bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current State in Scientific Publishing
Authors: Wolf Jennifer Moriatis , Sandell Linda J. , Leopold Seth S. , Dodson Karen L. 
Published: October 2019

Abstract:
Orthopaedic surgery has a rich history of publication of the science that supports the practice of our specialty, which dates from 1887. Orthopaedic publishing has evolved since that time, expanding from print to online access, with increasing variation in publication models, including open-access journals and article repositories, and methods of information delivery that include video, data archives, and commentary. This symposium provides an overview of the changes and challenges in the publication of orthopaedic science.
The Pediatric “Floating Knee” Injury
Authors:   CORTICES
Published: October 2019

Background:
Isolated femoral and tibial fractures are 2 of the top 5 causes of pediatric orthopaedic hospital admission, yet their simultaneous ipsilateral presentation, the “floating knee” injury, remains rare. Historically, treatment consisted of traction and cast immobilization, which resulted in prolonged periods of immobilization, lengthy hospitalizations, and high rates of malunion. As such, previous authors have recommended fixation of at least 1 bone in the setting of a floating knee injury. This strategy, however, has never been evaluated and the outcomes of modern treatment are unknown.

Methods:
We performed a multicenter retrospective review of the records of pediatric patients with ipsilateral femoral and tibial fractures that had been treated at 11 tertiary care level-I pediatric trauma centers from 2004 to 2014. Outcomes and treatment strategies were assessed with standardized means.

Results:
Over the study period, 130 floating knees in 129 patients met the inclusion criteria for evaluation. The average patient age was 10.2 years, and 63.1% were male. One-third of the patients presented with open injuries, and 83.8% of injuries were related to vehicular trauma. Simple diaphyseal fractures (OTA/AO 32-A and B femoral fractures and OTA/AO 42-A and B tibial fractures) were most common. Intramedullary fixation (rigid or flexible) was the most common treatment strategy for femoral fractures (69.2%). Tibial fractures were treated most commonly with casting (27.7%), followed by flexible intramedullary nailing (24.6%). The mean duration of hospitalization was 9.7 days. Outcomes were excellent in 66.6% of cases and good in 26.4% of cases.

Conclusions:
Previous literature on pediatric floating knee injuries consisted of small case series that were published prior to the introduction of flexible intramedullary nailing to North America. This multicenter study of a large cohort demonstrates a change in practice pattern from a largely nonoperative treatment strategy to operative fixation of at least the femoral fracture. In the present study, this approach led to good or excellent results in 93.1% of cases and was associated with a short duration of hospitalization.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Surgical Versus Nonsurgical Management of Rotator Cuff Tears
Authors: Ramme Austin J. , Robbins Christopher B. , Patel Karan A. , Carpenter James E. , Bedi Asheesh , Gagnier Joel J. , Miller Bruce S. 
Published: October 2019

Background:
Rotator cuff disease is a major medical and economic burden due to a growing aging population, but management of rotator cuff tears remains controversial. We hypothesized that there is no difference in outcomes between patients who undergo rotator cuff repair and matched patients treated nonoperatively.

Methods:
After institutional review board approval, a prospective cohort of patients over 18 years of age who had a full-thickness rotator cuff tear seen on magnetic resonance imaging (MRI) were retrospectively evaluated. After clinical evaluation, each patient elected to undergo either rotator cuff repair or nonsurgical treatment. Demographic information was collected at enrollment, and self-reported outcome measures (the Normalized Western Ontario Rotator Cuff Index [WORCnorm], American Shoulder and Elbow Surgeons score [ASES], Single Assessment Numerical Evaluation [SANE], and pain score on a visual analog scale [VAS]) were collected at baseline and at 6, 12, and >24 months. The Functional Comorbidity Index (FCI) was used to assess health status at enrollment. The size and degree of atrophy of the rotator cuff tear were classified on MRI. Propensity score analysis was used to create rotator cuff repair and nonsurgical groups matched by age, sex, symptom duration, FCI, tear size, injury mechanism, and atrophy. The Student t test, chi-square test, and regression analysis were used to compare the treatment groups.

Results:
One hundred and seven patients in each group were available for analysis after propensity score matching. There were no differences between the groups with regard to demographics or rotator cuff tear characteristics. For all outcome measures at the time of final follow-up, the rotator cuff repair group had significantly better outcomes than the nonsurgical treatment group (p < 0.001). At the time of final follow-up, the mean outcome scores (and 95% confidence interval) for the surgical repair and nonsurgical treatment groups were, respectively, 81.4 (76.9, 85.9) and 68.8 (63.7, 74.0) for the WORCnorm, 86.1 (82.4, 90.3) and 76.2 (72.4, 80.9) for the ASES, 77.5 (70.6, 82.5) and 66.9 (61.0, 72.2) for the SANE, and 14.4 (10.2, 20.2) and 27.8 (22.5, 33.5) for the pain VAS. In the longitudinal regression analysis, better outcomes were independently associated with younger age, shorter symptom duration, and rotator cuff repair.

Conclusions:
Patients with a full-thickness rotator cuff tear reported improvement in pain and functional outcome scores with nonoperative treatment or surgical repair. However, patients who were offered and chose rotator cuff repair reported greater improvement in outcome scores and reduced pain compared with those who chose nonoperative treatment.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Os Odontoideum in Children
Authors: Helenius Ilkka J. , Bauer Jennifer M. , Verhofste Bram , Sponseller Paul D. , Krengel Walter F. , Hedequist Daniel , Cahill Patrick J. , Larson A. Noelle , Pahys Joshua M. , Anderson John T. , Martus Jeffrey E. , Yaszay Burt , Phillips Jonathan H. 
Published: October 2019

Background:
Treatment outcomes and risk factors for neurological deficits in pediatric patients with an os odontoideum are unclear.

Methods:
We reviewed the data for 102 children with os odontoideum who were managed at 11 centers between 2000 and 2016 and had a minimum duration of follow-up of 2 years. Thirty-one children had nonoperative treatment, and 71 underwent instrumented posterior cervical spinal arthrodesis for the treatment of C1-C2 instability. Nonoperative treatment consisted of observation (n = 29) or immobilization with a cervical collar (n = 1) or halo body jacket (n = 1). Surgical treatment consisted of atlantoaxial (n = 50) or occipitocervical (n = 21) arthrodesis. One patient also underwent transoral odontoidectomy.

Results:
Thirty children (29%) presented with neurological deficits, 28 of whom had radiographic atlantoaxial instability (atlantoaxial distance >5 mm) or limited space (≤13 mm) available for the spinal cord (risk ratio, 7.8 [95% confidence interval, 2.0 to 31] compared with children with no radiographic risk factors). The 27 children without neurological deficits or atlantoaxial instability at presentation underwent nonoperative treatment and remained asymptomatic. Of the initial nonoperative cohort, one child developed atlantoaxial instability, and another had a persistent neurological deficit; both children underwent spinal arthrodesis during the study period. One child with cervical instability declined surgery and remained asymptomatic. Spinal fusion occurred in 68 patients in the surgical group by the end of the study period (mean, 3.7 years; range, 2.0 to 11.8 years). Surgical complications occurred in 21 children, including nonunion in 12, new neurological deficits in 4, cerebrospinal fluid leak in 2, symptomatic instrumentation requiring removal 2, and vertebral artery injury in 1. Nine children underwent revision surgery. In the surgical group, Japanese Orthopaedic Association neurological function scores improved significantly from preoperatively to the latest follow-up for the upper extremities (p = 0.026) and lower extremities (p = 0.007).

Conclusions:
The risk of developing a neurological deficit was strongly associated with atlantoaxial instability and limited space available for the spinal cord in children with os odontoideum. Nonoperative treatment was safe for asymptomatic patients without atlantoaxial instability. Spinal arthrodesis resolved the neurological deficits of children with symptomatic os odontoideum.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Acceptability and clinical trial feasibility evaluation of auditory rhythmical cueing to improve gait and physical activity in community dwelling stroke survivors (ACTIVATE): study protocol for a pilot randomised controlled trial
Authors: Moore Sarah , McCue Patricia , Din Silvia Del , Hunter Heather , Lord Sue , Price Christopher IM , Shaw Lisa , Rodgers Helen , Rochester Lynn 
Published: October 2019

Abstract
Background Mobility problems are present in 70-80% of stroke survivors, and can result in impaired gait and reduced physical activity limiting independent living. Auditory rhythmic cueing (ARC) has been used to provide auditory feedback and shows promise in improving a variety of walking parameters following stroke. The aim of this pilot study is to assess the feasibility of conducting a multi-centre, observer blind, randomised controlled trial of auditory rhythmical cueing (ARC) intervention in home and community settings in North East England. Methods This pilot observer blind randomised controlled feasibility trial aims to recruit 60 participants over 15 months from community stroke services in the North East of England. Participants will be within 24 months of stroke onset causing new problems with mobility. Each participant will be randomised to the study intervention or control group. Intervention treatment participants will undertake 18 auditory rhythmical cueing (ARC) treatment sessions over six weeks (3 x 30 minutes per week, 6 supervised (physiotherapist/research associate)/ 12 self-managed) in a home/community setting. A metronome will be used to provide ARC during a series of balance and gait exercises, which will be gradually progressed. The control treatment participants will undertake the same duration balance and gait exercise training programme as the intervention group but without the ARC. Feasibility will be determined in terms of recruitment, retention, adverse events, adherence, collection of descriptive clinical and accelerometer motor performance data at baseline, six weeks and ten weeks and description of participant, provider and clinical therapists’ experiences. As well as using questionnaires to collate participant views, qualitative interviews will be undertaken to further understand how the intervention is delivered in practice in a community setting and to identify aspects perceived important by participants. Discussion The ACTIVATE study will address an important gap in the evidence base by reporting whether it is feasible to deliver auditory rhythmical cueing in the home and community to improve gait and balance parameters following stroke. The feasibility of the study protocol will be established and results will inform the design of a future multi-centre randomised controlled trial. Trial Registration: Trial register: ISRCTN, Trial identifier: ISRCTN10874601: Date of registration: 12/03/2018, URL http://www.isrctn.com/search?q=ISRCTN10874601
Correlative Analysis between Expression of Estrogen Receptor, Progesterone Receptor, and HER2 Receptor and Clinicopathologic Features in Endometrial Cancer
Authors: Wang Caifeng , Tran Davis A. , Fu Melinda Z. , Chen Wei , Fu Sidney , Li Xu 
Published: October 2019

Abstract
Background: Endometrial cancer (EC) is a major gynecologic adenocarcinoma that arises from the endometrium. While the incidence of EC is on the rise worldwide, survivorship and clinical advancement have considerably lagged behind compared to other cancers. Given the sensitive nature of the endometrium and its high expression of hormone receptors, hormonal therapy has become a favorable alternative treatment compared to highly toxic chemotherapeutics and radiation therapy. Methods: Clinical samples from patients diagnosed with EC were obtained. ER and PR staining was performed according to the S-P kit, and HER2 staining was carried out according to the UltrasensitiveTM S-P immunohistochemistry kit protocol. Chi-square analysis was conducted using the SPSS. P-values of less than 0.05 were taken as an a priori value for statistical significance. Results: Immunohistochemical (IHC) analysis showed the overall positive expression rates of ER, PR, and HER2 to be 59.8%, 75.0%, and 71.1%, respectively. Significant co-expression was found among all three receptors, suggesting a cooperative, synergistic effect. More importantly, we found that ER expression was correlated with FIGO staging and cervical invasion, whereas PR expression was associated with histologic type. No clinicopathologic features were correlated with HER2 expression, but HER2 positivity was inversely associated with the degree of HER2 overexpression. Conclusions: These results suggest that EC is a heterogeneous disease that may not conform to traditional, prototypically defined subtypes. The status of ER, PR, and HER2 receptors may have the potential to serve as prognostic indicators for EC, but further analysis is needed to ascertain their prognostic significance.
Cryptosporidium parvum GP60 subtypes present in diarrheic dairy calves of two biogeographical regions of Chile
Authors: Peña Sebastian , Muñoz Pamela , Raffo Eduardo , Fredes Fernando , Ozaki Luiz S , Mercado Rubén 
Published: October 2019

Abstract
Background Cryptosporidium is an apicomplexan zoonotic pathogen primary causing diarrhea in vertebrate hosts notably bovines and humans. Here, we characterized Cryptosporidium isolates by using the GP60 gene fragment of C. parvum to observe the dynamics of cryptosporidiosis transmission in dairy calves from two distant biogeographical regions of Chile (Metropolitan and Los Rios Regions). We collected 72 fecal samples from diarrheic calves screening the parasite carried out microscopy of an acid-fast staining smear and molecular characterization employing PCR to directly detect the Sanger GP60 C. parvum subtype and simultaneously in one selected sample the NGS profile of the GP60 same gene fragment to determine same and/or others Cryptosporidium subtypes Results The IIaA15G2R1 subtype was present in the 100% of the bovine fecal samples studied from Los Rios Region. Along with this same subtype, another two were observed in the Metropolitan Region, IIaA17G2R1 and IIaA17G4R1. The NGS analysis of a single selected GP60 PCR amplicon of one selected sample of our study showed similarly the Sanger sequencing determined subtype, the IIaA17G4R1 in 90% of readable sequences observed. By using this approach another multiple low frequency IIa subtypes of C. parvum were observed confirming that in an infected host multiple subtypes of the parasite can be present. Conclusions Cryptosporidiosis in these dairy farms calves in Chile is produced by C. parvum limited number of subtypes, being IIaA15G2R1 the most frequent. The IIa subtype family is considered prevalent in calves in South America. Subtypes IIaA17G2R1 and IIaA17G4R1 had been worldwide distribution. As all C. parvum subtypes observed in calves in Chile were isolated from diarrheic animals, so, it can be possible to relate its presence with the pathogenic role in the bovine host and with a potential digestive disease risk for humans.
Diagnostic accuracy assessment of molecular prediction model for the risk of NAFLD based on MRI-PDFF diagnosed Chinese Han population
Authors: Zhang Qing , Zhu Yueli , Yu Wanjiang , Xu Zhipeng , Xin Yongning , Zhao Zhenzhen , Liu Shousheng , Lv Kuirong 
Published: October 2019

Abstract
Background: Several molecular prediction models based on the clinical parameters had been constructed to predict and diagnosis the risk of NAFLD, but the accuracy of these molecular prediction models remain need to be verified based on the most accurate NAFLD diagnostic method. The aims of this study was to verify the accuracy of three molecular prediction models Fatty liver index (FLI), NAFLD liver fat score system (NAFLD LFS), and Liver fat (%) in the prediction and diagnosis of NAFLD in MRI-PDFF diagnosed Chinese Han population. Patients and Methods: MRI-PDFF was used to diagnose the hepatic steatosis of all the subjects. Information such as name, age, lifestyle, and major medical histories were collected and the clinical parameters were measured by the standard clinical laboratory techniques. The cut-off values of each model for the risk of NAFLD were calculated based on the MRI-PDFF results. All data were analyzed using the statistical analysis software SPSS 23.0. Results: A total of 98 subjects were recruited with the matched sex and age. The ROC curves of FLI, NAFLD LFS, and Liver fat (%) models were plotted based on the results of MRI-PDFF. We founded that the accuracy of FLI, NAFLD LFS, and Liver fat (%) models for the prediction and diagnosis of NAFLD were comparative available in Chinese Han population as well as the validity of them in other ethnics and regions. Conclusions: The molecular prediction models FLI, NAFLD LFS, and Liver fat (%) were comparative available for the prediction and diagnosis of NAFLD in Chinese Han population. MRI-PDFF could be used as the golden standard to develop the new molecular prediction models for the prediction and diagnosis of NAFLD.
Determinants of enrollment decision in the community based health insurance, North West Ethiopia: A case control study
Authors: Tadesse Getasew , Debalkie Desta , Ketemaw Asmamaw , Alemu Yibeltal 
Published: October 2019

Abstract
Objective: - To identify determinants for enrollment decision in the community based health insurance program among informal economic sector engaged societies, North West Ethiopia.Method:-Unmatched case control study was conducted on 148 cases (member to insurance) and 148 controls (not member to insurance program) from September 1- October 30 2016. Stratified then simple random sampling method was employed. The data were entered in to Epi-info version 7 and exported to SPSS version 20 for analysis. Descriptive statistics, bi-variable, and multi-variable logistic regression analyses were computed to describe the study objectives and identify the determinants of enrolment decision for the insurance program. Odds ratio at 95 % CI was used to describe the association between the independent and the outcome variables. Result: - A total of 296 respondents (148 cases and 148 controls) were employed. A mean age for cases and controls was 42 ± 11.73 and 40 ± 11.37 years respectively. Majority of respondents were males (87.2 % for cases and 79 % for controls). Family size between 4 and 6 (AOR=2.26; 95% CI: 1.04, 4.89), history of illness by household (AOR=3.24; 95% CI: 1.68, 6.24), perceived amount of membership contribution was medium (AOR=2.3; 95% CI: 1.23, 4.26), being married (AOR=6; 95% CI:1.43, 10.18) and trust on program (AOR=4.79; 95% CI: 2.40, 9.55) were independent determinants for increased enrolment decision in the CBHI. While, being merchant (AOR=0.07; 95% CI: 0.09, 0.6) decreased the enrolment decision. Conclusion: - Societies enrollment decision to community based health insurance program was determined by demographic, social, economic and political factors. Households with large family size and farmers in the informal sector should be given maximal attention for escalating enrolment decision in the insurance program.
Investigating Inequalities in Access to Healthcare: The Case of Townships of Kermanshah, Iran
Authors: Reshadat Sohyla , Zangeneh Alireza , Saeidi Shahram , Teimouri Raziyeh , GolAnbari Shirin Zardui , Rostami Samira , Cheleii Mahsa , Ziapour Arash , Yigitcanlar Tan 
Published: October 2019

Abstract
Background: Access to medical care is one of the major issues affecting human health. This study aims to investigate inequality in access to medical care in the townships in Kermanshah, Iran. Methods: Methodology approach includes a descriptive-analytic study followed by determining the degree of development of the townships calculated in terms of access to medical care through the hierarchical cluster analysis and the combined model of human development index. Additionally, the mean center and standard distance tests are handled in a geographic information system software to identify the deployment pattern of the status of access to medical care indexes. Results: As for the ratio of physicians, nursing staff, paramedical staff, administrative staff of health care, dentists, pharmacists, hospitals, general and specialized clinics, radiology, rehabilitation centers and laboratories to a population of 10,000, the results of analyzing the findings were indicative of unequal distribution of facilities at the level of townships. This is based on The results of comparing the mean centers of population and health facilities showed that the centers of both data categories were located in Kermanshah. The two standard distances (i.e., population and health facilities) demonstrated that the health facilities witnessed more dispersion in the northwestern regions than the concentration of population in the central and southeastern regions of the province. Conclusions: The results indicated that the indexes of development of facilities and healthcare resources were not distributed equitably and with a balance between the townships of the Kermanshah Province. Keywords: healthcare; medical care inequality; human development index; spatial analysis, cluster analysis; Kermanshah, Iran
Health Assets and Frailty: Positive Psychosocial Resources and Health Status in Older Adult, a Prospective Cohort Study
Authors: Gregorevic Kate , Hubbard Ruth E , Peel Nancye M , Lau Wei Tong , Wu Jethro , Crammond Bradley , Lim Wen Kwang 
Published: October 2019

Abstract
Background: Although frailty is predictive of poorer outcomes for hospitalised older adults, it does not account for all variation in outcomes. Health assets are protective factors associated with wellbeing that may moderate frailty associated mortality and functional decline Objective: To determine whether frail older adults with a higher number of health assets have improved outcomes Design: Prospective cohort study Methods: Adults aged 70 and older with an unplanned admission to hospital were included. Recruitment took place on general medical, orthogeriatric and subacute wards of two hospitals in Australia. The Health Assets Index (HAI), frailty, functional status and covariates were measured at the time of recruitment. Outcomes were mortality at 30 days and functional decline at the time of discharge. Results: There were 298 participants, with an average age of 84.7 and 66% were women. 80.1% were frail. The mean score on the HAI was 10.86 with a range of 5.5-15. 56.4% of participants had functional decline on discharge from hospital with 30 day mortality of 5.7%. There was an inverse relationship between frailty and health assets. Neither frailty or a higher number of health assets alone predicted outcomes. In a post-hoc analysis to account for interaction, a higher number of health assets was protective against mortality for the least frail. This relationship was reversed at higher levels of frailty. Conclusions: A higher number of Health Assets correlated with a lower level of frailty. Although Health Assets alone did not predict mortality, this relationship may be moderated by frailty.