bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between a Holistic Review in Admissions Workshop and the Diversity of Accepted Applicants and Students Matriculating to Medical School
Authors: Grbic Douglas , Morrison Emory , Sondheimer Henry M. , Conrad Sarah S. , Milem Jeffrey F. 
Published: September 2018

Purpose
The authors tested for an association between the Association of American Medical Colleges’ holistic review in admissions (HRA) workshop and the compositional diversity of medical school accepted applicants and matriculants in schools that held workshops compared with those that did not.

Method
The authors examined school-level data from 134 medical schools accredited by the Liaison Committee on Medical Education for the years 2006–2016 using information from the American Medical College Application Service. They used a fixed-effects regression to examine the within-school association between an HRA workshop and four measures of diversity: percent first-generation college student, percent black/African American, percent Hispanic, and overall level of racial/ethnic diversity as measured by a diversity index.

Results
For schools that held an HRA workshop, descriptive statistics showed higher mean values across all four measures of diversity for the post-HRA workshop period (the HRA implementation period) compared with the preworkshop period (accepted applicants: d = 0.34–0.79; matriculants: d = 0.29–0.73). Analyzing data for all schools, including those that did not hold a workshop, regression models showed that the HRA implementation period was associated with a significant and sustained increase in all four measures of diversity. These findings were consistent for both accepted applicants (P < .01) and matriculants (P < .01).

Conclusions
The significant increases in all four measures of diversity following an HRA workshop support the conclusion that this workshop was associated with increased compositional diversity at the participating medical schools.
Prescription Benzodiazepine Use Among Older Adults: A Critical Review
Authors: Gerlach Lauren B. , Wiechers Ilse R. , Maust Donovan T. 
Published: September 2018

Objectives
Despite evidence for many potential risks, use of benzodiazepines (BZDs) among older adults is common. The authors evaluated the available evidence for BZD effectiveness and tolerability for use in older adults in three psychiatric conditions for which BZDs are commonly prescribed: insomnia, anxiety disorders, and behavioral and psychological symptoms of dementia.

Design
Electronic databases, including PubMed/MEDLINE, were searched to identify articles that (1) included patients ≥50 years of age, (2) focused on patients diagnosed with insomnia, anxiety disorders, or behavioral and psychological symptoms of dementia, and (3) were either a randomized, placebo-controlled trial or a randomized trial comparing a BZD with either another psychotropic medication or psychotherapy.

Results
Thirty-one studies met the inclusion criteria. Of the three clinical indications evaluated, treatment of insomnia had the greatest available evidence for use of BZDs among older adults, with 21 of 25 trials demonstrating improved sleep outcomes with use of BZDs. Only one trial was found to meet eligibility criteria for BZD use in anxiety disorders, demonstrating benefit over placebo. Five studies for use in behavioral disturbances in dementia were included, of which only one demonstrated improvement over placebo.

Conclusion
This systematic review suggests that BZD prescribing to older adults is significantly in excess of what the available evidence suggests is appropriate. Future trials should focus on efforts to reduce both acute and chronic BZD use among older adults while improving access to effective non-pharmacologic treatment alternatives.
A Survey of Perceived Implementation Gaps for a Clinical Practice Guideline for the Rehabilitation of Adults With Moderate to Severe Traumatic Brain Injury
Authors: Lamontagne Marie-Eve , Gargaro Judith , Marier-Deschênes Pascale , Truchon Catherine , Bayley Mark Theodore , Marshall Shawn , Kagan Corinne , Brière Anabèle , Swaine Bonnie 
Published: September 2018

Objective:
Appraising current practice is an important prerequisite for implementation of clinical practice guidelines (CPGs). The study objective was to determine the perceived level of implementation, priority, and feasibility of a subset of key CPG recommendations for the rehabilitation of individuals with moderate to severe traumatic brain injury (MSTBI).

Methods:
Fifty-one teams at acute care and rehabilitation facilities were invited to complete an electronic survey addressing the perceived level of implementation, priority, and feasibility of 109 fundamental and priority recommendations from the CPG-MSTBI.

Results:
Forty-four clinical teams responded across 2 Canadian provinces. Most of the recommendations were deemed as “fully” or “mostly” implemented, while relative gaps in implementation were perceived in recommendations regarding coordination with mental health and addiction providers (>75% of respondents indicated low levels of implementation), “Caregivers and Families” (26%), and “Psychosocial and Adaptation Issues” (25%). Priority levels and perceived feasibility were generally high (>60% and >86%, respectively) for recommendations with low levels of implementation. Priority recommendations for implementation were identified for both acute care and rehabilitation settings in Québec and Ontario.

Conclusions:
Assessment of clinician perception provides a helpful perspective for implementation. Exploring perceived implementation gaps based on users' needs and expectation should be a part of an implementation process.
Evaluating the Prognosis of Ischemic Stroke Using Low-Dose Multimodal Computed Tomography Parameters in Hyperacute Phase
Authors: Tang Biqiu , Zeng Jiaxin , Liu Lu , Xiao Yuan , Li Zhenlin , Zhang Kai , Chandan Shah , Zhao Youjin , Ye Zheng , Wang Wenhao , He Li , Lui Su 
Published: September 2018

PurposeThe aim of this study was to evaluate the potential value of low-dose multimodal computed tomography (CT) in predicting prognosis of acute ischemic stroke (AIS) within 6 hours.MethodsThe admission “one-stop-shop” multimodal CT examination, including noncontrast CT (NCCT), low-dose CT perfusion, and CT angiography (CTA), was performed in patients with symptoms of stroke within 6 hours. Noncontrast CT, CTA source image (CTA-SI), cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and mean transit time (MTT) maps were studied using Alberta Stroke Program Early CT Score (ASPECTS). The regional leptomeningeal collateral (rLMC) score (0–20) was dichotomized into 2 groups: good (11–20) and poor (0–10) rLMC. Poor functional outcomes were defined by a modified Rankin scale score of 3 to 6.ResultsOne hundred forty-four patients were ultimately selected; 43.8% of them showed poor functional outcomes. They had lower ASPECTSs on NCCT, CTA-SI, CBV, CBF, TTP, and MTT, and poor rLMC was more frequently associated with poor functional outcomes (allP< 0.001). In the multivariate analysis for AIS patients with conservative treatment, CTA-SI-ASPECTS 6 or less (odds ratio [OR], 5.9; 95% confidence interval [95% CI], 1.9–18.4;P= 0.002) and poor collaterals (OR, 5.0; 95% CI, 1.3–15.4;P= 0.017), CBV-ASPECTS 6 or less (OR, 8.0; 95% CI, 2.7–24.0;P< 0.001), CBF-ASPECTS 4 or less (OR, 8.0; 95% CI, 2.0–31.5;P= 0.003), MTT-ASPECTS≤3 (OR, 5.8; 95% CI, 1.8–18.1;P= 0.003), TTP-ASPECTS 4 or less (OR, 5.0; 95% CI, 1.6–15.1;P= 0.005), and NCCT-ASPECTS 8 or less (OR, 5.9; 95% CI, 1.7–20.4;P= 0.005) were significantly associated with poor functional outcome. In the multivariate analysis for AIS patients with thrombolysis, CTA-SI-ASPECTS 6 or less (OR, 27.5; 95% CI, 2.9–262.3;P= 0.004), poor collaterals (OR, 28.0; 95% CI, 2.8–283.0;P< 0.028), and CBV-ASPECTS 6 or less (OR, 18.0; 95% CI, 3.0–107.7;P= 0.002) were associated with poor functional outcomes. Furthermore, the area under the curve (AUC) of the combination of CTA-SI-ASPECTS 6 or less, poor collaterals, and CBV-ASPECTS 6 or less (AUC, 0.87) was greater than that for any single parameter alone: CTA-SI-ASPECTS 6 or less (AUC, 0.80;P< 0.001), poor collaterals (AUC, 0.76;P< 0.001), and CBV-ASPECTS 6 or less (AUC, 0.81;P= 0.002).ConclusionsThe combination of CTA-SI-ASPECTS, collaterals, and CBV-ASPECTS may improve predictive power compared with a single parameter alone.
American College of Surgeons Committee on Trauma verification level affects trauma center management of pelvic ring injuries and patient mortality
Authors: Oliphant Bryant W. , Tignanelli Christopher J. , Napolitano Lena M. , Goulet James A. , Hemmila Mark R. 
Published: September 2018

BACKGROUND
Pelvic ring fractures represent a complex injury that requires specific resources and clinical expertise for optimal trauma patient management. We examined the impact of treatment variability for this type of injury at Level I and II trauma centers on patient outcomes.

METHODS
Trauma quality collaborative data (2011–2017) were analyzed. This includes data from 29 American College of Surgeons Committee on Trauma verified Level I and Level II trauma centers. Inclusion criteria were adult patients (≥16 years), Injury Severity Score of 5 or higher, blunt injury, and evidence of a partially stable or unstable pelvic ring fracture injury coding as classified using Abbreviated Injury Scale version 2005, with 2008 updates. Patients directly admitted, transferred out for definitive care, with penetrating trauma, or with no signs of life were excluded. Propensity score matching was used to create 1:1 matched cohorts of patients treated at Levels I or II trauma centers. Trauma center verification level was the exposure variable used to compare management strategies, resource utilization, and in-hospital mortality in univariate analysis.

RESULTS
We selected 1,220 well-matched patients, from 1,768 total patients, using propensity score methods (610 Level I and 610 Level II cohort). There were no significant baseline characteristic differences noted between the groups. Patients with pelvic ring fractures treated at Level I trauma centers had significantly decreased mortality (7.7% vs. 11.6%, p = 0.02). Patients treated at Level II trauma centers were less likely to receive interventional angiography, undergo complicated definitive orthopedic operative treatment, and to be admitted to an intensive care unit.

CONCLUSION
Admission with a partially stable or unstable pelvic ring injury to a Level I trauma center is associated with decreased mortality. Level II trauma centers had significantly less utilization of advanced treatment modalities. This variation in clinical practice highlights potential processes to emphasize in the appropriate treatment of these critically ill patients.

LEVEL OF EVIDENCE
Economic/Decision, Level II.
Clearing the cervical spine in patients with distracting injuries: An AAST multi-institutional trial
Authors: Khan Abid D. , Liebscher Sean C. , Reiser Hannah C. , Schroeppel Thomas J. , Anstadt Michael J. , Bosarge Patrick L. , Carroll Shannon L. , Quick Jacob A. , Barnes Stephen L. , Sobrino Justin , Murry Jason , Morin Nicholas , Gomez Mario , Consani Heitor , Gonzalez Richard P. 
Published: September 2018

BACKGROUND
Single institution studies have shown that clinical examination of the cervical spine (c-spine) is sensitive for clearance of the c-spine in blunt trauma patients with distracting injuries. Despite an unclear definition, most trauma centers still adhere to the notion that distracting injuries adversely affect the sensitivity of c-spine clinical examination. A prospective AAST multi-institutional trial was performed to assess the sensitivity of clinical examination screening of the c-spine in awake and alert blunt trauma patients with distracting injuries.

METHODS
During the 42-month study period, blunt trauma patients 18 years and older were prospectively evaluated with a standard c-spine examination protocol at 8 Level 1 trauma centers. Clinical examination was performed regardless of the presence of distracting injuries. Patients without complaints of neck pain, tenderness or pain on range of motion were considered to have a negative c-spine clinical examination. All patients with positive or negative c-spine clinical examination underwent computed tomography (CT) scan of the entire c-spine. Clinical examination findings were documented prior to the CT scan.

RESULTS
During the study period, 2929 patients were entered. At least one distracting injury was diagnosed in 70% of the patients. A c-spine injury was found on CT scan in 7.6% of the patients. There was no difference in the rate of missed injury when comparing patients with a distracting injury to those without a distracting injury (10.4% vs. 12.6%, p = 0.601). Only one injury missed by clinical examination underwent surgical intervention and none had a neurological complication.

CONCLUSIONS
Negative clinical examination may be sufficient to clear the cervical spine in awake and alert blunt trauma patients, even in the presence of a distracting injury. These findings suggest a potential source for improvement in resource utilization.

LEVEL OF EVIDENCE
Therapeutic/care management, level IV.
Rapid energy expenditure estimation for assisted and inclined loaded walking
Authors: Slade Patrick , Troutman Rachel , Kochenderfer Mykel J. , Collins Steven H. , Delp Scott L. 
Published: September 2018

AbstractBackgroundEstimating energy expenditure with indirect calorimetry requires expensive equipment and provides slow and noisy measurements. Rapid estimates using wearable sensors would enable techniques like optimizing assistive devices outside a lab. Existing methods correlate data from wearable sensors to measured energy expenditure without evaluating the accuracy of the estimated energy expenditure for activity conditions or subjects not included in the correlation process. Our goal is to assess data-driven models that are capable of rapidly estimating energy expenditure for new conditions and subjects.MethodsWe developed models that estimated energy expenditure from two datasets during walking conditions with (1) ankle exoskeleton assistance and (2) various loads and inclines. The estimation was portable and rapid, using input features that are possible to measure with wearable sensors and restricting the input data length to a single gait cycle or four second interval. The performance of the models was evaluated for three use cases. The first case estimated energy expenditure during walking conditions for subjects with some subject specific training data available. The second case estimated all conditions in the dataset for a new subject not included in the training data. The third case estimated new conditions for a new subject. The models also ordered the magnitude of energy expenditure across all conditions for a new subject.ResultsThe average errors in energy expenditure estimation during assisted walking conditions were 4.4%, 8.0%, and 8.1% for the three use cases, respectively. The average errors in energy expenditure estimation during inclined and loaded walking conditions were 6.1%, 9.7%, and 11.7% for the three use cases. The models ordered the magnitude of energy expenditure with a maximum and average percentage of correctly ordered conditions of 56% and 43% for assisted walking and 85% and 55% for incline and loaded walking.ConclusionsOur data-driven models determined the accuracy of energy expenditure estimation for three use cases. For experiments where the accuracy of a data-driven model is sufficient, standard indirect calorimetry can be replaced. The energy expenditure ordering could aid in selecting optimal assistance conditions. The models, code, and datasets are provided for reproduction and extension of our results.
Effect of gender of new-born, antenatal care and postnatal care on breastfeeding practices in Ethiopia: Evidence from systematic review and meta-analysis of national studies
Authors: Habtewold Tesfa Dejenie , Sharew Nigussie Tadesse , Alemu Sisay Mulugeta 
Published: September 2018

AbstractObjectiveThe aim of this systematic review and meta-analysis was to investigate the association of gender of new-born, antenatal care (ANC) and postnatal care (PNC) with timely initiation of breastfeeding (TIBF) and exclusive breastfeeding (EBF) practice in Ethiopia.DesignSystematic review and meta-analysisMethodsPubMed, EMBASE, CINAHL, WHO Global Health Library, Web of Science and SCOPUS databases systematically searched and complemented by manual searches to retrieve all available literature. Newcastle-Ottawa Scale (NOS) was used for quality assessment of included studies. Egger’s regression test at p-value threshold ≤ 0.01 was used to examine publication bias. Cochran’s Q X2 test, τ2, and I2 statistics were used to test heterogeneity, estimate amount of total/residual heterogeneity and measure variability attributed to heterogeneity respectively. A meta-analysis using a weighted inverse variance random-effects model was performed. The trend of evidence over time was evaluated by performing a cumulative meta-analysis. Furthermore, mixed-effects meta-regression analysis was done to identify possible sources of heterogeneity.ResultsOf 523 articles retrieved, 17 studies (N = 26,146 mothers) on TIBF and 27 studies (N = 17,819 mothers) on EBF were included in the final analysis. ANC (OR = 2.24, 95% CI 1.65 -3.04, p <0.001, I2 = 90.9%), PNC (OR = 1.86, 95% CI 1.41 - 2.47, p <0.001, I2 = 63.4%) and gender of new-born (OR = 1.31, 95% CI 1.01 - 1.68, p = 0.04, I2 = 81.7%) significantly associated with EBF. In addition, ANC (OR = 1.70, 95% CI 1.10 - 2.65, p = 0.02, I2 = 93.1%) was significantly associated with TIBF but not gender of new-born (OR = 1.02, 95% CI 0.86 -1.21, p = 0.82, I2 = 66.2%).ConclusionsIn line with our hypothesis, gender of new-born, ANC and PNC significantly associated with EBF. Likewise, ANC significantly associated with TIBF. Optimal care during pregnancy and after birth is important to ensure adequate breastfeeding. This meta-analysis study provided evidence on breastfeeding practices and its associated factors in Ethiopian context, which can be useful for cross-country and cross-cultural comparison and for breastfeeding improvement initiative in Ethiopia.Protocol registration and publication:CRD42017056768 and 10.1136/BMJOPEN-2017-017437Strengths and limitations of this studyThis systematic review and meta-analysis was conducted based on the registered and published protocol.Since it is the first study in Ethiopia, the information could be helpful for future researchers, public health practitioners, and healthcare policymakers.Almost all included studies were observational which may hinder causality inference.Perhaps the results may not be nationally representative given that studies from some regions are lacking.Based on the conventional methods of the heterogeneity test, a few analyses suffer from high between-study variation.
Gelbox — An Interactive Simulation Tool for Gel Electrophoresis
Authors: Gingold Chaim , Douglas Shawn M. 
Published: September 2018

AbstractGel electrophoresis enables separation and visualization of biomolecules such as DNA, RNA, or proteins. Like many powerful tools, mastering the use of gels and making the information gained from them productive, can be dificult. Gelbox is a simulation tool that helps users understand how changing experimental input parameters can affect the data output from gel electrophoresis. Our simulation model handles a wide range of settings, including many “suboptimal” values that may be useful for troubleshooting common mistakes made by novices.
Trends in millennial adolescent mental health and health related behaviours over ten years: a population cohort comparison study
Authors: Patalay Praveetha , Gage Suzanne H 
Published: September 2018

AbstractBackgroundThere is evidence that mental health problems are increasing and substance use behaviours are decreasing. This paper aimed to investigate recent trends in mental ill-health and health-related behaviours in two cohorts of UK adolescents in 2005 and 2015.MethodTrends in harmonised mental ill-health (depressive symptoms, self-harm, anti-social behaviours, parent reported difficulties) and health related behaviours (substance use, weight, weight perception, sleep, sexual intercourse) were examined at age 14 in two UK birth cohorts; Avon Longitudinal Study of Parents and Children (ALSPAC, N=5627, born 1991-92) and Millennium Cohort Study (MCS, N=11318, born 2000-02). Prevalences and trend estimates are presented unadjusted and using propensity score matching and entropy balancing.ResultsDepressive symptoms (9% to ∼15%) and self-harm (11.8% to ∼14.5%) increased over the 10 years. Parent-reported emotional difficulties, conduct problems, hyperactivity and peer problems were higher in 2015 compared to 2005 (5.7 – 9% to 9 – 18%).Conversely, substance use (tried smoking 9% to 3%; tried alcohol 52% to ∼43%, cannabis 4.6% to ∼4%), sexual activity (2% to ∼1%) and anti-social behaviours (6.2 – 40.1% to 1.6 – 28%) were less common or no different. Adolescents in 2015 were spending less time sleeping, had higher BMIs and a greater proportion perceived themselves as overweight.ConclusionGiven health-related behaviours are often cited as risk-factors for poor mental health, our findings suggest relationships between these factors might be more complex and dynamic in nature than currently understood. Striking increases in mental health difficulties, BMI and poor sleep related behaviours highlight an increasing public health challenge.
Different analysis methods of Scottish and English child physical activity data explain the majority of the difference between the national prevalence estimates
Authors: Williamson Chloë , Kelly Paul , Strain Tessa 
Published: September 2018

AbstractBackgroundThe percentage of children in Scotland and England meeting the aerobic physical activity recommendation differ greatly according to the estimates derived from the respective national health surveys. The Scottish Health Survey (SHeS) usually estimates that over 70% meet the guidelines; Health Survey for England (HSE) estimates are usually below 25%. It is plausible that these differences originate from different analysis methods. The HSE monitor the percentage of children that undertake 60 minutes of moderate-to-vigorous physical activity on each day of the week (‘the daily minimum method’ (DMM)). The SHeS monitor the proportion that undertake at least seven sessions of moderate-to-vigorous physical activity, with an average daily duration over 60 minutes (‘the average method’ (WAM)). We aimed to establish how great an influence this difference in analysis methods has on the prevalence estimates.MethodsPhysical activity data from 5-15 year olds in the 2015 HSE and SHeS were reanalysed (weighted n=3840 and 965, respectively). Two comparable pairs of estimates were derived: a DMM and WAM estimate from the HSE not including travel to/from school, and WAM estimates from the HSE and the SHeS including travel to/from school. It is not possible to calculate a DMM estimate from the SHeS due to the way the questions are asked. Results were presented for the total samples, and by sex and age sub-groups.ResultsThe HSE WAM estimate was 31.7 (95% CI: 30.2-33.3) percentage points higher than the DMM estimate (54.3% (95% CI: 52.6-56.0) and 22.6% (95% CI: 21.2-24.1) respectively). The magnitude of this difference differed by age group but not sex. When comparable WAM estimates were derived from the SHeS and the HSE, the SHeS was 11.8 percentage points higher (73.6% (95% CI: 69.8-77.1) and 61.8% (95% CI: 60.2-63.5) respectively). The magnitude of this difference differed by age group and sex.ConclusionsThe results indicate that the difference in the analysis method explains the majority (approximately 30 percentage points) of the difference in the child physical activity prevalence estimates between Scotland and England. These results will help those involved in national surveillance to determine how to increase comparability between the U.K. home nations.