OMP method (80%). The participants rated the following aspects of training as very useful or moderately useful: Orientation checklist (100%), RIME framework (96%), and OMP (100%).

Conclusions:
We found that training preceptors on evidence-based, time-efficient strategies for precepting is feasible and valuable. If continued and expanded, this training may positively affect retention and recruitment of preceptors for our university's NP students. This training may be transferable to other geographical settings.
The preoperative platelet to albumin ratio predicts the prognosis of hepatocellular carcinoma patients without portal hypertension after liver resection
Authors: Li Chuan , Peng Wei , Zhang Xiao-Yun , Wen Tian-Fu , Chen Li-Ping 
Published: November 2019

Abstract
There is little information concerning the predictive ability of the preoperative platelet to albumin ratio (PAR) in hepatocellular carcinoma (HCC) patients after liver resection. In the current study, we aimed to assess the prognostic power of the PAR in HCC patients without portal hypertension (PH) following liver resection.
Approximately 628 patients were included in this study. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of the PAR for both recurrence-free survival (RFS) and overall survival (OS). Univariate and multivariate analyses were used to identify the independent risk factors for both RFS and OS.
During the follow-up period, 361 patients experienced recurrence, and 217 patients died. ROC curve analysis suggested that the best cut-off value of the PAR for RFS was greater than 4.8. The multivariate analysis revealed that microvascular invasion (MVI), tumor size >5 cm, high aspartate aminotransferase-to-platelet count ratio index (APRI) and high PAR were four independent risk factors for both RFS and OS. Patients with a low PAR had significantly better RFS and OS than those with a high PAR.
The PAR may be a useful marker to predict the prognosis of HCC patients after liver resection. HCC patients with a high preoperative PAR had a higher recurrent risk and lower long-term survival rate than those with a low preoperative PAR.
Consensus Definition of Muscle Tightness From Multidisciplinary Perspectives
Authors: Bhimani Rozina , Gaugler Joseph E. , Felts Jill 
Published: November 2019

BackgroundMuscle tightness is a complex ailment that affects quality of life in people who experience it. Muscle tightness is not clearly defined by the National Library of Medicine, which creates confusion in clinical practice.ObjectivesThe purpose of this study was to identify the attributes of muscle tightness from expert clinicians’ perception and develop a consensus definition from multidisciplinary perspectives.MethodsThis nonintervention study employed semistructured interviews using qualitative design. Twelve multidisciplinary expert clinicians participated in the study.ResultsThe results indicate that limited range of motion is a key feature of muscle tightness; however, there are six other attributes: loss of function, changes in muscle texture, change in sensation, asymmetry, pain, and contracted muscle state. These attributes are largely subjective and are interrelated.DiscussionThe new definition captures the multiple domains of muscle tightness. Lack of a standardized tool is a challenge, particularly when subjective assessments require patients’ input. Development of such a tool to measure muscle tightness is advocated.
The Monocle Sign in FDG-PET
Authors: Orita Erika , Meerwein Christian M. , Pizzuto Daniele A. , Stolzmann Paul , Huellner Martin W. 
Published: November 2019

Abstract
We report three cases of unilateral 18F-FDG uptake in the orbicularis oculi muscle in subjects with contralateral peripheral facial nerve palsy. We argue that this asymmetric uptake pattern in fact reflects lack of metabolism on the side affected by facial nerve palsy, owing to denervation. Since the unilateral periorbital uptake resembles a monocle, we chose to call this finding the monocle sign. The monocle sign should not be confused with inflammation or tumor, but should prompt a neurological assessment for facial nerve palsy and a potential underlying disease.