bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of Injury and Illness Surveillance Protocols in Varsity Athletes
Authors: Gamble Alexander Shand Davis , Mountjoy Margo Lynn , Bigg Jessica Lynne , Spriet Lawrence Leon 
Published: May 2018

Objective:To develop and implement a prospective varsity athlete surveillance system to identify injury and illness trends in a multisport varsity-level university setting.Design:Longitudinal prospective surveillance study.Setting:Varsity-level sport program at the University of Guelph, Guelph, ON, Canada.Participants:Athletic therapists (ATs) (n = 35) from 17 varsity sports provided injury and illness information on 624 varsity-level athletes (381 men and 243 women) during the 2016/2017 competitive season.Interventions:Team ATs reported athlete health complaints weekly. Athletes reported additional details on the injury or illness that was reported.Main Outcome Measures:The outcome measurements included when the injury or illness occurred, anatomical location, diagnosis, cause, perceived severity, treatment, estimated athlete exposure (AE) to training and competition, and time loss from sport. Measures were recorded from the teams' first competition through to the end the season and/or playoffs.Results:Twenty-nine of 30 varsity sports teams participated in this injury and illness surveillance protocol. The compliance of team ATs and varsity athletes was 89% (men: 94%, women: 82%). The overall injury and illness rates were 5.5 injuries and 1.7 illnesses per 1000 AEs, respectively. Men's injury rates were greater than women's, and injury rates of contact sports were greater than noncontact sports.Conclusions:The utilization of a prospective injury and illness surveillance protocol in the Canadian University sport system is feasible with good athlete, AT, and coach acceptance. The surveillance data should inform future injury and illness prevention strategies.
Postprofessional Physical Therapist Education: A Report From Two Regions of the World
Authors: Westervelt Karen C. , Chenette Jennifer , Merkel Liana , Sibold Jeremy , Crane Linda , Hing Wayne 
Published: May 2018

Introduction.
Leaders in the physical therapy profession have identified a global need for high-quality postprofessional physical therapist (PT) education. However, the educational needs and realities for busy practicing PTs have yet to be identified. Therefore, the purpose of this research was to provide information to assist institutions around the world in designing appropriate postprofessional education programs for PTs.

Methods.
The study sample consisted of 10 years of alumni from a Doctor of Physical Therapy (DPT) program in the United States of America (USA) and 7 years of alumni from an equivalent DPT program in Australia (AUS). Data were collected via survey and were analyzed using descriptive statistics and phenomenological analysis.

Results.
Approximately 10% of participants from each country had completed a formal postprofessional education program. More recent graduates in both groups reported the greatest interest in postprofessional education. Both groups showed high interest in returning to their alma maters, utilizing a hybrid learning format, and participating in international collaborations. Orthopedics and musculoskeletal were the specialty areas of greatest interest in the USA and AUS, respectively. Barriers to pursuing postprofessional education identified by both groups were cost and lack of access/locations. Focus group participants identified access to a mentor and increased recognition as important aspects of postprofessional education.

Discussion and Conclusion.
Universal interest in, and barriers to, postprofessional physical therapy education exists worldwide. Offering hybrid education including international collaboration and mentoring targeted at recent graduates may be effective in meeting the needs of busy PTs. Institutions looking to establish successful postprofessional education programs should take cost, access, time, and area of study into consideration.
Excess Cost of Cervical Cancer Screening Beyond Recommended Screening Ages or After Hysterectomy in a Single Institution
Authors: Teoh Deanna , Hultman Gretchen , DeKam McKenzie , Isaksson Vogel Rachel , Downs Levi S. , Geller Melissa A. , Le Chap , Melton Genevieve , Kulasingam Shalini 
Published: May 2018

Objective
The aim of the study was to estimate the excess cost of guideline nonadherent cervical cancer screening in women beyond the recommended screening ages or posthysterectomy in a single healthcare system.

Materials and Methods
All Pap tests performed between September 1, 2012, and August 31, 2014, in women younger than 21 years, older than 65 years, or after hysterectomy, were coded as guideline adherent or nonadherent per the 2012 America Society of Colposcopy and Clinical Pathology guidelines. We assumed management of abnormal results per the 2013 America Society of Colposcopy and Clinical Pathology management guidelines. Costs were obtained from a literature review and Center for Medicare and Medicaid Services data and applied to nonadherent screening and subsequent diagnostic tests.

Results
During this period, 1,398 guideline nonadherent Pap tests were performed (257 in women <21 years, 536 in women >65 years, and 605 after hysterectomy), with 88 abnormal results: 35 (13.5%) in women younger than 21 years, 14 (2.6%) in women older than 65 years, and 39 (6.5%) in women after hysterectomy. The excess cost for initial screening, diagnostic tests, and follow-up was US $35,337 for 2 years in women younger than 21 years, US $54,378 for 5 years in women older than 65 years, and US $77,340 for 5 years in women after hysterectomy, resulting in a total excess cost of US $166,100 for 5 years. Of the 1,398 women who underwent guideline nonadherent screening, there were only 2 (0.1%) diagnoses of high-grade dysplasia (VaIN3).

Conclusions
Guideline nonadherent cervical cancer screening in women beyond the recommended screening ages and posthysterectomy resulted in costs exceeding US $160,000 for screening, diagnostic tests, and follow-up with minimal improvement in detection of high-grade dysplasia.
Modern management of osteoradionecrosis
Authors: Raggio Blake S. , Winters Ryan 
Published: May 2018

Purpose of reviewDespite recent advances in radiotherapy, osteoradionecrosis (ORN) remains a common and difficult complication of radiation therapy in head and neck cancer patients. Available treatment options are complementary to its complex pathophysiology and the currently available theories of ORN development. The efficacy of hyperbaric oxygen therapy has recently been questioned, and therapies targeting the fibroatrophic process have become a focus of ORN treatment. The objective of this review is to evaluate the literature regarding ORN of the mandible, with a focus on available treatment options.Recent findingsThe recently proposed fibroatrophic theory has challenged the traditional hypovascular-hypoxic-hypocellular theory as the mechanism of ORN. Medical management targeting this fibroatrophic process offers promising results, but has yet to be confirmed with robust clinical trials. The routine use of hyperbaric oxygen therapy is not substantiated in the literature, but may be justified for select patients. Systemic steroids may also have a role, though data are limited.SummaryThe fibroatrophic process has gained acceptance as a main mechanism of ORN. No gold standard treatment or consensus guidelines exist, though a combination of therapeutic strategies should be considered, taking into account the severity of disease and individual patient characteristics.
Evaluation of Helicobacter pylori Infection and Clarithromycin Resistance in Strains From Symptomatic Colombian Children
Authors: Rosero Yuliet L. , Arévalo‐Jaimes Betsy V. , Delgado María Pilar , Vera‐Chamorro José F. , García Daniella , Ramírez Andrea , Rodriguez‐Urrego Paula A. , Álvarez Johanna , Jaramillo Carlos A. 
Published: May 2018

ABSTRACTThe aim of the study was to determine the current prevalence of Helicobacter pylori in symptomatic Colombian children and evaluate the presence of mutations associated with clarithromycin resistance. Biopsies from 133 children were analyzed. The gastric fragment was used for urease test and reused for polymerase chain reaction sequencing of the 23SrDNA gene. Mutations were detected by bioinformatic analysis. Polymerase chain reaction sequencing established that H pylori infection was present in 47% of patients. Bioinformatics analysis of the 62 positive sequences for 23SrDNA revealed that 92% exhibited a genotype susceptible to clarithromycin, whereas the remaining strains (8%) showed mutations associated with clarithromycin resistance. The low rate of resistance to clarithromycin (8%) suggests that conventional treatment methods are an appropriate choice for children. Recycling a biopsy that is normally discarded reduces the risks associated with the procedure. The 23SrDNA gene amplification could be used for a dual purpose: detection of H pylori and determination of susceptibility to clarithromycin.
Uneven Staining in Automated Immunohistochemistry: Cold and Hot Zones and Implications for Immunohistochemical Analysis of Biopsy Specimens
Authors: Cheung Carol C. , Swanson Paul E. , Nielsen Søren , Vyberg Mogens , Torlakovic Emina E. 
Published: May 2018

Objectives:
The occurrence of uneven staining (UES) in automated immunohistochemistry (IHC) has been experienced by clinical laboratories and has the potential to confound readout, interpretation, and reporting of IHC assays despite the presence optimally stained on-slide controls. However, there are no studies of this phenomenon in regard to the type, frequency, and association with different automated IHC platforms. We studied the occurrence of UES in automated IHC assays with real world examples from clinical practice and by using a laboratory developed methodology to monitor baseline and periodic performance of automated IHC instruments.

Materials and Methods:
Sections of formalin-fixed, paraffin-embedded normal liver tissue were mounted on 180 glass slides and stained for HepPar1 on 6 automated IHC instruments (4 different models from 3 different manufacturers). Macroscopic and microscopic defects of staining were recorded.

Results:
Only 8% of slides showed completely uniform staining. UES, including areas of both increased and decreased staining, occurred with all instruments. Decreased staining was often zonal, involving large regions of the slide. Decreased staining mostly localized in an instrument-dependent manner. Increased staining tended to occur in small foci with a random distribution.

Conclusions:
The common occurrence of UES (particularly decreased staining) has important implications for the reliable read-out of IHC assays on biopsy samples. Baseline and periodic quality assurance testing for UES is recommended for all automated IHC instruments.
Applying Machine Learning to Pediatric Critical Care Data*
Authors: Williams Jon B. , Ghosh Debjit , Wetzel Randall C. 
Published: May 2018

Objectives:
To explore whether machine learning applied to pediatric critical care data could discover medically pertinent information, we analyzed clinically collected electronic medical record data, after data extraction and preparation, using k-means clustering.

Design:
Retrospective analysis of electronic medical record ICU data.

Setting:
Tertiary Children’s Hospital PICU.

Patients:
Anonymized electronic medical record data from PICU admissions over 10 years.

Interventions:
None.

Measurements and Main Results:
Data from 11,384 PICU episodes were cleaned, and specific features were generated. A k-means clustering algorithm was applied, and the stability and medical validity of the resulting 10 clusters were determined. The distribution of mortality, length of stay, use of ventilation and pressors, and diagnostic categories among resulting clusters was analyzed. Clusters had significant prognostic information (p < 0.0001). Cluster membership predicted mortality (area under the curve of the receiver operating characteristic = 0.77). Length of stay, the use of inotropes and intubation, and diagnostic categories were nonrandomly distributed among the clusters (p < 0.0001).

Conclusions:
A standard machine learning methodology was able to determine significant medically relevant information from PICU electronic medical record data which included prognosis, diagnosis, and therapy in an unsupervised approach. Further development and application of machine learning to critical care data may provide insights into how critical illness happens to children.
Cross-Cultural Adaptation and Psychometric Evaluation of a Second Victim Experience and Support Tool (SVEST)
Authors: Brunelli Maria Victoria , Estrada Silvina , Celano Constanza 
Published: May 2018

Introduction
The second victim is defined as the health professionals who commit an error and are traumatized by the event manifesting psychological, cognitive, and/or physical reactions that have a personal negative impact.
The SVEST (Second Victim Experience and Support Tool) is a survey developed and validated in the United States, which describes the experience of second victims.
The objective of this study was to perform the cross-cultural adaptation of the instrument and to assess the psychometric characteristics in the sociocultural and professional context of Argentina.

Materials and Methods
The back translation of the instrument was carried out, which was approved by the authors. The survey consists of 29 questions divided into 9 dimensions corresponding to psychological stress, physical stress, colleague support, supervisor’s support, institutional support, non–work-related support, professional effectiveness assessment, change intention, and absenteeism. Subsequently, the survey was conducted to nursing professionals who had committed an error in medication. The reliability testing was done for internal consistency and the validity through construct validity using SPSS program.

Results
The population consisted of 452 nurses having an average of 10 years of practice (SD, 8.2). Eighty-two percent of those who made an error stated that they reported the event once it had occurred.
In our exploratory analysis, the survey presented no comprehension difficulties. The internal consistency of the instrument was adequate in its overall evaluation (Cronbach, 0.805).

Conclusion
The adaptation of SVEST is reliable for the use of this instrument in our environment to quantify the phenomenon and to be able to design strategies to reduce the impact of the error in the second victim.
A Standardized Handoff Simulation Promotes Recovery From Auditory Distractions in Resident Physicians
Authors: Matern Lukas H. , Farnan Jeanne M. , Hirsch Kristen W. , Cappaert Melissa , Byrne Ellen S. , Arora Vineet M. 
Published: May 2018

Introduction
Despite the increasing use of training simulations to teach and assess resident handoffs, simulations that approximate realistic hospital conditions with distractions are lacking. This study explores the effects of a novel simulation-based training intervention on resident handoff performance in the face of prevalent hospital interruptions.

Methods
After a preliminary educational module, entering postgraduate year 1 residents (interns) completed one of the following three handoff simulations: (1) no interruption, (2) hospital noise, or (3) noise and pager interruptions. Trained receivers rated interns using an evidence-based Handoff Behaviors Checklist and a previously validated Handoff Mini-Clinical Examination Exercise instrument.

Results
Of 127 eligible interns, 125 (98.4%) completed an online preparatory module and a handoff simulation. Interns receiving auditory interruptions were less likely to be heard adequately (48.8% noise and 71.8% noise + pager vs. 100.0% uninterrupted, P < 0.001) and scored lower on establishing appropriate handoff settings (5.7 ± 2.3 noise and 6.2 ± 1.8 noise + pager vs. 8.0 ± 0.8 uninterrupted, P < 0.001). Interns receiving noise only shared a written sign-out document more effectively (71.1% vs. 30.2% uninterrupted and 43.6% noise + pager, P < 0.001). There were no differences in averaged performance metrics on the Handoff Behaviors Checklist.

Discussion
While common hospital interruptions created nonideal circumstances for the handoff, interns receiving interruptions were rated similarly and recovered effectively. However, interns exposed to noise only used the written sign-out form more actively. Our findings suggest that this intervention was successful in promoting handoff proficiency despite exposure to common but significant hospital interruptions.
The Effect of Commonly Performed Exercises on the Levator Hiatus Area and the Length and Strength of Pelvic Floor Muscles in Postpartum Women
Authors: Siff Lauren N. , Hill Audra J. , Walters Samantha J. , Walters Ginny , Walters Mark D. 
Published: May 2018

Objective
The aim oft his study was to compare the effects of 10 common exercises to traditional pelvic floor muscle (PFM) contractions (Kegel) on levator hiatus (LH) area and PFM length and strength.

Methods
This is a cross-sectional study of 15 healthy postpartum women. Ten exercises were studied. These were common variations of leg, core, and back exercises used in yoga, Pilates, strength training, and physical therapy. Each participant performed all 10 exercises at a single visit in 2 examination settings: transperineal ultrasound and perineometry. Ultrasound measured the LH area and PFM length, and perineometry measured the muscle strength (peak squeeze pressure).

Results
Kegel generates an increase in squeeze pressure (24.3 cm H2O), shortens the muscles (−0.46 cm) and narrows the LH (−0.13 cm2). The bird-dog and plank exercises were not different from Kegel in any measurement. While the leg-lift ultrasound dimensions are similar to Kegel, leg lifts generated peak squeeze pressures stronger than any other exercise (including Kegel). Whereas ultrasound dimensions were similar to Kegel, tucked and untucked squats and thigh adductions generated weaker contractions than Kegel. While crunch generated a squeeze pressure similar to Kegel, the ultrasound dimensions showed a significantly wider LH and longer muscle than Kegel. Bridge, clam, and plié exercises affected the PFMs differently than Kegel in all measures.

Conclusions
Bird-dog, plank, and leg-lift exercises should be evaluated as alternative exercises to Kegel as they affect PFM strength and length and LH area similarly to Kegel, and leg lifts generate a stronger contraction than Kegel.
Summary: 2017 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse
Authors: Maher Christopher F. , Baessler Kaven K. , Barber Matthew D. , Cheon Cecilia , Consten Esther C.J. , Cooper Kevin G. , Deffieux Xavier , Dietz Viviane , Gutman Robert E. , van Iersel Jan J. , Nager Charles W. , Sung Vivian W. , de Tayrac Renaud 
Published: May 2018

Objective
The aim of this article is to summarize the relevant findings that inform the 2017 International Consultation on Incontinence pathway for surgical treatment of pelvic organ prolapse (POP).

Methods
We conducted an evidence-based review of the English-language peer-reviewed literature relating to POP surgery published prior to December 2016. Level 1 evidence (randomized controlled trials [RCTs] or systematic reviews of RCTs) was preferred; however, level 2 (poor-quality RCT, prospective cohort studies) or 3 evidence (case series or retrospective studies) has been included if level 1 data were lacking. The committee evaluated the literature and made recommendations based on the Oxford grading system summarized as follows: grade A recommendation usually depends on consistent level 1 evidence; grade B recommendation usually depends on consistent level 2 and/or 3 studies, or “majority evidence” from RCTs; grade C recommendation usually depends on level 3 studies or “majority evidence” from level 2/3 studies or Delphi-processed expert opinion; grade D, “no recommendation possible,” would be used where the evidence is inadequate or conflicting.

Results
The recommendations from each chapter of the review are presented and serve to inform an evidence-based pathway for the surgical treatment of prolapse. A Web-based interactive application of the pathway is presented.

Conclusions
The 2017 International Consultation on Incontinence pathway on surgery for POP is designed as an adjunct to transparent consultation and consent relating to POP surgery. The final decision regarding surgical intervention can be made only after a shared decision-making process between the patient and the clinician that will evaluate a variety of individual factors that cannot be assessed in the pathway.
Reversible two-state folding of the ultrafast protein gpW under mechanical force
Authors: Schönfelder Jörg , De Sancho David , Berkovich Ronen , Best Robert B. , Muñoz Victor , Perez-Jimenez Raul 
Published: May 2018

AbstractUltrafast folding proteins have limited cooperativity and thus are excellent models to resolve, via single-molecule experiments, the fleeting molecular events that proteins undergo during folding. Here we report single-molecule atomic force microscopy (AFM) experiments on gpW, a protein that, in bulk, folds in a few microseconds over a marginal folding barrier (~1 kBT). Applying pulling forces of only 5 pN we maintain gpW in quasi-equilibrium near its mechanical unfolding midpoint, and detect how it interconverts stochastically between the folded and an extended state. This binary pattern indicates that, under an external force, gpW (un)folds over a significant free energy barrier. Using molecular simulations and a theoretical model we rationalize how force induces such barrier in an otherwise downhill free energy surface. Force-induced folding barriers are likely a general occurrence for ultrafast folding biomolecules studied with single molecule force spectroscopy.
Calibration, Selection and Identifiability Analysis of a Mathematical Model of the in vitro Erythropoiesis in Normal and Perturbed Contexts
Authors: Duchesne Ronan , Guillemin Anissa , Crauste Fabien , Gandrillon Olivier 
Published: May 2018

AbstractThe in vivo erythropoiesis, which is the generation of mature red blood cells in the bone marrow of whole organisms, has been described by a variety of mathematical models in the past decades. However, the in vitro erythropoiesis, which produces red blood cells in cultures, has received much less attention from the modelling community. In this paper, we propose the first mathematical model of in vitro erythropoiesis. We start by formulating different models and select the best one at fitting experimental data of in vitro erythropoietic differentiation. It is based on a set of linear ODE, describing 3 hypothetical populations of cells at different stages of differentiation. We then compute confidence intervals for all of its parameters estimates, and conclude that our model is fully identifiable. Finally, we use this model to compute the effect of a chemical drug called Rapamycin, which affects all states of differentiation in the culture, and relate these effects to specific parameter variations. We provide the first model for the kinetics of in vitro cellular differentiation which is proven to be identifiable. It will serve as a basis for a model which will better account for the variability which is inherent to experimental protocol used for the model calibration.