bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a Self-contained Clinical Learning Space on a Physical Therapist Assistant Education Program
Authors: Reese Suzanne , Brown Suzanne Robben 
Published: May 2018

Background and Purpose.
Immersion within practice areas or clinical education (CE) experiences are required to be both integrated within the curriculum (ie, integrated clinical education [ICE] experiences) and at the end of the curriculum (ie, terminal clinical education [TCE] experiences) for an accredited physical therapist assistant (PTA) education program. In addition, programs must meet accreditation requirements for ICE and TCE within specified clock hour (520–720) and program length limitations (five semesters). The purpose of this article was to describe one program's model for providing integrated PTA CE in a self-contained learning space and to describe the outcomes achieved in the first 2 years of operation.

Method/Model Description and Evaluation.
Planning, administrative approval, community fund-raising, and institutional capital budget allocation commitments took 6 years before the Nate Waters Physical Therapy Clinic (NWPTC) at Tulsa Community College, Tulsa, OK, opened in August 2014. The clinic design is based on a learning spaces framework providing students an actual clinic setting to learn and practice skills. The learning space allows students to gain clinical confidence in a comfortable, supportive learning environment, in which time restraints, high productivity requirements, and reimbursement restrictions are eliminated or minimized for the novice student. A mixed-method program evaluation assessed the 2-year performance of the self-contained clinic with two quantitative and three qualitative assessments.

Outcomes.
Implementation of the self-contained clinic allowed for a curriculum reduction of clinical hours from 680 to 560. The clinic generated an average of 65 visits each month with a range of 41–124 visits. No significant difference was found on the PTA students' midterm scores from the final TCE's Clinical Performance Instrument (PTA CPI, Version 1998) for the 2015 and 2016 cohorts compared with two preclinic cohorts (2013 and 2014), despite 22% less clinical time for the studied cohorts. Qualitative interviews of faculty and students showed three parallel themes and two related themes. Parallel themes in both groups included teaching in context, confidence, and communication, whereas related themes included faculty absence of concerns or complaints and student fear of failure. Students also identified an enhanced PT/PTA role formation as a benefit of the clinic.

Discussion and Conclusion.
Student experiences in the NWPTC are aligned to support integration of learning in the classroom. Faculty supervision in the clinic reinforces the concepts taught in didactic courses. As a self-funded, self-contained teaching clinic, NWPTC allowed faculty control on curriculum alignment and scheduling, thus allowing for a reduction in required clinical contact hours with no indication of decreased student outcomes. While CE in PTA education programs continues to be predominantly outsourced, a self-contained ICE clinic can be of value to PTA programs.
Safe Intraoperative Neurophysiologic Monitoring During Posterior Spinal Fusion in a Patient With Cochlear Implants
Authors: Abiola Godwin , Ward Bryan Kevin , Bowditch Stephen , Ritzl Eva Katharina , Carey John Patrick 
Published: May 2018

Objective:
Cochlear implants are generally considered a contraindication for any procedure requiring electrical stimulation near the implant. We present a case of a patient undergoing intraoperative transcranial electrical motor-evoked potential monitoring with a cochlear implant without adverse outcomes.

Patient:
A 12-year-old girl with a history of VACTERL presented with worsening congenital kyphosis and bilateral severe-to-profound hearing loss. Since age 7 the patient used a cochlear implant in the right ear and hearing aid in the left ear. Physical examination and magnetic resonance imaging in 2016 revealed a left-sided 66-degree thoracolumbar kyphosis at T11 making the patient a candidate for surgical correction.

Interventions:
She underwent a posterior spinal fusion surgery, performed with intraoperative transcranial electrical motor-evoked potential monitoring. Steps were taken to mitigate electrical stimulation of the patient's cochlear implant.

Main Outcome Measures:
Postoperative impedance of individual channels, audiometry, and neural response testing were compared with preoperative measurements.

Results:
Significant (>10%) impedance changes were observed postoperatively in channels 1, 2, 4, and 6; however, the net variation across all the channels was low (3%). The patient reported no hearing changes, and no significant changes in hearing threshold were seen in postoperative audiometric testing or neural response testing.

Conclusion:
We present a case of successful posterior spinal fusion with intraoperative neurophysiological monitoring via transcranial electrical stimulation, in a patient with a cochlear implant. With proper precautions, motor-evoked potential monitoring can be safely performed in a patient with a cochlear implant.
Incidence and Risk Factors for Sigmoid Venous Thrombosis Following CPA Tumor Resection
Authors: Shew Matthew , Kavookjian Hannah , Dahlstrom Kelly , Muelleman Thomas , Lin James , Camarata Paul , Ledbetter Luke N. , Staecker Hinrich 
Published: May 2018

Objective:
Our primary aim was to determine the incidence of sigmoid venous thrombosis (SVT) and determine risks factors and sequelae of SVT following cerebellopontine angle tumor resection.

Study Design:
Retrospective cohort study.

Setting:
Academic tertiary care hospital.

Patients:
Patients over 18 years of age who underwent resection of cerebellopontine angle meningioma or vestibular schwannoma from January 2005 to April 2016 who had postoperative magnetic resonance imaging.

Intervention(s):
Diagnostic.

Main Outcome Measure(s):
Incidence of postoperative sigmoid venous thrombosis (SVT) from official radiology reports was compared with retrospective imaging review by our institutional neuroradiologists. Data collected included age, length of stay, body mass index, surgical approach, and postoperative complications.

Results:
A total of 127 patients were identified. Official radiology reads significantly underreported the incidence of postoperative SVT compared with retrospective review by our institutional neuroradiologist for patients who underwent routine postoperative imaging (n = 4 [3.1%] versus n = 22 [17.3%]; p < 0.001). There was a statistical trend toward increased risk for thrombosis in patients undergoing translabyrinthine and staged resection that did not reach significance (p = 0.068). Cerebrospinal fluid (CSF) leak incidence in patients with thrombosis was significantly increased (n = 9 [37.5%] versus n = 13 [12.6%]; p = 0.007). When controlling for approach, the presence of thrombus was associated with a more then three-fold increase in odds of CSF leak (OR = 3.28, 95% CI: 1.12–9.48, p = 0.030). There was no correlation between SVT and age (p = 0.788), body mass index (p = 0.686), length of stay (p = 0.733), preoperative tumor size (p = 0.555), or increased postoperative ICP (p = 0.645). Only one patient was symptomatic from sigmoid thrombosis compared with 21 who were not.

Conclusion:
Incidence of SVT is significantly underreported and may predispose patients to increase risk for CSF leak. Staged and translabyrinthine approaches demonstrate an increased trend toward thrombosis risk. Our findings suggest it may not be necessary to treat asymptomatic SVT.
Comparison of Clinical Characteristics and Surgical Outcomes of Cystic and Solid Vestibular Schwannomas
Authors: Han Ji Hyuk , Baek Kwang Ha , Lee Young Woo , Hur Young Kyun , Kim Hyun Ji , Moon In Seok 
Published: May 2018

Objective:
The aim of this study was to compare the clinical characteristics of cystic vestibular schwannomas (CVSs) and solid vestibular schwannomas (SVSs).

Study Design:
Retrospective review.

Setting:
Tertiary care center.

Patients:
A total of 220 patients who underwent microsurgery for vestibular schwannomas between 2007 and 2016.

Intervention:
CVSs were defined as cystic components ≥1/3 of total tumor volume based on automated volume measurement. Tumors larger than 5 cm3 were defined as large tumors.

Main Outcome Measures:
Clinical characteristics and surgical outcomes, including preoperative symptoms, hearing threshold, vestibular function, tumor volume, extent of resection, facial nerve outcomes, and nonfacial complications were evaluated.

Results:
Tumor volume was significantly larger in CVSs (20.44 ± 13.85 cm3 in CVSs; 4.75 ± 6.48 cm3 in SVSs, p < 0.001) and the proportion of larger tumors was also greater in CVSs (66.0% in CVSs; 11.4% in SVSs, p < 0.001). Preoperative dizziness was highly prevalent in CVSs (32.1% in CVSs; 18.6% in SVSs, p = 0.038) and postoperative facial nerve outcomes were significantly worse in CVSs (67.9% favorable rate in CVSs; 87.4% favorable rate in SVSs, p = 0.001). When the comparison was limited to large tumors, no clinical characteristics or surgical outcomes were significantly different. Tumor volume had a greater effect than tumor type on the surgical outcomes. The odds ratios for subtotal resection and unfavorable facial nerve function with a large tumor were 5.77 (confidence interval [CI]: 1.52–21.95, p = 0.010) and 5.34 (CI: 1.41–20.22, p = 0.014), respectively.

Conclusion:
CVSs tend to be larger than SVSs. Tumor volume, not cystic component, is thought to be a major determinant of surgical outcomes.
The Effect of Obesity on the Quality of Bowel Preparation for Colonoscopy
Authors: Anklesaria Ava B. , Ivanina Elena A. , Chudy-Onwugaje Kenechukwu O. , Tin Kevin , Levine Chaya M. , Homel Peter , Rojas Mary , Mayer Ira E. , Rahmani Rabin 
Published: May 2018

Background:
Obesity has been linked to suboptimal bowel preparation but this association has not been conclusively investigated in prospective studies.

Goals:
Our objective was to determine whether any relationship exists between obesity as measured by body mass index (BMI) and quality of bowel preparation.

Study:
Adult patients who presented for outpatient colonoscopy at a single urban ambulatory surgery center within a 6-month period and fulfilled inclusion criteria were prospectively enrolled for the study. Patients were divided by BMI into subcategories based on the World Health Organization international classification of obesity. The Modified Aronchick scale was used to assess bowel preparation for colonoscopy. A univariate and multivariate analysis was used to determine a possible association between BMI and poor preparation.

Results:
A total of 1429 patients were evaluated. On the basis of inclusion criteria, 1314 subjects were analyzed, out of which 73% were overweight or obese. Inadequate bowel preparation was noted in 21.1% of patients. There was no correlation between obesity and the quality of the bowel preparation. Male gender (P=0.002), diabetes mellitus (P<0.0001), liver cirrhosis (P=0.001), coronary artery disease (P=0.003), refractory constipation (P<0.0001), and current smoking (P=0.01) were found to be independently predictive of poor bowel preparation.

Conclusions:
Increased BMI is not predictive of suboptimal bowel preparation for colonoscopy. The results of our study are pivotal given the increased risk of colorectal cancer in obese patients and their known lower rate of colorectal cancer screening in certain populations. It is important to avoid subjecting these patients to an intensive bowel preparation that may further discourage screening in a patient population that requires it.
Red Meat Consumption and Serum Lipids and Fatty Acids in Toddlers
Authors: Szymlek‐Gay Ewa A. , Gray Andrew R. , Heath Anne‐Louise M. , Ferguson Elaine L. , Skeaff C. Murray 
Published: May 2018

ABSTRACTThe aim of the study was to examine the effects of promoting increased lean red meat consumption on serum concentrations of total and high‐density lipoprotein (HDL) cholesterol, and serum fatty acid composition, among toddlers. In a 20‐week randomized controlled trial healthy 12 to 20‐month‐old children were assigned to: red meat (n = 90; parents were encouraged to add 56 g/day of lean red meat to their toddler's usual diet), or control (n = 90) groups. Food and nutrient intakes were assessed with 3‐day weighed food records (baseline, week 4, and week 20). Serum was analyzed for total and HDL cholesterol concentrations, and fatty acid composition (baseline and week 20). At week 20, relative to control, the red meat group had higher intakes of red meat, all meat, and carbohydrate; and lower intakes of milk, energy, cholesterol, and total, saturated, and monounsaturated fat (P = 0.043 for energy, all others P ⩽ 0.002). No effects associated with the intervention were found for total cholesterol, HDL cholesterol, total to HDL cholesterol ratio, or serum fatty acid composition (all P ≥ 0.059) aside from pentadecanoic acid (P = 0.047). An ~3‐fold increase in lean red meat intake, from ~10 to ~30 g/day, resulted in no consistent changes in serum lipids or fatty acid composition, suggesting that the addition of ~2 tablespoons/day of lean red meat to toddlers’ diets will likely not adversely affect serum lipids or serum fatty acids.
Simple Bone Cyst Mimicking Stafne Bone Defect
Authors: Aoki Eduardo Massaharu , Abdala-Júnior Reinaldo , Nagano Cibele Pidorodeski , Mendes Elisabeth Bannwart , Oliveira Jefferson Xavier de , Lourenço Silvia Vanessa , Arita Emiko Saito 
Published: May 2018

Abstract
Stafne bone defects (SBDs) are asymptomatic lingual bony defects in mandible, which are usually detected as an incidental finding in plain radiographs. Similarly, simple bone cysts (SBCs) are most frequently found in posterior region of the mandible and also are asymptomatic. However, due to anatomical structures overlap in plain radiographs, there is a possibility of misdiagnosing SBD that often is diagnosed by presumptive diagnosis observed in plain radiograph. This report shows an unusual case that a SBC resembles a SBD.
Deepening Fornix Technique Using Central Split-Medium Thickness Skin Graft to Treat Contracted Anophthalmic Sockets
Authors: AlHassan Sultan , Galindo-Ferreiro Alicia , Khandekar Rajiv , AlShaikh Osama , Schellini Silvana Artioli 
Published: May 2018

Purpose:
The aim of thhis study was to present the outcomes of postauricular split-medium thickness skin graft (SMTSG) to treat anophthalmic sockets with contracted fornices.

Methods:
This case series enrolled patients with grade 2 or 3 anophthalmic sockets between 2015 and 2016. Data were collected on patient demographics, objective and subjective parameters preoperatively and 180 days postoperatively. Success of the surgery was graded on the height of the graft, the depth of the superior and inferior fornices, and presence/abscence of lagophthalmos, entropion, and ability to retain an external prosthesis.

Results:
Eighteen patients were enrolled with a mean age of 35.9 ± 18 years. The median height of the graft was 22 mm (25% quartile = 18.75) when removed and 20 mm (25% quartile = 16) postoperatively. The median depth of the superior fornix was 6.5 mm (25% quartile = 4.5 mm) preoperatively and 10 mm (25% quartile = 8 mm) postoperatively (P = 0.5). The median inferior fornix depth was 7 mm (25% quartile = 3.5 mm) preoperatively and 8 mm (25% quartile = 5 mm) (P = 0.27) postoperatively. Preoperatively, there were 13 (72.2%) patients with lagophthalmos, 10 (44.4%) with entropion, 3 (37.5%) with poor prosthesis retention, and 5 (62.5%) who were unable to retain the prosthesis. Postoperatively, 7 (38.9%) patients had lagophthamos, 1 (5.6%) had entropion, and all the patients could retain the prosthesis. None of the sockets had a foul odor postoperatively.

Conclusions:
Postauricular SMTSG achieves successful outcomes for the treatment of contracted anophthalmic sockets, reshaping the anterior socket surface and deepening the fornices.
Isolated Bilateral Macrostomia
Authors: Pradhan Rohan , Lin Bojie , Pan Xin-Yuan , Yin Guo-Qian 
Published: May 2018

Abstract
Macrostomia (Tessier's 7 cleft) is a rare congenital lip deformity. Macrostomia can occur unilateral or bilateral, isolated or associated with other syndromes. Isolated bilateral macrostomia is exceedingly rare with only a few cases reported to date. The authors report 6 cases of isolated bilateral macrostomia surgically repaired in 4-layered approaches. The traditional method was improved and the result obtained was satisfactory after longest follow-up of 3 years. The technique is easy to imitate, simple in design, aesthetically and functionally corrects the deformity.
Impact of Dexmedetomidine on Long-term Outcomes After Noncardiac Surgery in Elderly: 3-Year Follow-up of a Randomized Controlled Trial
Authors: Zhang Dan-Feng , Su Xian , Meng Zhao-Ting , Li Hong-Liang , Wang Dong-Xin , Xue-Ying Li  , Maze Mervyn , Ma Daqing 
Published: May 2018

Objectives:
The aim was to compare the long-term outcomes of low-dose dexmedetomidine versus placebo in a randomized controlled trial (ChiCTR-TRC-10000802).

Background:
Low-dose dexmedetomidine infusion decreased delirium occurrence within 1 week after surgery in elderly admitted to the intensive care unit (ICU) after noncardiac surgery, but the long-term outcome of this intervention is unknown.

Methods:
Patients or their family members were telephone-interviewed for a 3-year follow-up data collection of survival, cognitive function assessed with the modified Telephone Interview for Cognitive Status, and quality of life evaluated with the World Health Organization Quality of Life.

Results:
Of the 700 patients, 23 (3.3%) were lost at 3-year follow-up. The 3-year overall survival was not statistically different between the dexmedetomidine and placebo groups [114 deaths vs 122/350; hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.68–1.13, P = 0.303]. The survival rates at 6 months, 1 year, and 2 years were significantly higher in the dexmedetomidine than in the placebo group (rate difference of 5.2%, 5.3%, and 6.7% respectively; all P < 0.05). The remaining 98.4% (434/441) 3-year survivors, the dexmedetomidine group, had significantly better cognitive function (mean difference 4.7, 95% CI 3.8–5.6, P < 0.0001) and quality of life (physical domain: 13.6 [10.6–16.6]; psychological domain: 15.2 [12.5–18.0]; social relationship domain: 8.1 [5.5–10.7]; environment domain: 13.3 [10.9–15.7]; all P < 0.0001) than in the placebo group.

Conclusions:
For elderly admitted to ICU after noncardiac surgery, low-dose dexmedetomidine infusion did not significantly change 3-year overall survival, but increased survival up to 2 years, and improved cognitive function and quality of life in 3-year survivors.
Intracorporeal Isosceles Right Triangle-shaped Anastomosis in Totally Laparoscopic Distal Gastrectomy
Authors: Nakamura Kenichi , Suda Koichi , Suzuki Atsushi , Nakauchi Masaya , Shibasaki Susumu , Kikuchi Kenji , Nakamura Tetsuya , Kadoya Shinichi , Inaba Kazuki , Uyama Ichiro 
Published: May 2018

Purpose:
This study aimed to evaluate the feasibility and safety of intracorporeal anastomosis with Billroth I, Billroth II, or Roux-en-Y reconstructions in totally laparoscopic distal gastrectomy.

Materials and Methods:
A single-institution, retrospective, cohort study including 553 patients was conducted. Intracorporeal isosceles right triangle-shaped anastomosis without slack and torsion was created using linear staplers. Billroth I was primarily used. Surgical outcomes and perioperative nutritional status were assessed.

Results:
Morbidity was 11.5%. Postoperative early complications related to anastomosis occurred in 13 patients (2.4%). Operative time and reconstruction type (Billroth I vs. others) were the only significant independent risk factors determining postoperative early and late complications, respectively. No difference was observed in postoperative changes in nutritional status across the groups, although Billroth II increased reflux esophagitis requiring medication.

Conclusions:
Intracorporeal isosceles right triangle-shaped anastomosis using linear staplers in totally laparoscopic distal gastrectomy, in combination with our selection algorithm for type of reconstruction, is feasible and safe.
Automatic Classification of Prostate Cancer Gleason Scores from Digitized Whole Slide Tissue Biopsies
Authors: Xu Hongming , Park Sunho , Hwang Tae Hyun 
Published: May 2018

AbstractHistological Gleason grading of tumor patterns is one of the most powerful prognostic predictors in prostate cancer. However, manual analysis and grading performed by pathologists are typically subjective and time-consuming. In this paper, we propose an automatic technique for Gleason grading of prostate cancer from H&E stained whole slide biopsy images using a set of novel completed and statistical local bi-nary pattern (CSLBP) descriptors. First the technique divides the whole slide image into a set of small image tiles, where salient tumor tiles with high nuclei densities are selected for analysis. The CSLBP texture features that encode pixel intensity variations from circularly surrounding neighborhoods are then extracted from salient image tiles to characterize different Gleason patterns. Finally, CSLBP texture features computed from all tiles are integrated and utilized by the multi-class support vector machine (SVM) that assigns patient biopsy with different Gleason score of 6, 7 or ≥8. Experiments have been performed on 312 different patient cases selected from the cancer genome atlas (TCGA) and have achieved more than 79% classification accuracies, which is superior to state-of-the-art textural descriptors for prostate cancer Gleason grading.
Long-term seasonality of marine photoheterotrophic bacteria reveals low cohesiveness within the different phylogroups
Authors: Auladell Adrià , Sánchez Pablo , Sánchez Olga , Gasol Josep M. , Ferrera Isabel 
Published: May 2018

AbstractAerobic anoxygenic phototrophic (AAP) bacteria play a relevant role in the marine microbial food web, but little is known about their long-term seasonal dynamics. Using Illumina amplicon sequencing of thepufM gene coupled with multivariate, time series and co-occurrence analyses we examined their temporal dynamics over a decade at the Blanes Bay Microbial Observatory (NW Mediterranean). Phylogroup K (Gammaproteobacteria) was the most abundant over all seasons, with phylogroups E and G (Alphaproteobacteria) being often abundant in spring. A clear seasonal trend was observed in diversity, with maximum values in winter. Multivariate analyses showed sample clustering by season, with a relevant proportion of the variance (38%) explained by day length, temperature, salinity, phototrophic nanoflagellate abundance and phosphate concentration. Time series analysis showed that only 42% of the Amplicon Sequence Variants (ASVs) analyzed presented marked seasonality but these represented most of the abundance (92%). Interestingly, distinct temporal dynamics were observed within the same phylogroup and even within different ASVs conforming the same Operational Taxonomic Unit (OTU). Likewise, co-occurrence analysis highlighted negative associations between various ASVs within the same phylogroup. Altogether our results picture the AAP assemblage as highly seasonal, containing ecotypes with distinctive niche partitioning rather than being a cohesive functional group.