bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Healing Ligament Size and Magnetic Resonance Signal Intensity at 6 Months After Bridge-Enhanced Anterior Cruciate Ligament Repair
Authors: Murray Martha M. , Kiapour Ata M. , Kalish Leslie A. , Ecklund Kirsten ,   The BEAR Trial Team, Freiberger Christina , Henderson Rachael , Kramer Dennis , Micheli Lyle , Yen Yi-Meng , Fleming Braden C. 
Published: April 2019

Background: Primary repair of the anterior cruciate ligament (ACL) augmented with a tissue engineered scaffold to facilitate ligament healing is a technique under development for patients with ACL injuries. The size (the amount of tissue) and signal intensity (the quality of tissue) of the healing ligament as visualized on magnetic resonance imaging (MRI) have been shown to be related to its strength in large animal models. Hypothesis: Both modifiable and nonmodifiable risk factors could influence the size and signal intensity of the repaired ligament in patients at 6 months after surgery. Study Design: Case series; Level of evidence, 4. Methods: 62 patients (mean age, 19.4 years; range, 14-35 years) underwent MRI of the knee 6 months after ACL repair augmented with an extracellular matrix scaffold. The signal intensity (normalized to cortical bone) and average cross-sectional area of the healing ligament were measured from the MRI stack obtained by use of a gradient echo sequence. Associations between these 2 measures and patient characteristics, which included demographic, clinical, and anatomic features, were determined by use of multivariable regression analysis. Results: A larger cross-sectional area of the repaired ligament at 6 months was associated with male sex, older age, and the performance of a larger notchplasty ( P < .05 for all associations). A lower signal intensity at 6 months, indicating greater similarity to normal ligament, was associated with a smaller tibial slope and greater side-to-side difference in quadriceps strength 3 months after surgery. Other factors, including preoperative body mass index, mechanism of injury, tibial stump length, and Marx activity score, were not significantly associated with either MRI parameter at 6 months. Conclusion: Modifiable factors, including surgical notchplasty and slower recovery of quadriceps strength at 3 months, were associated with a larger cross-sectional area and improved signal intensity of the healing ACL after bridge-enhanced ACL repair in this preliminary study. Further studies to determine the optimal size of the notchplasty and the most effective postoperative rehabilitation strategy after ACL repair augmented by a scaffold are justified. Registration: NCT02664545 (ClinicalTrials.gov identifier).
Hinge Fractures Are Underestimated on Plain Radiographs After Open Wedge Proximal Tibial Osteotomy: Evaluation by Computed Tomography
Authors: Lee Bum-Sik , Jo Byeong-Kyu , Bin Seong-Il , Kim Jong-Min , Lee Chang-Rack , Kwon Young-Hee 
Published: April 2019

Background: Lateral hinge fracture (LHF) after medial open wedge high tibial osteotomy (MOWHTO) may not be recognized on perioperative plain radiographs. Such cases may be identified at follow-up and misdiagnosed as delayed LHF. Purpose: This study aimed to investigate the extent of LHF misdiagnosis and to determine whether patients with LHFs have inferior clinical outcomes after MOWHTO. Study Design: Case series; Level of evidence, 4. Methods: Fifty-one knees in 50 patients (36 women, 14 men; mean age, 51.8 years; range, 24-64 years) who had undergone MOWHTO with locking plate fixation between October 2013 and April 2016 were retrospectively reviewed. LHFs identified on intraoperative fluoroscopy and immediate postoperative radiographs were compared with the actual incidence based on computed tomography (CT) scans performed within 2 days of surgery. Delayed LHFs, not visible on the CT scans but found on later follow-up radiographs, were also assessed. More frequent radiographic check-ups were recommended in patients with LHFs, and weightbearing was delayed until evident callus formation was seen on follow-up radiographs for type 2 or 3 fractures. The loss of correction, the time of union, and complication rate were compared between the knees with LHF and those without LHF. Clinical outcome was measured according to the Knee Society (KS) scores. Results: Overall, 14 early LHFs (27.5%) were identified on CT scans. Of these, 7 LHFs (13.7%) were observed on perioperative radiographs, and the remaining 7 LHFs were identified on later radiographs. Delayed LHFs occurred in 2 cases (3.9%). In the 16 knees with LHF, minimal loss of correction was observed 1 month to 1 year postoperatively without statistical significance. No alignment changes were seen in the 35 knees without LHFs. In the LHF versus no LHF groups, no significant differences were seen regarding time of union (5.3 ± 1.7 months vs 5.4 ± 1.8 months, respectively; P = .898) and postoperative KS scores (knee score, 96.6 ± 2.5 vs 95.3 ± 6.4, P = .435; functional score, 94.4 ± 9.6 vs 89.1 ± 10.9, P = .107). No other complications occurred in either group. Conclusion: Most LHFs after MOWHTO occurred intraoperatively, but half (7/14) were not identified on postoperative radiographs. CT scans would enable detection of early LHFs that would otherwise have been mistaken for delayed LHF. However, clinical outcomes did not differ between patients with and without LHF.
A Low-Dose 4F-PCC Protocol for DOAC-Associated Intracranial Hemorrhage
Authors: Berger Karen , Santibañez Melissa , Lin Lina , Lesch Christine A. 
Published: April 2019

Purpose: Current guidelines favor 4F-PCC over plasma for reversal of warfarin. Uncertainty remains on the hemostatic effectiveness and thrombotic risk of 4F-PCC for direct-acting oral anticoagulants (DOACs), particularly in patients with intracranial hemorrhage (ICH). This study sought to evaluate the effectiveness and safety of a lower dose protocol of 25 units/kg 4F-PCC for the management of DOAC-associated ICH in a real-world setting. Materials and Methods: This was a retrospective study of adult patients who received at least one dose of 4F-PCC from March 2014 to December 2015 for DOAC-associated ICH. The primary outcome was hemostatic effectiveness within 24 hours. The secondary outcome was thromboembolic events within 14 days. Results: Twenty-two patients received 4F-PCC for DOAC-associated ICH and were included in the analysis. Hemostasis was evaluable in 19 patients with post-4F-PCC imaging available and occurred in 18/19 (94.7%) patients. Thromboembolism occurred in 2 out of 22 patients (9.1%). Conclusions: The use of a lower dose protocol of 25 units/kg of 4F-PCC resulted in high rates of hemostasis in patients with DOAC-associated ICH. Two patients developed thrombotic events within 14 days of 4F-PCC administration.
Nurses’ perception of organizational justice and its relationship to their workplace deviance
Authors: Hashish Ebtsam Aly Abou 
Published: April 2019

Background: Today, healthcare organizations are challenged to retain nurses’ generation and to maintain justice that is a predictor of nurses’ behaviors in their work environment. Acquiring knowledge about the level of organizational justice and workplace deviance could help in identifying factors amenable for change that can make a difference in enhancing nurses’ dedication and loyalty to their organizations. Aim: The aim of this study was to investigate nurses’ perception of organisational justice and workplace deviance in their hospital, and to determine the relationship between perceived organisational justice and workplace deviance. Methods: A cross-sectional design was used with a convenient sample of all nurses (N = 400) who were working in inpatient care units at two Egyptian hospitals affiliated to the university and private health sectors in Alexandria governorate, Egypt. Organisational justice and workplace deviance questionnaires proved valid and reliable to measure studied variables. Descriptive analysis, Student’s t-test, Pearson correlation (r), and regression analysis (R2) were used for statistical analysis. Ethical considerations: This study was approved by the Ethics Committee at the Faculty of Nursing, Alexandria University. Informed consent, information confidentiality, and voluntary participation were guaranteed. Results: This study showed that overall nurses’ perceptions of organisational justice and workplace deviance are lower than the average. Organisational justice significantly related negatively to workplace deviance (r = −0.152, p = 0.002) and organisational justice as an independent variable contributed a significant predictive power of workplace deviance (R2 = 0.023). Conclusions: This study highlighted important implications for hospital and nurse managers to create and maintain a healthy and supportive work environment that promotes organisational justice and decreases workplace deviance. To achieve this, a culture of respectful communication, justice in policies, and a proper procedure for allocating resources, workload, and rewards systems is a must. Educational interventions to increase nurses’ awareness of workplace deviance and its potential consequences and coping strategies are imperative for the health of the nursing profession.
A sense of dread: affect and risk perception in people with schizophrenia during an influenza pandemic
Authors: Maguire Paul A , Reay Rebecca E , Looi Jeffrey CL 
Published: April 2019

Objective: To explore the role of affect in risk perception and intention to adopt protective measures against pandemic swine influenza in people with schizophrenia. Methods: A cross-sectional study was conducted exploring the responses of 71 adults with schizophrenia and 238 adults attending general practice settings without schizophrenia. Participants completed a questionnaire that included items relating to: self-predicted affect (affective forecast) were they to contract swine influenza; perceived risk from swine influenza; and willingness to adopt protective measures against swine influenza. The 10-item Kessler Psychological Distress Scale (K10) and a single-item Self-Rated Health Question (SRHQ) were also included as measures. Results: In people with schizophrenia, higher levels of predicted fear were associated with increased likelihood of perceived substantive risk from swine influenza and self-reported willingness to adopt protective measures against it. However, higher K10 anxiety subscale scores, reflecting greater concurrent anxiety, were associated with reduced likelihood of perceived substantive risk from swine influenza in people with schizophrenia. Conclusion: Affect appears to play a role in risk perception of influenza and willingness to take protective measures against it in people with schizophrenia.
How Is End-of-Life Care With and Without Dementia Associated With Informal Caregivers’ Outcomes?
Authors: Boogaard Jannie A. , van der Steen Jenny T. , de Boer Alice H. , van Groenou Marjolein I. Broese 
Published: April 2019

Background: Palliative care for older people with life-limiting diseases often involves informal caregivers, but the palliative care literature seldom focuses on the negative and positive aspects of informal caregiving. Objective: To assess the association of proximity to end of life (EOL) and dementia caregiving with informal caregivers’ burden of care and positive experiences and explain differences in outcomes. Design: Data on 1267 informal caregivers of community-dwelling older people were selected from a nationally representative cross-sectional survey and analyzed using analysis of variance and multivariable regression analyses. Measurements: The Self-Perceived Pressure from Informal Care Scale and the Positive Experiences Scale were administered to assess caregiver burden and positive experiences with providing care. Results: Dementia care, both at EOL and not at EOL, was associated with the most caregiver burden relative to regular care. Dementia care not at EOL was associated with the fewest positive experiences, and EOL care not in dementia with the most positive experiences. Only the differences in burden of care could be explained by variables related to stressors based on Pearlin stress-coping model. Conclusions: Informal caregivers of people with dementia are at risk not only of high caregiver burden but also of missing out on positive experiences associated with caregiving at EOL. Future research should examine how dementia-related factors reduce positive caregiving experiences, in order to make palliative care a positive reality for those providing informal care to community-dwelling persons with dementia.
The Timing of Family Meetings in the Medical Intensive Care Unit
Authors: Piscitello Gina M. , Parham William M. , Huber Michael T. , Siegler Mark , Parker William F. 
Published: April 2019

Purpose: Family meetings in the medical intensive care unit can improve outcomes. Little is known about when meetings occur in practice. We aimed to determine the time from admission to family meetings in the medical intensive care unit and assess the relationship of meetings with mortality. Methods: We performed a prospective cohort study of critically ill adult patients admitted to the medical intensive care unit at an urban academic medical center. Using manual chart review, the primary outcome was any attempt at holding a family meeting within 72 hours of admission. Competing risk models estimated the time from admission to family meeting and to patient death or discharge. Results: Of the 131 patients who met inclusion criteria in the 12-month study period, the median time from admission to family meeting was 4 days. Fewer than half of patients had a documented family meeting within 72 hours of admission (n = 60/131, 46%), with substantial interphysician variability in meeting rates ranging from 28% to 63%. Patients with family meetings within 72 hours were 30 times more likely to die within 72 hours (32% vs 1%, P < .001). Of the 55 patients who died in the intensive care unit, 27 (49%) had their first family meeting within 1 day of death. Conclusions: Family meetings occur considerably later than 72 hours and are often held in close proximity to a patient’s death. This suggests for some physicians, family meetings may primarily be used to negotiate withdrawal of life support rather than to support the patient and family.
Hand hygiene practices in the context of Ebola virus disease: A cross-sectional survey of Lagos residents
Authors: Akinyinka Modupe R , Bakare Omowunmi Q , Oluwole Esther O , Odugbemi Babatunde A 
Published: April 2019

Background: The Ebola virus disease outbreak that ravaged parts of West Africa has been described as the most severe acute public health emergency seen in modern times. Hand washing was promoted among other measures for infection prevention. Objective: This study assessed the awareness of Ebola virus disease and hand-washing practices among Lagos residents, southwest Nigeria. Methods: A descriptive cross-sectional study was used. A total of 1982 respondents aged 18 ⩾ years were selected using a multi stage sampling technique. An interviewer-administered, pre-tested questionnaire was used for data collection between August and November 2015. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 22, with level of significance set at 0.05. Results: Almost all (97.3%) respondents were aware of Ebola virus disease, with over half of respondents having heard about it from television. A majority of 1890 (95.4%) respondents were aware of the importance of hand washing in disease prevention. Similarly, high proportions of respondents were aware they should wash their hands after an outing, toilet use, touching pets, before and after meals, while 1628 (82.1%) of respondents knew to wash their hands after a hand shake. However, less than half of respondents (38.8%) always washed their hands after handshakes. Discussion: A majority of respondents surveyed were aware of Ebola virus disease and hand washing, but the practice of hand washing, which is key in prevention of infection, lagged behind the knowledge of the respondents.
tPA for Acute Ischemic Stroke and Its Controversies: A Review
Authors: Dewar Brian , Shamy Michel 
Published: April 2019

Background and Purpose: Although neurologists consider intravenous tissue plasminogen activator (tPA) to be standard of care in the treatment of patients with acute ischemic stroke, its use remains contentious within the broader medical community, and particularly among emergency physicians. Why might this be? We provide a historical context to this ongoing controversy by reviewing how neurologists have conceptualized the acute stroke and its treatment, with the aim of bridging this gap. Methods: Based on historical sources in the Mackie Family History of Neuroscience Collection at the University of Calgary, as well as online resources, we trace the evolution of the concept of the “acute stroke,” which has come to mean a stroke that is potentially treatable with tPA. We frame this conceptualization in relation to historical “building blocks” in anatomy, pathology, and physiology. We then use these building blocks to explain why neurologists understand tPA to be effective and why emergency physicians often do not. Results and Conclusions: Arguments against the use of tPA reiterate 20-year-old concerns about its efficacy and safety. We believe these persistent concerns can be framed as a lack of understanding of the “building blocks” upon which neurologists’ conception of tPA is built. Our view suggests that the way forward to bridge the gap between neurology and other disciplines is not to conduct more trials but to offer a shared conceptualization of the trials already completed and of the intellectual tradition from which they emerged.
Brachytherapy for the urologist: A multidisciplinary team update for 2019
Authors: Teixeira Helen , Kang Myungkuk , Lees Kathryn , Beesley Sharon , Edwards Albert , Henderson Alastair 
Published: April 2019

Brachytherapy is a well-established treatment for localised prostate cancer. Urologists are often tasked with discussing all available treatment options with the newly diagnosed patient. Unlike radical prostatectomy and external beam radiotherapy, knowledge of brachytherapy may be limited. The aim of this article is to provide an up-to-date guide on patient selection, modern brachytherapy techniques and the management of side effects, such that the core urologist can be more confident in both discussing initial treatment options and the long-term management of brachytherapy patients. Level of Evidence: Level 5 - review article
Reduced Salience and Enhanced Central Executive Connectivity Following PTSD Treatment
Authors: Abdallah Chadi G. , Averill Christopher L. , Ramage Amy E. , Averill Lynnette A. , Alkin Evelyn , Nemati Samaneh , Krystal John H. , Roache John D. , A. Resick Patricia , Young-McCaughan Stacey , Peterson Alan L. , Fox Peter ,   the STRONG STAR Consortium
Published: April 2019

Background In soldiers with posttraumatic stress disorder, symptom provocation was found to induce increased connectivity within the salience network, as measured by functional magnetic resonance imaging and global brain connectivity with global signal regression (GBCr). However, it is unknown whether these GBCr disturbances would normalize following effective posttraumatic stress disorder treatment. Methods Sixty-nine US Army soldiers with (n = 42) and without posttraumatic stress disorder (n = 27) completed functional magnetic resonance imaging at rest and during symptom provocation using subject-specific script imagery. Then, participants with posttraumatic stress disorder received six weeks (12 sessions) of group cognitive processing therapy or present-centered therapy. At week 8, all participants repeated the functional magnetic resonance imaging scans. The primary analysis used a region-of-interest approach to determine the effect of treatment on salience GBCr. A secondary analysis was conducted to explore the pattern of GBCr alterations posttreatment in posttraumatic stress disorder participants compared to controls. Results Over the treatment period, present-centered therapy significantly reduced salience GBCr ( p = .02). Compared to controls, salience GBCr was high pretreatment (present-centered therapy, p = .01; cognitive processing therapy, p = .03) and normalized post-present-centered therapy ( p = .53) but not postcognitive processing therapy ( p = .006). Whole-brain secondary analysis found high GBCr within the central executive network in posttraumatic stress disorder participants compared to controls. Post hoc exploratory analyses showed significant increases in executive GBCr following cognitive processing therapy treatment ( p = .01). Conclusion The results support previous models relating cognitive processing therapy to central executive network and enhanced cognitive control while unraveling a previously unknown neurobiological mechanism of present-centered therapy treatment, demonstrating treatment-specific reduction in salience connectivity during trauma recollection.
Mutations in the zebrafish hmgcs1 gene reveal a novel function for isoprenoids during red blood cell development
Authors: Hernandez Jose A. , Castro Victoria L. , Reyes-Nava Nayeli , Montes Laura P. , Quintana Anita M. 
Published: April 2019

AbstractErythropoiesis is the process by which new red blood cells (RBCs) are formed and defects in this process can lead to anemia or thalassemia. The GATA1 transcription factor is an established mediator of RBC development. However, the upstream mechanisms that regulate the expression of GATA1 are not completely characterized. Cholesterol is 1 potential upstream mediator of GATA1 expression because previously published studies suggest that defects in cholesterol synthesis disrupt RBC differentiation. Here we characterize RBC development in a zebrafish harboring a single missense mutation in the hmgcs1 gene (Vu57 allele). hmgcs1 encodes the first enzyme in the cholesterol synthesis pathway and mutation of hmgcs1 inhibits cholesterol synthesis. We analyzed the number of RBCs in hmgcs1 mutants and their wild-type siblings. Mutation of hmgcs1 resulted in a decrease in the number of mature RBCs, which coincides with reduced gata1a expression. We combined these experiments with pharmacological inhibition and confirmed that cholesterol and isoprenoid synthesis are essential for RBC differentiation, but that gata1a expression is isoprenoid dependent. Collectively, our results reveal 2 novel upstream regulators of RBC development and suggest that appropriate cholesterol homeostasis is critical for primitive erythropoiesis.
Evaluation of a re-useable bronchoscopy biosimulator with ventilated lungs
Authors: Garner Justin L. , Garner Stefan D. , Hardie Robin J. , Molyneaux Philip L. , Singh Suveer , Kemp Samuel V. , Shah Pallav L. 
Published: April 2019

BackgroundRestrictions on respiratory trainee time and access to procedures reduce the opportunities to acquire necessary skills in bronchoscopy. Simulation, not subject to such impediments, is a useful supplementary aid to teaching bronchoscopic techniques in a safe environment but there is a limited choice of simulators that are sufficiently realistic and not prohibitively expensive. This study evaluated a low-cost device that simulates an intubated and ventilated patient, employing re-useable, inflatable, BioFlex-preserved, porcine lungs.Methods26 bronchoscopists, trainee and experienced, after using the bronchoscopy biosimulator, completed a questionnaire using a five-point Likert scale comparing its performance with that of the computerised CAE AccuTouch.ResultsParticipants were largely positive about their experience (mean score of 4.76). The bronchoscopy biosimulator was found to be realistic (mean score 4.64), easy to use (mean score 4.88), and helpful in learning to perform a variety of diagnostic and therapeutic procedures (mean score 4.85). Importantly, the bronchoscopy biosimulator compared favourably to the computer simulator (mean score 4.84).ConclusionsThese data support the concept of the bronchoscopy biosimulator as an acceptable model with which to supplement the experience of bronchoscopic procedures.