bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in the Incidence of Bowen Disease Based on a Single-Center Study in the Netherlands
Authors: Jansen Maud H.E. , Özhan-Hasan Hilal , Nelemans Patty J. , Winnepenninckx Veronique J. , Mosterd Klara 
Published: July 2019

BACKGROUND
Incidence trends of nonmelanoma skin cancer show an increase. Few data have been published about the incidence of Bowen disease (BD). Three previous studies, conducted more than 15 years ago in North America, found large variation in incidence rates in Caucasians, and trends over longer periods have never been studied.

OBJECTIVE
To estimate the incidence of BD in a Caucasian population in Northern Europe (Maastricht, the Netherlands) between 2003 and 2013.

METHODS
Primary and histologically confirmed BD, diagnosed in Maastricht, the Netherlands, in the years 2003, 2008, and 2013, was retrieved from a pathology database. Age-standardized and sex-specific incidence rates per 100,000 inhabitants were calculated by using the age distribution of the European standard population of 2013.

RESULTS
A statistically significant increase in the annual age-standardized incidence rates per 100,000 people was found from 8.1 (95% confidence interval [CI] 3.7–12.5) in 2003 to 68.9 (95% CI 57.2–80.7) in 2013 (p < .001). For women, there was an increase from 7.7/100,000 (95% CI 2.0–13.4) in 2003 to 76.8/100,000 (95% CI 60.2–93.5) in 2013, respectively (p < .001). An increase from 8.8/100,000 (95% CI 1.8–15.9) in 2003 to 59.2/100,000 men (95% CI 42.8–75.6) in 2013 (p < .001) was found.

CONCLUSION
These findings suggest an increase in the annual age-standardized incidence rates in BD.
Validated Assessment Scales for Cellulite Dimples on the Buttocks and Thighs in Female Patients
Authors: Hexsel Doris , Fabi Sabrina Guillen , Sattler Gerhard , Bartsch Rolf , Butterwick Kimberly , Casabona Gabriela , Yen-Yu Chao Yates , Costa Joana , Eviatar Joseph , Geister Thorin L. , Goldie Kate , Grice Jenny , Kerscher Martina , Lorenc Paul , Lupo Mary , Peeters Wouter , Pooth Rainer , Waldorf Heidi A. , Yutskovskaya Yana , Kaminer Michael S. 
Published: July 2019

BACKGROUND
New treatment methods for cellulite require globally accepted scales for aesthetic research and patient evaluation.

OBJECTIVE
To develop a set of grading scales for objective assessment of cellulite dimples on female buttocks and thighs and assess their reliability and validity.

MATERIALS AND METHODS
Two photonumeric grading scales were created and validated for dimples in the buttocks in female patients: Cellulite Dimples—At Rest, and Cellulite Dimples—Dynamic. Sixteen aesthetic experts rated photographs of 50 women in 2 validation sessions. Responses were analyzed to assess inter-rater and intra-rater reliability.

RESULTS
Overall inter-rater reliability and intra-rater reliability were both “almost perfect” (≥0.81, intraclass correlation efficient and weighted kappa) for the At Rest scale. For the Dynamic scale, inter-rater reliability and intra-rater reliability were “substantial” (0.61–0.80). There was a high correlation between the cellulite scales and body mass index, age, weight, and skin laxity assessments.

CONCLUSION
Consistent outcomes between raters and by individual raters at 2 time points confirm the reliability of the cellulite dimple grading scales for buttocks and thighs in female patients and suggest they will be a valuable tool for use in research and clinical practice.
PARACENTRAL ACUTE MIDDLE MACULOPATHY AFTER EPIRETINAL MEMBRANE REMOVAL
Authors: Ang Michael J. , Chen Judy J. , McDonald H. Richard 
Published: July 2019

Purpose:
To describe a patient with newly developed paracentral acute middle maculopathy after uncomplicated epiretinal membrane removal.

Methods:
Retrospective chart review.

Results:
A 74-year-old white man underwent uncomplicated vitrectomy and epiretinal membrane removal in his left eye. One week later, the patient complained of a small paracentral visual field deficit and decreased visual acuity. Spectral domain optical coherence tomography revealed a characteristic hyperreflective band-like lesion at the level of the inner nuclear layer, consistent with paracentral acute middle maculopathy. The patient was closely followed and endorsed subjective improvement of his paracentral visual deficit at 3 months postoperatively.

Conclusion:
Paracentral acute middle maculopathy, although rare, may be encountered after epiretinal membrane removal.
Interferon Alpha-2b Eye Drops Prevent Recurrence of Pterygium After the Bare Sclera Technique: A Single-Center, Sequential, and Controlled Study
Authors: Yin Mingyang , Li Hang , Zhang Yingnan , Dai Honglei , Luo Fei , Pan Zhiqiang 
Published: July 2019

Purpose:
To investigate the efficacy and safety of interferon (IFN) alpha-2b eye drops in preventing pterygium recurrence after the bare sclera technique.

Methods:
Sixty eyes in 53 patients who underwent treatment for primary pterygium (the length of corneal invasion ranged from 2 to 4 mm) were enrolled in this prospective study. All patients were divided in chronological sequence into 2 groups. The control group included the first 30 eyes, whereas the treatment group included the next 30 eyes. After treatment with the bare sclera technique, levofloxacin and 0.1% fluorometholone eye drops were used 4 times a day for 3 months after surgical excision in both groups. In addition, IFN alpha-2b eye drops were applied in the treatment group 4 times a day for 3 months. Throughout an 18-month follow-up period, all patients in both groups were examined 1 day, 10 days, 1 month, 3 months, 6 months, 12 months, and 18 months after surgery. The main outcome measures were pterygium recurrence, conjunctival redness and thickness, and neovascularization and complications (ie, delayed conjunctival healing, persistent corneal epithelial defection, conjunctival granuloma, and scleral melting and necrosis).

Results:
The recurrence rates in the control group and the treatment group at the end of the sixth month were 29.2% and 3.7%, respectively, and the rates were significantly different between the 2 groups (P = 0.019). Up to 12 months after surgeries, the recurrence rate was 33.3% in the control group and 7.4% in the treatment group, and the difference between the 2 groups was statistically significant (P = 0.048). The rates at the end of 18 months were the same. During the follow-up period, no complications were observed except for 1 conjunctival granuloma (in the treatment group) and 2 corneal epithelial defects (one in the control group and the other in the treatment group).

Conclusions:
Administration of IFN alpha-2b eye drops after the bare sclera technique appear safe and effective in reducing the recurrence of pterygium.
Short-Term Effects of Ground-Level Ozone in Patients With Dry Eye Disease: A Prospective Clinical Study
Authors: Kim Yewon , Paik Hae Jung , Kim Mee Kum , Choi Yoon-Hyeong , Kim Dong Hyun 
Published: July 2019

Purpose:
To investigate changes in the clinical features of patients with dry eye disease (DED) according to short-term outdoor ground-level ozone exposure.

Methods:
This prospective observational study included patients with DED who were treated with the same topical drugs (0.05% cyclosporine or 3% diquafosol) and visited the hospital twice at 2-month intervals. Patients who showed a short tear film breakup time and positive ocular surface staining were assigned to the diquafosol and cyclosporine groups, respectively. The ocular surface disease index (OSDI) score, tear secretion, tear film breakup time, and corneal fluorescein staining score were measured at each visit. The mean ground-level ozone concentration for 1 week before the ocular examinations was used as the ozone exposure level. Changes in dry eye parameters according to changes in ozone concentration were analyzed using univariate and multivariate linear analyses.

Results:
Thirty-three patients were included in the analysis. The mean age was 55.2 ± 10.5 years. Ozone concentrations were significantly associated with increased OSDI scores (R = 0.304, P = 0.0006) and a decreased tear secretion (R = −0.355, P = 0.0012) in univariate models. In multivariate models, the results were consistent; the OSDI score increased by 3.43 points (β = 3.43, P = 0.002), and tear secretion decreased by 1.43 mm (β = −1.43, P = 0.015) per 0.01 ppm increase in ozone concentrations over a 2-month interval. Notably, the cyclosporine group showed more prominent changes in the OSDI score and tear secretion with changes in the ozone concentration (P < 0.05).

Conclusions:
Short-term exposure to increased ground-level ozone concentration led to increased ocular discomfort and decreased tear secretion in patients with DED.
Lyme Neuroborreliosis in Children
Authors: Rožič Mojca , Lah Liza Lea , Ružić-Sabljić Eva , Kastrin Andrej , Arnež Maja 
Published: July 2019

Background:
Information on the etiology of Lyme neuroborreliosis (LNB) in children in Europe and the influence of Borrelia burgdorferi sensu lato species isolated from cerebrospinal fluid (CSF) on clinical presentation of LNB in children are limited.

Methods:
The study was monocentric. During its 17-year period, children younger than 15 years with presentation suggestive of LNB or confirmed Lyme borreliosis that had B. burgdorferi sensu lato isolated from CSF and had species of B. burgdorferi sensu lato identified by pulsed-field gel electrophoresis were included. Demographic and medical data were compared for children infected with Borrelia garinii to those infected with Borrelia afzelii.

Results:
One hundred and fifty-three children had B. burgdorferi sensu lato isolated from CSF. In 71/113 (62.8%) and 42/113 (37.2%) patients, B. garinii and B. afzelii, respectively, were identified. Patients infected with B. garinii did not report symptoms suggestive of central nervous system (CNS) involvement or any other symptoms more often than patients infected with B. afzelii. Compared with children infected with B. afzelii, children infected with B. garinii had erythema migrans less often (18.3% vs. 45.2%) but had positive meningeal signs (69.0% vs. 38.1%), CSF lymphocytic predominance (97.1% vs. 75.0%), and elevated albumin CSF/serum quotient (80.6% vs. 50.0%) more often.

Conclusions:
In Slovenia, LNB in children is more often caused by B. garinii, followed by B. afzelii. The clinical picture of LNB in children caused by B. garinii is not more often suggestive of CNS involvement, but CNS inflammation is more pronounced in children infected with B. garinii, compared with children infected with B. afzelii.
Educational and Experiential Factors Associated With Physical Therapists' Diagnostic Reasoning
Authors: Souter Courtney , Musy Emily , Hartstein Aaron , Lievre Arthur , Fergus Andrea 
Published: July 2019

Introduction.
The influence of education level, post-professional training, and experience on physical therapists' (PTs) diagnostic reasoning is unknown. The purpose of this study was to examine the influence of education, training, and experience on PTs' diagnostic reasoning through a series of musculoskeletal case-based surveys. While literature supports quality of care's influence on health care costs, the factors influencing PTs' quality of care are unclear. Literature suggests that surgeons with post-professional training and more experienced Emergency Room physicians demonstrate better patient outcomes, diagnostic accuracy, and efficiency.

Methods.
Five hundred and twenty-nine licensed PTs participated in this study. A series of 5 case-based electronic surveys assessed participants' diagnostic reasoning in orthopedic presentations. Response rates ranged from 55% to 40%. Accuracy, efficiency, and hypothesis-generation strategies were analyzed to examine diagnostic reasoning. Strength of associations, diagnostic accuracy, and hypothesis-generation strategies were examined via odds ratios; efficiency of determining the accurate diagnosis was examined via t tests.

Results.
Hypothetico-deductive reasoning by systematically eliminating competing diagnoses (funneling) demonstrated significant correlation with accuracy in 4 of the 5 cases (odds ratio [OR] 2.46 [1.19–5.10] to 13.9 [6.12–31.5]). Physical therapists with any American Board of Physical Therapy Specialities (ABPTS) certification demonstrated significantly greater diagnostic accuracy (OR 2.1 [1.41–3.807] to 3.00 [1.22–7.36]) and efficiency (P < .05) in 3 of the 5 cases compared to those without ABPTS certification. Board-Certified Orthopedic Clinical Specialists (OCS) demonstrated significantly greater diagnostic accuracy (OR 1.90 [1.08–3.34] to 3.42 [1.42–8.40]) and efficiency (P < .05) compared to those without ABPTS OCS certification. Residency-trained PTs demonstrated significantly greater diagnostic accuracy (OR 2.02 [1.03–3.96] to 2.84 [1.38–5.82]) and efficiency (P < .05) compared to those without residency training. Degree level, experience, and fellowship training were not related to accuracy, efficiency, or funneling hypotheses (P > .05).

Discussion and Conclusion.
American Board of Physical Therapy Specialities certification and American Board of Physical Therapy Residency and Fellowship Education training's significant association with both diagnostic accuracy and efficiency suggests the importance of PTs' pursuit of ABPTS certification and/or formal post-professional training in developing diagnostic reasoning and expertise. These post-professional endeavors may lead to appropriate care more quickly, improving patient outcomes, and decreasing health care costs.
Utilization of the Clinical Reasoning Assessment Tool Across a Physical Therapy Curriculum: Application for Teaching, Learning, and Assessment
Authors: McDevitt Amy , Rapport Mary Jane , Jensen Gail , Furze Jennifer 
Published: July 2019

Introduction.
Clinical reasoning is a multifaceted skill set crucial to optimal patient care. The ability to assess development of clinical reasoning skills in entry-level physical therapist students continues to be challenging. The Clinical Reasoning Assessment Tool (CRAT) was developed in order to assess students' progress in the essential link between clinical reasoning and the development of knowledge. Based on a previously published tool (Clinical Reasoning Grading Rubric), the CRAT considers 3 domains representing clinical reasoning and knowledge development (content knowledge, procedural knowledge and psychomotor skills, and conceptual reasoning).
The purpose of this study was to determine whether the use of the CRAT would reliably reflect student progress in acquisition and application of clinical reasoning skills across didactic and clinical components of physical therapist education and to determine whether case context impacts performance.

Methods.
A cross-sectional study was performed using the CRAT to assess student performance at 4 specific time points across 2 years of a physical therapy curriculum. Fifty-five students from 2 consecutive class cohorts were assessed using the CRAT. Eleven assessors scored 172 completed tools using a visual analog scale representing a learner continuum (beginner, intermediate, competent, and proficient). Analysis of variance (ANOVA) was used to determine whether time and case context were predictors of performance in each of the 3 clinical reasoning domains.

Results.
Mean scores in each of the 3 domains steadily increased at each performance assessment point, and results of the ANOVA showed that each specified time point was significantly predictive of performance in each of the 3 domains of interest (P < .0001 for each). In addition, case context is predictive of procedural knowledge (P = .007) and conceptual reasoning (P = .0297).

Discussion and Conclusions.
The results of this study, and observations related to use of the tool, demonstrate the utility of the CRAT in measuring the performance of physical therapy students.
Emergency care: Operationalizing the practice through a concept analysis
Authors: Davis Wesley D. , Dowling Evans Dian , Fiebig William , Lewis Chrystal L. 
Published: July 2019

ABSTRACT

Background and Purpose:
Current uses of emergency care are ambiguous and lack clarity, leading to imprecise use of the term in nursing practice. An explicit definition of emergency care is necessary to build and advance the field. An empirically driven definition of emergency care is lacking in the refereed literature. The purpose of this article was to present an in-depth inquiry of emergency care that contributes to the advancement of knowledge and to articulate a defensible definition of emergency care.

Methods:
This concept analysis was performed using the eight-step approach of Walker and Avant. A database search within the disciplines of nursing, medicine, education, and social sciences was conducted using the keyword emergency care. Databases of refereed literature were reviewed. Additional searches of nonrefereed literature, such as dictionaries and thesauri, were also examined.

Conclusions:
Based on this concept analysis, the attributes of emergency care include the immediate evaluation and treatment of an unexpected illness or injury. Emergency care is not specific to a setting or location. Antecedents to emergency care consist of a precipitating event, recognition that medical help is required, and access to emergency care. A model, borderline, related, and contrary cases of emergency care are presented.

Implications for practice:
The identification of emergency care attributes in this concept analysis contributes to the body of knowledge in emergency care and clarifies the ambiguity of the concept to prompt developments in practice, theory, and research with implications for emergency nurse practitioner clinical education, and scope of practice regulation.
The Changing Distribution of Length of Hospitalization at Academic Medical Centers 2007–2016
Authors: Doctoroff Lauren , Mukamal Kenneth J. 
Published: July 2019

Background:
Length of stay (LOS) remains a primary focus for hospitals, and patients with prolonged LOS disproportionately affect hospital capacity and costs. We recently showed that long LOS patients are increasingly hospitalized at academic centers, but their effect on the distribution of LOS is unknown.

Methods:
Using the Vizient Clinical Data Base/Resource Manager (CDB/RM), which includes over 90% of the academic medical centers in the United States, we examined trends in the distributions of LOS for acute medical/surgical hospitalizations from 2007 to 2016 in 117 hospitals. We excluded patients under 18 years and those with primary psychiatry, obstetric or rehabilitation diagnoses.

Results:
Two separate trends were evident during this time period. Mean LOS decreased steadily from 2007 to 2010, but then rose steadily from 2011 and reached its maximum in 2016. Median LOS remained consistent at 3 days from 2007 to 2013 but it too rose from 2014 to 2016. As expected from the difference between the mean and median values, LOS at the 99th percentile dropped from 2007 to 2010 but then rose back by 2016. Gini coefficient values, used to measure inequalities in distribution, declined modestly from 2007 to 2010 but then remained unchanged through 2016. Results were similar in analyses adjusted for age, sex, and case-mix index.

Conclusions:
The beginning of the study period was characterized by a reduction in mean LOS, driven largely by decreases of the longest hospitalizations and greater uniformity in LOS. The latter portion saw steady increases in LOS that were similar across the entire distribution of hospitalizations. If the nadir in LOS has truly been reached, these trends will complicate the long-term health of academic medical centers and their staff, faculty, and trainees.
Maximizing Effectiveness of the Holistic Admission Process
Authors: Wagner Robin , Maddox Krista R. , Glazer Greer , Hittle Beverly M. 
Published: July 2019

Background
Nursing programs have responsibility to become more holistic in admission practices, ensuring they admit applicants based on more than grades and test scores to determine the best fit for their program.

Problem
One frequently cited holistic admissions barrier is incorporating qualitative measurement of applicant characteristics through interviews. Finding the best interview model is a challenge, depending on a program's intent to learn about applicants.

Approach
This article describes the planning and implementation process for incorporating the Multiple Mini Interview (MMI) model into an existing holistic nursing program admission process.

Outcomes
MMI model implementation resulted in more congruency in student attributes with the college vision, mission, and values and increased diversity.

Conclusion
An efficient, well-organized MMI interview model was implemented, allowing achievement of overall admission goals and ensuring selected applicants demonstrate attributes aligned with college values and vision and increased diversity.
Spectral Evaluation of Eyeglass Blocking Efficiency of Ultraviolet/High-energy Visible Blue Light for Ocular Protection
Authors: Giannos Steven A. , Kraft Edward R. , Lyons Lance J. , Gupta Praveena K. 
Published: July 2019

SIGNIFICANCE
We investigated, for safety and awareness, ultraviolet and high-energy violet light–blocking protection provided by assorted types of eyewear. Ultraviolet and high-energy violet light–filtering efficiency varied and did not correlate with price or advertised claims. Standardization of methods and specifications for lens spectral transmission evaluation is recommended.

PURPOSE
Studies have linked exposure of high-energy visible blue light to effect and damage on retinal epithelial cells, photoreceptors, and ganglion cells. “Blue light” is more accurately differentiated into “high-energy visible blue-violet light” and “circadian rhythm blue-turquoise light.” This study measured and compared spectral transmission of ultraviolet and high-energy violet light of low-, medium-, and high-priced sunglasses.

METHODS
Sunglasses and lens blanks were obtained from the University of Texas Medical Branch Optical Shop and vendors. Groups were based on promotional, retail, designer sunglasses, or “blue blocker” lenses. The percent transmittance of ultraviolet/visible spectral scans (800 to 350 nm) was measured using an Agilent Cary 50 spectrophotometer. High-energy violet/blue light was defined as 400 to 450 nm.

RESULTS
Promotional sunglasses (tinted polycarbonate) blocked 100% ultraviolet and 67 to 99.8% high-energy violet blue light. Retail sunglasses filtered out 95 to 100% ultraviolet A and 67% high-energy violet light. The tested designer sunglasses varied widely in their optical transmissibility with respect to their ultraviolet A and high-energy violet light–blocking properties, with some not blocking ultraviolet A. Clear and colorless Kodak Total Blue provided maximal high-energy violet protection, whereas clear Essilor Crizal Prevencia provided less high-energy violet blocking between 400 and 450 nm.

CONCLUSIONS
The ultraviolet and high-energy violet (400 to 450 nm) light–filtering efficiency varied between sunglasses and clear lenses and did not correlate with price or advertised claims. Standardization of methods and specifications for lens spectral transmission evaluation is recommended.