bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship of Employment Scarcity and Perceived Threat With Ageist and Sexist Attitudes
Authors: Ospina Javier H , Cleveland Jeanette N , Gibbons Alyssa M 
Published: April 2019

Abstract
Using theories of intergroup relations, the current research examined whether personal experiences and perceptions of employment hardship (e.g., unemployment, underemployment, perceived job insecurity, and career optimism) were associated with ageist and sexist attitudes among younger workers and male workers toward older workers and female workers, respectively. In Study 1, a survey of working adults found that, among those under 35, underemployment and job insecurity predicted perceived threat from older workers, which was associated with ageist attitudes. In Study 2, in a survey of college students under age 35, career optimism was associated with the perceived threat from older workers, which was correlated with ageist attitudes. Among men, perceived job insecurity predicted threat from women, which was associated with sexist attitudes. These results suggest that groups traditionally viewed as noncompetitive or nonthreatening may be viewed more negatively (in ageist or sexist terms) under conditions of individual-level actual and perceived resource scarcity and competition.
A Core Components Framework for Evaluating Implementation of Competency-Based Medical Education Programs
Authors: Van Melle Elaine , Frank Jason R. , Holmboe Eric S. , Dagnone Damon , Stockley Denise , Sherbino Jonathan 
Published: April 2019

PurposeThe rapid adoption of competency-based medical education (CBME) provides an unprecedented opportunity to study implementation. Examining “fidelity of implementation”—that is, whether CBME is being implemented as intended—is hampered, however, by the lack of a common framework. This article details the development of such a framework.MethodA two-step method was used. First, a perspective indicating how CBME is intended to bring about change was described. Accordingly, core components were identified. Drawing from the literature, the core components were organized into a draft framework. Using a modified Delphi approach, the second step examined consensus amongst an international group of experts in CBME.ResultsTwo different viewpoints describing how a CBME program can bring about change were found: production and reform. Because the reform model was most consistent with the characterization of CBME as a transformative innovation, this perspective was used to create a draft framework. Following the Delphi process, five core components of CBME curricula were identified: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction, and programmatic assessment. With some modification in wording, consensus emerged amongst the panel of international experts.ConclusionsTypically, implementation evaluation relies on the creation of a specific checklist of practices. Given the ongoing evolution and complexity of CBME, this work, however, focused on identifying core components. Consistent with recent developments in program evaluation, where implementation is described as a developmental trajectory toward fidelity, identifying core components is presented as a fundamental first step toward gaining a more sophisticated understanding of implementation.
Importance of Syndesmotic Reduction on Clinical Outcome After Syndesmosis Injuries
Authors: Andersen Mette R. , Diep Lien M. , Frihagen Frede , Castberg Hellund Johan , Madsen Jan E. , Figved Wender 
Published: April 2019

Objectives:
To evaluate the relationship between syndesmosis reduction and outcome.

Design:
Retrospective cohort study.

Setting:
One Level 1 and 1 Level 3 Trauma Center.

Patients:
Ninety-seven patients with syndesmosis injury.

Intervention:
Stabilization of syndesmosis injury. Open reduction and internal fixation of malleolar fracture, if present.

Main Outcome Measurements:
Anterior, central, and posterior measures of syndesmosis width on computed tomography scans, Olerud–Molander Ankle score, American Orthopaedic Foot and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score, and range of motion measurements.

Results:
Eighty-seven patients completed 2 years of follow-up. The difference in anterior tibiofibular distance (aTFD) between the injured and noninjured ankle postoperatively had a significant effect on the Olerud-Molander Ankle score after 6 weeks [b = −2.6, 95% confidence interval (CI), −4.8 to −0.4; P = 0.02], 1 year (b = −2.7, 95% CI, −4.7 to −0.8; P < 0.001), and 2 years (b = −2.6, 95% CI, −4.6 to −0.6; P = 0.009) and on American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score after 6 weeks (b = −2.2, 95% CI, −3.7 to −0.7; P = 0.004), 1 year (b = −1.7, 95% CI, −3.0 to −0.4; P = 0.04), and 2 years (b = −1.9, 95% CI, −3.2 to −0.5; P = 0.006). The effect of computed tomography measurements on range of motion was inconsistent. Receiver operating characteristic (ROC) curves demonstrated that aTFD had adequate discriminatory performance (area under the ROC curve ≥ 0.7) 1 and 2 years after surgery and the central measurement at only 2 years after surgery. ROC analyses indicate a cutoff value for syndesmosis malreduction of 2 mm. The postoperative rate of malreduction was 32%.

Conclusions:
The aTFD correlated with clinical outcome. A 2-mm difference in aTFD seems to predict poorer clinical outcome.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Radiographic Evaluation of Bone Remodeling Around Osseointegration Implants Among Transfemoral Amputees
Authors: Thomson Seamus , Thomson Alasdair , Tetsworth Kevin , Lu William , Zreiqat Hala , Al Muderis Munjed 
Published: April 2019

Objectives:
To examine periprosthetic bone remodeling among the recipients of 2 types of lower-limb osseointegrated systems, the Integral Leg Prosthesis (ILP) and the Osseointegration Prosthetic Limb (OPL) type A, over a >24-month period.

Design:
Retrospective cohort study.

Setting:
Private hospital, with a specialized osseointegration unit.

Patients:
Twenty-eight patients with transfemoral lower-limb amputations were fitted with osseointegrated systems. Of these patients, 15 received the ILP and 13 the OPL osseointegrated implant.

Intervention:
Radiographic measurements were taken at baseline (0.4 ± 0.5 years) and at follow-up (3.0 ± 0.8 years) after the osseointegration procedure.

Main Outcome Measurements:
Radiographic bone density, longitudinal bone coverage, and bone width outcomes were measured in inverse “Gruen zones.” Bone remodeling was evaluated by comparing changes between baseline and follow-up measurements.

Results:
Radiographic bone density decreased in all zones among both ILP and OPL groups. Cortical bone thickness increased among the OPL group in zones 3 (P < 0.05) and 5 (P < 0.05). Distal bone coverage of the ILP implant decreased by 2.3% (P < 0.01) and 4.1% (P < 0.05) of the total implant length on the medial and lateral sides, respectively.

Conclusions:
Decreased bone density with increased periprosthetic cortical thickness suggests a change in the bone architecture for the OPL group. The findings of this study raise concerns for the long-term success of the ILP implant. Radiographic analysis of x-rays seems to be a useful tool for clinicians to evaluate bone remodeling around osseointegrated prosthesis.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Role of Type I Diabetes in Intervertebral Disc Degeneration
Authors: Russo Fabrizio , Ambrosio Luca , Ngo Kevin , Vadalà Gianluca , Denaro Vincenzo , Fan Yong , Sowa Gwendolyn , Kang James D. , Vo Nam 
Published: April 2019

Study Design.
An experimental laboratory study.

Objective.
To investigate the pathogenesis of intervertebral disc degeneration (IDD) in a murine model of type 1 diabetes mellitus (DM), namely nonobese diabetic (NOD) mouse.

Summary of Background Data.
IDD is a leading contributor of low back pain, which represents one of the most disabling symptoms within the adult population. DM is a chronic metabolic disease currently affecting one in 10 adults in the United States. It is associated with an increased risk of developing IDD, but the underlying process remains poorly understood.

Methods.
Total disc glycosaminoglycan content, proteoglycan synthesis, aggrecan fragmentation, glucose transporter gene expression, and apoptosis were assessed in NOD mice and wild-type euglycemic control mice. Spinal structural and molecular changes were analyzed by micro-computed tomography, histological staining (Safranin-O and fast green), and quantitative immunofluorescence (anti-ADAMTS-4 and -5 antibodies).

Results.
Compared with euglycemic controls, NOD mice showed increased disc apoptosis and matrix aggrecan fragmentation. Disc glycosaminoglycan content and histological features of NOD mice did not significantly differ from those of euglycemic littermates.

Conclusion.
These data demonstrate that DM may contribute to IDD by increasing aggrecan degradation and promoting cell apoptosis, which may represent early indicators of the involvement of DM in the pathogenesis of IDD.

Level of Evidence: N/A
Sex Differences in Rat Intervertebral Disc Structure and Function Following Annular Puncture Injury
Authors: Mosley Grace E. , Hoy Robert C. , Nasser Philip , Kaseta Timothy , Lai Alon , Evashwick-Rogler Thomas W. , Lee Michael , Iatridis James C. 
Published: April 2019

Study Design.
A rat puncture injury intervertebral disc (IVD) degeneration model with structural, biomechanical, and histological analyses.

Objective.
To determine if males and females have distinct responses in the IVD after injury.

Summary of Background Data.
Low back pain (LBP) and spinal impairments are more common in women than men. However, sex differences in IVD response to injury have been underexplored, particularly in animal models where sex differences can be measured without gender confounds.

Methods.
Forty-eight male and female Sprague Dawley rats underwent sham, single annular puncture with tumor necrosis factor α (TNFα) injection (1×), or triple annular puncture with TNFα injection (3×) surgery. Six weeks after surgery, lumbar IVDs were assessed by radiologic IVD height, spinal motion segment biomechanical testing, histological degeneration grading, second harmonic generation (SHG) imaging, and immunofluorescence for fibronectin and α-smooth muscle actin.

Results.
Annular puncture injuries significantly increased degenerative grade and IVD height loss for males and females, but females had increased degeneration grade particularly in the annulus fibrosus (AF). Despite IVD height loss, biomechanical properties were largely unaffected by injury at 6 weeks. However, biomechanical measures sensitive to outer AF differed by sex after 3× injury—male IVDs had greater torsional stiffness, torque range, and viscoelastic creep responses. SHG intensity of outer AF was reduced after injury only in female IVDs, suggesting sex differences in collagen remodeling. Both males and females exhibited decreased cellularity and increased fibronectin expression at injury sites.

Conclusion.
IVD injury results in distinct degeneration and functional healing responses between males and females. The subtle sex differences identified in this animal model suggest differences in response to IVD injury that might explain some of the variance observed in human LBP, and demonstrate the need to better understand differences in male and female IVD degeneration patterns and pain pathogenesis.

Level of Evidence: N/A
Short-term Outcomes Following Cervical Laminoplasty and Decompression and Fusion With Instrumentation
Authors: Boniello Anthony , Petrucelli Philip , Kerbel Yudi , Horn Samantha , Bortz Cole A. , Brown Avery E. , Pierce Katherine E. , Alas Haddy , Khalsa Amrit , Passias Peter 
Published: April 2019

Study Design.
Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2010 to 2015.

Objective.
Investigate which short-term outcomes differ for cervical laminoplasty and laminectomy and fusion surgeries.

Summary of Background Data.
Conflicting reports exist in spine literature regarding short-term outcomes following cervical laminoplasty and posterior laminectomy and fusion. The objective of this study was to compare the 30-day outcomes for these two treatment groups for multilevel cervical pathology.

Methods.
Patients who underwent cervical laminoplasty or posterior laminectomy and fusion were identified in National Surgical Quality Improvement Program (NSQIP) based on Current Procedural Terminology (CPT) code: laminoplasty 63,050 and 63,051, posterior cervical laminectomy 63,015 and 63,045, and instrumentation 22,842. Propensity-adjusted multivariate regressions assessed differences in postoperative length of stay, adverse events, discharge disposition, and readmission.

Results.
Three thousand seven hundred ninety-six patients were included: 2397 (63%) underwent cervical laminectomy and fusion and 1399 (37%) underwent cervical laminoplasty. Both groups were similar in age, sex, body mass index (BMI), American Society of Anesthesiologist Classification (ASA), Charleston Comorbidity Index (CCI), and had similar rates of malnutrition, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, and history for steroid use. Age more than 70 and age less than 50 were not associated with one treatment group over the other (P > 0.05). Compared with laminoplasty patients, laminectomy and fusion patients had increased lengths of stay (LOS) (4.5 vs. 3.7 d, P < 0.01) and increased rates of adverse events (41.7% vs. 35.9%, P < 0.01), discharge to rehab (16.4% vs. 8.6%, P < 0.01), and skilled nursing facilities (12.2% vs. 9.7%, P = 0.02), and readmission (6.2% vs. 4.5%, P = 0.05). Both groups experienced similar rates of death, pulmonary embolus, deep vein thrombosis, deep and superficial surgical site infection, and reoperation (P > 0.05 for all).

Conclusion.
Posterior cervical laminectomy and fusion patients were found to have increased LOS, readmissions, and complications despite having similar pre-op demographics and comorbidities. Patients and surgeons should consider these risks when considering surgical treatment for cervical pathology.

Level of Evidence: 3
Conditional Survival Analysis of Metastatic Colorectal Cancer Patients Living ≥24 Months
Authors: Ali Nadia D. , Donohue Kristen , Zandieh Shadi , Chen Chunxia , Moore Dirk , Poplin Elizabeth , Shah Mihir M. , Nosher John , Gui Bin , Jabbour Salma K. , Spencer Kristen , Carpizo Darren R. 
Published: April 2019

Objectives:
The survival of patients with metastatic colorectal cancer (CRC) has been increasing over recent decades due to improvements in chemotherapy and surgery. There is a need to refine prognostic information to more accurately predict survival as patients survive for any given length of time to assist multidisciplinary cancer management teams in treatment decisions.

Materials and Methods:
We performed a single center retrospective analysis of patients treated with metastatic CRC (unresectable and resectable) who survived >24 months between 2005 and 2015 (N=155). Patient tumor and treatment related variables were collected. Overall survival (OS) estimates conditional on surviving >24 months were compared with actuarial survival estimates of a cohort of patients (33,104 resected, 39,382 unresected) from the National Cancer Database (NCDB).

Results:
With a median follow-up of 44.2 months, the median OS of resected patients (n=86) was not reached. The median OS of unresected patients was 75.9 months. The conditional survival probabilities of living 1, 2, or 3 years longer after 24 months of survival are 92%, 72%, and 52%, respectively, in unresectable patients and 98%, 92%, and 89% in patients who were resected. The corresponding NCDB 1, 2, and 3 year actuarial survival was 38%, 20%, and 11% for unresected patients and 68%, 46%, and 32% for resected.

Conclusions:
These results indicate that CRC patients who survive 24 months with metastatic colorectal cancer have an excellent prognosis and surgery may be appropriate in a subset of patients initially deemed unresectable.
Efficacy and Safety of Gefitinib as Third-line Treatment in NSCLC Patients With Activating EGFR Mutations Treated With First-line Gefitinib Followed by Second-line Chemotherapy
Authors: Song Yong , Wu Yi-Long , Cao Le-Jie , Chen Jian-Hua , Ma Zhi-Yong , Cui Jiu-Wei , Wang Jie , Liu Hong-Bing , Ding Jing-Yan , Hu Min 
Published: April 2019

Objective:
There is no standard care for advanced non–small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation in the third line. Our study aimed to assess the efficacy and safety of gefitinib as a third-line re-challenge treatment for advanced NSCLC patients with EGFR mutation.

Materials and Methods:
It was a multicenter, open-label, single-arm, phase II study. Stage IIIB/IV NSCLC patients with EGFR exon 19del/L858R mutation, who had benefited from first-line gefitinib treatment followed by second-line chemotherapy, received gefitinib 250 mg/d. The primary objective was disease control rate (DCR) at week 8.

Results:
Predefined DCR was achieved in 69.8% (95% confidence interval, 49.87-74.91) patients and objective response rate was reported in 4.7% (95% confidence interval, 0.78-13.06) patients. Median progression-free survival (PFS) was 4.4 months and overall survival (OS) was 10.3 months. Baseline T790M-negative patients achieved favorable DCR compared with T790M-positive patients (78.1% vs. 45.5%, P=0.0418), significantly longer median PFS (4.7 vs. 2.0 mo, P=0.0009) and median OS (15.2 vs. 7.7 mo, P=0.0132). We observed a negative correlation of PFS (r=−0.4396, P=0.0032), and OS (r=−0.3630, P=0.0167) with mutation abundance of exon 19del/L858R at baseline.

Conclusions:
Re-challenge with gefitinib is effective and could be a choice for third-line patients after the first-line EGFR-TKI treatment and second-line chemotherapy, especially for the T790M-negative patients.
Uterine Papillary Serous Carcinoma Arising in a Polyp
Authors: Mandato Vincenzo D. , Torricelli Federica , Palomba Stefano , Uccella Stefano , Pirillo Debora , Ciarlini Gino , De Iaco Pierandrea , Lucia Emilio , Giorda Giorgio , Ditto Antonino , Ghezzi Fabio , Sanseverino Francesca , Franchi Massimo , Bifulco Giuseppe , Mastrofilippo Valentina , Abrate Martino , Aguzzoli Lorenzo , La Sala Giovanni B. 
Published: April 2019

Objectives:
The objectives of this study were to evaluate whether the international recommendations on the management of uterine papillary serous carcinoma arising in a polyp are uniformly followed in Italian Oncologic Centers and whether the strategy adopted is effective.

Materials and Methods:
Patients with uterine papillary serous carcinoma arising in a polyp and who had undergone a hysterectomy were identified in the 2003-2013 database of 7 Italian Gynecologic Oncology Centers. Clinical and pathologic characteristics and outcomes were compared between staging procedure types. Survival curves of the women were plotted using the Kaplan-Meier method and analyzed using Cox regression hazard model and the log-rank test. Associations between clinical parameters and the incidence of recurrence were assessed by generalized linear models and the Fisher test.

Results:
A total of 75 patients met the inclusion criteria. Recurrence-free survival was affected positively by type of surgical staging and negatively by preoperative diagnosis of hypertension. The association between surgical staging and recurrence-free survival resulted significant at univariate survival analysis (P=0.048 and 0.045) and maintained a trend of significance (P=0.070) in multivariate analysis, whereas hypertension was demonstrated to be the principal influencing factor.

Conclusions:
The international recommendations on the management of uterine papillary serous carcinoma are not uniformly followed in daily practice, although the extension of the surgery seems to be associated with lower recurrence rates also when uterine papillary serous carcinoma is confined to a polyp or endometrial surface.
Analysis of Outcomes in Patients With BRCA1/2 Breast Cancer Mutations Treated With Accelerated Partial Breast Irradiation (APBI)
Authors: Ahmed Faisal , Christos Paul J. , Singh Prabhsimranjot , Parashar Bhupesh , Wernicke Alla Gabriella 
Published: April 2019

Objective:
To analyze outcomes and survival for BRCA1/2+ patients treated with accelerated partial breast irradiation (APBI).

Materials and Methods:
Retrospective review was performed on 341 women treated with intracavitary APBI (Mammosite or Contura) postlumpectomy from 2002 to 2013. Patients were treated to 34.0 Gy in 10 BID fractions. Of 341 treated patients, 11 (3.2%) had BRCA1/2 mutations, 5 of whom had an oophorectomy. Ipsilateral breast tumor recurrence (IBTR), contralateral breast tumor recurrence (CBTR), and breast tumor recurrence progression-free survival were analyzed using SPSS-17. BRCA1/2+ patient outcomes were compared with a general population treated cohort.

Results:
Median age at diagnosis was 66 years, for BRCA1/2+ women it was 61 years. Median follow-up was 8.4 years and for BRCA1/2+ patients it was 8.8 years. IBTR for the entire cohort was 3.5%, while CBTR was 1.2%. Both IBTR and CBTR for the BRCA1/2+ group were 0%. The 5-year IBTR-free survival was 97.3% (95% confidence interval [CI]=94.9%, 98.6%), and the CBTR-free survival was 99.4% (95% CI=97.6%, 99.9%). The 5-year breast tumor recurrence-free survival was 96.7% (95% CI=94.1%, 98.2%). As no patients with BRCA1/2+ mutation died of metastatic breast cancer or recurrence during follow-up and review, overall survival could not be evaluated.

Conclusions:
To date, BRCA1/2+ patients treated with APBI sustained no recurrences, or second cancers. Most patients had an ER+ status and underwent oophorectomy, which may be a protective mechanism for recurrence. This is the first outcomes report in the literature of BRCA1/2 mutations treated with APBI technique.
Phase I Study of Aurora A Kinase Inhibitor Alisertib (MLN8237) in Combination With Selective VEGFR Inhibitor Pazopanib for Therapy of Advanced Solid Tumors
Authors: Shah Hiral A. , Fischer James H. , Venepalli Neeta K. , Danciu Oana C. , Christian Sonia , Russell Meredith J. , Liu Li C. , Zacny James P. , Dudek Arkadiusz Z. 
Published: April 2019

Objectives:
Pazopanib is a multikinase angiogenesis inhibitor. Alisertib is a highly selective inhibitor of mitotic Aurora A kinase. There is preclinical evidence that mitosis-targeting agents exhibit antiangiogenic effects. Thus, the combination of these 2 agents may have a synergistic effect on tumor vasculature. The primary objective of this study is to determine the optimal tolerated dose (OTD) for alisertib and pazopanib.

Materials and Methods:
This phase 1b study evaluated the OTD of alisertib twice a day, on days 1 to 7 with pazopanib, once a day, continuously in a 21-day cycle, both taken orally. Disease response was assessed using the Response Evaluation Criteria in Solid Tumors version 1.1 every 2 cycles. OTD cohort was expanded to assure safety and perform pharmacokinetics analysis.

Results:
A total of 27 patients received treatment. Seventy-seven percent of the patients had received at least 3 prior chemotherapy regimens. Dose-limiting toxicities occurred in dose level (DL) 2+ (grade 4 thrombocytopenia and grade 3 mucositis) and DL 3 (grade 3 liver transaminases elevation and grade 3 abdominal pain). The OTD was determined to be DL 2: alisertib 20 mg twice daily and pazopanib 600 mg daily. Pharmacokinetic analysis revealed that clearance of alisertib was reduced by ∼40% in the presence of pazopanib compared with clearance in the absence of pazopanib. Fourteen patients had stable disease and 2 patients had a partial response.

Conclusions:
The combination of alisertib with pazopanib demonstrates manageable safety and early clinical evidence of antitumor activity in patients with advanced malignancies (NCT01639911).