bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotic Resistance Among Pediatric-Sourced Ocular Pathogens: 8-Year Findings From the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) Surveillance Study
Authors: Alter Sherman J. , Sanfilippo Christine M. , Asbell Penny A. , DeCory Heleen H. 
Published: October 2018

Background:The Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) study is a nationwide longitudinal antibiotic resistance surveillance program specific to bacterial pathogens commonly encountered in ocular infections. We evaluated in vitro resistance rates and trends among isolates obtained from pediatric patients (≤17 years of age).Methods:Clinical centers across the United States were invited to submit ocular isolates ofStaphylococcus aureus, coagulase-negative staphylococci (CoNS),Streptococcus pneumoniae,Haemophilus influenzaeandPseudomonas aeruginosato a central laboratory. Minimum inhibitory concentrations for various antibiotic classes were determined by broth microdilution per Clinical and Laboratory Standards Institute guidelines and interpreted as susceptible, intermediate or resistant based on available breakpoints. Longitudinal trends were analyzed using a Cochran-Armitage test for linear trends in a proportion.Results:Of 4829 isolates collected from January 2009 to December 2016, 995 isolates, sourced primarily from hospitals and referral centers, were obtained from pediatric patients (n = 286H.influenzae, n = 284S.aureus, n = 213 CoNS, n = 150S. pneumoniaeand n = 62P. aeruginosa). With few exceptions,P. aeruginosaandH. influenzaewere generally susceptible to the antibiotics tested. OfS. aureusand CoNS isolates, respectively, 56% and 72% were resistant to azithromycin and 24% and 47% were methicillin-resistant (MR); concurrent resistance to other drug classes and multidrug resistance (≥3 drug classes) were prevalent among MR staphylococci. OfS. pneumoniaeisolates, 38% and 35% demonstrated resistance to azithromycin and penicillin, respectively. Besifloxacin had the lowest minimum inhibitory concentration against the Gram-positive isolates.Conclusions:These in vitro data suggest antibiotic resistance is common among staphylococcal and pneumococcal isolates collected from pediatric patients with ocular infections. Methicillin resistance was prevalent among staphylococci with many strains demonstrating multidrug resistance. These findings may not be representative of resistance trends in community-based practices.
Nasal and Lacrimal Sac Histopathology in Patients With Systemic Sarcoidosis Undergoing External Lacrimal Drainage Surgery
Authors: Stewart Christopher M. , Luthert Philip J. , Rose Geoffrey E. 
Published: October 2018

Purpose:
To review the histological findings in the lacrimal sac and nasal mucosa from patients with sarcoidosis undergoing external lacrimal drainage surgery.

Methods:
All patients undergoing external dacryocystorhinostomy at Moorfields Eye Hospital with a known history of sarcoidosis had biopsies taken from the lacrimal sac and/or nasal mucosa during surgery. These patients were identified from databases at Moorfields Eye Hospital and the Institute of Ophthalmology, and their clinical notes were reviewed retrospectively for intraoperative findings with a view to identifying common trends. The histological findings of each biopsy were reviewed and classified as showing granulomas, nongranulomatous inflammation, or nonspecific fibrosis.

Results:
Forty patients (29 females; 72%) were known to have systemic sarcoidosis prior to surgery, and they underwent 60 external dacryocystorhinostomies. Paired histological samples were available from 49/60 (82%) procedures, nasal biopsies alone in 3 dacryocystorhinostomies (5%), and solely lacrimal sac biopsies in 8 (13%). The main site of systemic sarcoidosis was pulmonary involvement (19 patients; 48%). Recorded operative findings included 9 large lacrimal sac mucoceles (29%), a “thick” (26%) or “inflamed” (9.7%) lacrimal sac mucosa, and “thick” (36%) or “friable” (32%) nasal mucosa. Noncaseating granulomas were identified in 34/57 (60%) sacs, and 45/52 (87%) nasal tissues—this being in 31/49 (63%) of paired tissues. Chronic inflammation, without granulomas, was present in 20/57 (35%) lacrimal sacs but only in 5/52 (9.6%) of nasal biopsies.

Conclusions:
In patients with sarcoidosis undergoing external dacryocystorhinostomy, the characteristic histological feature—noncaseating granulomas—is present in most patients’ lacrimal sac mucosa and in almost all of their nasal mucosae. The lacrimal sac and nasal mucosa often appears abnormal—thickened or friable—during surgery.
Spontaneous Orbital Hemorrhage Related to the Extraocular Muscles
Authors: Chan Helen H. L. , Hardy Thomas G. , McNab Alan A. 
Published: October 2018

Purpose:
The authors present the largest series of patients to date of spontaneous hemorrhage in relation to extraocular muscles (EOMs).

Methods:
Observational retrospective case series. Institutional review board approval was obtained.

Results:
Eighteen patients with a mean age of 71 years presented with 20 episodes of spontaneous orbital hemorrhage closely related to an EOM. Most patients woke with unilateral proptosis, pain, and diplopia. Vision was impaired in 25%. Imaging identified a characteristic well-circumscribed hematoma arising within the muscle sheath or intermuscular septum. Three episodes required surgical drainage. All patients had good recovery of vision.

Discussion:
The authors describe a distinct clinical entity of idiopathic hemorrhages related to EOMs. No patient had an underlying vascular malformation or other lesion. The authors demonstrate that a proportion of these patients have vascular risk factors, namely, hypertension, hyperlipidemia, and antiplatelet use. This study suggests that inferior rectus is the most commonly affected EOM and shows that it is the muscle sheath or intermuscular septum of inferior rectus that is involved, rather than the muscle belly. Most patients can be managed conservatively with good visual outcomes. However, there were 3 exceptional cases that required surgical intervention.

Conclusions:
The findings that spontaneous orbital hemorrhages related to EOMs have certain predisposing factors, a characteristic radiological appearance, and a typically benign course will be helpful for clinicians in the management of this condition.
Subcutaneous Dirofilariasis in a Returning Traveler From Costa Rica
Authors: Olivo Christian A. , Gundacker Nathan D. , Murillo Jorge , Weiss Steven D. , Suarez Desiree , Suarez Jose Antonio 
Published: October 2018

Abstract

Dirofilaria genus is the most common cause of zoonotic filariasis. It typically causes cardiopulmonary disease in canines, but in humans, it can cause pulmonary, subcutaneous, and ocular disease. In this report, we present a case of a young woman who traveled to Costa Rica and subsequently developed a subcutaneous nodule. A biopsy performed in our patient showed dirofilariasis, possibly Dirofilaria tenuis. Most human dirofilariases are caused by Dirofilaria immitis and Dirofilaria repens. This is the first case of possible D. tenuis in Central America. The animal reservoir (North American raccoon) has been described in Costa Rica, highlighting the importance of reservoir distribution in human disease.
A Swollen Leg
Authors: Xu Anthony Ang , Hyman David , Cortes-Penfield Nicolas , D'Souza Jessica , Mao Tiffany , Lu Lee Bach 
Published: October 2018

Abstract
We report a patient with a rheumatic overlap syndrome on hydroxychloroquine and prednisone who developed tuberculous pyomyositis shortly after receiving 9 months of treatment of miliary tuberculosis. Her only presenting symptom was swelling of the left lower extremity without any systemic manifestation, despite extensive radiographic evidence of disseminated abscess formation. Acid-fast bacilli stains and cultures of the purulent material were negative for Mycobacterium tuberculosis (MTB), but polymerase chain reaction confirmed the diagnosis. To our knowledge, this is the first case report of tuberculous pyomyositis that developed shortly after the patient completed a full course of antituberculous therapy. We believe that the concurrent therapy of her rheumatic overlap syndrome with hydroxychloroquine likely led to her treatment failure for MTB and will discuss the possible pathogenesis. Our case also illustrates that MTB can cause significant soft tissue disease without systemic manifestations and that polymerase chain reaction is a valuable diagnostic study.
Using a Valid and Reliable Measure to Assess Clinical Instructor Self-perception of Teaching Behaviors
Authors: Wormley Michelle E. , Romney Wendy , Schweizer Kristin , Fein Beverly , LaFay Vicki , Martin Rebecca , Greer Anna E. 
Published: October 2018

Introduction.The purpose of this study was to 1) use the Clinical Teaching Effectiveness Questionnaire (CTEQ) to determine the self-perception of clinical teaching effectiveness (CTE) with a current sample of clinical instructors (CIs) and 2) determine if a relationship exists between CI characteristics and self-perceived ratings.Methods.A cross-sectional study was completed with a convenience sample of 194 physical therapists who served as CIs for 2 universities in the Northeast. Participants completed demographic data and the 30-item CTEQ, a valid and reliable tool, consisting of 4 sections with 8 subscales. Data were reported descriptively, and Mann–WhitneyUtests were completed to determine significant relationships between CI characteristics and the CTEQ subscales.Results.Overall, CIs agreed they were effective clinical teachers. Analysis revealed significant differences in scoring on the subscales of the CTEQ based on curricular model of the program from which the CI graduated, American Physical Therapy Association (APTA) membership, number of students supervised, APTA Advanced CI Credentialing, experience in a teaching role, highest degree earned, and Center Coordinator of Clinical Education role.Discussion and Conclusion.The CTEQ provides a preliminary valid measure for assessing CTE in physical therapy practice. Multiple factors were discovered to have an influence on CI's self-perception of clinical teaching using the CTEQ. Notably, the long-term impact of problem-based learning curricula were associated with identification of student learning domains and total score on the CTEQ, adding new information regarding curricular influence on CIs' self-perception of CTE. The CTEQ can be used by academic programs and clinical sites to develop strategies to better prepare CIs delivery of high-quality clinical education experiences.
2015 Beers criteria medication review in assisted living facilities
Authors: Chun Jessica C. , Appel Susan J. , Simmons Steven 
Published: October 2018

ABSTRACT

Background and purpose:
The elderly population is expected to double by 2050 with falls and hospitalizations due to adverse drug events having a major effect on health and quality of life. With the release of the revised 2015 American Geriatrics Society (AGS) Beers criteria, usage of potentially inappropriate medications (PIMs) should be studied to determine their effect on falls and hospitalizations in frail populations such as those in assisted living facilities.

Methods:
This quality improvement project used a retrospective chart review on residents from a purposive sample of two assisted living facilities in Northern Virginia. Residents were aged ≥65 and lived at the facility for at least 6 months and were not enrolled in hospice and/or palliative care or living in the dementia unit. The 2015 AGS Beers criteria were used to evaluate the effect of PIMs on falls and hospitalization rates.

Conclusions:
This project did not find statistical significance between PIMs and falls (p = .276). A favorable, but not statistically significant trend, was noted between PIMs and hospitalizations (p = .079).

Implications for practice:
Understanding the effect of PIMs on falls and hospitalizations could help providers improve prescribing practices for the elderly population who are at the greatest risk for potential adverse effects from polypharmacy.
I Serve 2: Identifying and caring for military-connected children in civilian primary care settings
Authors: Rossiter Alicia Gill , Patrician Patricia A. , Dumas Mary Anne , Ling Catherine Gaines , Johnson Heather L. , Wilmoth Margaret C. 
Published: October 2018

ABSTRACT
Military children make tremendous sacrifices in support of a parent(s) military service. More than two million children have a parent who is serving or has served in the Armed Forces. Research shows that military-connected children are at higher risk of physical, psychological, and behavioral health issues. While “resilient” is the word used to describe most military children, it is important to recognize the stresses/stressors of military life— that military children serve too—to support and care for them.
Sudden Sensorineural Hearing Loss in Hemodialysis Patients Could be a Marker of Pathogenic Progression in the Mortality and Atherosclerotic Events: A National Cohort Study
Authors: Chou Chu-Lin , Hsieh Tsung-Cheng , Chen Jin-Shuen , Fang Te-Chao 
Published: October 2018

Objectives:
There are higher incidence of sudden sensorineural hearing loss (SSHL) in hemodialysis (HD) patients than in the general population. Long-term outcomes of HD patients with new-onset SSHL have yet to be investigated although SSHL is considered as an independent risk of cardiovascular diseases in the general population. We examined the risks of mortality and atherosclerotic events in HD patients with new-onset SSHL in Taiwan.

Study Design:
Cohort study.

Methods:
Using the Taiwan National Health Institutes Research Database, 105,243 HD patients were identified between 1997 and 2008. In total, 288 HD patients with a new diagnosis of idiopathic SSHL were enrolled and matched with 1,728 HD patients without SSHL by using propensity score matching at a ratio of 1:6.

Main Outcome Measures:
A multivariate Cox regression and a competing risk regression were used to evaluate mortality and atherosclerotic events.

Results:
Results revealed a risk of mortality in HD patients with SSHL than in HD patients without SSHL (adjusted hazard ratios [aHRs] 2.22, 95% confidence interval [CI] 1.71–2.89). HD patients with SSHL had higher risks of hemorrhagic stroke (competing risk aHR 4.08, 95% CI 1.93–8.61), ischemic stroke (competing risk aHR 2.34, 95% CI 1.45–3.78), acute coronary syndrome, and peripheral arterial occlusive disease than did the HD patients without SSHL.

Conclusion:
This study is the first to signify that the risks of mortality and atherosclerotic complications in HD patients with new-onset SSHL are increased. Therefore, we should pay attention to risks of mortality and atherosclerotic events in HD patients with new-onset SSHL.
The Medial Canthus Reference Electrode Is not Electrically Indifferent to the Ocular Vestibular Evoked Myogenic Potential
Authors: Piker Erin G. , Jacobson Gary P. , Makowiec Kathryn F. , Atabek Paris M. , Krolewicz Sara 
Published: October 2018

Objective:
To determine whether a reference electrode placed over the contralateral medical canthus is electrically indifferent to the ocular vestibular evoked myogenic potential (oVEMP).

Study Design:
Prospective observational study.

Setting:
Tertiary academic center.

Participants:
Nineteen otologically normal subjects.

Methods:
oVEMPs were recorded using a 500 Hz tone burst at 125 dB pSPL using both a conventional dual infra-orbital derivation and contralateral infraorbital electrode referenced to a medial canthus electrode known as the “belly-tendon” derivation.

Results:
The belly-tendon derivation produced significantly larger oVEMP amplitudes. This appears to be due to a polarity inversion of the first negative peak that occurs when the reference electrode is placed over the medial canthus. Thus, the belly-tendon derivation was associated with reference contamination, but in this instance the reference contamination produced an augmented oVEMP amplitude.

Conclusions:
Neither the dual infra-orbital nor belly-tendon electrode montages are electrically neutral. Reference contamination is the source of both a decrease in amplitude using conventional recording techniques and increased amplitude using the belly-tendon montage. The results support the contention that the belly-tendon montage generates a reversed polarity response, i.e., algebraically subtracted (i.e., added in the differential amplifier) from the response recorded at the infraorbital midline enhancing the oVEMP amplitude. It should be noted that the amplitude gained when using the belly-tendon montage may also be due to electromyographic (EMG) generated by extraocular muscles other than the inferior oblique generator, resulting in a loss of specificity. The authors recommend the belly-tendon montage be used in clinical situations where the oVEMP is absent or low in amplitude.
Causes of Persistent Positional Vertigo Following Posterior Semicircular Canal Occlusion for Benign Paroxysmal Positional Vertigo
Authors: Luryi Alexander L. , Schutt Christopher A. , Bojrab Dennis I. , LaRouere Michael , Zappia John , Sargent Eric W. , Babu Seilesh 
Published: October 2018

Objective:
To report causes of persistent recalcitrant positional vertigo (PRPV) after posterior semicircular canal occlusion (PSCO) for benign paroxysmal positional vertigo (BPPV).

Study Design:
Retrospective chart review.

Setting:
Single high-volume otology practice.

Patients:
Patients diagnosed with BPPV from 2007 to 2017.

Intervention:
PSCO and follow-up care including diagnostic and particle repositioning maneuvers for recurrent BPPV.

Main Outcome Measures:
PRPV, defined as recalcitrant positional vertigo for any reason following PSCO.

Results:
Twenty seven PSCO operations were performed in 26 patients. Twenty five patients (96.2%) had resolution of the Dix–Hallpike test in the operated ear. Eleven patients (42.3%) developed BPPV postoperatively, three (11.5%) in the operated ear and eight (30.8%) in the contralateral ear. Five of eight patients (62.5%) who developed contralateral BPPV had unilateral BPPV preoperatively. Eight patients (30.8%) developed BPPV at least twice after surgery or did not resolve, qualifying as PRPV, and all but one of these events occurred in the nonsurgical ear. No instances of cerebrospinal fluid leak, postoperative infection, facial palsy, clinically significant hearing loss, or death occurred.

Conclusions:
PSCO is a safe and effective option for recalcitrant BPPV. However, 30.8% of patients, including patients with initially unilateral BPPV, had recalcitrant positional vertigo postoperatively, usually due to contralateral BPPV. Patients considering PSCO should be counseled regarding this risk to ensure realistic expectations.
Relationship of a “Fundal Fluid Cap” and Vestibular Schwannoma Volume: Analysis of Preoperative Radiographic Findings and Outcomes
Authors: Sullivan Christopher Blake , Sun Daniel Q. , Al-Qurayshi Zaid , Bathla Girish , Policeni Bruno , Gantz Bruce J. , Hansen Marlan R. 
Published: October 2018

Objective:
To evaluate the relationship between radiographic fundal fluid cap in the lateral internal auditory canal, preoperative clinical characteristics, and postoperative outcomes in patients with vestibular schwannoma who underwent microsurgical excision.

Study Design:
Retrospective chart review.

Setting:
Academic tertiary referral center.

Patients:
Thirty-six consecutive patients (mean age 49.4 yr [range 29–74]) who underwent microsurgical vestibular schwannoma excision.

Interventions:
Microsurgical excision.

Main Outcome Measures:
Linear fundal fluid size and tumor size calculated using volumetric analysis were measured on preoperative magnetic resonance imaging, and correlated to hearing status and postoperative facial nerve function.

Results:
Mean fundal fluid size was 2.18 mm (range 0–7.32). Mean tumor volume was 5.58 cm3 (range, 0.210–40.3 cm3). Short- and long-term postoperative House–Brackmann scores were 2.4 and 1.4, respectively. Fundal fluid size was associated with tumor volume (r

s
= 0.488, p = 0.003) but not preoperative hearing status (p = 0.333). The presence of fundal fluid and larger tumor volumes were statistically associated with poorer short-term and long-term postoperative facial nerve function (p < 0.05).

Conclusions:
Radiographic fundal fluid size is correlated to tumor volume.
Noninvasive Registration Strategies and Advanced Image Guidance Technology for Submillimeter Surgical Navigation Accuracy in the Lateral Skull Base
Authors: Schneider Daniel , Hermann Jan , Gerber Kate A. , Ansó Juan , Caversaccio Marco D. , Weber Stefan , Anschuetz Lukas 
Published: October 2018

Hypothesis:
Combining novel registration strategies and advanced image guidance technology enable submillimeter accurate and noninvasive navigation for middle ear and lateral skull base surgery.

Background:
Surgery in the internal auditory canal and the petrous apex present a cognitive and motoric challenge for the surgeon. To date, image guidance rarely assists these procedures, mainly due to the lack of navigation solutions providing submillimeter accuracy associated with low cost in terms of invasiveness, radiation, and time.

Methods:
This study proposes an approach to clinically viable image guidance by using a combination of advanced image guidance technology and noninvasive registration strategies. Based on accuracy-optimized optical tracking hardware (accuracy: 0.05 ± 0.025 mm), 14 novel registration strategies were investigated. In human cadaveric temporal bone specimens n = 36 registration attempts per strategy were conducted. Target registration errors at 10 anatomical targets were measured.

Results:
The most accurate registration strategies were identified as paired-point-matching using eight landmarks located in the external auditory canal and middle ear and surface matching using combined surfaces of the middle ear, the external auditory canal and the mastoid cortex yielding target registration errors of 0.51 ± 0.28 mm and 0.36 ± 0.13 mm respectively.

Conclusions:
This study demonstrates submillimeter TREs achieved with noninvasive, anatomy-based registration strategies in combination with advanced image guidance technology. Clinically viable LSB and ME navigation is realized without additional invasiveness, radiation and time associated with artificial fiducials. The appropriate registration strategy can be chosen by the surgeon depending on the pathology and surgical approach.