bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accommodation as Displacement: Notes from Refugee Camps in Greece in 2016
Authors: Kandylis George 
Published: October 2018

Abstract
Since 2015, Greece has been in the midst of the so-called refugee crisis. State authorities and organisations of the national and international humanitarian system responded by providing refugees with accommodation in organised refugee camps that produce spatially isolated and socially marginal living spaces. Based on official data about the expansion and the characteristics of the camp system and on field observations in certain camps, I argue that camps prolong and expand displacement and thus place human suffering at a distance from which suffering tends to appear as normal.
Relationships Between Opioid Dosing, Pain Severity, and Disability in a Community-Based Chronic Pain Population: An Exploratory Retrospective Analysis
Authors: DiBenedetto David J , Wawrzyniak Kelly M , Finkelman Matthew , Kulich Ronald J , Chen Lucy , Schatman Michael E , Stone Melissa T , Mao Jianren 
Published: October 2018

AbstractObjective. To determine the relationship between opioid dose change, pain severity, and function in patients with chronic pain. Design. Retrospective cohort study. Setting. Community interdisciplinary pain management practice. Subjects. A total of 778 patients with chronic pain prescribed opioids for three or more consecutive months between April 1, 2013, and March 1, 2015. Methods. Changes in opioid dose, pain severity rating, modified Roland Morris Disability Questionnaire score, and opioid risk data were extracted from medical records and analyzed for associations. Results. Two hundred forty-three subjects (31.2%) had an overall dose decrease, 223 (28.7%) had a dose increase, and 312 (40.1%) had no significant change in dose (<20% change). There was a weak negative correlation between change in opioid dose and change in pain severity (r = –0.08, P = 0.04) but no association between change in disability scores and dose change (N = 526, P = 0.13). There was a weak positive correlation between change in pain severity rating and change in disability scores (r = 0.16, P < 0.001). Conclusions. The results suggest that escalating opioid doses may not necessarily result in clinically significant improvement of pain or disability. Similarly, significant opioid dose reductions may not necessarily result in worsened pain or disability. This exploratory investigation raised questions of possible subgroups of patients who might demonstrate improvement of pain and disability with opioid dose adjustments, and further research should prospectively explore this potential, given the limitations inherent in retrospective analyses. Prescribers should still consider reduction of opioid doses as recommended by current guidelines, in an effort to mitigate the potential risks associated with high-dose treatment.
C-Reactive Protein Predicts Risk of Venous Thromboembolism in Pediatric Musculoskeletal Infection
Authors: Amaro Emilie , Marvi Tanya K. , Posey Samuel L. , Benvenuti Michael A. , An Thomas J. , Dale Kevin M. , Lovejoy Steven A. , Martus Jeffrey E. , Johnson Megan E. , Mencio Gregory A. , Moore-Lotridge Stephanie N. , Thomsen Isaac P. , Schoenecker Jonathan G. 
Published: October 2018

Background:
The rate of venous thromboembolism in children with musculoskeletal infections (MSKIs) is markedly elevated compared with hospitalized children in general. Predictive biomarkers to identify high-risk patients are needed to prevent the significant morbidity and rare mortality associated with thrombotic complications. We hypothesize that overactivation of the acute phase response is associated with the development of pathologic thrombi and we aim to determine whether elevations in C-reactive protein (CRP) are associated with increased rates of thrombosis in pediatric patients with MSKI.

Methods:
A retrospective cohort study measuring CRP in pediatric MSKI patients with or without thrombotic complications.

Results:
The magnitude and duration of elevation in CRP values correlated with the severity of infection and the development of pathologic thrombosis. In multivariable logistic regression, every 20 mg/L increase in peak CRP was associated with a 29% increased risk of thrombosis (P<0.001). Peak and total CRP were strong predictors of thrombosis with area under the receiver-operator curves of 0.90 and 0.92, respectively.

Conclusions:
Future prospective studies are warranted to further define the discriminatory power of CRP in predicting infection-provoked thrombosis. Pharmacologic prophylaxis and increased surveillance should be strongly considered in patients with MSKI, particularly those with disseminated disease and marked elevation of CRP.

Level of Evidence:
Level III.
Persistence and Progression of Airway Obstruction in Children With Early Onset Scoliosis
Authors: Redding Gregory J. , Hurn Heidi , White Klane K. , Bompadre Viviana , Emerson Julia , Garza R. Zachary , Anigian Kendall , Waldhausen John , Krengel Walter , Joshi Ajeya 
Published: October 2018

Background:
Obstructive lung disease occurs in 30% of children with early onset scoliosis (EOS); changes in degree of airway obstruction over time have not been reported.

Methods:
Longitudinal patterns of incidental, persistent, and progressive airway obstruction were retrospectively analyzed in a cohort of children with EOS with at least 1 forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) value <85% on serial spirometric assessments over a ≥3-year observation period. The prevalence of clinical features and the severity of coronal and sagittal spine deformities for each group at the beginning and end of the study period were compared.

Results:
Airway obstruction was incidental in 12 (24%) and persistent in 37 (76%) of 49 children with EOS. Twenty of 37 (54%) of those with persistent obstruction developed progressive airway obstruction. The decline in FEV1/FVC over 6±2 years was insignificant in the incidental group (4%±2%) and the persistent nonprogressive group (7%±4%) but significant in the progressive group (13%±4%, t test; P=0.002). In total, 29% of the 49 children at the onset and 57% at the end of the study had airway obstruction. The incidental, persistent nonprogressive, and progressive groups did not differ with regard to age, diagnosis distribution, or sex. The initial coronal curve size, apex, direction of the curve, and degree of kyphosis were statistically similar among the 3 groups. Coronal curve magnitude inversely correlated with FEV1/FVC at the end but not the beginning of the study (r=−0.19, P=0.002). Six of 19 responded to bronchodilator treatment, suggesting concurrent asthma. Airway obstruction did not relate to restrictive pulmonary abnormalities measured by FVC at first or last timepoints [slope=−0.076 (95% confidence interval, −0.99 to 0.038; P=0.19)]. Changes in degrees of airway obstruction and restrictive lung disease over time did not correlate [slope=−0.125 (95% confidence interval, −0.294 to 0.044; P=0.14)].

Conclusions:
Children with EOS and progressive airway obstruction represent an important subgroup which may require new surgical and nonsurgical treatment strategies to prevent loss of lung function over time.
Factors Associated With Head and Neck Cancer Hospitalization Cost and Length of Stay—A National Study
Authors: Adjei Boakye Eric , Johnston Kenton J. , Moulin Thiago A. , Buchanan Paula M. , Hinyard Leslie , Tobo Betelihem B. , Massa Sean T. , Osazuwa-Peters Nosayaba 
Published: October 2018

Objectives:
The aim of the study was to estimate hospitalization cost, and factors associated with hospitalization costs and length of stay (LOS) of patients treated for head and neck cancer in the United States.

Methods:
Data on 71,440 weighted hospital admissions from the 2014 National Inpatient Sample with a diagnosis of head and neck cancer were examined. Multivariable linear regression models estimated factors associated with hospitalization costs, and negative binomial regression models were used to identify factors associated with hospital LOS. Factor variables included characteristics of the patient, clinical, and hospital characteristics.

Results:
The average hospitalization cost was US $18,371 and the average LOS was 6.6 days. LOS was significantly associated with admissions involving bacterial infection, major operating procedures, chemo procedure, and radiation procedure as well as admissions at medium or small bed size hospitals, and rural hospitals. Admissions among black patients, elective admissions, admissions involving bacterial infection, major operating procedures, chemo procedure, radiation procedure, and advance comorbidities were associated with increased hospitalization costs. In contrast, admissions at urban nonteaching or rural had increased hospitalization costs.

Conclusions:
Admissions that involve higher number of comorbidities, metastasis, bacterial infection, radiation, and chemo procedures had longer hospital stay and higher cost whereas admissions are rural hospitals had shorter hospital stay and lower cost. Understanding these factors associated with increased LOS and hospitalization cost will help efforts to decrease health care cost and improve quality of care.
COMPARISON BETWEEN RELEASABLE SCLERAL BUCKLING AND VITRECTOMY IN PATIENTS WITH PHAKIC PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Zhao Xiujuan , Huang Li , Lyu Cancan , Liu Bingqian , Ma Wei , Deng Xiaoyan , Jiang Huaiyan , Wang Yan , Yu Xiling , Ding Xiaoyan , Luo Yan , Ma Jin , Stewart Jay M. , Liang Xiaoling , Jin Chenjin , Lu Lin 
Published: October 2018

Purpose:
To compare the efficiency of releasable scleral buckling (RSB) and pars plana vitrectomy (PPV) in the treatment of phakic patients with primary rhegmatogenous retinal detachment.

Methods:
The current study was a prospective randomized clinical trial. One hundred and ten eyes from 110 patients with primary rhegmatogenous retinal detachment and proliferative vitreoretinopathy of Grade B or less were included in this study. The patients were randomly allocated into an RSB group and a PPV group. The functional and anatomical success was compared between groups.

Results:
The primary anatomical success rate (PPV 41/43 [95.35%] and RSB 38/41 [92.68%]) and final anatomical success rate (PPV and RSB 100%) showed a nonsignificant difference. The best-corrected visual acuity, intraocular pressure, and complications were not different between the groups. However, the incidence of cataract progression was higher in the PPV group (26 of 43 [60.47%]) than in the RSB group (4 of 41 [9.76%]) at the 12-month follow-up. The subfoveal choroidal thickness increased significantly in the RSB group 3 months after surgery, but no longer differed at the postoperative 6-month and 12-month follow-ups. The axial length had increased significantly 1 month after surgery, but the difference was no longer significant at 3 months, 6 months, and 12 months.

Conclusion:
The RSB and PPV procedures have the same effects on the functional and anatomical success for patients with phakic primary rhegmatogenous retinal detachment. Nevertheless, based on the few cases of intraocular complications and cataract progression, we believe that the RSB technique should be preferentially recommended.
Impact of Head Tilt on Optical Coherence Tomography Image Orientation
Authors: Mohammad Syed , Jarrar Faisal S. , Torres Lucas A. , Sharpe Glen P. , Vianna Jayme R. , Chauhan Balwantray C. 
Published: October 2018

Purpose:
Head tilt can have an impact on the orientation of posterior pole images. We conducted this study to determine the effect of head tilt on image orientation measured by the fovea-Bruch’s membrane opening (FoBMO) angle with optical coherence tomography (OCT) imaging.

Methods:
The study included 56 healthy subjects with mean (range) age of 33 (18 to 61) years. The dominant eye was first determined. To measure head tilt, a smartphone with a built-in gyroscope was affixed to the subject’s head with adjustable straps. OCT imaging was performed in both eyes (in randomized order) at 0, 5, and 10 degrees of head tilt in the direction of the imaged eye (ipsilateral head tilt), and then in the opposite direction (contralateral head tilt). For each image, the device software determined Bruch’s membrane opening center and the foveal pit from which the FoBMO angle was derived.

Results:
Thirty-eight (68%) subjects were right eye dominant and 18 (32%) were left eye dominant. Each 1 degree head tilt resulted in a mean change of 0.76 degree in the FoBMO angle (P<0.01), with no significant difference in effect between the 2 eyes (P=0.72). The magnitude of the effect increased from 5 to 10 degrees, and was similar for both ipsilateral and contralateral head tilt. Ocular dominance did not modulate the effect of head tilt (P=0.42).

Conclusions:
Head tilt significantly affects OCT image orientation as measured by the FoBMO angle, presumably because cyclotorsion is not fully compensatory. The magnitude and direction of the effect does not depend on the dominant eye.
Fecal calprotectin is not superior to serum C-reactive protein or the Harvey–Bradshaw index in predicting postoperative endoscopic recurrence in Crohn’s disease
Authors: Verdejo Cristina , Hervías Daniel , Roncero Óscar , Arias Ángel , Bouhmidi Abdelmouneim , Lorente Rufo , Salueña Irina , Lucendo Alfredo J. 
Published: October 2018

Background
Fecal calprotectin (FC) is a widely used noninvasive marker of gut inflammation that is associated with endoscopic severity in Crohn’s disease (CD). However, FC has been inconsistent in predicting postoperative recurrence of CD, and its utility in the postoperative setting remains unclear.

Materials and methods
Blood and fecal samples were collected in consecutively recruited patients with CD who had undergone ileocolonic resection and required a colonoscopy to assess postoperative recurrence, as defined by the Rutgeerts score (RS).

Results
A total of 86 patients were prospectively recruited at five centers. Overall, 49 (57%) had CD recurrence (RS≥i2). FC concentrations trended to increase with RS severity; FC median (interquartile range) was significantly higher in patients with endoscopic recurrence than those in endoscopic remission [172.5 (75–375) vs. 75 (36.5–180.5) μg/g, respectively]. The same occurred for C-reactive protein (CRP) [0.5 (0.1–0.95) vs. 0.1 (0.02–0.27)] mg/dl and the Harvey–Bradshaw index (HBI) [4 (2–7) vs. 1 (0–3.5)]. The three variables significantly correlated. The area under the curve to discriminate between patients in endoscopic remission and recurrence was 0.698 for FC, with 62 μg/g being the optimal cut-off point. This indicated FC would have 85.7% sensitivity and 45.9% specificity in detecting any recurrence, having positive predictive value and negative predictive value of 67.7 and 70.8%, respectively. Area under the curve for CRP and HBI were both 0.710. The combination of CRP and HBI provided a positive predictive value 95.7 and a diagnostic odds ratio of 30.8.

Conclusion
FC is not better than CRP combined with HBI to predict endoscopic postoperative recurrence of CD.
A Stimulus-Response Framework to Investigate the Influence of Continuous Versus Interval Walking Exercise on Select Serum Biomarkers in Knee Osteoarthritis
Authors: Jayabalan Prakash , Gustafson Jonathan , Sowa Gwendolyn A. , Piva Sara R. , Farrokhi Shawn 
Published: October 2018

Objective
The aim of the study was to compare changes in the concentration of serum biomarkers in response to continuous versus interval walking exercise in participants with knee osteoarthritis.

Design
This study used a two-phase sequential design. Twenty-seven participants with unilateral knee osteoarthritis completed two separate treadmill walking sessions: (1) continuous 45-min walking exercise and (2) three 15-min bouts of walking exercise separated by 1-hr rest periods for a total of 45 mins in an interval format. Participants reported their knee pain using the numeric pain rating scale and serum levels of biomarkers associated with tissue turnover (cartilage oligomeric matrix protein), inflammation (tumor necrosis factor α), and pain (neuropeptide Y) were evaluated at baseline and every 15 mins for both conditions.

Results
Continuous walking resulted in a cumulative increase in cartilage oligomeric matrix protein concentration up to 45 mins, whereas interval walking was associated with return of cartilage oligomeric matrix protein concentrations back to baseline at 45 mins. There were no significant changes in tumor necrosis factor α and neuropeptide Y concentration during walking. There was a significant increase in pain compared with baseline in the continuous walking regimen only.

Conclusions
Incorporating rest breaks in walking regimens may affect the potential deleterious effects of longer continuous bouts on the knee joint as well as limit pain during exercise.
Endometrioid Intraepithelial Neoplasia
Authors: Chiu Yu-Li , Wang Jyh-Seng , Peng Nan-Jing 
Published: October 2018

Abstract
The report describes a 55-year-old woman with postmenopausal abnormal vaginal spotting. PET/CT revealed focal hot 18F-FDG uptake in the fundus portion of the uterine cavity, and pathology of hysteroscopic dilation and curettage showed endometrioid intraepithelial neoplasia of uterine endometrium, an endometrial precancer. This case points to the significance of 18F-FDG PET/CT in determining the dilation and curettage site for the postmenopausal women with abnormal vaginal spotting. Increased 18F-FDG activity in the region of the uterus must be investigated to determine the possibilities of primary malignancies, metastases, and benign diseases.
Quality and Safety in Healthcare, Part XLVII
Authors: Harolds Jay A. 
Published: October 2018

Abstract
The ability to come back from challenges such as the many factors predisposing to burnout is resilience. Individual strategies to prevent and recover from burnout can be learned and practiced. This includes mindfulness, meditation, yoga, various stress reduction techniques, coaching, counseling, mentoring, discussions in small groups, workshops, and better work life balance. Other approaches include building a support network, taking care of one’s personal health, pursuing narrative medicine, engaging in reflection, emphasizing positive psychology approaches including learned optimism, encouraging a growth mindset, and volunteering. This article will focus on the topic of resilience as it is related to burnout, and subsequent articles will discuss some of the strategies for prevention and recovery in detail.
Hypermetabolism Caused by Seizure Mimicking Tumor Recurrence
Authors: Wang Jingnan , Zhang Yiwei , Sun Heyang , Cui Ruixue 
Published: October 2018

Abstract
A 41-year-old man had a right frontal grade I glioma resection 17 years ago. He was tumor free since. However, 1 month ago, he presented with an uncontrollable seizure, which raised the possibility of recurrent tumor. The 18FDG PET/CT brain scan showed increased tracer uptake at the margin of the previous resected tumor, suggesting the possibility of tumor recurrence. However, on a repeat FDG PET brain scan confirmed by electroencephalography monitory as an interictal study, no elevated FDG uptake was revealed at this site. These results indicate that the elevated 18F-FDG activity on the original study was a result of seizure.
Assessment of Subclinical Atherosclerosis in Vitamin D Deficiency
Authors: Aydin Elçin , Altin Cihan , Özcan Söylev Gözde , Tekindal Mustafa Agah , Ağildere Muhteşem 
Published: October 2018

Purpose
Patients with vitamin D deficiency (VDD) have potential to have increased cardiovascular morbidity and mortality. In this study, we aimed to discover the findings of early atherosclerosis in patients with VDD by measuring carotid intima-media thickness (CIMT) and epicardial fat thickness (EFT).

Materials and Methods
The study population includes 52 patients with VDD (n = 30 [57% female], mean ± SD age 54.28 ± 8.77 years, mean ± SD serum 25-hydroxyvitamin D (25 [OH] D) 11 ± 2.4 ng/mL) and 82 participants for control group (n = 52 [63.4% female], mean ± SD age 56.40 ± 7.90 years, mean ± SD serum (25 [OH] D) 53 ± 4.2 ng/mL) who have no cardiovascular disease. Carotid intima-media thickness was assessed by using ultrasonography, and EFT was measured on the free wall of the right ventricle at end diastole from the parasternal long-axis views by standard transthoracic 2-dimensional echocardiography.

Results
Both CIMT and EFT were significantly higher in patients with VDD compared with controls (0.75 ± 0.16 mm vs 0.68 ± 0.21 mm, P < 0.05, and 0.66 ± 0.15 cm vs 0.56 ± 0.15 cm, P < 0.001).

Conclusions
Patients with VDD seem to have increased CIMT and EFT, which are predictors of atherosclerotic process. Further studies are needed to confirm these results.
Cross-sectional Area Just Proximal to the Carpal Tunnel According to the Ulnar Variances
Authors: Cha Soo Min , Shin Hyun Dae , Song Seok Hwan 
Published: October 2018

Purpose
We evaluated the relationship between the area around the distal radioulnar joint according to the ulnar variances and the cross-sectional area using magnetic resonance imaging (MRI) scans in this prospective study of patients with carpal tunnel syndrome (CTS).

Methods
From among a total of 243 patients who had been diagnosed with CTS between March 2012 and February 2017 at our hospital, 41 patients with positive ulnar variance were enrolled in group 1. As control groups, 39 healthy volunteers who underwent MRI evaluations were included in group 2 (neutral ulnar variance) and group 3 (negative variance). Basic demographic data, including age, sex, and body mass index, were recorded for all 3 groups. An area encompassing the contents of carpal tunnel (nerves/tendons) was designated as area “A,” and the area just beneath the subcutaneous fat was designated as area “B” at the levels of the lunate (L) and pisiform (P) on axial MRI. Ratios of these areas (“A/B at L” and “A/B at P”) were evaluated in terms of their correlations with ulnar variance.

Results
Mean age, sex, and body mass index were not statistically different among the groups, respectively. Within each group, there was no difference between “A/B at L” and “A/B at P,” respectively. When comparing the 3 groups, “A/B at L” and “A/B at P” were all significantly decreased in group 1 than in other groups. Regardless of the group, ulnar length negatively correlated with both “A/B at L” and “A/B at P” ratios.

Conclusions
We found a positive relationship between decreased cross-sectional area around the distal radioulnar joint and positive ulnar variance on radiologic investigation. These findings show the importance of variance in the positive ulna variance to the development of CTS.