bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic drug monitoring (TDM) during maintenance phase treatment at a community mental health centre
Authors: Meehan Tom , Wang Hong , Drummond Allan , Lockman Hazlin 
Published: August 2019

Objective: To assess the extent to which therapeutic drug monitoring during maintenance phase treatment with lithium and clozapine was performed according to an agreed protocol and to identify strategies that may support monitoring. Methods: Data concerning the prescribing and monitoring patterns of lithium for 31 patients and clozapine for 53 patients were collected retrospectively over a period of 2 years. Results: Adherence to clozapine monitoring throughout the study period was 90.5%, while the monitoring of lithium was less likely at 58.1% ( P < 0.001). While those prescribed lithium were less likely to adhere to prescribed dosing than those prescribed clozapine ( P < 0.007), they were also more likely to have a change of medication ( P < 0.005) and require admission to inpatient care ( P < 0.002). Conclusions: Despite the initiatives established to improve adherence to monitoring, there was a significantly lower level of lithium monitoring compared to that of clozapine. Strategies that are likely to support monitoring include the use of labels to clarify tests required, the use of a database to keep track of those requiring pathology tests and allocation of time each week for a nurse to work with medical staff and case managers to support monitoring.
Validation of posterior corneal curvature measurements with color light-emitting diode topography
Authors: Piñero David P , Camps Vicent J , de Fez Dolores , García Celia , Caballero María Teresa 
Published: August 2019

Purpose: To evaluate the intrasession repeatability and validity of posterior corneal curvature and astigmatism measurements provided by a color light-emitting diode reflection topography system in healthy eyes. Methods: A total of 40 healthy eyes of 40 patients (age, 16–66 years) were enrolled. A complete eye examination was performed in all cases including posterior topographic analysis with two systems: the Scheimpflug-based system (Pentacam; Oculus Optikgeräte GmbH, Wetzlar, Germany) and the Cassini system (i-Optics; Ophthec, The Hague, The Netherlands). With this last system, three consecutive measurements were taken to assess the level of intrasession repeatability (within-subject standard deviation, Sw; intraclass correlation coefficient). The Bland & Altman analysis was used to evaluate the interchangeability of both devices. Results: The Sw was ⩽0.06 mm for all posterior corneal radius measurements, with intraclass correlation coefficient of ⩾0.960. The Sw for the magnitude of astigmatism, J0, and J45 were 0.15, 0.04, and 0.04 D, respectively, with intraclass correlation coefficient values of 0.876, 0.897, and 0.840, respectively. Statistically significant differences between devices were found in all parameters evaluated (p ⩽ 0.025). The interchangeability analysis revealed the presence of clinically relevant limits of agreement for the flattest (0.03 to 0.50 mm) and steepest posterior corneal radii (–0.01 to 0.39 mm). In contrast, limits of agreements were not clinically relevant for the magnitude of posterior astigmatism (–0.17 to 0.27 D) and their power vector components (–0.11 to 0.15 D). Conclusion: The Cassini system provides consistent measures of posterior corneal curvature and astigmatism in healthy eyes, but only measures of posterior astigmatism can be considered as interchangeable with those provided by the Pentacam.
Central retinal artery occlusion after Descemet membrane reposition by intracameral air: A case report
Authors: Meena Ashok Kumar , Ghodke Bhushan R , Parmar Gautam Singh 
Published: August 2019

Purpose: To report a case of central retinal artery occlusion after Descemet membrane reposition by intracameral air. Methods: An otherwise healthy 60-year-old woman presented with white mature cataract in her left eye. Ocular exam of both eyes was within normal limits. After an uneventful topical phacoemulsification, a moderate-grade striate keratopathy and non-planar Descemet membrane detachment was noted on first postoperative day, which was confirmed on anterior segment optical coherence tomography. The Descemet membrane was repositioned within 24 h of cataract extraction by intracameral air tamponade (pneumatic descematopexy) under topical anesthesia, and partial air release was done after 2 h. The patient was evaluated for decreased immediate postoperative vision of perception of light. Results: After pneumatic descematopexy, the stromal edema relatively cleared. The intraocular pressure before releasing the intracameral air was 38 mmHg and antiglaucoma medication was started. Dilated fundus exam showed retinal pallor and a cherry-red spot over the macula. A diagnosis of central retinal artery occlusion was confirmed, and thorough systemic workup was done. Systemic investigations were within normal limits. The patient was managed conservatively, but the final visual acuity remained at 1/60. Conclusion: Central retinal artery occlusion is not a reported complication after pneumatic descematopexy for Descemet membrane detachment management. The possible mechanism could be sudden increase in intraocular pressure due to pupil block by air, and thus, ocular surgeries with use of intracameral air for prolonged duration warrants close monitoring of intraocular pressure and its subsequent management.
Fascia lata augmented nasal transposition of split lateral rectus in complete oculomotor nerve palsy with a previous failed surgery
Authors: Tsai Chong-Bin , Fang Chien-Liang 
Published: August 2019

Purpose: To report our experience in the management of a complete oculomotor nerve palsy with a previous failed surgery. Methods: We used a fascia lata augmented nasal transposition of the split lateral rectus in a patient who had complete oculomotor nerve palsy with recurrent exotropia after previous recession-resection surgery. The lateral rectus muscle was split in half, and then joined end-to-end with fascia strips with a 5-0 polyester nonabsorbable suture. The superior and inferior fascia strips were transposed to the adjacent of the superior and inferior corners of the insertion of medial rectus. With the globe being adducted about 10 degrees, the strips were sutured on the globe using fixed 5-0 polyester sutures. Results: The patient showed orthotropic alignment at the primary position at the 5-month post-operation follow-up. Conclusion: With adequate preoperative imaging-aided evaluation and meticulous intraoperative exploration, fascia lata augmented nasal transposition of split lateral rectus could be an option of treatment for complete oculomotor nerve palsy after a previous failed surgery.
Radiographic evaluation of hip resurfacing: the role of x-rays in the diagnosis of a problematic resurfaced hip
Authors: Van Der Straeten Catherine , Calistri Alessandro , Grammatopoulos George , De Smet Koen 
Published: August 2019

Introduction: Hip resurfacing (HRA) requires a new standardised radiographic evaluation protocol. Evaluation of acetabular components is similar to total hip arthroplasty (THA) but femoral components require different criteria. This study evaluates the efficacy of a new femoral zonal system for radiographic HRA assessment in identifying clinical problems. Methods: A new proximal femoral zonal system divides implant-cement-bone interfaces at head and neck into 7 DeSmet zones. 611 in situ and 100 revised HRA were assessed for component positioning, borderline findings (reactive lines, cortical thickening, cancellous condensation) or sinister findings (lucent lines, bone resorption, osteolysis). Findings were correlated with gender, size, implant survival, clinical scores, metal ions, and adverse soft tissue reactions (ALTR). Results: Radiological changes were found in 265 hips (37.3%), 154 sinister (21.7%) and 111 borderline (15.6%). 84% of revisions had sinister findings versus 11.4% of in situ HRA ( p < 0.001). The mean number of abnormal acetabular and femoral zones was 3.3 in revised compared to 0.6 in situ HRA ( p < 0.001). Sinister findings were associated with female gender, lower clinical scores, smaller sizes or ASR design (all: p < 0.001). Metal ions were higher with sinister ( p < 0.001) and borderline ( p < 0.01) findings compared to normal radiographs. Pathological findings in ⩾4 zones had a sensitivity of 50% and specificity of 94.2% (AUC = 0.898) in detecting hips with ALTR (odds ratio = 49). Conclusion: In order to accurately evaluate progressive radiographic changes in HRA, specific zones have been established around the femoral component. There was a high correlation between radiographic findings and outcome measures. 84% of problematic hips and 90.4% of proven ALTR had sinister changes.
Mortality Risk Following Application of a Paclitaxel-Coated Stent in Femoropopliteal Lesions
Authors: Katsuki Tomonori , Takahara Mitsuyoshi , Soga Yoshimitsu , Okamoto Shin , Iida Osamu , Fujihara Masahiko , Kawasaki Daizo , Ando Kenji 
Published: August 2019

Purpose: To examine if endovascular therapy (EVT) with paclitaxel-coated stents increases the mortality risk in patients with symptomatic lower limb peripheral artery disease (PAD). Materials and Methods: A retrospective analysis was conducted of paclitaxel-coated stent use in the femoropopliteal segment of 1535 symptomatic (Rutherford category 2 to 4) patients treated between January 2010 and December 2016 at 4 hospitals in Japan. The risk of all-cause mortality was examined between the 285 patients (mean age 73±8 years; 213 men) treated with a paclitaxel-coated stent (PTX-coated group) and 1250 patients (mean age 73±9 years; 872 men) not exposed to a paclitaxel-coated device (PTX-free group) during EVT. Propensity score matching was employed to balance baseline characteristics. Cox proportional hazards models stratified on the quintiles of the propensity score were used to investigate paclitaxel-coated stent use and mortality risk as well as interactions among baseline variables and the main outcome. Interactions between a PXT-coated stent and subgroups of the PTX-free group (bare stent and angioplasty) were also investigated, as was the impact of paclitaxel dose on mortality risk. The results of regression analysis are reported as the hazard ratio (HR) and 95% confidence interval (CI). Results: The 3-year overall survival estimates were 86.4% in the PTX-coated group vs 87.7% in the PTX-free group; the corresponding 5-year estimates were 77.5% vs 73.7%, respectively. There was no significant difference in all-cause mortality between the 2 groups (HR 0.89, 95% CI 0.66 to 1.19, p=0.41). The cause of death also showed no remarkable difference between the groups. Chronic renal failure (p=0.044) and arterial calcification (p=0.022) demonstrated a significant interaction effect on the association of the use of a PTX-coated stent with all-cause mortality. No subgroup demonstrated that the use of a paclitaxel-coated stent was associated with an increased risk of all-cause mortality. A dose dependency was not evident. Conclusion: Mortality risk following application of a PTX-coated stent did not increase over 5 years, irrespective of the dose. A PTX-coated stent for femoropopliteal lesions in PAD patients is a safe treatment option.
Simulation of a Right Anterior Thoracotomy Access for Aortic Valve Replacement Using a 3D Printed Model
Authors: Wamala Isaac , Brüning Jan , Dittmann Johannes , Jerichow Samuel , Weinhold Joachim , Goubergritis Leonid , Hennemuth Anja , Falk Volkmar , Kempfert Jörg 
Published: August 2019

Objective The right anterior lateral thoracotomy (RALT) approach for aortic valve replacement provides excellent outcomes in expert hands while avoiding sternal disruption. It, however, remains a technically demanding niche operation. Instrument trajectories via this access are influenced by patient anatomy, the intercostal space chosen, and surgical retraction maneuvers. Methods To simulate the typical surgical maneuvers, on an anatomically accurate model, and to measure the instrument trajectories, we generated a 3-dimensional (3D) printed model of the heart and chest cavity. A simulated approach to the base of the right coronary sinus via the medial-second intercostal, the lateral-second intercostal, or third intercostal space was made. Keeping the instrument in place, 3D scans of the models and geometrical measurements of the instrument trajectories were performed. Results The 3D scans of the 3D printed model showed a high fidelity when compared to the original computed tomographic scan image geometry (mean deviation of 1.26 ± 1.27mm). The instrument intrathoracic distance was 75 mm via the medial-second, 115 mm via the lateral-second, and 80 mm via the third intercostal space. The 3D angulation of the instrument to the incision was 33.77o, 55.93o, and 38.4o respectively. The distance of the instrument to the lateral margin was 12, 26, and 5 mm respectively. The cranial margin of the incision was always a limiting margin for the instrument. Conclusions Three-dimensional printing and 3D scanning facilitated a realistic simulation of the instrument trajectory during RALT approach. The lateral-second intercostal approach showed the most favorable approach angle and distance from the lateral margin, although it also had the longest intrathoracic distance.
Carpal tunnel decompression in patients with normal nerve conduction studies
Authors: Mackenzie Samuel P. , Stone Oliver D. , Jenkins Paul J. , Clement Nicholas D. , Murray Iain R. , Duckworth Andrew D. , McEachan Jane E. 
Published: August 2019

Some patients present with typical clinical features of carpal tunnel syndrome despite normal nerve conduction studies. This study compared the preoperative and 1-year postoperative QuickDASH scores in patients with normal and abnormal nerve conduction studies, who underwent carpal tunnel decompression. Of the 637 patients included in the study, 19 had clinical features of carpal tunnel syndrome but normal nerve conduction studies, and underwent decompression after failure of conservative management. Preoperative QuickDASH scores were comparable in both groups (58 vs 54.8). However, there were significant differences between the normal and abnormal nerve conduction study groups in the QuickDASH at 1 year (34.9 vs 21.5) and change in QuickDASH postoperatively (23.1 vs 33.4). Patients with normal nerve conduction studies had comparable preoperative disability scores compared with those with abnormal studies. Although they had a significant improvement in QuickDASH at 1 year, this was significantly less than those with abnormal nerve conduction studies. Level of evidence: III
Repetitive Head Impacts in Youth Football: Description and Relationship to White Matter Structure
Authors: Nilsson Kurt J. , Flint Hilary G. , Gao Yong , Kendrick Leslie , Cutchin Steve , Pentecost Ryoko , Pardue Kristi 
Published: August 2019

Background: Few studies have examined white matter with diffusion tensor imaging in 8- to 12-year-old collision sport (CS) athletes. Hypothesis: Youth CS athletes will demonstrate change in brain fractional anisotropy (FA) after a season of CS compared with an age-matched noncollision sport (NCS) cohort, and the number, magnitude, and location of hits will correlate with changes in the brain determined via FA for CS athletes. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: Thirty-five 8- to 12-year-old males in a youth tackle football league (CS) and 12 males from local swim teams (NCS) were recruited. Participants underwent brain magnetic resonance imaging with FA before and after the football season. Number, magnitude, and direction of head impacts were recorded for CS participants throughout the season. Results: A total of 1905 hits were recorded in the CS group for the season, 341 (17.9%) collected during 7 games and 1564 (82.1%) observed during 31 practices. No significant interaction between group (CS and NCS) and time (pre- and postseason) was observed for FA ( P > 0.05). Correlation analysis revealed a significantly positive and moderate relationship between increase of left cingulate cortex (CgC) FA from pre- to postseason and the total magnitude of lateral head impacts ( r = 0.40; P = 0.03). Conclusion: There was no significant change in FA measurement of white matter integrity in a cohort of 8- to 12-year-old males after a season of youth football, nor was any difference detected in FA between youth football players and an age-matched cohort of swimmers. There was a significant correlation between total magnitude of hits sustained by youth football players and an increase in FA in the left CgC; whether this is adaptive or pathologic remains unknown. Clinical Relevance: These data can be used within the body of knowledge to counsel patients regarding the known risks of youth tackle football regarding brain health.
Heuristics and Public Policy: Decision-making Under Bounded Rationality
Authors: Dhami Sanjit , al-Nowaihi Ali , Sunstein Cass R. 
Published: August 2019

How do human beings make decisions when, as the evidence indicates, the assumptions of the Bayesian rationality approach in economics do not hold? Do human beings optimize, or can they? Several decades of research have shown that people possess a toolkit of heuristics to make decisions under certainty, risk, subjective uncertainty, and true uncertainty (or Knightian uncertainty). We outline recent advances in knowledge about the use of heuristics and departures from Bayesian rationality, with particular emphasis on growing formalization of those departures, which add necessary precision. We also explore the relationship between bounded rationality and libertarian paternalism, or nudges, and show that some recent objections, founded on psychological work on the usefulness of certain heuristics, are based on serious misunderstandings. JEL classifications: D01, D04, D81, D9
A Novel, Fast, Safe, and Effective All-Inside Arthroscopic Rotator Cuff Repair Technique: Results of 1000 Consecutive Cases
Authors: Elkins Ashleigh , Lam Patrick H. , Murrell George A.C. 
Published: August 2019

Background: Arthroscopic rotator cuff repair is a common but technically difficult surgical technique. This study describes a novel arthroscopic rotator cuff repair technique where the repair was performed while visualized entirely from the glenohumeral joint. A single-row knotless tension band inverted mattress suture technique was utilized with fixation obtained via suture anchors. The technique was relatively easy to perform and demonstrated good repair strength and footprint compression in an ex vivo ovine model. Purpose: To evaluate the safety and efficacy of this technique in 1000 consecutive patients. Study Design: Case series; Level of evidence, 4. Methods: This study was a retrospective analysis of prospectively collected data in 1000 consecutive patients. Included patients underwent primary arthroscopic rotator cuff repair by a single surgeon performing the undersurface repair technique and attended 6-month follow-up with ultrasound evaluation to determine repair integrity. Exclusion criteria were irreparable tears, incomplete repairs, tendon reconstruction with a synthetic patch, and revision cases. Results: The only complication was retear. The overall retear rate at 6 months following repair with the undersurface technique was 8.5%. The mean ± SEM operative time for the technique was 16 ± 0.3 minutes (range, 4-75 minutes). There were no infections. Smaller tears were repaired faster and had better healing rates. Conclusion: The novel all-inside arthroscopic rotator cuff repair technique was safe and significantly faster and provided better healing rates than other repair techniques. The retear rate of 8.5% is, to the authors’ knowledge, the lowest reported rotator cuff retear rate in a large cohort of patients based on a single technique.
Association of Upper Extremity Pain With Softball Pitching Kinematics and Kinetics
Authors: Oliver Gretchen D. , Friesen Kenzie , Barfield Jeff W. , Giordano Kevin , Anz Adam , Dugas Jeff , Andrews James 
Published: August 2019

Background: There is a paucity of research regarding the relationship between fastpitch softball pitching mechanics and reported pain. Thus, understanding the pitching mechanics of athletes pitching with upper extremity pain and those pain free is paramount. Purpose: To examine lower extremity pitching mechanics, upper extremity kinetics, and upper extremity pain in National Collegiate Athletic Association (NCAA) Division I female softball pitchers. Study Design: Descriptive laboratory study. Methods: A total of 37 NCAA Division I female softball pitchers (mean age, 19.84 ± 1.28 years; mean height, 173.67 ± 7.77 cm; mean weight, 78.98 ± 12.40 kg) from across the United States were recruited to participate. Participants were divided into 2 groups: upper extremity pain (n = 13; mean age, 19.69 ± 1.18 years; mean height, 172.60 ± 11.49 cm; mean weight, 86.75 ± 13.02 kg) and pain free (n = 24; mean age, 19.91 ± 1.35 years; mean height, 174.26 ± 4.96 cm; mean weight, 74.78 ± 9.97 kg). An electromagnetic tracking system was used to obtain kinematic and kinetic data during the riseball softball pitch. Results: At foot contact ( F 3,33 = 7.01, P = .001), backward elimination regression revealed that stride length, trunk rotation, and center of mass (COM) significantly explained about 33% of variance with softball pitchers experiencing upper extremity pain (adjusted R 2 = 0.33). Conclusion: At foot contact, the kinematic variables of increased trunk rotation toward the pitching arm side, increased stride length, and a posteriorly shifted COM were associated with upper extremity pain in collegiate softball pitchers. Variables early in the pitching motion that do not set a working and constructive proximal kinetic chain foundation for the rest of the pitch to follow could be associated with breakdowns more distal in the kinetic chain, possibly increasing the susceptibility to upper extremity pain. Clinical Relevance: The identification of pitching mechanics associated with pain allows clinicians to develop exercises to avoid such mechanics. Avoiding mechanics associated with pain may help reduce the prevalence of pain in windmill softball pitchers as well as help coaches incorporate quantitative biomechanics into their instruction.