bluuebunny/crossref_metadata_2025_split huggingface dataset:
The shipboard Beirut terrorist bombing experience: a historical account and recommendations for preparedness in events of mass neurological injuries
Authors: Hubbard Zachary S. , Henderson Fraser , Armonda Rocco A. , Spiotta Alejandro M. , Rosenbaum Robert , Henderson Fraser 
Published: February 2019

On a Sunday morning at 06:22 on October 23, 1983, in Beirut, Lebanon, a semitrailer filled with TNT sped through the guarded barrier into the ground floor of the Civilian Aviation Authority and exploded, killing and wounding US Marines from the 1st Battalion 8th Regiment (2nd Division), as well as the battalion surgeon and deployed corpsmen. The truck bomb explosion, estimated to be the equivalent of 21,000 lbs of TNT, and regarded as the largest nonnuclear explosion since World War II, caused what was then the most lethal single-day death toll for the US Marine Corps since the Battle of Iwo Jima in World War II. Considerable neurological injury resulted from the bombing. Of the 112 survivors, 37 had head injuries, 2 had spinal cord injuries, and 9 had peripheral nerve injuries. Concussion, scalp laceration, and skull fracture were the most common cranial injuries.Within minutes of the explosion, the Commander Task Force 61/62 Mass Casualty Plan was implemented by personnel aboard the USS Iwo Jima. The wounded were triaged according to standard protocol at the time. Senator Humphreys, chairman of the Preparedness Committee and a corpsman in the Korean War, commented that he had never seen such a well-executed evolution. This was the result of meticulous preparation that included training not only of the medical personnel but also of volunteers from the ship’s company, frequent drilling with other shipboard units, coordination of resources throughout the ship, the presence of a meticulous senior enlisted man who carefully registered each of the wounded, the presence of trained security forces, and a drilled and functioning communication system.Viewed through the lens of a neurosurgeon, the 1983 bombings and mass casualty event impart important lessons in preparedness. Medical personnel should be trained specifically to handle the kinds of injuries anticipated and should rehearse the mass casualty event on a regular basis using mock-up patients. Neurosurgery staff should participate in training and planning for events alongside other clinicians. Training of nurses, corpsmen, and also nonmedical personnel is essential. In a large-scale evolution, nonmedical personnel may monitor vital signs, work as scribes or stretcher bearers, and run messages. It is incumbent upon medical providers and neurosurgeons in particular to be aware of the potential for mass casualty events and to make necessary preparations.
Management of carotid artery stenosis in patients with coexistent unruptured intracranial aneurysms
Authors: Tallarita Tiziano , Sorenson Thomas J. , Rinaldo Lorenzo , Oderich Gustavo S. , Bower Thomas C. , Meyer Fredric B. , Lanzino Giuseppe 
Published: February 2019

OBJECTIVEConcomitant unruptured intracranial aneurysms (UIAs) are present in patients with carotid artery stenosis not infrequently and result in unique management challenges. Thus, we investigated the risk of rupture of an aneurysm after revascularization of a carotid artery in a contemporary consecutive series of patients seen at our institution.METHODSData from patients who underwent a carotid revascularization in the presence of at least one concomitant UIA at our institution from 1991 to 2018 were retrospectively reviewed. Patients were evaluated for the incidence of aneurysm rupture within 30 days (early period) and after 30 days (late period) of carotid revascularization, as well as for the incidence of periprocedural complications from the treatment of carotid stenosis and/or UIA.RESULTSOur study included 53 patients with 63 concomitant UIAs. There was no rupture within 30 days of carotid revascularization. The overall risk of rupture was 0.87% per patient-year. Treatment (coiling or clipping) of a concomitant UIA, if pursued, could be performed successfully after carotid revascularization.CONCLUSIONSCarotid artery revascularization in the setting of a concomitant UIA can be performed safely without an increased 30-day or late-term risk of rupture. If indicated, treatment of the UIA can take place after the patient recovers from the carotid procedure.
Comparison of head impact exposure in practice drills among multiple youth football teams
Authors: Kelley Mireille E. , Espeland Mark A. , Flood William C. , Powers Alexander K. , Whitlow Christopher T. , Maldjian Joseph A. , Stitzel Joel D. , Urban Jillian E. 
Published: February 2019

OBJECTIVELimiting contact in football practice can reduce the number of head impacts a player receives, but further research is needed to inform the modification of optimal drills that mitigate head impact exposure (HIE) while the player develops the skills needed to safely play the game. This study aimed to compare HIE in practice drills among 6 youth football teams and to evaluate the effect of a team on HIE.METHODSOn-field head impact data were collected from athletes (ages 10–13 years) playing on 6 local youth football teams (teams A–F) during all practices using the Head Impact Telemetry System. Video was recorded and analyzed to verify and assign impacts to a specific drill. Drills were identified as follows: dummy/sled tackling, half install, install, install walk through, multiplayer tackle, Oklahoma, one-on-one, open field tackling, other, passing, position skill work, scrimmage, special teams, tackling drill stations, and technique. HIE was quantified in terms of impacts per player per minute (ppm) and peak linear and rotational head acceleration. Generalized linear models were used to assess differences in head impact magnitude and frequency among drills as well as among teams within the most common drills.RESULTSAmong 67 athlete-seasons, a total of 14,718 impacts during contact practices were collected and evaluated in this study. Among all 6 teams, the mean linear (p < 0.0001) and rotational (p < 0.0001) acceleration varied significantly among all drills. Open field tackling had significantly (p < 0.001) higher mean linear acceleration than all other drills. Multiplayer tackle had the highest mean impact rate (0.35 ppm). Significant variations in linear acceleration and impact rate were observed among teams within specific drills. Team A had the highest mean linear acceleration in install, one-on-one, and open field tackling and the highest mean impact rate in Oklahoma and position skill work. Although team A spent the greatest proportion of their practice on minimal- or no-player versus player contact drills (27%) compared to other teams, they had the highest median (20.2g) and 95th percentile (56.4g) linear acceleration in practice.CONCLUSIONSFull-speed tackling and blocking drills resulted in the highest HIE. Reducing time spent on contact drills relative to minimal or no contact drills may not lower overall HIE. Instead, interventions such as reducing the speed of players engaged in contact, correcting tackling technique, and progressing to contact may reduce HIE more effectively.
Screening and surgery for foramen magnum stenosis in children with achondroplasia: a large, national database analysis
Authors: Nadel Jeffrey L. , Wilkinson D. Andrew , Garton Hugh J. L. , Muraszko Karin M. , Maher Cormac O. 
Published: February 2019

OBJECTIVEThe goal of this study was to determine the rates of screening and surgery for foramen magnum stenosis in children with achondroplasia in a large, privately insured healthcare network.METHODSRates of screening and surgery for foramen magnum stenosis in children with achondroplasia were determined using de-identified insurance claims data from a large, privately insured healthcare network of over 58 million beneficiaries across the United States between 2001 and 2014. Cases of achondroplasia and screening and surgery claims were identified using a combination of International Classification of Diseases diagnosis codes and Current Procedural Terminology codes. American Academy of Pediatrics (AAP) practice guidelines were used to determine screening trends.RESULTSThe search yielded 3577 children age 19 years or younger with achondroplasia. Of them, 236 met criteria for inclusion in the screening analysis. Among the screening cohort, 41.9% received some form of screening for foramen magnum stenosis, whereas 13.9% of patients were fully and appropriately screened according to the 2005 guidelines from the AAP. The screening rate significantly increased after the issuance of the AAP guidelines. Among all children in the cohort, 25 underwent cervicomedullary decompression for foramen magnum stenosis. The incidence rate of undergoing cervicomedullary decompression was highest in infancy (28 per 1000 patient-years) and decreased with age (5 per 1000 patient-years for all other ages combined).CONCLUSIONSChildren with achondroplasia continue to be underscreened for foramen magnum stenosis, although screening rates have improved since the release of the 2005 AAP surveillance guidelines. The incidence of surgery was highest in infants and decreased with age.
The Y-shaped trabecular bone structure in the odontoid process of the axis: a CT scan study in 54 healthy subjects and biomechanical considerations
Authors: Montemurro Nicola , Perrini Paolo , Mangini Vittoriano , Galli Massimo , Papini Andrea 
Published: February 2019

OBJECTIVEOdontoid process fractures are very common in both young and geriatric patients. The axial trabecular architecture of the dens appears to be crucial for physiological and biomechanical function of the C1–2 joint. The aim of this study is to demonstrate the presence of a Y-shaped trabecular structure of the dens on axial CT and to describe its anatomical and biomechanical implications.METHODSFifty-four C2 odontoid processes in healthy subjects were prospectively examined for the presence of a Y-shaped trabecular structure at the odontocentral synchondrosis level with a dental cone beam CT scan. Length, width, and axial area of the odontoid process were measured in all subjects. In addition, measurements of the one-third right anterior area of the Y-shaped structure were taken.RESULTSThe Y-shaped trabecular structure was found in 79.6% of cases. Length and width of the odontoid process were 13.5 ± 0.6 mm and 11.2 ± 0.9 mm, respectively. The mean area of the odontoid process at the odontocentral synchondrosis was 93.5 ± 4.3 mm2, whereas the mean one-third right anterior area of the odontoid process at the same level was 29.3 ± 2.5 mm2. The mean area of the odontoid process and its length and width were similar in men and women (p > 0.05). No significant difference was found in the mean area of the odontoid process in people older than 65 years (94 ± 4.2 mm2) compared to people younger than 65 years (93.3 ± 4.4 mm2; p > 0.05).CONCLUSIONSThe authors identified a new anatomical entity, named the Y-shaped trabecular structure of the odontoid process, on axial CT scans. This structure appears to be the result of bone transformation induced by the elevated dynamic loading at the C1–2 level. The presence of the Y-shaped structure provides new insights into biomechanical responses of C2 under physiological loading and traumatic conditions.
Nuances of transradial approach for mechanical thombectomy in acute basilar artery occlusion
Authors: Rangel-Castilla Leonardo , Lanzino Giuseppe 
Published: February 2019

In elderly patients with acute ischemic stroke, tortuosity of the proximal vertebral artery makes access from the transfemoral route challenging and time consuming. In such cases, a transradial approach (TA) offers a more direct vertebral artery (VA) access that overcomes proximal VA tortuosity. In this video the authors illustrate nuances of the TA for acute basilar artery occlusion in two patients with challenging proximal VA anatomy. Techniques, devices, and pitfalls are discussed. In both patients, mechanical clot retrieval was successful and resulted in significant recovery of function. The authors believe that the TA should be the initial approach for basilar artery (BA) occlusion management in elderly patients and should be considered for selected patients with other conditions requiring endovascular treatment.The video can be found here: https://youtu.be/_Ym9tMKUy_4.
PulseRider treatment of an anterior communicating artery aneurysm
Authors: Srinivasan Visish M. , Vedantam Aditya , Kan Peter 
Published: February 2019

We present a case of a patient with an anterior communicating artery aneurysm treated by PulseRider-assisted coil embolization. PulseRider is a new device, FDA approved for treatment of broad-necked aneurysms of the basilar apex or internal carotid artery terminus. The aneurysm was broad-necked and involved the anterior communicating artery and was considered for traditional stent-assisted coiling as well as PulseRider-assisted coiling. The authors present the treatment plan and strategy and then fluoroscopic recording of the PulseRider delivery and subsequent coiling phase. Nuances of technique for this new device used in a challenging setting are discussed.The video can be found here: https://youtu.be/ont7ggqgLH8.
Endovascular management of basilar artery occlusion secondary to fusiform aneurysm with intraluminal thrombus
Authors: Beer-Furlan André , Dasenbrock Hormuzdiyar H. , Joshi Krishna C. , Chen Michael 
Published: February 2019

Acute basilar artery occlusion is one of the most devastating subtypes of ischemic stroke with an extremely high morbidity and mortality rate. The most common causes include embolism, large-artery atherosclerosis, penetrating small-artery disease, and arterial dissection. The heart and vertebral arteries are the main source of emboli in embolic basilar occlusions. The authors present an uncommon acute basilar occlusion secondary to a fusiform aneurysm with intraluminal thrombus. The patient underwent a mechanical thrombectomy with successful recanalization, but persistent intraluminal thrombus. The authors discuss the management dilemma and describe their choice for placement of flow diverter stents.The video can be found here: https://youtu.be/XzBdgxJPSWQ.
Utility of 3D rotational angiography road map in flow diverter deployment in a distal dissecting MCA aneurysm
Authors: Rustemi Oriela , Di Clemente Loris , Raneri Fabio , Volpin Lorenzo , Iannucci Giuseppe 
Published: February 2019

Distal, dissecting, middle cerebral artery (MCA) aneurysms are changing surgically and endovascularly. Endovascular treatment requires flow diverter stenting. A good vessel visualization is crucial for safe navigation. Three-dimensional rotational digital subtraction angiography (3D-DSA) is used routinely in diagnostic imaging. The utilization of the 3D-DSA road map in vessel navigation and stent deployment is novel. An illustrative video of a distal, dissecting left MCA aneurysm treated with flow diverter stenting is presented. The technical issues were distal location, dissecting nature with double lumen, proximal stenosis, and vessel curves. The 3D-DSA road map helped to enhance visualization with a safer procedure.The video can be found here: https://youtu.be/sS3o1Z0P8WE.
Deployment of distal posterior cerebral artery flow diverter in tortuous anatomy
Authors: Vakharia Kunal , Munich Stephan A. , Waqas Muhammad , Setlur Nagesh Swetadri Vasan , Levy Elad I. 
Published: February 2019

Progressive deconstruction with flow diversion using a Pipeline embolization device (PED; Medtronic) can be utilized to promote thrombosis of broad-based fusiform aneurysms. Current flow diverters require a 0.027-inch microcatheter for deployment. The authors present a patient with a fusiform P2–3 junction posterior cerebral artery aneurysm in which they demonstrate the importance of haptics in microwire manipulation to recognize large-vessel anatomy versus perforator anatomy that may overlap, especially when access is needed in distal tortuous circulations. In addition, the authors demonstrate the need for appropriate visualization before PED deployment. Postembolization runs demonstrated optimal wall apposition with contrast stasis within the aneurysm dome.The video can be found here: https://youtu.be/8kfsSvN3XqM.
Os 30 Anos do SUS e do Modelo de Atenção ao Câncer retratados na RBC
Authors: Siqueira Alessandra de Sá Earp , Bergmann Anke , Casado Leticia , Silva Mario Jorge Sobreira da , Zamboni Mauro Musa 
Published: February 2019

Neste fascículo, com intuito de ampliar essa discussão, serão publicados três artigos de opinião redigidos por pesquisadores especialistas no tema, além de outros estudos que contribuem substancialmente para a compreensão do modelo de atenção ao câncer no SUS.
Experiência Subjetiva com Medicamentos de Pacientes convivendo com o Câncer de Mama: um Fotovoz
Authors: Silva Isabela Maria Vieira e , Oliveira Djenane Ramalho de , Mendonça Simone de Araújo Medina , Ribeiro Maria Ângela 
Published: February 2019

Introdução: A experiência subjetiva com medicamentos deve ser compreendida e explorada no dia a dia da prática clínica. Objetivo: Compreender a experiência subjetiva com medicamentos de mulheres convivendo com o câncer de mama. Método: Estudo qualitativo com orientação teórico-metodológica da Experiência Subjetiva com Medicamentos, proposta por Ramalho de Oliveira & Shoemaker, e do fotovoz na perspectiva de Wang & Burris, de um hospital oncológico em Minas Gerais, entre agosto e novembro de 2017. A amostra com três participantes foi estabelecida no momento em que a inclusão de novos participantes não acrescentava nada de novo à pesquisa e os objetivos foram alcançados. O critério de inclusão foi intencional entre mulheres acompanhadas pelo serviço de Gerenciamento da Terapia Medicamentosa e que aceitaram participar da pesquisa. As participantes utilizaram fotografias para retratar as suas experiências com o uso de medicamentos. Essas fotografias foram discutidas e interpretadas nos fotodiálogos, que foram gravados e transcritos, e cujos dados foram interpretados pela análise indutiva dos dados. Resultados: A experiência com o uso de medicamentos foi definida em quatro unidades temáticas: 1. Quimioterapia e a ideia de perda de cabelo; 2. Implicações da experiência subjetiva com medicamentos nas relações familiares e de trabalho; 3. Valorizando o uso da terapia endócrina: adesão ao tratamento. 4. Resposta do corpo às reações da quimioterapia! Conclusão: Os temas do estudo validaram a importância da atenção farmacêutica operacionalizada pelo gerenciamento da terapia medicamentosa no contexto da mulher com câncer de mama.
A Assistência Oncológica e os 30 Anos do Sistema Único de Saúde
Authors: Gadelha Maria Inez Pordeus 
Published: February 2019

O presente trabalho objetiva resumir, historicamente, a assistência oncológica nos 30 anos da criação constitucional do SUS e os seus 28 anos de regulamentação legal, intentando mostrar, às próximas gerações, o quanto se precisa melhorar e avançar para enfrentar os novos conhecimentos e tecnologias, diagnósticas e terapêuticas, nem sempre efetivas ou custo-efetivas, que, contínua e progressivamente, se apresentam para a prevenção e o controle do câncer.
El mercado energético y de renovables. El caso de Siemens Gamesa
Authors: Bilbao Morán Álvaro , Armesto García-Jalón Andrés 
Published: February 2019

El cambio económico que pretende llevar a cabo China hacia un sistema centrado en el consumo y el sector servicios, junto con la desaceleración económica del país, ha propiciado la transformación de su política energética hacia una nueva fase de impulso de la energía limpia, con el objetivo principal de reducir las altas cuotas de contaminación que sufre el país.
Por medio de este artículo, se pretende dar una visión general del cambio energético de China, así como explicar tanto las medidas esenciales tomadas por sus autoridades, como la evolución y perspectivas de las principales energías limpias. Finalmente, se abordarán los principales hitos de la empresa Siemens Gamesa, su entrada y sus perspectivas en el sector eólico chino.
Momento crucial para Puerto Rico. Una economía desconocida integrada en el mercado estadounidense
Authors: España en San Juan Oficina Económica y Comercial de 
Published: February 2019

El objetivo de este artículo es trasladar a los lectores una visión concreta de la actual situación económica, social y política de Puerto Rico, así como dar a conocer las perspectivas con las que la isla afronta la recuperación de unas infraestructuras devastadas por el paso de los huracanes Irma y María en septiembre de 2017, lo que agravó aún más su situación financiera, pero también ha supuesto una oportunidad antes las necesidades de reconstrucción y la recepción de nuevos fondos federales.
Este artículo pretende explicar los efectos para Puerto Rico de su especial relación con los EEUU. Además, dado el momento crucial para la isla, queremos dar a conocer las particularidades de Puerto Rico a las empresas españolas, las cuales podrían aprovechar nuestra proximidad dados nuestros fuertes vínculos históricos y culturales.
جودة التعليم الجامعي في الجامعة التقنية الوسطى في ضوء تطبيق مشروع التصنيف الوطني لجودة الجامعات العراقية
Authors: عبد فريد مجيد , محمد الجاف نادية عبد الله 
Published: February 2019

المستخلص:
يهدف البحث الى التعرف على سبل الارتقاء بمستوى جودة التعليم الجامعي في الجامعة التقنية الوسطى في ضوء تطبيقها لمشروع التصنيف الوطني لجودة الجامعات العراقية من اجل الحصول على مراتب متقدمة بين الجامعات العراقية والذي يؤهلها الى الدخول ضمن تصنيف الجامعات عالمياً، وذلك من خلال عرض آلية تطبيق مشروع التصنيف الوطني لجودة الجامعات العراقية في الجامعة التقنية الوسطى وتشكيلاتها المتكونة من (5) كليات تقنية و(11) معهد تقني. اظهرت نتائج التطبيق عدة ملاحظات أهما: المعايير المعتمدة لم تأخذ بنظر الاعتبار وجود مستويين من الدراسة في الجامعة التقنية الوسطى (الدبلوم التقني والبكالوريوس التقني) مقارنة بالجامعات العراقية الاخرى التي تقتصر على مستوٍ واحد هو البكالوريوس والذي اثر سلباً في درجة التقييم للجامعة، وتوصل البحث من خلال اعتماد المنهج الوصفي الى مجموعة من التوصيات والمقترحات الضرورية للنهوض بالجامعة والارتقاء بمستوى جودتها، من أهمها: إعادة النظر بالمعايير الموضوعة وبما يتلائم والتعليم التقني الذي يختلف عن التعليم الاكاديمي في اعتماده على الجانب العملي التطبيقي بشكل اكبر، كما اكد البحث على ضرورة تعزيز أواصر التعاون الاكاديمي ما بين الجامعة التقنية الوسطى ونظيراتها من الجامعات العراقية والعربية وذلك لتحديد القضايا المشتركة من وجهات نظر مختلفة والافادة من التجارب الناجحة في تطوير العمل للارتقاء بجودة التعليم التقني.
تقييم الاستراتيجية المقترحة لوزارة التخطيط للفترة من (2018-2022)
Authors: الكبيسي صلاح الدين عواد , حميد شيماء محمد 
Published: February 2019

ناقش البحث مرحلة من مراحل الادارة الاستراتيجية غاية الاهمية هو التقييم الاستراتيجي لتقييم الاستراتيجية المقترحة من خلال المعلومات المرتدة لضمان تنفيذها بأقل ما يمكن من التباين عن المخطط له ويهدف البحث دراسة وتقييم الاستراتيجية المقترحة لوزارة التخطيط للاعوام 2018-2022 ومدى فاعليتها وانسجامها مع توجهات الدولة، والتعرف على واقعية الخطط والبرامج والرؤى الاستراتيجية وبناء التصور الاستراتيجي اللازم لتطوير الخطط والبرامج الموضوعة تاخذ بنظر الاعتبار الظروف البيئية المحيطة وتعتمد على اسس وخطوات علمية لصياغة الاستراتيجية اتسمت بالشمولية والواقعية ، اذ تكونت عينة الدراسة من القيادات بالمستويات العليا من مدراء عامون وخبراء في وزارة التخطيط وعددهم (15) فردا تم اختيارهم باسلوب الحصر الشامل (العينة القصدية) توخيا لاختيار الخبراء الاكثر تماسا مع الاستراتيجية وقد استعملت الاستبانة لاستطلاع اراء الخبراء بوصفهم المستفيدين من الاستراتيجية المقترحة للوزارة والذين يقع عليهم متابعة تنفيذها ، واسلوب المقابلات، وتضمن البحث فرضية مفادها هناك ميل لاتفاق المديرين والخبراء في وزارة التخطيط على الاستراتيجية المقترحة للوزارة للاعوام الخمس القادمة وبكامل ابعادها ؟ واظهرت نتائج البحث ان واقع الخطط والبرامج والرؤى جيد جدا حيث تم وضعها من قبل قيادات تمتلك الخبرة الازمة لتقييم الاستراتيجية المقترحة كما وتؤشر النتائج تقبلا واضحا للاستراتيجية من قبل عينة البحث وانسجاما مع البديل الاستراتيجي المقترح. وتم تقديم عدد من التوصيات ابرزها ضرورة اعتماد هذه الوثيقة الاستراتيجية المقترحة لاسيما انها تحاكي واقع الوزارة وتستجيب لمتطلبات دورها التنموي ومتابعة مستوى تنفيذ البرامج والخطط بالمدة الزمنية المحددة لكل قضية استراتيجية تم تحديدها في الخطة والتقييم المستمر والتطوير .