bluuebunny/crossref_metadata_2025_split huggingface dataset:
E‐learning in advanced cardiac life support: Outcome and attitude among healthcare professionals
Authors: Arithra Abdullah Ariff , Nor Junainah , Baladas Jeewadas , Tg Hamzah Tg Mohd Azimin , Tuan Kamauzaman Tuan Hairulnizam , Md Noh Abu Yazid , Rahman Andey 
Published: June 2019

Background:Advanced cardiac life support provides healthcare professionals with knowledge and skills needed in dealing with cardiac emergencies. By incorporating e‐learning in advanced cardiac life support courses, it allows for easier accessibility of learning materials and a more personalized learning schedule at a lower overall cost.Objectives:This study aims to compare the outcome of e‐learning advanced cardiac life support versus conventional advanced cardiac life support among healthcare professionals and determine their attitude on e‐learning.Methods:A total of 96 candidates attending advanced cardiac life support courses in Hospital Universiti Sains Malaysia between January 2016 and May 2017 were included in the study. In total, 48 candidates were enrolled on each arm. Candidates in conventional advanced cardiac life support undertook a 2‐day face‐to‐face course. Participants in e‐learning advanced cardiac life support completed 6 h of online lecture videos prior to 1‐day modified face‐to‐face course. All candidates were assessed by pre‐ and post‐course multiple‐choice questions and practical cardiac arrest simulation test. Only post‐course and cardiac arrest simulation test marks contribute to the passing or failure of the candidates.Results:Candidates in e‐learning advanced cardiac life support courses had higher mean scores on the pre‐course multiple‐choice questions (69.1, SD: 19.1) compared to those in conventional advanced cardiac life support courses (58.6, SD: 16.6, p < 0.001). The cardiac arrest simulation test pass rate on e‐learning advanced cardiac life support was higher than conventional advanced cardiac life support courses although statistically not significant (95.8% vs 87.5%; p = 0.134). The overall pass rate was 93.8% for e‐learning advanced cardiac life support versus 83.3% in conventional advanced cardiac life support (p = 0.099). A majority of the candidates had positive attitude towards e‐learning.Conclusion:E‐learning advanced cardiac life support courses demonstrated better results in terms of knowledge compared to conventional advanced cardiac life support, with equivalent skill scores. Shorter course duration, lesser cost and participants’ satisfaction were the added benefits. Further study can be done to explore the utilization of e‐learning materials among healthcare professionals and its other advantages.
Feline non-regenerative anemia: Diagnostic and treatment recommendations
Authors: Winzelberg Olson Sarah , Hohenhaus Ann E 
Published: June 2019

Practical relevance: Non-regenerative anemia, or anemia with reticulocytopenia, is a daily diagnosis in feline practice. Clinical challenges: The disease processes underlying non-regenerative anemia are many and diverse. A major diagnostic evaluation may be required to correctly diagnose and treat the underlying cause. Audience: All veterinarians caring for cats will face the diagnostic and therapeutic challenge of non-regenerative anemia. Readers will benefit from the review of diagnostic testing and therapeutic options for non-regenerative anemia. Evidence base: This review summarizes the currently available literature informing diagnostic and treatment recommendations related to non-regenerative anemia. The evidence available to support the recommendations in this review is graded as low and includes predominantly expert opinion, case reports and cases series, on which the authors’ interpretation/consensus is based.
Feline abdominal ultrasonography: what’s normal? what’s abnormal? Hepatic vascular anomalies
Authors: Griffin Sally 
Published: June 2019

Practical relevance: Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Although hepatic vascular anomalies are less common than disorders of the hepatic parenchyma and biliary tree, our understanding and recognition of these is gradually increasing with advancements in ultrasound technology and image quality. Clinical challenges: Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even differentiating between normal variation and pathological changes can be challenging for all but the most experienced. In addition, some views may be obscured by overlying structures; for example, the termination of a shunt entering the left phrenic or azygous veins is often difficut to see due to the high probability of lung passing between the shunt and the transducer as the cat breathes. Equipment: Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. Aim: This review, part of an occasional series on feline abdominal ultrasonography, discusses the appearance of various hepatic vascular anomalies. It is aimed at general practitioners who wish to improve their knowledge and confidence in feline abdominal ultrasound and is accompanied by high-resolution images. Ultrasound of the liver and biliary tree were discussed in articles published in January and May 2019, respectively. Evidence base: Information provided in this article is drawn from the published literature and the author’s own clinical experience.
Dissociable cognitive patterns related to depression and anxiety in multiple sclerosis
Authors: Leavitt Victoria M , Brandstadter Rachel , Fabian Michelle , Katz Sand Ilana , Klineova Sylvia , Krieger Stephen , Lewis Christina , Lublin Fred , Miller Aaron , Pelle Gabrielle , Buyukturkoglu Korhan , De Jager Phillip L , Li Peipei , Riley Claire S , Tsapanou Angeliki , Sumowski James F 
Published: June 2019

Background: Individuals with multiple sclerosis (MS) frequently present with depression and anxiety, as well as cognitive impairment, challenging clinicians to disentangle interrelationships among these symptoms. Objective: To identify cognitive functions associated with anxiety and depression in MS. Methods: Mood and cognition were measured in 185 recently diagnosed patients (Reserve Against Disability in Early Multiple Sclerosis (RADIEMS) cohort), and an independent validation sample (MEM CONNECT cohort, n = 70). Partial correlations evaluated relationships of cognition to anxiety and depression controlling for age, sex, education, and premorbid verbal intelligence. Results: In RADIEMS cohort, lower anxiety was associated with better nonverbal memory ( rp = –0.220, p = 0.003) and lower depression to better attention/processing speed ( rp = –0.241, p = 0.001). Consistently, in MEM CONNECT cohort, lower anxiety was associated with better nonverbal memory ( rp = –0.271, p = 0.028) and lower depression to better attention/processing speed ( rp = –0.367, p = 0.002). Relationships were unchanged after controlling for T2 lesion volume and fatigue. Conclusion: Consistent mood–cognition relationships were identified in two independent cohorts of MS patients, suggesting that cognitive correlates of anxiety and depression are separable. This dissociation may support more precise models to inform treatment development. Treatment of mood symptoms may mitigate effects on cognition and/or treatment of cognition may mitigate effects on mood.
Reliability of ultrasound strain elastography in the assessment of the quadriceps and patellar tendon in healthy adults
Authors: Dickson Diane M , Fawole Henrietta O , Newcombe Lisa , Smith Stephanie L , Hendry Gordon J 
Published: June 2019

Objective To report the intra- and inter-operator reliability of ultrasound strain elastography measures in the assessment of quadriceps and patellar tendons. Materials and methods Forty tendons were investigated of 20 healthy volunteers. Five anatomical sites were examined and analysed by three operators of differing levels of experience. Ultrasound was performed over two measures, employing three sonoelastography measurement techniques using a GE S8 with linear probe (L6–15 MHz). The percentage of exact agreement, Cohen's kappa and ICC2,1 were performed to assess intra- and inter-operator reliability. Results The patellar tendon is more reliably measured across all techniques compared to the quadriceps tendon, particularly the distal region. Colour scoring was the most reliable method of sonoelastography. Colour scoring intra- and inter-operator reliability was better for patella tendon sites across all operators (60–95% agreement range), and greatest for experienced operators. Elasticity index intra-operator reliability was greatest for the most experienced operator compared with the least (ICC range 0.35–0.72 and ICC 0.17–0.60). Elasticity ratio intra-operator reliability of the patella tendon was fair–excellent for the experienced operator (ICC range 0.43–0.91), excluding the mid patellar region (ICC 0.13). Poor–fair inter-operator reliability was observed for elasticity ratio (ICC range 0.0–0.54) and elasticity index (ICC range 0.0–0.57). Conclusions Strain elastography of the patellar tendon is more reliable than the quadriceps tendon. Intra- and inter-operator reliability was better when undertaken by more experienced operators. Colour scoring was more reliable than elasticity ratio and index methods. Poor–fair intra- and inter-operator reliability of the elasticity ratio and elasticity index was observed.
Differential Expression of Extracellular Matrix Components in Nasal Polyp Endotypes
Authors: Feng Xin , Payne Spencer C. , Borish Larry , Steinke John W. 
Published: June 2019

Background Chronic rhinosinusitis is a difficult-to-treat disease that is often characterized by recurrent nasal polyp (NP) growth following surgical removal. The disease has been separated into distinct phenotypes based on cellular infiltrate or underlying physiological mechanisms. NPs are composed in part of an inflammatory cellular infiltrate, blood vessels, and a large amount of extracellular matrix (ECM). Despite the recognition of prominent ECM deposition, few studies have examined the components in detail and how they might differ with disease state. Objective The purpose of this study was to quantitate the expression of ECM components in NPs. Methods NPs were stained with pico-sirius red to determine total collagen content, and immunofluorescence was used to detect collagen I, collagen III, collagen IV, fibronectin, and laminin. Expression of each was quantitated and analyzed in relation to rhinosinusitis phenotype and separately as a function of polyp eosinophil number. Results When analyzed by phenotype, collagen I, collagen III, and fibronectin were expressed at the highest levels in noneosinophilic sinus disease. Collagen IV was not different among any groups, and its location was found predominately around vessels. When analyzed as a function of polyp eosinophil number, total collagen and collagen III showed a significant inverse correlation. Conclusions NP ECM composition differs with disease state with higher expression in cases where eosinophil levels are low. This suggests that in eosinophilic polyps there is a loss of matrix deposition either through break down or a failure to produce the essential components. Understanding these differences may identify new therapeutic targets.
Radial versus femoral access in patients with acute coronary syndrome undergoing invasive management: A prespecified subgroup analysis from VALIDATE-SWEDEHEART
Authors: Völz Sebastian , Angerås Oskar , Koul Sasha , Haraldsson Inger , Sarno Giovanna , Venetsanos Dimitrios , Grimfärd Per , Ulvenstam Anders , Hofmann Robin , Hamid Mehmet , Henareh Loghman , Wagner Henrik , Jensen Jens , Danielewicz Mikael , Östlund Ollie , Eriksson Peter , Scherstén Fredrik , Linder Rickard , Råmunddal Truls , Pétursson Pétur , Fröbert Ole , James Stefan , Erlinge David , Omerovic Elmir 
Published: June 2019

Aims: In the Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART), bivalirudin was not superior to unfractionated heparin in patients with acute coronary syndrome undergoing invasive management. We assessed whether the access site had an impact on the primary endpoint of death, myocardial infarction or major bleeding at 180 days and whether it interacted with bivalirudin/unfractionated heparin. Methods and results: A total of 6006 patients with acute coronary syndrome planned for percutaneous coronary intervention were randomised to either bivalirudin or unfractionated heparin. Arterial access was left to the operator discretion. Overall, 90.5% of patients underwent transradial access and 9.5% transfemoral access. Baseline risk was higher in transfemoral access. The unadjusted hazard ratio for the primary outcome was lower with transradial access (hazard ratio 0.53, 95% confidence interval 0.43–0.67, p<0.001) and remained lower after multivariable adjustment (hazard ratio 0.56, 95% confidence interval 0.52–0.84, p<0.001). Transradial access was associated with lower risk of death (hazard ratio 0.41, 95% confidence interval 0.28–0.60, p<0.001) and major bleeding (hazard ratio 0.57, 95% confidence interval 0.44–0.75, p<0.001). There was no interaction between treatment with bivalirudin and access site for the primary endpoint ( p=0.976) or major bleeding ( p=0.801). Conclusions: Transradial access was associated with lower risk of death, myocardial infarction or major bleeding at 180 days. Bivalirudin was not associated with less bleeding, irrespective of access site.
Cost Analysis of Single-Level Lumbar Fusions
Authors: Beckerman Daniel , Esparza Melissa , Lee Sun Ik , Berven Sigurd H. , Bederman S. Samuel , Hu Serena S. , Burch Shane , Deviren Vedat , Tay Bobby , Mummaneni Praveen V. , Chou Dean , Ames Christopher P. 
Published: June 2019

Study Design: Cost analysis of a retrospectively identified cohort of patients who had undergone primary single-level lumbar fusion at a single institution’s orthopedic or neurosurgery department. Objective: The purpose of this article is to analyze the determinants of direct costs for single-level lumbar fusions and identify potential areas for cost reduction. Methods: Adult patients who underwent primary single-level lumbar fusion from fiscal years 2008 to 2012 were identified via administrative and departmental databases and were eligible for inclusion. Patients were excluded if they underwent multiple surgeries, had previous surgery at the same anatomic region, underwent corpectomy, kyphectomy, disc replacement, surgery for tumor or infection, or had incomplete cost data. Demographic data, surgical data, and direct cost data in the categories of supplies, services, room and care, and pharmacy, was collected for each patient. Results: The cohort included 532 patients. Direct costs ranged from $8286 to $73 727 (median = $21 781; mean = $22 890 ± $6323). Surgical approach was an important determinant of cost. The mean direct cost was highest for the circumferential approach and lowest for posterior instrumented spinal fusions without an interbody cage. The difference in mean direct cost between transforaminal lumbar interbody fusions, anterior lumbar interbody fusions, and lateral transpsoas fusions was not statistically significant. Surgical supplies accounted for 44% of direct costs. Spinal implants were the primary component of supply costs (84.9%). Services accounted for 38% of direct costs and were highly dependent on operative time. Comorbidities were an important contributor to variance in the cost of care as evidenced by high variance in pharmacy costs and length of stay related to their management. Conclusion: The costs of spinal surgeries are highly variable. Important cost drivers in our analysis included surgical approach, implants, operating room time, and length of hospital stay. Areas of high cost and high variance offer potential targets for cost savings and quality improvements.
High Prevalence of Anterolateral Ligament Abnormalities on MRI in Knees With Acute Anterior Cruciate Ligament Injuries: A Case-Control Series From the SANTI Study Group
Authors: Ferretti Andrea , Monaco Edoardo , Redler Andrea , Argento Giuseppe , De Carli Angelo , Saithna Adnan , Helito Paulo Victor Partezani , Helito Camilo Partezani 
Published: June 2019

Background: Broad variation in the reported rate of magnetic resonance imaging (MRI)–detected abnormalities of the anterolateral structures of the anterior cruciate ligament (ACL)–injured knee suggests a lack of reliability that has limited the use of MRI in clinical decision making. Purpose/Hypothesis: The aim of this study was to use MRI to determine the prevalence and spectrum of abnormalities of the anterolateral structures in acute ACL-injured knees, using the contralateral uninjured knee as a reference. We hypothesized that MRI evaluation of the acutely injured knee (using the uninjured knee as a reference) would allow reliable identification of abnormalities of the anterolateral structures. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with acute ACL injury underwent MRI scan of both knees. Images were evaluated by 3 observers. Inter- and intraobserver reliabilities were determined for MRI parameters of anterolateral ligament (ALL) injury by use of the kappa (κ) test. Univariate and multivariate analyses were conducted to test associations between ALL abnormality and associated injuries. Results: A total of 34 patients were evaluated. Of these, 30 patients (88.2%) had at least 1 ALL abnormality in the ACL-injured knee (increased signal: n = 27[79.4%]; increased thickness: n = 15[44.1%]; tapering: n = 7[20.6%]; irregularities in the path of the ALL fibers: n = 21[61.7%]). Asymmetries of the genicular vessels were observed in 21 patients (61.7%). ALL abnormality was significantly associated with lateral joint capsular tears ( P < .001). No correlation was found between ALL lesions and iliotibial band lesions ( P = .49). Inter- and intraobserver reliabilities were very good concerning ALL signal changes and femoral and tibial bone bruises (κ coefficient, 0.81-1). Conclusion: MRI evaluation of the ALL was associated with good and very good inter- and intraobserver reliabilities, and it demonstrated abnormalities of the ALL in the majority of acutely ACL-injured knees. The index of suspicion for ALL injury should be elevated by the presence of lesions of the lateral capsule. This suggests that the ALL is part of a wider area of the lateral capsule that is often injured simultaneously in an acute ACL tear.
Prospective, Randomized, Double-Blind Evaluation of the Efficacy of a Single-Dose Hyaluronic Acid for the Treatment of Patellofemoral Chondromalacia
Authors: Hart Joe M. , Kuenze Chris , Norte Grant , Bodkin Stephan , Patrie James , Denny Claire , Hart Jennifer , Diduch David R. 
Published: June 2019

Background: Patellofemoral pain is common in the young and active populations. Nonoperative management is limited and focuses on physical therapy. Hyaluronic acid (HA) is an injectable device that has been used for the treatment of knee osteoarthritis. Hypothesis: A single injection of HA would reduce pain and improve function in patients with patellofemoral pain who had previously failed conservative management. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 86 patients with patellofemoral pain (65 females, 21 males; mean ± SD age, 27.0 ± 7.7 years; height, 168.6 ± 8.9 cm; weight, 74.6 ± 17.0 kg; body mass index, 26.2 ± 5.2 kg/m2) enrolled in this study after failing conservative management. Patients were randomly allocated to either 6 mL of HA or a sham injection. All patients were prescribed an additional home exercise program, including lower extremity strengthening and flexibility exercises, and were evaluated at 1, 3, and 6 months. Outcome assessments included patellofemoral pain assessment with a visual analog scale during a single-legged squat, KOOS (Knee injury and Osteoarthritis Outcome Score), Kujala score, Tegner activity rating, and normalized isometric knee extension strength. Group assignment was revealed after the 6-month assessment, and crossover treatment was offered to patients in the sham group who were still symptomatic. Linear mixed models were used to compare outcomes between groups and across time. Results: A total of 45 patients were randomized to HA injection and 41 to sham, with 6 patients lost to follow-up (93% follow-up rate). Patients in both groups experienced a significant reduction in visual analog pain ratings and significant improvements in all domains of the KOOS and in Kujala scores at 6 months when compared with baseline measurement ( P < .05); however, there was no significant difference between groups. There were no differences observed over time or between groups for normalized knee extension strength or Tegner activity rating ( P > .05). Conclusion: HA injection had no clinically meaningful effect on pain or functional outcomes in patients diagnosed with patellofemoral pain. Improvements were observed for both groups in patient-reported pain and function, with no change in quadriceps strength or activity rating. Registration: NCT01771952 ( ClinicalTrials.gov identifier).
Effect of solvent on PARALOID® B72 and B44 acrylic resins used as adhesives in conservation
Authors: Vinçotte Armand , Beauvoit Emmie , Boyard Nicolas , Guilminot Elodie 
Published: June 2019

Abstract
Paraloid® is one of the most frequently used acrylic polymers, employed mainly for its adhesive and consolidating properties in the conservation of a wide range of materials. Appreciated for its reversibility, mechanical characteristics and ease of use, application of the polymer requires it to be simply dissolved in a solvent. Nevertheless, the chemical nature of the relevant solvent must be regarded as an essential parameter, due to its influence on the physico-chemical characteristics of the resulting adhesive film. The aim of this study was to evaluate the effect of the solvents used with Paraloid® acrylic resin on adhesive film properties, and more specifically on their thermophysical characteristics. Two compounds used in conservation (Paraloid® B72 and B44) and six solvents (ethanol, acetone, ethyl acetate, ethyl lactate, butyl acetate and toluene) were used to make adhesive film replicates. Thermogravimetry and differential scanning calorimetry (DSC) analyses allowed us to determine the value of the glass transition temperature (Tg) of solvent/Paraloid® mixtures. Mass monitoring of the films enabled us to correlate Tg values with the quantity of residual solvent. Results showed that all the solvents remained present for a long time in Paraloid® films when drying took place at room temperature. Moreover, DSC analysis highlighted the fact that residual solvent had a considerable impact on the value of film Tg. In fact, residual solvent significantly lowered the Tg value of Paraloid® (by up to 30 °C below its theoretical value). This underlined the importance of taking the impact of solvent on resin properties into account.