bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Personal Financial Burden Associated with Musculoskeletal Trauma
Authors: Bhashyam Abhiram R. , McGovern Madeline M. , Mueller Taina , Heng Marilyn , Harris Mitchel B. , Weaver Michael J. 
Published: July 2019

Background:
Little is known about the effect of orthopaedic trauma on the financial health of patients. We hypothesized that some patients who sustain musculoskeletal trauma experience considerable financial hardship during treatment, and we also assessed for factors associated with increased personal financial burden.

Methods:
We surveyed 236 of 393 consecutive patients who were approached at 1 of 2 American College of Surgeons level-I trauma centers between 2016 and 2017 following the completion of treatment for a musculoskeletal injury (60% response rate). Two validated measures (financial burden composite score and dichotomized worry score) were used to assess the financial hardship that patients experienced with the injury.

Results:
There were 236 participants in the study, the mean age was 56.3 years (range, 19 to 94 years), and 48.7% of patients were male. Of the 236 patients, 97.9% had medical insurance, yet the mean financial burden composite score (and standard deviation) was 2.4 ± 2.2 (0 indicated low and 6 indicated high). In this study, 25.0% of patients had high levels of worry about financial problems that resulted from the injury. Fifty-four percent of patients used their savings to pay for their care, and 23% of patients borrowed money or took out a loan. Twenty-three percent of patients missed payment on other bills. Fifty-seven percent of patients were required to cut expenses in general. Patients with higher composite financial burden scores had a significantly increased likelihood of high financial worry (odds ratio [OR], 1.8 [95% confidence interval (CI), 1.5 to 2.2]; p < 0.001). Factors associated with increased financial hardship were high-deductible health plan insurance (coefficient, 0.3 [95% CI, 0.002 to 0.528]; p = 0.048), Medicaid insurance (coefficient, 0.6 [95% CI, 0.342 to 0.863]; p < 0.001), failure to complete high school (coefficient, 0.475 [95% CI, 0.033 to 0.918]; p = 0.035), increased number of surgical procedures (coefficient, 0.067 [95% CI, 0.005 to 0.129]; p = 0.035), and prior medical or student loans (coefficient, 0.769 [95% CI, 0.523 to 1.016]; p < 0.001).

Conclusions:
Despite a high rate of insurance, patients with orthopaedic trauma in our study had high rates of worry and financial distress. Asking about financial hardship may help to identify those patients with a higher personal financial burden and may promote allocation of additional social support and services.
Surgical Treatment of Localized-Type Tenosynovial Giant Cell Tumors of Large Joints
Authors: Mastboom M.J.L. , Staals E.L. , Verspoor F.G.M. , Rueten-Budde A.J. , Stacchiotti S. , Palmerini E. , Schaap G.R. , Jutte P.C. , Aston W. , Leithner A. , Dammerer D. , Takeuchi A. , Thio Q. , Niu X. , Wunder J.S. , van de Sande M.A.J. ,   on behalf of the Tenosynovial Giant Cell Tumors (TGCT) Study Group
Published: July 2019

Update
This article was updated on April 9, 2020, because of a previous error. On page 1309, in the list of Tenosynovial Giant Cell Tumors (TGCT) Study Group members, the contributor name that had read “M. Wook Joo” should have read “M.W. Joo.”
An erratum has been published: J Bone Joint Surg Am. 2020 May 20;102(10):e49.

Background:
Localized-type tenosynovial giant cell tumor (TGCT) is a rare, neoplastic disease with only limited data supporting treatment protocols. We describe treatment protocols and evaluate their oncological outcome, complications, and functional results in a large multicenter cohort of patients. A secondary study aim was to identify factors associated with local recurrence after surgical treatment.

Methods:
Patients with histologically proven localized TGCT of a large joint were included if they had been treated between 1990 and 2017 in 1 of 31 tertiary sarcoma centers. Of 941 patients with localized TGCT, 62% were female. The median age at initial treatment was 39 years, and the median duration of follow-up was 34 months. Sixty-seven percent of the tumors affected the knee, and the primary treatment at the tertiary center was 1-stage open resection in 73% of the patients. Proposed factors for predicting a first local recurrence after treatment in the tertiary center were tested in a univariate analysis, and those that demonstrated significance were subsequently included in a multivariate analysis.

Results:
The localized TGCT recurred in 12% of all cases, with local-recurrence-free rates at 3, 5, and 10 years of 88%, 83%, and 79%, respectively. The strongest factor for predicting recurrent disease was a prior recurrence (p < 0.001). Surgical treatment decreased pain and swelling in 71% and 85% of the patients, respectively, and such treatment was associated with complications in 4% of the patients. Univariate and multivariate analyses of the patients who had not undergone therapy previously yielded positive associations between local recurrence and a tumor size of ≥5 cm versus <5 cm (hazard ratio [HR] = 2.50; 95% confidence interval [CI] = 1.32 to 4.74; p = 0.005). Arthroscopy (versus open surgery) was significantly associated with tumor recurrence in the univariate analysis (p = 0.04) but not in the multivariate analysis (p = 0.056).

Conclusions:
Factors associated with recurrence after resection of localized-type TGCT were larger tumor size and initial treatment with arthroscopy. Relatively low complication rates and good functional outcomes warrant an open approach with complete resection when possible to reduce recurrence rates in high-risk patients.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Frequency of non-single canals in mandibular premolars and correlations with other anatomical variants: an in vivo cone beam computed tomography study
Authors: Jang Young-Eun , Kim Yemi , Kim Bom Sahn , Kim Sin-Young , Kim Hyung-Jong 
Published: July 2019

Abstract
Background: A knowledge regarding anatomical variants is important to achieve success in endodontic treatment. Root canal treatment of mandibular first premolars (PM1s) is challenging due to the existence of numerous variations in canal configurations, including a C-shaped variant. We aim to determine the frequency and morphologic characteristics of non-single canals of mandibular first (PM1s) and second (PM2s) premolars in a Korean population using cone beam computed tomography (CBCT) and to evaluate correlations between non-single canals of PM1s and other anatomical variants, such as distolingual roots (DLRs) in mandibular first molars (M1s) and C-shaped canals in mandibular second molars (M2s).
Methods: A total of 971 PM1s and 997 PM2s from 500 patients were examined in vivo by CBCT. Root canal configurations and C-shaped canals were determined in accordance with the Vertucci classification and Fan classification, respectively. The correlation between non-single canals in PM1s and DLRs in M1s was evaluated using logistic regression analysis.
Results: PM2s typically had one root (99.89%) with one canal (98.4%). Among PM1s with non-single canals (21.2%), Vertucci type V (10.9%) and C-shaped (3.7%) canals were prevalent. Among C-shaped PM1 canals, the majority were Vertucci type V (77.8%); a C-shaped configuration (C2) was predominant mostly at the middle and/or apical third of the root. After adjusting for other variables (i.e., sex, age, and side), C-shaped canals in PM1s was significantly correlated with the presence of DLRs in M1s (odds ratio = 2.616; 95% confidence interval, 1.257–5.443; p = 0.010).
Conclusions: The presence of C-shaped PM1 canals was positively related to the presence of DLRs in M1s. Although C-shaped canals in PM1s are difficult to distinguish, this finding could aid clinicians in predicting C-shaped canal configurations in PM1s of patients who exhibit DLRs in M1s.
Genomic content of chemosensory genes correlates with host range in wood-boring beetles (Dendroctonus ponderosae, Agrilus planipennis, and Anoplophora glabripennis)
Authors: Andersson Martin N. , Keeling Christopher I. , Mitchell Robert F. 
Published: July 2019

Abstract
Background

Olfaction and gustation underlie behaviors that are crucial for insect fitness, such as host and mate selection. The detection of semiochemicals is mediated via proteins from large and rapidly evolving chemosensory gene families; however, the links between a species’ ecology and the diversification of these genes remain poorly understood. Hence, we annotated the chemosensory genes from genomes of select wood-boring coleopterans, and compared the gene repertoires from stenophagous species with those from polyphagous species.

Results

We annotated 86 odorant receptors (ORs), 60 gustatory receptors (GRs), 57 ionotropic receptors (IRs), 4 sensory neuron membrane proteins (SNMPs), 36 odorant binding proteins (OBPs), and 11 chemosensory proteins (CSPs) in the mountain pine beetle (Dendroctonus ponderosae), and 47 ORs, 30 GRs, 31 IRs, 4 SNMPs, 12 OBPs, and 14 CSPs in the emerald ash borer (Agrilus planipennis). Four SNMPs and 17 CSPs were annotated in the polyphagous wood-borer Anoplophora glabripennis. The gene repertoires in the stenophagous D. ponderosae and A. planipennis are reduced compared with those in the polyphagous A. glabripennis and T. castaneum, which is largely manifested through small gene lineage expansions and entire lineage losses. Alternative splicing of GRs was limited in D. ponderosae and apparently absent in A. planipennis, which also has lost one carbon dioxide receptor (GR1). A. planipennis has two SNMPs which are related to SNMP3 in T. castaneum. D. ponderosae has two alternatively spliced OBPs, a novel OBP “tetramer”, and as many as eleven IR75 members. Simple orthology was generally rare, but we report one clade of orthologous putative bitter-taste GRs (named the “GR215 clade”), and conservation of IR60a from Drosophila melanogaster also in beetles.

Conclusions

Our annotation represents significant quantitative and qualitative improvements compared to original datasets derived from transcriptomes of D. ponderosae and A. planipennis. These gene sets facilitate evolutionary analysis of chemosensory genes in the Coleoptera where only a few genomes were annotated previously, and suggests a correlation between chemosensory gene content and host specificity in beetles. Future studies should include additional species to consolidate this correlation, and functionally characterize identified proteins, as an important step towards improved control of these destructive pests.
Surgical rib fixation: Five-year experience from an Australian trauma centre
Authors: Patel Bhavik , Hung Gary , Stroebel Andrie , Wullschleger Martin 
Published: July 2019

Abstract
Background
Literature suggests surgical rib fixation in the acute phase of injury leads to positive outcomes. We have implemented this practice since 2014 and detail the outcomes of rib fixation from our institution.
Methods
We implement a multidisciplinary team management for chest injury. Failure to progress despite maximum intervention by the pain specialist is identified early leading to operative intervention. Retrospective 5-year review was performed on patients undergoing surgical rib fixation looking into the effect on pain scores, length of in hospital stay, post-operative complications and follow up.
Results
Thirty-seven cases (81% males) with a mean age of 56 met the inclusion criteria. All patients underwent rib fixation within 96 hours of admission. Of all included patients, 57% (n=21) required intensive care unit admission for ventilatory support. Of this subset of patients, 66% (n=14) were discharged to ward management within 48 hours, the remaining seven patients required ongoing support secondary to co-existing injuries requiring ongoing management in the unit. Post operatively, pain scores reduced at median of 2 days with a standard deviation of 2.5 days. The in-hospital stay also reduced by 155 hours (6 days) over the period of 5 years. There were two early complications in the series, but no mortality. At 28 days post operatively, both clinical and radiological follow up suggested no hardware or residual pulmonary complications.
Conclusion
This single institution study presents the early results of surgical rib fixation with satisfactory outcomes and minimal complications. Ongoing follow-up will provide a more detailed analysis of long-term outcomes
Key Words Rib Fractures, Surgical stabilisation of rib fractures, Outcomes
Involving clinical staff members in the management of low back pain in general practice: a qualitative interview study
Authors: Knudsen Randi Hessellund , Thomsen Janus Laust , Andersen Camilla Aakjaer , Afzali Tamana , Riis Allan 
Published: July 2019

Abstract
Background

Low back pain (LBP) is the leading cause of disability worldwide. Patient education and self-management have the potential to improve the care of patients. However, high workload and little available time for consultations are argued to challenge the delivery of optimal care in general practice. Involving clinical staff members in the management of diabetes and of patients with hypertension has shown to be feasible. Consequently, involving clinical staff members in providing education and information to patients may improve the delivery of patient information and education. However, this require a shift in the division of tasks and general practitioners’ (GPs’) barriers and facilitators for this is currently unknown. The aim is to explore GPs’ barriers and facilitators to involve clinical staff members in the treatment of LBP in general practice.

Methods

This is a qualitative, semi-structured interview study. We used the phenomenological approach to study experiences and attitudes towards changing the management of patients with LBP from the GPs’ perspectives. Analysis was conducted using inductive descriptive methods.

Results

We conducted five 60-minute interviews with Danish GPs. All GPs had experience with task delegation, but it varied which tasks the GPs delegated and to which types of clinical staff members. The following barriers towards clinical staff member involvement were identified: Patients with LBP is a heterogeneous group with a variety of treatment needs, the examination and treatment can be considered as one coherent process, and it would require external support. Involving clinical staff members can release GP time. Another facilitator was the possibility for improving the uptake of clinical guidelines and involvement of practice nurses was considered to improve the provision of patient education and lead to greater patient self-management.

Conclusion

While some GPs currently consider delegation to clinical staff members a good idea in the treatment of LBP, others prefer the existing treatment strategy without clinical staff member involvement. Consequently, healthcare providers need to address existing barriers and facilitators for involving clinical staff members when advocating for a future multi professional treatment strategy of LBP in general practice.
Factors associated with HIV-related stigma toward people living with HIV among nurses in Liangshan Yi Autonomous Prefecture, China: a cross-sectional study
Authors: Yin Yao , Chen Angela Chia-Chen , Wan Shaoping , Chen Hong 
Published: July 2019

Abstract
Background

The Liangshan Yi Autonomous Prefecture has one of the most serious human immunodeficiency virus (HIV) epidemics in China. Evidence shows HIV-related stigma toward people living with HIV (PLWH) among nurses impedes HIV prevention and treatment. However, only limited research about HIV-related stigma toward PLWH from the perspective of nurses in Liangshan has been conducted. This cross-sectional study aimed to assess HIV-related stigma toward PLWH among nurses and determine factors associated with it in Liangshan, China.

Methods

Using a stratified, random cluster sampling method, registered nurses (N=1,248; primary hospitals=102, secondary hospitals=592, tertiary hospitals=554) were recruited 10 hospitals in Liangshan. All participants completed an anonymous online survey measuring sociodemographic characteristics, HIV-related stigma and HIV knowledge. We used multiple stepwise regression analysis to examine factors associated with HIV-related stigma toward PLWH among these nurses.

Results

The mean score of HIV-related stigma among nurses was 50.7 (SD = 8.3; range 25-78). Nurses who were more experienced, had higher levels of education, and were working in tertiary hospitals reported higher level of HIV-related stigma. Those who had better HIV knowledge, reported a willingness to receive HIV-related training, were working in areas that had a high prevalence of HIV, had prior experience working in acquired immune deficiency syndrome (AIDS) specialized hospitals, and worked in hospitals that had policies to protect PLWH showed a lower level of HIV-related stigma toward PLWH.

Conclusions

Findings suggested that providing culturally congruent education and training about HIV and care, and having hospitals that promoted policies protecting PLWH, may reduce HIV-related stigma toward PLWH among nurses in China.
The risk of cesarean delivery after labor induction among women with prior pregnancy complications: A subgroup analysis of the AFFIRM study
Authors: Skeith Leslie , Gal Grégoire Le , de Vries Johanna IP , Middeldorp Saskia , Goddijn Mariëtte , Kaaja Risto , Gris Jean-Christophe , Martinelli Ida , Schleußner Ekkehard , Petroff David , Langlois Nicole , Rodger Marc A. 
Published: July 2019

Abstract
Objective: To determine the risk of cesarean delivery after labor induction among patients with prior placenta-mediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction). Study Design: The AFFIRM database includes patient level data from 9 randomized controlled trials that evaluated the role of LMWH versus no LMWH during pregnancy to prevent recurrent placenta-mediated pregnancy complications. The primary outcome of this sub-study was the proportion of women who had an unplanned cesarean delivery after induction of labor compared to after spontaneous labor. Results: There were 512 patients from 7 randomized trials included in our sub-study. There was no difference in the risk of cesarean delivery between women with labor induction (21/148, 14.2%) and spontaneous labor (79/364, 21.7%) (odds ratio (OR) 0.60, 95% CI, 0.35-1.01; p=0.052). Among 274 women who used LMWH prophylaxis during pregnancy, the risk of cesarean delivery was lower among those that underwent labor induction (9.8%) compared to spontaneous labor (22.4%) (OR 0.38, 95% CI, 0.17-0.84; p=0.01). Conclusions: The risk of cesarean delivery is not increased after labor induction among a higher risk patient population with prior pregnancy complications. Our results suggest that women who receive LMWH during pregnancy might benefit from labor induction.
Abnormal Optic Nerves Signals in Orbital MRI: a Rare Sign in Idiopathic Intracranial Hypertension
Authors: Ma Zhonghua , Jiang Hanqiu , Wang Jiawei 
Published: July 2019

Abstract
Background It is recognized that radiological examination is essential for the diagnosis of Idiopathic intracranial hypertension (IIH). The present study demonstrated a rare sign of IIH in optic nerves on MRI images.

Methods Review the medical records and MRI images of 82 the patients with IIH referred to our neurology department from January 2017 to December 2018. Inclusion criteria were: 1) accorded with the IIH diagnostic criteria adapted from Friedman et al. [1], 2) abnormal optic nerve signal with enhancement on orbital MRI, 3) no better explanation for the optic nerve involvement.

Results 12 patients are enrolled. The age of patients ranged from 16 to 55 years, median age 32.91±14.36 years, two patients were male and ten were female. The CSF opening pressures (OP) of all patients were all above 30 cmH2O. Enhancement of optic nerves sheaths (ONS) in retrobulbar segments were observed in all affected eyes showed on coronal orbital MRI gadolinium (Gd)-enhanced T1WI sequence.

Conclusions Enhancement of ONS on MRI is a rare sign of IIH that clinicians should recognize in order to avoid misdiagnosis and mistreatment.

Keywords: Idiopathic intracranial hypertension, Optic nerves sheaths, Orbital MRI
Analysis on Factors Related to Family Caregivers Burden for Elderly Patients with Spinal Tumors in Northwest China
Authors: Luo Jing , Liu Haiping , Hu Jing 
Published: July 2019

Abstract
Background

Primary caregivers of elderly patients with spinal tumors suffer considerable pain and burden during the care process. This study aims to investigate the factors associated with caregiver burden in elderly patients with spinal tumors.

Methods

A total of 220 elderly patients with spinal tumors (age, ≥ 65 years) hospitalized in the spine center of our hospital from January 2015 to December 2017 and their primary caregivers were selected in this cross-sectional study. Patients and their primary caregivers were all investigated through the sociodemographic questionnaire. The caregiver burden, social support and self-efficacy were assessed by the Chinese version of the Zarit Burden Interview (ZBI), Social Support Rating Scale (SSRS) and General Self-Efficacy Scale (GSE), respectively. The related factors of caregiver burden were analyzed by multivariate analysis. P < 0.05 was considered as statistically significant.

Results

The 216 elderly patients with spinal tumors aged (71.59 ± 8.49) years, and their caregivers aged (70.46 ± 9.13) years. 170 patients were cared for by spouses, accounting for 78.7% of all caregivers. ZBI score of primary caregivers was 35.5 ± 7.5, and most caregivers (84.5%) showed moderate or heavy burden. The factors related to caregiver burden included patients’ paralysis and pain scores and caregivers’ SSRS scores, GSE scores and monthly income.

Conclusions

Most primary caregivers of elderly patients with spinal tumors have considerable caregiver burden. The intervention of social support and self-efficacy is helpful to reduce caregiver burden.
Use of plasma lactate level to predict 28-day mortality in non-elderly and elderly sepsis patients based on the MIMIC-III database
Authors: Dong Yihua , Miao Xiaoyang , Hu Yufeng , Huang Yueyue , Chen Jie , Lu Yingru , Pan Jingye 
Published: July 2019

Abstract
Purpose

We compared the use of lactate level for predicting 28-day mortality in non-elderly (<65 years) and elderly (≥65 years) sepsis patients who were admitted to an intensive care unit (ICU).

Methods

This retrospective study used the Medical Information Mart for Intensive Care III, a publicly available database of ICUs. Eligible sepsis patients were at least 18 years-old, hospitalized for at least 24 h, and had lactate levels measured in the ICU. The relationship of lactate level with 28-day mortality was determined.

Results

The 28-day mortality was 30.9% among the 2482 patients, and was significantly greater in elderly than non-elderly patients. Within each age group, the lactate level was greater for non-survivors than survivors. Among non-survivors, the lactate level was significantly higher for the non-elderly than the elderly. Adjusted logistic regression analysis showed that elderly and non-elderly patients with lactate levels of 2.0–4.0 mmol/L and above 4.0 mmol/L had greater risk of death than those with normal lactate. Cirrhosis, chronic renal failure, and malignancy were independent risk factors for 28-day mortality in each age group. Based on a lactate cut-off level of 2.1 mmol/L, the area under the receiver operating characteristic curve was 0.628 (overall), 0.707 (non-elderly), and 0.585 (elderly).

Conclusion

In our population of sepsis patients, a plasma lactate level above 2.0 mmol/L was an independent risk factor for death at 28-days. The lactate level among elderly non-survivors was about 0.9 mmol/L lower than among non-elderly survivors. Lactate was a better prognostic indicator for non-elderly than elderly patients.