bluuebunny/crossref_metadata_2025_split huggingface dataset:
Episcleral Venous Fluid Wave in the Living Human Eye Adjacent to Microinvasive Glaucoma Surgery (MIGS) Supports Laboratory Research: Outflow is Limited Circumferentially, Conserved Distally, and Favored Inferonasally
Authors: Fellman Ronald L. , Grover Davinder S. 
Published: November 2018

Purpose:
The purpose of this study was to describe downstream patterns of outflow with the episcleral venous fluid wave (EVFW) in the living human eye adjacent to microinvasive glaucoma surgery (MIGS) and determine if the EVFW supports existing ex-vivo laboratory outflow research.

Design:
Retrospective, noncomparative case series.

Patients:
A total of 10 eyes of 10 patients who underwent phaco-Trabectome and 10 eyes of 10 patients who underwent phaco-iStent consecutively at Glaucoma Associates of Texas for cataract and uncontrolled glaucoma who demonstrated an episcleral wave.

Methods:
The EVFW was visualized and recorded during irrigation and aspiration. To describe the hydrodynamic properties of the fluid wave, its degrees, extent, and characteristics were measured with a protractor in Photoshop.

Results:
The incised Trabectome arc produced adjacent episcleral blanching of 134±11 degrees (range, 112 to 150 degrees) with an additional 54 degrees of marginal recruitment (41 degrees inferonasal plus 13 degrees superonasal) adjacent to the ends of the Trabectome incision. The mean episcleral blanch for the iStent was 51±19 degrees (range, 19 to 90 degrees), comprised of 29 degrees inferonasal plus 22 degrees superonasal.

Conclusions:
Downstream episcleral flow in the living human eye adjacent to the iStent is variable and mainly confined to 2 clock hours indicating a lack of significant circumferential flow in glaucomatous eyes. Flow distal to the Trabectome site encompasses the Trabectome incisional arc with an additional 2 clock hours of lateral fluid wave favoring the inferonasal over superonasal quadrant 3 to 1. These in-vivo findings made visible with MIGS, corroborate recent in-vivo and long-standing ex-vivo laboratory research that outflow is largely segmented, favored inferonasally and conserved distally.
Healthcare Resource Utilization and Cost of Invasive Meningococcal Disease in Ontario, Canada
Authors: Rampakakis Emmanouil , Vaillancourt Julie , Mursleen Sara , Sampalis John S. 
Published: November 2018

Background:
Invasive meningococcal disease (IMD) is associated with significant morbidity and mortality, thus remaining a concern for healthcare providers and the public. Evidence of the longitudinal burden of IMD and associated costs are scarce. Here we have evaluated the healthcare utilization and cost associated with hospitalized IMD cases in Ontario, Canada.

Methods:
Observational cohort study utilizing the Ontario provincial claims databases, comprising: (1) individuals hospitalized with IMD between January 1995 and June 2012 and (2) age-, gender- and area-matched non-IMD controls (1:20 ratio). IMD cases were identified through diagnostic codes from hospitalization data and medical services claims. Costs are presented in Canadian dollars.

Results:
Nine-hundred twelve IMD cases and 18,221 non-IMD controls were included. Over 5 years of follow-up, 27% of IMD cases (excluding initial hospitalization and 30-day acute phase) versus 15% of non-IMD controls (P < 0.001) were hospitalized. Compared with controls, IMD cases were more likely to receive alternative level of care (6.7% vs. 1.1%; P < 0.001) or visit the intensive care unit (49.2% vs. 2.4%; P < 0.001), and were associated with significantly higher mean hospitalization cost per case ($40,075 vs. $2827; P < 0.001). The hospitalization cost per case remained significantly higher when excluding the initial hospitalization and acute phase ($9867 vs. $3312; P < 0.001). The mean total cost per IMD case, including medications, hospitalization and medical services, was $45,768–$52,631 ($13,520–$23,789 excluding initial hospitalization and acute phase), for an overall cost (all cases during total follow-up) of $41,740,142–$47,999,289.

Conclusions:
In addition to its clinical burden, IMD is associated with significant economic burden to the public health system.
Physicians in Kentucky Perceive Physician Assistants to Be Competent Health Care Providers
Authors: Chatterjee Somu , Westneat Susan , Wyant Andrew , Hunton Ryan 
Published: November 2018

Purpose
The use of certified physician assistants (PA) has increased throughout the US health care system. The purpose of this study was to objectively evaluate physicians' perceptions of PAs' mastery of specific skills. It is important to understand stakeholders' perceptions of PAs' capabilities to support future changes in policies for better utilization of PAs in our health care system.

Methods
From 2014 to 2015, randomly chosen “active” physicians listed with the Kentucky Board of Medical Licensure were surveyed about their perceptions of competencies of certified PAs. Six competency domains (medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning, and improvement and systems-based practice) were rated using a Likert scale. Each competency-derived skill-based question was ranked by the number of physicians giving the highest scores on the Likert scale (a score of 4 or 5) and by effect size. Cronbach's alpha for the survey was calculated.

Results
An overwhelming majority of the physicians perceived certified PAs to be competent (n ≥ 161, ≥ 60%) for specific skills. The survey had internal consistency with Cronbach's alpha ranging from 0.75 to 0.87 for competency domains. Effect size ranged from 0.44 to 0.98 for scores given by physicians with, versus without, experience with PAs.

Conclusions
For the first time, there is objective evidence of physicians' perceptions of PAs' mastery of specific competency-derived PA skill sets. This study will help guide effective utilization of PAs throughout the health care system and future PA education.
How Do Socket Size Adjustments during Ambulation Affect Residual Limb Fluid Volume? Case Study Results
Authors: Larsen Brian G. , McLean Jake B. , Redd Christian B. , Brzostowski Jacob T. , Allyn Katheryn J. , Sanders Joan E. 
Published: November 2018

ABSTRACT

Introduction
Adjustable prosthetic sockets may be useful in management of limb volume in individuals with amputation. Incrementally increasing socket size during ambulation may increase residual limb fluid volume, deterring daily volume loss without sacrificing gait stability.

Materials and Methods
Participants with transtibial limb loss wore motor-controlled cabled-panel adjustable sockets while residual limb fluid volume was monitored using bioimpedance analysis. Participants walked on a treadmill with a safety harness while socket size was adjusted to establish users' ranges of acceptable sizes and optimal size. Then single controlled size adjustments were made. In longer duration testing outside the laboratory, participants used a portable system controlled by a mobile phone app to incrementally increase or decrease their socket size.

Results
For the two participants tested, comfortable socket sizes spanned as low as a 1.6% range of socket volume to as high as a 6.1% range. Limb fluid volume changed in proportion to socket size when adjustments were near users' optimal socket size setting.

Conclusions
Adjustable sockets are a viable means to manipulate limb fluid volume during ambulation. Incremental changes in socket size, approximately 0.33% socket volume, were sufficient to induce detectable changes in socket fit.
Review of evidence for bosentan therapy for treatment of Eisenmenger syndrome
Authors: Hartwig Benjamin J. , Schultze Benjamin 
Published: November 2018

Background and purpose:
Eisenmenger syndrome (ES) is a rare condition caused by a right-to-left cyanotic shunt. To date, only heart–lung transplant has been shown to be curative. Bosentan is the only medication studied with a double-blind placebo-controlled randomized trial for management of this condition. The intent of this article is to explore the literature surrounding bosentan in ES and assess its efficacy.

Methods:
A literature review was conducted with no limitation on date. Titles were scanned for applicability, and abstracts of those articles found to be pertinent were reviewed. Those articles considered relevant based on the abstract were read in entirety.

Conclusions:
Eisenmenger syndrome remains incurable except through heart–lung transplant. Although no specific medical treatment or algorithm exists, three pharmacological classes show promise in disease management: endothelin receptor antagonists, phosphodiesterase inhibitors, and prostacyclins. Combined therapy with these agents may improve cardiopulmonary function. Bosentan has not been proven as a monotherapy for ES and is not appropriate in all patients as side effects are commonly reported.

Implications for practice:
Further study is required to assess efficacy of combination therapy and utilization as a bridge to transplant or surgical correction of the underlying defect.
Long-term Outcomes of Ossiculoplasty With and Without an Intact Malleus
Authors: Page Joshua Cody , Cox Matthew D. , King DeAnne , Allsopp Tristan , Dornhoffer John L. 
Published: November 2018

Objective:To compare long-term hearing outcomes following ossiculoplasty with cartilage tympanoplasty with (M+) and without (M−) the malleus present.Study Design:Retrospective chart review.Setting:Tertiary referral center.Patients:One twenty-six patients (18–88 yr of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts from 1998 to 2012 with at least 5 years of documented postoperative follow-up.Main Outcome Measures:Short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 d and 1 yr after surgery), long-term hearing results (PTA-ABG measured ≥5 yr after surgery), Ossiculoplasty Outcome Parameter Staging (OOPS) index, and complications.Results:There were 46 patients in the M+group and 80 in the M−group. Preoperative PTA-ABG was 23.8 dB for M+and 34.5 dB for M−(p = 0.00001). Short-term postoperative PTA-ABG was 19.3 dB for M+and 18.5 dB for M−(p = 0.727). Long-term postoperative PTA-ABG was 18.2 dB for M+and 19.6 dB for M−(p = 0.500). The OOPS index was 4.11 and 6.41 for M+and M_, respectively, (p = 0.00001). Thirteen patients (10.3%) experienced complications.Conclusion:Our data suggest that the malleus is not statistically significant with regard to its impact on final audiometric outcome following ossiculoplasty. This has implications in our clinic, particularly in our use of the OOPS index as a prognostic tool, and will likely lead to its revision. These data may further support the coupling theory of acoustic gain and weaken the catenary lever theory.
Treatment of chronic obstructive pulmonary disease in patients with different fractional exhaled nitric oxide levels
Authors: Wu Yao-Kuang , Su Wen-Lin , Huang Chun-Yao , Yang Mei-Chen , Chen Sin-Yi , Lan Chou-Chin 
Published: November 2018

Abstract
Some patients with chronic obstructive pulmonary disease (COPD) have eosinophilic inflammation which may be evaluated via the measurement of fractional exhaled nitric oxide (FeNO) like asthma. The aim of this prospective study was to assess whether FeNO levels can be used to identify patients with COPD with eosinophilic inflammation who may respond to inhaled corticosteroid (ICS) therapy.
This study included patients (N = 112) with COPD (age >18 years) who were divided into 4 groups depending upon whether they had high (≥25 parts per billion [ppb]) or low (<25 ppb) pretreatment (baseline) FeNO and if they were treated with either ICS plus long-acting β-agonist (ICS + LABA) or a long-acting muscarinic antagonist (LAMA). The 4 groups were: high FeNO/ICS + LABA, high FeNO/LAMA, low FeNO/ICS + LABA, and low FeNO/LAMA. Outcomes assessed included FeNO, COPD assessment test (CAT), and pulmonary function.
The high FeNO/ICS + LABA group had the greatest reduction from baseline in FeNO levels (−25.80 ppb ± 27.14) compared with the high FeNO/LAMA, low FeNO/ICS + LABA, and low FeNO/LAMA groups (range, −4.45 to 1.31 ppb; P < .001). The high FeNO/ICS + LABA group also showed the greatest improvement in CAT (−7.20), which was statistically larger than the low FeNO/ICS + LABA and low FeNO/LAMA groups (−1.72 and −2.03, respectively). No difference in pulmonary function following treatment was observed across the 4 groups.
This study found that patients with high FeNO showed the greatest reduction in FeNO and improvement in CAT with ICS + LABA therapy, supporting the use of FeNO to identify patients who would benefit from ICS use.
Efficacy of rational emotive digital storytelling intervention on knowledge and risk perception of HIV/AIDS among schoolchildren in Nigeria
Authors: Ezegbe Bernedeth , Eseadi Chiedu , Ede Moses O. , Igbo Janet N. , Aneke Anthonia , Mezieobi Daniel , Ugwu Gloria C. , Ugwoezuonu Amanda U. , Elizabeth Ebizie , Ede Kelechi R. , Ede Augustina O. , Ifelunni Clara O. , Amoke Chijioke , Eneogu Njideka D. , Effanga Offiong A. 
Published: November 2018

Abstract

Background:
This investigation was aimed at determining the efficacy of a rational emotive digital storytelling (REDStory) therapy on knowledge and perception of risk of HIV/AIDS among schoolchildren in Enugu State, Nigeria.

Methods:
The researchers adopted a group randomized controlled trial design involving a pretest, posttest, and follow-up design involving a treatment group and a waiting-list control group. Participants were 80 junior secondary schoolchildren attending public and private schools who met the criteria for inclusion in the sample of this study. The REDStory intervention program lasted for 8-week duration of REDStory therapy. The HIV Knowledge Questionnaire and the Perceived Risk of HIV Scale (PRHS) were used for data collection for this study. Repeated measures analysis of variance and t test were used for data analysis.

Results:
The results revealed that REDStory therapy had a significant effect in increasing knowledge level and perceived risk of HIV among schoolchildren compared to those in waitlisted control group. Lastly, the positive benefits of this study were significantly sustained by the treatment group at the follow-up.

Conclusion:
The current study therefore suggests the use of REDStory therapy in increasing knowledge and perception of risk of HIV/AIDS among schoolchildren in Enugu, Nigeria.
Surgical correction of residual facial deformity following conservative excision of a giant maxillary ossifying fibroma
Authors: Wu Zhuoxia , Xing Yunlong , Liu Xin , Chen Wanying , Kong Jiao , Wu Ronghui , Zhang Lianbo 
Published: November 2018

Abstract

Rationale:
Ossifying fibroma (OF) is a benign fibro-osseous lesion that can develop in the oral and maxillofacial region. OF is more common in females and has a marked predilection for the mandible, occurring rarely in the maxilla. Lesions grow slowly and are usually asymptomatic until growth produces an obvious swelling, pain, paresthesia, and facial deformity. With low rates of recurrence, treatment is usually curettage or resection. Very large lesions that invade other organs and that cannot be completely removed should be excised conservatively.

Patient concerns:
We present a case of a 46-year-old female with a very large fibro-osseous lesion arising from the maxilla who was more concerned about the facial appearance and requested conservative treatment for economic reasons.

Diagnoses:
The pathological results based on conservative excision of the lesion confirmed the diagnosis of OF.

Interventions:
We chose conservative excision via the Weber–Ferguson approach and followed up every 6 months. Facial deformity correction was performed 2 years postoperatively and right lower eyelid ectropion correction 3 years after the primary excision.

Outcomes:
The ectropion deformity in the right lower eyelid improved dramatically with a better facial appearance and no obvious swelling.

Lessons:
Treatment programs for OF should be individualized based on the size, growth rate, invasion, and interference with facial function and esthetics. If lesions grow slowly, we suppose that it is feasible to excise conservatively when reconstruction cannot be performed due to esthetic and functional problems. Also regular postoperative follow-up is necessary to detect recurrence, and to improve facial appearance as required.
Lymphomas diagnosed in an internal medicine department compared to lymphomas diagnosed in other departments
Authors: Pernot Benoit , Gyan Emmanuel , Maillot François , Hodges Penelope , Ertault Marjan , Ferreira-Maldent Nicole 
Published: November 2018

Abstract
Lymphomas are common malignancies with highly variable clinical presentations and prognosis. Prognostic value of clinical presentation at onset is still questioned. The objective of this study was to compare the disease presentation and the outcome of lymphomas diagnosed in an Internal Medicine Department of a University Hospital to disease presentation and outcome of patients who were referred to the Hematology Department of the same institution by other departments or healthcare facilities.
This retrospective monocentric observational study included 37 patients. They were matched to 73 patients, who were referred to the Hematology Department, according to age, histology, and Ann Arbor stage. The demographics, clinical and biological presentations, overall survival, and progression-free survival were compared.
Patients diagnosed with lymphoma in the Internal Medicine Department were more likely to be febrile (67.5% vs 21.9%; P < .001) and have higher inflammatory markers (mean C-reactive protein 86.6 vs 56.3 mg/L; P = .02). The median overall survival of these patients was poorer (P < .001), even in the subset of patients treated with standard treatment, and remained shorter in multivariable analysis (P = .002). The specific treatment started earlier (20.2 vs 37.5 days; P = .006), but was more frequently palliative (37.8% vs 19.2%; P = .04). There was no significant difference in median progression-free survival.
Lymphomas diagnosed in an Internal Medicine Department had aggressive clinical presentations and a poorer outcome, despite an early start of conventional treatment.
A body shape index and vascular structure and function in Spanish adults (MARK study)
Authors: Gomez-Marcos Manuel A. , Gomez-Sanchez Leticia , Patino-Alonso Maria Carmen , Recio-Rodriguez Jose I. , Gomez-Sanchez Marta , Rigo Fernando , Marti Ruth , Agudo-Conde Cristina , Ramos Rafel , Rodriguez-Sanchez Emiliano , Maderuelo-Fernandez Jose A. , Garcia-Ortiz Luis 
Published: November 2018

Abstract
A body shape index (ABSI) has been introduced as a marker of the relationship between body composition and all-cause mortality. However, until now, the relationships between ABSI and vascular structure and function have not been evaluated. The aim of this study was to investigate the association of ABSI with vascular structure and function in Spanish adults with intermediate cardiovascular risk. This cross-sectional study analyzed the data of 2354 subjects [age, 35–74 years (median, 62.0 years [range, 56.0–67.0 years]), 61.9% men] enrolled into the MediAte Risk management (MARK) study. ABSI was calculated by using the following formula: ABSI = waist circumference (m)/[body mass index2/3 × height (m)1/2)]. Vascular function was assessed by measuring cardio-ankle vascular index (CAVI) with the VaSera device and brachial ankle pulse wave velocity (baPWV) by using a validated equation. Vascular structure was assessed by measuring carotid intima-media thickness (IMT) by ultrasonography. Median value of ABSI was 0.083 (range, 0.081–0.090), mean CAVI was (8.5 ± 1.2), and median IMT was 0.727 (range, 0.672–0.799). The values of ABSI and CAVI were higher in men. After adjusting for confounders, ABSI was positively associated with CAVI, baPWV, and average mean IMT. Thus, for each unit increase in ABSI, CAVI increased by 0.16 units, baPWV by 0.25 m/s, and IMT by 0.033 mm. In the logistic regression analysis, the odds ratio of ABSI was > 1 for high CAVI ≥ 9, baPWV ≥ 15 m/s, and IMT ≥ 0.90 mm in the overall subject group, and in the sex- and age-specific (> 62 years, ≤ 62 years) subgroups, after adjusting for confounders. The area under the receiver-operating characteristic curve of the ABSI was 0.631 (95% confidence interval [CI], 0.608–0.654) for CAVI ≥ 9, and 0.617 (95% CI, 0.593–0.641) for high baPWV ≥ 15 m/s. ABSI showed a positive association with vascular structure and function, independent of other confounders that might influence weight and fat mass distribution in Spanish subjects at intermediate cardiovascular risk.

Trial Registration: ClinicalTrials.gov Identifier: NCT01428934 (registered: September 2, 2011; last updated: September 8, 2016)
Effect of community-based extension clinics of methadone maintenance therapy for opiate-dependent clients
Authors: Zhang Guang , Yang Yuecheng , Ye Runhua , Zhang Dapeng , Shan Duo , Hu Yifei , Dai Bing , Liu Zhongfu 
Published: November 2018

Abstract
Methadone maintenance therapy (MMT) is effective in treatment of opiate dependents. However, there is a gap between the coverage of standard MMT clinics and the need of opiate dependents. Establishment of extension clinics of methadone maintenance therapy (EMMT) will increase the coverage and improve MMT accessibility. We implemented a prospective cohort study to understand the effects of establishment of community-based EMMT clinics comparing with MMT clinics in Yunnan Province.
A total of 462 opiate-dependent clients were interviewed from the community-based EMMT clinics and standard MMT clinics located in 5 counties of Mangshi, Ruili, Longchuan, Yingjiang, and Lianghe in Yunnan Province. The information on the demographic characteristics, drug risk behaviors, quality of life (QOL), and urine testing results for morphine of the clients was collected and compared between the EMMT and MMT clinics. A survival analysis method was utilized to know the retention situation of the newly enrolled clients with Kaplan–Meier method during 9 months treatment.
Among the EMMT clients, 96.9% were male; 31.4% were Han; 61.4% were married; 39.0% had primary school education; 95.5% lived with their family or relatives; 96.9% who arrived the clinic less than 15 min; 52.9% had used drugs for more than 10 years; and 16.7% injected drug. After 9 months therapy, there was no difference in the changes of life quality such as physical and psychological features, social relationships, environmental function, and total QOL and well-being between those of EMMT and MMT clinics. The positive detection rate of urine-morphine testing among newly enrolled clients of EMMT clinics decreased as the period of treatment lengthened. The average time of retention for newly enrolled EMMT clients who are still receiving the treatment was 175 days. And the average time from initiations to drop-out of treatment for newly enrolled EMMT clients was 122 days. The 9-month retention rates of the clients were 52.1% and 60.9% at EMMT and MMT clinics, respectively.
The effect on EMMT retention was the same as that of MMT. Establishment of EMMT clinics was an effective strategy to expand the coverage of MMT and increase the retention of opiate dependents in the rural areas of the counties.