bluuebunny/crossref_metadata_2025_split huggingface dataset:
Very Distal Femoral Periprosthetic Fractures: Replacement Versus Fixation: A Systematic Review
Authors: Rubinger Luc , Khalik Hassaan Abdel , Gazendam Aaron , Wolfstadt Jesse , Khoshbin Amir , Tushinski Daniel , Johal Herman 
Published: May 2021

Objectives:
To synthesize all-cause reoperations and complications data as well as secondary clinical and functional outcomes, after the management of very distal femur periprosthetic fractures (vDFPFs) in a geriatric patient population with either a distal femoral locking plate (DFLP) or distal femoral replacement (DFR).

Data Sources:
MEDLINE, Embase, and Web of Science were searched for English language articles from inception to March 16, 2020, in accordance to the PRISMA guidelines.

Study Selection:
Studies reporting the management of vDFPFs in adults older than 65 years with either a DFLP or DFR were included. To ensure this review solely focused on very distal femoral periprosthetic fractures, only fractures of the following classifications were included: (1) Lewis and Rorabeck type II or III, (2) Su and Associates' Classification of Supracondylar Fractures of the Distal Femur type III, (3) Backstein et al type F2, and/or (4) Kim et al type II or III.

Data Extraction:
Three reviewers independently extracted data from the included studies. Study validity was assessed using the methodological index for nonrandomized studies (MINORS), a quality assessment tool for nonrandomized controlled studies in surgery.

Data Synthesis:
Twenty-five studies with 649 vDFPFs were included for analysis. There were 440 knees in the DFLP group (mean age range: 65.9–88.3 years) and 209 knees in the DFR group (mean age range: 71.0–84.8 years). Because of the literature's heterogeneity, the data were qualitatively synthesized.

Conclusions:
vDFPFs in the elderly treated with DFR underwent fewer reoperations relative to DFLP (0%–45% vs. 0%–77%, respectively). Time to weight-bearing was observably shorter in DFR studies relative to DFLP studies. Functional outcomes and postoperative range of motion indicated a trend for DFLP knees to outperform DFR knees. Future research should include prospective studies and cost-effectiveness evaluations to better understand the utility of DFR for these fractures.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Fracture and Patient Characteristics Associated With Early Conversion Total Hip Arthroplasty After Acetabular Fracture Fixation
Authors: Cichos Kyle H. , Spitler Clay A. , Quade Jonathan H. , McGwin Gerald , Ghanem Elie S. 
Published: May 2021

Objectives:
To determine risk factors for early conversion total hip arthroplasty (THA) after operative treatment of acetabular fractures.

Design:
Retrospective cohort.

Setting:
Level I trauma center.

Patients and Intervention:
We reviewed 685 operative acetabular fractures at our institution from 2011 to 2017, with a median follow-up of 12 months (range, 4–105 months).

Main Outcome Measure:
Multivariable regression analysis was performed after univariate analysis to identify independent risk factors for conversion THA. Sensitivity analysis was performed with minimum follow-up set at 6 and 12 months.

Results:
One hundred eight patients (16%) underwent conversion THA, with 52% of conversions occurring within 1 year, an additional 27% within 2 years, and the remaining 21% within 6 years of the index acetabular open reduction internal fixation. The median time to conversion THA was 11.5 months (range, 0.5–72 months). The risk of conversion THA by fracture pattern was 53 of 196 (27%) for transverse posterior wall (TPW), 12 of 52 (23%) for T shaped, 10 of 68 (15%) for posterior column with posterior wall, and 25 of 207 (12%) for posterior wall. Independent risk factors for early conversion included the following: TPW fracture, protrusio, hip dislocation, increased body mass index, increased age, infection, and dislocation after open reduction internal fixation. Independent risk factors for early conversion THA specific to patients with TPW fractures include only increased age and body mass index. Sensitivity analysis showed no change in results using either 6 or 12-month minimum follow-up.

Conclusion:
Transverse posterior wall fractures have a high risk of early conversion THA compared with other acetabular fracture patterns, especially when in combination with other significant risk factors. Consideration for different and novel management options warrants further study in this subset of acetabular fracture patients.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Prospective Clinical Trial Comparing Surgical Fixation Versus Nonoperative Management of Minimally Displaced Complete Lateral Compression Pelvis Fractures
Authors: Slobogean Gerard P. , Gaski Greg E. , Nascone Jason , Sciadini Marcus F. , Natoli Roman M. , Manson Theodore T. , Lebrun Christopher , McKinley Todd , Virkus Walter W. , Sorkin Anthony T. , Brown Krista , Howe Andrea , Rudnicki Joshua , Enobun Blessing , O'Hara Nathan N. , Gill Jeff , O'Toole Robert V. 
Published: May 2021

Objective:
To compare the early pain and functional outcomes of operative fixation versus nonoperative management for minimally displaced complete lateral compression (LC; OTA/AO 61-B1/B2) pelvic fractures.

Design:
Prospective clinical trial.

Setting:
Two academic trauma centers.

Patients:
Forty-eight adult patients with LC pelvic ring injuries with <10 mm of displacement were treated nonoperatively and 47 with surgical fixation. Sixty percent of participants were randomized. Seventy-three percent of the fractures were displaced <5 mm, and 71% were LC-1 patterns.

Intervention:
Operative fixation versus nonoperative management.

Main Outcome Measurements:
The primary outcome was patient-reported pain using the 10-point Brief Pain Inventory. Functional outcome was measured using the Majeed pelvic score. Outcomes were analyzed using hierarchical Bayesian models to compare the average treatment effect from injury to 12 and 52 weeks postinjury. The probability of the mean treatment benefit exceeding a clinically important difference was determined.

Results:
The 3-month average treatment effect of surgery compared with nonoperative management was a 1.2-point reduction in pain [95% credible interval (CrI): 0.4–1.9] and an 8% absolute improvement in the Majeed score (95% CrI: 3%–14%). Similar results persisted to 1 year. Patients with initial fracture displacement ≥5 mm experienced a larger reduction in pain (2.2, 95% CrI: 0.9–3.5) compared with those patients with less initial displacement (0.9, 95% CrI: 0.1–1.8).

Conclusion:
On average, surgical fixation likely provides a small improvement in pain and functional outcome for up to 12 months. Patients with ≥5 mm of posterior pelvic ring displacement are more likely to experience clinically important improvements in pain.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Robotics for Cochlear Implantation Surgery: Challenges and Opportunities
Authors: Panara Kush , Shahal David , Mittal Rahul , Eshraghi Adrien A. 
Published: May 2021

Objectives:
Recent advancements in robotics have set forth a growing body of evidence for the clinical application of the robotic cochlear implantation (RCI), with many potential benefits. This review aims to summarize these efforts, provide the latest developments in this exciting field, and explore the challenges associated with the clinical implementation of RCI.

Data Sources:
MEDLINE, PubMed, and EMBASE databases.

Study Selection:
A search was conducted using the keywords “robotics otolaryngology,” “robotic cochlear implant,” “minimally-invasive cochlear implantation,” “minimally-invasive mastoidectomy,” and “percutaneous cochlear implant” with all of their synonyms. Literature selection criteria included articles published in English, and articles from 1970 to present.

Results:
The use of robotics in neurotology is a relatively new endeavor that continues to evolve. Robotics is being explored by various groups to facilitate in the various steps of cochlear implant surgery, including drilling a keyhole approach to the middle ear for implants, inner ear access, and electrode insertion into the cochlea. Initial clinical trials have successfully implanted selected subjects using robotics.

Conclusions:
The use of robotics in cochlear implants remains in its very early stages. It is hoped that robotics will improve clinical outcomes. Although successful implants with robots are reported in the literature, there are some challenges that need to be addressed before this approach can become an acceptable option for the conventional cochlear implant surgery, such as safety, time, efficiency, and cost. However, it is hoped that further advancements in robotic technology will help in overcoming these barriers leading to successful implementation for clinical utility.
Clinical Prevalence of Enhanced Vestibulo-Ocular Reflex Responses on Video Head Impulse Test
Authors: Vargas-Alvarez Aitor , Ninchritz-Becerra Elisabeth , Goiburu Miren , Betances Frank , Rey-Martinez Jorge , Altuna Xabier 
Published: May 2021

Objective:
To measure and analyze the clinical and epidemiological characteristics of patients and healthy controls with enhanced eye velocity responses as well as evaluate their relationship with endolymphatic hydrops related diseases.

Study Design:
Cross-sectional clinical study.

Setting:
Tertiary hospital.

Participants:
Three hundred sixty three participants allocated to patients (310) and healthy control (53) groups were collected on first time visit to neurotology unit.

Intervention:
Diagnostic.

Main Outcome Measures:
Video head impulse test records, clinical diagnose, and variables and demographic data were used to get cross tables, a general linear model, diagnostic epidemiological parameters, and machine learning variable importance evaluation methods.

Results:
All the statistical tests revealed a significant association between enhanced vestibulo-ocular reflex (VOR) and diagnostic categories (p < 0.001). Chi-squared residual and machine learning analyses showed Menière's disease as the main associated diagnostic category, whereas the lowest residuals and gain values were found in the control group. Enhanced VOR as a diagnostic sign of Menière's disease had a sensitivity of 42.59% and a specificity of 86.32%, with an odds ratio of 4.68 (p < 0.001).

Conclusion:
There is a significantly higher prevalence of enhanced VOR responses in patients with Menière's disease, central origin vertigo, otosclerosis, and vestibular migraine than in those with other neurotologic diseases and controls. Our study found that enhanced VOR are not pathognomonic of hydrops-related diseases and the diagnosis should not solely be based on these and instead take into context other clinical and examination findings.
Reliability of Postsurgical Soft Tissue Reaction Grading Scales for Bone-anchored Hearing Implants
Authors: Bezdjian Aren , Nathoo-Khedri Nabil , Strijbos Ruben M. , Sewitch Maida , Thomeer Hans G.X.M. , Daniel Sam J. 
Published: May 2021

Objective:
This study aims to assess and compare the reliability of the Holgers, the IPS, and the Tullamore scales for skin tolerability assessment of postoperative bone-anchored hearing implant images.

Study Design:
A survey study and retrospective review of percutaneous osseointegrated auditory implant images for scoring using three skin classification scales.

Setting:
McGill University Health Center, Montreal, Quebec, Canada.

Participants:
Healthcare workers experienced and inexperienced with osseointegrated auditory implant skin classification scales.

Main Outcome Measures:
Participation involved completing: 1) survey questionnaires assessing experience with osseointegrated auditory implants and related skin reactions and 2) scoring postoperative osseointegrated auditory implant with surrounding skin images using the Holgers Classification, the IS (of the IPS) scale, and the Tullamore Classification. Participants were asked to rate 12 images of postoperative osseointegrated auditory implant and surrounding soft tissue. This process was repeated until participants scored all images using the three scales; each rater graded 36 images in total. The order in which scales were presented occurred at random. Intraclass correlation coefficients were calculated to assess reliability.

Results:
Thirty-one participants were recruited to the study. Fourteen (45.2%) had experience with at least 1 osseointegrated auditory implant skin classification scale, while 17 (54.8%) did not have experience. The wide and overlapping 95% confidence intervals of the intraclass correlation coefficients results do not provide us with enough evidence to define a well-established degree and hierarchy of reliability when comparing the scales. Among experienced raters, all scales presented moderate to good reliability.

Conclusions:
The Holgers Classification, the IPS scale, and the Tullamore Classification all present moderate to good reliability when used by experienced raters to assess skin reactions following surgical implantation of an osseointegrated hearing device. As a result, clinicians should use these scales with a degree of caution. The findings of this study do not provide us with enough evidence to single out one of the scales as a standard to follow, but more extensive studies are required to assess the reliability of the scales.
Management of dermatofibrosarcoma protuberans
Authors: Badhey Arvind K. , Tikhtman Raisa , Tang Alice L. 
Published: May 2021

Purpose of review
Provide an up to date review of the diagnosis, workup and treatment of dermatofibrosarcoma protuberans (DFSP). DFSP can be a challenging disease to manage and adequate understanding of the most up to date literature can help provide comprehensive treatment strategies.

Recent findings
DFSP is an infiltrative cutaneous sarcoma. It tends to have deep local invasion with a high risk of local recurrence, but a low risk of distant metastasis. It presents typically as a slow growing, asymptomatic skin lesion. It presents rarely in the head and neck, only 15% of the time. Recent data has discussed the role of wide local excision (WLE) vs. Mohs surgery. In addition, for unresectable disease the role of systemic therapy and immunomodulatory agents such as Imatinib has shown success.

Summary
Typically, surgical management is the first line for DFSP, however the risk for local recurrence still remains high with negative margins. Due to this risk, lifelong surveillance is required after initial diagnosis and management. Similar to other head and neck tumors, most recurrences happen within the first 3 years after treatment. DFSP can be treated with WLE or Mohs. For aggressive disease that is considered unresectable systemic therapy does exist, including molecular targeted therapies.
God Representation Types Are Associated With Levels of Personality Organization and Christian Religious Orthodox Culture
Authors: van der Velde Nathan , Schaap-Jonker Hanneke , Eurelings-Bontekoe Elisabeth H.M. , Corveleyn Jozef M.T. 
Published: May 2021

Abstract
This exploratory study shows that God representation types are associated with levels of personality organization. Among two Dutch samples of psychiatric patients (n = 136) and nonpatients (n = 161), we found associations between the psychotic, borderline, and neurotic personality organizations, and passive-unemotional, negative-authoritarian, and positive-authoritative God representation types, respectively. Both patients and nonpatients reported positive God representations, but only nonpatients and higher-level functioning patients reported an integrated God-object relation. For persons with personality pathology, the relationship with God can be a struggle and might have a defensive and/or compensating function. In addition to personality organization, Christian religious orthodox culture is a statistical predictor of God representations, but not of anger toward God. We offer suggestions for how psychotherapeutic work with God representations might differ for patients with different levels of personality organization.
Who Uses Veterans Mental Health Services?
Authors: Manhapra Ajay , Stefanovics Elina A. , Rhee Taeho Greg , Rosenheck Robert A. 
Published: May 2021

Abstract
Mental health (MH) research among veterans receiving services from the Veterans Health Administration (VHA) is extensive and growing and informs many clinical practice guidelines. We used nationally representative survey data to examine the generalizability of this extensive body of research by comparing sociodemographic and clinical characteristics of male veteran veterans health service (VHS) users (n = 491) with veteran non-VHS users (n = 840) and nonveteran (n = 6300) MH service users. VHS users were older, more often reported Black race, and less likely to have private or Medicaid insurance, but had similar prevalence of psychiatric or substance use disorder diagnoses but with a greater prevalence of posttraumatic stress disorder (PTSD). VHS users reported higher rates of medical diagnoses, pain interference, and poorer physical and MH status. These results suggest that VHA MH research may be reasonably generalizable to US mental health service users with caveats regarding age, PTSD diagnosis, pain, and racial distribution.
Costs of Identifying Cases of Syphilis Using Rapid Syphilis Tests in Multiple Nonclinical Settings in the United States
Authors: Williams Austin M. , Berruti Andrés A. 
Published: May 2021

Background
Outreach screening is a common strategy for detecting cases of syphilis in high-risk populations. New rapid syphilis tests allow for quicker response times and may alter the costs of detecting and treating syphilis in nonclinical settings.

Methods
Between May and October of 2017, we collected detailed retrospective cost data from 2 outreach screening programs engaging people experiencing homelessness and LGBTQ populations. Comprehensive and retrospective cost information, disaggregated by cost category, programmatic activity, and source of support, was collected during and after the testing period.

Results
Across all sites, rapid syphilis tests were conducted on 595 people at an average cost of $213 per person. Twenty-three cases of syphilis were confirmed and treated for an average cost of $5517 per case, ranging from $3604 at a rehabilitation facility to $13,140 at LGBTQ venues served by a mobile clinic. Personnel contributed the most to total costs (56.4%), followed by supplies (12.8%) and the use of buildings (10.4%). Expenditures by programmatic activity varied substantially across sites.

Conclusions
Testing costs varied between venues, reflecting differences in the models used and intensity of services provided. Although staff costs are the major driver, buildings and supplies costs are also significant. Our findings suggest that outreach screenings using rapid syphilis tests may be a feasible and cost-effective tool for health departments when targeting known high-prevalence areas and hard-to-reach populations.
Bacterial Vaginosis–Associated Bacteria and Uterine Fibroids: A Nested Case-Control Study
Authors: Moore Kristen R. , Tomar Meena , Umbach David M. , Gygax Scott E. , Hilbert David W. , Baird Donna D. 
Published: May 2021

Background
Reproductive tract infections are hypothesized to influence uterine fibroid development, yet few studies have investigated the common condition of bacterial vaginosis (BV). The literature is currently limited to data using self-report of BV.

Methods
We conducted a nested case-control study of 200 women (100 cases and 100 controls) from a large study of 23- to 35-year-old African American women, 1310 of whom were fibroid-free and prospectively followed up for 5 years to identify incident fibroids with standardized ultrasound examinations. We used quantitative polymerase chain reaction, an objective molecular method, to assess 9 BV-associated and 4 Lactobacillus species from vaginal swab specimens. We used hierarchical logistic regression to compute odds ratios and 95% confidence intervals to examine associations between bacterial species (both individually and grouped as (1) “optimal” Lactobacillus and (2) BV-associated species) with fibroid incidence and number. We also examined vaginal imbalance (quantitatively more BV-associated bacteria than optimal Lactobacilli).

Results
Contrary to our hypothesis, we found no increase in fibroid incidence or number among women with more BV-associated bacteria. High imbalance (only BV-associated bacteria, no optimal Lactobacillus bacteria) was actually inversely associated with fibroid incidence (odds ratio, 0.38; 95% confidence interval, 0.17–0.81).

Conclusions
This is the first study of ultrasound-detected incident fibroids and molecular vaginal bacterial assessment. We found no evidence that BV-associated bacteria increase the risk of fibroid incidence or number.
Modeling the Cost-Effectiveness of Express Multisite Gonorrhea Screening Among Men Who Have Sex With Men in the United States
Authors: Earnest Rebecca , Rönn Minttu M. , Bellerose Meghan , Menon-Johansson Anatole S. , Berruti Andrés A. , Chesson Harrell W. , Gift Thomas L. , Hsu Katherine K. , Testa Christian , Zhu Lin , Malyuta Yelena , Menzies Nicolas A. , Salomon Joshua A. 
Published: May 2021

Background
Men who have sex with men (MSM) experience high rates of gonococcal infection at extragenital (rectal and pharyngeal) anatomic sites, which often are missed without asymptomatic screening and may be important for onward transmission. Implementing an express pathway for asymptomatic MSM seeking routine screening at their clinic may be a cost-effective way to improve extragenital screening by allowing patients to be screened at more anatomic sites through a streamlined, less costly process.

Methods
We modified an agent-based model of anatomic site-specific gonococcal infection in US MSM to assess the cost-effectiveness of an express screening pathway in which all asymptomatic MSM presenting at their clinic were screened at the urogenital, rectal, and pharyngeal sites but forewent a provider consultation and physical examination and self-collected their own samples. We calculated the cumulative health effects expressed as gonococcal infections and cases averted over 5 years, labor and material costs, and incremental cost-effectiveness ratios for express versus traditional scenarios.

Results
The express scenario averted more infections and cases in each intervention year. The increased diagnostic costs of triple-site screening were largely offset by the lowered visit costs of the express pathway and, from the end of year 3 onward, this pathway generated small cost savings. However, in a sensitivity analysis of assumed overhead costs, cost savings under the express scenario disappeared in the majority of simulations once overhead costs exceeded 7% of total annual costs.

Conclusions
Express screening may be a cost-effective option for improving multisite anatomic screening among US MSM.
Nugent Score, Amsel's Criteria, and a Point-of-Care Rapid Test for Diagnosis of Bacterial Vaginosis: Performance in a Cohort of Kenyan Women
Authors: Lokken Erica M. , Jisuvei Clayton , Oyaro Brenda , Shafi Juma , Nyaigero Maureen , Kinuthia John , Mandaliya Kishor , Jaoko Walter , McClelland R. Scott 
Published: May 2021

Abstract
There are minimal data on the BVBlue test for diagnosis of bacterial vaginosis (BV) in Africa. Among 701 Kenyan women, compared with Nugent score ≥7, the BVBlue test had moderate sensitivity (81.9%; 95% confidence interval, 76.5%–86.5%) and high specificity (92.4%; 95% confidence interval, 89.5%–94.6%). This test may provide a complimentary approach to syndromic management.