bluuebunny/crossref_metadata_2025_split huggingface dataset:
Equinus Correction During Multilevel Surgery in Adults With Cerebral Palsy
Authors: Putz Cornelia , Mertens Eva Maria , Wolf Sebastian I. , Geisbüsch Andreas , Niklasch Mirjam , Gantz Simone , Döderlein Leonhard , Dreher Thomas , Klotz Matthias C. 
Published: April 2018

Background: Equinus foot deformity constitutes a common gait disorder in ambulatory adults with bilateral spastic cerebral palsy (BSCP). The outcome after intramuscular aponeurotic lengthening in the context of single-event multilevel surgery (SEMLS) in adulthood has not been investigated. Methods: We followed a group of 31 ambulatory adults with BSCP and equinus who underwent SEMLS including gastrocnemius-soleus intramuscular aponeurotic recession or Achilles tendon lengthening. All patients were analyzed preoperatively and at least 1 year (mean follow-up period: 1.6 years) postoperatively by clinical examination and 3-dimensional instrumented gait analysis including the Gait Profile Score (GPS). Results: Clinical examination showed no significant improvement of ankle dorsiflexion ( P = .5) and an unchanged plantarflexion ( P = .7) with knee extended but a significant postoperative reduction of spasticity in the calf muscle ( P = .0001) as measured by clinical examination following the modified Ashworth scale. Significant improvement of mean ankle dorsiflexion in stance and swing ( P = .0001) was found. The GPS decreased and improved significantly (15.9 ± 4.6 to 11.4 ± 3.1; P = .0001). Persistence of equinus and calcaneal gait indicating under- and overcorrection at follow-up was found in 1 patient (3%), respectively. Conclusion: Intramuscular gastrocnemius-soleus aponeurotic recession is part of multilevel surgery corrected equinus deformity in adults. The increase in muscle length led to significant improvement of kinetic and kinematic parameters during walking without a loss of muscle strength and push-off capacity. The risk of overcorrection after equinus correction in adults with BSCP was found to be relatively low. Level of Evidence: Level IV, retrospective case series.
Return to Sports and Physical Activities After Open Reduction and Internal Fixation of Lisfranc Injuries in Recreational Athletes
Authors: Mora Allan David , Kao Mark , Alfred Terrence , Shein Gregory , Ling Jeff , Lunz David 
Published: April 2018

Background: The purpose of this study was to assess participation in sport and physical activity following open reduction and internal fixation of a Lisfranc injury in a cohort of recreational athletes. Methods: This study identified all adult patients aged 55 years or younger who presented with a Lisfranc injury and underwent open reduction and internal fixation (ORIF) using a Lisfranc screw combined with bridge plating technique. Sports and physical activity participation was assessed with a new sports-specific, patient-administered questionnaire. Clinical outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). Thirty-three patients qualified for the study (21 men/12 women). Mean age and follow-up were 31.2 (range, 18-55) years and 2.9 (range, 1.5-5.4) years, respectively. Results: Postoperatively, 31 patients (94%) were able to return to some form of sport. Twenty-two patients (66%) returned to playing sport at or above their preinjury level. Of the 11 patients who played less sport, 6 had ongoing pain, and the remaining 5 were asymptomatic but were participating less frequently because of other lifestyle reasons. In addition, of the 33 patients, 11 (33%) had some degree of ongoing pain that might limit their ability to return to sports and physical activities. There was strong correlation between overall FAOS and the Sports Questionnaire. Conclusion: Most patients who sustained a Lisfranc injury could return to sport and physical activity after ORIF. Patients should be counseled preoperatively that about 1 in 3 might experience continued pain at the injury site Level of Evidence: Level IV, retrospective case series.
Implanting a posterior chamber phakic intraocular lens in highly myopic eyes with peripheral primary iris and ciliary body cysts
Authors: Zhao Jing , Luo Dongqiang , Sun Yong , Niu Lingling , Zhao Feng , Wang Xiaoying , Wang Hua , Chen Qian , Zhou Xingtao 
Published: April 2018

Purpose: To investigate the safety and efficacy of implanting a posterior chamber implantable collamer lens with a central hole in cases of high myopia with peripheral primary iris or ciliary body cysts. Methods: A total of 37 eyes of 19 patients with primary iris or ciliary body cysts detected by ultrasonic biological microscope were included, with spherical powers of −10.26 ± 3.28 D and cylinder powers of −1.71 ± 1.18 D. Each patient received ultrasonic biological microscope and a routine examination before implantation of the implantable collamer lens. A routine postoperative follow-up was performed to observe changes in the iris or ciliary body cyst, ranging from 3 to 18 months. Results: There were no complications. At the last follow-up, 56.8% (21/37) of eyes achieved the same corrected distance visual acuity as their preoperative measurements, 43.2% of eyes were enhanced by ≥1 line, and no patients’ corrected distance visual acuity declined. The efficacy index and safety index were 0.95 and 1.11, respectively. After 18 months, 66.7% of the spherical equivalents were between ±0.5 D with 100% between ±1.0 D. The postoperative mean spherical equivalents at 1, 3, 6, 12, and 18 months were −0.45 ± 0.31 D, −0.39 ± 0.29 D, −0.36 ± 0.30 D, −0.39 ± 0.38 D, and −0.48 ± 0.23 D (p = 0.789). The vaults were 516 ± 140, 548 ± 124, 498 ± 133, 582 ± 161, and 557 ± 110 μm (p = 0.355). There were no changes in size (p > 0.05), number, or position of the iris or ciliary body cysts. Conclusion: Implantable collamer lens implantation is safe and effective for highly myopic patients with peripheral primary iris and ciliary body cysts. The cysts did not change after operation in this study.
Toxicity and phototoxicity in human ARPE-19 retinal pigment epithelium cells of dyes commonly used in retinal surgery
Authors: Awad Doaa , Wilińska Joanna , Gousia Dimitra , Shi Xiaoye , Eddous Jnina , Müller Arne , Wagner Veit , Hillner Charlie , Brannath Werner , Mohr Andreas , Gabel Detlef 
Published: April 2018

Purpose: To compare, for the first time, systematically the toxicity and phototoxicity of dyes and dye combinations used in vitreoretinal surgery. The dyes were trypan blue, brilliant blue G, trypan blue + brilliant blue G, indocyanine green, bromophenol blue, bromophenol blue + brilliant blue G, and acid violet 17, in clinically used concentrations. Methods: Human ARPE retinal pigment epithelium cells were exposed to the dyes for 30 min. For phototoxicity, the cells were exposed for 15 min to high-intensity light from a light emitting diode source with an intensity similar to surgical conditions. Toxicity was assayed either directly after exposure to either dye alone or dye and light, or with a delay of 24 h. Results: None of the dyes or their combinations was toxic when cells were exposed to them at ambient light. Acid violet led to a reduction viability by 90% already immediately after light exposure. Bromophenol blue and its combination with brilliant blue G showed strong phototoxicity (reduction of viability by 83%) when assayed with delay. Indocyanine green with different agents to adjust osmolarity (balanced salt solution, glucose, and mannitol) was not found to be toxic. Conclusion: The strong immediate phototoxicity of acid violet reflects its clinical toxicity. Bromophenol blue might also be disadvantageous for patient outcome because of its delayed phototoxicity. The other dyes (trypan blue, brilliant blue g, and indocyanine green) were not found to be toxic neither with exposure to ambient light nor after exposure to light of intensities used in surgery.
Organized Labor's Check on Rising Economic Inequality in the U.S. States
Authors: Bucci Laura C. 
Published: April 2018

AbstractRecent demonstrations of growing economic inequality in the United States raise normative concerns about the political representation of all but the very wealthiest citizens. Building on existing cross-national work on the roles of unions in welfare states, I provide evidence that organized labor, as a political institution, limits unequal income distributions in the U.S. states. The states are useful to our understanding of labor's influence on inequality as states differ in their acceptance of labor unions, base levels of inequality, political preferences, industries, and levels of development but are all nested within a single overarching national framework. Over the 39-year period examined, states where unions maintain more members remain more equal within the labor market and after redistribution via government transfer. These effects persist after accounting for state-level policy, demography, and economic conditions. However, states where union membership has the largest influence on inequality have also seen growing attempts to reduce unionization rates. Overall, I find that unions are still able to limit the growth of economic inequality in spite of declining levels of union membership.
Uptake and impact of regulated pharmacy technicians in Ontario community pharmacies
Authors: Grootendorst Paul , Shim Minsup , Tieu Jimmy 
Published: April 2018

Background: Since 2010, most provincial Colleges of Pharmacists have licensed pharmacy technicians. The colleges hoped this would give pharmacists time to provide “expanded scope” activities such as medication reviews. Little is known, however, about the uptake and impact of pharmacy technicians on pharmacists’ provision of such services. We address these questions using data for Ontario community pharmacies. Methods: Data on pharmacists and pharmacy technicians were obtained from the Ontario College of Pharmacists website in September 2016. Their place of employment was used to calculate the number of full-time equivalent (FTE) pharmacists and technicians employed at each community pharmacy. Pharmacy claims data for the 12-month period ending March 31, 2016, were obtained from the Ontario Public Drug Programs (OPDP). These data included number of MedsChecks performed, type of MedsCheck and number of prescriptions dispensed to OPDP beneficiaries. Results: Pharmacy technicians were employed in 24% of the pharmacies in our sample. Technician employment rates were highest in Central Fill pharmacies and pharmacies serving long-term care facilities. In general, pharmacies employing 1 or fewer technician full-time equivalents (FTEs) had a slightly higher probability of providing MedsChecks and, of those that did provide Meds Checks Annuals, provided more of them. Pharmacies that hired 3 or more technician FTEs were markedly less likely to provide MedsChecks. Conclusions: Pharmacies differ in their employment of technicians and in the apparent impact of technicians on the provision of MedsChecks. However, these represent associations. Additional research is needed to assess the causal effect of technician employment on the provision of MedsChecks.
Reporting non-adherence in cluster randomised trials: A systematic review
Authors: Agbla Schadrac C , DiazOrdaz Karla 
Published: April 2018

Background: Treatment non-adherence in randomised trials refers to situations where some participants do not receive their allocated treatment as intended. For cluster randomised trials, where the unit of randomisation is a group of participants, non-adherence may occur at the cluster or individual level. When non-adherence occurs, randomisation no longer guarantees that the relationship between treatment receipt and outcome is unconfounded, and the power to detect the treatment effects in intention-to-treat analysis may be reduced. Thus, recording adherence and estimating the causal treatment effect adequately are of interest for clinical trials. Objectives: To assess the extent of reporting of non-adherence issues in published cluster trials and to establish which methods are currently being used for addressing non-adherence, if any, and whether clustering is accounted for in these. Methods: We systematically reviewed 132 cluster trials published in English in 2011 previously identified through a search in PubMed. Results: One-hundred and twenty three cluster trials were included in this systematic review. Non-adherence was reported in 56 cluster trials. Among these, 19 reported a treatment efficacy estimate: per protocol in 15 and as treated in 4. No study discussed the assumptions made by these methods, their plausibility or the sensitivity of the results to deviations from these assumptions. Limitations: The year of publication of the cluster trials included in this review (2011) could be considered a limitation of this study; however, no new guidelines regarding the reporting and the handling of non-adherence for cluster trials have been published since. In addition, a single reviewer undertook the data extraction. To mitigate this, a second reviewer conducted a validation of the extraction process on 15 randomly selected reports. Agreement was satisfactory (93%). Conclusion: Despite the recommendations of the Consolidated Standards of Reporting Trials statement extension to cluster randomised trials, treatment adherence is under-reported. Among the trials providing adherence information, there was substantial variation in how adherence was defined, handled and reported. Researchers should discuss the assumptions required for the results to be interpreted causally and whether these are scientifically plausible in their studies. Sensitivity analyses to study the robustness of the results to departures from these assumptions should be performed.
Estrogenicity of essential oils is not required to relieve symptoms of urogenital atrophy in breast cancer survivors
Authors: Simões Bruno M. , Kohler Bertram , Clarke Robert B. , Stringer Jacqui , Novak-Frazer Lily , Young Keely , Rautemaa-Richardson Riina , Zucchini Giorgia , Armstrong Anne , Howell Sacha J. 
Published: April 2018

Background Urogenital atrophy (UA) is a common treatment-limiting side effect of endocrine therapies. Topical estrogen is effective but systemic absorption may counter aromatase inhibitor efficacy. Numerous complementary approaches are marketed for use in UA without rigorous testing of their estrogenicity. We tested multiple essential oils in cancer cell growth and estrogen reporter assays in vitro and assessed clinical outcomes with the essential oil pessaries (EOPs) in breast cancer survivors with UA. Methods Effects on cell growth were tested in hormone-dependent (MCF-7) and -independent (MDA-MB-231) cell lines using the sulforhodamine-B assay. An estrogen response element (ERE) luciferase reporter assay was used to assess estrogenicity directly. Antifungal activity against two common pathogenic yeasts was assessed using standard microdilution methods. EOPs were offered to breast cancer survivors with symptomatic UA and the service evaluated using serial questionnaires. Results Two essential oils, Cymbopogon martinii and Pelargonium graveolens, demonstrated marked estrogenicity, stimulating ER+ cell growth and ERE-luciferase reporter activity to levels seen with premenopausal estradiol concentrations. Additional oils were screened for estrogenicity and Lavandula angustifolia and Chamaemelum nobile identified as non/minimally estrogenic. The antifungal activity of this combination of oils was confirmed. A second cohort of breast cancer survivors with UA received the second generation EOP with comparable improvement in symptom scores suggesting that estrogenicity may not be required for optimal therapy of UA. Conclusion Certain essential oils demonstrate profound estrogenicity and caution should be exercised before their use in breast cancer survivors. Our minimally estrogenic pessary will be formally tested in clinical trials.
Weight-Bearing Radiographic Analysis of the Tibiofibular Syndesmosis
Authors: Amin Arsalan , Janney Cory , Sheu Christopher , Jupiter Daniel C. , Panchbhavi Vinod K. 
Published: April 2018

Background: Diagnosis of distal tibiofibular syndesmotic injuries includes assessment of radiographs; however, there exist no agreed on standard diagnostic criteria. Previous studies lack consistency with radiographic evaluation methods. The dynamic nature of the ankle joint supports analyzing anatomical parameters using weight-bearing films to assess for tibiofibular syndesmotic integrity. Methods: Weight-bearing tibiofibular syndesmosis radiographs of 39 male and 40 female patients were retrospectively analyzed by 3 investigators, at different levels of orthopaedic training. Measurements 1 cm above the tibial plafond for the anterior tibiofibular overlap (TFO) and tibiofibular clear space (TCS) were recorded and standardized by the fibular width (FW) at 2 time points. Data were compared to check for agreement between the sets of measurements for each rater and agreement between investigators, and to ascertain underlying gender differences. Results: There was good intraobserver correlation (intraclass correlation coefficient [ICC] > 0.90) among investigators for each parameter. A significant difference in the TFO was noted between genders (P < .05). We establish the following radiographic (anteroposterior view) parameters for an intact syndesmosis: male patients, TCS <4.57 mm or TCS/FW <29% and TFO >9.29 mm or TFO/FW > 57%; female patients, TCS <4.28 mm or TCS/FW <30% and TFO >7.41 mm or TFO/FW >51%. Conclusions: Our study provides a more objective approach by utilizing weight-bearing radiographs and performing all measurements 1 cm above the tibial plafond. Levels of Evidence: Level IV
Endolaserless Vitrectomy With Intravitreal Aflibercept Injection for Proliferative Diabetic Retinopathy-Related Vitreous Hemorrhage (LASER LESS TRIAL)
Authors: Marcus Dennis M. , Singh Harinderjit , Starnes Davis C. , Walia Harveen , Farooq Amina , Frazier Heather , Marcus William B. , Lalane Robert A. 
Published: April 2018

Purpose: For proliferative diabetic retinopathy (PDR) eyes not requiring vitrectomy, Diabetic Retinopathy Clinical Research Protocol S and the CLARITY trial demonstrated better visual function and anatomical outcomes with less proliferative and diabetic macular edema consequences in the antivascular endothelial growth factor groups compared to the panretinal photocoagulation groups. Intravitreal aflibercept injection (IAI) may represent a useful therapy with vitrectomy for PDR-related vitreous hemorrhage (VH) as a viable alternative to intraoperative endolaser during vitrectomy. We will determine the safety and efficacy when aflibercept is used for PDR-related VH with endolaserless vitrectomy. Methods: Evaluation of endolaserless vitrectomy and 2 mg IAI for PDR-related VH. Eyes receive 1 preoperative and intraoperative IAI followed by randomization to a q8week group receiving 4 postoperative q4week IAI followed by q8week IAI or q16week group receiving 2 postoperative q4week IAI followed by q16week IAI. Main Outcome Measures: Herein, we present pooled safety and efficacy outcomes through 4 months. Results: Twenty-one of 24 eyes were randomized. Preoperative average visual acuity (VA) was 36 letters (20/200). At 4-month follow-up, 18 of 21 randomized eyes showed an average VA of 72 letters (20/40) with an average visual gain of 38 (range, 0-84 gain) letters. Average optical coherence tomography (OCT) central subfield thickness (CST) at 1-month postoperative follow-up was 311 µm. Average OCT CST at 4-month follow-up was 272 µm (average thinning of 38 µm). No significant short-term ocular or systemic adverse events were observed through 4 months. Conclusions: Endolaserless vitrectomy with IAI for PDR-related VH demonstrates short-term safety with significant VA improvement.
Cost of Oncology Drugs in the Middle-Eastern Country of Lebanon: An Update (2014-2016)
Authors: Elias Fadia , Bou-Orm Ibrahim R. , Adib Salim M. , Gebran Selim , Gebran Anthony , Ammar Walid 
Published: April 2018

Purpose This study aims to evaluate trends in the increasing costs of oncology drugs procured by the Lebanese Ministry of Public Health (MOPH) between 2014 and 2016 and to assess the impact of the introduction in mid-2015 of new immunotherapy drugs for the treatment of lung cancer on the overall and specific costs of that treatment. Methods A secondary analysis of data from the MOPH Cancer Drug Scientific Committee data base was conducted using a total of 18,133 cancer files between 2014 and 2016. Results Over the 3-year period, about $140 million (USD) was spent on cancer drugs by the MOPH free cancer drug dispensing program. The expenditures increased by 27% after immunotherapy was phased in. The average cost of drugs per patient per year measured across all cancer types increased from $7,000 in 2014 to $8,400 in 2016. Trastuzumab, approved for treating human epidermal growth factor receptor 2–positive breast cancer ranked first in total expenditures for 2014-2015. By 2016, two new immunotherapy drugs had topped the list: pembrolizumab ranked first and nivolumab ranked third, representing 64% of the total cost of lung cancer treatment and approximately 19% of the total yearly budget; beneficiaries represented only 3% of all patients. Conclusion This update documents the increasing financial impact of newer cancer drugs on the procurement process in the middle-income country of Lebanon. The trend is aligned with the financial burden of cancer drugs worldwide, which calls for a collaborative global response to this crisis.
Murder on Shades Mountain
Authors: Morrison Melanie S. 
Published: April 2018

One August night in 1931, on a secluded mountain ridge overlooking Birmingham, Alabama, three young white women were brutally attacked. The sole survivor, Nell Williams, age eighteen, said a black man had held the women captive for four hours before shooting them and disappearing into the woods. That same night, a reign of terror was unleashed on Birmingham's black community: black businesses were set ablaze, posses of armed white men roamed the streets, and dozens of black men were arrested in the largest manhunt in Jefferson County history. Weeks later, Nell identified Willie Peterson as the attacker who killed her sister Augusta and their friend Jenny Wood. With the exception of being black, Peterson bore little resemblance to the description Nell gave the police. An all-white jury convicted Peterson of murder and sentenced him to death.
In Murder on Shades Mountain Melanie S. Morrison tells the gripping and tragic story of the attack and its aftermath—events that shook Birmingham to its core. Having first heard the story from her father—who dated Nell's youngest sister when he was a teenager—Morrison scoured the historical archives and documented the black-led campaigns that sought to overturn Peterson's unjust conviction, spearheaded by the NAACP and the Communist Party. The travesty of justice suffered by Peterson reveals how the judicial system could function as a lynch mob in the Jim Crow South. Murder on Shades Mountain also sheds new light on the struggle for justice in Depression-era Birmingham. This riveting narrative is a testament to the courageous predecessors of present-day movements that demand an end to racial profiling, police brutality, and the criminalization of black men.