bluuebunny/crossref_metadata_2025_split huggingface dataset:
MACULAR MICROVASCULAR NETWORKS IN HEALTHY PEDIATRIC SUBJECTS
Authors: Borrelli Enrico , Lonngi Marcela , Balasubramanian Siva , Tepelus Tudor C. , Baghdasaryan Elmira , Iafe Nicholas A. , Pineles Stacy L. , Velez Federico G. , Sarraf David , Sadda SriniVas R. , Tsui Irena 
Published: February 2018

Purpose:
To report optical coherence tomography angiography (OCTA) values in healthy pediatric eyes and to identify factors that may modify these values.

Methods:
In this prospective observational cross-sectional study, macular OCTA images were acquired from healthy pediatric patients. Main outcome measures were 1) foveal avascular zone (FAZ) area at the level of the superficial retinal capillary plexus (SCP); 2) SCP and deep retinal capillary plexus (DCP) perfusion density (based on the area of vessels); 3) SCP and DCP vessel density (based on a map with vessels of 1-pixel width); and 4) CC perfusion density. Multiple regression analysis was performed to assess the effect of age, sex, ethnicity, refraction, and foveal macular thickness (FMT) on OCTA parameters.

Results:
Seventy-seven eyes from 52 subjects (23 male and 29 female) were included in analysis. Mean age was 11.1 ± 3.3 years (range = 5.0–17.0 years). Twenty-nine (55.8%) subjects were white, 14 (27.0%) Hispanic, 8 (15.4%) Asian, and 1 (1.8%) African-American. Mean refraction was −0.1 ± 2.4 diopters (D) (range = −5.75 to +9.0 D). Mean FMT was 248.6 ± 18.6 μm. Larger FAZ area was significantly associated with older age (P = 0.014). Furthermore, larger FAZ area was associated with reduced FMT (P < 0.0001). Male sex was associated only with increased SCP perfusion density (P = 0.042). Increased CC perfusion density was associated with younger age (P = 0.022).

Conclusion:
We report data for pediatric OCTA parameters in healthy subjects. Several variables influence the density of macular microvascular networks, and these factors should be considered in the OCTA study of pediatric eye disorders.
Assessment of Glaucomatous Damage After Boston Keratoprosthesis Implantation Based on Digital Planimetric Quantification of Visual Fields and Optic Nerve Head Imaging
Authors: Ali Mohsin H. , Dikopf Mark S. , Finder Anthony G. , Aref Ahmad A. , Vajaranant Thasarat , de la Cruz Jose , Cortina Maria Soledad 
Published: February 2018

Purpose:
To investigate glaucomatous damage in Boston keratoprosthesis type I (KPro) patients through structural analysis of the optic nerve head and digital planimetric quantification of Goldmann visual fields, a novel method of monitoring perimetric changes in KPro patients.

Methods:
Records of patients undergoing KPro implantation from 2007 to 2015 at a single institution were reviewed. Parameters related to glaucoma status and KPro outcomes were analyzed.

Results:
Twenty-two eyes from 21 patients met inclusion criteria, with mean follow-up of 49.4 months (range 15–90). Mean results for the following parameters before KPro implantation and at last follow-up were (pre-KPro; at last follow-up): best-corrected visual acuity (2.07; 0.70 logMAR), number of glaucoma medications (1.14; 1.05), intraocular pressure (IOP) (18.4; 18.4 mm Hg), vertical cup-to-disc ratio (C/D) (0.48; 0.50), and horizontal C/D (0.52; 0.52). IOP-lowering procedures were performed pre-KPro (5/22), concurrently with KPro (10/22), post-KPro (6/22), or never (6/22). An increase in C/D ≥0.1 and loss of V4e isopter area >30% occurred in 22.7% and 12.5%, respectively. Development of post-KPro glaucoma, progression of preexisting or post-KPro glaucoma, and no glaucoma development as evidenced by an objective assessment of structural and functional parameters were seen in 2/22 (9.1%), 7/22 (31.8%), and 6/22 (27.3%) eyes, respectively.

Conclusions:
Clinicians should strive to vigilantly monitor for glaucoma despite the inherent difficulties in tonometry, optic nerve visualization and imaging, and visual field testing in KPro patients. Meticulous glaucoma surveillance with structural and functional testing combined with earlier IOP-lowering surgical intervention may result in decreased rates of glaucomatous vision loss in KPro patients.
Refractive Outcomes After Phototherapeutic Refractive Keratectomy for Granular Corneal Dystrophy
Authors: Nakamura Tomoaki , Kataoka Takahiro , Kojima Takashi , Yoshida Yoko , Sugiyama Yasuo 
Published: February 2018

Purpose:
This retrospective study aimed to evaluate the effectiveness of a novel procedure named phototherapeutic refractive keratectomy (PTRK), which is a sequential procedure composed of phototherapeutic keratectomy ablation for removal of opacities, followed by smoothing ablation for reducing the corneal surface irregularities and photorefractive keratectomy ablation for correcting refractive errors in eyes with primary granular corneal dystrophy.

Methods:
Twenty-three eyes of 17 patients with granular corneal dystrophy were treated with PTRK. Preoperative and postoperative visual acuity, corneal topography, and changes in spherical equivalent and cylindrical refraction were examined and analyzed.

Results:
The mean spherical equivalent power changed from −0.11 ± 1.36 diopters (D) to 0.19 ± 0.91 D postoperatively (P = 0.121). The change in the mean spherical equivalent was +0.30 ± 0.99 D. The mean preoperative uncorrected distance visual acuity (logMAR) of 0.40 ± 0.26 significantly improved to 0.075 ± 0.145 at 3 months after PTRK (P < 0.001). The mean preoperative corrected distance visual acuity (logMAR) of 0.18 ± 0.17 significantly improved to −0.02 ± 0.11 at 3 months after PTRK (P < 0.01). The surface regularity index was significantly decreased from 0.93 ± 0.46 preoperatively to 0.60 ± 0.30 postoperatively (P < 0.001).

Conclusions:
Our results showed that PTRK could improve corneal surface irregularities and remove opacities. Furthermore, both corrected visual acuity and uncorrected visual acuity improved by the addition of refractive correction. PTRK is a promising surgical procedure for improving postoperative quality of life with a high degree of patient satisfaction.
Benchmarking Implications: Analysis of Medicare Accountable Care Organizations Spending Level and Quality of Care
Authors: Hong Young-Rock , Kates Frederick , Song Soon Ju , Lee Nayoung , Duncan R. Paul , Marlow Nicole M. 
Published: February 2018

ABSTRACT:
Early evidence has shown that Accountable Care Organizations (ACOs) have achieved some success in improving the quality of care and reducing Medicare costs. However, it has been argued that the ACO rewarding model may disproportionately affect relatively low-spending (LS; considered as efficient) organizations that have fewer options to cut unnecessary services compared with high-spending (HS; inefficient) organizations. We conducted a cross-sectional retrospective study to compare ACO financial and quality of care performance between HS-ACO and LS-ACO. After adjusting for ACO organizational factors and beneficiary characteristics, we found that HS-ACOs generated greater savings per beneficiary than LS-ACOs ($501 vs. −$108, p < .001); however, HS-ACOs had a lower quality of care performance (48.79 vs. 53.29, p = .002). Specifically, LS-ACOs had better quality performance than HS-ACOs in patient experience/satisfaction (p = .02), preventive care services (p = .004), and hospitalization management (p = .001), whereas HS-ACOs better performed in routine checkup/follow-up (p < .001) and risk population management (p = .048). Our findings indicated that Medicare ACO rewarding model seems to be advantageous for HS-ACOs regardless of the overall quality of care performance.
Perception of Patient Safety Culture in Pediatric Long-Term Care Settings
Authors: Hessels Amanda J. , Murray Meghan T. , Cohen Bevin , Larson Elaine L. 
Published: February 2018

Introduction:
Patient safety culture (PSC) is an emerging construct in adult long-term care settings. No measures are validated to quantify PSC in pediatric long-term care (pLTC) settings despite the importance of safety for this vulnerable population. The study purposes are to (1) describe PSC in pLTC, (2) assess the relationship of PSC to facility recommendation and overall safety rating, and (3) test the stability and reliability of the PSC survey over time.

Methods:
A modified Nursing Home PSC (NHSPSC) survey was administered to employees at three pLTC facilities over 3 years; data were summarized and compared over time.

Results:
In all, 208 surveys were completed. Staff perceptions on “feedback and communication about incidents” and “overall perceptions of resident safety” were most positive and associated with responses of recommending the facility and high overall ratings for child safety (p < .05).

Conclusions:
The modified NHSPSC survey was reliable by Cronbach alpha and findings were consistent over time in these pLTC settings. This tool may be a useful adjunct to safety initiatives in pLTC. Knowledge derived from this survey can provide actionable information for consumers, pLTC employees, managers, and administrators.
Defining the Role of the Center Coordinator of Clinical Education: Identifying Responsibilities, Supports, and Challenges
Authors: Fitzpatrick Timmerberg Jean , Dungey Jill , Stolfi Angela M. , Dougherty Mary Ellen 
Published: February 2018

Introduction.
Recent changes in physical therapy (PT) education along with changes in health care delivery have placed increased demands on sites providing clinical education. The center coordinator of clinical education (CCCE) has been identified as a critical component of ensuring the quality of clinical education experiences (CEEs). Little is known about how today's CCCEs are performing this position. The purpose of this study was to identify how CCCEs define their role and associated responsibilities in current practice, how they were prepared to be a CCCE, the structure of the clinical learning environment where they work, and available supports and challenges they encounter.

Methods.
A total of 1,109 CCCEs, identified from the Clinical Performance Instrument, responded to an online anonymous survey.

Results.
Respondents indicated that many of the CCCE's responsibilities as defined by the American Physical Therapy Association (APTA)
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are not being performed by all. Most CCCEs schedule students, meet with them while at their site, provide an orientation, monitor novice clinical instructor's (CI's), and assist in crisis intervention when a student is not meeting expectations. Most CCCEs report not having adequate time within their workday for those tasks. Fewer than half of the respondents were given support to attend professional development activities related to clinical education, had a job description provided, or had their role acknowledged on their facility's career ladder. Most CCCEs indicated that they had not been mentored but those who had, found it valuable. Fifty-two percent belong to the APTA, 5.5% were education section members, and 17% of respondents were members of a clinical education consortium. A vast majority of CCCEs requested support in providing crisis management when the student is not meeting expectations, as well as mentoring novice and experienced CI's. Respondents also noted that the best avenue to provide that support would be self-paced online modules.

Discussion and Conclusion.
There is considerable variability in the way individuals define and perform the role of CCCE. The structure of the clinical learning environment likely impacts the quality of the learning experiences offered, as well as the willingness of the staff to participate in clinical education. Many resources for the CCCE are provided through professional organizations. The results of this study indicate that many respondents are not members of such organizations and may not have access. Integral to the success of clinical education is the need for our profession, clinical facility administration, and clinical education consortia to value and support the vital role of the CCCE as a leader in providing CEEs that culminate in entry-level PT students.
Physical Therapist Students' Perceptions: Learning From a Community-Based, Client-Focused, Interprofessional Learning Experience
Authors: McGehee William F. , Dunleavy Kim , Blue Amy V. , Stetten Nichole E. , Black Erik W. 
Published: February 2018

Introduction.
This study examined physical therapist students' perceptions of their learning from a year-long, community-based, client-focused, interprofessional education experience (IPE) involving nine disciplines.

Methods.
Sixty-nine Doctor of Physical Therapy students (n = 69) completed a reflection paper at the end of an IPE, consisting of small group visits of students from four of the nine different health care disciplines, with families in their homes, larger structured group discussions with faculty, and a wellness project. The students participated in four home visits, and six discussion sessions were completed over two semesters. Two teams of two researchers reviewed and coded the papers to identify key words and phrases to reflect meaning. All researchers then reached a consensus on themes and subthemes. Triangulation of analysis occurred throughout the analysis, and quotes that reflected the important themes were identified.

Results.
Themes included the following: 1) learning about differences in perspective, 2) importance of team communication, 3) value of seeing a patient in their own environment and realizing how this affects their health and health behaviors, 4) making a connection with a patient, and 5) realizing that the patient's goals can be different from the students' expectations.

Discussion and Conclusions.
This IPE was perceived as an effective and meaningful instructional strategy. The realistic situated learning methods resulted in students appreciating the need for individualized consideration of the patient as a whole person. The extended period of team-based requirements fostered a deeper understanding of communication across professions and with clients, along with insights into the perspectives of different health care professionals.
Perceived Value of Preadmission Physical Therapy Observation Hours and Their Ability to Predict Academic Performance
Authors: Wheeler Emma , Finucane Sheryl , Soper Shawne , Mayhew Thomas 
Published: February 2018

Introduction.
Most physical therapist (PT) and physical therapist assistant (PTA) education programs require applicants to complete observation hours (ObHr) before admission. Observation hours are believed to enable the prospective PT and PTA student to gain knowledge about the profession and increase chances of success in academic programs; however, few studies have examined these relationships. The purposes of this study were to: 1) examine the relationship between the number of ObHr completed and indicators of success in a Doctor of Physical Therapy (DPT) program, 2) identify PT and PTA student opinions and perceived value of the required ObHr, including the number of hours needed to make an informed decision to pursue physical therapy as a career, and 3) identify clinical instructor (CI) opinions about the perceived value of ObHr and their impact on clinic productivity.

Methods.
Part 1 was a retrospective cohort study, examining data from 323 students who matriculated into a DPT program during a 6-year period (2009–2014). The relationship between admission variables (undergraduate grade point average [GPA], undergraduate math/science GPA, verbal Graduate Record Examination [GRE], quantitative GRE, age, and total ObHr) and outcome variables (National Physical Therapy Examination [NPTE] success, DPT probation status, and DPT GPA) were examined. Parts 2 and 3 focused on perceived value of ObHr gathered from surveys of PT and PTA students and CIs.

Results.
The number of ObHr was not a significant predictor of NPTE success, DPT probation status, or DPT GPA. Most PT (92%) and PTA (83%) students believed that ObHr positively impacted their decision to pursue physical therapy as a profession and that they needed 40–60 hours to make this decision. Most CIs (64%) do not believe that reducing ObHr opportunities would result in an increase in the number of full-time clinical experiences offered by their clinic. An overwhelming majority of the CIs (95%) believed that ObHr are meaningful for prospective students.

Discussion and Conclusion.
Observation hours were perceived as being valuable by both PT and PTA students and CIs. Observation hours may be useful to prospective PT students to help determine whether they pursue a career in physical therapy. However, there is no evidence that ObHr impact DPT academic performance. Physical therapist students may need fewer ObHr to confirm a career choice than what some programs currently require.
“The Future of Vulvar Disease: New and Ongoing Challenges”: Presidential Lecture - XXIV World Congress 2017, Mendoza, Argentina
Authors: Marchitelli Claudia 
Published: February 2018

Abstract
The 21st century brought along a number of discoveries and medical advances. With the advances, we can mention the following: target therapies for cancer, genomics and molecular biology, pharmacogenomics, minimally invasive and robotic surgery, immunosuppressive therapies in transplant patients, human papillomavirus in the era of vaccination, and aesthetic vulvovaginal procedures. All of them have greatly influenced medicine. As a scientific society, we have several challenges. In the past, you had to go to a library to get information. Now, we have readily available, accessible information. Thus, here comes the debate; we are facing a change in our educational paradigm, which needs to be approached from an integral and holistic perspective. New historical and cultural circumstances call for a deep reflection on the current social validity of scientific societies. They should be open to new ideas and allow dissent, work in teams, and speak a common language. They must be organized and, in constant communication with its members, support and organize research developing well-designed clinical trials and observational studies. We should work for our patients, recognizing the importance of the whole woman. We all have a great scientific and humanitarian challenge; to succeed, we must not lose sight of who we are working for. We work for them, our patients, and not for us. Our mission is to take care of our them!
Micronutrient Status and Nutritional Intake in 0‐ to 2‐Year‐old Children Consuming a Cows’ Milk Exclusion Diet
Authors: Kvammen Janne A. , Thomassen Rut A. , Eskerud Mari B. , Rugtveit Jarle , Henriksen Christine 
Published: February 2018

ABSTRACTObjectives:To study micronutrient status and nutritional intake from complementary feeding in children on a cows’ milk exclusion (CME) diet.Methods:Fifty‐seven children with cows’ milk allergy, younger than 2 years, were included in a cross‐sectional study. Blood was analyzed for micronutrient status. Complementary feeding was defined as all solids and liquids except of breast milk, and assessed by 3‐day food diary. The results were analyzed according to 3 feeding patterns: mainly breast‐fed (mBF), partially breast‐fed, and no breast milk group (nBM).Results:The children had a median age of 9 months and micronutrient status was within normal range for total homocysteine (p‐tHcy), s‐B12, s‐folate, b‐Hb, s‐ferritin, s‐zinc, and s‐25(OH)D. There were no significant differences between feedings groups, except for B12‐biomarkers. The mBF had higher p‐tHcy (P < 0.000) and lower s‐B12 (P = 0.002) compared nBM. Vitamin B12 deficiency (p‐tHcy >6.5 μmol/L combined with s‐B12 <250 pmol/L) was found in 12% of participants, most frequently among the mBF (36%) and none in nBM group (P = 0.009). Vitamin B12 intake from complementary feeding was negatively correlated with p‐tHcy (r = −0.479, P = 0.001) and positively with s‐B12 (r = 0.410, P = 0.003). Iron deficiency anemia was found in 5%. Iron intake correlated positively with b‐Hb (r = 0.324, P = 0.02). Zinc deficiency was found in 7% and low 25(OH)D in 9%. Vitamin D intake was positively correlated with the use of supplements (r = 0.456, P = 0.001).Conclusion:The risk of B12 deficiency was high in mBF infants on CME diet, and complementary feeding was associated with better B12 status. Iron, zinc, and vitamin D deficiencies were present in all feeding groups. Complementary feeding should be introduced at 4 to 6 months of age. Vitamin D supplement is recommended to ensure adequate intake.
Brief Report: Efficacy and Safety of Switching to Coformulated Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide (E/C/F/TAF) in Virologically Suppressed Women
Authors: Hodder Sally , Squires Kathleen , Kityo Cissy , Hagins Debbie , Avihingsanon Anchalee , Kido Anna , Jiang Shuping , Kulkarni Rima , Cheng Andrew , Cao Huyen 
Published: February 2018

Background:
The integrase inhibitor regimen [elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (TDF)] demonstrated superior efficacy when compared with a protease inhibitor regimen [ritonavir-boosted atazanavir (ATV + RTV) and FTC/TDF] in 575 treatment-naive women at week 48. We investigated the efficacy, safety, and tolerability of switching to a TAF-based, single-tablet regimen containing elvitegravir, cobicistat, FTC, and tenofovir alafenamide (E/C/F/TAF) versus remaining on ATV + RTV plus FTC/TDF.

Methods:
After completing the initial randomized, blinded phase, virologically suppressed (HIV-1 RNA <50 copies/mL) women on ATV + RTV plus FTC/TDF were rerandomized (3:1) to receive open-label E/C/F/TAF versus remaining on their current regimen. The primary end point was proportion of participants with plasma HIV-1 RNA <50 copies per milliliter at week 48 (U.S. FDA snapshot algorithm), with a prespecified noninferiority margin of 12%. Safety [adverse events (AEs)] and tolerability were also assessed.

Results:
Of 575 women originally randomized and treated in the blinded phase, 159 were rerandomized to switch to E/C/F/TAF and 53 to remain on ATV + RTV plus FTC/TDF. At week 48, virologic suppression was maintained in 150 (94%) of women on E/C/F/TAF and 46 (87%) on ATV + RTV plus FTC/TDF [difference 7.5% (95% confidence interval −1.2% to 19.4%)], demonstrating noninferiority of E/C/F/TAF to ATV + RTV and FTC/TDF. Incidence of AEs was similar between groups; study drug–related AEs were more common with E/C/F/TAF (11% versus 4%).

Conclusions:
Switching to E/C/F/TAF was noninferior to continuing ATV + RTV plus FTC/TDF in maintaining virologic suppression and was well tolerated at 48 weeks.