bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resection of Massive “Tarry” Intra/Extra-ventricular Prepontine Colloid Cyst: 2-Dimensional Operative Video
Authors: Sorenson Thomas J , Graffeo Christopher S , Marcellino Christopher R , Raghunathan Aditya , Van Gompel Jamie J 
Published: May 2019

Abstract
Colloid cysts are typically slow-growing lesions that account for approximately 1% of primary intracranial neoplasms and predominantly exist intraventricularly. These benign lesions typically can exist symptom-free for years and do not require surgical intervention. However, if the location of the colloid cyst is symptomatic, surgical debulking may be indicated. In this intraoperative video, we illustrate the case of an 8 cm, intra/extra-ventricular colloid cyst that appeared as a craniopharyngioma on preoperative imaging, but upon resection via a trans-middle temporal gyrus approach, was found to be very atypically filled with a thick, “tarry” substance, which we hypothesize is due to serial, subacute lesional hemorrhages. After debulking and piecemeal resection of the majority of the mass with ultrasonic aspiration and microsurgical tools, a hard, calcified nodule was left tenaciously adherent to the superior cerebellar artery to prevent damage to this vascular structure.
Influence of commissioned provider type and deprivation score on uptake of the childhood flu immunization
Authors: Christensen Hannah , Reynolds Rosy , Kwiatkowska Rachel , Brooks-Pollock Ellen , Dominey Matthew , Finn Adam , Gjini Ardiana , Hickman Matthew , Roderick Marion , Yates Julie 
Published: May 2019

Abstract

Background
Since 2015/16 the UK seasonal influenza immunization programme has included children aged 5 and 6 years. In the South West of England school-based providers, GPs or community pharmacies were commissioned to deliver the vaccine depending on the locality. We aimed to assess variation in vaccine uptake in relation to the type of commissioned provider, and levels of socioeconomic deprivation.

Methods
Data from the South West of England (2015–16 season) were analysed using multilevel logistic regression to assess variation in vaccine uptake by type of commissioned provider, allowing for clustering of children within delivery sites.

Results
Overall uptake in 5 and 6 year olds was 34.3% (37 555/109 404). Vaccine uptake was highest when commissioned through school-based programmes 50.2% (9983/19 867) and lowest when commissioned through pharmacies, 23.1% (4269/18 479). Delivery through schools resulted in less variation by site and equal uptake across age groups, in contrast to GP and pharmacy delivery for which uptake was lower among 6 year olds. Vaccine uptake decreased with increasing levels of deprivation across all types of commissioned provider.

Conclusion
School-based programmes achieve the highest and most consistent rates of childhood influenza vaccination. Interventions are still needed to promote more equitable uptake of the childhood influenza vaccine.
Enhanced Recovery After Surgery Pathway for Cesarean Delivery: Effect on Opioid Use and Pain Scores [5K]
Authors: Fay Emily E. , Delgado Carlos C. , Hitti Jane , Savitsky Leah , Mills Elizabeth , Bollag Laurent 
Published: May 2019

INTRODUCTION:
One in 300 opioid-naïve women develop opioid addiction following cesarean delivery (CD). Enhanced recovery after surgery (ERAS) pathways provide a multidisciplinary, evidence-based approach to postoperative care and have been shown to decrease postoperative opioid consumption. We implemented an ERAS CD pathway and evaluated the impact on postoperative opioid use and pain scores.

METHODS:
We conducted an IRB approved, retrospective cohort study comparing postoperative opioid use and pain scores among women on the ERAS CD pathway in the first year of implementation (4/2017-3/2018, n=531) compared to historical controls (3/2016-2/2017, n=661). Women with pregestational diabetes on insulin preconception, preeclampsia with severe features, and/or complex pain needs were excluded. Analysis was stratified for women undergoing planned (no labor, n=530) and unplanned (labor, n=662) CD. Postoperative opioid use and pain scores were compared using chi-squared and t-tests.

RESULTS:
During implementation, 531 (83%) of 640 eligible women were included in the ERAS CD pathway. Compared to baseline, the ERAS CD pathway resulted in an overall decrease of 13.7% (p=0.001) in postoperative opioid use with a 23.2% reduction in patients with unplanned CD (p<0.001). There was no difference in postoperative opioid use in patients with planned CD (p=0.456). ERAS patients with planned CD had a 9.5% reduction in pain scores on postoperative day 0 (p<0.05). There were no other significant differences in pain scores.

CONCLUSION:
The ERAS CD pathway was associated with decreased postoperative opioid use overall. Interestingly, the decrease in opioid use was driven by the unplanned CD subset. Further research should explore these differences.
Lifestyle Factors Do Not Meaningfully Impact Age-Based AMH Levels in Non-Infertile Women [30O]
Authors: Maslow Bat-Sheva L. , Mancinelli Kristen , Guarnaccia Michael , Klein Joshua U. 
Published: May 2019

INTRODUCTION:
Increasing age has a well-established negative association on ovarian reserve, reflected in decreasing AMH levels. The role of lifestyle on physiologic AMH levels is unknown. The aim of the study was to identify whether lifestyle factors impact AMH levels in a cohort of non-infertile women.

METHODS:
This retrospective cohort study includes all initial oocyte cryopreservation consultations from 3/1/2016 to 9/30/2018 at Extend Fertility Medical Practice. The study was granted IRB exempt status. Subjects were asked about smoking, drug use, caffeine intake, and exercise frequency. AMH levels were measured at an independent laboratory on the Gen-II ELISA platform. Lifestyle and BMI data were categorized. AMH levels were log transformed to approximate normal distribution. Linear regression analyses were performed controlling for age.

RESULTS:
2623 subjects were included in the study. Mean age 35.9Â±3.5 years. Median AMH 1.93 ng/mL [IQR 0.99-3.52]. Smoking, drug use, or caffeine intake were not significantly associated with age-controlled AMH levels. There was a trend towards an association with lower AMH levels for underweight (BMI<18.5kg/m2) and obese (BMI>30kg/m2) subjects (P=.03, P=.05 when controlled for age). Exercising more than two times per week was weakly associated with higher AMH levels (P=.03).

CONCLUSION:
This data supports that physiologic AMH levels are not meaningfully impacted by lifestyle factors such as exposure to caffeine, smoking, or drug use. The incidence of current smokers in our population was small and therefore the impact may be underestimated. A healthy body weight and exercise regimen may be associated with higher AMH levels, even when controlling for age.
Predictive Modeling of Spontaneous Preterm Birth Using Machine Learning [36C]
Authors: Guang Stephanie , Sarkar Indra N. , Werner Erika F. 
Published: May 2019

INTRODUCTION:
Spontaneous preterm birth (sPTB) is the clinical manifestation of many overlapping pathologies, making its prediction challenging. This study explored the potential of machine learning techniques to identify risk of sPTB using complex, non-linear associations between variables.

METHODS:
Data for this study came from the Healthcare Cost and Utilization Project National Inpatient Sample database, which included 835,704 obstetric patients. Subjects were divided into three cohorts for training (60%), validation (20%), and testing (20%). Thirty-one features, relating to clinical diagnoses and demographic data, were selected for developing predictive models. The goal of classification was the binary discrimination between spontaneous onset of delivery before 37 completed weeks of gestation versus full-term birth. Classification was performed using logistic regression (LR), random forest classifier (RFC), C and nu support vector machine classifiers (C/nu-SVC), and a multi-layer perceptron artificial neural network (ANN). Data processing, training, and testing of classifiers were done using the Julia programming language.

RESULTS:
Of the 835,704 obstetric patients, 49,563 resulted in sPTB (5.9%). Classifier models were constructed and assessed relative to the training dataset. The areas under the receiver operating characteristic curves (AUROC) were 0.50, 0.86, 0.79, 0.92, and 0.75 for LR, RFC, C-SVC, nu-SVC, and the ANN respectively. The nu-SVC performed best, with the highest AUROC and a sensitivity and specificity of 78.8% and 94.9%.

CONCLUSION:
Machine learning methodologies show promise in characterizing sPTB versus full term births using comorbidity information from administrative health data. Machine learning techniques, such as nu-SVC, might be considered as a supplement for clinical assessment of sPTB risk.
Medical Student Perceptions of Parenthood Timing [37A]
Authors: Berroth Margeaux , Miura Lisa , Robertson Katie , Feryn Alicia , Hui Jia , Lapidus Jodi 
Published: May 2019

INTRODUCTION:
The practice of delaying parenthood in lieu of professional pursuits is common in medicine. Scant literature exists on medical students' postponement of parenthood. We aimed to assess medical students' self-perceived fertility and preservation, attitudes toward delaying parenthood, and if the desire to have children affects specialty choice.

METHODS:
A 23-item survey of yes/no and multiple-choice questions was distributed to students at two west coast medical schools. Responses were voluntary and anonymous. 658 total surveys were collected and analyzed between October 2017 and March 2018. Nonparent and parent responses were analyzed separately using univariate logistic regression. All analyses were conducted in R software using the generalized linear model function.

RESULTS:
Among all those surveyed, 59.8% were female, 59.3% MD students, 85.1% age 30 or younger, and 88.5% were nonparents. Among nonparents who desire children: 55% want their first child between ages 31-35, 82.6% have concerns about the timing of when to start a family, 72% feel pressure to delay parenthood given career circumstances, and males more than females would consider cryopreservation in the face of subfertility.

CONCLUSION:
Many medical students have concerns about the timing of when to have children, feel the pressure to delay having children, and/or desire starting families when professional demands peak and fertility declines. Given the increasing age of matriculating medical students and the intensive time investment in education and training, our research suggests that medical education institutions consider how they can better aid students in balancing the challenges of pursuing medicine with the desire to have children.
Cesarean Prevalence Rates for Different Races by Maternal Characteristics [20B]
Authors: Thompson Jennifer Anne , Olyaei Amy , Skeith Ashley , Caughey Aaron B. 
Published: May 2019

INTRODUCTION:
Cesarean delivery rates reached a peak in 2009 and most recently have decreased to their lowest rate since 2007. Our goal was to examine if there were differences in rates of decline for each race (White, Black, Hispanic, Asian and American Indian/Alaska Native.

METHODS:
We conducted a retrospective cohort study of 1,868,948 singleton, non-anomalous, term gestations from 2010 through 2016 who underwent cesarean section. From there, the rates for each race (White, Black, Hispanic, Asian, American Indian and AI/AN) were stratified based on parity and prior cesarean section. Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.

RESULTS:
White, Hispanic, Asian and AI/AN all have statistically significant decreasing cesarean prevalence rates overtime for nulliparous, multiparous and prior cesarean section gestations. The rates of cesarean section in nulliparous black women however, did not decline (Table 1). Black and Asian gestations overall had higher prevalence rates for cesarean delivery among nulliparous women. AI/AN had the lowest prevalence rates of cesarean delivery in nulliparous gestations of all races (25.3, 24.5, 22.7, 22.9).

CONCLUSION:
Overall, there is a race disparity in cesarean section rates among nulliparous black women as compared to all other races, which have all shown a decline over time in cesarean section rates. Nulliparous Black and Asian women have an elevated prevalence rate while nulliparous AI/AN had the lowest cesarean delivery rates of all races. Resources should be targeted to reduce the cesarean section rate among nulliparous black women.
Trends in Radiation Dose and Technique For Anal Canal Squamous Cell Carcinoma
Authors: Wegner Rodney E. , Abel Stephen , Hasan Shaakir , White Richard J. , Raj Moses , Monga Dulabh , Finley Gene , McCormick James , Kirichenko Alexander V. 
Published: May 2019

Background:Anal canal squamous cell carcinoma (SCC) is managed definitively with chemoradiation, reserving surgery for salvage. The dosage of radiation has varied from 30 Gy to in excess of 60 Gy. RTOG 0529 established intensity modulated radiation therapy (IMRT) as standard of care for anal canal SCC with doses of 50.4 to 54 Gy. We sought to use the National Cancer Database to examine trends in dose selection and radiation technique over time.Methods:We queried the National Cancer Database from 2004 to 2015 for cases of anal cancer stage groups 1 to 3, treated with definitive doses of radiation with chemotherapy. Dose escalation was defined as >54 Gy. Univariable and multivariable analyses were performed to identify factors predictive of dose, IMRT, and overall survival. Propensity-adjusted Cox proportional hazard ratios for survival were used to account for indication bias.Results:We identified 7792 patients meeting the eligibility criteria, with 4269 treated to doses of 45 to 54 Gy and 3163 treated to doses >54 Gy. Patients who were older, had government or private insurance, IMRT treatment, treatment at an academic center, or more recent years were less likely to get dose escalation. The use of dose escalation decreased over time, from 50% in 2005 to 30% in 2015. IMRT use increased over time from 2% to 63%. On multivariable analysis with propensity score included it was found that increased age, higher comorbidity score, lower income, shorter distance to facility, and male sex were predictive of decreased overall survival. In addition, escalated dose was associated with a lower survival (hazard ratio: 1.10, 95% confidence interval: 1.01-1.20,P=0.03).Conclusions:The results of this analysis show a steady increase in the use of IMRT, with corresponding decrease in dose escalation. These findings correlate with the results of RTOG 0529 establishing IMRT as standard of care for anal SCC, using doses of 50.4 to 54 Gy.
Cost Implications of Varying the Surgical Setting and Anesthesia Type for Trigger Finger Release Surgery
Authors: Kazmers Nikolas H. , Stephens Andrew R. , Presson Angela P. , Yu Ziji , Tyser Andrew R. 
Published: May 2019

Background:
Trigger finger release (TFR) is a common surgical procedure, representing a financial burden to the healthcare system. Our null hypothesis is that the choice surgical setting [operating room (OR) versus procedure room (PR)] and anesthetic type [local-only or monitored anesthesia care (MAC)] do not affect surgical encounter costs for TFR.

Methods:
Adult patients undergoing isolated unilateral TFR between May 2014 and December 2017 by 5 fellowship-trained hand surgeons at a single academic medical center were identified by Current Procedural Terminology (CPT) code (26055). We excluded patients undergoing revision surgery, tenosynovectomy, or additional procedures. Using our institution’s information technology value tools, we calculated total direct costs for each surgical encounter, which were compared between groups. Univariate and multivariable gamma regression were used to model costs.

Results:
Of 210 included patients, 54% (113/210) of cases were performed in the PR and 46% (97/210) in the OR. No significant differences in demographics were observed between PR and OR groups. Compared to local-only in the PR, the OR with local-only, and OR with MAC, demonstrated 2.2- and 3.2-fold greater median costs. Multivariable models suggested that use of the OR independently led to 221% [95% Confidence interval: 137%–345%; P < 0.01] greater mean costs than the PR, and use of MAC was associated with 30% (95% confidence interval: 13%–49%; P < 0.01) greater mean costs for OR cases than local-only, while controlling for other confounders.

Conclusion:
Performing TFR in the PR setting under local-only anesthesia minimizes surgical encounter direct costs for this common procedure.
Subtenon Bupivacaine for Postoperative Pain in Patients Undergoing Pterygium Excision: A Double-Blinded Randomized Control Trial
Authors: Bhikoo Riyaz , Hughes Karen , Vather Ryash , Murphy Chris 
Published: May 2019

Purpose:
Patients undergoing primary pterygium excision with autologous conjunctival autograft and human tissue adhesive in New Zealand, currently receive subconjunctival anesthesia with oral postoperative analgesia for pain. Our aim was to investigate the potential added benefit of intraoperative subtenon bupivacaine to this regimen.

Methods:
A double-blinded, placebo-controlled, randomized trial was conducted at 2 centers. All patients received topical and subconjunctival anesthesia intraoperatively, with standardized oral analgesia as required postoperatively. Participants were allocated to receive subtenon bupivacaine 0.5% or placebo at the conclusion of surgery. Corneal epithelial defect and conjunctival graft size were recorded. Pain and ocular surface irritation were assessed (Likert scale) immediately postoperatively at 3, 6, 12, 24, and 36 hours. Cumulative oral analgesia consumption (doses) was reported at 24 and 36 hours.

Results:
Forty-two patients were randomized with participants evenly matched at baseline. Postoperative pain at all time points ≤24 hours was significantly less (2.4 vs. 1.2; P < 0.04) in the bupivacaine arm with no difference at 36 hours (P = 0.27). Ocular surface irritation was also significantly less at all time points ≤12 hours (4.8 vs. 1.3; P < 0.01) with no difference at 24 hours (P = 0.10). Analgesia consumption was less in the bupivacaine arm at 24 (6.5 vs. 2.5; P < 0.01) and 36 hours (7.6 vs. 3.4; P < 0.01). No complications were observed.

Conclusions:
Intraoperative subtenon bupivacaine improves patient comfort after pterygium excision by reducing pain, irritation, and requirement for oral analgesia after surgery.
Oxylipins and Free Fatty Acids in Parenteral Lipid Emulsions Currently Used in Preterm Infant Care
Authors: Suganuma Hiroki , Collins Carmel T. , McPhee Andrew J. , Liu Ge , Gibson Robert A. 
Published: May 2019

ABSTRACTLipid emulsions used to support nutrition in preterm infants contain long‐chain polyunsaturated fatty acids (LCPUFAs) as a source of essential fatty acids; these LCPUFAs and their parent polyunsaturated fatty acid (PUFA) can be oxidized by a variety of mechanisms to bioactive molecules called oxylipins, which are signaling molecules that initiate and/or resolve inflammation. The aim of this study was to explore levels of free LCPUFA and their related oxylipins in 3 commercially available lipid emulsions (Intralipid, SMOFlipid, and ClinOleic) using ultra high‐performance liquid chromatography mass spectroscopy. Free LCPUFA were detected in all lipid emulsions tested. Seven, 8, and 9 different oxylipin compounds were detected in the 3 emulsions, respectively. The oxylipins detected were mainly derived from omega‐6 PUFAs; these included 13‐hydroxyoctadecadienoic acid from linoleic acid and 5‐hydroxyeicosatetraenoic acid derived from arachidonic acid. It may be clinically important to know that oxylipins exist in lipid emulsions and to evaluate their potential effects on preterm infants.
A Prospective Look at Career Aspirations Among Pediatric Emergency Medicine Trainees
Authors: Morrison Sephora , Jones Nathaniel , Koutroulis Ioannis , Chamberlain James 
Published: May 2019

Objectives
Before delivering a contract negotiation workshop to pediatric emergency medicine fellows in training, we wanted to understand the group's career aspirations. We hypothesized that fellows would be interested in nonclinical skill building in addition to the clinical training.

Methods
A 9-question survey was anonymously administered to fellows registered for the national conference using SurveyMonkey before the conference date. Six questions were quantitative, 2 were qualitative and open ended, and 1 required ranking of elements.

Results
Seventy-seven (47%) of the conference attendees responded to the survey, and approximately 80 (48%) attended the workshop session.
Of the 77 fellows responding when asked about desired percentage of time per week devoted to the 4 categories of clinical, research, education, and administrative work within a 40-hour week, 76 (99%) chose the clinical category with an average of 58% of total hours devoted, 71 (92%) chose education with an average of 14% of total hours, 69 (90%) chose administration with an average of 8% of total hours, and 62 (81%) chose research with an average of 11% of total hours.
Seventy attendees provided 1 sentence with the description of their ideal job. Thematic analysis of these responses revealed the following 5 main themes: academic potential, clinical environment, remuneration, job location, and work-life balance.

Conclusions
Diversification in pediatric emergency medicine training is becoming a growing area of importance. Our study highlights a discrepancy in the expected time dedicated for nonclinical activities from those seen in previous workforce studies.
Surgery for Recurrent Hepatocellular Carcinoma
Authors: Yoh Tomoaki , Seo Satoru , Taura Kojiro , Iguchi Kohta , Ogiso Satoshi , Fukumitsu Ken , Ishii Takamichi , Kaido Toshimi , Uemoto Shinji 
Published: May 2019

Objective:
To evaluate the long-term outcomes of surgery for recurrent hepatocellular carcinoma (HCC).

Background:
HCC recurs with high incidence after liver resection. Little is known about long-term outcomes of patients undergoing surgery for recurrent HCC.

Methods:
Among 989 patients who underwent R0/R1 liver resection for HCC between 1995 and 2014, 676 patients who exhibited recurrence were included. Repeat surgery was performed in 128 patients (RS group), and not in the remaining 548 patients (NS group). Prognostic value after repeat surgery was evaluated by comparing survival after recurrence (SAR) between the RS and NS groups. Subgroup analyses according to the 3 recurrence patterns [intrahepatic recurrence (IHR), extrahepatic recurrence (EHR), and intra plus extrahepatic recurrence (IHR + EHR)] were performed.

Results:
Seventy-three of 430 patients (17.0%) with IHR, 17 of 57 patients (29.8%) with EHR, and 38 of 189 patients (20.1%) with IH + EHR underwent repeat surgery. Compared with the NS group, the RS group had better liver function and their time to recurrence was significantly longer (16.5 vs 11.4 months; P < 0.001). In the overall and 3 recurrence patterns, the 5-year SAR rate was better in the RS group compared with the NS group (RS vs NS group; overall, 53.0% vs 25.7%; IHR, 73.8% vs 37.2%; EHR, 30.0% vs 0%; IHR + EHR, 34.1% vs 10.6%; all P < 0.001, respectively). On multivariate analysis, repeat surgery was identified as an independent factor for better SAR (P < 0.001).

Conclusion:
Surgery for recurrent HCC may yield long-term survival for not only IHR but also for EHR in selected patients.