bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morbihan Disease Treatment: Two Case Reports and a Systematic Literature Review
Authors: Boparai Ranjodh S. , Levin Ariana M. , Lelli Gary J. 
Published: October 2018

Purpose:To assess the effectiveness of treatments for Morbihan disease.Methods:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was performed on April 1, 2018, using PubMed, Google Scholar, and Excerpta Medica dataBASE with terms used to describe Morbihan disease, including “Morbihan Disease,” “Morbihan Syndrome,” “lymphedema rosacea,” and “lymphedematous rosacea”. Case reports or case series were included if they fulfilled the following criteria: published in English, peer-reviewed, and reported Morbihan disease.Results:A total of 89 patients—87 patients from 49 articles and 2 cases from the authors’ institution—were included in the final analysis. The median age of patients was 51 years (range: 14–79), and 66 of 89 (74%) patients were men. Male gender correlated with lack of complete response to treatment (odds ratio: 0.25; 95% confidence interval: 0.06–0.97;p= 0.02), while presence of papules or pustules correlated with complete response to treatment (odds ratio: 4.07; 95% confidence interval: 1.04–17.68;p= 0.03). Longer antibiotic duration correlated with response to treatment (p= 0.03), favoring complete over partial response (p= 0.02). Mean antibiotic duration in patients who responded was 4.43 months (standard deviation: 3.49), with complete responders requiring 6.50 months (standard deviation: 4.57). Oral corticosteroids, isotretinoins, and combination therapies did not correlate with treatment response.Conclusions:The presence of papules and pustules correlates with a complete response to treatment, while male gender correlates with a partial response. Patients may benefit from 4- to 6-month duration of tetracycline-based antibiotics. Prospective studies are needed to assess the impact of antibiotic and isotretinoin dose and duration on treatment response.
Incidence Risk Level and Severity of Orthopedic Surgical Site Infection in Jordan
Authors: Hassan Zeinab M. , Najjar Yahya W. , Saleh Mohammad Y. , Hamdan Mohammad 
Published: October 2018

Background
Orthopedic surgical site infections are higher in developing countries compared with developed countries.

Purpose
This study aimed to determine the following: incidence rate of infection, levels of risk of infection, the severity of orthopedic infection, and the relationship between risk level of and severity level of orthopedic infection.

Methods
The study used a prospective approach to collect data about orthopedic surgery patients through assessing their health status and reviewing their medical records and monitoring for the occurrence of surgical site infection within 90 days after the operation. A total of 286 patients met the eligibility criteria from 18 hospitals. The severity of wound infection was assessed using the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, isolation of bacteria, and duration of inpatient Stay wound scoring scale, and the levels of risk were assessed using the National Nosocomial Infection Surveillance risk index score.

Results
The incidence rate of orthopedic surgical site infection was (n = 8; 2.8%). Five patients (62.5%) had a moderate-risk level of infection, and 2 patients (25%) had a high-risk level. Most patients (n = 278; 97.2%) had satisfactory healing level. Both risk levels and severity levels of orthopedic surgical site infection were significantly correlated with each other.

Conclusion
Appropriate risk level and severity level assessment tools should be used to aid in the assessment of orthopedic surgical site infection.
Interrater Reliability of the Functional Status Score for the Intensive Care Unit
Authors: Hiser Stephanie , Toonstra Amy , Friedman Lisa Aronson , Colantuoni Elizabeth , Connolly Bronwen , Needham Dale M. 
Published: October 2018

Background:
A decline in physical functioning is common during an intensive care unit (ICU) stay. The Functional Status Score for the Intensive Care Unit (FSS-ICU) is a performance-based measure designed to evaluate aspects of physical functioning in the ICU setting. While existing data support validity of the FSS-ICU, further investigation is needed regarding its interrater reliability.

Objective:
Evaluate interrater reliability of the FSS-ICU when completed by physical therapists (PTs), as part of routine clinical practice, across a wide range of patients with critical illness.

Design:
Prospective observational evaluation.

Methods:
Across patients in surgical, medical, and neurological ICUs, 8 PTs with 6 months of experience or more using the FSS-ICU (median [range] years of ICU experience = 2 [1-3]) administered the FSS-ICU. One of 2 reference rater PTs observed the FSS-ICU evaluation, and simultaneously scored it, with a minimum of 10 assessments per clinical PT. Reference rater and clinical PTs were blinded to each other's scores. Bland-Altman plots were constructed and intraclass correlation coefficients were computed using a random intercept (PT session and rater) model.

Results:
Eighty-one assessments on 76 different patients were observed by a reference rater PT. Bland-Altman plots revealed a mean difference in FSS-ICU scoring of 0.0 (95% limits of agreement: −4.0 to +4.0), with an intraclass correlation coefficient (95% confidence interval) of 0.985 (0.981-0.987). The intraclass correlation coefficients for patients in surgical, medical, and neurological ICUs were very similar: 0.984 (0.973-0.988), 0.987 (0.979-0.990), and 0.977 (0.963-0.983), respectively.

Limitations:
Single-center evaluation.

Conclusions:
The FSS-ICU evaluations, performed by PTs as part of routine clinical care across a variety of patients with critical illness, have excellent reliability compared with reference rater PTs.
Data-driven Decision Making in Doctor of Physical Therapy Curricula Part I: Program-level Analysis
Authors: Roller Dawn , Wininger Michael , Leard John , Crane Barbara 
Published: October 2018

Background and Purpose.
We describe a data-driven internal curricular review process for professional (entry-level) physical therapist education programs. Using National Physical Therapy Exam (NPTE) performance as an outcome measure, we test the ability of individual courses, as well as summary grade point averages (GPAs), to identify students at risk for failure in the first attempt of the NPTE.

Methods.
National Physical Therapy Exam score was modeled in a simple univariate linear regression on 2 sets of predictor variables: individual course final grades and summary GPAs. First-time NPTE performance was configured in 2 measures: a continuous measure of exam score and a dichotomous pass–fail index. For NPTE score as a continuous measure, linear regression was used to test for association. For pass–fail, we tested for optimal grade or GPA benchmark by systematic thresholding across a range of numerical grades (70–95%) or grade points (1.5–4.0). Methods were demonstrated in the setting of a dataset collected from a single graduate cohort (N = 36), among whom 26 first-time NPTE scores were available. Exploratory analyses tested the sensitivity of this analysis to datasets containing letter grades, and repeatability across 5 cohorts.

Outcomes.
Grade distributions in individual courses (n = 12) were weak to moderate predictors of NPTE score (range: 0.00 < R
2 < 0.60); curricular GPA distributions (n = 6) were moderate to fair predictors (0.4 < R
2 < 0.7). Overall undergraduate GPA and GPA in prerequisite science courses were found to not predict first-time NPTE score whatsoever. Optimal grade criterion within the classes ranged from 79 to 93 points; optimal GPA criteria ranged from 2.6 to 3.4. At-risk students were identifiable as early as the end of the first semester. Model consistency varied somewhat when replicated across 5 cohorts but showed general consistency in maintaining relative strengths of measured associations. This method showed robustness to conversion to letter-grade format.

Discussion and Conclusion.
Risk for failure in first-attempt NPTE is a parameter that can be measured, and at-risk students can be identified early in their physical therapist education programs. Internal policy making should be guided by program experience and use data at the per-course or per-semester level.
Cholesteatoma of the External Auditory Canal: Review of Staging and Surgical Strategy
Authors: HN Udayabhanu , Prasad Sampath C. , Russo Alessandra , Grinblat Golda , Sanna Mario 
Published: October 2018

Introduction:
External auditory canal cholesteatomas (EACC) is insidious in nature and rare entity. There are only few case series on EACCs and surgical strategy is not standardized.

Objectives:
1) To elucidate etiology of EACC and cardinal features. 2) To suggest a practical staging of EACC. 3) To enumerate surgical management according to stage of EACC.

Study Design:
Retrospective study in a quaternary referral center of 31 consecutive cases of EACC.

Results:
Thirty-one patients with EACC were reviewed. Unilateral otorrhea 19 (61.2%), hearing loss 22 (70.9%), and otalgia 8 (25.8%) are cardinal symptoms. Sixteen primary and 15 secondary EACCs were treated. Bone erosion was observed in 20 cases. In the present series, stage III = 12 (38.7%), stage II = 8 (25.8%), stage I = 11 (35.4%) underwent definitive treatment by surgery. Canalplasty with reconstruction was done in 19 cases of stages I and II. Of 12 cases in stage III, 3 cases underwent canalplasty with reconstruction. Subtotal petrosectomy was done in five cases. Intact canal wall mastoidectomy with canalplasty in two cases and radical mastoidectomy in two cases. Fascia, cartilage, muscle, and bone dust were used for reconstruction. Median follow-up period was 6 years and no recurrence of cholesteatoma was observed.

Conclusion:
EACC is unique entity. Intraoperative and radiological findings assist in correct and practical staging of EACC. Late stage presentations of EACC are common. Definitive surgical treatment in our series avoided recurrence of cholesteatoma.
Development of a Mixed Reality Platform for Lateral Skull Base Anatomy
Authors: McJunkin Jonathan L. , Jiramongkolchai Pawina , Chung Woenho , Southworth Michael , Durakovic Nedim , Buchman Craig A. , Silva Jonathan R. 
Published: October 2018

Objectives:
A mixed reality (MR) headset that enables three-dimensional (3D) visualization of interactive holograms anchored to specific points in physical space was developed for use with lateral skull base anatomy. The objectives of this study are to: 1) develop an augmented reality platform using the headset for visualization of temporal bone structures, and 2) measure the accuracy of the platform as an image guidance system.

Methods:
A combination of semiautomatic and manual segmentation was used to generate 3D reconstructions of soft tissue and bony anatomy of cadaver heads and temporal bones from 2D computed tomography images. A Mixed-Reality platform was developed using C# programming to generate interactive 3D holograms that could be displayed in the HoloLens headset. Accuracy of visual surface registration was determined by target registration error between seven predefined points on a 3D holographic skull and 3D printed model.

Results:
Interactive 3D holograms of soft tissue, bony anatomy, and internal ear structures of cadaveric models were generated and visualized in the MR headset. Software user interface was developed to allow for user control of the virtual images through gaze, voice, and gesture commands. Visual surface point matching registration was used to align and anchor holograms to physical objects. The average target registration error of our system was 5.76 mm ± 0.54.

Conclusion:
In this article, we demonstrate that an MR headset can be applied to display interactive 3D anatomic structures of the temporal bone that can be overlaid on physical models. This technology has the potential to be used as an image guidance tool during anatomic dissection and lateral skull base surgery.
Speech Recognition in Noise for Adults With Normal Hearing: Age-Normative Performance for AzBio, BKB-SIN, and QuickSIN
Authors: Holder Jourdan T. , Levin Laura M. , Gifford René H. 
Published: October 2018

Objective:
Characterize performance for adults aged 20 to 79 years with normal hearing on tasks of AzBio, Bamford–Kowal–Bench speech-in-noise (BKB-SIN), quick speech-in-noise (QuickSIN), and acoustic Quick Spectral Modulation Detection (QSMD) in the sound field.

Setting:
Cochlear implant (CI) program.

Patients:
Eighty-one adults with normal hearing and cognitive function were recruited evenly across four age groups (20–49, 50–59, 60–69, and 70–79 yr).

Interventions:
Subjects completed AzBio sentence recognition testing in quiet and in five signal-to-noise ratios (SNRs: +10, +5, 0, −5, −10 dB), as well as the BKB-SIN, QuickSIN, and QSMD tasks.

Main Outcome Measures:
AzBio, BKB-SIN, QuickSIN, and acoustic QSMD scores were analyzed to characterize typical sound field performance in an older adult population with normal hearing.

Results:
AzBio sentence recognition performance approached ceiling for sentences presented at ≥ 0 dB SNR with mean scores ranging from 3.5% at −10 dB SNR to 99% at +10 dB SNR. Mean QuickSIN SNR-50 was −0.02. Mean BKB-SIN SNR-50 was −1.31 dB. Mean acoustic QSMD score was 88%. Performance for all measures decreased with age.

Conclusion:
Adults with age-normative hearing achieve ceiling-level performance for AzBio sentence recognition at SNRs used for clinical cochlear implant and/or hearing aid testing. Thus, these tasks are not inherently contraindicated for older listeners. Older adults with normal hearing, however, demonstrated greater deficits for speech in noise compared to younger listeners—an effect most pronounced at negative SNRs. Lastly, BKB-SIN data obtained in the sound field replicated previous normative data for only the youngest age group, suggesting that new norms should be considered for older populations.
Otologic Outcomes After Blast Injury: The Brussels Bombing Experience
Authors: Van Haesendonck Gilles , Van Rompaey Vincent , Gilles Annick , Topsakal Vedat , Van de Heyning Paul 
Published: October 2018

Objective:
After the suicide bombings in Brussels on March 22, 2016, many victims consulted our emergency department with otologic symptoms. The aim of this study was to report the otologic morbidity and outcome after acute acoustic trauma in these patients.

Study Design:
Prospective cohort study.

Setting:
Tertiary referral center.

Patients:
Patients reporting subjective hearing loss, tinnitus, feeling of pressure in the ear, vertigo or hyperacusis after witnessing these bombings were included.

Intervention:
All included patients were treated with systemic corticosteroid therapy, concurrent hyperbaric oxygen therapy (HBOT) was advised to each and every included patient.

Main Outcome Measures:
Participants underwent a routine otologic work-up including otoscopy, liminal audiometry, and subjective outcome measures related to tinnitus at baseline and at follow-up. Primary outcome was to describe the otologic morbidity after acute acoustic trauma (AAT). Secondary outcome was to evaluate the recovery of hearing loss, subjective symptoms, and tympanic membrane perforations.

Results:
Fifty-six patients were included in our population with an average age of 27 ± 13 years, and 46% women/54% men. Thirty-two patients reported subjective hearing loss, 45 reported tinnitus, 45 reported a feeling of pressure in the ear, 2 patients experienced vertigo, and 18 patients reported hyperacusis. Otoscopic examination revealed three tympanic membrane perforation (TMP). Sensorineural hearing loss (SNHL) was observed in 41% (n = 23) and mixed hearing loss in 3.6% (n = 2). No conductive hearing loss (CHL) was observed. Follow-up was obtained in 76.8%, with the last follow-up available at 47 ± 74 days. Two perforations closed spontaneously, while one persistent perforation was successfully reconstructed with complete air-bone gap closure. There was a significant improvement in subjective symptoms. SNHL improvement was observed in 52.6% (10/19), mixed hearing loss improved in both patients. Improvement in hearing thresholds was seen in patients treated with steroids and in those treated with steroids and HBOT, there was no significant difference in the degree of improvement between these two groups.

Conclusions:
Blast-related otologic injuries have a significant impact on morbidity. Comprehensive otologic evaluation and state-of-the-art treatment may lead to a significant improvement in symptoms and hearing loss.
The Cleating Stitch: An Adjunctive Technique for Percutaneous and Revision Osseointegration Screws
Authors: Fort Matthew M. , Scarbrough Megan E. , McGrew Benjamin M. 
Published: October 2018

Objective:
The bone anchored hearing aid (BAHA) has become a widely used and successful option in treatment of conductive and mixed hearing loss, and single sided deafness. Despite improvements in technique and cosmesis, complications remain that can result in implant revision or removal. Herein we describe a unique adjunctive technique, the cleating stitch, in placement of osseointegration screws and examine its impact on complication rates.

Study Design:
Retrospective case review.

Setting:
Tertiary academic medical center.

Patients:
A total of 66 implants in 65 patients (35 men, 30 women) with an average age of 54 years (15–81 yr). Average follow up 10.8 months.

Intervention:
All patients underwent BAHA implant placement by a single surgeon between April 2012 and June 2017 using the linear incision or punch techniques with soft tissue reduction and placement of a cleating stitch.

Main Outcome Measure:
Main outcome measures include rates of revision surgery, overgrowth, extrusion, and Holgers reaction ≥2. Secondary outcome measures include associations between main outcome measures and outlying factors (obesity, smoking, diabetes mellitus, coronary artery disease, age).

Results:
The overall rate of revision was 3%, rate of overgrowth 1.5%, rate of extrusion 1.5%, and Holgers reaction ≥2 10.6%. Overgrowth and extrusion both required revision. Older age was associated with decreased risk of Holgers reaction ≥2 (p = 0.03) with a hazard ratio of 0.95 (confidence interval 0.9–1.0). There were no other statistically significant associations between primary outcome measures and outlying factors.

Conclusion:
The cleating stitch is an effective adjunctive technique in placement of osseointegration screws associated with low rates of overgrowth and overall revision surgery.
Recent Trends and the Impact of the Affordable Care Act on Emergency Department Visits and Hospitalizations for Gastrointestinal, Pancreatic, and Liver Diseases
Authors: Barakat Monique T. , Mithal Aditi , Huang Robert J. , Sehgal Alka , Sehgal Amrita , Singh Gurkirpal , Banerjee Subhas 
Published: October 2018

Background:
The Affordable Care Act (ACA) with Medicaid expansion implemented in 2014, extended health insurance to >20-million previously uninsured individuals. However, it is unclear whether enhanced primary care access with Medicaid expansion decreased emergency department (ED) visits and hospitalizations for gastrointestinal (GI)/pancreatic/liver diseases.

Methods:
We evaluated trends in GI/pancreatic/liver diagnosis-specific ED/hospital utilization over a 5-year period leading up to Medicaid expansion and a year following expansion, in California (a state that implemented Medicaid expansion) and compare these with Florida (a state that did not).

Results:
From 2009 to 2013, GI/pancreatic/liver disease ED visits increased by 15.0% in California and 20.2% in Florida and hospitalizations for these conditions decreased by 2.6% in California and increased by 7.9% in Florida. Following Medicaid expansion, a shift from self-pay/uninsured to Medicaid insurance was seen California; in addition, a new decrease in ED visits for nausea/vomiting and GI infections, was evident, without associated change in overall ED/hospital utilization trends. Total hospitalization charges for abdominal pain, nausea/vomiting, constipation, and GI infection diagnoses decreased in California following Medicaid expansion, but increased over the same time-period in Florida.

Conclusions:
We observed a striking payer shift for GI/pancreatic/liver disease ED visits/hospitalizations after Medicaid expansion in California, indicating a shift in the reimbursement burden in self-pay/uninsured patients, from patients and hospitals to the government. ED visits and hospitalization charges decreased for some primary care-treatable GI diagnoses in California, but not for Florida, suggesting a trend toward lower cost of gastroenterology care, perhaps because of decreased hospital utilization for conditions amenable to outpatient management.
Worldwide research productivity in the field of back pain
Authors: Wang Bin , Zhao Peng 
Published: October 2018

Abstract

Background:
This study aimed to show the world research productivity in the field of back pain and to help researchers follow the scientific development and promote the cooperation in this field.

Methods:
Web of Science (WoS) database was searched from 1995 to 2016 without other restrictions. The keywords were as follows: “lumbar NEAR pain,” “back pain,” “dorsalgia,” “backache,” “lumbago,” “back NEAR disorder,” and “discitis.” The following information of retrieved articles was analyzed: countries/territories, journals, publication year, authors, citation reports, and institutions. Publication activity was further adjusted for countries by gross domestic product (GDP) and population size.

Results:
A total of 50,970 articles were retrieved in WoS database from 1995 to 2016. The United States published the biggest number of articles (16,818, 33.00%), followed by England (4,582, 8.99%), Germany (3,871, 7.60%), Canada (3,613, 7.09%), and Australia (3,063, 6.01%). Sweden ranked the first after adjusted for publication, and Netherlands ranked the first after adjusted for GDP. Besides, there was positive correlation between total number of publications and GDP for each country (P < .05). Harvard University was the most productive institution (917, 1.80%), Maher CG was the most productive author (229, 0.45%) and Spine was the most popular journal (3605, 7.07%) in the field of back pain research. Moreover, the article titled “Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale” in Pain had the highest citations (1749).

Conclusion:
There was a significant increase in annual publications concerning back pain research worldwide. The total number of publications was positively associated with GDP in main productive countries. The United States was the most productive country, Harvard University was the most productive institution, Maher CG was the most productive author and Spine was the most popular journal in the field of back pain.