bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frobenius Splitting of Thick Flag Manifolds of Kac–Moody Algebras
Authors: Kato Syu 
Published: July 2018

Abstract
We explain that the Plücker relations provide the defining equations of the thick flag manifold associated to a Kac–Moody algebra. This naturally transplants the result of Kumar–Mathieu–Schwede about the Frobenius splitting of thin flag varieties to the thick case. As a consequence, we provide a description of the space of global sections of a line bundle of a thick Schubert variety as conjectured in Kashiwara–Shimozono [13]. This also yields the existence of a compatible basis of thick Demazure modules and the projective normality of the thick Schubert varieties.
US Emergency Department Visits for Adverse Drug Events From Antibiotics in Children, 2011–2015
Authors: Lovegrove Maribeth C , Geller Andrew I , Fleming-Dutra Katherine E , Shehab Nadine , Sapiano Mathew R P , Budnitz Daniel S 
Published: July 2018

Abstract

Background
Antibiotics are among the most commonly prescribed medications for children; however, at least one-third of pediatric antibiotic prescriptions are unnecessary. National data on short-term antibiotic-related harms could inform efforts to reduce overprescribing and to supplement interventions that focus on the long-term benefits of reducing antibiotic resistance.

Methods
Frequencies and rates of emergency department (ED) visits for antibiotic adverse drug events (ADEs) in children were estimated using adverse event data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project and retail pharmacy dispensing data from QuintilesIMS (2011–2015).

Results
On the basis of 6542 surveillance cases, an estimated 69464 ED visits (95% confidence interval, 53488–85441) were made annually for antibiotic ADEs among children aged ≤19 years from 2011 to 2015, which accounts for 46.2% of ED visits for ADEs that results from systemic medication. Two-fifths (40.7%) of ED visits for antibiotic ADEs involved a child aged ≤2 years, and 86.1% involved an allergic reaction. Amoxicillin was the most commonly implicated antibiotic among children aged ≤9 years. When we accounted for dispensed prescriptions, the rates of ED visits for antibiotic ADEs declined with increasing age for all antibiotics except sulfamethoxazole-trimethoprim. Amoxicillin had the highest rate of ED visits for antibiotic ADEs among children aged ≤2 years, whereas sulfamethoxazole-trimethoprim resulted in the highest rate among children aged 10 to 19 years (29.9 and 24.2 ED visits per 10000 dispensed prescriptions, respectively).

Conclusions
Antibiotic ADEs lead to many ED visits, particularly among young children. Communicating the risks of antibiotic ADEs could help reduce unnecessary prescribing. Prevention efforts could target pediatric patients who are at the greatest risk of harm.
Goodness-Fixing Isn’t Good Enough: A Reply to McHugh and Way
Authors: Hlobil Ulf 
Published: July 2018

Abstract
According to McHugh and Way, reasoning is a person-level attitude revision that is regulated by its constitutive aim of getting fitting attitudes. They claim that this account offers an explanation of what is wrong with reasoning in ways one believes to be bad, and that this explanation is an alternative to an explanation that appeals to the so-called Taking Condition. I argue that their explanation is unsatisfying.
Trends in social inequality in loneliness among adolescents 1991–2014
Authors: Madsen K R , Holstein B E , Damsgaard M T , Rayce S B , Jespersen L N , Due P 
Published: July 2018

Abstract

Background
Loneliness and social inequality in health are important public health concerns. We examined (i) trends in loneliness among adolescents from 1991 to 2014 in Denmark and (ii) trends in social inequality in loneliness.

Methods
Study population: 11–15-year olds in random samples of schools in 1991, 1994, 1998, 2006 and 2014, n = 19 096. Loneliness was measured by a single item and social background by parents’ occupational social class (OSC). We calculated absolute (%) differences in loneliness between high and low OSC and relative differences by odds ratio for loneliness.

Results
Across all surveys, 6.3% reported feeling lonely. The prevalence increased from 4.4% in 1991 to 7.2% in 2014. The prevalence of loneliness in high, middle and low OSC was 5.8, 5.9 and 8.0%. The increase in loneliness was more pronounced in higher than lower OSC, resulting in a decreasing absolute social inequality in loneliness. The statistical interaction between OSC and survey year was significant, P = 0.0176, i.e. the relative social inequality in loneliness also decreased from 1991 to 2014.

Conclusion
The prevalence of loneliness increased from 1991 to 2014. The social inequality in loneliness decreased in both absolute and relative terms because of a rising prevalence of loneliness among children from high OSC.
Characteristics of sleep-active neurons in the medullary parafacial zone in rats
Authors: Alam Md Aftab , Kostin Andrey , Siegel Jerome , McGinty Dennis , Szymusiak Ronald , Alam Md Noor 
Published: July 2018

Abstract
Growing evidence supports a role for the medullary parafacial zone in non-rapid eye movement (non-REM) sleep regulation. Cell-body specific lesions of the parafacial zone or disruption of its GABAergic/glycinergic transmission causes suppression of non-REM sleep, whereas, targeted activation of parafacial GABAergic/glycinergic neurons reduce sleep latency and increase non-REM sleep amount, bout duration, and cortical electroencephalogram (EEG) slow-wave activity. Parafacial GABAergic/glycinergic neurons also express sleep-associated c-fos immunoreactivity. Currently, it is not clear if parafacial neurons are non-REM sleep-active and/or REM sleep-active or play a role in the initiation or maintenance of non-REM sleep. We recorded extracellular discharge activity of parafacial neurons across the spontaneous sleep-waking cycle using microwire technique in freely behaving rats. Waking-, non-REM sleep-, and REM sleep-active neuronal groups were segregated by the ratios of their discharge rate changes during non-REM and REM sleep versus waking and non-REM sleep versus REM sleep. Parafacial neurons exhibited heterogeneity in sleep-waking discharge patterns, but 34 of 86 (40%) recorded neurons exhibited increased discharge rate during non-REM sleep compared to waking. These neurons also exhibited increased discharge prior to non-REM sleep onset, similar to median preoptic nucleus (MnPO) and ventrolateral preoptic area (VLPO) sleep-active neurons. However, unlike MnPO and VLPO sleep-active neurons, parafacial neurons were weakly-moderately sleep-active and exhibited a stable rather than decreasing discharge across sustained non-REM sleep episode. We show for the first time that the medullary parafacial zone contains non-REM sleep-active neurons. These neurons are likely functionally important brainstem compliments to the preoptic-hypothalamic sleep-promoting neuronal networks that underlie sleep onset and maintenance.
Managing sexually transmitted infections
Authors: Johnson-Mallard Versie , Curry Kim , Chandler Rasheeta , Alexander Ivy , Kostas-Polston Elizabeth , Orsega Susan , Woods Nancy Fugate 
Published: July 2018

Abstract:
Guidelines for the prevention and management of sexually transmitted infections (STIs) are updated periodically while new science is continuously developed. Advanced practice registered nurses implement clinical decisions based on current guidelines and evidence. This article provides recent updates on managing STIs.
Preoperative Planning for Percutaneous Transsacral, Transiliac Screws
Authors: Blum Laura E. , Hake Mark E. 
Published: July 2018

Summary:
Percutaneous transsacral, transiliac screw placement is a well-described, well-established management option for unstable posterior pelvic ring injuries. Safe and effective placement of these screws relies on extensive preoperative planning and scrutiny of the preoperative images. Malpositioning of the implants risks injury to the surrounding neurovascular structures. We present our methods for preoperative templating for safe placement of transsacral, transiliac screws.
Lateral Distal Femur Plate for Periprosthetic Fracture
Authors: Yarboro Seth R. 
Published: July 2018

Summary
In this case, a lateral locking plate is used for fixation of a periprosthetic distal femur fracture in a 68-year-old woman. Modern implants with locking screw options and soft-tissue–sparing surgical techniques have improved the care of periprosthetic distal femur fractures. Although much debate about the working length and technical variables of plating exists, it is generally accepted that longer (>10 hole) plates with adequate working length and careful soft-tissue handling are preferred. This case outlines a stepwise approach to distal femur fractures to achieve appropriate plate position and restoration of alignment while avoiding excessive surgical exposure or soft-tissue dissection. In this case, retrograde intramedullary nail was not considered because of the distal nature of the fracture, but this option may be favorable for cruciate-retaining total knee arthroplasty or open box designs that will accommodate nail insertion. Although weight bearing was protected for 6 weeks, plate fixation allows early rehabilitation and knee range of motion. This patient went on to successful union and excellent clinical outcome with return to baseline function.
Surgical Technique: Achieving Anatomic Alignment With Temporizing, Ankle-Spanning External Fixation
Authors: Liskutin Tomas , Bernstein Mitchell , Summers Hobie , Lack William 
Published: July 2018

Introduction:
Severe injuries to the ankle frequently result in soft tissue trauma too severe to proceed with immediate definitive fixation. Additionally, patients with multiple or vascular injuries may need a temporizing measure before undergoing definitive treatment. Temporizing, ankle-spanning external fixation offers a management strategy that allows for soft tissue rest and prioritized treatment of patients with polytrauma.

Methods:
The video demonstrates 2 clinical cases managed with temporizing, ankle-spanning external fixation: a pilon fracture and a bimalleolar ankle fracture–dislocation.

Results:
The indications, advantages, and a systematic operative approach to applying ankle-spanning external fixation are presented. Specific attention is paid to restoring an anatomic alignment of the ankle.

Conclusions:
Temporizing, ankle-spanning external fixation is an important modality in the management of fractures about the ankle, especially in patients with dislocation and/or severe soft tissue injury. A systematic approach that initially addresses length, followed by sagittal and coronal plane correction, can be used to restore anatomic alignment of the ankle.
Surgical Technique: Anterolateral Approach to the Humerus
Authors: Liskutin Tomas , Summers Hobie , Lack William , Bernstein Mitchell 
Published: July 2018

Introduction:
Although most humeral shaft fractures can be treated nonoperatively, many patients do benefit significantly from surgical treatment. The anterolateral approach to the humerus provides excellent exposure to the humeral shaft, especially to more proximal aspects. In addition, the approach can be extended both proximally and distally, providing the surgeon a dynamic exposure to the humerus for the treatment of fractures and other pathologies.

Methods:
This video highlights a clinical case where a mid-shaft humerus fracture was diagnosed and treated with open reduction internal fixation using an 8-hole 4.5-mm limited contact dynamic compression plate through an anterolateral approach.

Results:
We present indications, anatomic considerations, and surgical techniques used to surgically treat a transverse, mid-shaft humerus fracture through an anterolateral approach. In addition, we demonstrate the use of a push–pull screw to aid in achieving appropriate compression across a fracture site. Using this technique, an anatomic reduction and satisfactory clinical outcome were achieved.

Conclusions:
The anterolateral approach to the humerus offers excellent exposure to some humeral shaft fractures, particularly those that lie more proximally. However, its use must be weighed carefully against several other approach options, and the surgeon must account for the specific fracture pattern, as well as their own comfort and familiarity with the approach.
Posterior Scapula Approaches: Extensile and Modified Judet
Authors: Cole Peter A. , Dugarte Anthony J. 
Published: July 2018

Summary:The Extensile Judet has been widely used in the management of scapula fractures. An enhanced understanding of these injuries, however, has allowed for the strategic development of alternative methods in which soft tissues may be better spared. The purpose of this video is to highlight the indications and techniques for 2 posterior approaches to the scapula: The Extensile Judet and the Modified Judet. Case 1 demonstrates the Modified Judet approach. The “boomerang” incision follows the curve of the scapula spine and vertebral border, and fixation occurs through an intermuscular window. Case 2 illustrates the Extensile Judet. The incision is identical to that of the Modified Judet, but differs in that posterior musculature is elevated in 1 periosteocutaneous flap. The utility of 2 different posterior approaches to the scapula are described. Both include the same incision, but differ with regards to management of the musculature overlying the fracture. The Modified Judet lacks the exposure of the Extensile approach, but significant soft-tissue trauma is avoided. Regarding the Extensile Judet, substantial tissue trauma is incurred to gain the exposure necessary for complex fracture patterns. Reduction goals, wound closure, and postoperative care remain the same for both approaches. Both approaches are valuable in terms of operative management of scapula fractures, although certain populations may benefit from tissue-sparing procedures.
Supra-acetabular Pelvic External Fixator, Percutaneous With Fluoroscopic Guidance
Authors: Grannis Kimberly , Tidwell John , Cho Rosa 
Published: July 2018

Summary:
Unstable pelvic fractures are associated with high-energy trauma and can lead to increased morbidity and mortality if not managed properly in the acute setting. Early recognition and intervention is crucial for optimal patient outcomes. This article, in addition to the video footage, outlines a safe and effective method for stabilizing unstable pelvic fractures by applying a supra-acetabular pelvic external fixator using fluoroscopic guidance.
Distal Clavicle Fractures: Open Reduction and Internal Fixation With a Hook Plate
Authors: Kirsch Jacob M. , Blum Laura , Hake Mark E. 
Published: July 2018

Summary:
Displaced distal clavicle fractures pose unique challenges because of their propensity for instability. In particular, type II fracture patterns are associated with high rates of nonunion with nonoperative management; therefore, surgical fixation is often recommended. Hook plate fixation has demonstrated reliably high rates of osseous union with good functional outcomes. We present our surgical technique and rationale for using a hook plate in the setting of an unstable distal clavicle fracture.
Distal Tibial Intramedullary Nailing Using an Extraarticular, Lateral Parapatellar Approach in the Semiextended Position
Authors: McAndrew Christopher M. , Ricci William M. , Miller Anna N. , Avery Matthew C. 
Published: July 2018

Summary:
Semiextended positioning can improve the surgeon's ability to obtain, maintain, and fluoroscopically evaluate a fracture reduction when performing fixation with an intramedullary nail, especially in fractures at the proximal and distal ends. Furthermore, this position allows for evaluation of instrument placement, including the start point, without moving the fluoroscopic unit into extremes of angulation or compromising the quality of the beam orientation. The intraarticular suprapatellar approach has been described as a soft tissue approach to maintain the leg in a position that would not complicate management of these fractures, especially those in the proximal third of the tibia. A semiextended extraarticular soft tissue approach to the start point was described by Kubiak et al, and the lateral parapatellar version has become commonly used on the Orthopaedic Trauma Service at Washington University in Saint Louis. This video demonstrates advantages of semiextended positioning while performing reduction and intramedullary nail fixation for distal tibia fractures. This lateral parapatellar approach can be performed without specialized instrumentation, results in precise establishment of the start point and completion of the fixation without injury to the knee.
ORIF With Submuscular Plating of an Intercondylar/Supracondylar Distal Femur Fracture
Authors: Varkey Dax , Ostrum Robert F. 
Published: July 2018

Summary:
Fractures of the distal femur with intercondylar extension and comminution are challenging cases and demand a thorough preoperative evaluation and execution of proper surgical technique. Identification of the intra-articular fractures, including coronal fractures of the lateral condyle, is important in planning surgery and emphasizes the need for computerized tomography scans. Recent advances with anatomic, locking plates have made minimally invasive surgery easier, but joint reduction needs to be performed meticulously in an open manner, and restoration of the mechanical alignment through plate fixation is essential for a good clinical outcome. Stable fixation that allows for early range of motion and mobilization are essential for the patient's recovery. This video demonstrates open reduction and internal fixation of a high-energy supracondylar/intercondylar distal femur fracture and emphasizes minimally invasive, biologically friendly techniques.
Hip Power and “Stiff Knee” Gait: A Tool for Identifying Appropriate Candidates for Rectus Transfer
Authors: Moreira Brunno L. , Karakostas Tasos , Dias Luciano S. 
Published: July 2018

Background:
Rectus femoris transfer (RFT) is performed in children with cerebral palsy to treat stiff-knee gait. However, the results are variable in part because there is no gold standard to identify appropriate candidates. Hip flexion kinematics and kinetics are important factors in the determination of peak knee flexion during gait. This study aimed to evaluate whether a kinetic preoperative analysis of hip power can be a predictor of RFT outcomes and determine its usability for identifying appropriate candidates for the procedure.

Methods:
Sixteen children with spastic cerebral palsy (20 limbs) GMFCS I/II who underwent RFT for a stiff-knee gait and had preoperative and postoperative 3D gait analyses were retrospectively evaluated. Patient outcomes were classified as “good” or “poor” according to postoperative results. The outcomes were evaluated as a function of (a) 1-parameter criteria—peak hip power (PHP) with a cut-off magnitude≥0.60 W/kg; (b) 2-parameter criteria—PHP (cut-off magnitude≥0.60 W/kg) and the time the PHP occurred during the gait cycle (tPHP), with a cut-off ≤68% of the gait cycle.

Results:
When the 1-parameter criterion was used, 13 limbs met the criterion; of them, 11 had good outcomes. Seven limbs did not meet the criterion; of them, 6 had poor results (P=0.0049). When the 2-parameter criterion was used, 11 limbs met the criteria; all had good results. Nine limbs did not meet the criterion; of them, 8 had poor results (P=0.0002). PHP+tPHP had the same sensitivity as PHP alone (91%) but with higher specificity (100%) for predicting outcomes. The positive predictive value of magnitude PHP+tPHP was 100%, whereas the accuracy index was 95%.

Conclusions:
Preoperative kinetic evaluation of the hip power characteristics from 3D gait analysis appears to be a very important predictor for RFT outcomes and identifying appropriate candidates for the procedure.

Level of Evidence:
Level III—therapeutic retrospective study.
Double Cycling During Mechanical Ventilation: Frequency, Mechanisms, and Physiologic Implications*
Authors: de Haro Candelaria , López-Aguilar Josefina , Magrans Rudys , Montanya Jaume , Fernández-Gonzalo Sol , Turon Marc , Gomà Gemma , Chacón Encarna , Albaiceta Guillermo M. , Fernández Rafael , Subirà Carles , Lucangelo Umberto , Murias Gastón , Rué Montserrat , Kacmarek Robert M. , Blanch Lluís 
Published: July 2018

Objectives:
Double cycling generates larger than expected tidal volumes that contribute to lung injury. We analyzed the incidence, mechanisms, and physiologic implications of double cycling during volume- and pressure-targeted mechanical ventilation in critically ill patients.

Design:
Prospective, observational study.

Setting:
Three general ICUs in Spain.

Patients:
Sixty-seven continuously monitored adult patients undergoing volume control-continuous mandatory ventilation with constant flow, volume control-continuous mandatory ventilation with decelerated flow, or pressure control-continuous mandatory mechanical ventilation for longer than 24 hours.

Interventions:
None.

Measurements and Main Results:
We analyzed 9,251 hours of mechanical ventilation corresponding to 9,694,573 breaths. Double cycling occurred in 0.6%. All patients had double cycling; however, the distribution of double cycling varied over time. The mean percentage (95% CI) of double cycling was higher in pressure control-continuous mandatory ventilation 0.54 (0.34–0.87) than in volume control-continuous mandatory ventilation with constant flow 0.27 (0.19–0.38) or volume control-continuous mandatory ventilation with decelerated flow 0.11 (0.06–0.20). Tidal volume in double-cycled breaths was higher in volume control-continuous mandatory ventilation with constant flow and volume control-continuous mandatory ventilation with decelerated flow than in pressure control-continuous mandatory ventilation. Double-cycled breaths were patient triggered in 65.4% and reverse triggered (diaphragmatic contraction stimulated by a previous passive ventilator breath) in 34.6% of cases; the difference was largest in volume control-continuous mandatory ventilation with decelerated flow (80.7% patient triggered and 19.3% reverse triggered). Peak pressure of the second stacked breath was highest in volume control-continuous mandatory ventilation with constant flow regardless of trigger type. Various physiologic factors, none mutually exclusive, were associated with double cycling.

Conclusions:
Double cycling is uncommon but occurs in all patients. Periods without double cycling alternate with periods with clusters of double cycling. The volume of the stacked breaths can double the set tidal volume in volume control-continuous mandatory ventilation with constant flow. Gas delivery must be tailored to neuroventilatory demand because interdependent ventilator setting–related physiologic factors can contribute to double cycling. One third of double-cycled breaths were reverse triggered, suggesting that repeated respiratory muscle activation after time-initiated ventilator breaths occurs more often than expected.