bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Doxycycline Does Not Reduce Propionibacterium acnes in Shoulder Arthroplasty
Authors: Rao Allison J. , Chalmers Peter N. , Cvetanovich Gregory L. , O’Brien Michael C. , Newgren Jon M. , Cole Brian J. , Verma Nikhil N. , Nicholson Gregory P. , Romeo Anthony A. 
Published: June 2018

Background:

Propionibacterium acnes (P. acnes) is the most common bacteria associated with infection after shoulder arthroplasty. These bacteria can be grown on culture of skin after standard preoperative skin preparation and antibiotics. The purpose of this study was to determine whether adding preoperative intravenous doxycycline reduces the prevalence of positive P. acnes cultures of skin and deep tissues at the time of prosthetic joint implantation during shoulder arthroplasty.

Methods:
This was a randomized controlled trial. An a priori power analysis determined that a sample size of 56 patients was necessary. Patients scheduled to undergo shoulder arthroplasty were randomized to receive either standard perioperative cefazolin or a combination of doxycycline and cefazolin. Tissue specimens for culture were then taken from the skin edge, and swabs of the superficial dermal tissue and glenohumeral joint were obtained. All cultures were maintained for 14 days to allow for P. acnes detection. Groups were compared to determine if the addition of doxycycline reduced the rate of culture positivity.

Results:
Fifty-six patients were enrolled and randomized. Twenty-one (38%) had ≥1 positive cultures for P. acnes, with no significant difference between the group treated with cefazolin alone (10 [37%] of 27 patients) and the combined doxycycline and cefazolin group (11 [38%] of 29 patients) (p = 0.99). The greatest numbers of culture-positive samples were obtained from the skin (30%), followed by dermal tissue (20%) and the glenohumeral joint (5%). Patients who had ≥1 positive cultures were younger than those who did not (mean age [and standard deviation], 64.9 ± 7.7 versus 69.4 ± 7.7 years; p = 0.041), had a greater tendency to be male (16 [76%] of 21 versus 17 [49%] of 35; p = 0.053), and had a lower Charlson Comorbidity Index (3.35 ± 1.3 versus 4.09 ± 1.4; p = 0.051). There were no significant differences between the culture-positive and culture-negative groups in terms of body mass index (BMI) (p = 0.446) or arthroplasty type, with positive cultures found for 8 of the 29 anatomic shoulder arthroplasty procedures compared with 13 of the 27 reverse shoulder arthroplasty procedures (p = 0.280). There were no doxycycline-related adverse events.

Conclusions:
In this randomized controlled trial, doxycycline did not significantly decrease P. acnes culture positivity of the skin, dermis, or glenohumeral joint of patients undergoing shoulder arthroplasty. The addition of prophylactic intravenous antibiotics to cover P. acnes may not be an effective method to reduce postoperative and periprosthetic shoulder joint infections.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Predictors for Long-Term Hip Survivorship Following Acetabular Fracture Surgery
Authors: Verbeek Diederik O. , van der List Jelle P. , Tissue Camden M. , Helfet David L. 
Published: June 2018

Background:
Historically, the greatest residual (gap or step) displacement is used to predict clinical outcome following acetabular fracture surgery. Gap and step displacement may, however, impact the outcome to different degrees. We assessed the individual relationship between gap or step displacement and hip survivorship and determined their independent association with conversion to total hip arthroplasty.

Methods:
Patients who had acetabular fracture fixation (from 1992 through 2014), follow-up of ≥2 years (or early conversion to total hip arthroplasty), and postoperative computed tomography (CT) scans were included. Of 227 patients, 55 (24.2%) had conversion to total hip arthroplasty at a mean follow-up (and standard deviation) of 8.7 ± 5.6 years. Residual gap and step displacement were measured using a standardized CT-based method, and assessors were blinded to the outcome. Kaplan-Meier survivorship curves for the hips were plotted and compared (log-rank test) using critical cutoff values for gap and step displacement. These values were identified using receiver operating characteristic curves. Multivariate analysis was performed to identify independent variables associated with conversion to total hip arthroplasty. Subgroup analysis was performed in younger patients (<50 years old).

Results:
The critical CT cutoff value for total hip arthroplasty conversion was 5 mm for gap and 1 mm for step displacement. Hip survivorship at 10 years was 82.0% for patients with a gap of <5 mm compared with 56.5% for a gap of ≥5 mm (p < 0.001) and 80.0% for a step of <1.0 mm versus 65.5% for a step of ≥1.0 mm (p = 0.012). A gap of ≥5 mm (hazard ratio [HR], 2.3; p = 0.012) and an age of ≥50 years (HR, 4.2; p < 0.001) were independently associated with conversion to total hip arthroplasty in all patients. In the subgroup of younger patients, only a step of ≥1 mm (HR, 6.4; p = 0.017) was an independent factor for conversion to total hip arthroplasty.

Conclusions:
Residual gap and step displacement as measured on CT scans are both related to long-term hip survivorship, but step displacement (1 mm) is tolerated less than gap displacement (5 mm). Of the 2 types of displacement, only a large gap displacement (≥5 mm) was independently associated with conversion to total hip arthroplasty. In younger patients who had less articular impaction with smaller residual gaps, only step displacement (≥1 mm) appeared to be associated with this outcome.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Minimum Five-Year Outcomes of Hip Arthroscopy for the Treatment of Femoroacetabular Impingement and Labral Tears in Patients with Obesity
Authors: Perets Itay , Rybalko Danil , Chaharbakhshi Edwin O. , Mu Brian H. , Chen Austin W. , Domb Benjamin G. 
Published: June 2018

Background:
Obesity is a negative prognostic factor for various surgical procedures. The purpose of this study was to compare patients with obesity who underwent hip arthroscopy for femoroacetabular impingement and labral tears with a match-controlled group of normal-weight patients.

Methods:
Data were prospectively collected and retrospectively reviewed for patients who underwent arthroscopy between February 2008 and December 2011. Inclusion criteria were treatment for femoroacetabular impingement and labral tears and completed preoperative patient-reported outcomes and visual analog scale (VAS) for pain. Exclusion criteria were previous ipsilateral hip conditions or preoperative Tönnis grade of ≥2. Patients with obesity (body mass index [BMI] of ≥30 kg/m2) were matched and were compared with normal-weight patients (BMI of 18.5 to 24.99 kg/m2) using a 1:1 ratio by age at the time of the surgical procedure within 5 years, sex, acetabular Outerbridge grade (0 or 1 compared with 2, 3, or 4), and capsular treatment.

Results:
Of the 96 obesity cases with follow-up, 74 were pair-matched to control cases. The mean BMI was 34.3 kg/m2 for the obesity group and 22.7 kg/m2 for the control group (p < 0.0001). The mean follow-up time was 71.6 months for the obesity group and 71.3 months for the control group (p = 0.41). All mean preoperative patient-reported outcomes and VAS scores for patients without conversion to total hip arthroplasty were significantly worse in the obesity group: modified Harris hip score (p = 0.0001), Non-Arthritic Hip Score (p = 0.0001), Hip Outcome Score Sports-Specific Scale (HOS-SSS) (p = 0.015), and VAS (p = 0.01). No significant differences were observed with regard to demographic characteristics, intraoperative findings, procedures, follow-up scores, magnitudes of improvement, or secondary arthroscopy rates (p > 0.05). Both groups demonstrated significant improvements in mean outcome scores at ≥5 years (p < 0.0001). In both groups, no significant differences were detected in mean outcome scores between 2 years and ≥5 years (p > 0.05). The conversion rate to total hip arthroplasty was 29.7% for the obesity group and 14.9% for the control group (relative risk, 2.0 [95% confidence interval, 1.1 to 3.8]; p = 0.04).

Conclusions:
Hip arthroscopy for the treatment of femoroacetabular impingement and labral tears in patients with obesity yielded significant improvements at ≥5 years; these results were similar to a matched group of normal-weight patients. However, patients with obesity demonstrated a twofold increased risk of conversion to total hip arthroplasty.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Comparison of Defense and Plaintiff Expert Witnesses in Orthopaedic Surgery Malpractice Litigation
Authors: Park Howard Y. , Zoller Stephen D. , Sheppard William L. , Hegde Vishal , Smith Ryan A. , Borthwell Rachel M. , Clarkson Samuel J. , Hamad Christopher D. , Proal Joshua D. , Bernthal Nicholas M. 
Published: June 2018

Background:
According to the American Academy of Orthopaedic Surgeons (AAOS) Standards of Professionalism, the responsible testimony of expert witnesses in orthopaedic surgery malpractice lawsuits is important to the public interest. However, these expert witnesses are recruited and compensated without established standards, and their testimony can potentially sway court opinion, with substantial consequences. The objective of this study was to characterize defense and plaintiff expert orthopaedic surgeon witnesses in orthopaedic surgery malpractice litigation.

Methods:
Utilizing the WestlawNext legal database, defense and plaintiff expert witnesses involved in orthopaedic surgery malpractice lawsuits from 2013 to 2017 were identified. Each witness’s subspecialty, mean years of experience, involvement in academic or private practice, fellowship training, and scholarly impact, as measured by the Hirsch index (h-index), were determined through a query of professional profiles, the Scopus database, and a PubMed search. Statistical comparisons were made for each parameter among defense and plaintiff expert witnesses.

Results:
Between 2013 and 2017, 306 expert medical witnesses for orthopaedic cases were identified; 174 (56.9%) testified on behalf of the plaintiff, and 132 (43.1%) testified on behalf of the defense. Orthopaedic surgeons who identified themselves as general orthopaedists comprised the largest share of expert witnesses on both the plaintiff (n = 61) and defense (n = 25) sides. The plaintiff witnesses averaged 36 years of experience versus 31 years for the defense witnesses (p < 0.001); 26% of the plaintiff witnesses held an academic position versus 43% of the defense witnesses (p = 0.013). Defense witnesses exhibited a higher proportion of fellowship training in comparison to plaintiff expert witnesses (80.5% versus 64.5%, respectively, p = 0.003). The h-index for the plaintiff group was 6.6 versus 9.1 for the defense group (p = 0.04). Two witnesses testified for both the plaintiff and defense sides.

Conclusions:
Defense expert witnesses held higher rates of academic appointments and exhibited greater scholarly impact than their plaintiff counterparts, with both sides averaging >30 years of experience. These data collectively show that there are differences in characteristics between plaintiff and defense witnesses. Additional study is needed to illuminate the etiology of these differences.
Inability of Older Adult Patients with Hip Fracture to Maintain Postoperative Weight-Bearing Restrictions
Authors: Kammerlander Christian , Pfeufer Daniel , Lisitano Leonard Adolf , Mehaffey Stefan , Böcker Wolfgang , Neuerburg Carl 
Published: June 2018

Background:
For elderly trauma patients, a basic goal is early mobilization, as immobilization can trigger various complications, such as venous thromboembolism, pneumonia, urinary tract infections, and pressure ulcers. Although partial weight-bearing has been shown to significantly increase mortality compared with unrestricted weight-bearing, it remains a frequent recommendation of aftercare following lower-extremity fracture fixation.

Methods:
An insole force sensor was used to measure true postoperative weight-bearing by patients ≥75 years of age treated for hip fracture compared with patients 18 to 40 years of age treated for ankle fracture. Both groups were instructed to maintain partial weight-bearing on the affected limb (≤20 kg) postoperatively. Following standardized physiotherapy training, gait analysis was performed.

Results:
None of the patients in the elderly test group were able to comply with the weight-bearing restriction as recommended. We found that 69% (11 of 16) of the patients exceeded the specified load by more than twofold, whereas significantly more patients in the younger control group (>75% [14 of 18]) achieved almost the entire weight-bearing restriction (p < 0.001). Only 1 of the elderly patients was able to comply with the predetermined weight-bearing restriction, and only for a short period of time. In comparison, significantly more patients in the control group (89% [16 of 18]; p < 0.001) maintained the partial load for nearly the entire time during gait analysis.

Conclusions:
Elderly patients seem to be unable to maintain weight-bearing restrictions. As early mobilization of geriatric trauma patients is an important element for a successful rehabilitation, the directive of postoperative partial weight-bearing for these patients should be abandoned.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
The Effect of Previous Methylphenidate Use on Incidence of Stress Fractures in Military Recruits
Authors: Ben-Ami Ilan S. , Ankory Ran , Kadar Assaf , Rotman Dani , Snir Nimrod , Schermann Haggai 
Published: June 2018

Background:
Previous research has detected an increased risk of stress fractures among subjects who reported previous use of methylphenidate. Conversely, stimulant medication use has been associated with traumatic fracture risk reduction, possibly because of the improved control of the underlying symptoms of attention deficit hyperactivity disorder (ADHD). The goal of this study was to investigate the effect of previous methylphenidate use on the incidence of traumatic and stress fractures among combat soldiers with previously treated and untreated ADHD.

Methods:
The retrospective cohort included 100,000 combat soldiers recruited to the Israeli Defense Forces from 2005 through 2015. Diagnosis of ADHD and previous exposure to methylphenidate were determined on the basis of self-reported recruitment questionnaires and medical records. Accordingly, the cohort was divided into 3 groups: subjects with ADHD who were previously treated with methylphenidate (n = 689), untreated subjects with ADHD reporting no medication use (n = 762), and controls having no ADHD diagnosis (n = 98,549). Logistic regressions were fitted to determine the odds ratios (ORs) of study subjects for stress and non-stress (traumatic) fractures. Multivariate analysis incorporated baseline characteristics, including age, sex, weight, duration of service, and diagnosis of anemia, at some point during the service.

Results:
After adjustment for sex, anemia, weight, age, and duration of service, the risk of traumatic fractures was increased in both subjects with treated ADHD (OR, 1.03 [95% confidence interval (CI), 1.00 to 1.05]) and subjects with untreated ADHD (OR, 1.04 [95% CI, 1.02 to 1.07]) compared with controls. Subjects in the treated ADHD group were at a higher risk of stress fractures (OR, 1.04 [95% CI, 1.02 to 1.07]). Interestingly, a diagnosis of anemia was an independent predictor of stress fractures (OR, 1.05 [95% CI, 1.04 to 1.06]).

Conclusions:
Methylphenidate use is associated with an increased risk of stress fractures but a decreased risk of traumatic fractures in individuals diagnosed with ADHD. These and previous findings may serve as sufficient basis for screening for other risk factors and perhaps taking prevention measures in all those using stimulant medications, especially those planning to engage in strenuous physical activity.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Illicit drug use among university students in Lithuania: age, gender differences and correlation with lifestyle
Authors: Rupšienė Liudmila , Saveljeva Regina , Baranauskienė Ingrida , Batuchina Aleksandra 
Published: June 2018

The article presents the research aiming at answering a question What is the illegal drug use among university students in Lithuania and what is its correlation with the age, gender and lifestyle? The research data was obtained from 18 Lithuanian universities involved in the research. The questionnaire’s questions were answered by 1087 students: 37 % male and 63 % female students. The average age of the respondents was 21 years; minimal age was 18, maximum was 29. The ESPAD questionnaire was adapted for the research. Some research results proved earlier results of research studies carried out in Lithuania; however, new tendencies significant to practice of prevention of drug use were revealed as well.
Prospective foster parents‘ attitude towards the provided social worker‘s assistance: a case of an X Lithuanian town
Authors: Leliūgienė Irena , Stūglytė-Novickienė Inga , Kaušylienė Angelė 
Published: June 2018

The article introduces the significance of social worker's assistance to prospective foster parents: a case of an X Lithuanian town. The best place for the child development and improvement is the family. For some reasons not all the children are raised in families. Some children have no possibility to live with their biological families, therefore according to the established legislation, they live in foster homes under the supervision of foster parents or are adopted. Children adoption in our country is regulated by different acts of legislation. The activity of the ombudsperson for children’s rights is governed by the Law on the Ombudsman for Children Rights Protection of the Republic of Lithuania (2000), Civil Code of the Republic of Lithuania, Regulations of organization and management of children guardianship (2002), etc. Research aim is to analyze the social service worker's assistance to the prospective foster parents. The following objectives to reach our goal are presented: to analyze theoretical conception of adoption procedure and enforcement; to discuss the system of the social service workers’ assistance to prospective foster parents; to investigate foster parents' approach towards the social service worker's assistance and to reveal the main problems. Research methods: analysis of the scientific literature – scientific analysis of adoption issues. The stages of adoption procedures and the requirements overviewed and analysed are provided; document analysis: documents, acts of legislation, laws and regulations of child adoption regulations are analysed and overviewed; a qualitative study: semi-structured interview, analyzing the foster parents' approach towards the social service workers' assistance; problems and probable solutions are identified. The research results are obtained by content analysis. The article presents the following generalizations: 1) adoption is considered as a social process when specific rights and responsibilities are provided to foster parents in order to guarantee the child's safety. In case of inter-country adoption, the adoption opportunities are estimated, the child is prepared for the adoption and the family for the child is selected. At that period foster parents face internal and external factors. Seeking to grant the children rights and smooth adoption process, professional social workers should coordinate it; 2) institution of the Ombudsman for Children Rights of the Republic of Lithuania and State Child Rights Protection and Adoption Service under the Ministry of Social Security and Labour are also engaged in the adoption and foster care; 3) the research results reveal that the biggest problems for prospective foster parents are extensively long adoption period, lack of social service workers' assistance and poor knowledge on the available assistance.
Specifics of arts therapies in educational institutions comparing the institutions of health care setting
Authors: Kantor Jiri 
Published: June 2018

18 arts therapists from educational and healthcare institutions in Czech Republic were interviewed to determine the specifics of therapeutic practice in educational institutions. The results relate to the presence of different professions in the team, their qualification and level of therapeutic competence, understanding the roles and work of arts therapists, the impact of arts on institutions, the depth of therapeutic change, formulation of therapeutic contract, therapeutic goals, organisation of therapy, the therapy room and privacy and assessments/evaluation.
Ecological effect evaluation of water diversion in the Yellow River delta wetland
Authors: Wang Fuqiang , Yang Huan , Zhao Heng , Kang Pingping 
Published: June 2018

Abstract
Ecological effect evaluation of water diversion is a difficult and long-term process requiring complex monitoring data and scientific evaluation method. Based on remote sensing data and the ecological investigation data of Yellow River delta, this study built a wetland ecology evaluation index system with the analytic hierarchy process (AHP) framework, which included 13 evaluation indices of three criteria as suitability, diversity, and functionality. Fuzzy-AHP comprehensive evaluation method was used to evaluate the ecological effect of water diversion at Diaokou River wetland restoration zone. The results show that the comprehensive evaluation index (CEI) of wetland ecology is 0.464 before water diversion, which belongs to the ‘poor’ level, while after five years of water diversion, the CEI increased to 0.737, which belongs to the ‘fine’ level. It represents that ecological water diversion has made prominent positive effects for the ecosystem of Diaokou River wetland restoration zone. The research result could give decision-makers a clear understanding about the ecological effect of wetland water diversion and provide scientific guidance for strategic decisions.
Monitoring of iodine species during water purification at a public water treatment plant in Japan
Authors: Nishida Sho , Asami Maki , Ohata Naoya , Horigome Jun , Furuta Naoki 
Published: June 2018

Abstract
Iodine is an essential element for humans; however, it can be toxic depending on its chemical form. A variety of toxic and non-toxic iodine species have been identified in environmental water and in the drinking water produced by public water treatment plants. Here, we examined the change of iodine species during the water treatment process at a public water treatment plant in Japan. Samples of raw water and of treated water immediately after each of eight treatment stages comprising the treatment process were collected, and a speciation analysis was conducted by means of ion chromatography– and size-exclusion chromatography–inductively coupled plasma mass spectrometry. In the raw water, iodine was found mainly as iodide or iodinated humic substances that were ultimately oxidized and transformed into iodate, a form non-toxic to humans, by two independent oxidation stages in the water treatment process – ozone treatment and chlorine treatment. No disinfection byproducts were detected at any stage of the treatment process. Fluorescence spectrometry with multivariate analysis revealed that humic substances were markedly decreased by ozone treatment, but not by chlorine treatment. The present results show that, at the plant-scale, ozone treatment is an effective means of removing toxic iodine species from raw water.