bluuebunny/crossref_metadata_2025_split huggingface dataset:
The biomechanics of proximal humeral fractures: Injury mechanism and cortical morphology
Authors: Majed Addie , Thangarajah Tanujan , Southgate Dominic FL , Reilly Peter , Bull Anthony , Emery Roger 
Published: April 2018

Background The aim of this study was to examine the effect of arm position on proximal humerus fracture configuration and to determine whether cortical thinning would predispose to fracture propagation and more complex patterns of injury. Methods A drop test rig was designed to simulate falls onto an outstretched arm (‘parachute reflex’). Thirty-one cadaveric specimens underwent computer tomography scanning and cortical thicknesses mapping. Humeri were fractured according to one of the two injury mechanisms and filmed using a high-speed camera. Anatomical descriptions of the injuries were made. Areas of thinning were measured and correlated with zones of fracture propagation. Results Direct impact simulation resulted in undisplaced humeral head split fractures in 53% of cases, with the remainder involving disruption to the articular margin and valgus impaction. Alternatively, the ‘parachute reflex’ predominantly produced shield-type injuries (38%) and displaced greater tuberosity fractures (19%). A strong correlation was demonstrated between cortical thinning and the occurrence of fracture (odds ratio = 7.766, 95% confidence interval from 4.760 to 12.669, p<0.0001). Conclusion This study has shown that arm position during a fall influences fracture configuration of the proximal humerus. Correlating fracture pattern and mechanism of injury will allow more appropriate fracture reduction techniques to be devised.
Is hyponatremia associated with mortality in pulmonary arterial hypertension?
Authors: Rudkovskaia Anastasiia A. , Tonelli Adriano R. , Rao Youlan , Hammel Jeffrey P. , Buller Gregory K. , Dweik Raed A. , Fares Wassim H. 
Published: April 2018

Hyponatremia is associated with poor prognosis in left heart failure and liver disease. Its prognostic role in pulmonary arterial hypertension (PAH) is not well defined. We investigated the association between hyponatremia and one‐year mortality in two large cohorts of PAH. This study is a secondary analysis evaluating the association between hyponatremia and one‐year mortality in patients treated with subcutaneous treprostinil (cohort 1). The results are validated using a PAH registry at a tertiary referral center (cohort 2). Eight‐hundred and twenty patients were enrolled in cohort 1 (mean age = 47 ± 14 years) and 791 in cohort 2 (mean age = 55 ± 15 years). Sodium level is negatively correlated with mean right atrial pressure (r = −0.09, P = 0.018; r = −0.089, P = 0.015 in cohorts 1 and 2, respectively). In unadjusted analyses of cohort 1, the sodium level (as a continuous variable) is associated with one‐year mortality (hazard ratio = 0.94; P = 0.035). Hyponatremia loses its significance (as a continuous variable and when dichotomized at ≤ 137 mmol/L; P = 0.12) when adjusted for functional class (FC), which is identified as the variable whose presence turns the effect of sodium level into non‐significant. Secondary analyses using a cut‐off value of < 135 mmol/L showed similar results. These results are validated in cohort 2. Although the sample size for patients with sodium < 130 mmol/L is small (n = 31), severe hyponatremia is associated with higher overall mortality (47% versus 23%; P = 0.01), even when adjusting for age, FC, and baseline 6‐min walk distance (P < 0.001). Although baseline hyponatremia is associated with one‐year mortality, it loses its significance when adjusted for FC.
Trismus, masticatory myositis and antibodies against type 2M fibers in a mixed breed cat
Authors: Blazejewski Stanley W , Shelton G Diane 
Published: April 2018

Case summary A 1-year-old male neutered mixed breed cat presented with a 2 month history of inability to fully open the mouth when yawning and decreased ability to prehend food. Physical examination revealed severe bilaterally symmetrical masticatory muscle atrophy, a restricted vertical mandibular range of motion of 11–12 mm, and a normal body condition score. Skull radiography was normal. A canine ELISA system against unique masticatory muscle fibers (2M antibody titer), was positive at 1:1000 (reference interval <1:100 in dogs, and was <1:100 using serum from five archived normal cats), indicating the presence of cross-reacting antibodies. Owing to the chronicity and clinical severity, corticosteroid treatment did not result in improved jaw mobility, consistent with end-stage masticatory myositis. Masticatory muscle biopsy was declined at initial presentation. However, 1 year later at elective euthanasia, CT ruled out temporomandibular joint osseous restrictions, and masticatory and biceps femoral muscle histopathology evaluation confirmed end stage feline masticatory myositis with normal limb muscle. Relevance and novel information Masticatory myositis should be included in the differential diagnosis of trismus in cats. A canine ELISA can be used to indicate the presence of feline 2M cross-reacting antibodies. More cases are needed to fully elucidate the clinical presentation and best course of treatment.
Risk Factors for 30-Day Readmissions and Reoperations After 3-Column Osteotomy for Spinal Deformity
Authors: De la Garza Ramos Rafael , Nakhla Jonathan , Echt Murray , Gelfand Yaroslav , Scoco Aleka N. , Kinon Merrit D. , Yassari Reza 
Published: April 2018

Study Design: Retrospective study of a prospectively collected database. Objective: To investigate the rate and risk factors for 30-day readmissions and reoperations after 3-column osteotomy (3CO). Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2012-2014) was reviewed. Inclusion criteria were adult patients who underwent 3CO. The rate of 30-day readmission/reoperation was examined, and the association between patient/operative characteristics and outcome was investigated via multivariate analysis. Results: There were 299 patients who underwent a 3CO for spinal deformity. The rate of 30-day readmission and reoperation was 11.0% and 8.4%, respectively; 7.7% of readmissions were related to the primary procedure and 3.3% were unrelated. The most common unique cause for readmission was wound infection in 27.2% of cases. Among reoperations, the most common unique indications were wound infection (20.0%) and implant-related complications (20.0%). On multivariate analysis, obesity (odds ratio [OR] = 2.96; 95% CI = 1.06-8.25; P = .038), chronic obstructive pulmonary disease (OR = 20.8; 95% CI = 3.49-123.5; P = .001), and fusion of 13 or more spinal levels were independent predictors of readmission (OR = 4.86; 95% CI = 1.21-19.5; P = .025). On the other hand, independent predictors of reoperation included chronic obstructive pulmonary disease (OR = 6.33; 95% CI = 1.16-34.5; P = .033) and chronic steroid use (OR = 6.69; 95% CI = 1.61-27.7; P = .009). Conclusion: Wound complications and short-term implant-related complications are important causes of readmission and/or reoperation after 3CO. Preoperative factors such as obesity, chronic lung disease, chronic steroid use, and long-segment fusion procedures may significantly increase the risk of 30-day morbidity following high-grade osteotomies.
Serum levels of carotenoids in patients with osteonecrosis of the femoral head are lower than in healthy, community-living people
Authors: Okura Toshiaki , Seki Taisuke , Suzuki Koji , Ishiguro Naoki , Hasegawa Yukiharu 
Published: April 2018

Purpose: Oxidative stress is closely associated with the pathogenesis of nontraumatic osteonecrosis of the femoral head (ONFH). This study aimed to determine whether the serum levels of antioxidant nutrients were decreased in patients with ONFH. Methods: We analyzed the serum levels of antioxidant nutrients in 39 patients with ONFH (ONFH group) and 78 age- and gender-matched healthy people (control group) who voluntarily participated in the Yakumo study, which is a comprehensive health examination program. We measured and compared the serum levels of α-tocopherol (vitamin E) and total carotenoids, including zeaxanthin/lutein, β-cryptoxanthin, lycopene, α-carotene, and β-carotene, in the ONFH and control groups using high-performance liquid chromatography. Results: The mean serum levels of total carotenoids were significantly lower in the ONFH group than in the control group (2.36 ± 1.26 and 3.79 ± 2.36 µmol/l, respectively, p < 0.001). However, no significant difference was found in α-tocopherol between the two groups (26.37 ± 6.90 µmol/l in the ONFH group and 26.24 ± 6.28 µmol/l in the control group, p = 0.920). Among each carotenoid, the serum levels of zeaxanthin/lutein, lycopene, and β-carotene were significantly lower in the ONFH group than in the control group ( p < 0.001). Conclusions: The serum levels of carotenoids were lower in patients with ONFH than in healthy, community-living people. This result suggests that carotenoids may be related to the pathogenesis of ONFH.
Correlation Between Quality of Evidence and Number of Citations in Top 50 Cited Articles on Elbow Medial Ulnar Collateral Ligament Surgery
Authors: Jack Robert A. , Sochacki Kyle R. , Morehouse Hannah A. , McCulloch Patrick C. , Lintner David M. , Harris Joshua D. 
Published: April 2018

Background: Several studies have analyzed the most cited articles in shoulder, elbow, pediatrics, and foot and ankle surgery. However, no study has analyzed the quality of the most cited articles in elbow medial ulnar collateral ligament (UCL) surgery. Purpose: To (1) identify the top 50 most cited articles related to UCL surgery, (2) determine whether there was a correlation between the top cited articles and level of evidence, and (3) determine whether there was a correlation between study methodological quality and the top cited articles. Study Design: Systematic review. Methods: Web of Science and Scopus online databases were searched to identify the top 50 cited articles in UCL surgery. Level of evidence, number of times cited, year of publication, name of journal, country of origin, and study type were recorded for each study. Study methodological quality was analyzed for each article with the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-randomized Studies (MINORS). Correlation coefficients were calculated. Results: The 50 most cited articles were published between 1981 and 2015. The number of citations per article ranged from 20 to 301 (mean ± SD, 71 ± 62 citations). Most articles (92%) were from the United States and were level 3 (16%), level 4 (58%), or unclassified (16%) evidence. There were no articles of level 1 evidence quality. The mean MCMS and MINORS scores were 28.1 ± 13.4 (range, 3-52) and 9.2 ± 3.6 (range, 2-19), respectively. There was no significant correlation between the mean number of citations and level of evidence or quality ( rs = –0.01, P = .917), MCMS ( rs = 0.09, P = .571), or MINORS ( rs = –0.26, P = .089). Conclusion: The top 50 cited articles in UCL surgery constitute a low level of evidence and low methodological quality, including no level 1 articles. There was no significant correlation between the mean number of citations and level of evidence or study methodological quality. However, weak correlations were observed for later publication date and improved level of evidence and methodological quality.
TRAIL mediates and sustains constitutive NF-κB activation in LGL leukemia
Authors: Yang Jun , LeBlanc Francis R. , Dighe Shubha A. , Hamele Cait E. , Olson Thomas L. , Feith David J. , Loughran Thomas P. 
Published: April 2018

Key Points
TRAIL is upregulated in LGL leukemia and TRAIL-DcR2 signaling drives constitutive activation of NF-κB. Proteasome inhibitors (bortezomib and ixazomib) effectively interrupt TRAIL-induced activation of NF-κB and induce apoptosis.
Scepticaemia: The impact on the health system and patients of delaying new treatments with uncertain evidence; a case study of the sepsis bundle
Authors: Blythe Robin , Cook David , Graves Nicholas 
Published: April 2018

Background: A sepsis care bundle of intravenous vitamin C, thiamine, and hydrocortisone was reported to improve treatment outcomes. The data to support it are uncertain and decision makers are likely to be cautious about adopting it. The objective of this study was to model the opportunity costs in dollars and lives of waiting for better information before adopting the bundle. Methods: A decision tree was built using information from the literature. We modelled the impact of bundle adoption under three scenarios using a simulation in which the bundle was effective as reported in the primary trial, less effective based on other information, and ineffective. The measurements were health services costs, quality-adjusted life years, and transition probabilities. Results: If the bundle proves to be effective under either scenario, it will save billions of dollars and millions of life-years in the United States. This is the opportunity cost of delaying an adoption decision and waiting for better quality evidence. We suggest that hospital decision-makers consider implementing the bundle on a trial basis while monitoring costs and outcomes data even while the evidence base is uncertain. Conclusions: If the decision maker is unwilling to use the best available evidence now, but rather wishes to wait for definitive evidence they are risking incurring large costs for health care systems and for the patients they serve. An explicit analysis of uncertain clinical outcomes is a useful adjunct to guide decision making where there is clinical ambiguity. This approach offers a valid alternative to the default of clinical inactivity when faced with uncertainty.
The utility of repeat Xpert MTB/RIF testing to diagnose tuberculosis in HIV-positive adults with initial negative result
Authors: Hanifa Yasmeen , Fielding Katherine L. , Chihota Violet N. , Adonis Lungiswa , Charalambous Salome , Foster Nicola , Karstaedt Alan , McCarthy Kerrigan , Nicol Mark P. , Ndlovu Nontobeko T. , Sinanovic Edina , Sahid Faieza , Stevens Wendy , Vassall Anna , Churchyard Gavin J. , Grant Alison D. 
Published: April 2018

Background: Amongst HIV-positive adults in South Africa with initial negative Xpert results, we compared the yield from repeating Xpert MTB/RIF (“Xpert”) on sputum to guideline-recommended investigation for tuberculosis (TB). Methods: A systematic sample of adults attending for HIV care were enrolled in a cohort exploring TB investigation pathways. This substudy was restricted to those at highest risk of TB (CD4<200 cells/mm3 or unknown) who had a negative initial Xpert result. At attendance for the Xpert result, a repeat sputum sample was stored, and further investigations facilitated per national guidelines. Participants were reviewed monthly, with reinvestigation if indicated, for at least three months, when sputum and blood were cultured for mycobacteria, and the stored sputum tested using Xpert. We defined TB as “confirmed” if Xpert, line probe assay or Mycobacterium tuberculosis culture within six months of enrolment were positive, and “clinical” if TB treatment was started without microbiological confirmation. Results: Amongst 227 participants with an initial negative Xpert result (63% female, median age 37 years, median CD4 count 100 cells/mm3), 28 (12%) participants had TB diagnosed during study follow-up (16 confirmed, 12 clinical); stored sputum tested positive on Xpert in 5/227 (2%). Amongst 27 participants who started TB treatment, the basis was bacteriological confirmation 11/27 (41%); compatible imaging 11/27 (41%); compatible symptoms 2/27 (7%); and unknown 3/27 (11%). Conclusions: Amongst HIV-positive individuals at high risk of active TB with a negative Xpert result, further investigation using appropriate diagnostic modalities is more likely to lead to TB treatment than immediately repeating sputum for Xpert. TB diagnostic tests with improved sensitivity are needed.
Developing new health technologies for neglected diseases: a pipeline portfolio review and cost model
Authors: Young Ruth , Bekele Tewodros , Gunn Alexander , Chapman Nick , Chowdhary Vipul , Corrigan Kelsey , Dahora Lindsay , Martinez Sebastián , Permar Sallie , Persson Johan , Rodriguez Bill , Schäferhoff Marco , Schulman Kevin , Singh Tulika , Terry Robert F , Yamey Gavin 
Published: April 2018

Background: Funding for product development for neglected diseases fell from 2009-2015, other than a short-term injection of Ebola funding. One impediment to mobilizing resources is a lack of information on product candidates, the estimated costs to move them through the pipeline, and the likelihood of specific launches. This study aimed to help fill these information gaps. Methods: We conducted a pipeline portfolio review to identify current candidates for 35 neglected diseases. Using an adapted version of the Portfolio to Impact (P2I) financial modelling tool, we estimated the costs to move these candidates through the pipeline over the next decade and the likely launches. Since the current pipeline is unlikely to yield several critical products, we estimated the costs to develop a set of priority “missing” products. Results: We found 685 product candidates for neglected diseases as of August 31, 2017; 538 candidates met inclusion criteria for input into the model. It would cost about $16.3 billion (range $13.4-19.8B) to move these candidates through the pipeline, with three-quarters of the costs incurred in the first 5 years, resulting in about 128 (89-160) expected product launches. Based on the current pipeline, there would be very few launches of complex new chemical entities; launches of highly efficacious vaccines for HIV, tuberculosis, or malaria would be unlikely. Estimated additional costs to launch one of each of 18 key missing products range from $13.6B-$21.8B, depending on product complexity. Over the next 5 years, total estimated costs to move current candidates through the pipeline and develop these 18 missing products would be around $4.5-5.8B/year. Conclusions: Since current annual global spending on product development is about $3B, this study suggests the annual funding gap over the next 5 years is at least $1.5-2.8B, which is probably an underestimate. The current portfolio is not balanced across health needs.
РАЗРАБОТКА МОДЕЛИ ПРОДЛЕНИЯ ЖИЗНЕННОГО ЦИКЛА КОММЕРЧЕСКОЙ МЕДИЦИНСКОЙ ОРГАНИЗАЦИИ НА ЭТАПЕ ЗРЕЛОСТИ И ЕЕ АПРОБАЦИЯ
Authors: Borisova Svetlana Sergeevna 
Published: April 2018

Согласно концепции жизненного цикла организации этап зрелости характеризуется достижением одного из лидирующих положения на рынке. По мере расширения комплекса предоставляемых услуг / производства продукции создаются новые подразделения, структура становится более сложной и иерархической. Вместе с тем происходит замедление темпов экономического роста, их стабилизация на сравнительно низком уровне. Падение спроса и процессы бюрократизации (а зачастую и излишняя самоуверенность руководства, обусловленная ранними успехами компании) приводят к постепенному «старению» организации и его гибели. Ключевой целью менеджмента на данном этапе является максимально возможное увеличение времени пребывания на этапе зрелости и недопущение гибели организации (за исключением случаев отсутствия заинтересованности собственников в дальнейшем функционировании компании).Цель – разработка модели продления жизненного цикла коммерческой медицинской организации на этапе зрелости и ее апробация на примере коммерческих медицинских организаций г. Пенза. Для достижения поставленной цели, необходимо достичь выполнения следующих задач:1) провести оценку факторов, оказывающих влияние на деятельность коммерческих медицинских организаций на этапе зрелости;2) разработать методы и управленческие решения, способные нейтрализовать данные факторы;3) разбить вышеуказанные методы и управленческие решения по блокам и объединить их в модель продления жизненного цикла коммерческой медицинской организации на этапе зрелости;4) произвести апробацию модели продления жизненного цикла коммерческой медицинской организации на этапе зрелости на примере коммерческой медицинской организации «Эскулап» (г. Пенза).Метод или методология проведения работы: в статье использовались статистические методы анализа.Результаты:1) разработана и апробирована на практике модель продления жизненного цикла коммерческой медицинской организации на этапе зрелости;2) результаты апробации методических разработок по управлению медицинской организацией на различных этапах жизненного цикла подтверждают их эффективность и целесообразность использования и, соответственно практическую значимость проведенного исследования.
Transforming families using performance: Witnessing performed lived experience
Authors: Wood Shea M. 
Published: April 2018

Abstract
This research investigated how performances based on lived experience can be used as a tool within family support or pyshcosocial education groups to initiate a process of transformation for the participants/witnesses. This study found that witnesses’ emotional arousal and reflection appear to be encouraged by a sense of resonance resulting from the inclusion of lived experience presented using combined representation strategies (realistic and symbolic), which assisted in achieving optimal aesthetic distance.
α-Terpineol, a natural monoterpene: A review of its biological properties
Authors: Khaleel Christina , Tabanca Nurhayat , Buchbauer Gerhard 
Published: April 2018

AbstractTerpineols are monocyclic monoterpene tertiary alcohols which are naturally present in plant species. There are five common isomers of terpineols, alpha-, beta-, gamma-, delta- and terpinen-4-ol, of which α-terpineol and its isomer terpinen-4-ol are the most common terpineols found in nature. α-Terpineol plays an important role in the industrial field. It has a pleasant odor similar to lilacs and it is a common ingredient in perfumes, cosmetics, and aromatic scents.In addition, α-terpineol attracts a great interest as it has a wide range of biological applications as an antioxidant, anticancer, anticonvulsant, antiulcer, antihypertensive, anti-nociceptive compound. It is also used to enhance skin penetration, and also has insecticidal properties. This study reviews the relevance of α-terpineol based on scientific findings on Google Scholar, Pubmed, Web of Science, Scopus and Chemical Abstracts.Collectively, the use of α-terpineol in medicine and in the pharmaceutical industry plays an important role in therapeutic applications. This review will, therefore, support future research in the utilization of α-terpineol.
Estimation of change in forest height growth
Authors: Lang Mait , Arumäe Tauri , Laarmann Diana , Kiviste Andres 
Published: April 2018

Abstract
Forest height increment rate is related to the forest growth conditions. Data bases of previous forest inventories contain information about forest heightage relationship on large number of forest stands while repeated measurements of permanent sample plots provide an excellent reference for comparison. Repeated airborne laser scanning of forest stands is an additional source for the estimation of change in forest structure. In this study, height growth of middle-aged and older forest stands for about 10 year period was compared to an algebraic difference model on permanent sample plots (66) and for a sample of forest stands with repeated airborne laser scanning data (61). The model was based on a large dataset of forest inventory records from the period of 1984–1993. Statistically significant increased forest height growth was found in permanent sample plots based on tree height measurements (9 cm yr−1) as well in stands with repeated laser scanning data (4.5 cm yr−1) in South-East Estonia compared to the algebraic difference model. The difference between the two data sets was explained by their mean age and site class, but the increased forest height growth compared to the old forest inventory data indicates improved growth conditions of forests in the test area. The results hint also that empirical data-based forest growth models need to be updated to avoid biased growth estimates.