bluuebunny/crossref_metadata_2025_split huggingface dataset:
Limb Salvage and Functional Outcomes following Free Tissue Transfer for the Treatment of Recalcitrant Diabetic Foot Ulcers
Authors: Lu Jocelyn , DeFazio Michael , Lakhiani Chrisovalantis , Abboud Michel , Penzler Morgan , Elmarsafi Tammer , Kim Paul , Attinger Christopher , Evans Karen 
Published: August 2018

Background Recent evidence documenting high success rates following microvascular diabetic foot reconstruction has led to a paradigm shift in favor of more aggressive limb preservation. The primary aim of this study was to examine reconstructive and functional outcomes in patients who underwent free tissue transfer (FTT) for recalcitrant diabetic foot ulcers (DFUs) at our tertiary referral center for advanced limb salvage.
Methods Between June 2013 and June 2016, 29 patients underwent lower extremity FTT for diabetic foot reconstruction by the senior author (K.K.E.). In all cases, microsurgical reconstruction was offered as an alternative to major amputation for the management of recalcitrant DFUs. Overall rates of flap survival, limb salvage, and postoperative ambulation were evaluated. The lower extremity functional scale (LEFS) score was used to assess functional outcomes after surgery.
Results Overall rates of flap success and lower limb salvage were 93 and 79%, respectively. Flap failure occurred in two patients with delayed microvascular compromise. Seven patients in this series ultimately required below-knee amputation secondary to recalcitrant infection (n = 5), intractable pain (n = 1), and limb ischemia (n = 1). The average interval between FTT and major amputation was 8 months (r, 0.2–15 months). Postoperative ambulation was confirmed in 25 patients (86%) after a mean final follow-up of 25 months (r, 10–48 months). The average LEFS score for all patients was 46 out of 80 points (r, 12–80 points), indicating the ability to ambulate in the community with some limitations.
Conclusion FTT for the management of recalcitrant DFUs is associated with high rates of reconstructive success and postoperative ambulation. However, several patients will eventually require major amputation for reasons unrelated to ultimate flap survival. These data should be used to counsel patients regarding the risks, functional implications, and prognosis of microvascular diabetic foot reconstruction.
Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps
Authors: Ritschl Lucas , Georg Rali , Kolk Andreas , Kesting Marco , Wolff Klaus-Dietrich , Mücke Thomas , Fichter Andreas 
Published: August 2018

Background Indocyanine green (ICG) videoangiography is routinely used to evaluate skin and organ perfusion and to assess patency rates of microvascular anastomoses. This study uses ICG angiography as a novel approach to qualitatively and quantitatively evaluate bone perfusion of microvascular fibula grafts intraoperatively and to assess the effect of fibula segment length and number of osteotomies on bone perfusion.
Methods All patients planned for mandible reconstruction using a microvascular fibula graft between January 2013 and May 2017 were considered for this study. ICG videoangiography of cancellous bone perfusion was performed using a handheld ICG camera. Videos were analyzed, and a perfusion curve was generated. Peak enhancement, time to peak, slope, and wash-in area under the curve were extracted; rise time, wash-in rate (WiR), and wash-in perfusion index were calculated. Results were statistically analyzed with regard to distal fibula segment length and number of osteotomy sites.
Results Thirty-nine patients (age 59 ± 8 years) were included in the study. Mandible reconstruction was achieved with 1 (n = 15), 2 (n = 13), or 3 (n = 11) fibula segments. The WiR was 6.4 ± 2.3 and 4.4 ± 0.2 before and after proximal osteotomy, respectively. The wash-in perfusion index was 114.2 ± 48.4 before and 84.4 ± 20.0 after proximal osteotomy. Bone perfusion was significantly reduced after additional proximal osteotomies. Both the segment length and number of proximal osteotomies correlated with bone perfusion, with longer segments and fewer osteotomies showing higher perfusion.
Conclusion This study demonstrates the feasibility of cancellous bone perfusion analysis using ICG and can serve as a basis for future bone perfusion studies. Additional osteotomies and short segment length negatively affects cancellous bone perfusion of the distal fibula segment in free fibula flaps. The extent to which the observed decrease in arterial inflow to the distal fibula segment affects the further course of healing needs to be addressed in future studies.
Impact of Contralateral Symmetry Procedures on Long-Term Patient-Reported Outcomes following Unilateral Prosthetic Breast Reconstruction
Authors: Razdan Shantanu , Panchal Hina , Albornoz Claudia , Pusic Andrea , McCarthy Colleen , Cordeiro Peter , Disa Joseph , Mehrara Babak , Matros Evan 
Published: August 2018

Background One aim of unilateral postmastectomy breast reconstruction (BR) is to restore symmetry with the contralateral breast. As such, unilateral prosthetic reconstruction often requires a contralateral symmetry procedure (CSP). There is sparse literature on the impact of CSPs on long-term patient-reported outcomes (PROs) such as satisfaction and health-related quality of life (HRQoL). This study aims to describe PROs following CSPs, using a validated PRO tool, BREAST-Q. The hypothesis is that CSPs are associated with greater patient-reported satisfaction and HRQoL.
Methods This study is a single institutional analysis of prospectively collected BREAST-Q scores of patients who underwent unilateral prosthetic BR during 2011 to 2015. Women 18 years and older with BREAST-Q scores measured ≥ 9months after BR with or without CSP(s) at the time of expander replacement were included. Patients were classified into four subcohorts: augmentation, mastopexy, reduction, and no symmetry procedure (controls). Sociodemographic, clinical characteristics, and BREAST-Q scores were analyzed. Multivariable linear regression was performed.
Results Of 553 patients, 67 (12%) underwent contralateral augmentation, 68 (12%) mastopexy, 93(17%) reduction, and 325 (59%) were controls. Mean follow-up time was 52 months. Satisfaction with breast and outcomes were higher in the augmentation compared with the control groups (p = 0.01). On multivariable analysis, augmentation remained an independent predictor of satisfaction with breast (p = 0.04). Physical well-being scores were lower for contralateral mastopexy and reduction compared with the controls with a trend toward statistical significance on multivariable models. Psychological and sexual well-being was similar across groups.
Conclusion Prosthetic reconstruction with contralateral breast augmentation was associated with greater satisfaction with breast and reconstructive outcome. In contrast, breast reduction and mastopexy procedures demonstrated equivalent satisfaction with breasts compared with controls but may be associated with lower physical well-being. Such information can be used to improve the shared decision-making process for women who choose unilateral prosthetic BR.
Practice Patterns after the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial: A Survey of Pediatric Critical Care Physicians
Authors: Gildea Marianne , Moler Frank , Page Kent , Pemberton Victoria , Holubkov Richard , Nadkarni Vinay , Dean J. , Olson Lenora 
Published: August 2018

AbstractThe Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) Trial showed therapeutic hypothermia, versus normothermia, did not significantly improve 1-year survival with good neurobehavioral outcome. Our survey of pediatric critical care physicians, designed to assess the use of targeted temperature management (TTM) after publication of the main THAPCA-OH Trial results, found most respondents were aware of trial results, and over 90% agreed THAPCA-OH was well-designed with important clinical outcomes. While most respondents reported TTM usage consistent with THAPCA-OH results in different patient scenarios, 15% did not select TTM for fever management. Since trials prior to THAPCA-OH established that fever is harmful following brain injury, the continued incomplete adoption of TTM warrants further research on challenges and facilitators to the adoption of clinical trial findings.
Functional Dissociation between Cognitive Estimation and Object Naming in Focal Temporal and Frontal Lobe Epilepsies
Authors: Braun Isabella , Schwarz Michael , Walther Katrin , Stemmler Mark , Kasper Burkhard , Hamer Hajo 
Published: August 2018

Abstract
Purpose This study addresses specific impairments of cognitive estimation and object naming in patients with focal temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). It was investigated whether selective impairments can be explained by differences in lesion localization and functional hemispheric specialization.
Materials and Methods Seventy-eight patients (39 females, 39 males) with FLE and TLE were investigated using the German “Test zum Kognitiven Schätzen” and the “Boston Naming Test” to assess cognitive estimation abilities and visual object naming.
Questions According to theoretical models that support a distinct hemispheric dominance for estimation and naming, it was expected that epilepsy localization in the right hemisphere would result in impairments of cognitive estimation, whereas patients with left epileptogenic foci would show deficits in object naming.
Results In comparison to a healthy control group, a significant impairment in estimation performance was present in patients with right temporal mesial and right frontal epilepsy. A significant impairment of naming performance was found in patients with left temporal mesial, right temporal mesial, left temporal neocortical, and left frontal epilepsy. Overall, localization-dependent deficits were detected in patients with hippocampal sclerosis (cognitive estimation and object naming), right frontal epilepsy (cognitive estimation), and left temporal neocortical/left frontal epilepsy (object naming). In patients with right temporal neocortical epilepsy, no functional deficits were found.
Conclusion It is hypothesized that there is a functional dissociation between cognitive estimation processes and object naming due to different functional specialization of the left and right hemispheres, respectively.
Hand Perfusion in Patients with Physiological or Pathological Allen's Tests
Authors: Flick Nina , Kamal Mohammad , Steegmann Julius , Kloss-Brandstätter Anita , Teichmann Jan , Hölzle Frank , Lethaus Bernd , Bartella Alexander 
Published: August 2018

Background The Allen test (AT) is a widely used clinical tool for the preoperative assessment of sufficient dual vessel hand perfusion although the impact of a pathological AT on tissue perfusion of the hand is not entirely clear. This study reveals perfusion changes of the hand in patients with pathological and physiological AT after terminating the dual blood supply.
Methods Patients were distributed into 2 groups (physiological and pathological AT) that each contained 25 members. Perfusion of the thumb, middle, and small fingers was measured with a laser Doppler based (“oxygen-to-see” [O2C]) device. A steady state was measured and also values at 1, 3, 5, and 10 minutes after radial occlusion were measured.
Results In patients with a physiological AT, only 1 out of 18 values differed significantly from the steady state measurements after 10 minutes, whereas patients with a pathological AT showed significant alterations in 8 out of 18 values. Oxygen saturation of the superficial and deep tissues appeared to be significantly worse in patients with a pathological AT.
Conclusion Patients with a pathological AT suffered significantly more from the loss of dual hand perfusion than patients with a physiological AT. Patients with a pathological AT need more time to compensate for the altered perfusion pattern.
Use and Opinions of Prescription Opioids Among Older American Adults: Sociodemographic Predictors
Authors: Grol-Prokopczyk Hanna 
Published: August 2018

Abstract

Objectives
This study identifies sociodemographic predictors of prescription opioid use among older adults (age 65+) during the peak decade of U.S. opioid prescription, and tests whether pain level and Medicaid coverage mediate the association between low wealth and opioid use. Predictors of prescription nonsteroidal anti-inflammatory drug (NSAID) use, and of opinions of both drug classes, are also examined.

Method
Regressions of opioid and NSAID use on sociodemographic characteristics, pain level, and insurance type were conducted using Health and Retirement Study 2004 core and 2005 Prescription Drug Study data (n = 3,721). Mediation analyses were conducted, and user opinions of drug importance, quality, and side effects were assessed.

Results
Low wealth was a strong, consistent predictor of opioid use. Both pain level and Medicaid coverage significantly, but only partially, mediated this association. Net of wealth, there were no significant associations between education and use of, or opinions of, either class of drugs.

Discussion
Among older American adults, the poorest are disproportionately likely to have been exposed to prescription opioid analgesics. Wealth, rather than education, drove social class differences in mid-2000s opioid use. Opioid-related policies should take into account socioeconomic contributors to opioid use, and the needs and treatment histories of chronic pain patients.
Implementation trial of school staff health promotion: Polish experiences
Authors: Woynarowska-Sołdan Magdalena 
Published: August 2018

SummaryThe paper presents the results of the trial implementation of staff health promotion in the Health Promoting Schools (HPS) programme in Poland. The design and key results of the summative evaluation of the 3-year project and activities of schools after completion of the project are described. Over 900 teachers and non-teaching employees from 21 schools participated in the project. Its purpose was to verify the schools’ ability to take action related to the promotion of staff health in the HPSs in Poland. The results of the summative evaluation of the project were considered positive and promising. The percentage of persons who declared that they take greater care of their health, and teachers who described their health as very good, increased. Most employees introduced beneficial changes in their health behaviours. In all schools, changes in working conditions and personnel relations were introduced. Eighty-two per cent of teachers and seventy-five per cent of other employees had a positive attitude to the project and ninety per cent declared that the activities ought to be continued. Nearly all the schools’ project leaders considered it a valuable initiative, had personal benefits and satisfaction from its implementation. After completing the project, 16/20 schools continued activities promoting the health of employees. Since the trial implementation of health promotion among school staff was considered a success, in 2016 some indicators relating to school staff health were included in the self-evaluation of HPS, and work began to prepare coordinators of regional and district HPS networks to work with the schools.
Stressful conditions affect reproducing cuttlefish (Sepia officinalis), reducing egg output and quality
Authors: O’Brien Caitlin E , Bellanger Cécile , Jozet-Alves Christelle , Mezrai Nawel , Darmaillacq Anne-Sophie , Dickel Ludovic 
Published: August 2018

Abstract
Stress has profound effects on animals, particularly if it occurs during reproduction or embryonic development. The cuttlefish Sepia officinalis is an economically and scientifically important species that is often cultured in captivity. The effects of stressors applied to reproducing females and developing embryos were investigated and compared by measuring the number and quality of eggs produced by females in a typical captive setting with females subjected to stress during egg-laying (confined space and repeated removal from the water) as well as comparing the hatching size and success of embryos subjected to naturally occurring (predator cues) and artificial (random bouts of bright LED light) stressors. Stressed females produced significantly fewer eggs and fewer of those eggs hatched. In addition, nearly a quarter of stressed mothers laid mostly white eggs lacking the dark pigment typical of this species. In contrast to maternal stress, stressors applied directly to embryos had no effect on hatching rate and neither maternal nor embryonic stress was associated with differences in hatching size. Our results suggest that reducing stress during egg-laying can increase aquacultural egg yields in S. officinalis and that the presence of pigment-less (white) eggs is a sign of maternal stress during egg-laying.
Robust H∞ control of neutral system for sampled-data dynamic positioning ships
Authors: Zheng Minjie , Zhou Yujie , Yang Shenhua , Li Lina 
Published: August 2018

Abstract
This study focuses on the robust ${H}_{\infty }$ sampled-data control problem of neutral system for dynamic positioning (DP) ships. Using the input delay approach and a state-derivative control law, the ship DP system is turned into a neutral system with time-varying delays. By incorporating the delay-decomposition technique, Wirtinger-based integral inequality and an augmented Lyapunov–Krasovskii functional, less conservative result is derived for the resulting system. Sufficient conditions are established to determine the system’s asymptotical stability and achieve ${H}_{\infty }$ performance using Lyapunov stability theorems. Then the ${H}_{\infty }$ sampled-data controller is obtained by analyzing the stabilization conditions. Finally, simulation result is shown that the proposed method is effective.
The Korean Triage and Acuity Scale: associations with admission, disposition, mortality and length of stay in the emergency department
Authors: Kwon Hyuksool , Kim Yu Jin , Jo You Hwan , Lee Jae Hyuk , Lee Jin Hee , Kim Joonghee , Hwang Ji Eun , Jeong Joo , Choi Yoo Jin 
Published: August 2018

Abstract

Objective
The Korean Triage and Acuity Scale (KTAS) was implemented in our emergency department (ED) in May 2016 and is fully integrated into the electronic medical record (EMR) system. Our objective was to determine whether the KTAS is associated with changes in admissions to the hospital, admission disposition, inpatient mortality and length of stay (LOS).

Design
Quasi-experimental, uncontrolled before-and-after study.

Setting
The urban tertiary teaching hospital with 1100 beds and receives approximately annual 90 000 ED visits.

Participants
122 370 patients who visited the ED during the before-and-the after period.

Interventions
ED staff were educated on the KTAS for 1 month, after which the KTAS evaluation period began. Admission, disposition, mortality and LOS were compared between the ‘before’ period (1 June 2015 to 30 April 2016) and the ‘after’ period (1 June 2016 to 30 April 2017).

Main outcome measures
Admissions to the hospital, admission disposition, inpatient mortality and LOS.

Results
A total of 59 220 and 63 150 patients were included in the before-and-after periods of KTAS implementation, respectively. The pattern of admission and disposition changed significantly after implementation of the KTAS. The mean LOS was 343 min (standard deviation [SD] = 432 min) during the before period, which significantly decreased to 289 min (SD = 333 min) after implementation (P < 0.001). The total mortality rate was significantly reduced after implementation of the KTAS (213 (0.36%) vs. 179 (0.28%), P = 0.020).

Conclusion
Implementation of the KTAS changed admission and disposition patterns and reduced the LOS and mortality in the ED.
Heterogeneous network embedding for identifying symptom candidate genes
Authors: Yang Kuo , Wang Ning , Liu Guangming , Wang Ruyu , Yu Jian , Zhang Runshun , Chen Jianxin , Zhou Xuezhong 
Published: August 2018

Abstract

Objective
Investigating the molecular mechanisms of symptoms is a vital task in precision medicine to refine disease taxonomy and improve the personalized management of chronic diseases. Although there are abundant experimental studies and computational efforts to obtain the candidate genes of diseases, the identification of symptom genes is rarely addressed. We curated a high-quality benchmark dataset of symptom-gene associations and proposed a heterogeneous network embedding for identifying symptom genes.

Methods
We proposed a heterogeneous network embedding representation algorithm, which constructed a heterogeneous symptom-related network that integrated symptom-related associations and applied an embedding representation algorithm to obtain the low-dimensional vector representation of nodes. By measuring the relevance between symptoms and genes via calculating the similarities of their vectors, the candidate genes of given symptoms can be obtained.

Results
A benchmark dataset of 18 270 symptom-gene associations between 505 symptoms and 4549 genes was curated. We compared our method to baseline algorithms (FSGER and PRINCE). The experimental results indicated our algorithm achieved a significant improvement over the state-of-the-art method, with precision and recall improved by 66.80% (0.844 vs 0.506) and 53.96% (0.311 vs 0.202), respectively, for TOP@3 and association precision improved by 37.71% (0.723 vs 0.525) over the PRINCE.

Conclusions
The experimental validation of the algorithms and the literature validation of typical symptoms indicated our method achieved excellent performance. Hence, we curated a prediction dataset of 17 479 symptom-candidate genes. The benchmark and prediction datasets have the potential to promote investigations of the molecular mechanisms of symptoms and provide candidate genes for validation in experimental settings.
A Coskewness Shrinkage Approach for Estimating the Skewness of Linear Combinations of Random Variables*
Authors: Boudt Kris , Cornilly Dries , Verdonck Tim 
Published: August 2018

Abstract
Decision-making in finance often requires an accurate estimate of the coskewness matrix to optimize the allocation to random variables with asymmetric distributions. The classical sample estimator of the coskewness matrix performs poorly for small sample sizes. A solution is to use shrinkage estimators, defined as the convex combination between the sample coskewness matrix and a target matrix. We propose unbiased consistent estimators for the MSE loss function and include the possibility of having multiple target matrices. In a portfolio application, we find that the proposed shrinkage coskewness estimators are useful in mean–variance–skewness efficient portfolio allocation of funds of hedge funds.