bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disseminating Evidence-Based Interventions in Small, Low-Wage Worksites: A Randomized Controlled Trial in King County, Washington (2014–2017)
Authors: Hannon Peggy A. , Hammerback Kristen , Kohn Marlana J. , Kava Christine M. , Gary Chan Kwun C. , Parrish Amanda T. , Allen Claire , Helfrich Christian D. , Mayotte Caitlin , Beresford Shirley A. , Harris Jeffrey R. 
Published: October 2019

Objectives. To determine whether (1) participating in HealthLinks, and (2) adding wellness committees to HealthLinks increases worksites’ evidence-based intervention (EBI) implementation. Methods. We developed HealthLinks to disseminate EBIs to small, low-wage worksites. From 2014 to 2017, we conducted a site-randomized trial in King County, Washington, with 68 small worksites (20–200 employees). We assigned worksites to 1 of 3 arms: HealthLinks, HealthLinks plus wellness committee (HealthLinks+), or delayed control. At baseline, 15 months, and 24 months, we assessed worksites’ EBI implementation on a 0% to 100% scale and employees’ perceived support for their health behaviors. Results. Postintervention EBI scores in both intervention arms (HealthLinks and HealthLinks+) were significantly higher than in the control arm at 15 months (51%, 51%, and 23%, respectively) and at 24 months (33%, 37%, and 24%, respectively; P < .001). Employees in the intervention arms perceived greater support for their health at 15 and 24 months than did employees in control worksites. Conclusions. HealthLinks is an effective strategy for disseminating EBIs to small worksites in low-wage industries. Public Health Implications. Future research should focus on scaling up HealthLinks, improving EBI maintenance, and measuring impact of these on health behavior.
Coverage Expansions and Utilization of Physician Care: Evidence From the 2014 Affordable Care Act and 1966 Medicare/Medicaid Expansions
Authors: Gaffney Adam , McCormick Danny , Bor David , Woolhandler Steffie , Himmelstein David 
Published: October 2019

Objectives. To evaluate the effects of the 2 major coverage expansions in US history—Medicare/Medicaid in 1966 and the Affordable Care Act (ACA) in 2014—on the utilization of physician care. Methods. Using the National Health Interview Survey (1963–1969; 2011–2016), we analyzed trends in utilization of physician services society-wide and by targeted subgroups. Results. Following Medicare/Medicaid’s implementation, society-wide utilization remained unchanged. While visits by low-income persons increased 6.2% (P < .01) and surgical procedures among the elderly increased 14.7% (P < .01), decreases among nontargeted groups offset these increases. After the ACA, society-wide utilization again remained unchanged. Increased utilization among targeted low-income groups (e.g., a 3.5-percentage-point increase in the proportion of persons earning less than or equal to 138% of the federal poverty level with at least 1 office visit [P < .001]) was offset by small, nonsignificant reductions among the nontargeted population. Conclusions. Past coverage expansions in the United States have redistributed physician care, but have not increased society-wide utilization in the short term, possibly because of the limited supply of physicians. Public Health Implications. These findings suggest that future expansions may not cause unaffordable surges in utilization.
Alternatives to SNAP: Global Approaches to Addressing Childhood Poverty and Food Insecurity
Authors: Fernald Lia C. H. , Gosliner Wendi 
Published: October 2019

The Supplemental Nutrition Assistance Program (SNAP) in the United States is a key element of the nation’s safety net. Yet, 12.5 million US children live in households that experience food insecurity, despite national spending of $65 billion on SNAP alone.In analyses integrating data from the 36 Organisation for Economic Co-operation and Development (OECD) countries, we found that child poverty and food insecurity are much higher in the United States than in most of the other OECD countries. The United States has higher total social spending than other OECD countries, but a lower rate of spending on children and families. This international comparison suggests that potentially effective solutions implemented in other countries might help further alleviate US childhood poverty and food insecurity.Broadly, we recommend increasing investments in families with children, particularly low-income families. Our specific recommendations include increasing SNAP benefits, establishing additional benefits to support low-income families with young children, and implementing a universal child allowance. Achieving substantial reductions in child poverty and food insecurity will require overcoming many challenges, including the current US political climate, a national history of underinvestment in social programs, a lack of political will, and a culture of structural racism.
Identifying Technical Procedures in Orthopaedic Surgery and Traumatology That Should Be Integrated in a Simulation-Based Curriculum
Authors: Gustafsson Amandus , Viberg Bjarke , Paltved Charlotte , Palm Henrik , Konge Lars , Nayahangan Leizl Joy 
Published: October 2019

Background:
Simulation-based training is emerging within the orthopaedic field to alleviate the challenges that trainees face such as work-hour restrictions, limited exposure to procedures, and increasing pressures to reduce risk to patients. This training modality has grown increasingly popular over the last 2 decades. However, integration into the curriculum often fails to follow a structured educational plan. The development of simulation-based curricula should follow a structured and stepwise approach that starts with a general needs assessment. This study aimed to identify and prioritize procedures within orthopaedic surgery to be included in a simulation-based curriculum on a national basis.

Methods:
A national needs assessment was conducted using the Delphi method. Ninety-five experts who are involved in the training of orthopaedic surgeons from all orthopaedic departments in Denmark were selected to participate in the assessment. Round 1 was a brainstorming phase to identify technical procedures that are relevant for orthopaedic surgeons in training. Round 2 was performed on a departmental basis; it explored the frequency of procedures, the number of surgeons performing each procedure, the risk and/or discomfort to patients, and the feasibility for simulation-based training to prioritize and eliminate some of the procedures that were determined in round 1. During round 3, the experts eliminated and reprioritized procedures from round 2 to produce a final prioritized list.

Results:
During the first round, 194 procedures were identified. These were reduced to 62 in round 2, and the final list after round 3 consisted of 33 prioritized procedures that are relevant for simulation-based training in orthopaedic surgery. The response rates were 63 of 95 physicians for round 1, 26 of 26 departments for round 2, and 64 of 97 physicians for round 3. The highest prioritized procedures were basic surgical techniques and principles for osteosynthesis, osteosynthesis of proximal femoral fracture, and surgical exposure of the upper and lower extremities.

Conclusions:
The prioritized list of technical procedures in orthopaedic surgery that are suitable for simulation-based training can aid in the development of a simulation-based curriculum.

Clinical Relevance:
This article offers insights into needs assessment and curriculum development of simulation-based training in orthopaedic surgery and traumatology.
Adhering to Radiographic Clinical Practice Guidelines for Distal Radial Fracture Management Is Associated with Improved Outcomes and Lower Costs
Authors: Giladi Aviram M. , Giberson-Chen Carew C. , Parker Amber M. , Desale Sameer , Rozental Tamara D. 
Published: October 2019

Background:
The American Academy of Orthopaedic Surgeons Clinical Practice Guideline on the Treatment of Distal Radius Fractures has not been evaluated in clinical practice. We hypothesized that adhering to the distal radial fracture radiographic clinical practice guideline (CPG) improves outcomes and reduces costs.

Methods:
We reviewed 266 patients with distal radial fractures treated at 1 institution. Based on CPG radiographic parameters (Recommendation 3), care was rated as “appropriate” or “inappropriate.” QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) scores were collected. The direct costs of distal radial fracture care were determined. Descriptive statistics and nonparametric tests were used to evaluate demographic characteristics and outcomes across groups. QuickDASH scores, grouped by postoperative time interval, were analyzed using linear mixed effect models to predict outcome trends.

Results:
In this study, 145 patients in the operative treatment group and 121 patients in the nonoperative treatment group were included. Of the 145 patients in the operative treatment group, 6 underwent an inappropriate surgical procedure, limiting any analyses of that group. Of the 121 patients in the nonoperative treatment group, 68 were treated inappropriately. For the patients in the nonoperative treatment group, appropriate care provided a significant outcome benefit by 1 year; the median QuickDASH score was 10.1 points for the appropriate treatment group and 19.5 points for the inappropriate treatment group (p = 0.05). The total direct costs for inappropriate nonoperative treatment were, on average, 60% higher than appropriate nonoperative treatment. In predictive models, patients with appropriate care in the operative treatment group and the nonoperative treatment group had better outcomes than patients with inappropriate nonoperative treatment at all time points after 29 days.

Conclusions:
When nonoperative distal radial fracture management was aligned with radiographic CPG criteria, patients in our cohort had improved patient-reported outcomes with lower costs.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Graft Diameter and Graft Type as Predictors of Anterior Cruciate Ligament Revision
Authors: Snaebjörnsson Thorkell , Hamrin-Senorski Eric , Svantesson Eleonor , Karlsson Louise , Engebretsen Lars , Karlsson Jon , Samuelsson Kristian 
Published: October 2019

Background:
It is important to investigate and compare graft diameters as well as graft types to identify risk factors for revision after an anterior cruciate ligament (ACL) reconstruction. We performed the current study in order to analyze the early ACL revision rate among patients treated with hamstring tendon (HT) autografts or patellar tendon (PT) autografts of different diameters. Our hypothesis was that an increase in both HT and PT autograft diameters would reduce the risk of early ACL revision.

Methods:
This retrospective study was based on prospectively collected data from the national knee ligament registries of Norway and Sweden and included patients who underwent primary ACL reconstruction during the period of 2004 through 2014. The primary end point was the 2-year incidence of ACL revision. The impact of graft type and diameter on the incidence of revision surgery was reported as relative risks (RRs) with 95% confidence intervals (CIs), estimated by using generalized linear models with a binomial distribution and log-link function.

Results:
Of 58,692 patients identified, a total of 18,425 patients were included in this study. The 2-year rate of ACL revision was 2.10% (PT autografts, 2.63%; HT autografts, 2.08%; RR = 0.93 [95% CI = 0.60 to 1.45]). There was an increased risk of ACL revision among patients treated with HT autografts with a diameter of <8 mm compared with larger HT autografts (RR = 1.25 [95% CI = 1.01 to 1.57]). Patients treated with HT autografts with a diameter of ≥9.0 mm or ≥10.0 mm had a reduced risk of early ACL revision compared with patients treated with PT autografts.

Conclusions:
Patients treated with larger-diameter HT autografts had a lower risk of early ACL revision compared with those treated with HT autografts of <8 mm. Patients treated with HT autografts of ≥9 or ≥10 mm had a reduced risk of early ACL revision compared with patients treated with PT autografts.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Comparison of Long-Term Outcomes of Computer-Navigated and Conventional Total Knee Arthroplasty
Authors: Rhee Seung Joon , Kim Hyun-Jung , Lee Chang-Rack , Kim Chang-Wan , Gwak Heui-Chul , Kim Jung-Han 
Published: October 2019

Background:
It is not clear whether long-term outcomes differ between computer-navigated and conventional total knee arthroplasty. The purpose of this study was to perform a meta-analysis comparing the radiographic outcomes, the long-term functional outcomes, and survivorship between computer-navigated total knee arthroplasty and conventional total knee arthroplasty.

Methods:
We searched MEDLINE, Embase, and the Cochrane Library to identify studies comparing long-term outcomes between computer-navigated total knee arthroplasty and conventional total knee arthroplasty. Randomized controlled trials with mean follow-up durations of >8 years were included. The meta-analysis compared radiographic outcomes (postoperative alignment), functional outcomes (range of motion and patient-reported outcomes), and survivorship of the 2 techniques.

Results:
Nine studies were included. A meta-analysis of accuracy revealed better outcomes in computer-navigated total knee arthroplasty when compared with conventional total knee arthroplasty in terms of the sagittal alignment of the femoral component (risk ratio [RR], 0.69; [95% confidence interval (CI), 0.51 to 0.93]; p = 0.02) and the coronal alignment of the tibial component (RR, 0.75 [95% CI, 0.60 to 0.95]; p = 0.02). The mechanical axis of the lower extremity, the coronal alignment of the femoral component, and the sagittal alignment of the tibial component did not differ significantly between the 2 groups. The functional outcomes did not differ significantly between the 2 techniques. Both in terms of the revision rate and the incidence of aseptic loosening, there were no differences between the 2 techniques.

Conclusions:
Although computer-navigated total knee arthroplasty resulted in better outcomes in postoperative component alignment than conventional total knee arthroplasty, there were no significant differences in long-term functional outcomes and survivorship between the 2 techniques. To fully evaluate the utility of computer navigation in total knee arthroplasty, additional randomized controlled studies including diverse ethnic groups and countries, as well as studies evaluating the correlation between postoperative alignment and long-term survivorship, are necessary.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
β2AR-HIF-1α-CXCL12 signaling of osteoblasts activated by isoproterenol promotes migration and invasion of prostate cancer cells
Authors: Huang Zhibin , Li Guihuan , Zhang Zhishuai , Gu Ruonan , Wang Wenyang , Lai Xiaoju , Cui Zhong-kai , Zeng Fangyin , Xu Shiyuan , Deng Fan 
Published: October 2019

Abstract
Background: Chronic stress is well known to promote tumor progression, however, little is known on whether neurotransmitters released after chronic stress induced sympathetic activation regulate the function of osteoblasts to affect migration and invasion of metastatic cancer cells.
Methods: First, the changes in migration and invasion ability of prostate cancer cell lines PC-3 and DU145 were assessed by transwell migration assay. PC-3 and DU145 cells proliferation ability were detected by CCK-8, and HIF-1α expression of osteoblasts and the momentous proteins of epithelial-mesenchymal transition (EMT) of PC-3 and DU145 cells were examined by Western blot. Then, an analysis of the main cytokines associated with bone metastasis in osteoblasts and EMT-related biomarkers in PC-3 and DU145 cells was performed by qRT-PCR. Finally, rescue experiment was performed by using HIF-1α siRNA and inhibitor, HIF-1α overexpression plasmid, β2-adrenergic receptor (β2AR) inhibitor, CXCR4 siRNA and inhibitor.
Results: In this study, isoproterenol (ISO), a non-selective β-adrenergic receptor (βAR) agonist, used as a pharmacological surrogate of sympathetic nerve activation induced by chronic stress, exhibited no direct effect on migration and invasion of PC-3 and DU145 prostate cancer cells. Whereas, osteoblasts pretreated with ISO promoted EMT and migration as well as invasion of PC-3 and DU145 cells, which was independent of promoting cell proliferation and could be inhibited by β2AR inhibitor. Mechanically, ISO increased the secretion of CXCL12 via the β2AR-HIF-1α signaling in osteoblasts. Moreover, overexpression of HIF-1α osteoblasts promoted migration and invasion of PC-3 and DU145 cells, which was inhibited by addition of recombinant knockdown of CXCR4 in PC-3 and DU145 cells, and inhibiting CXCL12-CXCR4 signaling with LY2510924 blunted the effects of osteoblasts in response to ISO on EMT and migration as well as invasion of PC-3 and DU145 cells.
Conclusions: These findings indicate that β2AR-HIF-1α-CXCL12 signaling in osteoblasts facilitates migration and invasion as well as EMT of prostate cancer cells, and may play a potential role in affecting bone metastasis of prostate cancer.
Primary solid lung cancerous nodules with different sizes: computed tomography features and their variations
Authors: Chu Zhi-gang , Zhang Yan , Li Wang-jia , Li Qi , Zheng Yi-neng , Lv Fa-jin 
Published: October 2019

Abstract
Background: The computed tomography (CT) features of small solid lung cancers and their changing regularity as they grow have not been well studied. The purpose of this study was to analyze the CT features of solid lung cancerous nodules (SLCNs) with different sizes and their variations.
Methods: Between February 2013 and April 2018, a consecutive cohort of 224 patients (225 nodules) with confirmed primary SLCNs was enrolled. The nodules were divided into four groups based on tumor diameter (A: diameter ≤ 1.0 cm, 35 lesions; B: 1.0 cm < diameter ≤ 1.5 cm, 60 lesions; C: 1.5 cm < diameter ≤ 2.0 cm, 63 lesions; and D: 2.0 cm < diameter ≤ 3.0 cm, 67 lesions). CT features of nodules within each group were summarized and compared.
Results: Most nodules in different groups were located in upper lobes (groups A−D：50.8%−73.1%) and had a gap from the pleura (groups A−D：89.6%−100%). The main CT features of smaller (diameter ≤ 1 cm) and larger (diameter > 1 cm) nodules were significantly different. As nodule diameter increased, more lesions showed a regular shape, homogeneous density, clear but coarse tumor–lung interface, lobulation, spiculation, spinous protuberance, vascular convergence, pleural retraction, bronchial truncation, and beam-shaped opacity (p < 0.05 for all). The presence of halo sign in all groups was similar (17.5%−22.5%; p > 0.05).
Conclusions: The CT features vary among SLCNs with different sizes. Understanding their changing regularity is helpful for identifying smaller suspicious malignant nodules and early determining their nature in follow-up.
Estimating health burden and economic loss attributable to short-term exposure to multiple air pollutants in China
Authors: Yao Minghong , Wu Gonghua , Zhao Xing , Zhang Juying 
Published: October 2019

Abstract
Background Existing studies focused on the evaluation of health burden of long-term exposure to air pollutants, whereas limited information is available on short-term exposure, particularly in China.Methods Air pollutants concentrations in 338 Chinese cities in 2017 were used to estimate the air pollutants related health burden which was defined as premature mortalities from all-cause, cardiovascular and respiratory disease as well as hospital admissions (HAs) for cardiovascular and respiratory disease. Log-linear model was used as the exposure-response function to estimate the health burden attributable to each air pollutant. The value of statistical life and cost of illness methods were used to estimate economic loss of the premature mortalities and HAs, respectively.Results The national all-cause premature mortalities attributable to all air pollutants was 1.35 million, accounting for 17.2% of reported deaths in China in 2017. Among all-cause premature mortality, contributions of PM10, SO2, NO2, CO, and O3 were 16.3%, 9.6%, 28.9%, 22.2% and 23.0%, respectively. The national cardiovascular and respiratory premature mortalities were 0.78 and 0.21 million, respectively. About 6.79 million cardiovascular and respiratory disease HAs were attributed to short-term exposure to PM10, SO2, NO2, and O3. The economic loss of the overall health burden was 2057.66 billion Yuan, which was equivalent to 2.5% of the national GDP in 2017.Conclusions The health burden and economic loss attributable to short-term exposure to ambient air pollutant are substantial in China. It suggested that the adverse health effects attributable to short-term exposure to air pollutant should not be neglected in China.
A retrospective analysis of risk factors associated with catheter-related thrombosis: a single-center study
Authors: Runnan Shen , Xuezhen Zhou , Xi Lin , Yingying Qu , Chunling Mo , Yan Li , Qingchang Chen , Guitao Wu , Zhenhong Chen , Kai Huang 
Published: October 2019

Abstract
Background: Catheter-related thrombosis (CRT) may lead to catheter infections and failure, further deep venous thrombosis (DVT), and pulmonary embolism (PE). Recognizing the risk factors for CRT is extremely important to inform the development of catheter-nursing guidelines.Methods: Data were collected from a total of 1532 patients who had undergone venous catheterization, including indwelling catheterization from March 19 to March 30, 2019 in Sun Yat-sen Memorial Hospital. The factors for which data were to be collected included the patients’ physical characteristics, catheter-associated factors, and factors associated with catheter nursing. Logistic regression analysis, the chi-square test, Fisher’s exact test, and the t-test were used to analyze the data. Results: Of the 1532 patients studied, 28 developed intraductal thrombi, and of the factors analyzed, tumor, a catheterization history, a history of thrombophilia, surgery during the week before catheterization, the catheterization duration were significant risk factors associated with CRT (all P < 0.05). There were no significant associations between the catheter brand, the number of lumens, the insertion direction, or the factors associated with catheter nursing and CRT (all P > 0.05). Anticoagulation therapy significantly decreases the risk of CRT ( P < 0.05 ). Conclusion: Tumor, a history of thrombophilia, a history of catheterization, surgery during the week before catheterization, and catheterization duration were associated with increased risks of CRT. Prophylactic anticoagulation is effective for preventing and treating CRT. Our study incorporates clear and systematic risk factors associated with CRT. The results are different from those of previous studies.