bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLINICAL FEATURES, IMAGING, AND NATURAL HISTORY OF MYELINATED RETINAL NERVE FIBER LAYER
Authors: Rao Raksha , Turkoglu Elif B. , Say Emil A. T. , Shields Carol L. 
Published: February 2018

Purpose:
To evaluate the natural history of myelinated retinal nerve fiber layer (MRNFL) through clinical features and enhanced depth imaging optical coherence tomography.

Methods:
This is a retrospective, noncomparative, case series of patients who underwent thorough clinical examination to document associated ocular and systemic features. Enhanced depth imaging optical coherence tomography was performed when MRNFL was located posteriorly and accessible to imaging.

Results:
Seventy-two eyes of 62 patients had a total of 86 MRNFL lesions. Enhanced depth imaging optical coherence tomography (n = 42 eyes) showed that all lesions originated in the nerve fiber layer with preservation of the vascular structures. Mean thickness by enhanced depth imaging optical coherence tomography was 255 μm (median, 182 μm; range, 61–717 μm). Natural history was obtainable in 58 lesions with a mean follow-up duration of 57 months (median, 37 months; range, 2–253 months) with no significant change overall in largest basal diameter (2.5 vs. 2.5 mm; P = 0.361) or thickness (255 vs. 240 μm; P = 0.053). However, evidence of lesion change included growth in base only (≥0.5 mm) (3 of 58; 5%), growth in base (≥0.5 mm) and thickness (≥50 μm) (3 of 58; 5%), and reduction in base (≥0.5 mm) after plaque radiotherapy for choroidal melanoma (3 of 58; 5%).

Conclusion:
In general, MRNFL is a rare, benign retinal finding with a potential for growth in 10% of cases. This supports previous histopathological reports that MRNFL represents accumulation of both myelin and oligodendrocytes and could be an oligodendrocytic choristoma.
NITINOL FLEX LOOP–ASSISTED RETRIEVAL AND SUTURELESS INTRASCLERAL REFIXATION OF A DISLOCATED INTRAOCULAR LENS IMPLANT
Authors: Hsu Jason 
Published: February 2018

Background/Purpose:
To describe a novel use of the flexible nitinol loop membrane scraper (FINESSE Flex loop; Alcon, Fort Worth, TX) for rescue and refixation of a dislocated intraocular lens (IOL).

Methods:
A 27-gauge nitinol flex loop was used to lasso each haptic of a dislocated 3-piece IOL. By retracting the loop, the haptic could be effectively locked to the instrument and externalized through a scleral tunnel, thereby fixating it to the sclera in a sutureless fashion.

Results:
A 50-year-old man presented with a posteriorly dislocated Sensar AR40e IOL (Abbott Medical Optics, Inc; Santa Barbara, CA) and retained lens material after a complicated cataract surgery in the left eye. His visual acuity was counting fingers at face. The patient underwent 27-gauge pars plana vitrectomy with successful rescue and refixation of the IOL using the nitinol flex loop. One week postoperatively, his visual acuity had improved to 20/40.

Conclusion:
The nitinol flex loop may be used to lasso the haptics of a dislocated IOL and refixate it using a sutureless intrascleral fixation technique. This instrument may be a safer alternative compared with forceps for retrieving posteriorly dislocated IOLs that are sitting on the retinal surface.
FULL-THICKNESS MACULAR HOLE WITH MACULAR INTRACHOROIDAL CAVITATION IN A PATIENT WITH PATHOLOGIC MYOPIA
Authors: Örnek Nurgül , Örnek Kemal 
Published: February 2018

Purpose:
To describe a full-thickness macular hole (MH) opening to macular intrachoroidal cavitation in a patient with pathologic myopia.

Methods:
Full ophthalmologic examination, fundus camera (Topcon TRC; Topcon Co, Tokyo, Japan), optical coherence tomography (RetinaScan Advanced RS-3000; NIDEK, Gamagori, Japan) imaging, and cataract surgery.

Results:
A 61-year-old woman admitted with decreased vision in the left eye. Visual acuity was counting fingers from 30 cm. Anterior segment examination showed advanced cataract. Fundus examination revealed pathologic myopia. There was full-thickness MH opening to macular intrachoroidal cavitation in contact with the anterior surface of the sclera subfoveally. Except for the communicating part of MH and macular intrachoroidal cavitation, outer retina, ellipsoid zone, and retinal pigment epithelium were intact. Choroid was intact except for a small part at subfoveal area. The patient received an uncomplicated cataract surgery. Visual acuity improved to 5/10. Because she was satisfied, MH surgery was postponed to a later date.

Conclusion:
Full-thickness MH may occur within the area of macular intrachoroidal cavitation in pathologic myopia.
Maternal Influenza Immunization and Prevention of Severe Clinical Pneumonia in Young Infants
Authors: Omer Saad B. , Clark Dayna R. , Aqil Anushka R. , Tapia Milagritos D. , Nunes Marta C. , Kozuki Naoko , Steinhoff Mark C. , Madhi Shabir A. , Wairagkar Niteen 
Published: February 2018

Background:
To evaluate the effect of antenatal influenza vaccination on all-cause severe infant pneumonia, we performed pooled analysis of 3 randomized controlled trials conducted in Nepal, Mali and South Africa.

Methods:
The trials were coordinated from the planning phase. The follow-up period was 0–6 months postpartum in Nepal and Mali and 0–24 weeks in South Africa. Pregnant women with gestational age 17–34 weeks in Nepal, ≥28 weeks in Mali and 20–36 weeks in South Africa were enrolled. Trivalent inactivated influenza vaccine (IIV) was compared with either saline placebo (Nepal and South Africa) or quadrivalent meningococcal conjugate vaccine (Mali). In South Africa, cases were hospitalized and were therefore considered to have severe pneumonia. In Nepal and Mali, severe infant pneumonia diagnosis was based on the WHO Integrated Management of Childhood Illness definition.

Results:
A total of 10,002 mothers and 9801 live-born eligible infants were included in the present analysis. There was a 31% lower incidence rate of severe pneumonia in the IIV group compared with the control group in Nepal [incidence rate ratio (IRR): 0.69; 95% CI: 0.50–0.94; Table 1]. In South Africa, there was a 43% lower incidence rate of severe pneumonia in the IIV group versus the control group (IRR: 0.57; 95% CI: 0.33–1.0). There was no difference in incidence rates between the IIV group and the control group in Mali. Overall, incidence rate of severe pneumonia was 20% lower in the IIV group compared with the control group (IRR: 0.80; 95% CI: 0.66–0.99; P = 0.04). Protection was highest in the high influenza circulation period (IRR: 0.44; 95% CI: 0.23–0.84).

Conclusions:
Maternal influenza immunization may reduce severe pneumonia episodes among infants—particularly those too young to be completely vaccinated against Streptococcus pneumoniae and influenza.
Retained Guidewires in the Veterans Health Administration: Getting to the Root of the Problem
Authors: Cherara Leila , Sculli Gary L. , Paull Douglas E. , Mazzia Lisa , Neily Julia , Mills Peter D. 
Published: February 2018

Objectives
The aims of this study were to investigate the demographics, causes, and contributing factors of retained guidewires (GWs) and to make specific recommendations for their prevention.

Methods
The Veterans Administration patient safety reporting system database for 2000–2016 was queried for cases of retained GWs (RGWs). Data extracted for each case included procedure location, provider experience, insertion site, urgency, time to discovery, root causes, and corrective actions taken.

Results
There were 101 evaluable cases of RGWs. Resident trainee (36%), critical care unit (38%), femoral vein (44%), and nonemergent placement (79%) were the conditions most frequently associated with a RGW. While discovery occurred almost immediately (30%) or in next 24 hours (31%), there were instances of RGWs found months (2%) or years (3%) later. Common root causes included inexperience (46%), lack of standardization (35%), distractions (25%), and lack of a checklist (23%).

Conclusions
The results demonstrate the result of human factors–based errors such as posttask completion errors. We recommend human factor–based interventions such as checklists and devices employing forcing functions that do not allow clinicians to complete the insertion process without first removing the GW.
An Automated Segmentation of R2* Iron-Overloaded Liver Images Using a Fuzzy C-Mean Clustering Scheme
Authors: Saiviroonporn Pairash , Korpraphong Pornpim , Viprakasit Vip , Krittayaphong Rungroj 
Published: February 2018

Objectives
The objectives of this study were to develop and test an automated segmentation of R2* iron-overloaded liver images using fuzzy c-mean (FCM) clustering and to evaluate the observer variations.

Materials and Methods
Liver R2* images and liver iron concentration (LIC) maps of 660 thalassemia examinations were randomly separated into training (70%) and testing (30%) cohorts for development and evaluation purposes, respectively. Two-dimensional FCM used R2* images, and the LIC map was implemented to segment vessels from the parenchyma. Two automated FCM variables were investigated using new echo time and membership threshold selection criteria based on the FCM centroid distance and LIC levels, respectively. The new method was developed on a training cohort and compared with manual segmentation for segmentation accuracy and to a previous semiautomated method, and a semiautomated scheme was suggested to improve unsuccessful results. The automated variables found from the training cohort were assessed for their effectiveness in the testing cohort, both quantitatively and qualitatively (the latter by 2 abdominal radiologists using a grading method, with evaluations of observer variations). A segmentation error of less than 30% was considered to be a successful result in both cohorts, whereas, in the testing cohort, a good grade obtained from satisfactory automated results was considered a success.

Results
The centroid distance method has a segmentation accuracy comparable with the previous-best, semiautomated method. About 94% and 90% of the examinations in the training and testing cohorts were automatically segmented out successfully, respectively. The failed examinations were successfully segmented out with thresholding adjustment (3% and 8%) or by using alternative results from the previous 1-dimensional FCM method (3% and 2%) in the training and testing cohorts, respectively. There were no failed segmentation examinations in either cohort. The intraobserver and interobserver variabilities were found to be in substantial agreement.

Conclusions
Our new method provided a robust automated segmentation outcome with a high ease of use for routine clinical application.
Teaching Vaginal Hysterectomy via Simulation: Creation and Validation of the Objective Skills Assessment Tool for Simulated Vaginal Hysterectomy on a Task Trainer and Performance Among Different Levels of Trainees
Authors: Malacarne D.R. , Escobar C.M. , Lam C.J. , Ferrante K.L. , Szyld D. , Lerner Veronica T. 
Published: February 2018

Objectives
The use of simulation-based education to train surgeons is widely accepted. Although many authors describe the use of an Objective Skills Assessment Test (OSAT) to assess performance of various surgical procedures, there is a paucity of research on use of this modality to evaluate vaginal surgery skills. We created a vaginal hysterectomy procedure-specific checklist (PSC) to complete the OSAT (which is composed of a PSC and a global rating scale [GRS]). The primary objective of this study is to evaluate the performance of a novel evaluation strategy for vaginal hysterectomy using an OSAT combining PSC and GRS.

Methods
This is a descriptive prospective study from a single institution. After orientation to the model, participants were filmed performing vaginal hysterectomy. A blinded grader scored each subject using the PSC and GRS.

Results
Medical students, residents, fellows, and attendings performed vaginal hysterectomy on a simulated model. Mean PSC and GRS scores increased significantly with surgeon level of experience (P < 0.001). Procedure-specific checklist scores significantly correlated with GRS scores (P < 0.001).

Conclusions
The vaginal hysterectomy model and PSC have been studied across different surgeon levels using OSATs. Training programs should consider using this low-cost task trainer as a teaching tool.
Red tides: Mass casualty and whole blood at sea
Authors: Miller Benjamin T. , Lin Andrew H. , Clark Susan C. , Cap Andrew P. , Dubose Joseph J. 
Published: February 2018

BACKGROUND
The U.S. Navy’s casualty-receiving ships provide remote damage control resuscitation platforms to treat injured combatants deployed afloat and ashore. We report a significant mass casualty incident aboard the USS Bataan, and the most warm fresh whole blood (WFWB) transfused at sea for traumatic hemorrhagic shock since the Vietnam War.

METHODS
Casualty-receiving ships have robust medical capabilities, including a frozen blood bank with packed red blood cells (pRBC) and fresh frozen plasma (FFP). The blood supply can be augmented with WFWB collected from a “walking blood bank.”

RESULTS
Following a helicopter crash, six patients were transported by MV-22 Osprey to the USS Bataan. Patient 1 had a pelvic fracture, was managed with a pelvic binder, and received 4 units of pRBC, 2 units of FFP, and 6 units of WFWB. Patient 2, with a comminuted tibia and fibula fracture, underwent lower extremity four-compartment fasciotomy, and received 4 units of WFWB. Patient 3 underwent several procedures, including left anterior thoracotomy, aortic cross-clamping, exploratory laparotomy, small bowel resection, and tracheostomy. He received 8 units of pRBC, 8 units of FFP, and 28 units of WFWB. Patients 4 and 5 had suspected spine injuries and were managed nonoperatively. Patient 6, with open tibia and fibula fractures, underwent lower extremity four-compartment fasciotomy with tibia external fixation and received 1 unit of WFWB. All patients survived aeromedical evacuation to a role 4 medical facility and subsequent transfer to local hospitals.

CONCLUSION
Maritime military mass casualty incidents are challenging, but the U.S. Navy’s casualty-receiving ships are ready to perform remote damage control resuscitation at sea. Activation of the ship’s walking blood bank to transfuse WFWB is essential for hemostatic resuscitations afloat.

LEVEL OF EVIDENCE
Study type: case series, level V.
Stability of Early EEG Background Patterns After Pediatric Cardiac Arrest
Authors: Abend Nicholas S. , Xiao Rui , Kessler Sudha Kilaru , Topjian Alexis A. 
Published: February 2018

Purpose:
We aimed to determine whether EEG background characteristics remain stable across discrete time periods during the acute period after resuscitation from pediatric cardiac arrest.

Methods:
Children resuscitated from cardiac arrest underwent continuous conventional EEG monitoring. The EEG was scored in 12-hour epochs for up to 72 hours after return of circulation by an electroencephalographer using a Background Category with 4 levels (normal, slow-disorganized, discontinuous/burst-suppression, or attenuated-featureless) or 2 levels (normal/slow-disorganized or discontinuous/burst-suppression/attenuated-featureless). Survival analyses and mixed-effects ordinal logistic regression models evaluated whether the EEG remained stable across epochs.

Results:
EEG monitoring was performed in 89 consecutive children. When EEG was assessed as the 4-level Background Category, 30% of subjects changed category over time. Based on initial Background Category, one quarter of the subjects changed EEG category by 24 hours if the initial EEG was attenuated-featureless, by 36 hours if the initial EEG was discontinuous or burst-suppression, by 48 hours if the initial EEG was slow-disorganized, and never if the initial EEG was normal. However, regression modeling for the 4-level Background Category indicated that the EEG did not change over time (odds ratio = 1.06, 95% confidence interval = 0.96–1.17, P = 0.26). Similarly, when EEG was assessed as the 2-level Background Category, 8% of subjects changed EEG category over time. However, regression modeling for the 2-level category indicated that the EEG did not change over time (odds ratio = 1.02, 95% confidence interval = 0.91–1.13, P = 0.75).

Conclusions:
The EEG Background Category changes over time whether analyzed as 4 levels (30% of subjects) or 2 levels (8% of subjects), although regression analyses indicated that no significant changes occurred over time for the full cohort. These data indicate that the Background Category is often stable during the acute 72 hours after pediatric cardiac arrest and thus may be a useful EEG assessment metric in future studies, but that some subjects do have EEG changes over time and therefore serial EEG assessments may be informative.
Songbird dynamics under the sea: acoustic interactions between humpback whales suggest song mediates male interactions
Authors: Cholewiak Danielle M. , Cerchio Salvatore , Jacobsen Jeff K. , Urbán-R. Jorge , Clark Christopher W. 
Published: February 2018

The function of song has been well studied in numerous taxa and plays a role in mediating both intersexual and intrasexual interactions. Humpback whales are among few mammals who sing, but the role of sexual selection on song in this species is poorly understood. While one predominant hypothesis is that song mediates male–male interactions, the mechanism by which this may occur has never been explored. We applied metrics typically used to assess songbird interactions to examine song sequences and movement patterns of humpback whale singers. We found that males altered their song presentation in the presence of other singers; focal males increased the rate at which they switched between phrase types (
p
= 0.005), and tended to increase the overall evenness of their song presentation (
p
= 0.06) after a second male began singing. Two-singer dyads overlapped their song sequences significantly more than expected by chance. Spatial analyses revealed that change in distance between singers was related to whether both males kept singing (
p
= 0.012), with close approaches leading to song cessation. Overall, acoustic interactions resemble known mechanisms of mediating intrasexual interactions in songbirds. Future work should focus on more precisely resolving how changes in song presentation may be used in competition between singing males.
Information synergy: adding unambiguous quality information rescues social information use in ants
Authors: Czaczkes Tomer J. , Beckwith John J. , Horsch Anna-Lena 
Published: February 2018

AbstractAnimals have access to many alternative information sources when making decisions, such as private information (e.g. memory) and social information. Social insects make extensive use of social information. However, when intentional social information (e.g. pheromone trails in ants) conflicts with private information (e.g. route memories), insects often follow their private information. Why is this? We propose that an asymmetry in the type of information provided by these two information sources drives the neglect of social information: In ants, workers with certain information about the quality of a food source (memory) ignore valuable social information (pheromone trails) because the pheromone trails encode only a very ambiguous measure of food quality. This leads to a testable hypothesis: the addition of unambiguous quality information should rescue social information following. To test this, we trained ants to a poor quality (0.25M sucrose) food source, and then provided an alternative path along with either 1) no information, 2) a pheromone trail, 3) a 0.2μl 1.5M sucrose droplet, providing unambiguous quality information, or 4) both a trail and a droplet. When either no or only one information source was provided (1-3), most ants (60-75%) continued following their own memory. However, the addition of unambiguous quality information (4) rescued trail following: when both a trail and a droplet were provided, 75% of ants followed the trail. In further experiments, we show that quality information gleaned from direct contact with fed nestmates produced similar effects. Using florescence microscopy, we demonstrate that food (and information) flows from fed workers to outgoing foragers, explaining the frequent contacts on trails. We propose that the type of information an information source can convey, and its ambiguity, is a strong driver of which source of information is attended to.
Exploring the relationship between altmetrics and traditional measures of dissemination in health professions education
Authors: Maggio Lauren A. , Leroux Todd C. , Meyer Holly S. , Artino Anthony R. 
Published: February 2018

AbstractResearchers, funders, and institutions are interested in understanding and quantifying research dissemination and impact, particularly related to communicating with the public. Traditionally, citations have been a primary impact measure; however, citations can be slow to accrue and focus on academic use. Recently altmetrics, which track alternate dissemination forms (e.g., social media) have been suggested as a complement to citation-based metrics. This study examines the relationship between altmetrics and traditional measures: journal article citations and access counts.The researchers queried Web of Science and Altmetric Explorer for articles published in HPE journals between 2013-2015. They identified 2,486 articles with altmetrics. Data were analyzed using negative binomial and linear regression models.Blogging was associated with the greatest increase in citations (13% increase), whereas Tweets (1.2%) and Mendeley (1%) were associated with smaller increases. Journal impact factor (JIF) was associated with a 21% increase in citations. Publicly accessible articles were associated with a 19% decrease, but the interactive effect between accessible articles and JIF was associated with a 12% increase. When examining access counts, publicly accessible articles had an increase of 170 access counts whereas blogging was associated with a decrease of 87 accesses.This study suggests that several altmetrics outlets are positively associated with citations, and that public accessibility, holding all other independent variables constant, is positively related to article access. Given the scientific community’s evolving focus on dissemination—including to the public—these findings have implications for stakeholders, providing insight into the factors that may improve citations and access of articles.