bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional Outcomes of a Patient With Acute Paraplegia After Open Heart Surgery: A Case Report
Authors: Irons Sonya L. , Hoffman Julie E. 
Published: July 2018

Introduction:
Paraplegia is a complication that may occur after open heart surgery. Minimal published research exists regarding functional outcomes for this patient population. The purpose of this case report is to describe the physical therapy management, including functional outcomes, as defined by the FIM instrument, before and after rehabilitation for a patient who developed paraplegia after open heart surgery.

Case Presentation:
A 69-year-old man with a past lumbar fusion presented with acute paraplegia immediately after a coronary artery bypass graft and aortic valve replacement surgery. Two months postoperatively, a neurologist determined the probable etiology to be a lumbar disc herniation. The medical charts were reviewed retrospectively. He spent 92 days in the hospital undergoing physical and occupational therapy in acute care and inpatient rehabilitation. He did not regain function in his lower extremities, and a power wheelchair became his primary mode of mobility. The patient was discharged home with his spouse as the primary caregiver.

Conclusion:
The patient demonstrated functional gains as evidenced by an increase of FIM total score, FIM efficacy, and FIM efficiency after multidisciplinary inpatient rehabilitation. This case report could assist health care professionals in the comprehensive rehabilitation management of this patient population regardless of etiology.
Physical Therapists' Clinical Reasoning and Decision-Making Processes When Mobilizing Patients Who Are Critically Ill: A Qualitative Study
Authors: Amundadottir Olof R. , Jonsdottir Helga , Sigurdsson Gisli H. , Dean Elizabeth 
Published: July 2018

Purpose:
Although mobilization is a widely practiced intervention for patients who are critically ill, the clinical reasoning and decision-making processes used by physical therapists to maximize its effectiveness warrants elucidation. This study's purpose was to investigate factors guiding physical therapists' clinical reasoning and decision-making processes when initiating and progressing mobilization in patients who are critically ill.

Methods:
In a 2-phased qualitative research design, 12 physical therapists working in a tertiary care university hospital were observed before, during, and after a mobilization session with 1 patient, followed by a semistructured interview.

Results:
Six categories (patient; intensive care unit-context; physical therapist; transfer; FITT parameters [frequency, intensity, type, and time]; and expected outcome) and 4 encompassing factors (safety and well-being; continuous assessment and intervention intertwined; individualized and response-driven intervention; and barriers and solutions) emerged as important in guiding participants' clinical reasoning when mobilizing their patients.

Conclusions:
The categories and encompassing factors identified, influenced, and guided participants in their clinical reasoning and decision-making when they initiated mobilization and progressed its parameters. The approach was goal-oriented and tailored to each patient's needs based on moment-to-moment evaluation of responses. The categories and factors that emerged favored a response-driven rather than a protocol-driven approach to mobilizing patients who are critically ill.
Association Between Physical Activity and Cognitive Function Among a National Sample of Adults With Diabetes
Authors: Frith Emily , Loprinzi Paul D. 
Published: July 2018

Purpose:The cardiometabolic consequences associated with diabetes increase the risk of cognitive dysfunction. Physical activity is favorably associated with diabetes incidence and executive function, but surprisingly, there is limited research evaluating the effects of physical activity on cognitive function among adults with diabetes, which was the purpose of this study.Methods:Data from the 1999 to 2002 National Health and Nutrition Examination Survey (NHANES) were used. A national sample of older adults with diabetes was evaluated (N = 503; 60–85 yrs). The digit symbol substitution test (DSST) was used to assess executive function, with physical activity assessed through a valid questionnaire.Results:In an unadjusted weighted multivariable linear regression model, those meeting moderate-to-vigorous physical activity (MVPA) guidelines (vs not) had a DSST score 5.7 units higher (β = 5.7; 95% CI [1.46, 9.95];P= .01). After adjusting for age, sex, race-ethnicity, smoking status, energy intake, weight status, and hypertension, those meeting MVPA guidelines (vs not) had a DSST score 3.8 units higher (β = 3.8; 95% CI [0.25, 7.32];P= .03).Discussion:Physical activity is favorably associated with executive function among older adults with diabetes, but this association was attenuated after controlling for physical function and chronic illness.
Alternatives to excisional therapy: a clinical review of our current options to conservatively manage symptomatic leiomyomas
Authors: Ito Traci , Mattingly Patricia J. , Jan Ambareen G. , Biscette Shan M. , Kim Jin Hee J. 
Published: July 2018

Purpose of review
This article provides a clinical review of the alternatives to traditional excisional surgical therapies for uterine leiomyomas, such as myomectomy or hysterectomy.

Recent findings
In this review, currently available hormonal medications will be briefly discussed. Then, nonhormonal medical therapy will be addressed with respect to mechanism of action, safety, and efficacy. Finally, the risk–benefit profile of nonexcisional procedures for management of leiomyomas will be addressed.

Summary
This provides an update on the information available for more conservative options for symptomatic leiomyoma management
PHACOEMULSIFICATION CATARACT SURGERY WITH PROPHYLACTIC INTRAVITREAL BEVACIZUMAB FOR PATIENTS WITH COEXISTING DIABETIC RETINOPATHY
Authors: Feng Yifan , Zhu Senmiao , Skiadaresi Eirini , McAlinden Colm , Tu Ruixue , Gao Rongrong , Stephens Jeffrey W. , Wang Qinmei , Huang Jinhai 
Published: July 2018

Purpose:
To evaluate the clinical effectiveness of intravitreal bevacizumab (IVB) injection combined with cataract surgery in the treatment of patients with cataract and coexisting diabetic retinopathy (DR).

Methods:
Pertinent comparative studies were identified through systemic searches of PubMed, EMBASE, and the Cochrane Controlled Trials Register up to March 1, 2016. Outcome measures included corrected distance vision acuity, central macular thickness, and progression of DR and maculopathy. A meta-analysis was performed using RevMan (Cochrane Collaboration, Oxford, United Kingdom).

Results:
Six studies describing a total of 283 eyes were identified. The meta-analysis results showed that corrected distance vision acuity measured at 1 month and 3 months after cataract surgery was significantly better in the IVB groups than in the control groups (P < 0.00001 and P = 0.01), whereas the corrected distance vision acuity at 6 months did not vary significantly between the 2 groups (P = 0.24). Similarly, the central macular thickness at 1, 3, and 6 months after surgery was significantly thinner in the IVB groups than in the control groups (P = 0.01, P = 0.0004, and P = 0.01, respectively). At 6 months, the progression of postoperative DR and maculopathy occurred more frequently in the control group than in the IVB group (P = 0.0001 and P < 0.0001, respectively).

Conclusion:
Our meta-analysis indicates that cataract surgery combined with IVB seems to be an effective treatment in patients with coexisting DR in the short term (up to 6 months). More randomized, prospective, and large-sample–sized trials are needed to evaluate the long-term effects of IVB at the time of cataract surgery in patients with DR.
Early Results of Penetrating Keratoplasty in Patients With Unilateral Chemical Injury After Simple Limbal Epithelial Transplantation
Authors: Gupta Nidhi , Farooqui Javed Hussain , Patel Nikunj , Mathur Umang 
Published: July 2018

Purpose:
To evaluate clinical outcomes of sequential PKP in eyes with unilateral chemical injury, which have previously undergone autologous simple limbal epithelial transplantation (SLET) at a tertiary eye center in North India.

Methods:
This is a single-center, retrospective, noncomparative interventional case series reviewing patients with unilateral limbal stem cell deficiency treated by SLET and sequential PKP between 2012 and 2017. The primary outcome was defined as allograft survival, defined as a completely epithelialized, clear, avascular graft. The secondary outcome was improvement in best-corrected visual acuity by 2 lines or any complications.

Results:
Seven eyes of 7 patients, all aged below 40 years, who underwent SLET followed by PKP for unilateral ocular surface injury were included. Most of the patients were male (71.4%), and alkali injury (42.8%) was the most common cause of limbal stem cell deficiency. The mean duration between SLET and PK was 9.5 ± 11.9 months (2–36 mo), and the mean follow-up duration after PKP was 15.1 ± 5.4 months (6–21 mo). A successful outcome after SLET was achieved in all 7 patients and clear grafts in 6 patients, with a graft survival rate of 85% at 6 months. Visual success was noted in 4 patients. Poor vision in 3 patients was due to glaucoma, amblyopia, and graft failure.

Conclusions:
PKP was found to have a good outcome when the surface has been stabilized by SLET as an initial procedure in unilateral ocular chemical injury. The visual outcome was restricted mainly by other causes such as glaucoma and amblyopia.
Assessment of Infraorbital Hypesthesia Following Orbital Floor and Zygomaticomaxillary Complex Fractures Using a Novel Sensory Grading System
Authors: Homer Natalie , Glass Lora R. , Lee N. Grace , Lefebvre Daniel R. , Sutula Francis C. , Freitag Suzanne K. , Yoon Michael K. 
Published: July 2018

Purpose:
Introduction of a novel sensory grading system to assess the incidence and long-term recovery of infraorbital hypesthesia following orbital floor and inferior orbital rim fractures.

Methods:
Patients who presented for evaluation of orbital floor and/or zygomaticomaxillary complex (ZMC) fractures between January 2015 and April 2016 were analyzed. Two-point subjective infraorbital sensory grading in 5 discrete anatomic areas was performed. Fractures were repaired based on traditional criteria; hypesthesia was not an indication for surgery. The sensory grading system was repeated a mean 21.7 months (range 18–28) after initial fracture.

Results:
Sixty-two patients (mean 41.8 years) participated in the initial symptom grading, and 42 patients (67.7%) completed the 2-year follow-up. Overall, 20 of 42 patients (47.6%) had some infraorbital hypesthesia. There were fewer with isolated orbital floor fractures versus ZMC fractures (31.8% vs. 68.4%; p = 0.019). Two years postinjury, 9.1% and 40.0% with isolated floor and ZMC fractures, respectively, had persistent sensory disturbance (p = 0.0188). Of patients with sensory disturbance on presentation, 71.4% with isolated floor fractures and 38.5% with ZMC fractures experienced complete sensory recovery (p = 0.1596). Patients with isolated floor fractures had improved recovery after surgery (100% vs. 33.3% recovery; p = 0.0410). Patients with ZMC fractures showed no difference in sensory prognosis between those repaired and observed.

Conclusions:
In this pilot study, isolated orbital floor fractures carried a good infraorbital sensory prognosis, further improved by surgical repair. Zygomaticomaxillary complex fractures portended a worse long-term sensory outcome, unaffected by management strategy. This study validates the novel sensory grading system in post-fracture analysis.
Interrelatedness of Distress Among Chinese-Speaking Patients and Family Caregivers
Authors: Lee Joyce W.K. , Gotay Carolyn , Sawatzky Richard , Kazanjian Arminée 
Published: July 2018

Background
Cancer is a family disease, affecting the individual patient and the family. For Chinese patients and their families in Canada, adjusting to cancer may be particularly distressing when culture and language are not congruent with the mainstream model of care delivery.

Objective
In view of the limited research on the cancer experience of Chinese families, this study aims to examine the interrelatedness of patients and family caregivers' distress among a Chinese-speaking cancer population in Canada.

Methods
Semi-structured interviews were conducted with a purposive sample of 10 Chinese-speaking cancer patients and 6 family caregivers. Qualitative analysis of the interview data was conducted to construct cross-cutting themes regarding the experiences of distress after a cancer diagnosis.

Results
Four overarching themes emerged from the analysis: (1) misconception about cancer, (2) tensions in disclosure, (3) patient and family caregiver distress, and (4) concealing emotion in patient and family caregiver. Notably, the interrelatedness of patients and family caregivers' distress was highlighted, as patients and family caregivers both sought to regulate their own emotions to protect one another's mental well-being.

Conclusion
The study provides insights into the distress of living with cancer and the impact on family relationships. Understanding the patients and family members' cultural and social contexts also provides the foundation for patient- and family-centered care.

Implications for Practice
Healthcare professionals can provide culturally appropriate care by recognizing the needs, values, and beliefs of cancer patients and their families. Furthermore, the patient–family-caregiver dyad needs to be considered as the unit of care.
Nurses' Perception of the Impact of Electronic Documentation on the Nurse-Patient Relationship
Authors: Misto Kara , Padula Cynthia , Bryand Elizabeth , Nadeau Kate 
Published: July 2018

Background:
While there are many benefits of electronic medical record documentation, the presence of a computer may adversely affect provider-patient interaction.

Purpose:
The purpose of this project was to examine staff nurses' perception of the impact of electronic documentation in the presence of the patient on the nurse-patient relationship.

Methods:
A survey was administered to 276 staff nurses, and open-ended interviews were conducted with 11 novice and 20 expert nurses.

Results:
Nurses identified benefits and challenges to electronic medical record documentation as well as strategies used to maintain therapeutic relationships and communication. Numerous nurses commented that documenting with their back to the patient had a negative impact on the nurse-patient relationship and communication.

Conclusions:
Both novice and expert nurses identified strategies that they used to ensure they were “maintaining the connection” to patients during electronic medical record documentation.
A Cost Reimbursement Model for Hepatitis C Treatment Care Coordination
Authors: Behrends Czarina N. , Eggman Ashley A. , Gutkind Sarah , Bresnahan Marie P. , Fluegge Kyle , Laraque Fabienne , Litwin Alain H. , Meissner Paul , Shukla Shuchin J. , Perumalswami Ponni V. , Weiss Jeffrey , Wyatt Brooke E. , Schackman Bruce R. 
Published: July 2018

Objective:
To estimate the cost of delivering a hepatitis C virus care coordination program at 2 New York City health care provider organizations and describe a potential payment model for these currently nonreimbursed services.

Design:
An economic evaluation of a hepatitis C care coordination program was conducted using micro-costing methods compared with macro-costing methods. A potential payment model was calculated for 3 phases: enrollment to treatment initiation, treatment initiation to treatment completion, and a bonus payment for laboratory evidence of successful treatment outcome (sustained viral response).

Setting:
Two New York City health care provider organizations.

Participants:
Care coordinators and peer educators delivering care coordination services were interviewed about time spent on service provision. De-identified individual-level data on study participant utilization of services were also used.

Intervention:
Project INSPIRE is an innovative hepatitis C care coordination program developed by the New York City Department of Health and Mental Hygiene.

Main Outcome Measures:
Average cost per participant per episode of care for 2 provider organizations and a proposed payment model.

Results:
The average cost per participant at 1 provider organization was $787 ($522 nonoverhead cost, $264 overhead) per episode of care (5.6 months) and $656 ($429 nonoverhead cost, $227 overhead, 5.7 months) at the other one. The first organization had a lower macro-costing estimate ($561 vs $787) whereas the other one had a higher macro-costing estimate ($775 vs $656). In the 3-phased payment model, phase 1 reimbursement would vary between the provider organizations from approximately $280 to $400, but reimbursement for both organizations would be approximately $220 for phase 2 and approximately $185 for phase 3.

Conclusions:
The cost of this 5.6-month care coordination intervention was less than $800 including overhead or less than $95 per month. A 3-phase payment model is proposed and requires further evaluation for implementation feasibility. Project INSPIRE's HCV care coordination program provides good value for a cost of less than $95 per participant per month. The payment model provides an incentive for successful cure of hepatitis C with a bonus payment; using the bonus payment to support HCV tele-mentoring expands HCV treatment capacity and empowers more primary care providers to treat their own patients with HCV.
Choosing Between Daily and Event-Driven Pre-exposure Prophylaxis: Results of a Belgian PrEP Demonstration Project
Authors: Reyniers Thijs , Nöstlinger Christiana , Laga Marie , De Baetselier Irith , Crucitti Tania , Wouters Kristien , Smekens Bart , Buyze Jozefien , Vuylsteke Bea 
Published: July 2018

Background:
Daily pre-exposure prophylaxis and event-driven pre-exposure prophylaxis (PrEP) are efficacious in reducing HIV transmission among men who have sex with men (MSM). We analyzed baseline data from a PrEP demonstration project “Be-PrEP-ared” in Antwerp, Belgium, to understand preferences for daily PrEP or event-driven PrEP among MSM at high risk of HIV and factors influencing their initial choice.

Methods:
Cross-sectional data from an open-label prospective cohort study, using mixed methods. Participants who preregistered online were screened for eligibility and tested for sexually transmitted infections (STIs). Eligible participants chose between daily PrEP and event-driven PrEP and reported on behavioral data through an electronic questionnaire. In-depth interviews were conducted with a selected subsample. Bivariate associations were examined between preferred PrEP regimens and sociodemographic factors, sexual behavior, and STIs at screening.

Results:
In total, 200 participants were enrolled between October 2015 and December 2016. Self-reported levels of sexual risk-taking before enrollment were high. STI screening revealed that 39.5% had at least 1 bacterial STI. At baseline, 76.5% of participants preferred daily PrEP and 23.5% event-driven PrEP. Feeling able to anticipate HIV risk was the most frequent reason for preferring event-driven PrEP. Regimen choice was associated with sexual risk-taking behavior in the past 3 months. Almost all participants (95.7%) considered it likely that they would change their dosing regimen the following year.

Conclusion:
Event-driven PrEP was preferred by 23.5% of the participants, which better suits their preventive needs. Event-driven PrEP should be included in PrEP provision as a valuable alternative to daily PrEP for MSM at high risk of HIV.
Structural rearrangement of TFIIS- and TFIIE/TFIIF-like subunits in RNA polymerase I transcription complexes
Authors: Tafur Lucas , Sadian Yashar , Wetzel Rene , Weis Felix , Müller Christoph W. 
Published: July 2018

AbstractRNA polymerase (Pol) I is a 14-subunit enzyme that solely transcribes pre-ribosomal RNA. Cryo-EM structures of Pol I initiation and elongation complexes have given first insights into the molecular mechanisms of Pol I transcription. Here, we present cryo-electron microscopy structures of yeast Pol I elongation complexes (ECs) bound to the nucleotide analog GMPCPP at 3.2 to 3.4 Å resolution that provide additional insight into the functional interplay between the TFIIE/TFIIF-like A49-A34.5 heterodimer and the TFIIS-like subunit A12.2 present in Pol I. Strikingly, most of the nucleotide-bound ECs lack the A49-A34.5 heterodimer and adopt a Pol II-like conformation, in which the A12.2 C-terminal domain is bound in a previously unobserved position at the A135 surface. Our work suggests a regulatory mechanism of Pol I transcription where the association of the A49-A34.5 heterodimer to Pol I is regulated by subunit A12.2, thereby explaining in vitro biochemical and kinetic data.
Genetic, inflammatory, and epithelial cell differentiation factors control expression of human calpain-14
Authors: Miller Daniel E. , Forney Carmy , Rochman Mark , Cranert Stacey , Habel Jeffery , Rymer Jeffrey , Lynch Arthur , Schroeder Connor , Lee Josh , Sauder Amber , Smith Quinton , Chawla Mehak , Trimarchi Michael P. , Lu Xiaoming , Fjellman Ellen , Brusilovsky Michael , Barski Artem , Waggoner Stephen , Weirauch Matthew T. , Rothenberg Marc E. , Kottyan Leah C. 
Published: July 2018

ABSTRACTEosinophilic esophagitis (EoE) is a chronic, food-driven allergic disease resulting in eosinophilic esophageal inflammation. We recently found that EoE susceptibility is associated with genetic variants in the promoter ofCAPN14, a gene with reported esophagus-specific expression.CAPN14is dynamically up-regulated as a function of EoE disease activity and after exposure of epithelial cells to interleukin-13 (IL-13). Herein, we aimed to explore molecular modulation ofCAPN14expression. We identified three putative binding sites for the IL-13-activated transcription factor STAT6 in the promoter and first intron ofCAPN14. Luciferase reporter assays revealed that the two most distal STAT6 elements were required for the ~10-fold increase in promoter activity subsequent to stimulation with IL-13 or IL-4, and also for the genotype-dependent reduction in IL-13-induced promoter activity. One of the STAT6 elements in the promoter was necessary for IL-13-mediated induction ofCAPN14promoter activity while the other STAT6 promoter element was necessary for full induction. Chromatin immunoprecipitation in IL-13 stimulated esophageal epithelial cells was used to further support STAT6 binding to the promoter ofCAPN14at these STAT6 binding sites. The highestCAPN14and calpain-14 expression occurred with IL-13 or IL-4 stimulation of esophageal epithelial cells under culture conditions that allow the cells to differentiate into a stratified epithelium. This work corroborates a candidate molecular mechanism for EoE disease etiology in which the risk variant at 2p23 dampens mediatedCAPN14expression in differentiated esophageal epithelial cells following IL-13/STAT6 induction ofCAPN14promoter activity.