bluuebunny/crossref_metadata_2025_split huggingface dataset:
One-Year Outcomes Following Tracheostomy for Acute Respiratory Failure*
Authors: Mehta Anuj B. , Walkey Allan J. , Curran-Everett Douglas , Douglas Ivor S. 
Published: August 2019

Objectives:
Tracheostomy utilization has dramatically increased recently. Large gaps exist between expected and actual outcomes resulting in significant decisional conflict and regret. We determined 1-year patient outcomes and healthcare utilization following tracheostomy to aid in decision-making and resource allocation.

Design:
Retrospective cohort study.

Setting:
All California hospital discharges from 2012 to 2013 with follow-up through 2014.

Patients:
Nonsurgical patients who received a tracheostomy for acute respiratory failure.

Interventions:
None.

Measurements and Main Results:
Our primary outcome was 30-day, 90-day, and 1-year mortality. We also determined hospitals readmissions rates and healthcare utilization in the first year following tracheostomy. We identified 8,343 tracheostomies during the study period. One-year mortality following tracheostomy was high, 46.5%. Older adults (≥ 65 yr) had significantly higher mortality compared with younger patients (< 65 yr) (54.7% vs 36.5%; p < 0.0001). Median survival for older adults was 175 days (95% CI, 150–202 d) compared with greater than 1 year for younger adults (adjusted hazard ratio, 1.25; 95% CI, 1.14–1.36). Within 1 year of tracheostomy, 60.3% of patients required hospital readmission. Older adults were more likely to be readmitted in the first year after tracheostomy compared with younger adults (66.1% vs 55.2%; adjusted hazard ratio, 1.19; 95% CI, 1.09–1.29). Total short-term acute care hospital costs (index and readmissions) in the first year after tracheostomy were high (mean, $215,369; sd, $160,874).

Conclusions:
Long-term outcomes following tracheostomy are extremely poor with high mortality, morbidity, and healthcare resource utilization especially among older patients. Some subsets of younger patients may have better outcomes compared with the general tracheostomy population. Short-term acute care costs were extremely high in the first year following tracheostomy. If extended to the entire U.S. population, total short-term acute care hospital costs approach $11 billion dollars per year for tracheostomy-related to acute respiratory failure. These findings may aid families and surrogates in the decision-making process.
Health and Neurodevelopment of Children Born to Opioid-Dependent Mothers at School Entry
Authors: Lee Samantha J. , Pritchard Verena E. , Austin Nicola C. , Henderson Jacqueline M. T. , Woodward Lianne J. 
Published: August 2019

ABSTRACT:

Objective:
To examine the school readiness of a regional cohort of prenatally methadone-exposed children across 5 domains and to examine factors contributing to impairment risk.

Methods:
Data were drawn from a single-center, prospective longitudinal study. One hundred children born to women in methadone maintenance treatment and 110 randomly identified non–methadone-exposed children were studied from birth (2003–2008) to age 4.5 years. At 4.5 years, children underwent comprehensive assessment of their physical/motor development, social-emotional skills, approaches to learning, language development, and cognitive functioning. Predictors of children's overall school readiness were examined, including the extent of prenatal substance exposure (number and quantity of different substances), social risk, maternal mental health, infant clinical factors, and the quality of the home environment at age 18 months Home Observation for Measurement of the Environment (HOME) score.

Results:
Methadone-exposed children had higher rates of delay/impairment across all outcome domains (odds ratios 4.0–5.3), with 72% impaired in at least 1 domain. Multiple problems were also common, affecting 48% of methadone-exposed children compared with 15% of control children. The mean number of school readiness domains impaired increased, with increasing prenatal substance exposure (rate ratio [RR] = 1.05 [1.01–1.11]), higher social risk (RR = 1.35 [1.20–1.53]), male sex (RR = 1.69 [1.27–2.25]), and lower HOME scores indicating a poorer quality postnatal environment (RR = 0.96 [0.94–0.99]).

Conclusion:
Children born to opioid-dependent mothers are at high risk of impaired school readiness, with multiple domain problems being common. Impaired school readiness was associated with greater maternal prenatal substance use, higher social risk, male sex, and lower‐quality caregiving environments.
Emerging Nonsteroid-Based Procedural Therapies for Alopecia Areata: A Systematic Review
Authors: Marchitto Mark C. , Qureshi Azam , Marks Dustin , Awosika Olabola , Rengifo-Pardo Monica , Ehrlich Alison 
Published: August 2019

BACKGROUNDAlopecia areata (AA) is a common form of patchy, nonscarring hair loss. Although intralesional steroid injections are currently the mainstay procedural therapy for AA, other nonsteroid-based procedural therapies, including platelet-rich plasma (PRP), ultraviolet radiation (UVR), and laser-based modalities, are emerging as practical options.OBJECTIVETo systematically review nonsteroid-based procedural therapies for AA and recapitulate the available clinical data.MATERIALS AND METHODSA systematic review of the literature was performed searching PubMed/MEDLINE databases identifying studies investigating PRP, UVR, and laser-based modalities for AA treatment.RESULTSLiterature search yielded 644 articles encompassing PRP, UVR, and laser treatment modalities for AA. Of the 644 articles, 46 met inclusion criteria. Although numerous reports demonstrate strong potential for PRP, UVR, and laser modalities in treating AA, high-quality evidence supporting their efficacy is still lacking.CONCLUSIONThere is an abundance of evidence for nonsteroid-based procedural therapies in the treatment of AA. Randomized control trials comparing these treatment options head-to-head should be performed to better understand the true efficacy of these treatments.
Teledermatology as a Tool for Preoperative Consultation Before Mohs Micrographic Surgery Within the Veterans Health Administration
Authors: Lee Steven , Dana Ali , Newman Jessica 
Published: August 2019

BACKGROUND
Telemedicine is improving access to subspecialty care within the Veterans Health Administration (VHA). Mohs micrographic surgery (MMS) is a surgical modality used to treat nonmelanoma skin cancers.

OBJECTIVE
This study evaluates the use of teledermatology for preoperative consultation for MMS.

METHODS AND MATERIALS
A retrospective analysis of interfacility MMS referrals to the Bronx Veterans Affairs Medical Center (VAMC) was conducted. The consult failure rates (CFRs), treatment follow-through rates, time to treatment, and travel savings for “face-to-face” preoperative consults were compared with store-and-forward “teledermatology” preoperative consults.

RESULTS
Although both “teledermatology” and “face-to-face” preoperative consults resulted in an equivalent percentage of treated lesions, teledermatology had a significantly decreased CFR. In addition, teledermatology decreased the time to treatment by 2 weeks, increased the percentage of lesions treated within 60 days, and resulted in average travel savings of 162.7 minutes, 144.5 miles, and $60.00 per person.

CONCLUSION
This study demonstrates that teleconsultation is effective for preoperative consults for MMS within the VHA system. Teledermatology improved access measures such as time to treatment and travel burden. This program may serve as a model not only for other VAMCs that accept interfacility MMS consults, but also for VAMCs that provide other types of access-limited subspecialty care.
A Critical Appraisal of Adult Trigger Finger: Pathophysiology, Treatment, and Future Outlook
Authors: Brozovich Nikolas , Agrawal Devandra , Reddy Gangadasu 
Published: August 2019

Background:
Trigger finger (TF) is a common referral to a hand surgeon, with people with diabetess being the most at-risk population. Abnormal thickening, scarring, and inflammation occur at the A1 pulley and flexor tendon, and histological changes correlate well with the clinical severity of TF. Corticosteroid injections decrease the thickness of the A1 pulley and are considered a first-line treatment. However, corticosteroids are only moderately effective, especially for people with diabetes. Patients may elect for surgery if nonoperative treatments prove ineffective; some may choose immediate surgical release instead. To release the A1 pulley, patients have the option of an open or percutaneous approach. The open approach has a greater risk of infection and scar tissue formation in the short run but an overall superior long-term outcome compared with the percutaneous approach.

Methods:
We critically reviewed the efficacy and cost-effectiveness of the treatment methods for TF through a comprehensive search of the PubMed Database from 2003 to 2019.

Results:
To reduce costs, while still delivering the best possible care, it is critical to consider the likelihood of success for each treatment method in each subpopulation. Furthermore, some patients may need to return to work promptly, which ultimately may influence their desired treatment method.

Conclusions:
Currently, there is no universal treatment algorithm for TF. From a purely financial standpoint, women without diabetes presenting with a single triggering thumb should attempt 2 corticosteroid trials before percutaneous release. It is the most cost-effective for all other subpopulations to elect for immediate percutaneous release.
Direct Reprogramming Into Corneal Epithelial Cells Using a Transcriptional Network Comprising PAX6, OVOL2, and KLF4
Authors: Kitazawa Koji , Hikichi Takafusa , Nakamura Takahiro , Nakamura Masahiro , Sotozono Chie , Masui Shinji , Kinoshita Shigeru 
Published: August 2019

Abstract:
In its early stages, an embryo polarizes to form cell subpopulations that subsequently produce specific organ cell types. These cell subpopulations are defined by transcription factors (TFs) that activate or repress specific genes. Although an embryo comprises thousands of TFs, surprisingly few are needed to determine the fate of a given cell. The ectoderm divides into the neuroectoderm and surface ectoderm, the latter of which gives rise to epidermal keratinocytes and corneal epithelial cells (CECs). Meanwhile, neuroectoderm cells give rise to other parts of the eye such as the corneal endothelium and retina. To investigate the regulatory role of TFs in CECs, we overexpressed the “core TFs” (PAX6, OVOL2, and KLF4) in human fibroblasts and found that the cells adopted a CEC-like quality. OVOL2 overexpression was even able to directly induce cells with a neuroectoderm fate toward a surface ectoderm fate, designated “direct reprogramming.” Conversely, suppression of OVOL2 or PAX6 expression induced CECs to show qualities consistent with neural lineage cells or epidermal keratinocytes, respectively. This suggests that these core TFs can maintain the CEC phenotype through reciprocal gene regulation. Direct reprogramming has important implications for cell therapies. The potential benefits of cells derived by direct reprogramming compared with induced pluripotent stem cells include the fact that it requires less time than reprogramming a cell back to the pluripotent state and then to another cell type. Further understanding of the reciprocally repressive mechanism of action for core TFs could lead to alternative treatments for regenerative medicine not requiring cell transplantation.
Testing the intergenerational model of transmission of risk for chronic pain from parents to their children: an empirical investigation of social transmission pathways
Authors: Higgins Kristen S. , Chambers Christine T. , Rosen Natalie O. , Sherry Simon , Mohammadi Somayyeh , Lynch Mary , Campbell-Yeo Marsha , Clark Alexander J. 
Published: August 2019

Abstract
Children of parents with chronic pain have higher rates of pain and internalizing (eg, anxiety and depressive) symptoms than children of parents without chronic pain. Parental modeling of pain behaviour and reinforcement of child pain have been hypothesized to underlie these relationships. These mechanisms were tested in a sample of 72 parents with chronic pain and their children (aged 8-15 years). Standardized measures were completed by parents (pain characteristics, pain interference, and child internalizing) and children (pain catastrophizing, pain over previous 3 months, and internalizing). In a laboratory session, children completed the cold pressor task in the presence of their parent, and parent–child verbalizations were coded. Significant indirect effects of parental pain interference on child self-reported (B = 0.12, 95% confidence interval [CI]: 0.01-0.29) and parent-reported (B = 0.16, 95% CI: 0.03-0.40) internalizing symptoms through child pain catastrophizing were found (parental modeling mechanism), and were not moderated by child chronic pain status. Significant indirect effects were found between parent pain-attending verbalizations and child self-reported (B = 2.58, 95% CI: 1.03-5.31) and parent-reported (B = 2.18, 95% CI: 0.93-4.27) cold pressor task pain intensity and tolerance (B = −1.02, 95% CI: −1.92 to −0.42) through child pain-attending verbalizations (parental reinforcement mechanism). Although further understanding of the temporal relationships between these variables is needed, the current study identifies constructs (eg, parent pain interference, child pain catastrophizing, and parent reinforcement of child pain) that should be further examined as potential targets for prevention and intervention of pain and internalizing symptoms in children of parents with chronic pain.
Gait Analysis in Individuals with Transtibial Amputation Walking on Sand: Comparing Everyday Prosthesis with a Water-Activity Prosthesis
Authors: van den Berg Maayken E.L. , Barr Christopher J. , Cavenett Sally , Crotty Maria 
Published: August 2019

ABSTRACT

Introduction
This exploratory descriptive case-control study examined gait characteristics during sand walking in people with unilateral transtibial amputation, comparing patterns between everyday prosthesis with shoe, everyday prosthesis without shoe (EPWS), and a water-activity prosthesis (WAP), and evaluated how users experience the use of the WAP.

Materials and Methods
Three-dimensional gait analysis, using an eight-camera Vicon motion capture system, was completed for 16 participants (mean age, 51.4 ± 5.5; 75% male, amputation etiology 63% trauma) when walking independently over level ground (baseline) and sand (gait adaptation response). Outcome variables were spatiotemporal data and kinematic data for the hip, knee, and ankle, and additionally, a purposefully designed Water Activity Prosthesis Survey was completed.

Results
The results demonstrated cautious gait with reduced walking speed (P < 0.05) and decreased ankle range of motion (<0.05) in the prosthetic limb when walking with the EPWS and WAP. Using the WAP resulted in most prominent kinematic adaptational changes on sand. When comparing differences between the EPWS and WAP, significantly less hip extension (−2.92°; 95% confidence interval, −5.56 to −0.28; P = 0.02) and significantly less movement at the ankle (P < 0.05) occurred in the prosthetic limb in walking trials with the WAP. Nevertheless, more than 80% of the participants used the WAP at least twice a week for shower, pool, and beach activities.

Conclusions
This study suggests that, although important for participation in ADL and leisure activities and supporting higher quality of life, the use of the WAP leads to unfavorable biomechanical gait alterations. Therefore, when prescribing the WAP, this trade-off should be taken into consideration.
Does expanded state scope of practice for nurse practitioners and physician assistants increase primary care utilization in community health centers?
Authors: Park Jeongyoung , Han Xinxin , Pittman Patricia 
Published: August 2019

ABSTRACT

Background and purpose:
Expanding state scope of practice (SOP) for nurse practitioners (NPs) and physician assistants (PAs) can boost productivity and improve access to health care services. Existing analyses on regulatory policies in NP or PA SOP have primarily focused on the direct effects on their own professions but have not fully considered the potential cross-professional effects. This study examines the impact of expanded state SOP for NPs and PAs on primary care utilization by NP, PA, and primary care physician (PCP) in community health centers (CHCs).

Methods:
We conducted a difference-in-differences approach using the Uniform Data System for 739 CHCs from 2009 to 2015. During our study period, 12 states liberalized NP SOP laws and 14 states changed their PA SOP regulations. The number of visits per full-time equivalent clinician (NP, PA, and PCP) per year was the outcome of interest and was linked to the degree of state SOP restriction for NPs and PAs in a given year.

Conclusions:
Granting independent practice and prescriptive authority for NPs resulted in statistically significant increases in NP visits, and decreases in both PA and PCP visits, for those CHCs with a high proportion of NPs and PAs along with the increased provision of support staff. PA SOP liberalization had no statistically significant effect on PA visits.

Implications for practice:
As the NP and PA workforce continues to grow, and as SOP laws continue to be liberalized, it is important to advance evidence on how to most efficiently deploy these staff.
Recombined humanized endostatin (Endostar) intravenous infusion in the treatment of refractory nasopharyngeal carcinoma
Authors: Chen Chen , Liu Song-Ran , Zhou Shu , Li Xiao-Hui , Wang Xiao-Hui , Tao Ya-Lan , Chang Hui , Zhang Wen-Wen , Li Wen-Fei , Zhou Si-Lang , Xia Yun-Fei 
Published: August 2019

Abstract

Rationale:
Refractory nasopharyngeal carcinoma is challenging to treat and at present there is no standard treatment or any good choice.

Patient concerns:
Although the three patients in our case reports had already underwent multiple treatments before, they still suffered from disease recurrence of nasopharyngeal carcinoma.

Diagnosis:
They were diagnosed as refractory nasopharyngeal carcinoma.

Interventions:
A continuous infusion of Endostar, an antiangiogenic agent, combined with chemotherapy and radiation therapy was given to treat the patients.

Outcomes:
Patients showed complete or partial response to the combined therapy as evidenced by regression of tumors and decrease in plasma Epstein–Barr virus (EBV) DNA load.

Lessons:
Continuous infusions of Endostar in combination with chemotherapy and/or radiation therapy showed promising efficacy and safety. The combination therapy indicates a new approach to treat refractory nasopharyngeal carcinoma.
Is allograft a more reliable treatment option than autograft in 2-level anterior cervical discectomy and fusion with plate fixation?
Authors: Park Jin-Sung , Park Se-Jun , Lee Chong-Suh , Chung Sung-Soo , Park Hyun-Jin 
Published: August 2019

Abstract
This study aimed to assess the efficacy of allograft in 2-level anterior cervical discectomy and fusion (ACDF) with plate fixation by comparing its clinical and radiological outcomes to those of autograft.
Thirty five patients with femur cortical allografts and 32 patients with tricortical iliac autografts were evaluated. All surgeries were performed by a single senior surgeon. During routine follow-up (at 3 months, 6 months, and annually after the surgery), the fusion rate, subsidence rate, and fused segmental lordosis angle were assessed by radiologic evaluation. Clinical outcomes were assessed using the visual analog scale (VAS), neck disability index (NDI) scores, and Odom criteria. This study was conducted using the results of the 2-year postoperative follow-up.
Among 67 patients, 62 (92.5%) showed successful bone fusion at 2 years postoperatively: 91.4% (32/35) in the allograft group and 93.8% (30/32) in the autograft group. The fusion rate was 37.1% (13/35) in the allograft group and 68.8% (23/32) in the autograft group at 6 months and 68.5% (24/35) in the allograft group and 93.8% (30/32) in autograft group at 1 year. Eight (72.7%) of the remaining 11 patients with allograft achieved bone fusion without any intervention at the 2-year follow-up. The fusion was achieved faster in the autograft group than in the allograft group (P = .003). There was no significant difference in the subsidence rate or change in the fused segmental lordosis angle between the 2 groups; there was also no significant difference in clinical outcomes (NDI scores, VAS scores, Odom criteria) between the 2 groups. However, the intraoperative blood loss was significantly greater in the autograft group, and the operative time was also significantly longer in the autograft group (P < .001). In the autograft group, 6 patients (18.8%) had minor complications at the donor site.
In 2-level ACDF with plate fixation, the radiologic and clinical outcomes of autograft and allograft were similar at 2-year follow-up, although fusion was observed earlier in the autograft group.
Analysis of human leukocyte antigen allele polymorphism in patients with non alcoholic fatty liver disease
Authors: Karrar Azza , Hariharan Siddharth , Fazel Yousef , Moosvi Ali , Houry Mohamad , Younoszai Zahra , Jeffers Thomas , Zheng Li , Munkhzul Otgonsuren , Hunt Sharon , Monge Fanny , Goodman Zachary , Younossi Zobair M. 
Published: August 2019

Abstract
The human leukocyte antigen (HLA) genes may play a role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH). The aim of this study was to assess the association of HLA class I and II alleles with NASH and its histological features.
Deoxyribonucleic acid (DNA) was extracted from 140 subjects (85 biopsy-proven NAFLD and 55 controls) and genotyped for HLA (-A, -B, -C, -DR1, -DR3, -DQ, and -DP). Liver biopsies were assessed for presence of NASH, degree of fibrosis and inflammation. Multivariate analysis was performed to assess associations between HLA genes and different histologic features of NAFLD.
Our data for HLA class I showed that HLA-C∗4 was associated with lower risk for histologic NASH and HLA-C∗6 was protective against portal fibrosis. Conversely, HLA-B∗27 was associated with high-grade hepatic steatosis, while HLA-A∗31 was associated with increased risk for advanced fibrosis. Among HLA class II alleles, HLA-DQA1∗01 was associated with lower risk for NASH while HLA-DRB1∗03 was associated with increased risk for NASH.
Our findings indicate that HLA class I and II gene polymorphism may be associated with susceptibility to NASH, fibrosis and other pathologic features and may be involved in the pathogenesis of NAFLD.