bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Isolated Skull Fractures in Pediatric Patients
Authors: Donaldson Katelyn , Li Xun , Sartorelli Kennith H. , Weimersheimer Peter , Durham Susan R. 
Published: March 2019

Objectives
Isolated skull fractures (ISFs) in children are one of the most common emergency department injuries. Recent studies suggest these children may be safely discharged following ED evaluation with little risk of delayed neurological compromise. The aim of this study was to propose an evidence-based protocol for the management of ISF in children in an effort to reduce medically unnecessary hospital admissions.

Methods
Using PubMed and The Cochrane Library databases, a literature search using the search terms (pediatric OR child) AND skull fracture AND (isolated OR linear) was performed. Three hundred forty-three abstracts were identified and screened based on the inclusion criteria: (1) linear, nondepressed ISF; (2) no evidence of intracranial injury; (3) age 18 years or younger; and (4) data on patient outcomes and management. Data including age, Glasgow Coma Scale score on arrival, repeat imaging, admission rates, need for neurosurgical intervention, and patient outcome were collected. Two authors reviewed each study for data extraction and quality assessment.

Results
Fourteen articles met the eligibility criteria. Data including admission rates, outcomes, and necessity of neurosurgical intervention were analyzed. Admission rates ranged from 56.8% to 100%; however, only 8 of more than 5000 patients developed new imaging findings after admission, all of which were nonsurgical. Only 1 patient required neurosurgical intervention for a finding evident upon initial evaluation.

Conclusions
Pediatric ISF patients with a presenting Glasgow Coma Scale score of 15 who are neurologically intact and tolerating feeds without concern for nonaccidental trauma or an unstable social environment can safely be discharged following ED evaluation to a responsible caregiver.
Prospective Associations of Adolescent Conscientiousness With Psychological Resources and Metabolic Syndrome in Black and White Men
Authors: Duggan Katherine A. , Jennings J. Richard , Matthews Karen A. 
Published: March 2019

ABSTRACT

Objective
Conscientiousness predicts better psychological resources as well as lower cardiovascular mortality and lower metabolic syndrome (MetS) risk. However, the benefits of conscientiousness might be amplified, disabled, or reversed in disadvantaged groups. This study is the first to test these competing hypotheses for prospective associations between adolescent conscientiousness and adult psychological resources and MetS.

Method
Participants were 220 men (54.6% black) from the Pittsburgh Youth Study. Adolescent conscientiousness (M [SD] age = 16 [1]) was rated by participants and their parents. Adult (M [SD] age = 32 [1]) socioeconomic status (SES; occupation and education), psychological resources (composite of positive affect, purpose in life, optimism, self-mastery, and self-esteem), and MetS scores (glucose, lipids, waist circumference, and blood pressure) were measured. Hierarchical regressions were used to evaluate the association of conscientiousness with adult psychological resources and MetS scores, with testing of moderation by race and SES.

Results
Self- and parent-reported conscientiousness were associated with better psychological resources (βs = 0.23–0.29, ps ≤ .015), with no moderation by race or socioeconomic status. In the full sample, a three-way interaction of self-reported conscientiousness, race, and SES was obtained for MetS (β = 0.12, p = .093). Subgroup analysis indicated that self-reported conscientiousness was related to higher MetS scores in low SES black men (βint = −0.22, p = .022), but there was no comparable linear (βs ≤ 0.08, ps ≥ .50) or interaction (βs ≤ −0.13 ps ≥ .25) pattern in white men.

Conclusions
Adolescent conscientiousness was beneficial for adult psychological resources, regardless of race or SES. However, there may be physiological costs of conscientiousness for black men from disadvantaged backgrounds.
Platelet Serotonin Signaling in Patients With Cardiovascular Disease and Comorbid Depression
Authors: Williams Marlene S. , Ziegelstein Roy C. , McCann Una D. , Gould Neda F. , Ashvetiya Tamara , Vaidya Dhananjay 
Published: March 2019

ABSTRACT

Objective
Depression in patients with cardiovascular disease is associated with increased risk of adverse clinical outcomes. Investigators have searched for potential biobehavioral explanations for this increased risk. Platelet activation and response to serotonin is an attractive potential mechanism. The aim of the study was to examine platelet serotonin signaling in a group of patients with coronary artery disease (CAD) and comorbid depression to define the relationship between platelet serotonin signaling and cardiovascular complications.

Methods
A total of 300 patients with CAD were enrolled (145 with acute coronary syndrome and 155 with stable CAD). Depression was assessed using the Structured Clinical Interview for DSM-IV as well as Beck Depression Inventory II in a dichotomous and continuous manner. Platelet serotonin response was measured by serotonin augmented aggregation, direct platelet serotonin activation, platelet serotonin receptor density, and platelet serotonin uptake. Cardiovascular outcomes were assessed at 12-month follow-up.

Results
One third of enrolled participants had at least minimal depressive symptoms and 13.6% had major depressive disorder. Depressed cardiovascular patients had significantly higher incidence of major (odds ratio = 3.43, 95% confidence interval = 1.49–7.91, p = .004) and minor (odds ratio = 2.42, 95% confidence interval = 1.41–4.13, p = .001) adverse cardiac events. Platelet serotonin response was not significantly different in patients with depression. Participants with major depressive disorder had higher serotonin receptor density (997.5 ± 840.8 vs 619.3 ± 744.3 fmol/ug, p = .009) primarily found in ACS patients. Depressed patients with minor adverse cardiac events had increased platelet response to serotonin.

Conclusions
Depressed cardiovascular patients had higher serotonin receptor density and significantly higher incidence of major and minor cardiac adverse events. Future studies with larger sample sizes including patients with more severe depression are needed to expand on the present hypothesis-generating findings.
Establishing the Foundation to Support Health System Quality Improvement: Using a Hand Hygiene Initiative to Define the Process
Authors: Anderson Rebecca , Rosenberg Alexandra , Garg Swati , Nahass Jennifer , Nenos Andrew , Egorova Natalia , Rowland John , Mari Joseph , LoPachin Vicki 
Published: March 2019

Objectives
As hospitals are increasingly consolidating into larger health systems, they are becoming better positioned to have far reaching and material impacts on safety and quality of care. When the Mount Sinai Health System (MSHS) was formed in 2013, it sought to ensure the delivery of safe, high-quality care to every patient. In 2014, the MSHS addressed hand hygiene as the first major system-wide process improvement project focused on quality and safety. The goals of this study were to evaluate a system-wide hand hygiene program and to create a foundation for future process improvement projects.

Methods
The MSHS implemented the Joint Commission’s Targeted Solutions Tool as a way to improve hand hygiene compliance and reduce harm from hospital-acquired infections, specifically Clostridium difficile infections. A multifaceted approach was used to improve hand hygiene and promote a culture of patient safety.

Results
The MSHS improved hand hygiene compliance by approximately 20% from a baseline compliance of 63.3% to an intervention compliance of 82.8% (P < 0.001). Additional correlation analysis revealed a significant correlation between increasing hand hygiene compliance and reduction in C. difficile infections.

Conclusions
Through a focus on leadership engagement, data transparency, data and observer management, and system-wide communication of best practices, the MSHS was able to improve hand hygiene compliance, reduce infection rates, and build an effective foundation for future process improvement programs.
Dual-Energy Computed Tomography in Loosening of Revision Hip Prosthesis: A Comparison Between MARS and non-MARS Images
Authors: Guziński Maciej , Kubicki Konrad , Waszczuk Łukasz , Morawska-Kochman Monika , Kochman Andrzej , Sąsiadek Marek 
Published: March 2019

Purpose
The aim of the study was to assess potential endoprosthesis loosening in patients after revision total hip arthroplasty, based on monochromatic dual-energy computed tomography (DECT) images obtained with and without metal artifact reduction software (MARS) and comparison with the clinical examination and hip function.

Materials and Methods
Twenty-five consecutive patients underwent DECT examinations. Two monochromatic data sets were generated: with MARS (75-keV MARS) and without MARS (140-keV non-MARS) and evaluated for signs of loosening, using a dedicated radiological score. The Harris Hip Score (HHS) was used to evaluate patients' hip function.

Results
The mean radiological score for loosening in the non-MARS group was 16.2, in the MARS group 17.0 and was significantly higher (P < 0.001). Radiological loosening evaluation in non-MARS images correlated with the HHS score (ρ = 0.43, P = 0.03), whereas there was no correlation between MARS images and HHS (ρ = 0.15, P = 0.47). New MARS-related artifacts, which hinder implant-bone interface evaluation, were found in 75-keV MARS images (“pseudo-loosening” in 33 of 34 prostheses, “ground-glass blurring” in 20 of 32).

Conclusions
High-energy monochromatic DECT images are superior to low-energy DECT MARS images in assessment of the potential loosening and correlate better with the clinical examination outcomes. For revision total hip arthroplasty evaluation, 2 data sets should be assessed inseparably because of extra artifacts in MARS images.
Quantitative Assessment of Thyroid Gland Vascularization With Vascularization Index Using Color Superb Microvascular Imaging in Pediatric Patients With Hashimoto Thyroiditis
Authors: Durmaz Mehmet Sedat , Akyürek Nesibe , Kara Turgay , Ateş Fatih , Özbakir Bora , Gökgöz Durmaz Funda , Soğukpinar Karaağaç Seda , Öztürk Mehmet 
Published: March 2019

Abstract
The study aimed to investigate the effectiveness of the vascularization index (VI) obtained using superb microvascular imaging (SMI) technique in the diagnosis of Hashimoto thyroiditis (HT). The thyroid glands of 80 patients with HT and 107 healthy, asymptomatic participants were examined using SMI. The thyroid parenchyma echogenicity was evaluated, and the thyroid gland volume was measured. Vascularization index measurements were performed by manually drawing the contours of the thyroid parenchyma using the free region of interest with color 2-dimensional SMI VI mode. The quantitative VI values of the patients and the asymptomatic group were compared. Correlations between VI values and thyroid autoantibodies and thyroid hormone levels were analyzed. The mean VI value of the thyroid gland was 4.74% ± 1.96% in the asymptomatic group and 12.45% ± 5.87% in HT patients with a statistically significant difference (P < 0.001). Hashimoto thyroiditis can be diagnosed with 86.3% sensitivity and 82.2% specificity when 6.00% VI value was designated as the cutoff value. There was a positive significant correlation between the VI value and the thyroid-stimulating hormone, antithyroglobulin antibodies, anti–thyroid peroxidase antibody levels (P < 0.05); however, no significant correlation was found between the VI values and thyroglobulin and free thyroxine levels (P > 0.05). There was a significant negative correlation between the VI values and the parenchyma echogenicity and positive significant correlation between the thyroid gland volume and the antithyroglobulin antibody and anti–thyroid peroxidase antibody levels (P < 0.05). The VI obtained using the SMI technique can be effectively used as an imaging method for the diagnosis of HT because of its high sensitivity and specificity in representing objective, quantitative numerical values.
Should We Perform Transthoracic Trucut Lung Biopsies of Pleural-Based Lung Masses Under Ultrasound Guidance or Computed Tomography Guidance?
Authors: Tekin Ali Fuat , Turgut Bekir , Öncü Fatih 
Published: March 2019

Abstract
We aimed to emphasize which method should be prioritized by comparing the ultrasound and computed tomography (CT) guidance for percutaneous transthoracic biopsy of pleural-based lung lesions in terms of comorbidity, diagnostic success, time, and costs.
Approximately 700 biopsy procedures performed between 2014 and 2018 were retrospectively reviewed. The files of these patients and picture archiving and communication system were scanned.
Size and localization of the lesion, pathological diagnosis, comorbidity status, pneumothorax complications at the end of the procedure, and whether or not a thoracic tube was placed due to pneumothorax were recorded. Fisher exact test and Pearson χ2 test were used for statistical analysis.
A total of 181 patients who underwent the pleural-based biopsy procedure, the subject of study, were included in the study. One hundred (55.2%) of the biopsy procedures of these patients were performed under the guidance of tomography, and 81 (44.8%) were performed under the guidance of ultrasound (US). Median size of the lesions is 38 mm (25%–75%, 33–55 mm). Pneumothorax complications were observed in 6 patients (6%) who had CT-guided procedures and 4 patients (4.9%) who had US-guided procedures. Of the patients who developed pneumothorax, 2.8% were inserted thoracic tubes owing to the complication. Diagnostic efficacy of our procedures is 99.8% in US-guided procedures and 97% in CT-guided transthoracic biopsy. The average duration of US-guided transthoracic biopsy procedures is 17 minutes, and the average duration of CT-guided biopsy procedures is 35 minutes.
The Incidence of Snow Blower–Related Injuries to the Hand in the United States
Authors: Rubinstein Aaron J. , Thomson Jennifer E. , Siracuse Brianna L. , DeCotiis Mark R. , Ahmed Irfan H. , Vosbikian Michael M. 
Published: March 2019

Background
Snow blowers represent a highly preventable and increasingly common mechanism of hand injury. This study examines current safety features and their impact on decreasing the incidence of snow blower–related injuries.

Methods
The National Electronic Injury Surveillance System was queried to look for injuries related to the use of snow throwers or blowers between 2001 and 2016. From all of the injuries related to snow blowers, we collected information on identifying characteristics, location of injury, and type of injury (i.e., avulsion). Chi-squared tests were used for categorical variable comparisons, and Student t tests were used for continuous variable comparisons. Data analysis was performed using SAS statistical software, version 9.3 (SAS Institute, Inc., Cary, NC). The Consumer Product Safety Commission's provided SAS algorithm was used to calculate all national injury estimates and variances. Statistical significance was determined based on P < 0.05.

Results
Within the study period, there were 3,550 reported injuries. The extrapolated national incidence was 92,799, with an average annual incidence of 5,800 or 1.9 injuries per 100,000 US population per year. The most commonly injured body part was the finger followed by the hand. Most common types of injuries were fractures, lacerations, and amputations.

Conclusions
The incidence of snow blower injuries increased from 2001 to 2016. Unlike with other power tools, Consumer Product Safety Commission–mandated guidelines for safer operation and improvements in equipment have not been successful in producing a decrease in the incidence of snow blower injuries to the upper extremity. Based on this, further equipment modifications are necessary and should be aimed at preventing operators from placing their hand into the exit chute while the machine is still running. Physicians should take an active role in their practice as well as in their professional societies to educate and counsel patients to prevent further injury.
Fractures of the Base of the Proximal Phalanx in Children
Authors: Al-Qattan Mohammad M. 
Published: March 2019

Background
The diaphyseal axis–metacarpal head angle (DHA) measures the angle between the axis of the proximal phalanx and the center of the metacarpal head. In unfractured fingers, the normal DHA ranges from 177.1° to 180.0°. The angle may be used to quantify the degree of lateral displacement of pediatric fractures of the base of the proximal phalanx. Previous authors have shown that if the postreduction x-rays show an angle greater than 169° remodeling with normalization of the DHA is expected to occur in children. The degree of remodeling of more severe angulations is unknown.

Patients and Methods
This is a retrospective study (over the last 5 years) that identified 8 late referrals (4–6 weeks after injury) of inadequately reduced pediatric fractures of the base of the proximal phalanx with a postreduction DHA of 156° to 163°. At the time of presentation to the author, there was lateral deviation of the finger, and the fracture site was not tender, indicating malunion. All patients were offered surgery, but this was refused by the parents. Follow-up appointments to the clinic were made, and the DHAs were serially measured to investigate the degree of remodeling.

Results
Seven patients had normalization of the DHA (ie, an angle >177°) between 9 and 18 months. In the remaining patient, the DHA was 175.7° at 2 years.

Conclusions
The current study shows adequate remodeling of severe residual angular deformities (DHA of 156°–163°). The clinical implication of this finding is regarding late referrals with no tenderness at the fracture site. In these cases, refracturing usually requires general anesthesia. Our study shows that patients may be given the option of conservative management awaiting remodeling.
Using π-Shaped Auricular Cartilage With a Local Flap for Lower Eyelid Support
Authors: Zhai Zhen , Jin Xiaolei , Yu Lu , Yang Xiaonan , Qi Zuoliang 
Published: March 2019

Introduction
Auricular cartilage has been largely reported as an available substitute of defected tarsus to restore lower eyelid stability. However, undesirable results such as displacement, detachment, warping, down-gaze disturbance, and surface irregularity of the cartilage graft have been reported in previous reports, some of which require reoperations. In this study, the authors present a new technique to use strips of auricular cartilage with a local flap to restore the lower eyelid stability for a reliable eyelid support.

Methods
From 2013 to 2018, the technique was carried out on 13 patients who suffered inadequate lower eyelid support with cicatricial retraction or ectropion and incomplete eyeball coverage, which was caused by soft tissue deletion secondary to different etiologies. Two kinds of local flaps were used to reconstruct the anterior soft tissue layer, whereas the posterior layer was supported with a π-shaped auricular cartilage. The preoperative and postoperative photographs were taken. Three indexes, including the vertical distance between inferior corneal margin and inferior palpebral margin, the maximal breadth of palpebral conjunctiva caused by ectropion, and the maximal palpebral fissure breadth when eyelid is closed, were measured before and 6 months after the operation to evaluate the operative effect.

Results
The average follow-up was 32 months (range, 6–62 months). The local flap survived in all patients. No complications were seen in any of the patients. Postoperative average of the aforementioned first 2 indexes measured at 6 months was 0 mm, whereas the preoperative one was 2.69 and 1.08 mm, respectively. Postoperative average of the third index was also far more lower than the preoperative one (0.08 vs 2.77 mm). The difference between the preoperative and postoperative evaluation of the 3 indexes was statistically significant (paired t test, P < 0.001). No further intervention was required.

Conclusions
The present technique using a combination of π-shaped auricular cartilage and a local flap provides a satisfying horizontal and vertical support to maintain the lower eyelid in a normal position without compromising the mobility of the lower eyelid. This technique can be used as an effective and safe method for lower eyelid support.
Poor Access to Breast Reconstruction
Authors: Teng Teng L. , Hall Ryan , Graham Roger A. , Reiland Juliann , Chatterjee Abhishek 
Published: March 2019

Background
Breast cancer surgery involves removal of cancer performed by a breast surgeon and reconstruction performed by a plastic surgeon. Historically, many women have not undergone breast reconstruction surgery (BRS), with current literature suggesting that geographic barriers may play a role. Our objective was to determine if there is a geographic shortage of plastic surgeons in the United States and to assess for trends in access to BRS for rural, suburban, and urban populations.

Methods
A database investigation of the 2018 membership for the American Society of Breast Surgeons and the American Society of Plastic Surgeons was performed. We searched for a breast surgeon's geographic presence by zip code and looked for the presence of a plastic surgeon within 10 and 20 miles. Zip codes were then categorized as urban, suburban, or rural. Within each population category, the average numbers of breast surgeons and plastic surgeons were quantified.

Results
Twenty-five percent of breast surgeon zip codes had no plastic surgeons located within 10 miles; 10% of breast surgeon zip codes had no plastic surgeon within 20 miles. There were on average 7.03 breast surgeons in each urbanized area. Suburban and rural areas had an average of 1.14 and 1.00 breast surgeons, respectively. There were on average 10.97 plastic surgeons per urbanized area. Suburban and rural areas had, on average, 0.23 and 0.06 plastic surgeons, respectively.

Conclusions
A national comparison of the geographical distribution between breast surgeons and plastic surgeons indicates a shortage of plastic surgeons, especially in rural and suburban areas.