bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Instruction of Balance and Its Measurement in Professional Physical Therapy Education Programs
Authors: Oates Alison R. , Santoro Regan , Arnold Catherine , Sibley Kathryn M. 
Published: July 2018

Introduction.
Physical therapists (PTs) have an important role in identifying and treating individuals with balance impairments to help modify fall risk; however, gaps in comprehensive assessment of balance among practicing PTs have been consistently identified. As academic preparation influences clinical practice, identifying the balance measurement tools included in entry-level training for PTs is important. In particular, exploring their underlying content in relationship to recognized components of balance described in the Systems Framework for Postural Control can highlight strengths and may identify opportunities to advance training and future practice. The objective of this study was to examine how balance and its measurement are included in entry-level physical therapy education programs.

Methods.
Faculty from 110 physical therapy programs in Canada and the United States were surveyed on the inclusion of balance components and validated balance measures using an online survey.

Results.
Descriptive analysis of 95 completed responses illustrated that instructors reported including detailed instruction and practical experience for most balance components. Almost all (26/27) measures included in the survey were included in course content with practical experience by at least one participant. Years of instructing had minimal effect on how the components and/or measures were included in course content. The measures reported to be included with practical experience most often do not assess all components of balance.

Discussion and Conclusions.
Overall, instructors in participating physical therapy education programs reported providing detailed and practical instruction of commonly used balance measures and multiple components of balance. There is opportunity to enhance instruction by incorporating currently available measures that assess most and/or all balance components to ensure newly educated PTs are equipped to comprehensively assess and treat balance to improve fall prevention efforts.
Use of the Dual-Processing Theory to Develop Expert Clinical Reasoning in Physical Therapy Students
Authors: Prokop Tricia R. 
Published: July 2018

Background and Purpose.
Cognitive error as a result of poor judgment accounts for a significant percentage of diagnostic errors in medicine. Use of judgment in the clinical setting can be described as clinical reasoning. Therefore, if educators of PT students intend to cultivate safe and effective practitioners, it is imperative to assist students in the development of effective judgment in addition to requisite knowledge and skills. Despite the importance, there are currently many limitations in clinical reasoning research in the field of physical therapy education. The purposes of this article are to introduce dual-processing theory as a means of conceptualizing clinical reasoning in physical therapy education and to provide recommendations for development of clinical reasoning.

Position and Rationale.
Clinical reasoning in physical therapy education lacks a unified theoretical framework from which to base instructional methods. It is the opinion of this author that in conjunction with an understanding of the development of expertise and expert performance, the dual-processing theory of reasoning provides an optimal foundation for clinical reasoning instruction and assessment. The dual-processing theory is underused despite being the prevailing theory to describe reasoning in health care providers. The dual-processing theory describes clinical reasoning as a balance between type I, intuitive, and type II, analytical processing. The final decision made is the result of the interaction between the two types of processing rather than sole reliance on analytical or intuitive thinking alone. This balance is how health care providers make decisions during the evaluation, examination, and treatment of patients. A key component in the ability to accurately manage the use of both types of processing is the awareness of the accuracy of thought processes. This awareness is also referred to as metacognition and is the necessary component of accurate clinical reasoning.

Discussion and Conclusion.
This position paper addresses one of the current limitations in clinical reasoning research in physical therapy by providing a theoretical rationale for use of the dual-processing theory in conceptualizing the components of clinical reasoning. PT students must cultivate an awareness of the accuracy of their thought processes in addition to acquiring deep-structure disciplinary knowledge. In accordance with the dual-processing theory as the theoretical framework for clinical reasoning, explicit teaching of accurate metacognitive self-monitoring in physical therapy education is integral to effective clinical reasoning.
Critical care outcomes in resource-limited settings
Authors: Vukoja Marija , Riviello Elisabeth D. , Schultz Marcus J. 
Published: July 2018

Purpose of review
The burden of critical illness in low-income and middle-income countries (LMICs) is substantial. A better understanding of critical care outcomes is essential for improving critical care delivery in resource-limited settings. In this review, we provide an overview of recent literature reporting on critical care outcomes in LMICs. We discuss several barriers and potential solutions for a better understanding of critical care outcomes in LMICs.

Recent findings
Epidemiologic studies show higher in-hospital mortality rates for critically ill patients in LMICs as compared with patients in high-income countries (HICs). Recent findings suggest that critical care interventions that are effective in HICs may not be effective and may even be harmful in LMICs. Little data on long-term and morbidity outcomes exist. Better outcomes measurement is beginning to emerge in LMICs through decision support tools that report process outcome measures, studies employing mobile health technologies with community health workers and the development of context-specific severity of illness scores.

Summary
Outcomes from HICs cannot be reliably extrapolated to LMICs, so it is important to study outcomes for critically ill patients in LMICs. Specific challenges to achieving meaningful outcomes studies in LMICs include defining the critically ill population when few ICU beds exist, the resource-intensiveness of long-term follow-up, and the need for reliable severity of illness scores to interpret outcomes. Although much work remains to be done, examples of studies overcoming these challenges are beginning to emerge.
Both WHR and FLI as Better Algorithms for Both Lean and Overweight/Obese NAFLD in a Chinese Population
Authors: Li Chunlong , Guo Panpan , Zhang Runan , Zhang Meng , Li Yanchuan , Huang Min , Ji Xiaoning , Jiang Yongshuai , Wang Cheng , Li Rui , Feng Rennan 
Published: July 2018

Goals:
To compare current nonalcoholic fatty liver disease (NAFLD)-related algorithms to find suitable algorithms for NAFLD, especially lean NAFLD in middle-aged and elderly Chinese population.

Background:
NAFLD is the most common cause of chronic liver disease in the world today. Various algorithms based on obesity indicators, blood lipids, and liver enzymes, etc. have been developed to screen NAFLD.

Materials and Methods:
General, anthropometric and biochemical characteristics were collected. One-way analysis of variance and the χ2 test were applied to test the differences in continuous and categorical variables, respectively. Multivariable logistic regression analyses, adjusted by age, gender, body mass index, tobacco use, alcohol consumption, and physical activities, were used to investigate the associations between NAFLD-related algorithms and NAFLD. The accuracy and cut-off point of NAFLD-related algorithms to detect NAFLD were evaluated by area under the receiver operator characteristic curve and the maximum Youden index analysis, respectively.

Results:
In 8 NAFLD-related algorithms, the receiver operator characteristic of fatty liver index (FLI) and waist circumstance-to-height ratio (WHR) for NAFLD were in the whole (0.83 and 0.84), lean (0.74 and 0.74), and overweight/obese (0.71 and 0.72) population, respectively, which were higher than those of other algorithms. The cut-off points of WHR and FLI for NAFLD were different in the overall (0.50 and 20), lean (0.47 and 10), and overweight/obese (0.53 and 45) population.

Conclusions:
WHR and FLI could be the most accurate of 8 algorithms for the noninvasive diagnosis of NAFLD in both lean and overweight/obese population.
Cardiovascular disease in Williams syndrome
Authors: Collins R. Thomas 
Published: July 2018

Purpose of review
Williams syndrome is a multisystem disorder seen with some regularity at most pediatric centers and usually fairly often at larger centers. Cardiovascular abnormalities, because of elastin deficiency, are the leading cause of morbidity and mortality in patients with Williams syndrome. The present article presents a review of the most recent developments regarding the cardiovascular issues in Williams syndrome.

Recent findings
Cardiovascular abnormalities occur in 80% of patients with Williams syndrome, the majority of which are arterial stenoses. The stenoses seen in Williams syndrome now appear to arise from deficient circumferential arterial growth. Pharmacological therapies aimed at improving the vascular stenoses have shown some promise in animal models. Surgical outcomes for supravalvar aortic stenosis are good at most centers. Transcatheter interventions are largely ineffective in Williams syndrome. Multilevel surgical pulmonary artery reconstruction has excellent results for peripheral pulmonary artery stenosis. Periprocedural risk stratification and management algorithms may decrease the risk of cardiovascular complications.

Summary
Cardiovascular abnormalities are a major determining factor in the clinical picture and trajectory of patients with Williams syndrome. Advances in surgical techniques, medical therapeutic options, and periprocedural management hold promise for significant improvements in the cardiovascular outcomes of these patients.
Patient and Procedural Factors Associated With Increased Islet Cell Yield in Total Pancreatectomy With Islet Autotransplantation
Authors: Trinh Katherine V. , Smith Kerrington D. , Gardner Timothy B. 
Published: July 2018

Objectives
Total pancreatectomy with islet autotransplantation (TPIAT) offers symptom relief to highly selected patients with recurrent acute and/or chronic pancreatitis. However, with variable clinical response, it is important to refine islet manipulation technique and patient selection criteria. This study explores the variables associated with high islet cell yield, a driver of success in TPIAT.

Methods
This study evaluated patients who underwent TPIAT at Dartmouth-Hitchcock Medical Center from 2012 to 2016. Odds ratios were calculated for various patient and procedural characteristics. The primary clinical outcome was the number of isolated islet equivalents per kilogram body weight.

Results
Thirty-eight patients met inclusion criteria. Patients with no computed tomography or magnetic resonance imaging evidence of chronic pancreatitis, without pancreatic duct stones, and without parenchymal stones were associated with higher odds of success (P = 0.02, P = 0.02, and P = 0.002, respectively). Patients with preoperative glycated hemoglobin greater than 5.6, with islet cell suspensions positive for cultures, and with positive gram stains were associated with lower odds of success (P = 0.02, P = 0.01, and P = 0.02, respectively).

Conclusions
Factors that diminish a successful islet cell harvest during TPIAT include the presence of infected islets, an elevated preoperative glycated hemoglobin, and the presence of pancreatic duct stones.
Depressive Symptom Clusters and Their Relationships With Anxiety and Posttraumatic Stress Disorder Symptoms in Patients With Cancer
Authors: Li Jie , Zhang Huihui , Shao Di , Xue Jiaomei , Bai Huayu , Sun Jiwei , Lin Pingzhen , Cao Fenglin 
Published: July 2018

Background
Depressive symptoms are prevalent in patients with cancer and are heterogeneous; however, existing methods of grouping patients with heterogeneous symptoms have limitations.

Objectives
The purpose of this study was to identify depressive symptom clusters in patients with cancer using a data-driven method and to explore their relationships with symptoms of anxiety and posttraumatic stress disorder.

Methods
Data from 247 patients were analyzed in this cross-sectional study. Latent class analysis was used to identify depressive symptom clusters, using 9 depressive symptoms from the Patient Health Questionnaire. Symptoms of anxiety and posttraumatic stress disorder were measured, and the relationships between them and the clusters were explored through linear regression analyses.

Results
Four clusters of depressive symptoms were identified: (1) minimal with sleep and appetite disturbances (23.9%), (2) somatic (22.3%), (3) moderate with sleep disturbance and fatigue (32.4%), and (4) severe (21.5%). The order of severity of anxiety and posttraumatic stress disorder symptoms was comparable across the 4 clusters of depressive symptoms. The anxiety and posttraumatic stress disorder symptoms of patients in clusters 3 and 4 were more severe than those in cluster 1 (B = 4.70-19.19, P < .001).

Conclusion
Using latent class analysis, 4 clusters of depressive symptoms were identified in patients with cancer, which were significantly correlated with symptoms of anxiety and posttraumatic stress disorder.

Implications for Practice
Latent class analysis can be used to identify clusters of depressive symptoms in patients with cancer. Such groupings may hasten the development of individualized intervention approaches tailored to patients' specific depressive clusters.
Combination Antimicrobial Prophylaxis for Hysterectomy: Harm Without the Benefit?
Authors: Branch-Elliman Westyn , Ripollone John , O’Brien William , Itani Kamal , Strymish Judith , Gupta Kalpana 
Published: July 2018

(Abstracted from Am J Obstet Gynecol 2018;218(5):536–537)
Results from several studies suggest that prophylactic use of combination antimicrobial regimens reduce postoperative surgical site infections (SSIs) after cesarean delivery and other surgical procedures. A recent study, however, reported that combination regimens were associated with increases in postoperative acute kidney injury (AKI) after nongynecologic surgical procedures.
Does Implementing a Regime of Dexamethasone Before Planned Cesarean Section at Term Reduce Admission With Respiratory Morbidity to Neonatal Intensive Care Unit? A Randomized Controlled Trial
Authors: Nooh Ahmed Mohamed , Abdeldayem Hussein Mohammed , Arafa Eisa , Shazly Sherin Attia , Elsayed Hany , Mokhtar Wesam A. 
Published: July 2018

(Abstracted from J Matern Fetal Neonatal Med 2018;31:614–620)
Planned cesarean section (CS) has been found to lead to significantly higher rates of overall neonatal respiratory morbidity than intended vaginal delivery. Various etiologies for these complications have been proposed such as iatrogenic prematurity with surfactant deficiency and an absence of hormonal and physiological changes necessary for proper lung functioning in infants delivered by planned CS.
Impact of Significant Decreases Over Time in the Proportion of Sexually Active Medicaid Women Who Had Papanicolaou Testing or Were Pregnant on Trends of Overall Chlamydia Testing Rates
Authors: Tao Guoyu , Kreisel Kristen , Gift Thomas L. 
Published: July 2018

Abstract
We examined Medicaid claims data during 2004 to 2013. The proportion of sexually active females aged 15 to 25 years who had Papanicolaou testing or were pregnant significantly decreased during 2004 to 2013 (67.0% to 43.9%, P < 0.05), resulting in a slowed increasing trend in overall chlamydia screening rates. Structural-level interventions for improving chlamydia screening are urgently needed.
Differences Between Pulmonary and Extrapulmonary Pediatric Acute Respiratory Distress Syndrome: A Multicenter Analysis
Authors: Gan Chin Seng , Wong Judith Ju-Ming , Samransamruajkit Rujipat , Chuah Soo Lin , Chor Yek Kee , Qian Suyun , Anantasit Nattachai , Feng Xu , Ong Jacqueline Soo May , Phuc Phan Huu , Phumeetham Suwannee , Sultana Rehena , Loh Tsee Foong , Lum Lucy Chai See , Lee Jan Hau 
Published: July 2018

Objectives:
Extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome are poorly described in the literature. We aimed to describe and compare the epidemiology, risk factors for mortality, and outcomes in extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome.

Design:
This is a secondary analysis of a multicenter, retrospective, cohort study. Data on epidemiology, ventilation, therapies, and outcomes were collected and analyzed. Patients were classified into two mutually exclusive groups (extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome) based on etiologies. Primary outcome was PICU mortality. Cox proportional hazard regression was used to identify risk factors for mortality.

Setting:
Ten multidisciplinary PICUs in Asia.

Patients:
Mechanically ventilated children meeting the Pediatric Acute Lung Injury Consensus Conference criteria for pediatric acute respiratory distress syndrome between 2009 and 2015.

Interventions:
None.

Measurements and Main Results:
Forty-one of 307 patients (13.4%) and 266 of 307 patients (86.6%) were classified into extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome groups, respectively. The most common causes for extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome were sepsis (82.9%) and pneumonia (91.7%), respectively. Children with extrapulmonary pediatric acute respiratory distress syndrome were older, had higher admission severity scores, and had a greater proportion of organ dysfunction compared with pulmonary pediatric acute respiratory distress syndrome group. Patients in the extrapulmonary pediatric acute respiratory distress syndrome group had higher mortality (48.8% vs 24.8%; p = 0.002) and reduced ventilator-free days (median 2.0 d [interquartile range 0.0–18.0 d] vs 19.0 d [0.5–24.0 d]; p = 0.001) compared with the pulmonary pediatric acute respiratory distress syndrome group. After adjusting for site, severity of illness, comorbidities, multiple organ dysfunction, and severity of acute respiratory distress syndrome, extrapulmonary pediatric acute respiratory distress syndrome etiology was not associated with mortality (adjusted hazard ratio, 1.56 [95% CI, 0.90–2.71]).

Conclusions:
Patients with extrapulmonary pediatric acute respiratory distress syndrome were sicker and had poorer clinical outcomes. However, after adjusting for confounders, it was not an independent risk factor for mortality.
Acute Scrotal Pain and a Different Use of an Old Imaging Method
Authors: Tramma Despoina , Gogou Maria , Lambropoulos Vasilios 
Published: July 2018

Abstract
The differential diagnosis of scrotal pain in childhood is a challenge for every primary care physician. We report the case of a 5-year-old boy presenting to the emergency department owing to acute left scrotal pain. Ultrasound screening revealed a Morgagni hydatid in the left testis, which was surgically removed. X-rays revealed microcalcifications of the cyst wall and stroma, signs indicative of chronic inflammation. Results of histological examination confirmed radiographic evaluation. No similar use of x-rays has been described in literature before, to the best of our knowledge. A brief discussion also follows about Morgagni hydatid in childhood.
Latent Classes of Sexual Risk Behavior and Engagement in Outreach, Intervention and Prevention Services Among Women Who Inject Drugs Across 20 US Cities
Authors: Mackesy-Amiti Mary Ellen , Boodram Basmattee , Handanagic Senad , Paz-Bailey Gabriela , Prachand Nikhil G. , Broz Dita ,   for the NHBS Study Group
Published: July 2018

Background:
Monitoring the effects of HIV prevention efforts among persons who inject drugs is key to informing prevention programs and policy.

Methods:
Data for this study came from the 2012 National HIV Behavioral Surveillance interviews with persons who inject drugs across 20 US cities. The present analyses include those who identified as female, ever had sex with a man, and were at risk of HIV infection (did not report a previous positive HIV test result) (n = 2624). We conducted latent class analysis to identify sexual risk classes, and modeled associations with engagement in HIV prevention services and HIV test results.

Results:
We identified 6 classes of sexual risk behavior: (1) low risk, (2) monogamous, (3) casual partner, (4) multiple partners, (5) exchange sex, and (6) exchange plus main partner. The class distribution was similar across the mainland regions. Bisexual orientation and homelessness were significant predictors of higher-risk class. HIV prevalence and participation in behavioral interventions did not vary significantly by risk class, while obtaining and using free condoms did. Independent of risk class, women in cities in the South were significantly less likely to use free condoms, and HIV prevalence was higher among non-Hispanic black women and women aged 40–49 years.

Conclusions:
Bisexual orientation and homelessness were predictors of higher risk. Condom distribution programs reached fewer women in cities in the South. Race and age disparities in HIV-positive rates persisted after adjusting for sexual risk class.
Lymphocytic Thrombophilic Arteritis
Authors: Vakili Sharif , Zampella John G. , Kwatra Shawn G. , Blanck Jaime , Loss Manisha 
Published: July 2018

Abstract
Macular lymphocytic arteritis or lymphocytic thrombophilic arteritis (LTA) is a recently described cutaneous arteritis that is characterized by asymptomatic macules and patches of the extremities associated with lymphocytic arteritis at the deep dermal/subcuticular junction for which little information exists on demographics, evaluation, and management. There has been recent debate in the literature whether this disease is a new distinct entity, misdiagnosed cutaneous polyarteritis nodosa (cPAN), or a disease on a spectrum with cPAN. We systematically review the literature on demographic information, medical history, histopathology findings, and treatment management to analyze trends and clarify controversies in characterizations of LTA. Forty detailed cases of LTA have been published. We submit that, although literature is limited, a review of the data still suggests that LTA is distinct from cPAN and systemic PAN. In addition, to better reflect the pathophysiologic natural history of this condition and correct for the historical artifact of how the disease was identified, we encourage the disease to be referred to as LTA and discourage ongoing use of macular lymphocytic arteritis.