bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standardized Psychosocial Assessment Before Left Ventricular Assist Device Implantation
Authors: Sperry Brett W. , Ikram Asad , Alvarez Paulino A. , Perez Antonio L. , Kendall Kay , Gorodeski Eiran Z. , Starling Randall C. 
Published: January 2019

Background:
Before consideration of advanced cardiac therapies, guidelines recommend a comprehensive multidisciplinary examination, including psychosocial assessment. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) has emerged as a highly reproducible tool to assess for psychosocial impairment and is associated with negative medical and psychosocial outcomes after transplantation. We sought to assess the association between SIPAT and outcomes after left ventricular assist device.

Methods and Results:

We evaluated 128 patients implanted with a first left ventricular assist device at the Cleveland Clinic from 2013 to 2017 who underwent a prospectively collected quantitative psychosocial assessment using SIPAT. Several survival analyses were performed testing the association between SIPAT score and mortality, first adverse event (defined as hospitalization, device exchange, or death), and recurring adverse events after multivariable adjustment. Median SIPAT score was 14 (interquartile range, 9.5–22.5), with higher values (representing more impairment) seen in patients implanted as destination therapy. After a median follow-up of 349 (interquartile range, 178–684) days, there were 319 adverse events (18 deaths, 10 device exchanges, and 291 readmissions) with 2.5±2.4 events per patient. Higher preimplant SIPAT scores were not associated with mortality (
P
=0.764) or time to a first adverse event (
P
=0.589) but were associated with cumulative adverse events (hazard ratio, 1.31; 95% CI, 1.09–1.58;
P
=0.005 per Δ10 in score). In addition, SIPAT was associated with days alive outside of the hospital (
P
=0.016).

Conclusions:
A standardized assessment of psychosocial impairment after left ventricular assist device using the SIPAT score was not associated with mortality or time to first adverse event but was associated with cumulative adverse cardiac events. This score may provide insight when structuring mitigation strategies for high-risk patients and should be further tested in a prospective multicenter study.
Postpartum Period Is a Risk Factor for Cerebral Venous Thrombosis
Authors: Silvis Suzanne M. , Lindgren Erik , Hiltunen Sini , Devasagayam Sharon , Scheres Luuk J. , Jood Katarina , Zuurbier Susanna M. , Kleinig Timothy J. , Silver Frank L. , Mandell Daniel M. , Middeldorp Saskia , Putaala Jukka , Cannegieter Suzanne C. , Tatlisumak Turgut , Coutinho Jonathan M. 
Published: January 2019

Background and Purpose—
Pregnancy and the postpartum period are generally considered to be risk factors for cerebral venous thrombosis (CVT), but no controlled studies have quantified the risk.

Methods—
Case-control study using data of consecutive adult patients with CVT from 5 academic hospitals and controls from the Dutch MEGA study (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis). Men, women over the age of 50, women using oral contraceptives or with a recent abortion or miscarriage were excluded. We adjusted for age and history of cancer, and stratified for pregnancy versus postpartum, and 0 to 6 versus 7 to 12 weeks postpartum.

Results—
In total 163/813 cases and 1230/6296 controls were included. Cases were younger (median 38 versus 41 years) and more often had a history of cancer (14% versus 4%) than controls. In total 41/163 (25%) cases and 82/1230 (7%) controls were pregnant or postpartum (adjusted odds ratio, 3.8; 95% CI, 2.4–6.0). The association was fully attributable to an increased risk of CVT during the postpartum period (adjusted odds ratio, 10.6; 95% CI, 5.6–20.0). We found no association between pregnancy and CVT (adjusted odds ratio, 1.2; 95% CI, 0.6–2.3). The risk was highest during the first 6 weeks postpartum (adjusted odds ratio, 18.7; 95% CI, 8.3–41.9).

Conclusions—
Women who have recently delivered are at increased risk of developing CVT, while there does not seem to be an increased risk of CVT during pregnancy.
Mountain Volume Control on Deep-Convective Rain Amount during Episodes of Weak Synoptic Forcing
Authors: Imamovic Adel , Schlemmer Linda , Schär Christoph 
Published: January 2019

AbstractThermally driven upslope flows in mountainous areas provide favorable conditions for diurnal deep moist convection especially during episodes of weak synoptic forcing. The present study investigates the response of deep convection to axisymmetric orography as a function of orographic width and height by running ensembles of idealized convection-resolving simulations with a horizontal grid spacing of Δx = 1 km, full-physics parameterizations, and an interactive land surface. Deep convection is explicitly resolved and not parameterized. To cover a wide range of orographic scales, simulations are conducted with heights between 250 and 4000 m and widths between 5 and 30 km. The mountain slope strongly affects upslope wind speed characteristics, the timing and intensity of local updrafts, and local rain intensity. Although the day-to-day variability is substantial, the statistical-mean rain amount extracted by the mountain scales almost linearly with the mountain volume. Simulations with alternative mountain geometries, multiple peaks, and large-scale flow suggest that the linear scaling is valid for a surprisingly large portion of the parameter space. The scaling breaks down in the limit of relatively strong large-scale flows, sufficiently tall mountains, or elongated mountains. The existence of the simple linear scaling over such a wide range of configurations suggests that the response of thermally driven orographic deep convection over many mountainous areas is strongly affected by mountain volume. As a consequence, the rain amount is disproportionally dominated by the large horizontal scales of orography, as they contribute mostly to the mountain volume.
Issues, Strategies, and Perspectives in the Management of Disruptive Child Behavior in the Classroom
Authors: Walker Hill M. , Holland Francine 
Published: January 2019

This paper focuses upon disruptive child behavior in the classroom. The goals of the paper are twofold: (a) to communicate knowledge and information regarding the dynamics of disruptive child behavior, and (b) to present practical, cost-effective behavior management strategies that teachers can use in remediating such behavior. Initially, the paper addresses the apparent trend toward an increase in both the frequency and the severity of child behavior problems occurring in the school setting. Possible reasons for this trend are presented, and our capacity as educators to respond to the challenge presented by it is discussed. In this section of the paper, factors relating to limitations in the educational setting which prevent or constrain the application of systematic behavior management procedures in the remediation of child behavior problems are also discussed. The main body of the paper deals with the following issues: (a) characteristics of disruptive child behavior in school; (b) teacher attempts to cope with disruptive child behavior; (c) strategies for remedying behavior problems in the classroom; (d) procedures for building in durability and generalization of treatment gains; and (e) limitations and ethical issues associated with the use of behavior management procedures. Behavior management procedures and strategies are presented in such a way, it is hoped, as to maximize their usage by classroom teachers. Considerable attention is given to the issues of practicality and cost-effectiveness in their application. The procedures presented and discussed are applicable in both regular and special classroom settings.
Participant Understandings and the Complexities of Educational Change: The Breakdown and Regeneration of the Greenfield Experiment
Authors: Seldin Clement A. , Maloy Robert W. 
Published: January 2019

In June of 1977, the public school system of Greenfield, Massachusetts, * in conjunction with the Massachusetts State Department of Education and the School of Education at the University of Massachusetts, embarked on a two-year collaboration to conceptualize and design a more responsive and effective secondary education process. The Greenfield Secondary Schools Project (GSSP) was to be an attempt by teachers, students, administrators, and community members to develop comprehensive solutions to educational problems. The GSSP represented a major attempt at broad-based, decentralized innovation in public education. Despite the collaborative approach, shared decision-making strategies, local control, and decentralized structure, the GSSP was unable to effectively manage major obstacles, and participant commitment to the change process began to dissolve. The main body of this article contends that preexisting expectations and assumptions about change, shared by participants, can inhibit and even break down a progressive, elaborately preplanned change model. The article's postscript describes the unique regeneration of the GSSP in terms of a new minigrant program and the consolidation of project leadership.
Assessing sizes of breast cancers that show non-mass enhancement on MRI based on inter-observer variability and comparison with pathology size
Authors: Koh Jieun , Park Ah Young , Ko Kyung Hee , Kim Sewha , Jung Hae Kyoung 
Published: January 2019

Background Magnetic resonance imaging (MRI) is largely used for preoperative evaluation of breast cancer. Purpose The aim of this study is to evaluate inter-observer variability for measuring the sizes of non-mass enhancement (NME) breast cancers on various sequences of MRI and to compare with pathology size. Material and Methods From January 2013 to April 2017, 70 breast cancers in 70 women showed NME on preoperative MRI. Three observers retrospectively measured the cancers with the longest diameters on subtracted early dynamic contrast-enhanced (DCE) T1 (early T1), delayed DCE T1 (delayed T1), and maximum intensity projection (MIP) images; the measurements between observers were analyzed using the intraclass correlation coefficient (ICC). Pathology sizes were compared using ICCs and Bland–Altman plots, and concordance rates were calculated with MRI and pathology size differences of ≤0.5 cm. Results The ICC for the three observers’ breast cancer size measurements was excellent (0.945) and that between MRI and pathology size was good to excellent in all observers (0.742–0.850). Compared with pathology size, the Bland–Altman plots revealed a positive trend of differences in all MRI measurements. Three observers overestimated nearly half of the measured breast cancers on all three MRI sequences; the overestimation rates were the highest on MIP for observers 1 and 3 (68.6% and 55.7%) and on delayed T1 for observer 2 (57.1%). Conclusion The size assessments of NME breast cancer on MRI showed high correlation between observers and with pathology size. However, MRI measurements need a cautious approach because of their high overestimation rates. Measurements from early T1 images showed the highest concordance rate with pathology size.
Osteochondral Autograft Transplantation Technique Augmented by an Ultrapurified Alginate Gel Enhances Osteochondral Repair in a Rabbit Model
Authors: Hishimura Ryosuke , Onodera Tomohiro , Hontani Kazutoshi , Baba Rikiya , Homan Kentaro , Matsubara Shinji , Joutoku Zenta , Kim WooYoung , Nonoyama Takayuki , Kurokawa Takayuki , Gong Jian Ping , Iwasaki Norimasa 
Published: January 2019

Background: One of the most important limitations of osteochondral autograft transplantation (OAT) is the adverse effect on donor sites in the knee. To decrease the number and/or size of osteochondral defects, we devised a method with biomaterial implantation after OAT. Hypothesis: OAT augmented by ultrapurified alginate (UPAL) gel enhances cartilage repair capacity. Study Design: Controlled laboratory study. Methods: Seventy-five osteochondral defects in rabbits were divided into 3 groups: osteochondral defects with OAT alone, defects with OAT augmented by UPAL gel (combined group), and defects without intervention as controls. Macroscopic and histological evaluations of the reparative tissues were performed at 4 and 12 weeks postoperatively. Histological evaluation of graft cartilage degradation was also performed. To evaluate the effects of UPAL gel on graft healing, repaired bone volumes and osseointegration of the graft were evaluated. Collagen orientation and the mechanical properties of the reparative tissue and graft cartilage were also evaluated qualitatively. Results: The macroscopic and histological evaluations of the combined group were significantly superior to the other groups at 12 weeks postoperatively. Regarding degenerative change of the graft, the histological scores of the combined group were significantly higher than those of the OAT-alone group. The values of repaired subchondral bone volumes and osseointegration of the graft were almost identical in both groups. Collagen orientation and the mechanical properties of the reparative tissue and graft cartilage were significantly better in the combined group than in the other groups. Conclusion: Administration of UPAL gel in OAT enhanced cartilage repair and protected graft cartilage without inhibiting subchondral bone repair and graft survival. Clinical Relevance: OAT augmented by UPAL gel decreases the number and/or size of osteochondral grafts, minimizing the risk of donor site morbidity. This combination technique has the potential to improve clinical outcomes and expand the surgical indications for OAT.
Delayed ACL Reconstruction in Patients ≥40 Years of Age Is Associated With Increased Risk of Medial Meniscal Injury at 1 Year
Authors: Stone Jonathan A. , Perrone Gabriel S. , Nezwek Teron A. , Cui Qingping , Vlad Steven C. , Richmond John C. , Salzler Matthew J. 
Published: January 2019

Background: Anterior cruciate ligament (ACL) tears in the pediatric and young adult ACL-deficient knee are often associated with meniscal or chondral injury with delayed time to surgery. The incidence of ACL reconstruction performed in patients aged ≥40 years is rising, and it is unclear if delayed surgery in this cohort similarly affects the health of the meniscus and cartilage. Purpose: To evaluate whether delayed reconstruction in a cohort of patients aged ≥40 years is associated with an increased risk of meniscal or chondral injury. Study Design: Cohort study; Level of evidence, 3. Methods: Records of patients aged ≥40 years who underwent primary arthroscopic ACL reconstruction between 2012 and 2016 at an academic hospital were retrospectively reviewed. Patient characteristic data and time to surgery were recorded. Operative reports were analyzed for meniscal and chondral injuries as well as treatment. Patients were grouped according to time to surgery, defined as early (<90 days) or delayed (≥90 days). Logistic regression modeling was used to form associations between elapsed time to surgery and patient characteristics to meniscal and chondral damage. Additionally, risks for meniscal and chondral injury were analyzed at time points of 180 days and 1 year from injury to surgery. Results: A total of 227 patients met the study criteria: 106 patients underwent early surgery, and 121 underwent delayed surgery. The authors identified 127 medial meniscal tears and 106 lateral meniscal tears. Medial, lateral, and patellofemoral compartment chondral injury was reported in 127, 82, and 130 patients, respectively. Delayed surgery (≥90 days) was not associated with increased risk of medial or lateral meniscal tears or any chondral injury at 90 days. Each year of increased age was associated with an increased odds ratio: 1.09 ( P = .001) for medial meniscal tears, 1.06 ( P = .014) for lateral meniscal tears, 1.10 ( P = .001) for medial compartment chondral injuries, and 1.07 ( P = .007) for patellofemoral compartment chondral injuries. Additionally, each unit of increased body mass index was associated with an increased odds ratio: 1.09 ( P = .039) for medial meniscal tears and 1.14 ( P = .003) for medial compartment cartilage injury. Analysis of 180-day and 1-year time points revealed an increased risk (odds ratio, 3.47; 95% CI, 1.55-7.77; P = .002) for medial meniscal injury when surgery was delayed for >1 year. Conclusion: Delayed ACL reconstruction (≥90 days) among patients aged ≥40 years was not associated with an increased risk of meniscal or chondral injury. Increasing age and body mass index were associated with higher risks of meniscal and chondral injuries in this cohort. Delay in surgery for >1 year was associated with increased risk of medial meniscal tear.
Towards prompt electrocardiogram acquisition in triage: Preliminary testing of a symptom-based clinical prediction rule for the Android tablet
Authors: O’Donnell Sharon , Monahan Peter , McKee Gabrielle , McMahon Geraldine , Curtin Elizabeth , Farrell Sean , Moser Debra 
Published: January 2019

Background: For patients with suspected acute coronary syndrome, international guidelines indicate that an Electrocardiogram (ECG) should be performed within 10 min of first medical contact, however success at achieving these guidelines is limited. Aims: The purpose of this study was to develop and perform initial testing of a clinical prediction rule embedded in a tablet application, and to expedite the identification of patients who require an electrocardiogram within 10 min. Methods: This derivation of the Acute Coronary Syndrome Application (AcSAP) comprised of three local studies, an unpublished audit and literature critique. The AcSAP was prospectively tested over four months in patients presenting to the Emergency Department (ED) of a Dublin teaching hospital. An audit form retrieved data pertaining to times of: registration to the emergency department, triage, first electrocardiogram and diagnosis. The AcSAP was subsequently evaluated by experienced triage nurses ( n=18) who had utilised it. Results: The AcSAP was activated 379 times. Patients with ST Elevation Myocardial Infarction (STEMI) and non-ST Elevation Myocardial Infarction (NSTEMI) were significantly more likely to return a categorisation of ‘immediate ECG’ or ‘ECG within 10 min’ ( p<0.001). There was a significant difference in ‘triage to ECG’ times across categories, the ‘immediate ECG’ categorisation resulting in the shortest time ( p=0.002). Evaluations suggest that staff found the tool quick and easy to use and results seemed accurate. Conclusion: Testing of the AcSAP suggests that it accurately identifies patients who require an ECG within 10 min. As such, it has the potential to support the meeting of clinical guidelines for ECG acquisition.
Anatomic robotic prostatectomy: current best practice
Authors: Martini Alberto , Tewari Ashutosh Kumar 
Published: January 2019

Urologic prostate surgery has changed dramatically over the past decades. Following the introduction of the robot, the surgical approach has been modified and thanks to the magnification allowed by the robot a further level of precision can be achieved. Moreover, advances in the anatomical studies have provided new evidence regarding the periprostatic anatomy. The aim of this review is to describe our approach to robot-assisted radical prostatectomy. Our holistic perspective towards patient selection, pre- and postoperative care is provided. In our center, robot-assisted radical prostatectomy is performed by means of an anterograde approach. A nonbladder-sparing dissection with a graded approach towards nerve preservation is carried out. The procedure is concluded with what we call ‘total anatomical reconstruction’.
A revisit at 16 years for individuals from peri-urban New Delhi for tobacco use and associated oral lesions
Authors: Mehrotra Ravi , Nethan Suzanne Tanya , Ravi Priyanka , Grover Shekhar , Sharma Shashi , Rath GK , Kaur Jatinder , Ralhan Ranju , Srivastava Anurag 
Published: January 2019

Objectives: India has a high incidence of oral cancer due to multifarious tobacco use. The objective of this study was to assess the status of tobacco-related oral lesions over 16 years, in a screen-detected population. Methods: This cross-sectional study involved home visits of 2000 Delhi residents, previously screened for oral potentially malignant disorders/oral cancer and counseled for tobacco cessation. Their basic demographics and tobacco/alcohol history were noted followed by oral visual examination for any related mucosal abnormalities. The data thus obtained were statistically analyzed. Results: Two hundred and sixty-five individuals (13.2%) could be traced after 16 years. The status of oral lesions varied across the participants, mainly in terms of their location, type, number, and/or presence/absence; no oral malignancies were noted. Most individuals had either a decreased use (34%, p < 0.001) or had quit tobacco (25.7%, p < 0.001); 8.3% individuals from the former and 5.7% from the latter group showed complete lesion(s) regression. The overall change in the tobacco use and oral lesions showed a highly significant positive association ( p < 0.05). Conclusion: A direct relationship exists between tobacco use and oral lesions. Repeated, tobacco cessation counseling provided by health-care professionals is effective. Oral screening of high-risk individuals, along with tobacco cessation, is thus essential.
Dexamethasone implant for immunogammopathy maculopathy associated with IgA multiple myeloma
Authors: Georgakopoulos Constantine D. , Plotas Panagiotis , Angelakis Angelos , Kagkelaris Konstantinos , Tzouvara Evangelia , Makri Olga E. 
Published: January 2019

Background: We describe a case where hyperviscosity retinopathy and immunogammopathy maculopathy were the presenting features of IgA multiple myeloma and report the response of maculopathy to intravitreal injection of dexamethasone implants. Case presentation: A 56-year-old man presented at the Department of Ophthalmology with the chief complain of reduced vision for the past 10 days in both eyes. Ophthalmic examination revealed central retinal vein occlusion resembling signs with severe macular edema in both eyes with prominent serous macular detachment. After comprehensive evaluation, an IgA type kappa multiple myeloma was diagnosed complicated with hyperviscosity-associated retinopathy and immunogammopathy maculopathy. Patient was treated with multiple sessions of plasmapheresis, systemic chemotherapy, and finally intravitreal implants of dexamethasone with complete restoration of macular edema and serous macular detachment in both eyes. The visual function and the hyperviscosity-associated retinopathy were partially restored. Conclusion: Ocular manifestation might be the only presenting sign of a life-threatening disease such as IgA multiple myeloma. A high level of suspicion is required to diagnose and treat such cases promptly and effectively.