bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autologous Ear Reconstruction for Microtia Does Not Result in Loss of Cutaneous Sensitivity
Authors: Denadai Rafael , Raposo-Amaral Cassio Eduardo , Zanco Guilherme Luis , Raposo- Amaral Cesar Augusto 
Published: March 2019

Background:
Cutaneous sensitivity of microtia reconstruction has been sparsely documented. The purpose of this study was to evaluate whether there is a loss of cutaneous sensitivity following two-stage autologous ear reconstruction for unilateral microtia.

Methods:
A prospective study was performed including unilateral microtia patients who underwent two-stage autologous ear reconstruction performed by a single plastic surgeon between 2011 and 2016. Standardized sensory testing (i.e., temperature discrimination and Semmes-Weinstein monofilaments) was executed at 11 predefined anatomical points of the affected and unaffected ears preoperatively and at 6 and 12 months postoperatively.

Results:
Thirty-eight patients were included. Affected and unaffected sides presented similar (all p > 0.05) preoperative cutaneous sensitivity. Most (72.7 percent) of the tested points showed (all p < 0.05) preservation or recovery of cutaneous sensitivity at 12 months postoperatively. When comparing the reconstructed ears with the unaffected ears, there was no significant difference (all p > 0.05) in most (72.7 percent) of the tested points, except (all p < 0.05) at those points involving the postauricular sulcus.

Conclusion:
There is a temporary cutaneous sensitivity loss after a two-stage autologous microtia reconstruction, which returned to similar preoperative sensitivity at 12-month follow-up, except in the postauricular sulcus.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Abdominal Etching: Surgical Technique and Outcomes
Authors: Husain Tarik M. , Salgado Christopher J. , Mundra Leela S. , Perez Chelsey , AlQattan Husain T. , Bustillo Erik , Perez Ramiro , Garri Jose I. 
Published: March 2019

Background:
The ideal body is characterized by a muscular physique and defined anterior abdominal wall. Despite diet and exercise, many are unable to achieve this desired result. Liposuction with abdominal etching is used to achieve high-definition abdominal aesthetics. The etching technique is performed with liposuction in a superficial plane, to create indentures consistent with “six-pack abs,” or definition of vertical abdominal lines.

Methods:
The authors’ abdominal etching preoperative markings, surgical technique, and postoperative care are discussed. The surgeons’ experience with abdominal etching in 50 consecutive patients is reviewed, including rate of complications and patient satisfaction.

Results:
The average patient age was 36.4 years. We had an almost equal number of men (n = 26) and women (n = 24), with an average body mass index of 26.7 kg/m2. The average blood loss was 275 ml, the average tumescence was 6 liters, and the average lipoaspirate was 5 liters. There were no major complications such as fat embolus, deep venous thrombosis, or intraabdominal injury. The most common minor postoperative complications were contour irregularities (12 percent), seromas (10 percent), and hyperpigmentation (2 percent). The majority of patients were satisfied (98 percent). The average length of postoperative follow-up was 27 months.

Conclusions:
Abdominal etching is a safe and effective method of creating a defined anterior abdominal wall for patients who desire the muscular definition of vertical abdominal lines. Almost all of our patients reviewed were satisfied with this procedure, maintained long-term results, and had an acceptable rate of complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Psychological and Psychosomatic Symptoms of Second Victims of Adverse Events: a Systematic Review and Meta-Analysis
Authors: Busch Isolde M. , Moretti Francesca , Purgato Marianna , Barbui Corrado , Wu Albert W. , Rimondini Michela 
Published: March 2019

Objectives
Despite growing interest in the second-victim phenomenon and greater awareness of its consequences, there has not been a meta-analysis quantifying the negative impact of adverse events on providers involved in adverse events. This study systematically reviewed the types and prevalence of psychological and psychosomatic symptoms among second victims.

Methods
We conducted a systematic review of nine electronic databases up to February 2017, without restrictions to publication date or language, examining also additional sources (e.g., gray literature, volumes of journals). Two reviewers performed the search, selection process, quality assessment, data extraction, and synthesis. We resolved disagreements by consensus and/or involving a third reviewer. Quantitative studies on the prevalence of psychological and psychosomatic symptoms of second victims were eligible for inclusion. We used random effects modeling to calculate the overall prevalence rates and the I
2 statistic.

Results
Of 7210 records retrieved, 98 potentially relevant studies were identified. Full-text evaluation led to a final selection of 18 studies, based on the reports of 11,649 healthcare providers involved in adverse events. The most prevalent symptoms were troubling memories (81%, 95% confidence interval [CI] = 46–95), anxiety/concern (76%, 95% CI = 33–95), anger toward themselves (75%, 95% CI = 59–86), regret/remorse (72%, 95% CI = 62–81), distress (70%, 95% CI = 60–79), fear of future errors (56%, 95% CI = 34–75), embarrassment (52%, 95% CI = 31–72), guilt (51%, 95% CI = 41–62), and sleeping difficulties (35%, 95% CI = 22–51).

Conclusions
Second victims report a high prevalence and wide range of psychological symptoms. More than two-thirds of providers reported troubling memories, anxiety, anger, remorse, and distress. Preventive and therapeutic programs should aim to decrease second victims’ emotional distress.
Validation of an Instrument to Measure the Results of Quality Assurance in the Operating Room
Authors: Gomes José Augusto Pereira , Martins Maria Manuela , Tronchin Daisy , Fernandes Carla Sílvia 
Published: March 2019

Background and Objectives:
This study aims to validate an instrument designed to measure care quality in the operating room.

Methods:
We conducted a transversal exploratory descriptive study with the objective of analyzing the psychometric properties of the scale. The 13 items included in the scale result from 2 previously conducted studies, a literature review study and a Delphi study. The instrument was administered to health professionals with at least 2 years of experience in the operating room in 71 Portuguese hospitals.

Results:
The sample consisted of 1019 professionals who worked in an operating room; among them were nurses and doctors. The results show that the scale is a reliable and valid instrument composed of 3 dimensions: assessment of the quality of care; evaluation of processes; and control systems.

Conclusion:
The final version of the scale meets the validity requirements, revealing high potential to be used in research and clinical practice. The use of this scale will allow evaluation and comparison of the results among the different operating rooms.
Implementing Daily Leadership Safety Huddles in a Public Hospital: Bridging the Gap
Authors: Castaldi Maria , Kaban Jody M. , Petersen Martina , George Geena , O'Neill Andrea , Mullaney Kathi , Pennacchio Suzanne , Morley John 
Published: March 2019

Background:
A Leadership Safety Huddle was instituted in efforts to improve communication and make safety culture a priority at our institution. The Huddle is a transparent, regularly recurring forum of clinical and administrative hospital leaders, in which safety issues and concerns are identified, shared, and swiftly addressed.

Methods:
Metrics regarding huddle effectiveness in 3 areas are studied: information technology (IT) services ticket resolution time, bladder catheterization, and one-to-one inpatient monitoring.

Results:
Analysis revealed effectiveness of the huddle on quality of inpatient care and cost savings. Survey revealed 75% or higher favorable responses to huddle improving communication, transparency, time to resolution of issues, ability to voice concerns, and patient safety. As a result of huddle implementation, metrics showed 46% reduction in IT ticket turnaround time (P = .0001), 28% reduction in non–intensive care unit bladder catheter days (P = .011), and 10% decrease in continuous observations (P = .008), allowing a 24% reduction in cost (P = .001) with quarterly savings of $139 107.00.

Conclusion:
These metrics demonstrate how huddles are instrumental in infusing and sustaining a culture of patient safety in hospitals.
Different Methods of Fabricating Cartilaginous Ear Framework in Children With Microtia According to the Length of the Eighth Costal Cartilage Intraoperatively
Authors: Yan Hongshan , Zhang Guohui , Liu Wenming , Wang Ningning , Liu Zhenzhong 
Published: March 2019

Background:
There is controversy over the optimal timing of microtia reconstruction. The eighth costal cartilage, which is used to shape the helix framework, can be one of the key factors determining surgical timing of microtia reconstruction. Nevertheless, it is difficult to predict the length of the eighth costal cartilage preoperatively. The aim of the present study was to discuss different methods of fabricating cartilaginous ear framework in children with microtia according to different lengths of the eighth costal cartilage.

Methods:
Based on the actual length of the eighth costal cartilage in microtia children, there are 2 methods to fabricate auricular framework. In method I, the eighth costal cartilage was divided into 2 parts. Part A was used to fashion the helix, while part B was used to protrude the antihelix, superior, and inferior crus. The seventh rib was used to form the main body and the sixth rib was used to form the base of the framework. In method II, the seventh costal cartilage was used to fashion the helix and extrude the antihelix, superior, and inferior crus as method I did. The sixth rib was used to form the main body and the eighth rib was used to form the base of the framework.

Results:
A total of 68 microtia children underwent auricular reconstruction adopting the modified techniques between 2015 and 2016. The great majority of patients (66 patients) were satisfied with the reconstructed ears. Two patients were relatively satisfied with the reconstructed ears. Three cases have been selected to illustrate the favorable result achieved. They revealed that the helix, antihelix, superior crus, and inferior crus all appeared distinct and presented a favorable result of the contour of the reconstructed auricle.

Conclusions:
Based on different lengths of eighth costal cartilage in children, different methods of fabricating ear framework make full use of the autogenous costal cartilage and elevate anatomical details, demonstrating that personalized treatment is necessary.
The Regenerated Tissue at the Donor Site After Costal Cartilage Harvest for Auricular Reconstruction
Authors: Yang Jinxiu , Lin Lin , Zhang Ye , Wang Yongzhen , Cui Lei , He Leren 
Published: March 2019

Objective:
To observe and summarize the nature of the regenerative tissue at the donor site after harvesting costal cartilage for auricular reconstruction and to explore the contribution of the perichondrium to the regeneration of costal cartilage in the clinic.

Methods:
From January 2016 to June 2017, 23 patients with microtia who were performed chest computed tomography (CT) after costal cartilage harvest for ear reconstruction were reviewed. And they had the surgery for at least 6 months. Of 23 patients, 17 patients were males and 6 were females; these patients were aged 7 to 43 years (mean age, 15.2 years). The authors divided the patients into 2 groups according to whether the perichondrium was retained or not. Group 1 was patients with intact perichondrium, total 20. Group 2 was patients with damaged perichondrium, total 3. Every patients’ regenerative tissue CT value at the donor-site region of costal cartilage was measured and recorded. In addition, 2 regenerated tissue samples for examined histologic evaluation by hematoxylin and eosin stain were collected.

Results:
Of 23 patients, regenerated tissue with high CT value (above 100 Hounsfield unit [Hu]) was observed in 19 (82.61%) patients from group 1. And the direction of the regenerated tissue is roughly similar to that of the resected cartilage in the early surgery. Of 4 patients (1 from group and 3 from group 2), nothing on the donor site was found. From histologic evaluation, fibrocalcific tissue was seen, and cartilage cells were not seen in 2 patients with high CT value.

Conclusion:
Clinical observation presented that regenerative tissue at the donor site after harvesting costal cartilage, leaving the subjacent perichondrium completely intact, was mostly fibrocalcific tissue rather than cartilage tissue. The authors suspect that the perichondrium itself may not have regenerative power, but as an envelope for regeneration, perichondrium has a role.
Incidence of Familial Craniosynostosis Among Patients With Nonsyndromic Craniosynostosis
Authors: Kalantar-Hormozi Hadis , Abbaszadeh-Kasbi Ali , Sharifi Guive , Davai Nazanin Rita , Kalantar-Hormozi Abdoljalil 
Published: March 2019

Background:
Craniosynostosis has an incidence of 1 in 2000 to 2500 live births, and is categorized into syndromic and nonsyndromic types. Nonsyndromic ones can be familial in which more than one of the family members are involved.

Methods:
This is a prospective study which is carried out from April 2015 to January 2018 in 2 academic hospitals. Those patients who had nonsyndromic craniosynostosis and completed medical follow-up were included in the study as well as their 1st degree relatives. Age of patients, gender, existing consanguineous marriage, type of deliveries, type of pregnancy (assisted reproductive technologies [ART] versus sexual intercourse), severity and type of craniosynostosis were gathered.

Results:
Ninety-four (46.0%), 58 (28.4%), 28 (13.7%), 16 (7.8%), and 8 (3.9%) of patients had trigonocephaly, scaphocephaly, anterior plagiocephaly, complex, and brachycephaly, respectively. A total number of 204 patients were included in the study. Of all 204 families which were included, 30 (14.7%) families had positive familial history. Familial patients were determined in 10, 15, 8, 1, and 5 patients with scaphocephaly, trigonocephaly, anterior plagiocephaly, rachycephaly, and mixed type. Male to female ratio was 2:1, 1.9:1, 1.3:1, 1:1, and 1:1 for scaphocephaly, trigonocephaly, anterior plagiocephaly, brachycephaly, and mixed craniosynostosis. Twelve (5.9%) women had applied ART.

Conclusion:
Present study reveals that metopic suture is the most frequent craniosynostosis within nonsyndromic types. All the types of nonsyndromic craniosynostosis had male prevalence but for complex one which was equal in both gender. Nonsyndromic craniosynostosis in about 14.7% of patients was familial.
Macular Ganglion Cell and Inner Plexiform Layer Thickness Is More Strongly Associated With Visual Function in Multiple Sclerosis Than Bruch Membrane Opening–Minimum Rim Width or Peripapillary Retinal Nerve Fiber Layer Thicknesses
Authors: Nguyen James , Rothman Alissa , Gonzalez Natalia , Avornu Ama , Ogbuokiri Esther , Balcer Laura J. , Galetta Steven L. , Frohman Elliot M. , Frohman Teresa , Crainiceanu Ciprian , Calabresi Peter A. , Saidha Shiv 
Published: March 2019

Background:Optical coherence tomography (OCT) measurements of ganglion cell + inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses are associated with visual function (VF) and disability in multiple sclerosis (MS). However, the value of measuring Bruch membrane opening–minimum rim width (BMO-MRW) thickness in MS remains unclear.Methods:Sixty-eight patients with MS and 22 healthy controls (HCs) underwent spectral domain OCT, 100%-contrast visual acuity (VA), 2.5%- and 1.25%-contrast letter acuity (LA), and Expanded Disability Status Scale (EDSS) testing. Mixed-effects linear regression models, accounting for within-subject, intereye correlations, were used to assess relationships.Results:The MS cohort exhibited significantly lower BMO-MRW (P= 0.01), pRNFL at 3.7-, 4.1-, and 4.7-mm diameters surrounding the optic disc (P< 0.001 for all), and GCIPL (P< 0.001) thicknesses than HCs. BMO-MRW thickness was associated with 100%-VA (P< 0.001, R2= 0.08), 2.5%-LA (P< 0.001; R2= 0.13), and 1.25%-LA (P= 0.002; R2= 0.11). All measured pRNFL thicknesses were associated with high- and low-contrast VF (all:P< 0.001). GCIPL thickness was more strongly associated with 100%-VA (P< 0.001; R2= 0.23), 2.5%-LA (P< 0.001; R2= 0.27), and 1.25%-LA (P< 0.001; R2= 0.21) than the other OCT measures assessed. All OCT measures were significantly, but weakly, associated with EDSS scores.Conclusions:BMO-MRW and pRNFL thicknesses are reduced and associated with VF and disability in MS, but GCIPL thickness is a stronger marker of visual impairment. Our findings corroborate the utility of OCT in providing valuable information regarding the MS disease process.
Surveillance-embedded genomic outbreak resolution of methicillin-susceptibleStaphylococcus aureusin a neonatal intensive care unit
Authors: Cremers AJH , Coolen JPM , Bleeker-Rovers CP , van der Geest-Blankert ADJ , Haverkate D , Hendriks H , Henriet SSV , Huynen MA , Kolwijck E , Liem D , Melchers WJG , Rossen JW , Zoll J , van Heijst A , Hopman J , Wertheim HFL 
Published: March 2019

AbstractBackgroundWe observed an increase in methicillin-susceptibleStaphylococcus aureus(MSSA) infections among neonates at a Dutch third level neonatal intensive care unit. Weekly surveillance data of MSSA carriage among neonates and cross-sectional screenings of health care workers (HCWs) were available for outbreak tracing. While traditional typing of MSSA isolates by staphylococcal protein A gene (spatyping) and Multiple-Locus Variable number tandem repeat Analysis (MLVA) suggested that nosocomial transmission had contributed to the infections, here they lacked the resolution to draw solid conclusions.MethodsMSSA isolates from neonatal infections, carriage surveillance, and HCWs were subjected to whole-genome sequencing and compared by a series of automated tools includingde novoassembly, identification and localization of high-quality single nucleotide polymorphisms, and in-depth analysis of subsets of isolates. Outbreaks were defined as isolates that were more closely related than was to be expected from the genetic diversity in background surveillance.ResultsGenomic analysis identified isolates that had been unjustly assigned to clusters based on MLVA typing, whilespatyping was concordant but of insufficient resolution. Detailing particular subsets of isolates further improved resolution and although it provided evidence that HCWs were involved in multiple outbreaks, it alleviated heavy concerns about one particular HCW. Genomic clustering of isolates based on deviations from background surveillance matched epidemiological patient linkage. Compared to MLVA typing, the genomic analysis demonstrated more, shorter, and re-assorted nosocomial transmission chains during this outbreak.ConclusionsIn this study the improved resolution and accuracy of genomic outbreak analyses compared tospatyping and MLVA substantially altered the view on outbreaks, along with apposite outbreak measures. Inclusion of the circulating background population has the potential to overcome current issues in genomic outbreak inference.
Model-based tumor subclonal reconstruction
Authors: Caravagna Giulio , Heide Timon , Williams Marc , Zapata Luis , Nichol Daniel , Chkhaidze Ketevan , Cross William , Cresswell George D. , Werner Benjamin , Acar Ahmet , Barnes Chris P. , Sanguinetti Guido , Graham Trevor A. , Sottoriva Andrea 
Published: March 2019

AbstractThe vast majority of cancer next-generation sequencing data consist of bulk samples composed of mixtures of cancer and normal cells. To study tumor evolution, subclonal reconstruction approaches based on machine learning are used to separate subpopulation of cancer cells and reconstruct their ancestral relationships. However, current approaches are entirely data-driven and agnostic to evolutionary theory. We demonstrate that systematic errors occur in subclonal reconstruction if tumor evolution is not accounted for, and that those errors increase when multiple samples are taken from the same tumor. To address this issue, we present a novel approach for model-based subclonal reconstruction that combines data-driven machine learning with evolutionary theory. Using public, synthetic and newly generated data, we show the method is more robust and accurate than current techniques in both single-sample and multi-region sequencing data. With careful data curation and interpretation, we show how the method allows minimizing the confounding factors that affect non-evolutionary methods, leading to a more accurate recovery of the evolutionary history of human tumors.
Estimating spatially and temporally complex range dynamics when detection is imperfect
Authors: Rushing Clark S. , Royle J. Andrew , Ziolkowski David J. , Pardieck Keith L. 
Published: March 2019

AbstractSpecies distributions are determined by the interaction of multiple biotic and abiotic factors, which produces complex spatial and temporal patterns of occurrence. As habitats and climate change due to anthropogenic activities, there is a need to develop species distribution models that can quantify these complex range dynamics. In this paper, we develop a dynamic occupancy model that uses a spatial generalized additive model to estimate non-linear spatial variation in occupancy not accounted for by environmental covariates. The model is flexible and can accommodate data from a range of sampling designs that provide information about both occupancy and detection probability. Output from the model can be used to create distribution maps and to estimate indices of temporal range dynamics. We demonstrate the utility of this approach by modeling long-term range dynamics of 10 eastern North American birds using data from the North American Breeding Bird Survey. We anticipate this framework will be particularly useful for modeling species’ distributions over large spatial scales and for quantifying range dynamics over long temporal scales.
Easily adaptable head-free training system of macaques for tasks requiring precise measurements of eye position
Authors: Kawaguchi Katsuhisa , Pourriahi Paria , Seillier Lenka , Clery Stephane , Nienborg Hendrikje 
Published: March 2019

AbstractWe describe a modified system for training macaque monkeys without invasive head immobilization on visuomotor tasks requiring the control of eye-movements. The system combines a conventional primate chair, a chair-mounted infrared camera for measuring eye-movements and a custom-made concave reward-delivery spout firmly attached to the chair. The animal was seated head-free inside the chair but the concavity of the spout stabilized its head during task performance. Training on visual fixation and discrimination tasks was successfully performed with this system. Eye-measurements, such as fixation-precision, pupil size as well as micro-saccades were comparable to those obtained using conventional invasive head-fixation methods. The system is inexpensive (∼$40 USD material cost), easy to fabricate in a workshop (technical drawings are included), and readily adjustable between animals without the need to immobilize or sedate them for these adjustments.HighlightsWe developed an approach to train macaque monkeys head-free on visuomotor tasks requiring measurements of eye positionThe setup is inexpensive, easy to build, and readily adjusted to the animal without the need for sedationThe system was tested for training on a visual fixation and a visual discrimination taskEye measurements (fixation precision, pupil size, microsaccades) were comparable to those from head-fixed animals