bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Most Valuable Resource Is Time: Insights From a Novel National Program to Improve Retention of Physician–Scientists With Caregiving Responsibilities
Authors: Jones Rochelle D. , Miller Jacquelyn , Vitous C. Ann , Krenz Chris , Brady Kathleen T. , Brown Ann J. , Daumit Gail L. , Drake Amelia F. , Fraser Victoria J. , Hartmann Katherine E. , Hochman Judith S. , Girdler Susan , Libby Anne M. , Mangurian Christina , Regensteiner Judith G. , Yonkers Kimberly , Jagsi Reshma 
Published: July 2019

Purpose
To enhance understanding of challenges related to work–life integration in academic medicine and to inform the ongoing implementation of an existing program and the development of other interventions to promote success of physician–scientists.

Method
This study is part of a prospective analysis of the effects of the Fund to Retain Clinical Scientists (FRCS), a national program launched by the Doris Duke Charitable Foundation at 10 U.S. institutions, which provides financial support to physician–scientists facing caregiving challenges. In early 2018, 28 of 33 program awardees participated in semistructured interviews. Questions were about challenges faced by physician–scientists as caregivers and their early perceptions of the FRCS. Multiple analysts reviewed deidentified transcripts, iteratively revised the coding scheme, and interpreted the data using qualitative thematic analysis.

Results
Participants’ rich descriptions illuminated 5 interconnected themes: (1) Time is a critical and limited resource, (2) timing is key, (3) limited time resources and timing conflicts may have a particularly adverse effect on women’s careers, (4) flexible funds enable reclamation and repurposing of time resources, and (5) FRCS leaders should be cognizant of time and timing conflicts when developing program-related offerings.

Conclusions
Programs such as the FRCS are instrumental in supporting individuals to delegate time-consuming tasks and to control how they spend their valuable time. Qualitative analysis suggests that access to and command of valuable time resources are crucial to career advancement, research productivity, and work–life flexibility, especially during critical time points along the physician–scientist trajectory.
Irrigation and Debridement of an Open Ankle Fracture With Open Reduction and Internal Fixation and Syndesmotic Fixation Using a Suture Button Device
Authors: Davis Max E. , Blum Laura , Talusan Paul G. , Hake Mark E. 
Published: July 2019

Summary:
Ankle fractures are among the most common surgically treated fractures. The incidence of syndesmotic injury in ankle fractures is 13%–20%. The goal of syndesmotic fixation is a stable, symmetric ankle joint. Missing or poorly reducing a syndesmotic injury can result in diminished function and tibiotalar arthritis. Recently, a suture button–type device has been used instead of the traditional trans-syndesmotic screw-type fixation. This case-based video demonstrates a technique for using suture button–type devices to repair syndesmotic ankle injuries and presents the data regarding the outcomes of this novel technique.

Video available at:
http://links.lww.com/JOT/A807
Treatment of a Complex Interprosthetic Humerus Fracture
Authors: DeFroda Steven , Henry Havalee , Paxton E. Scott 
Published: July 2019

Summary:
Interprosthetic humeral shaft fractures involving shoulder and elbow arthroplasty can be difficult to manage surgically, both due to fracture and patient characteristics. Adequate fixation can be difficult, given the intramedullary nature of the adjacent implants. Careful attention must be paid to regional anatomy, and care must be taken to not damage the radial or ulnar nerve during dissection and mobilization of the fracture, especially if scar tissue exists from multiple previous surgeries. Finally, fixation strategies must be used to gain stability in areas where there is a cement mantle or well-fixed intramedullary stem to impart the stability required for adequate healing and postoperative mobilization. Biologic augmentation is often used as well, given the relatively poor biologic environment for bone healing. We review our technique for operative fixation of a patient with a humeral shaft fracture between a cemented shoulder hemiarthroplasty and total elbow arthroplasty.

Video available at:
http://links.lww.com/JOT/A788
Radial Head Replacement Through a Kocher Approach
Authors: Petersen Kyle A. , Siesel Craig , Miller Eric T. 
Published: July 2019

Purpose:
Radial head fractures are some of the most common elbow fractures. Fractures with 3 or more fracture fragments have been shown to have worse outcomes when treated with open reduction and internal fixation (ORIF). Radial head replacement offers an alternative treatment for those more comminuted radial head fractures.

Methods:
Three-part radial head fractures make anatomical reduction more difficult to obtain with ORIF. Radial head fractures requiring replacement have shown good clinical outcomes. As a result, radial head arthroplasty offers a good treatment option for 3-or-more-part radial head fractures.

Results:
This video presents a case of a radial head arthroplasty for a 3-part radial head fracture in a 23-year-old man. The radial head implant provides a smooth and concentric surface for articulation with the capitellum while providing stability to the elbow.

Conclusions:
Radial head replacement provides a good alternative to ORIF, producing similar elbow range of motion and providing good stability compared with the contralateral elbow.

Video available at:
http://links.lww.com/JOT/A793
Arm Fasciotomy Through Lateral Approach
Authors: Carlock Kurtis D. , Shenoy Kartik , Ramme Austin , McLaurin Toni M. 
Published: July 2019

Summary:
Acute compartment syndrome represents one of the few true orthopaedic emergencies. Timely management is essential to prevent permanent sequelae. This video describes a case of acute compartment syndrome of the arm. Relevant patient history, physical examination, and laboratory findings are discussed, and a presentation of the operative technique for arm fasciotomy through a lateral approach is highlighted. Diagnostic criteria for acute compartment syndrome and indications for fasciotomy are reviewed, with a discussion of published outcomes after fasciotomy.

Video available at:
http://links.lww.com/JOT/A792
Repair of Distal Femoral Periprosthetic Nonunion: Linked Nail Plate Construct
Authors: Egol Kenneth A. , Delsole Edward , Mandel Jessica , Konda Sanjit 
Published: July 2019

Introduction:
Periprosthetic fracture nonunions represent a rare problem in orthopaedic practice, although their incidence has increased with the increased frequency of joint replacement surgery. This video demonstrates the use of a linked nail-plate construct to repair a distal femoral periprosthetic fracture nonunion.

Methods:
The patient is a 93-year-old woman who is 1-year status-post a left distal femoral periprosthetic fracture with known delayed healing. She presents with a low energy trauma and hardware failure. The patient was indicated for operative fixation using a linked nail-plate construct given the patient's previous hardware failure, advanced age, and poor bone quality.

Results:
This video demonstrates the linked nail-plate technique for the repair of a distal femoral periprosthetic fracture nonunion. Anatomical reduction and stable fixation with bone graft was performed with excellent results. There were no intraoperative or postoperative complications and no issues related to metallurgy.

Conclusions:
In this video, we present the case of an atrophic distal femoral periprosthetic nonunion treated with a linked nail-plate construct with autologous bone graft. Although femoral periprosthetic fracture nonunions are a rare occurrence, they can be successfully treated with operative intervention aimed at compression plating with supplemental bone grafting.

Video available at:
http://links.lww.com/JOT/A797
Comparing Dried Blood Spots and Plasma Concentrations for Busulfan Therapeutic Drug Monitoring in Children
Authors: Dilo Ana , Daali Youssef , Desmeules Jules , Chalandon Yves , Uppugunduri Chakradhara R. S. , Ansari Marc 
Published: July 2019

Background:
Busulfan (Bu) is one of the conditioning regimen components for pediatric hematopoietic stem cell transplantation. Bu therapeutic drug monitoring (TDM) is essential for a successful treatment outcome and toxicity evasion. Dried blood spot (DBS) sampling is a rapid and simple method for Bu TDM, compared with conventional plasma sampling. This study evaluated the feasibility of using the DBS method for Bu TDM. The hematocrit (Hct) and conditioning day were also examined for their impact on the DBS method's performance.

Methods:
Venous blood collected from 6 healthy volunteers was diluted, using their plasma into 4 samples of varying Hct values. Each sample was spiked with Bu calibrators (300, 600, and 1400 ng/mL), prepared using DBS and dried plasma spot (DPS) sampling and analyzed using a validated liquid-chromatography tandem-mass spectrometry method. Clinical blood samples (n = 153) from pediatric patients (n = 15) treated with Bu (mainly from doses 1, 2, 5, and 9) were used to prepare paired volumetric DBS and DPS samples. A Bland–Altman plot and Deming regression were used to define the agreement between the paired DBS and DPS measurements. Passing–Bablok regression analyses investigated the effects of Hct and conditioning day on the linearity between both methods.

Results:

In vitro analyses showed good agreement between DBS and DPS measurements, with a mean difference of −5.4% and a 95% confidence interval on the limits of agreement of −15.3% to 4.6%. Clinical samples showed good correlation (Pearson correlation coefficient = 0.96; slope = 1.00) between the DBS and DPS methods. The DBS method met the clinical acceptance limits for clinical samples, with a bias <±20%. Bland–Altman plots showed good agreement, with only 5.8% of paired measurements exceeding the limits of agreement (±1.96 SD), although within its 95% confidence interval. Hct observations ranged from 21.7% to 34.7% and did not affect Bu concentrations measured from DBS in either the in vitro or in vivo studies.

Conclusions:
These results show that DBS is a useful method for Bu TDM, provided samples are analyzed on the collection day. DBS sampling offers advantages over traditional plasma sampling in infants and younger children because only small volumes of blood are required.
Prepectoral Site Conversion for Animation Deformity
Authors: Jones Glyn E. , King Victor A. , Yoo Aran 
Published: July 2019

Background:
A signifcant disadvantage of subpectoral breast reconstruction procedures is animation deformity during pectoralis major contraction. In this study, we discuss one surgeon’s experience with elective subpectoral to prepectoral implant site conversion as a definitive solution to animation deformity..

Methods:
Authors performed a retrospective review of pre-pectoral and sub-pectoral breast reconstructions performed by a single surgeon. Implants placed in the prepectoral plane were supported with total anterior AlloDerm coverage.

Results:
One hundred forty-two breasts in 90 patients who had underwent elective subpectoral to prepectoral implant site conversion. Postoperative resolution of animation deformity was 100%. Overall, complications are minimal with rates at 4.2% for infection, 2.1% for seroma, and 0.7% for hematoma, dehiscence, partial thickness necrosis, and explantation. One patient requested reoperation for reduction in implant volume. Baker grades II–IV capsular contractures are 0% at 43 months.

Conclusion:
Breast implant site conversion from the subpectoral to the prepectoral plane is a safe and definitive solution for animation deformity.
The Simultaneous Application of OASIS and Skin Grafting in the Treatment of Tendon-exposed Wound
Authors: Nobuyma Ayami , Ayabe Shinobu , Kang Songsu , Akome Kenji , Motomura Hisashi 
Published: July 2019

Summary:
In the present case, we successfully applied the OASIS extracellular matrix to a tendon-exposed wound and simultaneously performed skin grafting. In the future, this approach can be used to further reduce a patient’s burden, as it is more effective than PAT transplantation for wounds with exposed tendons.
Possible Missed Acute Coronary Syndrome Rate in North Texas: Is There Room to Improve?
Authors: Chang Mary P. , Vigen Rebecca , Sharma Sushma , Diercks Deborah B. 
Published: July 2019

Background:
Acute coronary syndrome (ACS) is a common diagnosis in the emergency department (ED). Missing this diagnosis may lead to increased morbidity or mortality. With improved cardiac biomarkers tests, it is unknown if that has decreased the prevalence of ACS diagnoses in ED patients who were recently evaluated in the ED.

Methods:
This is a retrospective review of ED patients who were diagnosed with ACS and seen in the ED 7 and 30 days before that visit in North Texas between 2009 and 2015. The demographics and temporal trends of missed ACS rates are described. Logistic regression was used to evaluate if any factors (ie, age, ethnicity, sex, insurance status) were significant.

Results:
Between December 26, 2008 and June 29, 2015, there were 24,914 diagnoses of ACS in the ED. The overall prevalence of patients diagnosed with ACS 7 days after their ED visit was 3.2% and 8.8% at 30 days. For patients diagnosed with ACS 7 days and 30 days after an ED visit, the most common initial ED diagnoses were nonspecific chest pain (57.7%), atherosclerotic disease (19.5%), and heart failure (12.8%). Between 2009 and 2015, there was no overall change in the rate of ACS diagnoses in patients seen 7 or 30 days before an ED visit.

Conclusions:
The prevalence of missed ACS in the North Texas region at 7 and 30 days after the initial ED visit is low and has not changed over the past several years.
Human Ocular Surface Particulate Composition in the Clinical Versus Home Environment
Authors: Kaplan Carol , Galor Anat , Blackwelder Patricia , Hackam Abigail S. , Jeng Bennie H. , Menendez Dhariyat , Kim Sung-Jin , Kumar Naresh 
Published: July 2019

Purpose:
Our eyes are chronically exposed to airborne particulate matter shown to adversely affect the ocular surface. This research examines size, type (organic vs. inorganic), and elemental composition of particles recovered from the ocular surface in 2 environments and their associations with dry eye (DE) metrics.

Methods:
Particles were recovered from the right eye using Schirmer strips obtained both in the clinic and home environments 9 ± 8 days apart. Particle size and elemental composition were assessed using scanning electron microscopy and energy dispersive spectroscopy. The paired t test was used to evaluate the differences in the size and types of ocular surface particles recovered from the clinic and home settings. Associations of particle size and type with home environmental conditions and DE measures were evaluated using correlation analyses.

Results:
The mean age of the 15 patients was 56 years, standard deviation (±) 12 years; 93% were men and 53% self-identified as white. Size, type, and elemental composition did not vary significantly between clinic and home. Particle surface area was marginally associated with home indoor temperature (25 °C ± 2, ρ=−0.53, P = 0.06) and significantly associated with the select DE signs: tear osmolality (304 mOsm/L ± 14, ρ= −0.60, P = 0.02), inflammation (0.7 ± 0.8, ρ = 0.53, P = 0.04), and tear breakup time (7 seconds ± 3, ρ = 0.56, P = 0.03).

Conclusions:
Ocular surface particles were consistently detected across 2 different environments. Greater particle area detected on Schirmer strips correlated with some DE measures, suggesting that particles detected on the ocular surface may affect eye health.
Sensorineural Hearing Loss in the Nonimplanted Ear Following Cochlear Implantation in a Patient With Bilateral Enlarged Vestibular Aqueducts
Authors: Vaisbuch Yona , Thai Anthony , Pirko Sarah L. , Santa Maria Peter L. 
Published: July 2019

Objective:
To document the case of a patient with bilateral enlarged vestibular aqueducts who experienced sensorineural hearing loss in the nonimplanted ear following unilateral cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion and to highlight the need to counsel regarding the risk of potential hearing loss to the contralateral ear when preparing for cochlear implants in the setting of inner ear malformations.

Patients:
One patient with bilateral enlarged vestibular aqueducts in a tertiary referral center.

Intervention(s):
Cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion.

Main Outcome Measure(s):
Bone conduction hearing thresholds, word recognition scores.

Results:
The patient underwent unilateral cochlear implantation, which was complicated by a perilymphatic gusher and	necessitated placement of an intraoperative lumbar drain. On postoperative day 1, the patient reported hearing loss in the opposite ear. The word recognition score in the contralateral ear dropped from 24% at preimplantation to 8% at 2-weeks postimplantation, and did not improve at 6 months postimplantation. Moreover, the bone conduction threshold at 1 kHz worsened from 20 dB preoperatively to no response at 75 dB (the limit of the testing equipment) at 2-weeks postoperatively and only partially improved to 40 dB at 6 months postimplantation.

Conclusion:
As patients with inner ear malformations potentially have direct high-pressure anatomical connections between the perilymphatic spaces and the cerebrospinal fluid, they are at risk of hearing loss in the nonimplanted ear during cochlear implantation. This case highlights the need for potential additional patient counseling regarding this risk in the nonimplanted ear.
Hearing Improvement Following Middle Cranial Fossa Floor Defect Repair Utilizing a Modified Middle Fossa Approach and Reconstructive Techniques
Authors: Alwan Mostafa , Ibbett Imogen , Pullar Michael , Lai Leon T. , Gordon Michael 
Published: July 2019

Background:
Few studies report hearing preservation following middle cranial fossa (MCF) floor defect repair.

Objective:
To investigate audiological outcomes following MCF floor defect repair using a modified MCF suprapetrous approach.

Study Design:
Retrospective cohort.

Setting:
Tertiary referral center.

Patients:
Eleven patients, with MCF floor defects.

Interventions:
MCF floor defect surgical repairs with either fascia or fascia and bone graft.

Main Outcome Measured:
Hearing outcomes.

Results:
Eleven patients (two men) aged 34 to 82 years (median, 62 yrs) were identified. All patients were operated on by the same two senior surgeons (M.P. and M.G.). One patient with conductive hearing loss (based on tuning fork test) was excluded from the analysis due to missing preoperative audiogram data. All patients had middle fossa plate defects leading to cerebrospinal fluid (CSF) otorrhoea, rhinorrhoea, or meningitis. Nine patients had retrieval of herniated contents from the defect. Five patients had repair with temporalis fascia and split calvarial bone graft, and six patients had repair with fascia only. Follow up audiogram was performed at a mean 7.5 months (range, 0.5–24 mo). There was no recurrent CSF leak during the follow up period. The 10 patients (90.9%, 95% confidence interval [CI] 60.1–100.6) who had complete audiologic data sets demonstrated a mean improvement of 18.86 dB (range, –7.5 to 33.75 dB) in hearing postoperatively. One of these patients acquired a 7.5 dB reduction in postoperative hearing due to post-procedural middle ear effusion which subsequently resolved. Hearing improvement following fascial graft alone versus fascial graft with bone was 12.5 and 26.5 dB, respectively (p < 0.01).

Conclusion:
Middle fossa craniotomy with or without retrieval of herniated contents and floor reconstruction with fascia and bone is associated with improved hearing. Clinical efficacy of this technique, however, can be only fully established when a statistically meaningful number of cases have been performed.
Endoscopic Versus Microscopic Middle Ear Surgery: A Meta-analysis of Outcomes Following Tympanoplasty and Stapes Surgery
Authors: Manna Sayan , Kaul Vivian F. , Gray Mingyang L. , Wanna George B. 
Published: July 2019

Objective:
This meta-analysis compares the efficacy and safety of endoscopic and microscopic approaches to tympanoplasty and stapes surgery, two common middle ear procedures.

Data Sources:
A comprehensive electronic search of PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library was conducted for studies published from the year 1960 through June 2018. Article selection and screening proceeded according to the strategies outlined in the standard Preferred Reporting Items for Systematic Reviews and Meta-analysis statement.

Methods:
Studies were assessed for quality using the Newcastle-Ottawa Scale and the Jadad scale depending on the presence of randomization. Bias was analyzed using funnel plots. For each outcome measure, a forest plot was generated and a pooled relative risk or risk difference was calculated to assess significance.

Results:
Twenty-one studies met the inclusion criteria, 16 tympanoplasty (1,323 ears) and 5 stapes surgery (283 ears). The nonrandomized studies scored moderately well but the randomized studies were of low quality with respect to the Newcastle-Ottawa Scale and the Jadad Scale, respectively. With respect to tympanoplasty, statistical analysis demonstrated that the endoscopic approach had significantly lower canalplasty rates, better cosmetic outcomes, and shorter operative times. Furthermore, endoscopic compared to microscopic methods were similar in terms of audiological outcome, graft success rate, and complication rate. Among stapes surgeries, the endoscopic approach demonstrated a significantly decreased incidence of postoperative pain and chorda tympani injury but was similar to the microscopic approach with respect to audiological outcome, postoperative dizziness, and operative time.

Conclusions:
Though the merits of endoscopic techniques are becoming more well known, there are still concerns regarding their efficacy and safety. An analysis of the current literature suggests that audiological, functional, and safety outcomes are similar, if not superior, for the endoscopic approach to both tympanoplasty and stapes surgery compared to the microscopic approach. With respect to tympanoplasty, patients undergoing the endoscopic approach had lower canalplasty rates, better cosmetic outcomes, and shorter operative times. Among stapes surgeries, patients in the endoscopic group had a lower incidence of postoperative pain and injury to the chorda tympani. This meta-analysis of the current evidence supports the use of endoscopic techniques for tympanoplasty and stapes surgery.