bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicted shortages of physicians might even disappear if we fully account for PAs and NPs
Authors: Morgan Perri 
Published: September 2019

ABSTRACT
Healthcare workforce projections have important policy implications. Provider shortages can shortchange patients, and overproduction of providers imposes costs on society. The most publicized physician supply and demand projections, commissioned annually by the Association of American Medical Colleges, regularly predict dire physician shortages. These projections are based on unrealistically low estimates of the amount of physician work that can be replaced by physician assistants (PAs) and NPs. For example, the projections factor in the contribution of one primary care PA or NP as one-fourth that of a physician. If workforce projections used evidence-based productivity estimates, the predicted physician shortfalls would be much smaller and perhaps even disappear.
Statin therapy: does sex matter?
Authors: Faubion Stephanie S. , Kapoor Ekta , Moyer Ann M. , Hodis Howard N. , Miller Virginia M. 
Published: September 2019

Abstract

Objective:
Statins are a class of drugs that competitively bind to the active site of HMG-CoA reductase enzyme, thereby inhibiting the initial steps in cholesterol synthesis. Originally approved for use in lowering serum cholesterol, a risk factor for developing atherosclerosis and coronary heart disease, statins have subsequently been noted to have myriad extrahepatic effects, including potential effects on cognition, diabetes, breast cancer, bone, and muscle. This narrative review assesses the current state of the science regarding the risks and benefits of statin therapy in women to identify areas where additional research is needed.

Methods:
Basic and clinical studies were identified by searching PubMed with particular attention to inclusion of female animals, women, randomized controlled trials, and sex-specific analyses.

Results:
Statin therapy is generally recommended to reduce the risk of cardiovascular disease. None of the current clinical guidelines, however, offer sex-specific recommendations for women due to lack of understanding of sex differences and underlying mechanisms of disease processes. In addition, conclusions regarding efficacy of treatments do not consider lipid solubility for the drug, dosing, duration of treatment, interactions with estrogen, or comorbidities. Pleiotropic effects of statins are often derived from secondary analysis of studies with cardiovascular events as primary outcomes.

Conclusions:
Many of the trials that have established the efficacy and safety of statins were conducted predominantly or entirely in men, with results extrapolated to women. Additional research is needed to guide clinical recommendations specific to women.

Video Summary:
http://links.lww.com/MENO/A462.
Efficacy of the Fluorescein Tear Breakup Time Test in Dry Eye
Authors: Paugh Jerry R. , Tse June , Nguyen Tiffany , Sasai Alan , Chen Elaine , De Jesus Melinda Thomas , Kwan Justin , Nguyen Andrew Loc , Farid Marjan , Garg Sumit , Jester James V. 
Published: September 2019

Purpose:
To examine the effects of volume and method on fluorescein tear breakup time (TBUT) values and to evaluate test efficacy in an independent sample free of selection bias.

Methods:
Subjects were assessed using a battery of dry eye tests (DETs). Efficacy study: Subjects were randomized to the DET, standard strip, and liquid NaFl on separate days. A masked examiner measured TBUTs from video recordings. Verification study: Subjects were investigated for efficacy using volumes of 5.0 and 2.0 μL mL of NaFl for TBUT.

Results:
Efficacy study: 46 subjects completed the study. Log-transformed TBUTs were significantly different, normal subjects versus dry subjects, for all 3 methods (all P values < 0.001). Area under the curves (AUCs), cut-points, sensitivity, and specificity were 1) DET: 0.873, 4.4 seconds, 0.97, and 0.67, respectively; 2) 2.0 mL: 0.901, 3.22 seconds, 0.90, and 0.87, respectively; and 3) standard strip: 0.912, 3.42 seconds, 0.97, and 0.80, respectively. Verification study: Data splitting analysis for the 2.0 μL data (n = 174 dry subjects and 97 normal subjects) generated an AUC of 0.917 and a cut-point of 6.05 seconds for a sensitivity of 0.87 and a specificity of 0.81. The 5.0 μL sample yielded an AUC of 0.940, with a sensitivity and specificity of 0.92 and 0.83, respectively, at a cut-point of 5.5 seconds.

Conclusions:
Little difference in TBUT was found using the 3 clinical methods with video recordings. Analysis using liquid NaFl suggests that the TBUT test has excellent diagnostic accuracy and that a cut-point of 5.3 to 6.0 seconds is the optimum to differentiate normals from persons with dry eye.
Appalachian Status Is a Negative Predictor of Breast Reconstruction Following Breast Cancer Resection
Authors: DeCoster Ryan C. , Stout Megan A. , Burns Jack C. , Shrout Max A. , Wetzel Margaret , Dugan Adam J. , Rinker Brian D. , Butterfield Timothy A. , Webster J. Matthew , Vasconez Henry C. 
Published: September 2019

Background
Health care disparities in Appalachia are well documented. However, no previous studies have examined possible differences in the utilization of breast reconstruction (BR) in Appalachia. This study aims to determine if a disparity in BR utilization exists in women from Appalachia Kentucky.

Methods
A retrospective, population-based cohort study was conducted from January 1, 2006, to December 31, 2015. The Kentucky Cancer Registry was queried to identify population-level data for female patients diagnosed with breast cancer and treated with mastectomy. A multivariate logistic regression model controlling for patient, disease, and treatment characteristics was constructed to predict the likelihood of BR.

Results
Bivariate testing showed differences (P < 0.0001) in BR utilization between Appalachian and non-Appalachian women in Kentucky (15.0% and 26.3%, respectively). Multivariate analysis showed that women from Appalachia (odds ratio, 0.54; confidence interval (95), 0.48–0.61; P < 0.0001) were less likely to undergo BR than non-Appalachian women. Interestingly, the rate of BR increased over time in both Appalachian (r = 0.115; P < 0.0001) and non-Appalachian women (r = 0.148; P < 0.0001).

Conclusions
Despite the benefits of BR, women from Appalachia undergo BR at lower rates and are less likely to receive BR than non-Appalachian Kentuckians. Although the rates of BR increased over time in both populations, access to comprehensive breast cancer care remains a challenge for women from Kentucky's Appalachian region.
Course Review
Authors: Rivers C. M. 
Published: September 2019

Abstract
The Newcastle Surgical Training Centre Cadaveric Speech and Palate Surgery Course is an interactive and practical 1-day course for plastic surgery, ear, nose and throat surgery, and maxillofacial surgery trainees wishing to develop skills in cleft palate and speech surgery. The course is delivered by an expert faculty with delegates attending from the United Kingdom and abroad and costs £495 (US $650) to attend. This review provides information and an evaluation of the course.
Can Nicotine Replacement Therapy Decrease Complications in Plastic Surgery?
Authors: Xu Zhenzhen , Norwich-Cavanaugh Amanda , Hsia Henry C. 
Published: September 2019

Abstract
Cigarette smoking has been well demonstrated to be associated with adverse outcomes and increased complications in surgical patients in the operative and postoperative periods. There is general agreement that smoking cessation decreases such risks; however, much debate still exists regarding the most effective modalities for risk mitigation, especially concerning modalities involving nicotine replacement in some form. This article reviews the discussion regarding smoking cessation therapies, in particular those involving nicotine replacement, in the context of mitigating risk in plastic surgery procedures. The recent rise in popularity of electronic cigarettes poses further challenges for clinicians in minimizing risk and optimizing outcomes for patients. Prospective studies including high-level evidence such as randomized controlled clinical trials will be required to help plastic surgeons develop guidelines that will enable optimization of patient safety and clinical outcomes.
A Deceptive Diagnosis
Authors: Mella Juan Rodolfo , Maselli Amy M. , Guo Lifei 
Published: September 2019

Abstract
Postsurgical pyoderma gangrenosum is a rare neutrophilic dermatosis that presents with characteristic ulcerative lesions and systemic signs and symptoms of inflammation. It has been well documented after both cosmetic and reconstructive breast surgeries. Given its similarity to postoperative infectious processes, a high index of suspicion is necessary to initiate treatment with immunosuppression and avoid unnecessary and potentially disfiguring debridements. We present our experience with 4 cases of pyoderma gangrenosum after breast reconstruction and review the existing literature regarding pyoderma gangrenosum after breast surgery.
Preoperative Planning and Simulation in Patients With Cleft Palate Using Intraoral Three-Dimensional Scanning and Printing
Authors: Choi Yean Su , Shin Ho Seong 
Published: September 2019

Background:
In cleft palate, surgery is necessary for recovering important functions of the normal palate, such as speech and feeding. Herein, a three-dimensional (3D) scanning program with an intraoral scanner was used to evaluate the palate status of patients with cleft palate before palatoplasty. Further, a 3D cleft palate printed model of the patients’ palate using 3D printing technology was produced.

Methods:
Three patients with cleft palate were included (1 male and 2 female patients with a mean age of 13 months). Extended scanning from the maxillary arch to the soft palate was conducted, without any direct contact of the scanner with the tissues of the palatal area. The maxillary arch dimensions and cleft size of the scanned data were measured using a 3D analysis software. After all 3D analyses, the scanned data were printed to a 3D cleft model, which was used as a training and simulation model.

Results:
The overall contour and size of the cleft were observed on the scanned 3D images. There was a large inter-individual range in the cleft dimensions among the subjects. Double-opposing Z-plasty was then simulated on the printed 3D cleft palate model completely.

Conclusions:
The present study concentrated on the possibility of an intraoral scanner as a novel diagnostic tool for recording data of patients with cleft palate; 3D cleft palate models created using 3D printers can be used as training models for surgical trainees.
Self-Made Rapid Prototyping Technique for Orbital Floor Reconstruction: Showcases for Technical Description
Authors: Abbate Vincenzo , Iaconetta Giorgio , Califano Luigi , Pansini Antonio , Bonavolontà Paola , Romano Antonio , Salzano Giovanni , Somma Teresa , D’Andrea Luca , Dell’Aversana Orabona Giovanni 
Published: September 2019

Background:
Restoring the orbital cavity integrity in orbital floor defects is a challenging issue due to the anatomical complexity of the floor's surface. This is a showcase for technical description of a novel “in house” rapid prototyping protocol aimed to customize implant for orbital floor reconstruction.

Methods:
The authors present 4 cases to show our Computer-aided-design and Computer-aided-manufacturing digital workflow. The system was based on a 3D-printed press that; through a virtually designed mold, was used to conform a patient specific titanium mesh for orbital floor reconstruction.

Results:
The merging procedure analysis by iPlan Cranial 3.0 (Brainlab, Munich, Germany) highlighted a 0.71 ± 0.23 mm (P <0.05) discrepancy in a point-to-point superimposition between the digital planned reconstruction and the real in vivo result.

Conclusions:
The authors expect that this technique will reduce operative time and cost however further study and larger series may better define the applicability in everyday surgical practice.
Incidence and Risk Factors of Pressure Injuries in Surgical Spinal Patients
Authors: Luo Min , Long Xin-Hua , Wu Jia-li , Huang Su-Zhen , Zeng Yu 
Published: September 2019

PURPOSE:
The purpose of this study was to measure the incidence and identify risk factors of pressure injury development during the perioperative period in patients undergoing spinal surgery requiring intraoperative positioning in the prone position.

DESIGN:
Review of medical records.

SUBJECTS AND SETTING:
The sample comprised 3834 patients; 52.2% (n = 2006) were male and 65.5% (n = 2516) were older than 60 years. Most patients underwent surgery of the lumbosacral spinal segments (43.4%, n = 1667) followed by cervical (32.3%, n = 1241) and thoracic spinal segments (24.2%, n = 932). The study setting was the First Affiliated Hospital of Nanchang University, Jiang XI Province in southeastern China.

METHODS:
We reviewed charts of patients who underwent spinal surgery requiring intraoperative positioning in the prone position from November 2013 to July 2016. Demographic data, Braden Scale for Pressure Sore Risk cumulative score (measured before preoperative transport), body mass index (BMI), duration of surgery, preoperative time (time between preoperative transport from the inpatient unit to when the operation began), postoperative time (time between when the operation was over and postoperative transport to the inpatient unit), and development of any pressure injury were collected using a standardized form. Factors associated with an increased or decreased likelihood of pressure injury were initially evaluated with χ2 and independent t tests. Logistic regression was then used to identify potential risk factors for perioperative pressure injury in patients undergoing open spinal surgery requiring placement in the supine position during surgery.

RESULTS:
One hundred eighty-four of 3840 patients (4.7%) developed pressure injuries. Multivariate analysis indicated that factors associated with intraoperative pressure injury development were older than 60 years (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1.02-2.17), BMI under 18 kg/m2 (OR = 2.45, 95% CI = 4.05-5.21), cumulative Braden Scale score 13 or less (OR = 6.59, CI = 2.23-3.98), prolonged preoperative time (OR = 5.99, 95% CI = 3.21-6.12), and prolonged postoperative time (OR = 14.23, 95% CI = 10.23-21.19).

CONCLUSIONS:
Based on these findings we recommend extending preventive interventions for pressure injury to incorporate the time from preoperative transport to the surgical suite to inpatient care unit following surgery.
Exploring Incontinence-Associated Dermatitis in a Single Center Intensive Care Unit
Authors: Campbell Jill , Cook Jane-Louise , Doubrovsky Anna , Vann Amanda , McNamara Greg , Coyer Fiona 
Published: September 2019

PURPOSE:
The purpose of this study was to provide longitudinal prevalence rates of incontinence-associated dermatitis (IAD) in patients in an intensive care unit (ICU) and to identify patient characteristics associated with IAD development.

DESIGN:
Prospective observational.

SUBJECTS AND SETTING:
The sample comprised 351 patients aged 18 years and older in a major metropolitan public hospital ICU in Queensland, Australia.

METHODS:
All consenting, eligible participants at risk of developing IAD underwent weekly skin inspections to determine the presence of IAD. Data were collected weekly for 52 consecutive weeks. Descriptive statistics described the study sample and logistic regression analysis was used to identify patient characteristics associated with development of IAD.

RESULTS:
The weekly IAD prevalence ranged between 0% and 70%, with IAD developing in 17% (n = 59/351) of ICU patients. The odds of IAD developing increased statistically significantly with increasing age (odds ratio [OR]: 1.029, 95% confidence interval [CI]: 1.005-1.054, P = .016), time in the ICU (OR = 1.104; 95% CI: 1.063-1.147, P < .001), and Bristol Stool chart score (OR = 4.363, 95% CI: 2.091-9.106, P < .001). Patients with respiratory (OR = 3.657, 95% CI: 1.399-9.563, P = .008) and sepsis (OR = 3.230, 95% CI: 1.281-8.146, P = .013) diagnoses had increased odds of developing IAD.

CONCLUSIONS:
These data show the high variability of IAD prevalence over a 1-year period. Characteristics associated with the development of IAD in patients in the ICU included older age, longer lengths of ICU stay, incontinent of liquid feces, and having respiratory or sepsis diagnoses.
Nursing Practice Related to Intermittent Catheterization
Authors: Gray Mikel , Wasner Mary , Nichols Thom 
Published: September 2019

PURPOSE:
The purpose of this study was to describe nursing practice and clinical decision-making related to intermittent catheterization (IC).

DESIGN:
Cross-sectional survey.

SUBJECTS AND SETTING:
Three hundred forty-three nurses responded to the survey, yielding a margin of error of 5.3%. The majority (70%; n = 240) indicated they were RNs, and 15.6% stated they practiced as advanced practice nurses (nurse practitioners or clinical nurse specialists). Most (75.9%; n = 260) held at least one certification in rehabilitation, WOC, or urologic nursing. Most nurses (70.5%; n = 242) indicated 11 or more years of experience in their specialty practice.

METHODS:
Data were collected via an electronic questionnaire that comprised 50 items and required 35 to 40 minutes to complete. Ten items queried demographic data and professional background, 13 queried facility policies and practice patterns related to use of IC, and 27 focused on various aspects of decision making regarding IC practice including 8 items related to catheter selection in 4 case scenarios. The questionnaire was completed online after viewing a written explanation of the purpose of the survey. Completion of the questionnaire acted as consent to study participation.

RESULTS:
All respondents indicated regularly teaching IC within their practice, and 61.2% (n = 210) stated they were confident that 70% or more of patients or caregivers understood the instructions. However, responses varied considerably when asked who they involved in IC education; less than half (48.1%; n = 165) responded that they included a lay caregiver or family member when teaching a patient to perform IC. Responses also varied when asked about who was included in this education; when asked about catheter selection in 4 clinical scenarios, 9.0% to 20.9% selected inappropriate catheters. Similarly, responses varied when they were asked about use of resources to guide IC practice; 25.4% (n = 87) indicated they relied on their own best practice.

CONCLUSIONS:
Findings from 343 nurses experienced in IC teaching showed considerable variability when asked about sources used to guide IC practice, who should be included in IC education, and catheter selection in 4 case scenarios. Additional research and evidence, and consensus-based resources such as clinical guidelines of a decision-making algorithm, are needed.
Revisiting Feature Selection with Data Complexity
Authors: Dong Ngan Thi , Khosla Megha 
Published: September 2019

AbstractThe identification of biomarkers or predictive features that are indicative of a specific biological or disease state is a major research topic in biomedical applications. Several feature selection(FS) methods ranging from simple univariate methods to recent deep-learning methods have been proposed to select a minimal set of the most predictive features. However, there still lacks the answer to the question of “which method to use when”. In this paper, we study the performance of feature selection methods with respect to the underlying datasets’ statistics and their data complexity measures. We perform a comparative study of 11 feature selection methods over 27 publicly available datasets evaluated over a range of number of selected features using classification as the downstream task. We take the first step towards understanding the FS method’s performance from the viewpoint of data complexity. Specifically, we (empirically) show that as regard to classification, the performance of all studied feature selection methods is highly correlated with the error rate of a nearest neighbor based classifier. We also argue about the non-suitability of studied complexity measures to determine the optimal number of relevant features. While looking closely at several other aspects, we also provide recommendations for choosing a particular FS method for a given dataset.
Fully Automated Brain Tumor Segmentation and Survival Prediction of Gliomas using Deep Learning and MRI
Authors: Yogananda Chandan Ganesh Bangalore , Nalawade Sahil S. , Murugesan Gowtham K. , Wagner Ben , Pinho Marco C. , Fei Baowei , Madhuranthakam Ananth J. , Maldjian Joseph A. 
Published: September 2019

ABSTRACTTumor segmentation of magnetic resonance (MR) images is a critical step in providing objective measures of predicting aggressiveness and response to therapy in gliomas. It has valuable applications in diagnosis, monitoring, and treatment planning of brain tumors. The purpose of this work was to develop a fully automated deep learning method for brain tumor segmentation and survival prediction. Well curated brain tumor cases with multi-parametric MR Images from the BraTS2019 dataset were used. A three-group framework was implemented, with each group consisting of three 3D-Dense-UNets to segment whole tumor (WT), tumor core (TC) and enhancing tumor (ET). This method was implemented to decompose the complex multi-class segmentation problem into individual binary segmentation problems for each sub-component. Each group was trained using different approaches and loss functions. The output segmentations of a particular label from their respective networks from the 3 groups were ensembled and post-processed. For survival analysis, a linear regression model based on imaging texture features and wavelet texture features extracted from each of the segmented components was implemented. The networks were tested on the BraTS2019 validation dataset including 125 cases for the brain tumor segmentation task and 29 cases for the survival prediction task. The segmentation networks achieved average dice scores of 0.901, 0.844 and 0.801 for WT, TC and ET respectively. The survival prediction network achieved an accuracy score of 0.55 and mean squared error (MSE) of 119244. This method could be implemented as a robust tool to assist clinicians in primary brain tumor management and follow-up.
Robust perisomatic GABAergic self-innervation inhibits basket cells in the human and mouse supragranular neocortex
Authors: Szegedi Viktor , Paizs Melinda , Baka Judith , Barzo Pal , Molnar Gabor , Tamas Gabor , Lamsa Karri 
Published: September 2019

ABSTRACTInhibitory autapses are self-innervating synaptic connections in GABAergic interneurons in the brain. Autapses in neocortical layers have not been systematically investigated, and their function in different mammalian species and specific interneuron types is poorly known. We investigated GABAergic parvalbumin-expressing basket cells (pvBCs) in layer 2/3 (L2/3) in mice as well as in human neocortical tissue resected in deep-brain surgery. Most pvBCs showed robust GABAAR-mediated self-innervation in both species, but autapses were rare in nonfast spiking GABAergic interneurons. Light- and electron microscopy analyses revealed pvBC axons innervating their own soma and proximal dendrites. GABAergic self-inhibition conductance was similar in human and mouse pvBCs and comparable to that of synapses from pvBCs to other L2/3 neurons. Autaptic conductance prolonged somatic inhibition in pvBCs after a spike and inhibited repetitive firing. Perisomatic autaptic inhibition has evolved in pvBCs of various cortical layers and different mammalian species to control discharge of these interneurons.