bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traction force for peroperative hip dislocation in hip arthroscopy
Authors: Röling Maarten A , Mathijssen Nina MC , Blom Ian , Lagrand Tirza , Minderman Donny , Bloem Rolf M 
Published: April 2019

Objectives: Traction force widens the joint space during hip arthroscopy. It is unclear how much the traction force varies and if it is related to the joint space widening. Main goal of our study was to measure the amount of force needed to widen the hip joint. Second goal was to study the relation between this force and the amount of joint space widening. Methods: Traction force was measured in 27 patients (of whom 24 female, mean age 41) during arthroscopy. Measurements were performed before the procedure, after vacuum seal release and after capsulotomy. Joint space widening was measured with fluoroscopy and was calibrated. Friedman and Wilcoxon tests were used to measure differences in traction. The Spearman’s rho correlation coefficient was used to identify a correlation in traction force and joint space widening. Regression analyses were used to identify relations between age, body mass index (BMI), hip degeneration and traction force. Results: The median traction force before arthroscopy was 714 N, lowered to 520 N after vacuum seal release and to 473 N after capsulotomy ( p < 0.001). Median joint space widening was 8.8 mm. Spearmans’ rho correlation between traction force and joint space widening was ‒0.13. Discussion: Median traction force of 714 N resulted in 8.8 mm of joint space widening. This traction force was significantly lowered by 200 N after release of the vacuum seal of the hip and 250 N after additional capsulotomy without loss of joint space narrowing. No significant relation was identified for age, BMI or progression of the Kellgren-Lawrence classification for hip degeneration and traction force. Netherlands Trial Registry number 8610
Altered Tryptophan Catabolism in Placentas From Women With Pre-eclampsia
Authors: Keaton Sarah A , Heilman Patrick , Bryleva Elena Y , Madaj Zachary , Krzyzanowski Stanislaw , Grit Jamie , Miller Emily S , Jälmby Maya , Kalapotharakos Grigoros , Racicot Karen , Fazleabas Asgerally , Hansson Stefan R , Brundin Lena 
Published: April 2019

Background: The kynurenine pathway enzymes, breaking down tryptophan, are abundant in placental tissue. These metabolites are involved in immunoregulatory mechanisms, although the role of this pathway in pre-eclampsia (PE) has only begun to be characterized. Here, we determined tryptophan and metabolite levels together with the expression of kynurenine pathway enzymes and inflammatory factors in placental tissue from women with and without PE. Methods: Thirty-six placentas (18 PE and 18 controls) were analyzed for expression of kynurenine pathway enzymes indoleamine-2,3-dioxygenase (IDO1 and 2), tryptophan-2,3-dioxygenase (TDO), kynurenine-3-mono-oxygenase (KMO) and quinolinate phosphoribosyltransferase (QPRT) as well as interleukin (IL)-1β, IL-6, and serum amyloid A (SAA). Tryptophan and kynurenine content were measured using high-pressure liquid chromatography and quinolinic acid was measured using gas chromatography-mass spectrometry. Conclusions: Tryptophan content was reduced in placentas from women with PE. There was an increased kynurenine/tryptophan ratio in placentas from women with PE but no significant change in downstream metabolites. We confirmed a reduction in IDO1 expression and found a compensatory increase in TDO expression in placentas from women with PE. SAA was reduced in PE placentas compared with controls. Our data show that tryptophan content and the inflammatory mediator SAA are both compromised in placentas from women with PE. Further studies on the role of tryptophan catabolism and mediators of inflammation in sustaining healthy immunobiological pathways in the placenta are warranted.
Gamblers’ (mis-)interpretations of Problem Gambling Severity Index items: Ambiguities in qualitative accounts from the Swedish Longitudinal Gambling Study
Authors: Samuelsson Eva , Wennberg Peter , Sundqvist Kristina 
Published: April 2019

The Problem Gambling Severity Index (PGSI) is a screening instrument frequently used to identify risk and problem gambling. Even though the PGSI has good psychometric properties, it still produces a large proportion of misclassifications. Aims: To explore possible reasons for misclassifications in problem gambling level by analysing previously classified moderate-risk gamblers’ answers to the PGSI items, in relation to their own current and past gambling behaviours. Methods: Semi-structured telephone interviews were conducted with 19 participants reporting no negative consequences from gambling. They were asked the PGSI questions within an eight-year time frame (2008 to 2016). Ambiguous answers to PGSI items were subject to content analysis. Results: Several answers to the PGSI items contained ambiguities and misinterpretations, making it difficult to assess to what extent their answers actually indicated any problematic gambling over time. The item about feelings of guilt generated accounts rather reflecting self-recrimination over wasting money or regretting gambling as a meaningless or immoral activity. The item concerning critique involved mild interpretations such as being ridiculed for buying lottery tickets or getting comments for being boring. Similar accounts were given by the participants irrespective of initial endorsement of the items. Other possible reasons for misclassifications were related to recall bias, language difficulties, selective memory, and a tendency to answer one part of the question without taking the whole question into account. Conclusions: Answers to the PGSI can contain a variety of meanings based on the respondents’ subjective interpretations. Reports of lower levels of harm in the population should thus be interpreted with caution. In clinical settings it is important to combine use of screening instruments with interviews, to be able to better understand gamblers’ perceptions of the gambling behaviour and its negative consequences.
Prediction of Early Response to Chemotherapy in Breast Cancer Liver Metastases by Diffusion-Weighted MR Imaging
Authors: Bai Genji , Wang Yating , Zhu Yan , Guo Lili 
Published: April 2019

Objective: To determine whether change in apparent diffusion coefficient value could predict early response to chemotherapy in breast cancer liver metastases. Materials and Methods: We retrospectively studied 42 patients (86 lesions) with breast cancer liver metastases who had undergone conventional magnetic resonance imaging and diffusion-weighted imaging (b = 0.700 s/mm2) before and after chemotherapy. Maximum diameter and mean apparent diffusion coefficient value (×10−3 mm2/s) of liver metastases from breast cancer were evaluated. The grouping reference was based on magnetic resonance imaging according to Response Evaluation Criteria in Solid Tumors (RECIST). Analysis of variance and receiver–operating characteristic analyses were performed. Results: Eighty-six metastases were classified as 40 responders and 46 nonresponders. A statistically significant correlation was found between prechemotherapy and postchemotherapy apparent diffusion coefficient values in responders, which were 0.9 ± 0.16 × 10−3 mm2/s, 1.05 ± 0.12 × 10−3 mm2/s, 1.26 ± 0.12 × 10−3 mm2/s, and 1.33 ± 0.87 × 10−3 mm2/s, respectively. No statistically significant difference was found between prechemotherapy and postchemotherapy apparent diffusion coefficient values in nonresponders. Differences were statistically significant between responders and nonresponders at prechemotherapy, 2 weeks after chemotherapy, and 4 weeks after chemotherapy ( P = 0.014, P = .001, and P = .000, respectively). Receiver operating characteristic curves showed that apparent diffusion coefficient values could predict treatment response early at 2 weeks after chemotherapy with 64.5% sensitivity and 91.8% specificity. Conclusion: The change in apparent diffusion coefficient value may be a sensitive indicator to predict early response to chemotherapy in breast cancer liver metastases.
Adherence to recommended imaging surveillance of acutely presenting Stanford type-B aortic dissections
Authors: Doshi Sachin , Eisenberg Naomi , Bailey Shawn , Annamalai Ganesan , Roche-Nagle Graham 
Published: April 2019

Objective Acutely presenting Stanford type B aortic dissections (type-B AD) primarily receive medical or endovascular management and require lifelong imaging surveillance. CT and MR imaging are the best modalities to assess early indications of potentially fatal developments. Published guidelines recommend that imaging occur at 1, 3, 6, and 12 months following acute presentation, and annually thereafter. This study evaluates adherence to recommended imaging surveillance for newly presenting type-B AD patients at a tertiary hospital. Methods A retrospective review of patients presenting with a new, acute type-B AD between January 2010 and March 2017 was performed. Patient demographics, type-B AD admission details, and medical histories were obtained from electronic and paper chart reviews. CT and MR images were reviewed, and aortic sizes were measured by two independent radiologists. Patients without a clinical visit or type-B AD surveillance imaging for greater than 15 months were considered lost to follow-up after their last appointment. Overall clinical follow-up and adherence to recommended were analyzed using Kaplan–Meier graphs. Log-rank analysis assessed factors increasing risk of poor clinical follow-up and adherence to surveillance guidelines. Results Sixty-two patients (38 male, 24 female) were included. At the time of index admission, median age was 62 (SD 14), and median aortic diameter was 45 mm (SD 11.2). Median duration of overall follow-up was 24 months. Kaplan–Meier analysis of overall follow-up, censoring death, and external follow-up, indicated clinical follow-up rates of 87.1% (SE = 4.3%) at 3 months, 85.2% (SE = 4.6%) at 6 months, 77.5% (SE = 5.6%) at 12 months, and 63.8% (SE = 8.1%) at 60 months. Similar analysis of adherence to recommended imaging surveillance revealed rates of 56.5% (SE 6.3%) at 3 months, 36.9% (6.7%) at 6 months, 21.5% (6.5%) at 12 months, and 12.9% (6.1%) at 24 months. Log-rank analysis indicated that specialty arranging follow-up – medical ( n = 24) versus surgical ( n = 38) – did not impact overall follow-up or adherence to recommended guidelines. Similarly, none of patient distance to hospital, medical versus endovascular intervention, initial dissection size, smoking history, or additional medical/demographic impacted these outcomes. Conclusions At our institution, we identified a gap between imaging surveillance following type-B AD and adherence to recommended, published guidelines. This was consistent across all type-B AD patients with no subset in isolation. Multiple opportunities for quality improvement exist to facilitate improved compliance with published guidelines.
The patient experience in a community pharmacy mental illness and addictions program
Authors: Murphy Andrea L. , Gardner David M. , Jacobs Lisa M. 
Published: April 2019

Background: The Bloom Program was designed to enhance pharmacists’ care of people with lived experience of mental illness and addictions in Nova Scotia. The Program’s demonstration period was from September 2014 to December 2016 and included a qualitative evaluation of the patient experience. Methods: Patients were recruited for individual interviews through Bloom Program pharmacies. Interviews were transcribed verbatim and analyzed following Braun and Clarke’s 6-step approach for thematic analysis. Results: Ten patients were interviewed between May and June 2016. Ten themes were determined through data analysis and included medication management, accessing pharmacists in a new way, providing social support, bridging service gaps, providing interim care, reducing financial barriers, navigation and advocacy, holistic approaches, empowerment through knowledge and awareness and collaboration. Discussion: Pharmacists expectedly provided medication management activities to patients for both physical and mental health concerns in the Bloom Program. Many activities conducted with Bloom Program patients fell outside of dispensing roles and medication management. These activities, such as social support, triage, navigation and increasing access, which were highly valued by patients, are poorly measured and assessed in pharmacy practice research. Conclusion: Participants in the Bloom Program reported the significant contributions of pharmacists and pharmacy teams in their overall health and wellness. Future evaluations of interventions like the Bloom Program should include measurement of constructs valued by patients and also consider impacts on inequalities and inequities. Pharmacy practice researchers can benefit from other research and evaluation being conducted for primary care interventions.
Noho Taiao: reclaiming Māori science with young people
Authors: Moewaka Barnes Helen , Henwood Wendy , Murray Joanne , Waiti Pauline , Pomare-Peita Mina , Bercic Selena , Chee Rebecca , Mitchell Mishayla , McCreanor Tim 
Published: April 2019

Connections and belonging to ancestral lands are strongly and consistently argued as fundamental to Māori education, health and wellbeing. When our connections with and access to health-promoting places of belonging are damaged, we lose more than component parts of wellbeing. An entire cultural infrastructure integral to identity, community, spirituality, sustainability and even material sustenance is eroded, compromising health, wellbeing and vitality. Young people in rural areas are often seen as missing out on the amenities and attractions available in cities, but are assumed to have compensatory access to and positive relationships with ‘nature’. For multiple reasons, many arising from colonial legacies, this is often not so for young Māori and there are initiatives underway that seek to reconnect them with customary environments. Place-based learning approaches that use local environments and ecosystems as living laboratories, reimagining the way students engage with knowledge, science and understandings of the natural world can be valuable in this respect. Te Rārawa Noho Taiao projects in the Far North of Aotearoa have been operating for nearly a decade, using indigenous pedagogy that promotes Māori science, science leadership, and learning, applying them in ways that produce a range of health and wellbeing benefits. These include enhanced educational engagement, strengthened capabilities, increased participation/belonging, stronger connections, constructive peer processes and positive intergenerational interactions, all based in Māori values and praxis. Such elements are widely recognised in health-promoting frameworks as highly implicated in the creation and maintenance of health and wellbeing for individuals, communities and populations. In this paper, we use interviews with organisers and teachers of these Noho Taiao and a survey of student participants, to explore the educational and health promotion effects.
False activation of the cardiac catheterization laboratory: The price to pay for shorter treatment delay
Authors: Degheim George , Berry Abeer , Zughaib Marcel 
Published: April 2019

Introduction In patients with acute ST elevation myocardial ischemia (STEMI), national efforts have focused on reducing door-to-balloon (D2B) times for primary percutaneous coronary intervention (PCI). This emphasis on time-to-treatment may increase the rate of inappropriate cardiac catheterization laboratory (CCL) activations and unnecessary healthcare utilization. To achieve lower D2B times, community hospitals and EMS systems have enabled emergency medical technicians (EMTs) and emergency department (ED) physicians to activate the CCLs without immediately consulting a cardiologist. Objective The purpose of this study is to determine the rate and main causes of inappropriate activation of the CCL which will aid in finding solutions to reduce this occurrence. Method This is a retrospective study, based on an electronic medical system review of all inappropriate CCL activation who presented to Providence Hospital and Medical Centers (PHMC) in Michigan, from January 2015 to July 2016. Results The CCL was activated 375 times for suspected STEMI. The false STEMI activation was identified in 47 patients which represents 12.5% of total CCL activation. The vast majority of this false activation was due to non-diagnostic electrocardiogram (ECG) that did not meet the STEMI criteria. Conclusion The subjective interpretation of the ECG by EMTs and ED physicians tend to show a wide variability, which may lead to higher-than-anticipated false activation rates of up to 36% in one study. Some studies had reported that up to 72% of inappropriate activations were caused by ECG misinterpretations. These false activations have ramifications that lead to both clinical and financial costs.
Late-onset osteosarcoma after onychectomy in a cat
Authors: Breitreiter Katrina 
Published: April 2019

Case summary A 12-year-old neutered male onychectomized Ragdoll cat presented for a 3 day history of swelling and hemorrhagic purulent discharge on the first digit of the left manus. Radiographs revealed fragments of the third phalangeal bone (P3) present in the partially amputated digits with swelling adjacent to the P3 fragment on the first digit of the left manus. Thoracic radiographs revealed no evidence of primary or metastatic neoplasia. Surgery was performed to remove all P3 fragments and the associated swelling on the diseased digit. On gross examination of the excised swelling, a mass was present at the cut edge of P3. The bone fragment and associated mass were submitted for histopathological evaluation. Osteosarcoma was diagnosed. Because neoplastic cells extended to the surgical margins, amputation of the left thoracic limb was performed. The cat recovered from surgery, and survival time at the time of writing was 8 months. Relevance and novel information To our knowledge, this is the first reported case of onychectomy-associated osteosarcoma. Trauma from partial P3 amputation during onychectomy is suspected to have played a role in osteosarcoma development in this case. Malignant transformation may be considered a potential complication of onychectomy achieved by partial P3 amputation.
Intramural duodenal hematoma: clinical course and imaging findings
Authors: Niehues Stefan M , Denecke Timm , Bassir Christian , Hamm Bernd , Haas Matthias 
Published: April 2019

Background Intramural duodenal hematoma is a rare condition. Different imaging modalities are at hand for diagnosis. Purpose To identify patients with intramural duodenal hematoma and report imaging findings and clinical courses. Material and Methods Typical imaging patterns using ultrasound, computed tomography, and magnetic resonance imaging were carried out on 10 patients. Results The mean patient age was 7.5 years. The average disease duration was 13 months. Clinical signs of improvement were observed within 16 days. Residues were still detectable at long-term follow-up. Conclusion For patients with intramural duodenal wall hematoma, diagnosis should be considered early. Typical imaging findings should be known to ensure optimal treatment.
Evaluation of the geriatric curriculum implemented at Shiraz University of Medical Sciences, Iran, since 2017: A qualitative study
Authors: Jaafari Faezeh , Delavari Somayeh , Bazrafkan Leila 
Published: April 2019

Background:Recently, there has been an increase in life expectancy due to improvements in nutrition, health, and sanitation. The aim of this study was to evaluate the geriatric curriculum in the field of general medicine at Shiraz University of Medical Sciences (SUMS), Iran to improve the quality of services provided to this population in the community.Methods:This was a qualitative study­­. Six educational hospitals and ambulatory centers of Shiraz University of Medical Sciences participated in this study. Within these centers, 15 medical education faculty members and educational experts, 6 medical students, 6 elderly patients and 6 nurses working in the university related to the geriatric field were selected using purposive sampling. Data were gathered through semi-structured interviews, focus group discussion and field observations in the teaching hospital and ambulatory setting of SUMS from June 2017 to May 2018. Based on the qualitative research, the data underwent conventional content analysis and the main themes were developed from this.Results:Three main themes were extracted from the data: effective clinical education, geriatrics curriculum challenges and promotion strategies for geriatric medicine. Subcategories that emerged were a competent curriculum teacher, a challenging program, management of resources, promotion of the program, and the revision required in the curriculum, which were related to other concepts and described in the real-world situation of the geriatric curriculum in the university, as observed in field observations.Conclusions:This study identified three concepts as main themes that can be used to explain how to implement a geriatric curriculum in a medical university. The main contributing factor to different views of the participants was identified as the revision required to the curriculum for integrative care in a geriatric patient. This should be taken into consideration while planning any programs and decisions aimed at education of medical students on this topic.
Presence and diversity of Salmonella isolated from layer farms in central Ecuador
Authors: Salazar Gabriela A. , Guerrero-López Ricardo , Lalaleo Liliana , Avilés-Esquivel Diana , Vinueza-Burgos Christian , Calero-Cáceres William 
Published: April 2019

Background: Given the considerable role played by Salmonella in the incidence of food contamination, around the world, surveillance of this infection is prioritized by both food producers and health care authorities. Data remains insufficient concerning the prevalence of Salmonella in poultry systems in Ecuador and in Latin America in general. Methods: In this study, we evaluated the presence and diversity of Salmonella serovars in samples taken from 21 layer farms and backyard layers in central Ecuador during August-November 2017. Salmonella was isolated following standardized methods (ISO 6579) and the serovar determination was carried out by PCR. Results: A significant presence of Salmonella was detected in the 21 farms evaluated, with a frequency of 76% (95% confidence interval (CI): 53-92) in environmental surfaces, 33% (95%CI: 15-57) in pooled cloacal swabs from layer hens, 33% (95% CI: 13–59) on feed samples, and 10% (95%CI: 1-30) in backyard layer feces from traditional local markets. The dominant serovars detected were S. Infantis and S. Typhimurium. Conclusions: This study forms a basis for further surveillance of Salmonella serovars in layer farms in central Ecuador.