bluuebunny/crossref_metadata_2025_split huggingface dataset:
Milk of Calcium
Authors: Ho Christopher P. 
Published: March 2018

Abstract
Milk of calcium (MOC) is simply calcium oxalate crystals precipitated within the microcysts (acini) of the breast lobules. MOC has a very distinct mammographic appearance. It is a benign entity, and when seen and properly identified, it requires no further workup or follow-up. It is, however, important to recognize the proper initial evaluation of MOC so as to avoid misdiagnosis or potential unnecessary biopsies.
This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for milk of calcium. Topics discussed include appropriate use of magnification views, hints to recognize the distinct appearance of milk of calcium, and management.
Amorphous/Indistinct Calcifications (Regional/Diffuse)
Authors: Wang Lilian 
Published: March 2018

Abstract
Amorphous calcifications are calcifications that are sufficiently small and/or hazy that a more specific morphological classification cannot be made. Historically, such calcifications were referred to as “indistinct” calcifications. The likelihood of malignancy and the management of amorphous calcifications largely depend on their distribution. The majority of amorphous calcifications are benign, most often due to fibrocystic change (60%). Sclerosing adenosis commonly occurs in perimenopausal women and is associated with a 1.5–2.1x relative risk for development of breast cancer. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnosis, and management recommendations for amorphous/indistinct calcifications in a regional or diffuse distribution. Topics discussed include influence of distribution on risk of malignancy and pathological entities, including sclerosing adenosis.
Fine, Linear/Branching Calcifications
Authors: Doepke Laura 
Published: March 2018

Abstract
Of all of the calcifications identified on mammography, fine, linear/branching calcifications are the most suspicious for malignancy, most commonly ductal carcinoma in situ (DCIS). The risk of malignancy associated with fine, linear/branching calcifications is approximately 70%. A recent study evaluating the positive predictive value of suspicious calcifications based on the fifth edition of BI-RADS found the positive predictive value of fine pleomorphic/linear or segmental calcifications was 93.8%. This chapter, which appears in the section on calcifications, reviews the key imaging features, imaging protocols for evaluating calcifications, management, and potential pitfalls or mimics of fine, linear/branching calcifications. Topics discussed will include magnification views, stereotactic core needle biopsy, and radiology–pathology correlation.
Duct Ectasia
Authors: Winkler Nicole S. 
Published: March 2018

Abstract
Duct ectasia is a term used to describe benign dilation of fluid-filled mammary ducts. Duct ectasia is characterized by tubular fluid-filled structures &gt;2 mm in diameter that are commonly bilateral and subareolar in location. Ductal dilation is due to weakened wall elasticity that occurs with age. The ducts fill with secretions that may result in intermittent nipple discharge or chronic inflammation. When duct ectasia involves multiple ducts bilaterally, it can be dismissed on screening mammography; however, a solitary dilated duct should be further evaluated, given the potential for associated non-calcified DCIS. This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for duct ectasia. Topics discussed include solitary dilated duct, nipple discharge, and sonographic evaluation of ducts.
Ductography
Authors: Harvey Susan C. 
Published: March 2018

Abstract
Ductography or galactography is a technique used in the diagnostic workup of unilateral, single duct, spontaneous, and bloody or clear nipple discharge. Mammographic imaging with magnification may reveal the source of the discharge. The technique is challenging, yet it can be mastered with attention to detail, a well thought-out protocol, and practice. Imaging findings can be non-specific, yet may guide biopsy or surgical excision. Now with the wide use of breast magnetic resonance imaging (MRI), which has been shown to be more sensitive for lesion detection, ductography is used less frequently. This chapter, appearing in the section on interventions and surgical changes, reviews the indications, procedure protocols, and pitfalls, as well as the management and imaging follow-up for ductography or galactography.
The Role of Physical Activity in the Association Between Smoking Status and Quality of Life
Authors: Nduaguba Sabina O , Ford Kentya H , Rascati Karen 
Published: March 2018

Abstract

Objectives
Nonsmoking status and physical activity have, individually, been shown to be associated with health-related quality of life (HRQoL). The objective of this study was to assess whether the relationship between smoking status and HRQoL is modified or influenced by physical activity.

Methods
Data were extracted from the 2014 Behavioral Risk Factor Surveillance Survey dataset (N = 332680) in 2015. Logistic regression models were used to address study objectives. Health-related quality of life (HRQoL), measured using eight domains (general health, physical health, mental health, activity limitations, pain, depressive symptoms, anxiety, and vitality), was regressed on smoking status without and with adjustment for age, race, gender, education, marital status, income, employment, healthcare coverage, comorbidity, body mass index, flu vaccination, alcohol use, and physical activity. Smoking status by physical activity interaction term was added to the adjusted model and evaluated for significance.

Results
There were significant smoking status by physical activity interaction effects on general health, physical health, activity limitations, and depressive symptoms domains. Among those who exercised, relative differences in the odds of a high HRQoL was smaller between former smokers and nonsmokers and larger between current smokers and nonsmokers when compared to those who did not exercise. Similarly, there were sharper relative differences between those who exercised and those who did not exercise among former smokers than among current smokers.

Conclusions
Smokers who successfully quit smoking (former smokers) may benefit from enhanced HRQoL that tends towards that of nonsmokers if they adopt physical activity in their daily routine.

Implications
Behavioral interventions that combine smoking cessation and physical activity may be more effective than either smoking cessation or physical activity alone in improving the quality of life measures such as overall, physical and mental health, and degree of limitation to activities due to poor health. Health care providers can support patients who successfully quit smoking to add exercise to their daily routine with the expectation of enhanced HRQoL.
Infectious Diseases Consultation Reduces 30-Day and 1-Year All-Cause Mortality for Multidrug-Resistant Organism Infections
Authors: Burnham Jason P , Olsen Margaret A , Stwalley Dustin , Kwon Jennie H , Babcock Hilary M , Kollef Marin H 
Published: March 2018

Abstract

Background
Multidrug-resistant organism (MDRO) infections are associated with high mortality and readmission rates. Infectious diseases (ID) consultation improves clinical outcomes for drug-resistant Staphylococcus aureus bloodstream infections. Our goal was to determine the association between ID consultation and mortality following various MDRO infections.

Methods
This study was conducted with a retrospective cohort (January 1, 2006–October 1, 2015) at an academic tertiary referral center. We identified patients with MDROs in a sterile site or bronchoalveolar lavage/bronchial wash culture. Mortality and readmissions within 1 year of index culture were identified, and the association of ID consultation with these outcomes was determined using Cox proportional hazards models with inverse weighting by the propensity score for ID consultation.

Results
A total of 4214 patients with MDRO infections were identified. ID consultation was significantly associated with reductions in 30-day and 1-year mortality for resistant S. aureus (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.36–0.63; and HR, 0.73, 95% CI, 0.61–0.86) and Enterobacteriaceae (HR, 0.41; 95% CI, 0.27–0.64; and HR, 0.74; 95% CI, 0.59–0.94), and 30-day mortality for polymicrobial infections (HR, 0.51; 95% CI, 0.31–0.86) but not Acinetobacter or Pseudomonas. For resistant Enterococcus, ID consultation was marginally associated with decreased 30-day mortality (HR, 0.81; 95% CI, 0.62–1.06). ID consultation was associated with reduced 30-day readmission for resistant Enterobacteriaceae.

Conclusions
ID consultation was associated with significant reductions in 30-day and 1-year mortality for resistant S. aureus and Enterobacteriaceae, and 30-day mortality for polymicrobial infections. There was no association between ID consultation and mortality for patients with resistant Pseudomonas, Acinetobacter, or Enterococcus, possibly due to small sample sizes. Our results suggest that ID consultation may be beneficial for patients with some MDRO infections.
Application of Lean Principles to Neurosurgical Procedures: The Case of Lumbar Spinal Fusion Surgery, a Literature Review and Pilot Series
Authors: Liu Jesse J , Raskin Jeffrey S , Hardaway Fran , Holste Katherine , Brown Sarah , Raslan Ahmed M 
Published: March 2018

Abstract

BACKGROUND
Delivery of higher value healthcare is an ultimate government and public goal. Improving efficiency by standardization of surgical steps can improve patient outcomes, reduce costs, and lead to higher value healthcare. Lean principles and methodology have improved timeliness in perioperative medicine; however, process mapping of surgery itself has not been performed.

OBJECTIVE
To apply Plan/Do/Study/Act (PDSA) cycles methodology to lumbar posterior instrumented fusion (PIF) using lean principles to create a standard work flow, identify waste, remove intraoperative variability, and examine feasibility among pilot cases.

METHODS
Process maps for 5 PIF procedures were created by a PDSA cycle from 1 faculty neurosurgeon at 1 institution. Plan, modularize PIF into basic components; Do, map and time components; Study, analyze results; and Act, identify waste. Waste inventories, spaghetti diagrams, and chartings of time spent per step were created. Procedural steps were broadly defined in order to compare steps despite the variability in PIF and were analyzed with box and whisker plots to evaluate variability.

RESULTS
Temporal variabilities in duration of decompression vs closure and hardware vs closure were significantly different (P = .003). Variability in procedural step duration was smallest for closure and largest for exposure. Wastes including waiting and instrument defects accounted for 15% and 66% of all waste, respectively.

CONCLUSION
This pilot series demonstrates that lean principles can standardize surgical workflows and identify waste. Though time and labor intensive, lean principles and PDSA methodology can be applied to operative steps, not just the perioperative period.
Next Generation Case Report: Supraorbital Craniotomy for Anterior Communicating Artery Aneurysm Clipping in Annotated Virtual Reality Environment
Authors: Tucker Alexander M , Beckett Joel S , Martin Neil A 
Published: March 2018

Abstract

BACKGROUND AND IMPORTANCE
Recent years have seen significant advancements in virtual reality. Implementation of this technology in combination with traditional learning methods is a powerful tool for medical teaching.

CLINICAL PRESENTATION
This is a 60-yr-old woman who presented with a history of headaches and was found to have an unruptured 4-mm anterior communicating artery aneurysm. After discussion, the patient elected to have the aneurysm treated by surgical clipping. The aneurysm was completely occluded through a supraorbital craniotomy with a single clip. The patient was discharged home in good condition on postoperative day 2. This case was imported into a virtual reality environment with annotated slides and operative video for resident teaching.

CONCLUSION
As virtual reality technology continues to grow, library of interactive case reports could revolutionize neurosurgical education.
Does Cannabis Use Influence Opioid Outcomes and Quality of Life Among Buprenorphine Maintained Patients? A Cross-sectional, Comparative Study
Authors: Bagra Igam , Krishnan Vijay , Rao Ravindra , Agrawal Alok 
Published: March 2018

Objectives:
Use of various psychoactive substances can influence outcomes of patients on opioid agonist treatment (OAT). While use of alcohol and cocaine has shown to adversely affect OAT results, associated cannabis use shows mixed results. This study aimed to assess the pattern of cannabis use among opioid-dependent patients maintained on buprenorphine. Additionally, the study compared the dose of buprenorphine, opioid-related craving and withdrawals, productivity, and also quality of life between those with and without recent (past 90-day) cannabis use.

Methods:
We collected data on demographic and drug use details in 100 randomly selected adult male patients attending a community drug treatment clinic, who were stabilized on buprenorphine for more than 3 months. Other measures included scores on World Health Organization (WHO)-Alcohol, Smoking and Substance Involvement Screening Tool and WHO-Quality of Life-Brief (WHOQOL-Bref) version.

Results:
The average duration of maintenance treatment with buprenorphine was 96 months, with excellent compliance for buprenorphine (86.92 ± 9.58 days in 90 days). Thirty-five per cent had used cannabis in past 90 days, with lifetime use of cannabis in 77%. Participants using cannabis currently were on lower doses of buprenorphine (mean dose per day: 7.9 mg vs 8.9 mg; P = 0.04). Yet, there was no significant difference in the rates of opioid use or opioid withdrawals and craving between the 2 groups. Compliance to OAT, number of days of employment, daily earning, and WHOQOL-Bref scores in all domains were comparable between those with and without cannabis use. Duration of cannabis use, current use of alcohol, and dose of buprenorphine predicted current cannabis use in multivariable logistic regression analysis.

Conclusions:
Cannabis use does not negatively influence opioid outcomes among patients receiving buprenorphine maintenance treatment. There is no difference in productivity and quality of life between individuals maintained on buprenorphine with and without current cannabis use.
Tattoos in Nursing
Authors: Williams Barbara Miller , Wright Cindy , Leigh Katherine H. , Armstrong Brittney , Kelley Sabrina 
Published: March 2018

ABSTRACT:
Tattoos have become increasingly popular in the United States among the general population. Furthermore, the popularity of body art, primarily tattoos, among nursing students generates issues about professionalism in academics and in clinical settings. Nursing faculty are faced with conflicting views on cultural awareness, professionalism, and self-expression. With nursing viewed as one of the most trusted professions, the policy of covering tattoos should be discussed, and more research is necessary.
Total Ambient Dose Equivalent Buildup Factor Determination for Nbs04 Concrete
Authors: Duckic Paulina , Hayes Robert B. 
Published: March 2018

Abstract
Buildup factors are dimensionless multiplicative factors required by the point kernel method to account for scattered radiation through a shielding material. The accuracy of the point kernel method is strongly affected by the correspondence of analyzed parameters to experimental configurations, which is attempted to be simplified here. The point kernel method has not been found to have widespread practical use for neutron shielding calculations due to the complex neutron transport behavior through shielding materials (i.e. the variety of interaction mechanisms that neutrons may undergo while traversing the shield) as well as non-linear neutron total cross section energy dependence. In this work, total ambient dose buildup factors for NBS04 concrete are calculated in terms of neutron and secondary gamma ray transmission factors. The neutron and secondary gamma ray transmission factors are calculated using MCNP6™ code with updated cross sections. Both transmission factors and buildup factors are given in a tabulated form. Practical use of neutron transmission and buildup factors warrants rigorously calculated results with all associated uncertainties. In this work, sensitivity analysis of neutron transmission factors and total buildup factors with varying water content has been conducted. The analysis showed significant impact of varying water content in concrete on both neutron transmission factors and total buildup factors. Finally, support vector regression, a machine learning technique, has been engaged to make a model based on the calculated data for calculation of the buildup factors. The developed model can predict most of the data with 20% relative error.
Relationship Between Central Epithelial Thickness and Central Corneal Thickness in Healthy Eyes and Eyes After Laser In Situ Keratomileusis
Authors: Maltsev Dmitrii S. , Kudryashova Elena V. , Kulikov Alexei N. , Mareichev Artem Yu. 
Published: March 2018

Purpose:
To study the relationship between central epithelial thickness (CET) and central corneal thickness (CCT) in healthy individuals and to evaluate their changes after laser in situ keratomileusis (LASIK).

Methods:
In this study, we included 150 patients (150 eyes) who underwent LASIK and 83 healthy individuals (83 eyes). In all patients, CET and CCT were measured using anterior segment optical coherence tomography with Copernicus REVO on B-scans. Statistical analysis was performed using the Spearman rank test, t test, and receiver operating characteristic curve analysis.

Results:
In healthy individuals, CET positively correlated with CCT (r = 0.5, P < 0.001), the CET-to-CCT ratio being 0.100 ± 0.006. The CET-to-CCT ratio increased to 0.111 ± 0.009 (P < 0.001) and to 0.132 ± 0.021 (P < 0.001) at 1 day and 1 month postoperatively, respectively. The area under the curve for the CET-to-CCT ratio as a diagnostic criterion for previously performed myopic LASIK was 0.97 (sensitivity 93.5% and specificity 91.6%).

Conclusions:
In healthy individuals, the corneal epithelium contributes a mean of 10.0% of corneal thickness. The CET-to-CCT ratio has a highly predictive value for indication of previously performed myopic LASIK. It seems that clinical application of epithelial thickness measurement can be improved by adjusting CET for CCT.
Nutritional Status in the First 2 Years of Life in Cystic Fibrosis Diagnosed by Newborn Screening
Authors: Munck Anne , Boulkedid Rym , Weiss Laurence , Foucaud Pierre , Wizla‐Derambure Nathalie , Reix Philippe , Bremont François , Derelle Jocelyne , Schroedt Julien , Alberti Corinne ,   Gastroenterology and Nutrition Société française de la Mucoviscidose (SFM) Working Group and the ALIMUDE Study Group
Published: March 2018

ABSTRACTObjective:To evaluate nutritional status and associated factors in a cystic fibrosis (CF) cohort diagnosed by newborn screening and followed up to month 24.Methods:A prospective longitudinal multicenter study assessing nutritional status according to pancreatic status, feeding modalities, prescriptions, pulmonary outcome, and biological nutritional parameters.Results:One hundred and five infants were recruited and 99 completed the study. Nutritional care management prevented undernutrition and stunting in those with exocrine pancreatic sufficiency (EPS), but affected (13/87) 15% and (21/86) 24%, respectively, of infants with exocrine pancreatic insufficiency (EPI). The logistic regression model found a positive association between both weight and length z scores “at risk” at month 24, and initial pulmonary symptoms (odds ratio [OR] 0.06, P < 0.01 and OR 0.08, P < 0.01, respectively); these symptoms were less frequent when age at first visit was earlier than 1.2 months (33% vs 67%, P = 0.02); stunting was also associated with high‐calorie density intake and Staphylococcus aureus (OR 0.05, P = 0.01 and OR 0.17, P < 0.01). Pulmonary outcome did not differ according to pancreatic status; breast‐feeding for at least 3 months delayed first acquisition of Pseudomonas aeruginosa. Despite sodium and fat‐soluble vitamin supplementation, half of both cohorts had low urinary sodium output and half of the EPI cohort had low vitamin D levels.Conclusions:Our data shed light on the fact that stunting was more frequent than undernutrition, while both parameters involved only patients with pancreatic insufficiency. Modalities of feeding were not associated with nutritional status; breast‐feeding may provide some protection against acquisition of P aeruginosa.
Dose‐response Relationship Between Donor Human Milk, Mother's Own Milk, Preterm Formula, and Neonatal Growth Outcomes
Authors: Brownell Elizabeth A. , Matson Adam P. , Smith Kelsey C. , Moore James E. , Esposito Patricia A. , Lussier Mary M. , Lerer Trudy J. , Hagadorn James I. 
Published: March 2018

ABSTRACTBackground:A dose‐response relationship between proportions of donor human milk (DHM) intake and in‐neonatal intensive care unit (in‐NICU) growth rates, if any, remains poorly defined. Objective was to evaluate interrelationships between percentages of DHM, mother's own milk (MOM), and preterm formula (PF) intake and neonatal growth parameters at 36 weeks postmenstrual age or NICU discharge.Methods:Infants eligible for this single‐center retrospective study were inborn at ⩽32 weeks gestation or ⩽1800 g, stayed in the NICU for ≥7 days, and received enteral nutrition consisting of human milk fortified with Enfamil human milk fortifier acidified liquid. Study exposures were defined as 10% increments in the total volumetric proportions of infant diet provided as MOM, DHM, or PF. Outcomes were growth parameters at 36 weeks postmenstrual age or NICU discharge. Multivariable linear regression modeled the adjusted additive effect of infant diet on individual growth parameters.Results:A total of 314 infants records were eligible for analysis. Using MOM as reference, the adjusted mean growth velocity for weight significantly decreased by 0.17 g · kg−1 · day−1 for every 10% increase in DHM intake, but did not vary with PF intake. The adjusted mean change in weight z score significantly decreased with increasing proportion of DHM intake but significantly improved with increasing PF intake. The adjusted mean head circumference velocity was significantly decreased by 0.01 cm/wk for every 10% increase in DHM intake, in reference to MOM, but did not vary with PF intake. Neither proportion of DHM nor PF intake was associated with length velocity.Conclusions:When DHM and MOM are fortified interchangeably, preterm infants receiving incremental amounts of DHM are at increased risk of postnatal growth restriction. The dose‐response relationship between DHM, MOM, and PF and long‐term growth and neurodevelopmental outcomes warrants further research.