bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors That Predict Institutional Adoption of Professional Physical Therapist Education Programs
Authors: Dickson Tara , Taylor Barrett J 
Published: March 2019

Abstract

Background
Between 1995 and 2015, the number of accredited physical therapist education programs in the United States rose from 127 to 224. Colleges and universities have been known to develop new programs in an effort to generate revenues through student tuition.

Objective
In the present study, sources of institutional revenue and expenditures were used as predictors for the adoption of physical therapist education programs.

Design
Yearly data from the Integrated Postsecondary Education Data System for 1731 higher education institutions were combined with dates from the Commission on Accreditation in Physical Therapy Education for physical therapist education program accreditation from 1995 to 2015.

Methods
A retrospective event history analysis of yearly institutional data was used to calculate the hazard of an institution adopting a physical therapist education program on the basis of institutional revenues and expenditures.

Results
Private institutions were 62% less likely to adopt a physical therapist education program when they experienced a 1% increase in total revenue per full-time–equivalent student. Conversely, a given private institution was 2.71 times more likely to adopt a physical therapist education program for every 1% increase in total expenditures per full-time–equivalent student. Both public and private institutions experienced an increased chance of adopting an entry-level (professional) physical therapist education program when instructional expenditures rose. They were also more than twice as likely to adopt physical therapist education programs when they experienced a 1% increase in the number of students.

Limitations
Causation between professional physical therapist education program adoption and the variables studied cannot be determined through observational analysis alone.

Conclusions
The more revenue a private institution generated, the less likely it was to add a program in the search for further revenues. As expenses rose, the chance of adoption trended upward beyond increases in institutional revenues for both public and private not-for-profit institutions.
Evaluation complacency or evaluation inertia? A study of evaluative metrics and research practices in Irish universities
Authors: Ma Lai , Ladisch Michael 
Published: March 2019

AbstractEvaluative metrics have been used for research assessment in most universities and funding agencies with the assumption that more publications and higher citation counts imply increased productivity and better quality of research. This study investigates the understanding and perceptions of metrics, as well as the influences and implications of the use of evaluative metrics on research practices, including choice of research topics and publication channels, citation behavior, and scholarly communication in Irish universities. Semi-structured, in-depth interviews were conducted with researchers from the humanities, the social sciences, and the sciences in various career stages. Our findings show that there are conflicting attitudes toward evaluative metrics in principle and in practice. The phenomenon is explained by two concepts: evaluation complacency and evaluation inertia. We conclude that evaluative metrics should not be standardized and institutionalized without a thorough examination of their validity and reliability and without having their influences on academic life, research practices, and knowledge production investigated. We also suggest that an open and public discourse should be supported for the discussion of evaluative metrics in the academic community.
‘To Be Shut Up’: New Evidence for the Development of Quarantine Regulations in Early-Tudor England
Authors: Roger Euan C 
Published: March 2019

Summary
On 13 January 1518, a series of ordinances to regulate plague outbreaks were proclaimed in London. These have previously been thought to have been the first set of quarantine measures issued in England; part of an ambitious new social policy led by the King’s chief minister, Cardinal Thomas Wolsey, and intended to bring England in line with the leading Renaissance states in Europe. The discovery of two previously unknown documents from the archives of St George’s College, Windsor—which predate the London ordinances—requires a reconsideration of this narrative. The article argues that demands for plague quarantine regulations were driven primarily by Henry VIII’s personal and pronounced fear of infection and considers the factors that may have led to such a fear. In doing so, it introduces new evidence for the death of Henry’s grandmother, Elizabeth Woodville, and explores the ways in which medical ideas travelled across Europe.
An Interdisciplinary, Multi-Institution Telehealth Course for Third-Year Medical Students
Authors: Jonas Christopher E. , Durning Steven J. , Zebrowski Catherine , Cimino Francesca 
Published: March 2019

Problem
The American Medical Association has called for telehealth to become a core competency of medical students. Studies indicate that a principal reason physicians do not practice telehealth is lack of training, yet patient interest in and satisfaction with telehealth are high. No comprehensive U.S. undergraduate medical education curriculum teaching telehealth principles has been published.

Approach
In February 2018, the Uniformed Services University of the Health Sciences (USU) provided an innovative telehealth training experience for third-year medical students. USU led an interinstitutional, interprofessional learner-centered course including six segments: (1) multiple-choice pretest; (2) asynchronous lectures covering telehealth history, applications, ethics, safety, military uses, etiquette, and patient considerations; (3) in-person interactive telehealth instruction including patient selection, current uses, and risk management; (4) faculty-supervised mock patient telehealth encounters; (5) hands-on diagnosis and advanced surgical procedures using telehealth equipment; and (6) multiple-choice posttest.

Outcomes
This course was piloted with 149 third-year medical students. Students’ improvement in telehealth knowledge was demonstrated through (1) 10.1% average improvement between pre- and posttest scores, (2) completion of competency-based checklists, and (3) postcourse preceptor and student feedback. Faculty feedback indicated that technology use was novel and effective based on student input. Faculty noted that students enjoyed engaging via videoconference. Of participating medical students, 119 (80%) indicated future plans to practice telehealth; several requested to be part of future telehealth courses.

Next Steps
Telehealth will be integrated into clinical rotations in collaboration with other institutions. As the telehealth curriculum is taught at other institutions, lessons learned will inform enhancements at USU.
Near-infrared Spectroscopy–derived Cerebral Autoregulation Indices Independently Predict Clinical Outcome in Acutely Ill Comatose Patients
Authors: Rivera-Lara Lucia , Geocadin Romegryko , Zorrilla-Vaca Andres , Healy Ryan , Radzik Batya R. , Palmisano Caitlin , White Mirinda A. , Sha Dhaval , Ponce-Mejia Luciano , Brown Charles , Hogue Charles , Ziai Wendy C. 
Published: March 2019

Objective:
Outcome prediction in comatose patients with acute brain injury remains challenging. Regional cerebral oxygenation (rSO2) derived from near-infrared spectroscopy (NIRS) is a surrogate for cerebral blood flow and can be used to calculate cerebral autoregulation (CA) continuously at the bedside from the derived cerebral oximetry index (COx). We hypothesized that COx derived thresholds for CA are associated with outcomes in patients with acute coma from neurological injury.

Methods:
A prospective cohort study was conducted in 88 acutely comatose adults with heterogenous brain injury diagnoses who were continuously monitored with COx for up to 3 consecutive days. Multivariable logistic regression was performed to investigate association between averaged COx and short (in-hospital and 3 mo) and long-term (6 mo) outcomes.

Results:
Six month mortality rate was 62%. Median COx in nonsurvivors at hospital discharge was 0.082 [interquartile range, IQR: 0.045 to 0.160] compared with 0.042 [IQR: −0.005 to 0.110] in survivors (P=0.012). At 6 months, median COx was 0.075 [IQR: 0.27 to 0.158] in nonsurvivors compared with 0.029 [IQR: −0.015 to 0.077] in survivors (P=0.02). In the multivariable logistic regression model adjusted for confounders, average COx ≥0.05 was associated with both in-hospital mortality (adjusted odds ratio [OR]=2.9, 95% confidence interval [CI]=1.15-7.33, P=0.02), mortality at 6 months (adjusted OR=4.4, 95% CI=1.41-13.7, P=0.01), and severe disability (modified Rankin Score ≥4) at 6 months (adjusted OR=4.4, 95% CI=1.07-17.8, P=0.04). Area under the receiver operating characteristic curve for predicting mortality and severe disability at 6 months were 0.783 and 0.825, respectively.

Conclusions:
Averaged COx ≥0.05 is independently associated with short and long-term mortality and long-term severe disability in acutely comatose adults with neurological injury. We propose that COx ≥0.05 represents an accurate threshold to predict long-term functional outcome in acutely comatose adults.
Bone Conduction Amplification in Children: Stimulation via a Percutaneous Abutment versus a Transcutaneous Softband
Authors: Pittman Andrea L. 
Published: March 2019

Objectives:
Research suggests that the speech perception of children using bone conduction amplification improves if the device is coupled to an implanted abutment rather than to a softband. The purpose of the present study was to determine if the benefit of direct stimulation via an abutment is limited to small improvements in speech perception or if similar or greater benefits occur for other auditory tasks important for learning and communication.

Design:
Fourteen children (7 to 15 years of age) with bilateral conductive and three children with unilateral conductive or sensorineural hearing loss were enrolled. Each child completed four tasks while using a bone conduction device coupled to an implanted abutment and with the device coupled to a softband. The two devices were worn at the same time and activated one at a time for testing. The children completed four tasks under each coupling condition: (a) a traditional word recognition task, (b) an auditory lexical decision task in which the children repeated aloud, and indicated the category of, real and nonsense words, (c) a nonsense-word detection task which required the children to identify nonsense words within short sentences, and (d) a rapid word learning task in which the children learned to associate nonsense words with novel images.

Results:
Regression analyses revealed that age, duration of device use, in-situ hearing thresholds, or device output did not account for a significant portion of the variability in performance for any of the four tasks. Repeated-measures analysis of variance revealed significant increases in word recognition with the abutment as well as significantly better performance for the lexical decision and word learning tasks. The data indicated that the children with the poorest performance with the softband tended to benefit most with the abutment. Also, the younger children showed improved performance for more tasks with the abutment than the older children. No difference between coupling conditions was observed for nonsense-word detection.

Conclusions:
The improved recognition of familiar words, categorization and repetition of nonsense words, and speed of word learning with the abutment suggests that direct stimulation provides a higher-quality signal than indirect stimulation through a softband. Because these processes are important for vocabulary acquisition and language development, children may experience long-term benefits of direct stimulation for academic, social, and vocational purposes in addition to immediate improvement in communication.
Nurses' Perspectives on Spiritual Caregiving
Authors: Janzen Kyla C. , Reimer-Kirkham Sheryl , Astle Barbara 
Published: March 2019

ABSTRACT:This qualitative secondary analysis explored the narratives of 14 nurses from various practice settings. Data analysis identified that although nurses share responsibility for spiritual caregiving for their patients, the ability to provide this care is greatly influenced by intrinsic and the extrinsic factors. Spiritual caregiving was seen as both a discrete act that facilitated patients' spiritual practices and, in other situations, took the form of integrative spiritual caregiving that was part of the interpersonal connection in the nurse–patient relationship.
Crescentic Modification to Island Pedicle Rotation Flaps for Defects of the Distal Nose
Authors: Howe Nicole M. , Chen David L. , Holmes Todd E. 
Published: March 2019

BACKGROUND
Island pedicle flaps based on a lateral sling of the nasalis have difficulty reaching distal nasal defects due to tethering of the muscle to its insertion point. The authors hypothesized that reach could be improved by modifying a crescentic flap to rotate around a pivot point equidistant to the flap and the defect.

OBJECTIVE
To describe the design, execution, and results with a modified crescentic island pedicle rotation flap for repair of distal nasal defects after Mohs micrographic surgery.

METHODS
The authors performed a retrospective analysis of patients who had distal nasal defects repaired with a modified crescentic island pedicle rotation flap over an 8-year period. All charts and photographs were examined. Sex and age of the patient, type of cutaneous carcinoma, location and size of the defect, and complications were recorded.

RESULTS
Forty-eight patients were included. The flap was used to successfully reconstruct defects on the distal nose ranging in size from 0.25 cm2 to 3.8 cm2. Complications involved one wound infection and one episode of postoperative bleeding.

CONCLUSION
The authors' modifications to the island pedicle flap may be reliably used to reconstruct small- to medium-sized defects of the distal nose in a single stage with minimal risk of complications.
Shear Wave Elastography in the Evaluation of Facial Skin Stiffness After Focused Ultrasound Treatment
Authors: Paluch Lukasz , Ambroziak Marcin , Pietruski Piotr , Noszczyk Bartlomiej 
Published: March 2019

BACKGROUND
No objective method for the evaluation of facial aesthetic procedures has been proposed thus far. The authors hypothesized that shear wave elastography may be an appropriate method to evaluate the outcomes of some aesthetic treatments.

OBJECTIVE
The aim of the study was to compare elastographic parameters of facial skin, subcutaneous fat, and superficial musculoaponeurotic system before high-intensity focused ultrasound treatment and 60 days after this procedure.

METHODS AND MATERIALS
The study included 57 female patients aged 51.5 ± 7.3 years. Shear wave elastography of facial skin was performed before the aesthetic procedure and 2 months thereafter.

RESULTS
Baseline stiffness of all examined layers correlated inversely with patients' age. Sixty days after the aesthetic treatment, the stiffness of all tissues improved significantly. The extent of the improvement correlated inversely with patients' body mass index.

CONCLUSION
Shear wave elastography can accurately assess the outcomes of facial treatment with high-intensity focused ultrasound. Using this method, the authors documented improved stiffness of facial skin as early as 60 days after the procedure. The beneficial effect of the aesthetic treatment was observed regardless of patients' age but was less evident in women with excess body weight.
Orbital Nasal-Type Extranodal Natural Killer/T-Cell Lymphoma: An Ongoing Diagnostic Challenge Further Confounded by Small-Cell Predominance
Authors: Wolkow Natalie , Jakobiec Frederick A. , Habib Larissa A. , Freitag Suzanne K. 
Published: March 2019

Purpose:
To highlight the histopathologic diagnostic challenges of small-cell predominant extranodal nasal-type natural killer/T-cell lymphoma (ENTNKT) of the orbit.

Methods:
Retrospective chart review and histopathologic study with immunohistochemistry and in situ hybridization of 3 cases.

Results:
Three cases of ENTNKT presented to the Mass Eye and Ear emergency room as orbital cellulitis over 1 year. The first case was unusual in that there was a predominance of small cells, giving the ENTNKT the histopathologic appearance of a nonmalignant inflammatory process. This challenging case is juxtaposed alongside 2 other cases, which exhibited the more typical lymphomatous microscopic appearance.

Discussion:
ENTNKT can extend into the orbit from the adjacent sinuses or rarely arise primarily in the orbit. A diagnosis is typically made with a biopsy. Occasionally, however, the histopathologic diagnosis can be elusive when a predominance of small lymphomatous cells that are virtually indistinguishable from non-neoplastic inflammatory cells is present. Demonstration of CD56 positivity by immunostaining and in situ hybridization for Epstein–Barr virus are essential in confirming the diagnosis.

Conclusions:
ENTNKT should be considered both in the clinical and histopathologic differential diagnoses of orbital infections and idiopathic inflammations (pseudotumor).
Early Mobilization of Patients With External Ventricular Drains: Does Therapist Experience Matter?
Authors: Stout Kristen , Ankam Nethra S. , Athar M. Kamran , Bu Paula , Dabbish Nooreen S. , Leiby Benjamin E. , Melnyk Sara , Shah Syed Omar , Tarkiainen Ashley 
Published: March 2019

Objective:
Growing evidence supports the benefits and safety of early mobilization of patients in intensive care units. Frequently cited barriers to early mobilization are insufficient staffing and training. This study examines the number of professionals and years of physical therapy or occupational therapy experience needed to mobilize patients in neuro-intensive care units with external ventricular drains (EVDs).

Design:
The study was a retrospective review of a prospective quality improvement database, which includes 185 encounters with 90 patients with EVDs from June 2014 through July 2015.

Results:
Ninety-five percent of encounters required at most 2 professionals for mobilization. No evidence of association between number of people required to mobilize and highest activity achieved was found. Neither the number of people to mobilize patients nor the primary therapist's years of experience were associated with the type of activity achieved or the occurrence of an adverse event.

Conclusion:
This analysis suggests that patients with EVDs in the neuro-intensive care unit can be safely and efficiently mobilized by physical therapists and occupational therapists of varying levels of clinical experience. Early mobilization of patients with EVDs may demand fewer staff resources than perceived by clinicians.
Surgical Flaps in Mohs Micrographic Surgery
Authors: Goddard Lindsey , Ivey Lauren , Seeburger Jack 
Published: March 2019

ABSTRACT
Skin cancer can be broadly categorized into melanoma and nonmelanoma skin cancer (NMSC). Squamous cell carcinoma and basal cell carcinoma are the most common subtypes of NMSC. When a patient presents with a skin finding suspect for NMSC, a confirming skin biopsy is performed. On the basis of the biopsy results, patient factors, and clinical characteristics of the cancer, an appropriate form of treatment is selected. Mohs micrographic surgery (or Mohs) is a tissue-sparing surgical approach, utilizing frozen section margin control. Once removal of the NMSC has been assured by Mohs surgery, the resultant skin defect is evaluated for repair. The choice of repair should maintain or restore function and aesthetic form while minimizing skin tension. Using a skin flap may be the best choice of repair to achieve these goals. Here, we describe both rotation and advancement flaps. Rotation flaps are constructed using an arciform incision adjacent to the original wound. Advancement flaps describe the movement of skin and tissue directly forward to close the wound, employing no rotational movement. There are three main subtypes of advancement flaps: unidirectional, bidirectional, and island pedicle or V-to-Y flaps.
Effect of Korean medicine as add-on therapy to phototherapy for psoriasis
Authors: Lee Sam-Ro , Kim Sungha , Park Chul-Eun , Lee Jun-Hwan , Lee Dong-Hyo 
Published: March 2019

Abstract

Rationale:
Psoriasis is a common chronic, immune-mediated inflammatory skin disease. Here, we describe 2 patients who presented with psoriasis to illustrate the potential efficacy of Korean medicine treatment combined with phototherapy.

Patient concerns:
A 33-year-old female (Case 1) and a 37-year-old male (Case 2) presented at the clinic with symptoms of itching, erythema, and scaliness.

Diagnosis:
Both patients were diagnosed with psoriasis based on the locations of erythema, as well as the appearance of circumscribed scaly papules and plaques.

Interventions:
Patients underwent 5 months (Case 1) and 8 months (Case 2) of treatments with acupuncture, herbal medicine, probiotics, and phototherapy.

Outcomes:
After treatment, the patients improved in Psoriasis Area and Severity Index score from 7 to 1.2 (Case 1), and 23.2 to 2.2 (Case 2).

Lessons:
These outcomes suggest that Korean medicine therapies combined with phototherapy may be effective for resolution of psoriasis; however, further research is needed to confirm these findings.
Tranexamic acid can reduce blood loss in patients undergoing intertrochanteric fracture surgery
Authors: Jiang Wenming , Shang Liyong 
Published: March 2019

Abstract

Background:
This meta-analysis aimed to assess whether administration tranexamic acid (TXA) could reduce blood loss and transfusion requirements in patients undergoing intertrochanteric fracture surgery.

Methods:
We performed an electronic search of PubMed (1950–October 2018), EMBASE (1974–October 2018), the Cochrane Library (October 2018 Issue 3), the Google database (1950–October 2018), and the Chinese Wanfang database (1950–October 2018). Studies were included in accordance with Population, Intervention, Comparison, Outcomes, and Setting (PICOS) including criteria. Intertrochanteric fracture patients prepared for surgery were selected. Administration with TXA and the placebo or no interventions were considered as an intervention and comparators, respectively. Measures related to total blood loss, blood loss in drainage, hemoglobin on postoperative day were analyzed. A fixed/random-effects model was used according to the heterogeneity assessed by the I
2 statistic. Data analysis was performed using Stata 12.0 software.

Results:
A total of five RCTs with 584 patients (TXA group = 289, control group = 298) were included in the meta-analysis. Based on the results, administration of TXA was associated with a reduction in total blood loss, blood loss in drainage, need for transfusion, length of hospital stay, and occurrence of hematoma (P < .05). Administration of TXA increased the hemoglobin level at 3 days after surgery (P < .05). There were no significant differences between the two groups in terms of the occurrence of deep venous thrombosis, pulmonary embolism, or infection (P > .05).

Conclusion:
Administration of TXA is associated with reduced total blood loss, postoperative hemoglobin decline, and transfusion requirements in patients with intertrochanteric fractures. Additional high-quality RCTs should be conducted in the future.