bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of for-profit hospital ownership status with intracranial hemorrhage outcomes and cost of care
Authors: Chiu Ryan G. , Murphy Blake E. , Rosenberg David M. , Zhu Amy Q. , Mehta Ankit I. 
Published: December 2019

OBJECTIVEMuch of the current discourse surrounding healthcare reform in the United States revolves around the role of the profit motive in medical care. However, there currently exists a paucity of literature evaluating the effect of for-profit hospital ownership status on neurological and neurosurgical care. The purpose of this study was to compare inpatient mortality, operation rates, length of stay, and hospital charges between private nonprofit and for-profit hospitals in the treatment of intracranial hemorrhage.METHODSThis retrospective cohort study utilized data from the National Inpatient Sample (NIS) database. Primary outcomes, including all-cause inpatient mortality, operative status, patient disposition, hospital length of stay, total hospital charges, and per-day hospital charges, were assessed for patients discharged with a primary diagnosis of intracranial (epidural, subdural, subarachnoid, or intraparenchymal) hemorrhage, while controlling for baseline demographics, comorbidities, and interhospital differences via propensity score matching. Subgroup analyses by hemorrhage type were then performed, using the same methodology.RESULTSOf 155,977 unique hospital discharges included in this study, 133,518 originated from private nonprofit hospitals while the remaining 22,459 were from for-profit hospitals. After propensity score matching, mortality rates were higher in for-profit centers, at 14.50%, compared with 13.31% at nonprofit hospitals (RR 1.09, 95% CI 1.00–1.18; p = 0.040). Surgical operation rates were also similar (25.38% vs 24.42%; RR 0.96, 95% CI 0.91–1.02; p = 0.181). Of note, nonprofit hospitals appeared to be more intensive, with intracranial pressure monitor placement occurring in 2.13% of patients compared with 1.47% in for-profit centers (RR 0.69, 95% CI 0.54–0.88; p < 0.001). Discharge disposition was also similar, except for higher rates of absconding at for-profit hospitals (RR 1.59, 95% CI 1.12–2.27; p = 0.018). Length of stay was greater among for-profit hospitals (mean ± SD: 7.46 ± 11.91 vs 6.50 ± 8.74 days, p < 0.001), as were total hospital charges ($141,141.40 ± $218,364.40 vs $84,863.54 ± $136,874.71 [USD], p < 0.001). These findings remained similar even after segregating patients by subgroup analysis by hemorrhage type.CONCLUSIONSFor-profit hospitals are associated with higher inpatient mortality, lengths of stay, and hospital charges compared with their nonprofit counterparts.
Cognitive outcomes after unruptured intracranial aneurysm treatment with flow diversion
Authors: Wagner Kathryn , Srivatsan Aditya , Mohanty Alina , Srinivasan Visish M. , Saleem Yasir , Cherian Jacob , James Robert F. , Chen Stephen , Burkhardt Jan-Karl , Johnson Jeremiah , Kan Peter 
Published: December 2019

OBJECTIVEFlow diversion is increasingly used to treat a variety of intracranial aneurysms with good safety and efficacy; however, there is some evidence that this treatment is associated with a larger postoperative ischemic burden on imaging than that with other traditional endovascular modalities. These findings typically do not manifest as neurological deficits, but any subtle effects on cognition remain unknown. In this study, the authors describe the neurocognitive performance of a cohort of patients with unruptured intracranial aneurysms (UIAs) before and after treatment with flow diversion. This is the first report of cognitive outcomes following aneurysm treatment with flow diversion.METHODSThe authors prospectively collected data on cognitive function using the Montreal Cognitive Assessment (MoCA) tool in patients with UIAs who were undergoing endovascular aneurysm treatment with flow diversion between June 2017 and July 2019. Patients completed the MoCA prior to intervention, at the 1-month follow-up after treatment, and again at 6 months after the procedure. All patients with UIAs treated with flow diversion were included regardless of age, aneurysm location, or morphology, unless their functional status precluded completion of the MoCA instrument. A repeated-measures linear mixed-effects model was used to compare preintervention and postintervention cognitive status at the time intervals outlined.RESULTSFifty-one patients with 61 aneurysms underwent endovascular aneurysm treatment with flow diversion (mean age 52.5 years, 90.2% females). There was no difference between baseline and postprocedure MoCA scores at any time interval (p > 0.05). The MoCA scores at baseline, 1 month postprocedure, and 6 months postprocedure were 26.1, 26.2, and 26.6, respectively. There was also no difference between pre- and postprocedure scores on any individual domain of the instrument (visuospatial, naming, attention, language, abstraction, delayed recall, and orientation) at any time interval (p > 0.05). Thirty-four patients had follow-up MRI or CT imaging, 5 of whom showed radiographic changes or ischemia. All patients with follow-up clinical evaluation had a 6-month modified Rankin Scale score ≤ 2.CONCLUSIONSFlow diversion is increasingly used in the treatment of intracranial aneurysms. This study suggests that this treatment may not alter neurocognitive function. Larger patient samples and longer follow-ups with other tests of cognitive functions are needed to confirm these findings.
For the further training of individuals in neurosurgery II: the academic legacy of the William P. Van Wagenen Fellowship
Authors: Ormond D. Ryan , Abozeid Mohab , Kurpad Shekar , Haines Stephen J. 
Published: December 2019

OBJECTIVEWilliam P. Van Wagenen pursued a research fellowship in Europe early in his career under the recommendation of Harvey Cushing. Later, Van Wagenen would be instrumental in the establishment of the William P. Van Wagenen Fellowship, a postgraduate fellowship for neurosurgeons from the AANS that requires study outside of a fellow’s country of residency training with plans to return to academic practice.METHODSSince 1968, 54 Van Wagenen Fellowships have been awarded, sending 54 fellows from 31 institutions to 13 different countries. The academic productivity of fellows was studied to determine the academic “return on investment” of the fellowship.RESULTSAlmost all fellows have spent some time in academic neurosurgery (94%), with the vast majority remaining in academics for their entire career (87%); 52% of fellows have received NIH funding, and 55% have been promoted to professor. The numbers are even more striking for the first half of Van Wagenen Fellows (who received the fellowship from its inception in 1968 to 1994) with at least 25 years of career development who remained in academics: 65% received NIH funding, 86% were promoted to professor, and 62% became chairs of academic departments. The Hirsch index of fellows, defined as h papers from an individual with at least h citations, is higher than the national mean and median values for academic neurosurgeons at every academic rank. Fellows have served on national committees and as AANS and CNS presidents and have given back financially to the Neurosurgery Research and Education Foundation (NREF) to fund future research activities of neurosurgical residents and young faculty.CONCLUSIONSThe Van Wagenen Fellowship will continue to provide young neurosurgeons with opportunities to pursue novel research and network with peers internationally and to motivate young neurosurgeons to transform neurosurgery. The legacy of Cushing and Van Wagenen continues today through the Van Wagenen Fellowship, a legacy that will only continue to grow.
Stimulated Raman histology for rapid and accurate intraoperative diagnosis of CNS tumors: prospective blinded study
Authors: Eichberg Daniel G. , Shah Ashish H. , Di Long , Semonche Alexa M. , Jimsheleishvili George , Luther Evan M. , Sarkiss Christopher A. , Levi Allan D. , Gultekin Sakir H. , Komotar Ricardo J. , Ivan Michael E. 
Published: December 2019

OBJECTIVEIn some centers where brain tumor surgery is performed, the opportunity for expert intraoperative neuropathology consultation is lacking. Consequently, surgeons may not have access to the highest quality diagnostic histological data to inform surgical decision-making. Stimulated Raman histology (SRH) is a novel technology that allows for rapid acquisition of diagnostic histological images at the bedside.METHODSThe authors performed a prospective blinded cohort study of 82 consecutive patients undergoing resection of CNS tumors to compare diagnostic time and accuracy of SRH simulation to the gold standard, i.e., frozen and permanent section diagnosis. Diagnostic accuracy was determined by concordance of SRH-simulated intraoperative pathology consultation with a blinded board-certified neuropathologist, with official frozen section and permanent section results.RESULTSOverall, the mean time to diagnosis was 30.5 ± 13.2 minutes faster (p < 0.0001) for SRH simulation than for frozen section, with similar diagnostic correlation: 91.5% (κ = 0.834, p < 0.0001) between SRH simulation and permanent section, and 91.5% between frozen and permanent section (κ = 0.894, p < 0.0001).CONCLUSIONSSRH-simulated intraoperative pathology consultation was significantly faster and equally accurate as frozen section.
Neuroendovascular-specific engineering modifications to the CorPath GRX Robotic System
Authors: Britz Gavin W. , Panesar Sandip S. , Falb Peter , Tomas Johnny , Desai Virendra , Lumsden Alan 
Published: December 2019

OBJECTIVEThe aim of this study was to evaluate new, neuroendovascular-specific engineering and software modifications to the CorPath GRX Robotic System for their ability to support safer and more effective cranial neurovascular interventions in a preclinical model.METHODSActive device fixation (ADF) control software, permitting automated manipulation of the guidewire relative to the microcatheter, and a modified drive cassette suitable for neuroendovascular instruments were the respective software and hardware modifications to the current CorPath GRX robot, which was cleared by the FDA for percutaneous coronary and peripheral vascular intervention. The authors then trialed the modified system in a live porcine model with simulated neuroendovascular pathology. Femoral access through the aortic arch to the common carotid artery was accomplished manually (without robotic assistance), and the remaining endovascular procedures were performed with robotic assistance. The system was tested for the enhanced ability to navigate and manipulate neurovascular-specific guidewires and microcatheters. The authors specifically evaluated the movement of the wire forward and backward during the advancement of the microcatheter.RESULTSNavigation of the rete mirabile and an induced aneurysm within the common carotid artery were successful. The active device fixation feature enabled independent advancement and retraction of the guidewire and working device relative to the microcatheter. When ADF was inactive, the mean forward motion of the guidewire was 5 mm and backward motion was 0 mm. When ADF was active, the mean forward motion of the guidewire was 0 mm and backward motion was 1.5 mm. The modifications made to the robotic cassette enabled the system to successfully manipulate the microcatheter and guidewire safely and in a manner more suited to neuroendovascular procedures than before. There were no occurrences of dissection, extravasation, or thrombosis.CONCLUSIONSThe robotic system was originally designed to navigate and manipulate devices for cardiac and peripheral vascular intervention. The current modifications described here improved its utility for the more delicate and tortuous neurovascular environment. This will set the stage for the development of a neurovascular-specific robot.
Spatial convergence of distant cortical regions during folding explains why arteries do not cross the sylvian fissure
Authors: Bush Alan , Nuñez Maximiliano , Brisbin Alyssa K. , Friedlander Robert M. , Goldschmidt Ezequiel 
Published: December 2019

OBJECTIVECortical folding places regions that are separated by a large distance along the cortical surface in close proximity. This process is not homogeneous; regions such as the insular opercula have a much higher cortical surface distance (CSD) to euclidean distance (ED) than others. Here the authors explore the hypothesis that in the folded brain the CSD, and not the ED, determines regions of common irrigation, because this measure corresponds more closely with the distance along the prefolded brain, where the subarachnoid arterial vascular network starts forming.METHODSThe authors defined a convergence index that compared the ED to the CSD and applied it to the cortical surface reconstruction of an average brain. They then compared cortical convergence to the irrigation patterns of major sulci and fissures of the brain, by assessing whether these structures were crossed or not crossed by arterial vessels in 20 fixed hemispheres.RESULTSThe regions of highest convergence (top 1%) were clustered around the sylvian fissure, which is the only brain depression with high convergence values along its edges. Arterial crossings were commonly observed in every major sulcus of the brain, with the exception of the sylvian fissure, constituting a highly significant difference (p < 10−4).CONCLUSIONSArteries do not cross regions of high convergence. In the adult brain the CSD, rather than the ED, predicts the regional irrigation pattern. The distant origin of the frontal and temporal lobes creates a region of high cortical convergence, which explains why arteries do not cross the sylvian fissure.
Impact of master’s degree attainment upon academic career placement in neurosurgery
Authors: Khalafallah Adham M. , Jimenez Adrian E. , Tamargo Rafael J. , Witham Timothy , Huang Judy , Brem Henry , Mukherjee Debraj 
Published: December 2019

OBJECTIVEPrevious authors have investigated many factors that predict an academic neurosurgical career over private practice, including attainment of a Doctor of Philosophy (PhD) and number of publications. Research has yet to demonstrate whether a master’s degree predicts an academic neurosurgical career. This study quantifies the association between obtaining a Master of Science (MS), Master of Public Health (MPH), or Master of Business Administration (MBA) degree and pursuing a career in academic neurosurgery.METHODSPublic data on neurosurgeons who had graduated from Accreditation Council for Graduate Medical Education (ACGME)–accredited residency programs in the period from 1949 to 2019 were collected from residency and professional websites. Residency graduates with a PhD were excluded to isolate the effect of only having a master’s degree. A position was considered “academic” if it was affiliated with a hospital that had a neurosurgery residency program; other positions were considered nonacademic. Bivariate analyses were performed with Fisher’s exact test. Multivariate analysis was performed using a logistic regression model.RESULTSWithin our database of neurosurgery residency alumni, there were 47 (4.1%) who held an MS degree, 31 (2.7%) who held an MPH, and 10 (0.9%) who held an MBA. In bivariate analyses, neurosurgeons with MS degrees were significantly more likely to pursue academic careers (OR 2.65, p = 0.0014, 95% CI 1.40–5.20), whereas neurosurgeons with an MPH (OR 1.41, p = 0.36, 95% CI 0.64–3.08) or an MBA (OR 1.00, p = 1.00, 95% CI 0.21–4.26) were not. In the multivariate analysis, an MS degree was independently associated with an academic career (OR 2.48, p = 0.0079, 95% CI 1.28–4.93). Moreover, postresidency h indices of 1 (OR 1.44, p = 0.048, 95% CI 1.00–2.07), 2–3 (OR 2.76, p = 2.01 × 10−8, 95% CI 1.94–3.94), and ≥ 4 (OR 4.88, p < 2.00 × 10−16, 95% CI 3.43–6.99) were all significantly associated with increased odds of pursuing an academic career. Notably, having between 1 and 11 months of protected research time was significantly associated with decreased odds of pursuing academic neurosurgery (OR 0.46, p = 0.049, 95% CI 0.21–0.98).CONCLUSIONSNeurosurgery residency graduates with MS degrees are more likely to pursue academic neurosurgical careers relative to their non-MS counterparts. Such findings may be used to help predict residency graduates’ future potential in academic neurosurgery.
Neurophysiological seizure-onset predictors of epilepsy surgery outcome: a multivariable analysis
Authors: Tanaka Hideaki , Gotman Jean , Khoo Hui Ming , Olivier André , Hall Jeffery , Dubeau François 
Published: December 2019

OBJECTIVEThe authors sought to determine which neurophysiological seizure-onset features seen during scalp electroencephalography (EEG) and intracerebral EEG (iEEG) monitoring are predictors of postoperative outcome in a large series of patients with drug-resistant focal epilepsy who underwent resective surgery.METHODSThe authors retrospectively analyzed the records of 75 consecutive patients with focal epilepsy, who first underwent scalp EEG and then iEEG (stereo-EEG) for presurgical assessment and who went on to undergo resective surgery between 2004 and 2015. To determine the independent prognostic factors from the neurophysiological scalp EEG and iEEG seizure-onset information, univariate and standard multivariable logistic regression analyses were used. Since scalp EEG and iEEG data were recorded at different times, the authors matched scalp seizures with intracerebral seizures for each patient using strict criteria.RESULTSA total of 3057 seizures were assessed. Forty-eight percent (36/75) of patients had a favorable outcome (Engel class I–II) after a minimum follow-up of at least 1 year. According to univariate analysis, a localized scalp EEG seizure onset (p < 0.001), a multilobar intracerebral seizure-onset zone (SOZ) (p < 0.001), and an extended SOZ (p = 0.001) were significantly associated with surgical outcome. According to multivariable analysis, the following two independent factors were found: 1) the ability of scalp EEG to localize the seizure onset was a predictor of a favorable postoperative outcome (OR 6.073, 95% CI 2.011–18.339, p = 0.001), and 2) a multilobar SOZ was a predictor of an unfavorable outcome (OR 0.076, 95% CI 0.009–0.663, p = 0.020).CONCLUSIONSThe study findings show that localization at scalp seizure onset and a multilobar SOZ were strong predictors of surgical outcome. These predictors can help to select the better candidates for resective surgery.
Hyperoxemia during the hyperacute phase of aneurysmal subarachnoid hemorrhage is associated with delayed cerebral ischemia and poor outcome: a retrospective observational study
Authors: Fukuda Shinya , Koga Yasutaka , Fujita Motoki , Suehiro Eiichi , Kaneda Kotaro , Oda Yasutaka , Ishihara Hideyuki , Suzuki Michiyasu , Tsuruta Ryosuke 
Published: December 2019

OBJECTIVEThe harmful effects of hyperoxemia have been reported in critically ill patients with various disorders, including those with brain injuries. However, the effect of hyperoxemia on aneurysmal subarachnoid hemorrhage (aSAH) patients is unclear. In this study the authors aimed to determine whether hyperoxemia during the hyperacute or acute phase in patients with aSAH is associated with delayed cerebral ischemia (DCI) and poor neurological outcome.METHODSIn this single-center retrospective study, data from patients with aSAH treated between January 2011 and June 2017 were reviewed. The patients were classified into groups according to whether they experienced DCI (DCI group and non-DCI group) and whether they had a poor outcome at discharge (poor outcome group and favorable outcome group). The background characteristics and time-weighted average (TWA) PaO2 during the first 24 hours after arrival at the treatment facility (TWA24h-PaO2) and between the first 24 hours after arrival and day 6 (TWA6d-PaO2), the hyperacute and acute phases, respectively, were compared between the groups. Factors related to DCI and poor outcome were evaluated with logistic regression analyses.RESULTSOf 197 patients with aSAH, 42 patients experienced DCI and 82 patients had a poor outcome at discharge. TWA24h-PaO2 was significantly higher in the DCI group than in the non-DCI group (186 [141–213] vs 161 [138–192] mm Hg, p = 0.029) and in the poor outcome group than in the favorable outcome group (176 [154–205] vs 156 [136–188] mm Hg, p = 0.004). TWA6d-PaO2 did not differ significantly between the groups. Logistic regression analyses revealed that higher TWA24h-PaO2 was an independent risk factor for DCI (OR 1.09, 95% CI 1.01–1.17, p = 0.037) and poor outcome (OR 1.17, 95% CI 1.06–1.29, p = 0.002).CONCLUSIONSHyperoxemia during the first 24 hours was associated with DCI and a poor outcome in patients with aSAH. Excessive oxygen therapy might have an adverse effect in the hyperacute phase of aSAH.
TÜRKİYE ‘DE YAŞAYAN GÖÇMEN SURİYELİ ANNELERİN ÇOCUK EĞİTİMİ YETERLİLİĞİ DÜZEYLERİNİN FARKLI DEĞİŞKENLER AÇISINDAN İNCELENMESİ
Authors: EMRE Oğuz , ULUTAŞ Ayşegül , AYANOĞLU Mine , KAÇMAZ Cihangir 
Published: December 2019

Bir çocuğun gelişiminde çocuğun bulunduğu çevre ve aile faktörü önemli bir yere sahiptir. Çocuğun gelişiminde anne önemli yere sahiptir. Annelik ile ilgili olarak sorumlulukları uygun şekilde gerçekleştirme ve organize etme yeteneği ebeveyn yeterliliği olarak tanımlanmaktadır. Ebeveynin çocuğun bakım ve yetiştirilmesiyle ilgili sorumlulukları sahip olduğu kapasitesi, inançları yargıları ve kendi kültürüne göre değişiklik göstermektedir. Bu araştırmada çocuğu 5-12 yaş aralığında olan Türkiye ‘de yaşayan göçmen Suriyeli annelerin çocuk eğitimi yeterliliği düzeylerinin farklı değişkenler açısından incelenmesi amaçlanmıştır. Araştırmanın evrenini Mardin ilinde yaşayan Suriyeli anneler oluştururken, Türkçe okuryazar ve çalışmaya katılmaya istekli olan anneler içerisinden seçkisiz örnekleme yöntemiyle seçilen 130 anne araştırmanın örneklemini oluşturmaktadır. Araştırmanın verileri "Genel Bilgi Formu" ve "Çocuk Eğitimi Yeterliliği Ölçeği (ÇEYÖ)" aracılığıyla toplanmıştır. Araştırmadan elde edilen veriler SPSS 24.0 paket programı ile değerlendirilmiş olup, verilerin analizinde tek yönlü varyans analizi (ANOVA) ve Tukey HSD testi kullanılmıştır. Araştırma sonuçları, annelerin çocuk eğitimi yeterliğinin annelerin yaşına ve çocuğun kaldığı kişilere göre farklılaşmadığını ortaya koymuştur. Anne eğitim durumu değişkenine göre çocuğu tanıma ve çocuğu yönlendirme alt boyut puan ortalamalarında ve çocuk sayısı değişkenine göre ise çocuğu geliştirme alt boyut puan ortalamalarında istatistiksel olarak anlamlı fark olduğu saptanmıştır (p&lt;0,05).
PENDAMPINGAN IDENTIFIKASI PUSAKA BUDAYA DESA BALI AGA BELANDINGAN KINTAMANI BANGLI
Authors: Ambarwati Kardinal Ni G.A. Diah , Ketut Artatik I Gusti Ayu , Sarjana I Putu 
Published: December 2019

Belandingan is the village of Bali Aga mountain type located in Kintamani District, Bangli Regency, Bali. The location of Belandingan Village itself is quite secluded compared to other villages around Batur. Mount Batur was named the world geopark by UNESCO on 22 September 2013. Belandingan Village is included in 15 Batur Geopark Supporting villages. Although it has become a Supporting Village of Batur Geopark, there is not tourism planning done by the government. Research on the Village of Blandingan itself is difficult to find. The distinctive cultural richness of the Bali Aga Village has the potential for the development of a heritage Tourism Village. The character of Belandingan Village community that is friendly and open to outsiders is also a potential in promoting the tourism of the village. Existing traditions are still in verbal version. The community has not been moved to document their culture. The people themselves when invited to discuss are less aware of the cultural uniqueness they have. For this reason, assistance was provided to the community in this case the religious leaders in the village of Belandingan and Sekaa Teruna Teruni Mandala Cipta Belandingan Village to identify village heritage. It is hoped that the results of this identification will become written data and become material in promoting the field of tourism as a Bali Aga tourist village.