bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nurse Practitioner and Medical Students’ Perceptions of Teamwork Before and After a Standardized Patient Pilot Simulation
Authors: Tankimovich Mariya , Swails Jennifer , Hamburger Marcelle 
Published: May 2019

Abstract
Attitudes toward interprofessional education are positive overall, but inferences about its key elements are hard to draw. Studies with qualitative strands examining interprofessional education’s key elements (communication, collaboration/teamwork, learning in practice, and understanding of roles) are especially needed. This mixed quantitative/qualitative standardized patient simulation involved 10 family nurse practitioner and 10 medical students. Both cohorts expressed improved teamwork confidence but were concerned about the complexity of teamwork and pressures on communication. At the complexity/communication nexus, nurse practitioner students thought interprofessional trust and equality were key; medical students saw the importance of strategizing multiple professional perspectives.
Subanesthetic Dose of Ketamine Improved CFA-induced Inflammatory Pain and Depression-like Behaviors Via Caveolin-1 in Mice
Authors: Wang Juan , Zhao Qiuhua , Zhou Yang , Sun Wanchen , Han Song , Peng Yuming , Li Junfa , Han Ruquan 
Published: May 2019

Background:
Ketamine, a commonly used nonbarbiturate anesthetic drug, possesses antidepressant properties at subanesthetic doses; however, the underlying mechanisms remain unclear.

Materials and Methods:
The analgesic and antidepressant effects of ketamine were explored using a complete Freund adjuvant (CFA)-induced peripheral inflammatory pain model in vivo. Mice were first divided into sham or CFA injection group randomly, and were observed for mechanical hyperalgesia, depression-like behavior, and mRNA expression of caveolin-1. Then ketamine was administered in CFA-treated mice at day 7.

Results:
The behavioral testing results revealed mechanical hyperalgesia and depression in mice from days 7 to 21 after CFA injection. Ketamine reversed depression-like behaviors induced by CFA injection. It also restored the brain-regional expression levels of caveolin-1 in CFA-treated mice. In addition, caveolin-1 mRNA and protein expression were increased in the prefrontal cortex and nucleus accumbens of CFA-treated mice. However, ketamine reversed the increase in caveolin-1 expression in the ipsilateral and contralateral prefrontal cortex and nucleus accumbens, supporting the distinct roles of specific brain regions in the regulation of pain and depression-like behaviors.

Conclusions:
In CFA-treated mice that exhibited pain behavior and depression-like behavior, ketamine reversed depression-like behavior. The prefrontal cortex and nucleus accumbens are the important brain regions in this regulation network. Despite these findings, other molecules and their mechanisms in the signal pathway, as well as other regions of the brain in the pain matrix, require further exploration.
The use of biologics for uveitis associated with spondyloarthritis
Authors: Arepalli Sruthi , Rosenbaum James T. 
Published: May 2019

Purpose of review
The term spondyloarthritis (SpA) encompasses a group of chronic inflammatory disorders of the joints, including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, inflammatory bowel disease, juvenile SpA and undifferentiated SpA. These diseases can also present with uveitis, or intraocular inflammation, which can be controlled with biologics.

Recent findings
Profound success has occurred with the tumor necrosis factor-α inhibitors infliximab and adalimumab, moderate success with certolizumab pegol and golimumab and less encouraging results with etanercept. Promising results have also been demonstrated with interleukin-17 (IL-17) antagonists, such as secukinumab ixekizumab or combined IL-12 and 23 medications, such as ustekinumab.

Summary
In cases of uveitis that require long-term control, biologics are an emerging and valuable class of medications for these patients, and may provide avenues to control both their underlying SpA and uveitis manifestations.
Patellar-Trochlear Morphology in Pediatric Patients From 2 to 11 Years of Age: A Descriptive Analysis Based on Computed Tomography Scanning
Authors: Richmond Connor G. , Shea Kevin G. , Burlile Jessica F. , Heyer Ann M. , Ellis Henry B. , Wilson Philip L. , Arendt Elizabeth A. , Tompkins Marc A. 
Published: May 2019

Background:
Despite the critical role the trochlea plays in patellofemoral (PF) pathology, the development of the trochlea is poorly understood. The purpose of this study was 2-fold: (1) Describe quantitative osseous and soft tissue anatomy of the patella and trochlea in skeletally immature cadaveric specimens utilizing known measurements used in PF instability, and (2) evaluate additional measurement techniques in the sagittal plane as they relate to PF morphologic development.

Methods:
Thirty-one skeletally immature fresh frozen cadaveric knees between the ages of 2 and 11 years old were evaluated using 0.625 mm computed tomography scans. In the axial plane, measurements included condylar height asymmetry, trochlear facet asymmetry, trochlear depth, osseous sulcus angle, cartilaginous sulcus angle, patella sulcus angle, and tibial tubercle-trochlear groove distance. In the sagittal plane, measurements included previously undescribed measurements of trochlear length and condylar height asymmetry which are based on the anterior femoral cortex.

Results:
Analysis of trochlear morphology using condylar height asymmetry (both axial and sagittal), trochlear facet asymmetry, and trochlear depth and length demonstrated an increase in the size of the medial and lateral trochlea as age increased. There was more variability in the change of size of the medial trochlea (height, length, and facet length) than the lateral trochlea. The osseous sulcus angle, cartilaginous sulcus angle, and patella sulcus angle decreased (became deeper) with age until after 8 years and then plateaued.

Conclusions:
This cadaveric analysis demonstrated that there is an increase in the medial and lateral trochlear height as age increased by all measurements analyzed. The findings also demonstrate that the shape of the patella and trochlea change concurrently, which suggests that there may be interplay between the 2 during development. These new sagittal measurement techniques evaluating the medial, central, and lateral trochlear height and length with respect to age may help guide clinicians when investigating patellar instability in skeletally immature patients.

Levels of Evidence:
Level IV.
Monocyte Distribution Width: A Novel Indicator of Sepsis-2 and Sepsis-3 in High-Risk Emergency Department Patients*
Authors: Crouser Elliott D. , Parrillo Joseph E. , Seymour Christopher W. , Angus Derek C. , Bicking Keri , Esguerra Vincent G. , Peck-Palmer Octavia M. , Magari Robert T. , Julian Mark W. , Kleven Jennifer M. , Raj Paarth J. , Procopio Gabrielle , Careaga Diana , Tejidor Liliana 
Published: May 2019

Objectives:
Most septic patients are initially encountered in the emergency department where sepsis recognition is often delayed, in part due to the lack of effective biomarkers. This study evaluated the diagnostic accuracy of peripheral blood monocyte distribution width alone and in combination with WBC count for early sepsis detection in the emergency department.

Design:
An Institutional Review Board approved, blinded, observational, prospective cohort study conducted between April 2017 and January 2018.

Setting:
Subjects were enrolled from emergency departments at three U.S. academic centers.

Patients:
Adult patients, 18–89 years, with complete blood count performed upon presentation to the emergency department, and who remained hospitalized for at least 12 hours. A total of 2,212 patients were screened, of whom 2,158 subjects were enrolled and categorized per Sepsis-2 criteria, such as controls (n = 1,088), systemic inflammatory response syndrome (n = 441), infection (n = 244), and sepsis (n = 385), and Sepsis-3 criteria, such as control (n = 1,529), infection (n = 386), and sepsis (n = 243).

Interventions:
The primary outcome determined whether an monocyte distribution width of greater than 20.0 U, alone or in combination with WBC, improves early sepsis detection by Sepsis-2 criteria. Secondary endpoints determined monocyte distribution width performance for Sepsis-3 detection.

Measurements and Main Results:
Monocyte distribution width greater than 20.0 U distinguished sepsis from all other conditions based on either Sepsis-2 criteria (area under the curve, 0.79; 95% CI, 0.76–0.82) or Sepsis-3 criteria (area under the curve, 0.73; 95% CI, 0.69–0.76). The negative predictive values for monocyte distribution width less than or equal to 20 U for Sepsis-2 and Sepsis-3 were 93% and 94%, respectively. Monocyte distribution width greater than 20.0 U combined with an abnormal WBC further improved Sepsis-2 detection (area under the curve, 0.85; 95% CI, 0.83–0.88) and as reflected by likelihood ratio and added value analyses. Normal WBC and monocyte distribution width inferred a six-fold lower sepsis probability.

Conclusions:
An monocyte distribution width value of greater than 20.0 U is effective for sepsis detection, based on either Sepsis-2 criteria or Sepsis-3 criteria, during the initial emergency department encounter. In tandem with WBC, monocyte distribution width is further predicted to enhance medical decision making during early sepsis management in the emergency department.
What Proportion of Women Who Received Funding to Attend a Ruth Jackson Orthopaedic Society Meeting Pursued a Career in Orthopaedics?
Authors: Vajapey Sravya , Cannada Lisa K. , Samora Julie Balch 
Published: May 2019

Abstract

Background
Orthopaedic surgery has the lowest percentage of women residents and faculty of any medical and surgical specialty. Diversity in medicine has been shown to improve patient outcomes and satisfaction. Although some scholarships are designed to increase the exposure of women medical students to orthopaedic surgery, the impact of those scholarships is largely unknown.

Questions/purposes
To determine the proportion of medical students who received a scholarship to attend the Ruth Jackson Orthopaedic Society (RJOS) annual meeting and later pursued a career in orthopaedic surgery.

Methods
The RJOS scholarship was advertised through the RJOS website, current members, and newsletters. Any RJOS medical student member in good standing was eligible to receive the award. Eighty-one scholarship winners were selected from 2003 to 2016. From 2003 to 2010, there were two awards each year. Starting in 2011, 10 students were selected yearly, and these numbers increased annually secondary to increased industry financial support. Recipients received a check for USD 1500 and were able to attend both the RJOS and American Academy of Orthopaedic Surgeons annual meetings. We collected the names of all RJOS medical student scholarship winners from 2003 to 2016, and one author performed an internet search to determine whether these individuals are currently in an orthopaedic residency program or are orthopaedic surgeons. Secondary confirmation was performed to ensure accuracy by the RJOS administrative staff and the other two authors, independently, after the initial results were tabulated.

Results
Of the 81 scholarship winners, 65 women (80%) now either practice orthopaedic surgery or are in an orthopaedic surgery residency program. Of the applicants who were not selected as scholarship recipients from 2014-2016, 44.9% went on to pursue a career in orthopaedics.

Conclusions
The RJOS scholarship may have helped young women decide to pursue careers in orthopaedic surgery, although it is also possible that some scholarship winners were inclined to do so before receiving the funding. Based partly on these results, the RJOS continues to award this scholarship. Future studies evaluating the impact of such scholarships and comparing them with alternative recruitment methods such as summer camps might be useful in determining the most effective way of increasing minority representation in orthopaedics, a factor that has been shown to be clinically relevant and one that can contribute to patient satisfaction.

Level of Evidence
Level IV, therapeutic study.
Does Medial Patellofemoral Osteoarthritis Influence Outcome Scores and Risk of Revision After Fixed-bearing Unicompartmental Knee Arthroplasty?
Authors: Berger Y. , Ftaita S. , Thienpont E. 
Published: May 2019

Abstract

Background
Patellofemoral osteoarthritis (OA) and anterior knee pain sometimes are considered contraindications for unicompartmental knee arthroplasty (UKA). However, several studies have demonstrated excellent patient-reported outcome scores in patients with patellofemoral OA treated with medial mobile-bearing UKA. Because these studies assessed the outcome of mobile-bearing UKA only, we were interested to see whether that finding also applies to fixed-bearing medial UKA.

Questions/purposes
(1) Does patellofemoral OA influence patient-reported outcome scores after medial fixed-bearing UKA? (2) Does untreated medial patellofemoral OA increase the revision rate after medial fixed-bearing UKA?

Methods
Between 2008 and 2015, one surgeon performed 308 medial fixed-bearing UKAs of a single design. Of those, 80 (26%) had patellofemoral OA of at least moderate severity (ICRS III or IV), and 228 (74%) did not. During that period, the surgeon did not use patellofemoral OA as a contraindication to UKA. In all, 13 patients (10%) in the patellofemoral OA group were lost before 2-year minimum followup, and 20 (11%) in the control group (without patellofemoral OA) were lost; all other patients were available, seen in the last 5 years, and included in this retrospective study. Mean (± SD) followup in the patellofemoral OA group was 39 ± 25 months, and it was 41 ± 23 in the control group. There were 100 women and 120 men. Patients had a mean age ± SD of 65 ± 10 years and mean ± SD BMI of 29 ± 4.5 kg/m2.The intraoperative status of the patellofemoral joint was assessed using the International Cartilage Repair Society (ICRS) classification. The primary study endpoint was the Forgotten Joint Score (FJS-12); we also compared scores on the Lonner PatelloFemoral Score (LPFS), Oxford Knee Score (OKS) and Short-Form 12 (SF-12). With the numbers available, we had 80% power to detect a difference of 12.3 points on the Forgotten Joint Score. A secondary endpoint was femoral or tibial component revision for any reason verified over the phone for each included patient.

Results
With the numbers available, there was no difference in FJS-12 score between the UKA with patellofemoral OA group and the group without patellofemoral OA 71 ± 29 versus 77 ± 26, mean difference - 6; 95% CI, -16 to 4.5; p = 0.270). Likewise, with the numbers available, we saw no differences in LPFS, OKS and SF-12. There was no difference in survivorship from all-cause revision at 4 years between the patellofemoral OA group and the group without patellofemoral OA (98%; 95% CI, 85.8–99.7 versus 99.5%; 95% CI, 96.0–99.2%; p = 0.352).

Conclusions
Patients with medial osteoarthritis in this single-center study generally benefitted from medial fixed-bearing UKA with good-to-excellent outcomes scores at short term, whether or not medial patellofemoral wear is present.

Level of Evidence
Level III, therapeutic study.
Value-Driven Care in Developmental-Behavioral Pediatrics, Part 1: The Value Proposition of Developmental-Behavioral Pediatrics
Authors: Sandler Adrian D. 
Published: May 2019

ABSTRACT:
The drive to improve quality and reduce cost of health care is leading to a value-driven transformation of the US health care landscape. This is the first of a 2-part series on value-driven care and its implications for developmental-behavioral pediatrics (DBP). Tools derived from business/manufacturing models have been applied with some success to health care to better understand and enhance value. Value can be defined most simply as health outcomes achieved per dollar spent, but there are challenges in accounting for the full cost of a cycle or episode of care. When taking into account the “five Ds”—Development, Dependency, Differential Epidemiology, Demographics, and Dollars—the potential value of pediatric care is brought into sharper focus. The field of DBP in particular has the potential to add value through prevention, integration, efficiency, standardization, and innovation. The value proposition of DBP is illustrated by focusing on particular conditions or cycles of care commonly encountered in DBP practice: (1) children 0 to 3 years of age identified as having global developmental delay, (2) recent diagnosis of complex attention-deficit hyperactivity disorder (ADHD) (ADHD plus comorbid conditions), and (3) children with autism spectrum disorder and disruptive behavior. The second part of the series focuses on quality of care, emphasizing the important challenges that lie ahead for the field of DBP in measuring outcomes of care. With a discussion of national trends and a local example of a DBP program's response to these trends, the series is intended to provoke discussion and action in the field, contribute to the demonstration of value of a DBP approach to care, and help to chart a course toward growth and sustainability of DBP in an era of value-based care.
Early Shared Reading Is Associated with Less Harsh Parenting
Authors: Jimenez Manuel E. , Mendelsohn Alan L. , Lin Yong , Shelton Patricia , Reichman Nancy 
Published: May 2019

ABSTRACT:

Objective:
Shared reading is believed to enhance parent-child relationships, but the extent to which it reduces harsh parenting is understudied. Associations between early shared reading and subsequent harsh parenting were investigated.

Methods:
Data from a national urban birth cohort were used to estimate associations between mother-reported shared reading at ages 1 and 3 years and harsh parenting—based on a composite of psychological and physical aggression subscales of a validated self-report instrument—when the children were at ages 3 and 5 years. The authors used multivariable linear regression and generalized estimating equations to account for repeated observations. Given potential inverse associations between shared reading and child disruptive behaviors, which can trigger harsh parenting, the authors investigated the extent to which children's behavior at age 3 years mediated the association between shared reading at age 1 year and harsh parenting at age 5 years.

Results:
This study included 2165 mother-child dyads. Thirty-four percent and 52% of mothers reported daily reading at ages 1 and 3 years. In adjusted models, shared reading at age 1 year was associated with less harsh parenting at age 3 years. Similarly, shared reading at age 3 years was associated with less harsh parenting at age 5 years. These associations remained significant in lagged repeated-measures models. Decreased disruptive behaviors partially mediated the association between shared reading at age 1 year and harsh parenting at age 5 years.

Conclusion:
Shared reading predicted less harsh parenting in a national urban sample. These findings suggest that shared reading contributes to an important aspect of the parent-child relationship and that some of the association operates through enhanced child behaviors.
Anterior Chamber Rebubbling With Perfluoropropane (C3F8) After Failed Rebubbling Attempts for Persistent Descemet Membrane Endothelial Keratoplasty Graft Detachments
Authors: Keshet Yariv , Nahum Yoav , Bahar Irit , Livny Eitan 
Published: May 2019

Purpose:
To describe the clinical outcomes of using C3F8 as a tamponade agent for the attachment of partially detached Descemet membrane endothelial keratoplasty (DMEK) grafts after failure of previous rebubbling attempts.

Methods:
Interventional case series. We reviewed the medical records of all DMEK surgeries performed at Rabin Medical Center (Petach Tikva, Israel) between January 2016 and December 2018 in which 10% C3F8 tamponade was used for graft reattachments. Patient demographic details, indication for surgery, early postoperative endothelial cell loss, postoperative visual acuity, intraoperative and postoperative complications as well as graft survival were noted.

Results:
Five patients were included in this case series. Indications for DMEK were pseudophakic bullous keratopathy (n = 3), failed penetrating graft (n = 1), and Fuchs endothelial dystrophy (n = 1). In 4 of 5 cases, SF6 tamponade was used at the end of the initial DMEK surgery. In 1 case, air tamponade was used. In all cases, partial graft detachment was seen 1 to 2 weeks postoperatively, and anterior chamber rebubbling was performed using 20% SF6 gas. A second C3F8-assisted rebubbling was performed 10 to 70 days after the primary DMEK surgery. In all cases, complete graft attachment was achieved, and the corneas cleared. Early endothelial cell loss rates averaged at 44% ± 26% (range 20%–74%). One case which had a previous trabeculectomy with chronic preoperative and postoperative hypotony had failed 6 months after surgery. All the other grafts were clear at last visit.

Conclusions:
Tamponade using nonexpansile 10% C3F8 gas can attach partially detached DMEK grafts after the failure of previous air- or SF6-assisted rebubbling attempts.
A Clinical Score to Support Antiretroviral Management of HIV-exposed Infants on the Day of Birth
Authors: Nesheim Steven R. , Rose Charles , Pan Yi , Mahle Gray Kristen , Rao Shubha , Singh Sonia , Lampe Margaret 
Published: May 2019

Background:
The benefits of combination antiretroviral (ARV) prophylaxis for infants whose HIV exposure is recognized near birth have been established, and the benefits of early ARV therapy are well known. Decisions about ARVs can be supported by the probability that the child has acquired HIV.

Methods:
Using 2005–2010 data from Enhanced Perinatal Surveillance of the Centers for Disease Control and Prevention, we developed a tool for use at birth to help predict HIV acquisition of HIV-exposed infants to support ARV management. A logistic regression model, fit using a fully Bayesian approach, was used to determine maternal variables predictive of infant HIV acquisition. We created a score index from these variables, established the sensitivity and specificity of each possible score, and determined the distribution of scores among infants, with and without HIV, in our study population.

Results:
Multivariable analysis of data from 8740 HIV-exposed infants (176 infected and 8564 uninfected) yielded 4 maternal variables in the perinatal HIV acquisition prediction model: sexually transmitted infection, substance use, last HIV viral load before delivery and ARV use. Using the regression coefficient estimates, we rescaled each possible score to make the maximum score equal to 100. For each score, sensitivity and specificity were determined; the area under the receiver operating characteristic curve was 0.79. Median index scores for infants with HIV and without HIV were 43 (first quartile 27 and third quartile 60), and 12 (first quartile, 0 and thirs quartile, 29), respectively.

Conclusions:
Decisions to begin infants on 3 ARVs—whether considered therapeutic or prophylactic—can be supported by data available on the day of birth.