bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulsed Ultrasounds Reduce Pain and Disability, Increasing Rib Fracture Healing, in a Randomized Controlled Trial
Authors: Santana-Rodríguez Norberto , Clavo Bernardino , Llontop Pedro , Fiuza María D , Calatayud-Gastardi Joaquín , López Daniel , López-Fernández Daniel , Aguiar-Santana Ione A , Ayub Adil , Alshehri Khalid , Jordi Nagib A , Zubeldia José , Bröering Dieter C 
Published: October 2018

AbstractIntroductionRib fractures are an important health issue worldwide, with significant, pain, morbidity, and disability for which only symptomatic treatment exists.ObjectivesBased on our previous experimental model, the objective of the current study was to assess for the first time whether pulsed ultrasound (PUS) application could have beneficial effects on humans.MethodsProspective, double-blinded, randomized, controlled trial of 51 patients. Four were excluded, and 47 were randomized into the control group (N = 23) or PUS group (N = 24). The control group received a PUS procedure without emission, and the PUS group received 1 Mhz, 0.5 W/cm2 for 1 min/cm2. Pain level, bone callus healing rate, physical and work activity, pain medication intake, and adverse events were blindly evaluated at baseline and one, three, and six months.ResultsThere were no significant differences at baseline between groups. PUS treatment significantly decreased pain by month 1 (P = 0.004), month 3 (P = 0.005), and month 6 (P = 0.025), significantly accelerated callus healing by month 1 (P = 0.013) and month 3 (P < 0.001), accelerated return to physical activity by month 3 (P = 0.036) and work activity (P = 0.001) by month 1, and considerably reduced pain medication intake by month 1 (P = 0.057) and month 3 (P = 0.017). No related adverse events were found in the PUS group.ConclusionsThis study is the first evidence that PUS treatment is capable of improving rib fracture outcome, significantly accelerating bone callus healing, and decreasing pain, time off due to both physical activity and convalescence period, and pain medication intake. It is a safe, efficient, and low-cost therapy that may become a new treatment for patients with stable rib fractures.
Characteristics associated with influenza vaccination uptake among adults
Authors: Tian Changwei , Wang Hua , Wang Wenming , Luo Xiaoming 
Published: October 2018

Abstract

Background
Annual influenza vaccination has been recommended for all adults since 2010. This study aimed to identify characteristics associated with influenza vaccination among adults.

Methods
Data from the National Health Interview Survey from 2011 to 2016 were analyzed.

Results
Influenza vaccination coverage among adults increased from 38.28% in 2011 to 44.75% in 2016 (1.50% per year on average). In multivariate analysis, the largest magnitude of association was found with pneumococcal vaccine (lowest and highest odds ratios from 2011 to 2016: 3.37–3.78), followed by physician visits ≥4 in the past 12 months (2.33–3.03), age ≥65 years (1.69–2.07), having a usual place for sick care (1.41–1.94), insurance coverage (1.52–1.79), hepatitis B vaccine (1.48–1.71), ratio of family income to the poverty threshold ≥4 (1.19–1.54), race of Asian (1.24–1.47), number of years on the job ≥21 (1.21–1.41), class of worker (Federal government: 1.23–1.32, State government: 1.15–1.38), high-risk conditions (1.13–1.26), physical activity ≥5 times/week (1.11–1.25) and being female (1.13–1.20). However, adults living in West, and adults of Black/African American, never married, high school education, self-employed and current smokers had lower vaccine uptake.

Conclusions
Several characteristics were identified to be associated with influenza vaccination uptake, which could be useful for targeted efforts to improve influenza vaccination coverage among adults.
OPTIMIZATION OF AN ADDITIONAL COLLIMATOR IN A BEAM DELIVERY SYSTEM FOR REDUCTION OF THE SECONDARY NEUTRON EXPOSURE IN PASSIVE CARBON-ION THERAPY
Authors: Komori Masataka , Takeuchi Akihiko , Niwa Maiko , Harada Takaomi , Oguchi Hiroshi 
Published: October 2018

Abstract
The aim of this work is to optimize an additional collimator in a beam delivery system to reduce neutron exposure to patients in passive carbon-ion therapy. All studies were performed by Monte Carlo simulation assuming the beam delivery system at Heavy-Ion Medical Accelerator in Chiba. We calculated the neutron ambient dose equivalent at patient positions with an additional collimator, and optimized the position, aperture size and material of the collimator to reduce the neutron ambient dose equivalent. The collimator located 125 and 470 cm upstream from the isocenter could reduce the dose equivalent near the isocenter by 35%, while the collimator located 813 cm upstream from the isocenter was ineffective. As for the material of the collimator, iron and nickel could conduct reduction slightly better than aluminum and polymethyl methacrylate. The additional collimator is an effective method for the reduction of the neutron ambient dose equivalent near the isocenter.
ASSESSMENT OF RADIOLOGICAL DOSES FOR PEOPLE LIVING IN KOREA FOLLOWING ACCIDENTAL RELEASES OF RADIONUCLIDES FROM NUCLEAR POWER PLANTS IN KOREA AND CHINA
Authors: Kim Sora , Park Kihyun , Min Byung-Il , Yang Byung-Mo , Kim Jiyoon , Suh Kyung-Suk 
Published: October 2018

Abstract
Accidentally released radionuclides are dispersed into the environment and cause human exposure through various pathways. Concerns about radiological impacts of a possible Nuclear power plant (NPP) accident in neighboring countries, especially in China, are increasing in Korea. Dose assessments for the hypothetical nuclear accidents in Korea (Hanbit and Wolsong NPPs) and China (Tianwan NPP) were conducted using the developed Korean code system. The results show that there is a possibility that a Tianwan NPP accident could have a slightly greater or similar impact on certain parts of Korea compared to accidents occurring at domestic NPPs, and could affect Korea within a few days of the accident. This research is expected to be used as basic material for preparing against nuclear accidents in neighboring countries.
EFFECTS OF FLIGHT ROUTE VARIATION AND GREAT-CIRCLE APPROXIMATION ON AVIATION DOSE ASSESSMENT FOR POPULAR FLIGHTS FROM TAIWAN
Authors: Yang Zi-Yi , Sheu Rong-Jiun 
Published: October 2018

Abstract
Galactic cosmic-ray-induced secondary particles in the atmosphere constitute an important source of radiation exposure to airline crews and passengers. In this study, a systematic dose assessment was conducted for 11 popular flights from Taiwan, with an emphasis on the effects of flight route variation and assumption. The case studies covered a broad range of commercial flights departing from Taipei, from a domestic flight of <1 h to a long-haul international flight of more than 14 h. For each route under study, information on 100 actual flight routes was retrieved from flight tracking data collected from June to September 2017, and the information was analyzed using a self-developed program called the ‘NTHU Flight Dose Calculator’. The resulting distribution of route doses provided not only the mean value and associated standard deviation but also information on the characteristics of aviation dose assessment and management. Furthermore, compared with actual flight routes, the dose differences introduced by great-circle approximation were evaluated, and the effects of solar activity on the dose assessment of these flights were reported.
The Conservative Tradition in British Thoracic and Cardiac Surgery 1900–1956
Authors: Lawrence Christopher 
Published: October 2018

Summary
Guy’s Hospital was a major setting for the creation of heart surgery as a practice and speciality in immediate post-war Britain. Medical reformers of the twentieth century characterised much London hospital medicine as conservative and not organised for the production of modern research. Through the minutes of a hospital club formed to manage congenital heart disease, the paper explores how dynamic surgical research was carried out in an institution committed to traditional values and organisation. I trace the background to this development from around 1900.
Conceptualizing Neonatal Abstinence Syndrome as a Cascade of Care
Authors: Syvertsen Jennifer L. , Toneff Hannah , Madden Danielle R. , Clapp John D. 
Published: October 2018

Background:
The opioid epidemic remains a serious issue in the United States and presents additional challenges for women of childbearing age. An increasingly common complication of opioid use is neonatal abstinence syndrome (NAS), or infant withdrawal from in utero exposure to opioids.

Purpose:
The objective of our qualitative study was to identify service needs and barriers to care in the NAS epidemic in Ohio, which has among the highest rates of opioid use and NAS in the nation.

Methods:
Drawing on interviews with 18 healthcare providers, we investigated the challenges, opportunities, and service gaps in treating NAS. Open-ended questions covered opioid misuse and drug treatment, provision of and barriers to healthcare, and suggestions to improve prevention and programming. Content analysis identified major themes.

Findings:
Providers were primarily women (67%) and included individuals working in healthcare administrative positions, hospital settings, clinics, and social support positions for pregnant women or new mothers. Our results suggest that rather than an acute diagnosis, NAS is better conceptualized as a “cascade of care” including (1) prevention, (2) prenatal care, including drug treatment, (3) labor and delivery, and (4) aftercare. Providers identified challenges and opportunities at each stage of the cascade that could influence NAS outcomes.

Implications for Practice:
Our results suggest that greater resources, coordination, and cross-disciplinary education are urgently needed across the cascade of care to effectively address NAS.

Implications for Research:
Framing NAS as a cascade of care allows researchers to identify points along a cascade where mothers and infants require enhanced care and access to social and health services.
Bimodal Hearing or Bilateral Cochlear Implants? Ask the Patient
Authors: Gifford René H. , Dorman Michael F. 
Published: October 2018

Objective:
The objectives of this study were to assess the effectiveness of various measures of speech understanding in distinguishing performance differences between adult bimodal and bilateral cochlear implant (CI) recipients and to provide a preliminary evidence-based tool guiding clinical decisions regarding bilateral CI candidacy.

Design:
This study used a multiple-baseline, cross-sectional design investigating speech recognition performance for 85 experienced adult CI recipients (49 bimodal, 36 bilateral). Speech recognition was assessed in a standard clinical test environment with a single loudspeaker using the minimum speech test battery for adult CI recipients as well as with an R-SPACETM 8-loudspeaker, sound-simulation system. All participants were tested in three listening conditions for each measure including each ear alone as well as in the bilateral/bimodal condition. In addition, we asked each bimodal listener to provide a yes/no answer to the question, “Do you think you need a second CI?”

Results:
This study yielded three primary findings: (1) there were no significant differences between bimodal and bilateral CI performance or binaural summation on clinical measures of speech recognition, (2) an adaptive speech recognition task in the R-SPACETM system revealed significant differences in performance and binaural summation between bimodal and bilateral CI users, with bilateral CI users achieving significantly better performance and greater summation, and (3) the patient’s answer to the question, “Do you think you need a second CI?” held high sensitivity (100% hit rate) for identifying likely bilateral CI candidates and moderately high specificity (77% correct rejection rate) for correctly identifying listeners best suited with a bimodal hearing configuration.

Conclusions:
Clinics cannot rely on current clinical measures of speech understanding, with a single loudspeaker, to determine bilateral CI candidacy for adult bimodal listeners nor to accurately document bilateral benefit relative to a previous bimodal hearing configuration. Speech recognition in a complex listening environment, such as R-SPACETM, is a sensitive and appropriate measure for determining bilateral CI candidacy and also likely for documenting bilateral benefit relative to a previous bimodal configuration. In the absence of an available R-SPACETM system, asking the patient whether or not s/he thinks s/he needs a second CI is a highly sensitive measure, which may prove clinically useful.
Reducing cost by using a smaller instrument tray in hand surgery
Authors: Kirn Philip T. , Angermeier Eric , Kokko Kyle P. 
Published: October 2018

Background:
The cost of US healthcare continues to rise at an unsustainable rate. A significant amount of waste occurs in the operating room. One way to reduce cost is by using trays with fewer instruments. The purpose of our study was to determine the cost to sterilize and process an instrument at our institution and calculate the expected savings when using a smaller tray for selected hand procedures.

Methods:
This was a single-site, observational study conducted at an academic medical center. The cost to sterilize an instrument was determined by dividing relevant labor and operating expenses by the total number of instruments processed. The ambulatory hand set was decreased from 105 to 16 instruments. Using the calculated cost to process an instrument, we determined cost savings per tray. By multiplying this value with the total number of cases for which the new tray would be used, we were able to determine expected cost savings per year. We also surveyed operating room staff with regards to work flow and satisfaction with the smaller tray.

Results:
Using the observed time to decontaminate and package an instrument, the labor cost was calculated to be $0.14 per instrument. The cost increased to $0.60 per instrument after including operating expenses. Decreasing the hand tray in selected procedures was calculated to save $31,500 per year. The smaller tray resulted in improved work flow and high satisfaction scores among operating room staff.

Conclusions:
Our calculated expense to sterilize and process an instrument is similar to prior studies. Processing fewer instruments in selected hand procedures is expected to result in significant cost savings and improvement in operating room workflow and satisfaction.
The opioid epidemic and patient satisfaction: a review of one institution’s experience
Authors: Hagedorn John C. , Myers Mitchell , Holihan Julie , Choo Andrew , Achor Timothy , Munz John , Gary Joshua 
Published: October 2018

Background:
The opioid crisis caused the Drug Enforcement Administration (DEA) to reschedule hydrocodone to schedule II from III. Other narcotics (i.e. codeine) were not reclassified, becoming the narcotic medications for many surgeons. We wanted to review how this rescheduling of hydrocodone influenced prescribing practices and Press Ganey scores.

Methods:
A retrospective review from April 6, 2014, to April 5, 2015, was conducted on all orthopaedic trauma patients at a level I trauma center. Patient charts were abstracted for the type and amount of narcotic prescribed. Press Ganey scores for the surgeons were collected during the same period. The data were used to determine the percentage of hydrocodone prescription before and after reclassification as well as the effect on Press Ganey Scores.

Results:
Surgeons significantly decreased the percentage of hydrocodone prescriptions, 70% versus 44% (P < 0.001), after reclassification. Two surgeons, A (76% vs. 11%) and B (69% vs. 30%), had a significant decrease in the percentage of hydrocodone (P < 0.0001), surgeon C’s percentage (67% vs. 67%) did not change (P =0.96), and surgeon D significantly increased (67% vs. 86%) (P =0.009). No significant changes were seen for overall Press Ganey scores for the group aggregate or individual providers, 91 versus 91 (P =0.993) after reclassification.

Conclusions:
The results show that the percentage of hydrocodone to all narcotic prescriptions decreased after rescheduling hydrocodone. This did vary by individual surgeon, with one surgeon’s percentage being significantly increased. Press Ganey scores did not appear to be influenced by rescheduling hydrocodone.
Barriers to the identification of fragility fractures for secondary fracture prevention in an orthopaedic clinic-based fracture liaison service: a prospective cohort study
Authors: Senay Andréa , Delisle Josée , Banica Andreea , Laflamme G. Yves , Leduc Stéphane , Mac-Thiong Jean-Marc , Ranger Pierre , Rouleau Dominique , Fernandes Julio C. 
Published: October 2018

Background:
The goal of this study was to determine the identification and participation rates of fragility fracture patients in a Fracture Liaison Service (FLS). We also identified factors affecting performance in patient identification.

Methods:
Surgeons, staff, and FLS nurses of an outpatient orthopaedic clinic from a hospital (Montreal, Canada) identified patients 50 yr of age or older with a fragility fracture eligible to join an FLS from January 2014 to March 2015. The list of orthopaedic referrals for the same period was retrieved and compared to our list of patients in the FLS to determine the participation rate. An in-house questionnaire was dispensed to volunteer staff to identify gaps in fragility fracture identification.

Results:
We identified 1011 patients with fractures from the orthopaedic referral list. Two hundred forty-nine patients (24.6%) were not identified because of nonreferral by surgeons or staff. Of the 762 remaining patients, 288 were excluded for high-energy trauma (n = 126), fracture of the face, skull, foot, or hand (n = 87), and other reasons (n = 75). Out of 474 patients with fragility fracture, 295 (62.2%) joined the FLS (178 refusals (37.6%). FLS managers only accessed 46.9% (474/1011) of eligible patients. The highest difficulty reported by the staff was about the time allocated to patient identification considering their workload.

Conclusions:
Major barriers to diagnosis and treatment of underlying osteoporosis in fragility fractures are nonreferral from orthopaedic surgeons or staff, and patient refusal. Challenges reside in implementing an institutional policy for optimal screening, better surgeon, staff, and patient education combined with improved systematic clinical management programs.
Subtrochanteric femoral fractures in osteopetrotic patients: problematic cases to handle
Authors: Diab Ramy Ahmed , Ghafar Khaled Abd EL 
Published: October 2018

Background:
Osteopetrosis is characterized by abnormally diminished osteoclast mediated skeletal resorption that leads to excessive accumulation of bone matrix, causing hard, dense bones with obliteration of the medullary canal, but with fragile, brittle bone. Osteopetrosis is endemic in North Sinai. The aim of the study was to assess the results of treatment of osteopetrotic subtrochanteric femoral fracture by open reduction and internal fixation using a locked plate combined with intramedullary reaming, describing the difficulties and the technical tips during fixation.

Methods:
Eight patients with osteopetrotic subtrochanteric femoral fractures (bilateral in two patients but not simultaneous) were treated. Osteosynthesis with internal fixation was performed using proximal femoral locked plates (in eight femora) or a dynamic hip screw (in two femora). Proper preoperative planning, presence of spare drill bits, patience during opening the medullary canal, and extra care with the sterilization rules are necessary. Delayed or nonunion and infection should be included in the informed consent.

Results:
No perioperative complications including infection, implant failure, or nonunion were observed during the follow-up period. All fractures healed at an average of 6.4 mo (6-8.4 mo) with no patients requiring bone grafting or additional procedures. All the patients were able to walk without pain and without assistance at the final follow-up.

Conclusions:
Management of osteopetrotic subtrochanteric femoral fractures by open reduction and internal fixation using locked plates combined with medullary canal reaming with extra care of the perioperative and intraoperative challenges and complications achieve successful results.
Epithelioid Fibrous Histiocytoma: A Concise Review
Authors: Felty Cameron C. , Linos Konstantinos 
Published: October 2018

Abstract:
Epithelioid fibrous histiocytoma (EFH) is a rare lesion believed to arise from dermal microvascular unit fibroblasts and dendritic histiocytes. EFH has long been considered a morphologic variant of benign fibrous histiocytoma (dermatofibroma), with prominent epithelioid cytomorphology that can mimic both vascular and melanocytic neoplasms. The molecular basis for the relationship between EFH and benign fibrous histiocytoma has remained largely unknown, with some authors suggesting that EFH represents an entity that is biologically distinct from benign fibrous histiocytoma. Recent molecular studies have identified the presence of recurrent anaplastic lymphoma kinase (ALK) gene rearrangements, a phenomenon that has not been described in benign fibrous histiocytoma. These new molecular findings highlight the uniqueness of this rare tumor and may prove useful as a diagnostic tool for differentiation from other histologic mimics.
Patient and Physician Preferences for Nonoperative Management for Low Rectal Cancer: Is It a Reasonable Treatment Option?
Authors: Kennedy Erin D. , Borowiec Anna M. , Schmocker Selina , Cho Charles , Brierley James , Li Shirley , Victor J. Charles , Baxter Nancy N. 
Published: October 2018

BACKGROUND:
Although the body of evidence supporting nonoperative management for rectal cancer has been accumulating, there has been little systematic investigation to explore how physicians and patients value the tradeoffs between oncologic and functional outcomes after abdominal perineal resection and nonoperative management.

OBJECTIVE:
The purpose of this study was to elicit patient and physician preferences for nonoperative management relative to abdominal perineal resection in the setting of low rectal cancer.

DESIGN:
We conducted a standardized interviews of patients and a cross-sectional survey of physicians.

SETTINGS:
Patients from 1 tertiary care center and physicians from across Canada were included.

PATIENTS:
The study involved 50 patients who were previously treated for rectal cancer and 363 physicians who treat rectal cancer.

INTERVENTIONS:
Interventions included standardized interviews using the threshold technique with patients and surveys mailed to physicians.

MAIN OUTCOMES MEASURES:
We measured absolute increase risk in local regrowth and absolute decrease in overall survival that patients and physicians would accept with nonoperative management relative to abdominal perineal resection.

RESULTS:
Patients were willing to accept a 20% absolute increase for local regrowth (ie, from 0% to 20%) and a 20% absolute decrease in overall survival (ie, from 80% to 60%) with nonoperative management relative to abdominal perineal resection, whereas physicians were willing to accept a 5% absolute increase for local regrowth (ie, from 0% to 5%) and a 5% absolute decrease in overall survival (ie, from 80% to 75%) with nonoperative management relative to abdominal perineal resection.

LIMITATIONS:
Data were subject to response bias and generalizable to only a select group of patients with low rectal cancer.

CONCLUSIONS:
Offering nonoperative management as an option to patients, even if oncologic outcomes are not equivalent, may be more consistent with the values of patients in this setting. See Video Abstract at http://links.lww.com/DCR/A688.