bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ten-year Longitudinal Follow-up MRI Study of Age-related Changes in Thoracic Intervertebral Discs in Asymptomatic Subjects
Authors: Okada Eijiro , Daimon Kenshi , Fujiwara Hirokazu , Nishiwaki Yuji , Nojiri Kenya , Watanabe Masahiko , Katoh Hiroyuki , Ishihama Hiroko , Fujita Nobuyuki , Tsuji Takashi , Nakamura Masaya , Matsumoto Morio , Watanabe Kota 
Published: July 2019

Study Design.
Prospective longitudinal study.

Objective.
The aim of this study was to evaluate long-term degenerative changes in intervertebral discs in the thoracic spine in healthy asymptomatic subjects.

Summary of Background Data.
Longitudinal magnetic resonance imaging (MRI) studies of intervertebral disc degeneration have been reported for the cervical and lumbar but not the thoracic spine.

Methods.
In this longitudinal study (average follow-up 10.0 ± 0.6 years), we assessed degenerative changes in the thoracic spine of 103 volunteers (58 men) of 223 healthy volunteers in the initial MRI study of the thoracic spine (follow-up rate 46.2%). The mean age at the initial study was 45.0 ± 11.5 years (24–77 years). Initial and follow-up thoracic-spine MRIs were graded for the following 4 factors of degenerative changes: decrease in signal intensity of intervertebral disc (DSI), posterior disc protrusion (PDP), anterior compression of dura and spinal cord (AC), and disc-space narrowing (DSN) from T1–2 to T12–L1. We assessed associations between changes in MRI grade and demographical factors such as age, sex, body mass index, smoking habits, sports activities, and disc degeneration in the cervical spine.

Results.
MRIs revealed that 63.1% of the subjects had degenerative changes in the thoracic intervertebral discs that had progressed at least one grade during the follow-up period. DSI progressed in 44.7% of subjects, PDP in 21.4%, and AC in 18.4% during the 10-year period. No DSN progression was seen. DSI was frequently observed in the upper thoracic spine (T1–2 to T4–5). Disc degeneration was relatively scarce in the lower thoracic spine (T9–10 to T12–L1). PDP was frequently observed in the middle thoracic spine (T5–6 toT8–9). We found significant associations between DSI and cervical-spine degeneration (P = .004) and between AC and smoking (P = .04).

Conclusion.
Progressive thoracic disc degeneration, observed in 63.1% of subjects; was significantly associated with smoking and with cervical-spine degeneration.

Level of Evidence: 2
Preoperative Dehydration does not Increase the Risk of Complications Following Elective Lumbar Surgery
Authors: Renfree Sean P. , Chung Andrew S. , Waldrop Robert A. , Crandall Dennis , Chang Michael S. 
Published: July 2019

Study Design.
A retrospective cohort study.

Objective.
The aim of this study was to evaluate the effect of preoperative dehydration on hospital length of stay (LOS), rates of 30-day postoperative complications, related reoperations, and readmissions.

Summary of Background Data.
Preoperative dehydration has long been associated with postoperative infection, deep vein thrombosis (DVT), acute renal failure, and an increased hospital LOS. To our knowledge, the effect of preoperative dehydration on complication rates for patients undergoing elective lumbar spine surgery has not been well described.

Methods.
An analysis of American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data from 2006 to 2013 was performed. Patients undergoing elective lumbar procedures were identified and exclusion criteria eliminated patients who underwent any emergency procedures, infections, tumor cases, or revision surgeries. Patient dehydration was defined as preoperative blood urea nitrogen/creatinine (BUN/Cr) ratio greater than 20.

Results.
Patients (4698; 34.5%) with preoperative dehydration based on BUN/Cr ratio were identified. Univariate analysis was suggestive of an association between preoperative dehydration and an increased risk of DVT (1.1% compared with 0.6%; P = 0.002), urinary tract infection (2.5% compared with 1.6%; P < 0.001), and need for transfusion postoperatively (17.6% compared with 14.4%; P < 0.001). However, on the basis of multivariate regression, no significant association between dehydration and increased odds of aforementioned outcomes was identified.

Conclusion.
Preoperative dehydration does not appear to negatively affect perioperative outcomes or readmission in patients undergoing elective lumbar spine surgery.

Level of Evidence: 3
Cervical Spine Fractures
Authors: Fourman Mitchell S. , Shaw Jeremy D. , Vaudreuil Nicholas J. , Dombrowski Malcolm E. , Wawrose Rick A. , Boakye Lorraine A.T. , Alarcon Louis H. , Lee Joon Y. , Donaldson William F. 
Published: July 2019

Study Design.
Retrospective cohort study.

Objective.
Compare a novel two-step algorithm for indicating a computed tomography angiography (CTA) in the setting of a cervical spine fracture with established gold standard criteria.

Summary of Background Data.
As CTA permits the rapid detection of blunt cerebrovascular injuries (BCVI), screening criteria for its use have broadened. However, more recent work warns of the potential for the overdiagnosis of BCVI, which must be considered with the adoption of broad criteria.

Methods.
A novel two-step metric for indicating CTA screening was compared with the American College of Surgeons guidelines and the expanded Denver Criteria using patients who presented with cervical spine fractures to a tertiary-level 1 trauma center from January 1, 2012 to January 1, 2016. The ability for each metric to identify BCVI and posterior circulation strokes that occurred during this period was assessed.

Results.
A total of 721 patients with cervical fractures were included, of whom 417 underwent CTAs (57.8%). Sixty-eight BCVIs and seven strokes were diagnosed in this cohort. All algorithms detected an equivalent number of BCVIs (52 with the novel metric, 54 with the ACS and Denver Criteria, P = 0.84) and strokes (7/7, 100% with the novel metric, 6/7, 85.7% with the ACS and Denver Criteria, P = 1.0). However, 63% fewer scans would have been needed with the proposed screening algorithm compared with the ACS or Denver Criteria (261/721, 36.2% of all patients with our criteria vs. 413/721, 57.3% with the ACS standard and 417/721, 57.8%) with the Denver Criteria, P < 0.0002 for each).

Conclusion.
A two-step criterion based on mechanism of injury and patient factors is a potentially useful guide for identifying patients at risk of BCVI and stroke after cervical spine fractures. Further prospective analyses are required prior to widespread clinical adoption.

Level of Evidence: 4.
Incorporating Laboratory Values Into a Machine Learning Model Improves In-Hospital Mortality Predictions After Rapid Response Team Call
Authors: Reardon Peter M. , Parimbelli Enea , Wilk Szymon , Michalowski Wojtek , Murphy Kyle , Shen Jennifer , Herritt Brent , Gershkovich Benjamin , Tanuseputro Peter , Kyeremanteng Kwadwo 
Published: July 2019

Objectives:
Machine learning models have been used to predict mortality among patients requiring rapid response team activation. The goal of our study was to assess the impact of adding laboratory values into the model.

Design:
A gradient boosted decision tree model was derived and internally validated to predict a primary outcome of in-hospital mortality. The base model was then augmented with laboratory values.

Setting:
Two tertiary care hospitals within The Ottawa Hospital network.

Patients:
Inpatients over the age of 18 years who experienced a rapid response team activation between January 1, 2015, and May 31, 2016.

Interventions:
None.

Measurements and Main Results:
A total of 2,061 rapid response team activations occurred during the study period. The in-hospital mortality rate was 29.4%. Patients who died were older (median age, 72 vs 68 yr; p < 0.001), had a longer length of stay (length of stay) prior to rapid response team activation (4 vs 2 d; p < 0.001), and more often had respiratory distress (31% vs 22%; p < 0.001). Our base model without laboratory values performed with an area under the receiver operating curve of 0.71 (95% CI, 0.71–0.72). When the base model was augmented with laboratory values, the area under the receiver operating curve improved to 0.77 (95% CI, 0.77–0.78). Important mortality predictors in the base model were age, estimated ratio of Pao
2 to Fio
2 (calculated using oxygen saturation and estimated Fio
2), length of stay prior to rapid response team activation, and systolic blood pressure.

Conclusions:
Machine learning models can identify rapid response team patients at a high risk of mortality and potentially supplement clinical decision making. Incorporating laboratory values into model development significantly improved predictive performance in this study.
Ultrasonographic Detection of Micro-Bubbles in the Right Atrium to Confirm Peripheral Venous Catheter Position in Children
Authors: Takeshita Jun , Nakajima Yasufumi , Kawamura Atsushi , Taniguchi Masashi , Shimizu Yoshiyuki , Takeuchi Muneyuki , Shime Nobuaki 
Published: July 2019

Objectives:
In pediatric patients, indwelling peripheral venous catheters are sometimes displaced to extravascular positions, causing infiltration or extravasation. No reliable techniques are available to confirm accurate IV catheterization. However, ultrasonographic detection of micro-bubble turbulence in the right atrium after saline injection has been reported to be useful in confirming central venous catheter positions in both adults and children. This study evaluated whether this micro-bubble detection test can offer better confirmation of peripheral venous catheter positions compared with the smooth saline injection technique in pediatric patients.

Design:
Randomized controlled study.

Setting:
Single tertiary PICU.

Patients:
Pediatric patients (weighing < 15 kg) who already had or required a peripheral venous catheter.

Interventions:
Patients were randomly allocated to either of the two groups (150 patients per group): undergoing either the micro-bubble detection test (M group) or the smooth saline injection test (S group).

Measurements and Main Results:
The peripheral venous catheters were confirmed to be IV located in the final position in 137 and 139 patients in the M and S groups, respectively. In properly located catheters, the tests were positive in 100% (n = 137/137; sensitivity, 100%; 95% CI, 97.8–100), and in 89% (n = 124/139; 95% CI, 82.8–93.8) of the M and S groups, respectively (p = 0.0001). Among the catheters located in extravascular positions, the tests were negative in 100% (n = 13/13; specificity, 100%; 95% CI, 79.4–100), and in 64% (n = 7/11; 95% CI, 30.8–89.1) of the M and S groups, respectively (p = 0.017).

Conclusions:
The micro-bubble detection test is a useful technique for detecting extravasation and confirming proper positioning of peripheral IV catheters in pediatric patients.
A Motivational Telephone Intervention to Reduce Early Dropouts in Cardiac Rehabilitation
Authors: LaValley Grace , Storer Andrew , Szalai Heidi , Farah Michel , Pack Quinn R. 
Published: July 2019

Purpose:
Cardiac rehabilitation (CR) improves outcomes, yet early dropout is common. The purpose of the study was to determine whether a motivational telephone intervention among patients at risk for nonadherence would reduce early dropouts.

Methods:
We performed a randomized double-blind pilot study with the intervention group receiving the telephone intervention 1 to 3 d after outpatient CR orientation. The control group received the standard of care, which did not routinely monitor attendance until 2 wk after orientation. The primary outcome was the percentage of patients who attended their second exercise session as scheduled. Secondary outcomes included attendance at the second CR session at any point and total number of sessions attended. Because not everyone randomized to the intervention was able to be contacted, we also conducted a per-protocol analysis.

Results:
One hundred patients were randomized to 2 groups (age 62 ± 15 yr, 46% male, 40% with myocardial infarction) with 49 in the intervention group. Patients who received the intervention were more likely to attend their second session as scheduled compared with the standard of care (80% vs 49%; relative risk = 1.62; 95% CI, 1.18-2.22). Although there was no difference in total number of sessions between groups, there was a statistically significant improvement in overall return rate among the per-protocol group (87% vs 66%; relative risk = 1.31; 95% CI, 1.05-1.63).

Conclusions:
A nursing-based telephone intervention targeted to patients at risk for early dropout shortly after their CR orientation improved both on-time and eventual return rates. This straightforward strategy represents an attractive adjunct to improve adherence to outpatient CR.
Functional and Cardiovascular Measurements in Patients With Peripheral Artery Disease
Authors: Correia Marilia A. , de Sousa Adilson Santos Andrade , Andrade-Lima Aluísio , Germano-Soares Antônio H. , Zerati Antônio Eduardo , Puech-Leao Pedro , Wolosker Nelson , Gardner Andrew W. , Ritti-Dias Raphael M. , Cucato Gabriel G. 
Published: July 2019

Purpose:
To compare functional and cardiovascular variables of men and women with peripheral artery disease (PAD).

Methods:
This observational, cross-sectional study included 67 women and 144 men (age 66 ± 9 and 67 ± 10 yr, respectively) with PAD. Patients were submitted to a clinical evaluation, 6-min walk test (6MWT) and cardiovascular evaluation, including blood pressure, arterial stiffness variables, and heart rate variability.

Results:
Women had lower claudication onset distance (P = .033) and 6MWT distance (P < .001), and similar percentage of the predicted 6MWT distance (P > .05). Women had higher pulse pressure (P = .002), augmentation index (P < .001), augmentation index corrected by 75 bpm (P < .001), and brachial and central systolic blood pressure (P = .041 and P = .029). Diastolic blood pressure, pulse wave velocity, and heart rate variability were similar between sexes (P > .05).

Conclusion:
Although predicted 6MWT performance was similar between sexes, women had higher blood pressure and wave reflection variables compared with men. Interventions to reduce blood pressure and wave reflection should be emphasized in women with PAD.
The Process of Implementing a Mobility Technician in the General Medicine and Surgical Population to Increase Patient Mobility and Improve Hospital Quality Measures: A Pilot Study
Authors: Exum Emelia , Hull Brian L. 
Published: July 2019

Background:
Hospital-associated disability (HAD) has been linked to prolonged and inappropriate immobility. HAD and increased postacute care (PAC) rehabilitation spending are also associated.

Purpose:
This pilot aims to describe the implementation processes of a designated mobility technician (MT), providing daily mobility on a medical and surgical acute care unit. During the MT implementation, we explore the resulting effects on patient length of stay (LOS), PAC utilization, patient satisfaction, falls, and hospital cost.

Methods:
A quality improvement pilot study was created comparing the percentage of PAC discharge locations before and during the mobility pilot (MP) on 1 general medical (GM) unit (37 beds) and 1 general surgical (GS) unit (27 beds). Following the nursing assessment of medical stability and mobility with a progressive mobility algorithm, patients were assigned a Johns Hopkins Highest Level of Mobility (JH-HLM) score and placed on the MT schedule. The MT mobilized each selected patient to the next appropriate level of mobility, with a goal of at least 1 JH-HLM level of increase and recorded the score. Patient discharge location was recorded at the end of the inpatient stay. Patient satisfaction scores, LOS, and incidence of falls were also monitored throughout the pilot.

Outcomes:
Eighty-nine percent of GM compared with 83% of the baseline data group patients and 83% of the GS compared with 90% for the baseline data group patients discharged to home with an average increase in JH-HLM score of 1.22 per mobility session. In addition, during the MP both units decreased the LOS by 5.84% to 9.03%, the GS unit experienced increased patient satisfaction scores by 9.19%, and both units improved Press Ganey ratings of Responsiveness of Staff by 16.47% to 37.00%. No falls were associated with the MT or MP and the GM unit decreased overall falls by 53.3%.

Discussion:
The MP is a promising tool for increasing patient mobility in the nonintensive care GM and GS setting, while potentially decreasing the need for PAC rehabilitation for many patients with minimal mobility deficits. Although not all of the results were statistically significant, positive effects on hospital ratings show promise toward helping to improve the overall patient experience during admission, decreasing LOS, decreasing overall fall rate, and an associated decrease in GM patient PAC spending in those most likely to be affected by HAD related to immobility. These positive effects can potentially improve hospital profit margins through the Centers for Medicare & Medicaid Services' value-based purchasing reimbursement program.
Heart Rate Variability and Cardiorespiratory Fitness in Non-Hispanic Black Versus Non-Hispanic White Adolescents With Type 1 Diabetes
Authors: Faulkner Melissa Spezia , Quinn Laurie , Fritschi Cynthia , Tripp Natalie , Hayat Matthew J. 
Published: July 2019

Background
Evidence indicates that fewer non-Hispanic black versus non-Hispanic white youths with type 1 diabetes are meeting treatment goals for optimal glycemic outcomes, predisposing them to risks for cardiovascular (CV) morbidity and mortality in adulthood.

Purpose
We sought to assess the association of sex and race with heart rate variability (HRV) and cardiorespiratory fitness in adolescents with type 1 diabetes. The association between the HRV and cardiorespiratory outcomes with glucose control was also examined.

Methods
A secondary data analysis of 95 adolescents with type 1 diabetes (n = 66 non-Hispanic white n = 29 non-Hispanic black) was used. Using 24-hour Holter recordings, spectral and time domain measures of HRV were obtained. Cardiorespiratory fitness using a graded exercise test was completed. Descriptive statistics and Pearson correlation coefficients were used to assess associations between glucose control and study outcomes, and general linear models were applied to explore and quantify associations of sex and race with HRV and cardiorespiratory fitness.

Results
Body mass index (mean [standard deviation]) was similar between non-Hispanic black (23.5 [3.9]) and non-Hispanic white (22.7 [3.8]) adolescents. Females and non-Hispanic black adolescents had significantly lower HRV and cardiorespiratory fitness levels. Moderate associations were found between lower HRV and poorer glycemic control (HbA1c). Recent HbA1c was significantly higher in non-Hispanic black (9.7 [1.8]) than non-Hispanic white (8.2 [1.2]).

Conclusion
Findings support the importance of early identification of CV health risks in adolescents with type 1 diabetes, particularly for non-Hispanic black adolescents. Interventions focused on overall improvement in glycemic control for adolescents with type 1 diabetes are a priority for minimizing future CV complications.
Monthly Extended-Release Risperidone (RBP-7000) in the Treatment of Schizophrenia
Authors: Andorn Anne , Graham Jay , Csernansky John , Newcomer John W. , Shinde Sunita , Muma Gilbert , Heidbreder Christian , Fava Maurizio 
Published: July 2019

Abstract

Purpose/Background
The Phase 3 program for RBP-7000, a once-monthly subcutaneous (SC) extended-release risperidone formulation approved for treatment of schizophrenia, consisted of a double-blind placebo-controlled trial (previously reported) and a 52-week open-label study of monthly RBP-7000 120 mg. The primary objective of the open-label study was to evaluate the long-term safety and tolerability of RBP-7000 in adults with schizophrenia. A secondary objective was to assess long-term maintenance of effectiveness.

Methods/Procedures
The 52-week Phase 3 open-label study (NCT02203838) enrolled 92 rollover participants from the double-blind trial (NCT02109562) and 408 stable (Positive and Negative Syndrome Scale [PANSS] total score, ≤70) de novo participants. Participants received up to 13 monthly SC injections of RBP-7000 120 mg. Safety assessments included treatment-emergent adverse events, injection-site assessments, vital signs, laboratory and ECG parameters, extrapyramidal symptoms, and suicidality. Clinical outcomes included the PANSS and Clinical Global Impression—Severity.

Findings/Results
Overall, 367 participants (73.4%) reported 1 or more treatment-emergent adverse event; the most common were injection-site pain (13.0%) and weight increase (12.8%). Most participants (>80%) experienced no injection-site reactions. No clinically meaningful changes were observed in laboratory or electrocardiogram values, vital signs, extrapyramidal symptoms, or suicidality. Over 12 months of exposure, mean PANSS scores continued to improve in rollover participants and remained stable among de novo participants. Mean Clinical Global Impression—Severity scores remained stable among all participants.

Implications/Conclusions
Except for anticipated injection-site reactions, RBP-7000 demonstrated a favorable safety and tolerability profile similar to oral risperidone. Notably, PANSS scores continued to improve for participants from the pivotal study and remained stable for de novo participants.
Mobility Disorders in Stroke, Parkinson Disease, and Multiple Sclerosis
Authors: Cattaneo Davide , Gervasoni Elisa , Pupillo Elisabetta , Bianchi Elisa , Aprile Irene , Imbimbo Isabella , Russo Rita , Cruciani Arianna , Jonsdottir Johanna , Agostini Michela , Beghi Ettore 
Published: July 2019

ObjectiveThe aims of the study were to compare mobility in multiple sclerosis, Parkinson disease, and stroke, and to quantify the relationship between mobility and participation restrictions.DesignThis is a multicenter cross-sectional study. Included were compliant subjects with Parkinson disease, multiple sclerosis, and stroke seen for rehabilitation, with no comorbidities interfering with mobility. Functional scales were applied to each subject to investigate gait speed (10-meter walking test), balance while maintaining body position (Berg Balance Scale), dynamic balance and mobility (Timed Up and Go and Dynamic Gait Index), and participation (Community Integration Questionnaire).ResultsTwo hundred ninety-nine patients (111 multiple sclerosis, 94 Parkinson disease, and 94 stroke) were enrolled. Stroke had the slowest gait speed (mean gait speed = 0.9 m/sec) compared with Parkinson disease (1.1 m/sec), and multiple sclerosis (1.2 m/sec) (P< 0.001). Multiple sclerosis was more limited than Parkinson disease and stroke in dynamic balance both in the Timed Up and Go Test (multiple sclerosis = 16.7 secs, Parkinson disease = 11.4 secs, stroke = 14.0 secs;P< 0.001) and Dynamic Gait Index (multiple sclerosis = 11.6 points, Parkinson disease = 12.9 points, stroke = 13.6 points;P= 0.03); ability to maintain balance and body position (Berg Balance Scale) was more affected in stroke and Parkinson disease than multiple sclerosis (multiple sclerosis = 42.6 points, Parkinson disease = 39.4 points, stroke = 39.7 points;P= 0.03). Balance disorders were associated with participation restrictions but not gait speed.ConclusionsNeurological conditions have differing impacts on gait and balance, leading to different levels of participation restriction.