bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep debt: the impact of weekday sleep deprivation on cardiovascular health in older women
Authors: Cabeza de Baca Tomás , Chayama Koharu Loulou , Redline Susan , Slopen Natalie , Matsushita Fumika , Prather Aric A , Williams David R , Buring Julie E , Zaslavsky Alan M , Albert Michelle A 
Published: July 2019

Abstract

Study Objectives
Short sleep duration is associated with increased cardiovascular disease (CVD) risk. However, it is uncertain whether sleep debt, a measure of sleep deficiency during the week compared to the weekend, confers increased cardiovascular risk. Because sleep disturbances increase with age particularly in women, we examined the relationship between sleep debt and ideal cardiovascular health (ICH) in older women.

Methods
Sleep debt is defined as the difference between self-reported total weekday and weekend sleep hours of at least 2 hours among women without apparent CVD and cancer participating in the Women’s Health Stress Study follow-up cohort of female health professionals (N = 22 082). The ICH consisted of seven health factors and behaviors as defined by the American Heart Association Strategic 2020 goals including body mass index, smoking, physical activity, diet, blood pressure, total cholesterol, and glucose.

Results
Mean age was 72.1 ± 6.0 years. Compared to women with no sleep debt, women with sleep debt were more likely to be obese and have hypertension (pall < .05). Linear regression models adjusted for age and race/ethnicity revealed that sleep debt was significantly associated with poorer ICH (B = –0.13 [95% CI = –0.18 to –0.08]). The relationship was attenuated but remained significant after adjustment for education, income, depression/anxiety, cumulative stress, and snoring.

Conclusion
Sleep debt was associated with poorer ICH, despite taking into account socioeconomic status and psychosocial factors. These results suggest that weekly sleep duration variation, possibly leading to circadian misalignment, may be associated with cardiovascular risk in older women.
Trust the State: the relevance of principles of public law in trust law and practice
Authors: Graham Toby , Beasley Thomas 
Published: July 2019

Abstract
Lord Walker, in Futter and Pitt v HMRC1, noted that there are “superficial similarities between what the law requires of trustees in their decision-making and what it requires of decision-makers in the field of public law.” We examine these similarities under the following headings: (1) natural justice; (2) the application of Wednesbury unreasonableness to trust law (an area in which there is far more common ground between public and private law than natural justice); and (3) the decision in Braganza v BP Shipping Limited2 and how this has been subsequently applied. We suggest that the similarities go beyond merely superficial and that public law principles are having an inexorable impact on trust law and practice.
PANDAS
Authors: Melerine Chelsea , Ledet Linda M. 
Published: July 2019

Abstract:
Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) describes a disorder that develops in children who abruptly develop neurologic abnormalities following a streptococcal infection. The authors discuss what is known about this poorly understood disorder and how nurses can educate and support patients and their families.
Association Between Frailty Status and Odontoid Fractures After Traumatic Falls: Investigation of Varying Injury Mechanisms Among 70 Elderly Odontoid Fracture Patients
Authors: Alas Haddy , Segreto Frank A. , Chan Hoi Ying , Brown Avery E. , Pierce Katherine E. , Bortz Cole A. , Horn Samantha R. , Varlotta Christopher G. , Baker Joseph F. , Passias Peter G. 
Published: July 2019

Objectives:
To determine significant associations between patient frailty status and odontoid fractures across common traumatic mechanisms of injuries (MOIs) in the elderly.

Design:
Retrospective review.

Setting:
Single, academic-affiliated hospital with full surgical services.

Patients/Participants:
Patients 65 years or older with traumatic odontoid fractures were included.

Intervention:
Nonoperative management (soft/hard collar, halo, traction tongs, and Minerva) and/or operative fixation.

Main Outcome Measurements:
Modified frailty index (mFI), MOI, concurrent injuries, inpatient length of stay (LOS), reoperation, and mortality rates.

Results:
Seventy patients were included (80.6 ± 8.5 years, 60% F, 88% European, 10% Maori/Pacific, 1.4% Asian, Charlson Comorbidity Index 5.3 ± 2.2, mFI 0.21 ± 0.15). The most common MOIs were falls (74.3%), high-speed motor vehicle accidents (MVAs) (17.1%), low-speed MVAs (5.7%), and pedestrian versus car (2.9%). Patients with traumatic falls exhibited significantly higher mFI scores (0.25) compared with low-speed MVAs (0.16), high-speed MVAs (0.08), and pedestrian versus car (0.01) (P = 0.003). Twenty-seven patients with odontoid fractures were frail, 33 were prefrail, and 10 were robust. Ninety-two percent of frail patients had a traumatic fall as their MOI, as opposed to 73% of prefrail and 30% of robust patients (P < 0.001). Prefrail and frail patients were 4.3 times more likely than robust patients to present with odontoid fractures through traumatic fall [odds ratio (OR): 4.33 (1.47–12.75), P = 0.008], and frailty increased likelihood of reoperation [OR: 4.2 (1.2–14.75), P = 0.025] and extended LOS [OR: 5.71 (1.05–10.37), P = 0.017]. Frail patients had the highest 30-day (P = 0.017) and 1-year mortality (P < 0.001) compared with other groups.

Conclusion:
Patients with traumatic odontoid fractures from falls were significantly more frail in comparison with any other MOIs, with worse short- and long-term outcomes.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Heterogeneity of Pediatric Knee Infections: A Retrospective Analysis
Authors: Gibian Joseph T. , Daryoush Joshua R. , Wollenman Colby C. , Johnson Samuel R. , Henry Abigail , Koehler Ryan J. , Moore-Lotridge Stephanie N. , Schoenecker Jonathan G. 
Published: July 2019

Background:
Musculoskeletal infection is a major cause of morbidity in the pediatric population. Despite the canonical teaching that an irritable joint and signs of infection likely represent an infected joint space, recent evidence in the pediatric hip has demonstrated that alternative diagnoses are equally or more likely and that combinations of pathologies are common. The knee is the second most commonly infected joint in children, yet there remains a paucity of available data regarding the epidemiology and workup of the infected pediatric knee. The authors hypothesize that there is heterogeneity of pathologies, including combinations of pathologies, that presents as a potentially infected knee in a child. The authors aim to show the utility of magnetic resonance imaging and epidemiologic and laboratory markers in the workup of these patients.

Methods:
A retrospective review of all consults made to the pediatric orthopaedic surgery team at a single tertiary care center from September 2009 through December 2015 regarding a concern for potential knee infection was performed. Excluded from the study were patients with penetrating trauma, postoperative infection, open fracture, no C-reactive protein (CRP) within 24 hours of admission, sickle cell disease, an immunocompromised state, or chronic osteomyelitis.

Results:
A total of 120 patients were analyzed in this study. There was marked variability in pathologies. Patients with isolated osteomyelitis or osteomyelitis+septic arthritis were older, had an increased admission CRP, were more likely to be infected with Staphylococcus aureus, required an increased duration of antibiotics, and had an increased incidence of musculoskeletal complications than patients with isolated septic arthritis.

Conclusions:
When considering a child with an irritable knee, a heterogeneity of potential underlying pathologies and combinations of pathologies are possible. Importantly, the age of the patient and CRP can guide a clinician when considering further workup. Older patients with a higher admission CRP value warrant an immediate magnetic resonance imaging, as they are likely to have osteomyelitis, which was associated with worse outcomes when compared with patients with isolated septic arthritis.

Level of Evidence:
Level III—retrospective research study.
Is Anterior Release Obsolete or Does It Play a Role in Contemporary Adolescent Idiopathic Scoliosis Surgery? A Matched Pair Analysis
Authors: Lonner Baron S. , Haber Lawrence , Toombs Courtney , Parent Stefan , Shah Suken A. , Lenke Lawrence , Sucato Daniel , Clements David , Newton Peter O. 
Published: July 2019

Study Design:
A retrospective analysis of a prospectively collected database was performed.

Objective:
The purpose of this study is to compare 3-dimensional correction associated with the anterior release (AR) and contemporary posterior instrumentation versus posterior-only surgery.

Summary of Background Data:
The role of AR as a tool in the treatment of adolescent idiopathic scoliosis (AIS) has seen a decline with the popularization of thoracic pedicle screw instrumentation.

Methods:
Five surgeons were queried for all surgical thoracic AIS cases from 2003 to 2010 treated with thoracoscopic AR/fusion and contemporary posterior instrumentation and fusion and thoracic pedicle screw instrumentation (>80% screws) with 2-year follow-up. These cases were then matched with posterior spinal fusion only cases from a multicenter prospective database. The 2 groups were matched on the basis of major curve magnitude within 5 degrees, T5-T12 kyphosis within 9 degrees, and angle of trunk rotation within 9 degrees. Radiographic and clinical parameters were compared for the 2 groups. Continuous variables were analyzed with analysis of variance and categorical dependent variables with the χ2 test.

Results:
A total of 47 cases of AR were matched to 47 (1:1 match) posterior spinal fusion cases. Preoperative parameters were similar between groups (P>0.05). Postoperatively, AR cases had a lower major curve (20 vs. 25 degrees, P=0.034; 72% vs. 66% correction, P=0.037). T5-T12 kyphosis was greater in the AR cases (26 vs. 20 degrees; P=0.005). The angle of trunk rotation was similar for the groups. Anchor density was lower in the AR group (1.6 vs. 1.9; P<0.0001). There were 3 complications associated with the AR: 1 pneumothorax and 2 conversions to minithoracotomies for failure to maintain single lung ventilation.

Conclusions:
AR improves coronal and sagittal plane correction in contemporary AIS surgery with a satisfactory complication profile with less pedicle screw density required for clinically similar corrections. A further prospective study on the benefits of AR may help define specific indications.
Reducing Surgical Site Infections in Spine Tumor Surgery
Authors: Mesfin Addisu , Baldwin Avionna , Bernstein David N. , Emanski Eric , Molinari Robert , Menga Emmanuel , Rubery Paul T. 
Published: July 2019

Study Design.
Case control series.

Objective.
The aim of this study was to evaluate and compare the effectiveness of methods to decrease surgical site infections (SSIs) following spine tumor surgery.

Summary of Background Data.
With the aging population of the United States, the prevalence of cancer and associated metastatic spine disease is increasing. The most common complication of spine tumor surgery is SSI.

Methods.
This a single-institution case-control series of patients undergoing spine tumor surgery from June 2003 to October 2018. Patients were grouped into the following groups: Betadine irrigation and intrawound vancomycin powder (BIVP), intrawound vancomycin powder only (IVP), and patients receiving neither (NONE). The primary outcome was SSIs/wound complications.

Results.
One hundred fifty-one spine tumor patients undergoing 174 procedures meeting our inclusion criteria were identified. The BIVP group had 60 patients (73 procedures); the IVP group had 46 patients (47 procedures); and the NONE group had 45 patients (54 procedures). The overall infection rate was 8.6% of all procedures (15/174) and 9.9% (15/151) of all patients. Bivariate analysis comparing patients with and without infections noted the patients with SSIs had significantly higher rates of preoperative radiation treatment (53.3% in infection group vs. 25.5% in noninfection group), P = 0.02. Patients undergoing procedures in the BIVP group had a significantly lower rate of infections (2.7%) than the patients in the IVP (12.8%) and NONE (13%) groups, P = 0.04. Stepwise regression analysis was used to evaluate further factors associated with SSIs. Elevated BMI was significantly associated with SSIs in the model [P = 0.02, odds ratio (OR) 1.14]. BIVP was also protective against infections as compared to the IVP and NONE groups, P = 0.02, OR 0.02.

Conclusion.
BIVP led to a significant decrease in SSI rates following spine tumor surgery. Administration of BIVP is not time consuming and decreased SSI rates.

Level of Evidence: 3
Indirect Decompression on MRI Chronologically Progresses After Immediate Postlateral Lumbar Interbody Fusion
Authors: Nakashima Hiroaki , Kanemura Tokumi , Satake Kotaro , Ishikawa Yoshimoto , Ouchida Jun , Segi Naoki , Yamaguchi Hidetoshi , Imagama Shiro 
Published: July 2019

Mini
On magnetic resonance imaging, indirect decompression using lateral lumbar interbody fusion and posterior fixation was confirmed immediately after surgery and also continuously progressed after surgery, particularly during the first 6 months. Thecal sac enlargement was also confirmed, and is suspected to be caused by the atrophy of the ligamentum flavum and the disc.

Study Design.
A prospective cohort study.

Objective.
The aim of this study was to investigate radiographical changes related to indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation.

Summary of Background Data.
Indirect lumbar decompression via LLIF is used to treat degenerative lumbar diseases requiring neural decompression. Although evidence suggests that thecal sac enlargement follows shortly after surgery, few studies have described the postoperative changes on MRIs.

Methods.
This study involved 102 patients who underwent indirect decompression at 136 levels, with LLIF and posterior fixation. Magnetic resonance imaging (MRIs) were collected preoperatively and several times postoperatively (over a 2-year period starting immediately after surgery). We then quantified the cross-sectional areas of the thecal sac and ligamentum flavum, as well as the anteroposterior diameter of disc bulging, and qualitatively assessed lumbar spinal stenosis according to a modified version of Schizas’ classification [Grades A (mild) to C (severe)]. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for the assessment of the clinical symptoms.

Results.
All changes were observable immediately after surgery, progressed over time, and were significantly different statistically at 2 years after surgery. The thecal sac was significantly larger (189% of preoperative; P < 0.0001), while the ligamentum flavum and disc bulge were significantly smaller [58.9% and 67.3% of preoperative (P < 0.001), respectively]. The number of patients with grade C (severe) lumbar stenosis also dropped significantly (preoperative, 17.6%; 2 years postoperative, 0%). There were no significant differences in JOABPEQ results at 6 months, 1 year, and 2 years postsurgery.

Conclusion.
Indirect decompression produces immediate positive results that continue to improve over time. The cross-sectional area of the thecal sac doubled by 2 years after surgery, and the ligamentum flavum cross-sectional area and disc bulging both shrank significantly. At the same time, however, postoperative radiographical improvements do not appear to correlate with clinical symptoms.

Level of Evidence: 3
Surgical Management and Adjuvant Therapy for Patients With Neurological Deficits From Vertebral Hemangiomas
Authors: Piper Keaton , Zou Liling , Li Dongmei , Underberg Daniel , Towner James , Chowdhry Amit K. , Li Yan Michael 
Published: July 2019

Study Design.
Meta-analysis.

Objective.
To understand the benefits and limitations of surgical management and adjuvant therapies for patients presenting with neurological deficits from vertebral hemangiomas (VH).

Summary of Background Data.
VH is the most common benign spine tumor but rarely causes symptoms. Patients with back pain alone are treated with conservative management (kyphoplasty and radiation therapy), while those with neurological deficits require complex multi-modal treatment plans.

Methods.
A PubMed literature search for “symptomatic vertebral hemangioma with spinal cord compression” identified 47 articles. From these articles and their references, 19 observational studies on patients who underwent surgery for VH met inclusion criteria. Meta-analyses were performed comparing outcomes of the surgical and adjuvant therapies using Stata13 software. For those with insufficient data for meta-analyses, descriptive analyses of variables were completed.

Results.
One hundred ninety seven surgical cases of VH with neurologic deficits were identified. Surgery provided a complete remission of symptoms in 84% of patients, however 18% of patients had recurrence of hemangioma. Adjuvant interventions included radiation, embolization, and kyphoplasty. Radiation therapy (XRT) was associated with a lower recurrence rate and an increase in minor transient adverse effects. Preoperative embolization performed in 98 patients was associated with improved symptoms, reduced complications, lower recurrence rate, less blood loss, and higher incidence of pathologic vertebral fractures. Meta-analyses did not yield statistically significant results, likely due to the heterogeneity amongst the studies and small sample sizes, but the results compiled together provide insight on potential benefits of preoperative embolization for symptomatic relief and reduced risk of recurrence with XRT that deserves further study.

Conclusion.
For patients with neurologic deficits from spinal cord or nerve root compression, surgery provides improvement in symptoms. Recurrence of VH and symptoms refractory to surgery can be further reduced by adjuvant therapies such as embolization, kyphoplasty, and radiation with some unique risks to each therapy.

Level of Evidence: 2
Medication use and climacteric syndrome: a cross-sectional population-based study
Authors: de Moraes Anna Valéria Gueldini , Costa-Paiva Lúcia , Lui-Filho Jeffrey Frederico , Pedro Adriana Orcesi 
Published: July 2019

Abstract

Objective:
The aim of this study was to evaluate medication use during the climacteric period and assess its association with sociodemographic factors, morbidities, and climacteric symptoms.

Methods:
Secondary analysis of data from a previous exploratory cross-sectional population-based study, conducted with 749 women (45-60 y), with the help of home interviews. Associations between medication use and climacteric symptoms were analyzed, and their correlations with other variables were made. Univariate analysis was made using the χ2 test, followed by Bonferroni correction (multiple comparison method). Values were adjusted for age using the polytomic logistic multivariate regression analysis. Using Poisson regression analysis, simple and multiple, we identified the main factors for medication use, with forward stepwise variable selection criteria (95% CI).

Results:
The mean age was 52.5 years and menopause occurred at 46.5 years (mean). The overall prevalence of medication use was 68.8%. The use of exclusive medications for relieving climacteric symptoms was associated with the absence of diseases (prevalence ratio [PR] = 8.2; 95% CI = 3.5-18.9; P<0.001) and menopause onset between 40 and 44 years (PR = 4.9; 95% CI = 2.0-11.9; P<0.001). Polypharmacy was associated with the highest number of diseases (PR = 10.6; 95% CI = 4.6-24.2; P<0.001) and somatic Menopause Rating Scale (MRS) score >3 (PR = 1.4; 95% CI = 1.01-1.96; P = 0.044).

Conclusions:
The prevalence of medication use among middle-aged women was high and was associated with the age of menopause onset, chronic diseases, and obesity/overweight status.
Efficacy and Safety of OTX-101, a Novel Nanomicellar Formulation of Cyclosporine A, for the Treatment of Keratoconjunctivitis Sicca: Pooled Analysis of a Phase 2b/3 and Phase 3 Study
Authors: Sheppard John , Kannarr Shane , Luchs Jodi , Malhotra Ranjan , Justice Angela , Ogundele Abayomi , Darby Charles , Bacharach Jason 
Published: July 2019

Background:
OTX-101 (CEQUA™) is approved in the United States for treatment of keratoconjunctivitis sicca (KCS). This pooled analysis of 2 studies (phase 2b/3 and phase 3) evaluates the efficacy and safety of OTX-101 0.09% in the intent-to-treat (ITT) population and the subgroup of patients with a baseline Schirmer score less than 10 mm.

Methods:
In these randomized, multicenter, double-masked, vehicle-controlled studies, patients received 1 drop of either OTX-101 or vehicle in both eyes twice daily. A Schirmer's test was performed at baseline and day 84/early discontinuation. Symptom Assessment iN Dry Eye (SANDE) scores and adverse events were monitored at each visit.

Results:
The pooled analysis included 523 and 525 patients randomized to OTX-101 0.09% and vehicle, respectively. In the ITT population, 16.6% of eyes receiving OTX-101 and 9.0% of eyes receiving vehicle showed a day 84 increase in Schirmer score ≥10 mm from baseline (P<0.0001). In the subgroup with Schirmer score less than 10 mm at baseline, 18.7% and 10.2% of eyes receiving OTX-101 and vehicle, respectively, exhibited this outcome (P=0.0001). The mean (SD) percent change from baseline in global SANDE scores on day 84 in the ITT population was −29.0% (39.0%) and −30.4% (39.5%) for OTX-101 and vehicle groups, respectively. In the subgroup, the mean (SD) percent change was −27.3% (39.7%) and −31.4% (38.3%) for OTX-101 and vehicle groups, respectively. Adverse events were mostly mild to moderate.

Conclusions:
OTX-101 improved tear production compared with vehicle. Both OTX-101 and vehicle showed improved SANDE scores over baseline. OTX-101 was well tolerated in patients with KCS.
Long-term Clinical Outcomes of Ahmed and Baerveldt Drainage Device Surgery for Pediatric Glaucoma Following Cataract Surgery
Authors: Esfandiari Hamed , Kurup Sudhi P. , Torkian Pooya , Mets Marilyn B. , Rahmani Bahram , Tanna Angelo P. 
Published: July 2019

Precis:
In this retrospective case series, both Baerveldt and Ahmed glaucoma drainage devices resulted in good long-term outcomes in eyes with pediatric glaucoma following cataract surgery (GFCS).

Background:
The aim of this study was to describe the long-term safety and efficacy of primary glaucoma drainage device surgery in patients with pediatric GFCS.

Methods:
We retrospectively identified 28 eyes of 28 patients with GFCS that underwent tube shunt surgery with the Ahmed Glaucoma Valve or Baerveldt Glaucoma Implant. The primary outcome measure was a surgical failure, defined as intraocular pressure (IOP) >21 mm Hg or not reduced by 20% below baseline on 2 consecutive follow-up visits after 3 months, IOP <5 mm Hg on 2 consecutive follow-up visits after 3 months, and reoperation for glaucoma.

Results:
The mean duration between cataract removal and the diagnosis of glaucoma was 3.6±1.5 years. Kaplan-Meier survival curves indicated a mean time to failure of 41.9±2.1 months after drainage device surgery. The cumulative probability of failure at 1, 2, 3, and 4 years was 3.6%, 19%, 28%, and 28%. IOP was significantly decreased from 29.3±4.1 mm Hg preoperatively to 17.6±1.6 mm Hg at the final follow-up visit (P<0.001). The number of glaucoma medications at baseline was 3.1±0.6, which decreased to 2.1±0.7 at the final visit (P=0.001).

Conclusions:
Glaucoma drainage device surgery results in good long-term outcomes in patients with GFCS.