bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age Differences in the Effects of Speaking Rate on Auditory, Visual, and Auditory-Visual Speech Perception
Authors: Sommers Mitchell S. , Spehar Brent , Tye-Murray Nancy , Myerson Joel , Hale Sandra 
Published: August 2019

Objectives:
This study was designed to examine how speaking rate affects auditory-only, visual-only, and auditory-visual speech perception across the adult lifespan. In addition, the study examined the extent to which unimodal (auditory-only and visual-only) performance predicts auditory-visual performance across a range of speaking rates. The authors hypothesized significant Age × Rate interactions in all three modalities and that unimodal performance would account for a majority of the variance in auditory-visual speech perception for speaking rates that are both slower and faster than normal.

Design:
Participants (N = 145), ranging in age from 22 to 92, were tested in conditions with auditory-only, visual-only, and auditory-visual presentations using a closed-set speech perception test. Five different speaking rates were presented in each modality: an unmodified (normal rate), two rates that were slower than normal, and two rates that were faster than normal. Signal to noise ratios were set individually to produce approximately 30% correct identification in the auditory-only condition and this signal to noise ratio was used in the auditory-only and auditory-visual conditions.

Results:
Age × Rate interactions were observed for the fastest speaking rates in both the visual-only and auditory-visual conditions. Unimodal performance accounted for at least 60% of the variance in auditory-visual performance for all five speaking rates.

Conclusions:
The findings demonstrate that the disproportionate difficulty that older adults have with rapid speech for auditory-only presentations can also be observed with visual-only and auditory-visual presentations. Taken together, the present analyses of age and individual differences indicate a generalized age-related decline in the ability to understand speech produced at fast speaking rates. The finding that auditory-visual speech performance was almost entirely predicted by unimodal performance across all five speaking rates has important clinical implications for auditory-visual speech perception and the ability of older adults to use visual speech information to compensate for age-related hearing loss.
Clinico-Genotypic Correlation: Recurrent Attacks of Paralysis and Skeletal Muscle SCN4A Mutation (p.Ile693Thr)
Authors: Nanda Satyan , Tandon Vaibhav , Menon Ramshekhar , Sundaram Soumya , Nair Muralidharan 
Published: August 2019

Abstract
Skeletal sodium channel mutations have been known to demonstrate a multitude of clinical manifestations of which one such commonly known entity is paramyotonia congenita. We describe the clinical features of proband in our case report and the various phenotypic manifestations described with the mentioned mutation from different centres. Our case serves to highlight the heterogeneity that exists in SCN4A mutations and the possible effect of other genetic/environmental factors in determining the final phenotype.
XEN-augmented Baerveldt Implantation for Refractory Childhood Glaucoma: A Retrospective Case Series
Authors: Arad Tschingis , Hoffmann Esther M. , Prokosch-Willing Verena , Pfeiffer Norbert , Grehn Franz 
Published: August 2019

Background:
Tube implants can lead to long-term decompensation of the cornea after decades, in particular in complicated childhood glaucoma, because of a variety of causes including contact between the tube tip and the corneal endothelium. The augmentation of a XEN implant with a Baerveldt (250) tube implant, introduced 2016 by Mermoud et al for refractory glaucoma in adult patients, may reduce this risk in children. In our retrospective study, we report on the XEN-augmented Baerveldt (250) tube implant in children.

Patients and Methods:
Ten consecutive patients with refractory childhood glaucoma who underwent XEN-augmented Baerveldt implantation by a single surgeon (F.G.) between January 2016 and August 2018 were retrospectively analyzed. In this technique, a XEN tube was inserted under a standard scleral flap from outside into the anterior chamber and its outer end was connected to the Baerveldt (250) tube. The follow-up consisted of regular anterior and posterior segment examination with intraocular pressure (IOP) measurements using a hand-held slit lamp and a Perkins applanation tonometer and/or rebound tonometer (Icare).

Results:
Ten cases (6 female individuals, 4 male individuals, median age 6 years) were operated using a XEN-augmented Baerveldt implant [aphakic glaucoma, primary congenital glaucoma, secondary congenital glaucoma (Peters anomaly), ectropion uveae, and Stickler syndrome were 4, 3, 1, 1, and 1]. Before surgery (XEN-augmented Baerveldt implantation), median IOP was 31 mm Hg. At the last postoperative follow-up, the mean IOP was 18.5 mm Hg with a median follow-up period of 13 months (range, 3 to 21 mo). No shallow or flat anterior chamber was observed. In all cases, this technique could be performed without intraoperative complications. In 3 cases, however, a surgical revision was necessary. There was no prolonged postoperative hypotony or short-term corneal alteration. By using an S-shaped loop the original Baerveldt tube length could be preserved for potential future use. In a total of 6 out of 10 cases, the procedure was a complete success (IOP, ≤20 mm Hg without additional medication).

Conclusions:
XEN-augmented Baerveldt implantation was used for refractory pediatric glaucoma in which conventional surgery had already failed. A new additional modification using an S-shaped loop was introduced. Short-term IOP control seems promising, but long-term results are still pending and the long-term efficacy and safety must still be proven before this technique can be generally recommended.
Doctor of Physical Therapy Student Perceptions of Near-Peer Teaching in an Anatomy Educational Experience
Authors: Haladay Douglas E. , Miro Rebecca M. , Hardwick Dustin , Swisher Laura L. , Klein Aimee B. 
Published: August 2019

Background and Purpose.Near-peer (NP) teaching, teaching by students where a gap greater than 1 year exists between teacher and learner, has been found to produce positive results in both teacher and learner alike. Gross anatomy courses often include NP teaching experiences; however, those experiences tend to limit the NP teachers to strong academic performers.Method/Model Description and Evaluation.The University of South Florida School of Physical Therapy and Rehabilitation Sciences' Doctor of Physical Therapy (DPT) students participated in a NP teaching experience. All third-year DPT students served as a NP teacher, as either a planner (n= 31) or a laboratory assistant (n= 8). Third-year students were responsible for content development (planners) and/or delivery (planners and laboratory assistants) for an anatomy module within a movement science course. After each module, first-year students completed a survey and course assessments while third-year planners completed a self-reflection. A thematic analysis was completed using the first- and third-year responses.Outcomes.First-year students reported that the experience enhanced their understanding of anatomy as it relates to physical therapist practice, provided them strategies to correctly identify important anatomical concepts, and was preferable over instructor led anatomy. Third-year students (planners) acknowledged the benefit of teaching peers and reflected on knowledge reinforcement with a greater level of comfort and understanding of effort for teaching.Discussion and Conclusion.The findings support the existing literature that NP opportunities are beneficial for NP teachers and learners and have potential as an additional strategy for teaching human anatomy in physical therapist education programs.
The influence of nurse practitioner staffing on intensive care unit mortality
Authors: Chang Chih-Lun , Tang Gau-Jun , Wu Chin-Pyng , Pu Christy , Chen Hsin-Chih 
Published: August 2019

ABSTRACT

Background:
In Taiwan, nurse practitioners (NPs) have taken on expanded clinical roles in the intensive care unit (ICU) due to insufficient staffing of attending physicians and resident physicians.

Local problem:
The objective of this study was to investigate the influence of NP staffing on the quality of patient care in ICUs.

Methods:
This is a retrospective study that selected patients from the ICUs of three hospitals during 2015. The mortality risks among the three hospitals were compared after adjusting variables using the Cox regression model. The care qualities of the three hospitals were analyzed using the standardized mortality ratio.

Interventions:
Hospital A consisted of attending physicians and resident physicians. Hospital B consisted of attending physicians and NPs. Hospital C consisted of attending physicians, NPs, and resident physicians.

Results:
Outcomes were assessed for 2,932 patients. The patients in hospital A had a lower mortality risk than hospital B or C. Septic shock patients received better care quality in hospital B than in hospital A or hospital C.

Conclusions:
In regional hospitals with lower NP-to-patient ratios, increasing that ratio could reduce the risk of mortality in the ICU and increase the quality of care.
Electronic interventions aimed at increasing self-worth in mild dementia may not be feasible
Authors: Martinez Natalie , Stutzman Sonja E. , Olson DaiWai M. 
Published: August 2019

ABSTRACT
Alzheimer disease (AD) is a devastating diagnosis. Milieu therapy and memory activities have been shown to improve self-worth and improve mood in AD patients, but adherence to these activities is challenging. This prospective randomized pilot study examined adherence to memory recall activities using positive reinforcement and explored the impact on self-worth and depression. Pretest-posttest scores and data abstraction were used to measure protocol adherence, self-worth (Rosenberg Self-Esteem Scale), cognitive decline (Mini-Mental Status Examination), and symptoms of depression (Geriatric Depression Scale). Among 22 mild AD participants, there were no statistically significant differences in pretest versus posttest scores for all measures. The results suggest that the intervention of memory recall did not enhance self-worth, improve the status of memory recall, or lower symptoms of depression. Additionally, positive reinforcement did not play a role in adherence to accessing the tasks.
Provider-directed education to reduce unnecessary neuroimaging in uncomplicated headache disorders
Authors: Cook Calli Leighann , Bowles Wendy , Zurmehly Joyce , McDaniel Jodi 
Published: August 2019

ABSTRACT

Background:
More than 1.9 million annual outpatient visits to neurologists in the United States are associated with headache diagnoses. For uncomplicated headache disorders, the evidence-based practice (EBP) guidelines recommend against neuroimaging unless specific neurological signs and symptoms are present; however, neuroimaging rates have only modestly decreased since the guidelines were developed.

Local Problem:
We evaluated unnecessary neuroimaging rates in patients with uncomplicated headache at the Emory Department of General Neurology. The rate of unnecessary neuroimaging suggested a provider knowledge gap in the use of neuroimaging in patients with uncomplicated headaches.

Methods:
A provider-directed educational session was delivered, and outcomes were evaluated 8 weeks after implementation. The postintervention rates of unnecessary neuroimaging were compared with preintervention rates.

Interventions:
A 15-minute educational session on the EBP guidelines for neuroimaging use in uncomplicated headache was presented to all general neurology providers (n = 9). The providers were given an electronic version of the presentation and a pocket-sized EBP algorithm for neuroimaging in this population.

Results:
Data collected from the project site's neuroimaging dashboard showed a significantly lower proportion of unnecessary neuroimaging orders in the 8-week posteducational interval (4.2%) compared with the 8-week preeducation interval (7.2%) (t = 2.78, p = .014), a 41.6% reduction.

Conclusions:
We found that a provider-directed educational session reviewing the EBP guidelines for neuroimaging in patients with uncomplicated headache disorders was successful in lowering rates of neuroimaging. Implementing similar projects in other departments could further reduce unnecessary neuroimaging use across the organization.
Predictive criteria for acute heart failure in emergency department patients with acute dyspnoea: the PREDICA study
Authors: Roncalli J. , Picard F. , Delarche N. , Faure I. , Pradeau C. , Thicoipe M. , Galinier M. , Charpentier S. 
Published: August 2019

Objectives
The early identification of patients with Acute Heart Failure Syndrome (AHFS) among patients admitted to the Emergency Department (ED) with dyspnoea can facilitate the introduction of appropriate treatments. The objectives are to identify the predictive factors for AHFS diagnosis in patients with acute dyspnoea (primary objective) and the clinical ‘gestalt’ (secondary objective) in ED.

Methods
PREDICA is an observational, prospective, multicentre study. The enrolment of patients admitted to the ED for nontraumatic acute dyspnoea and data collection on admission were recorded by the patient’s emergency physician. The AHFS endpoints were assessed following a duplicate expert evaluation by pairs of cardiologists and emergency physicians. Step-by-step logistic regression was used to retain predictive criteria, and the area under the receiver operating characteristic (ROC) curve of the model was constructed to assess the ability of the selected factors to identify real cases. The probability of AHFS was estimated on a scale from 1 to 10 based on the emergency physician’s perception and understanding (gestalt).

Results
Among 341 patients consecutively enrolled in three centres, 149 (44%) presented AHFS. Eight predictive factors of AHFS were detected with a performance test showing an area under the model ROC curve of 0.86. Gestalt greater than or equal to five showed sensitivity of 78% and specificity of 90% (AUC 0.91) and diagnosed 88% of AHF in our population.

Conclusions
We identified several independant predictors of final AHFS diagnosis. They should contribute to the development of diagnostic strategies in ED. However, unstructured gestalts seem to perform very well alone.
Laboratory testing and imaging in the evaluation of cranial cerebrospinal fluid leaks and encephaloceles
Authors: Lipschitz Noga , Hazenfield J. Michael , Breen Joseph T. , Samy Ravi N. 
Published: August 2019

Purpose of review
To summarize the current evidence on the diagnostic evaluation of cranial cerebrospinal fluid (CSF) leaks and encephaloceles, including laboratory testing and imaging studies.

Recent findings
The most sensitive and specific laboratory tests for CSF leak diagnosis are beta-2-transferrin and beta trace protein assays, the former more commonly used because of availability. Imaging studies used for localization of the leak site include high resolution computed tomography (HRCT) and magnetic resonance cisternography (MRC), often used in combination. Intrathecal contrast administration is reserved for complex cases with prior equivocal test results or for patients with multiple skull base defects to localize the leak site.

Summary
Diagnosis of CSF leaks and encephaloceles is aimed at both confirming the leak and localizing the leak site. Future advancements in testing techniques may shorten the diagnostic process, limit the need for invasive testing, and improve the safety of such testing in indicated cases.
Sexually Transmitted Infection Positivity Among Adolescents With or at High-Risk for Human Immunodeficiency Virus Infection in Los Angeles and New Orleans
Authors: Shannon Chelsea L. , Keizur Erin M. , Fehrenbacher Anne , Wood-Palmer Drew , Ramos Wilson , Koussa Maryann , Fournier Jasmine , Lee Sung-Jae , Patel Dhara , Akabike Whitney N. , Abdalian Sue Ellen , Rotheram-Borus Mary Jane , Klausner Jeffrey D. 
Published: August 2019

Background
Gay, bisexual, and transgender youth and homeless youth are at high risk for sexually transmitted infections (STIs). However, little recent data exist describing STI positivity by anatomical site among those groups. We determined the positivity of Chlamydia trachomatis (CT) infection, Neisseria gonorrhoeae (NG) infection, and syphilis antibody reactivity among lesbian, gay, bisexual, transgender, and homeless youth.

Methods
We recruited 1,264 adolescents with high risk behavior aged 12 to 24 years from homeless shelters, lesbian, gay, bisexual, and transgender organizations, community health centers, and using social media and online dating apps in Los Angeles, California and New Orleans, Louisiana from May 2017 to February 2019. Participants received point-of-care pharyngeal, rectal, and urethral/vaginal CT and NG testing and syphilis antibody testing. We calculated STI positivity by anatomical site and compared positivity by participant subgroups based on human immunodeficiency virus (HIV) status, sex assigned at birth, and gender identity.

Results
CT and NG positivity and syphilis antibody reactivity was higher among HIV-infected adolescent men who have sex with men (MSM) than HIV-uninfected adolescent MSM (40.2% vs. 19%, P < 0.05), particularly CT or NG rectal infection (28% vs. 12.3%, P < 0.05). Of participants with positive CT or NG infections, 65% had extragenital-only infections, 20% had both extragenital and urogenital infections, and 15% had urogenital-only infections.

Conclusions
Sexually transmitted infection positivity was high, particularly among transgender women and MSM. The high proportion of rectal and pharyngeal infections highlights the importance of both urogenital and extragenital STI screening. More accessible STI testing is necessary for high-risk adolescent populations.
Survival and Cardiopulmonary Resuscitation Hemodynamics Following Cardiac Arrest in Children With Surgical Compared to Medical Heart Disease*
Authors: Yates Andrew R. , Sutton Robert M. , Reeder Ron W. , Meert Kathleen L. , Berger John T. , Fernandez Richard , Wessel David , Newth Christopher J. , Carcillo Joseph A. , McQuillen Patrick S. , Harrison Rick E. , Moler Frank W. , Pollack Murray M. , Carpenter Todd C. , Notterman Daniel A. , Dean J. Michael , Nadkarni Vinay M. , Berg Robert A. 
Published: August 2019

Objectives:
To assess the association of diastolic blood pressure cutoffs (≥ 25 mm Hg in infants and ≥ 30 mm Hg in children) during cardiopulmonary resuscitation with return of spontaneous circulation and survival in surgical cardiac versus medical cardiac patients. Secondarily, we assessed whether these diastolic blood pressure targets were feasible to achieve and associated with outcome in physiology unique to congenital heart disease (single ventricle infants, open chest), and influenced outcomes when extracorporeal cardiopulmonary resuscitation was deployed.

Design:
Multicenter, prospective, observational cohort analysis.

Setting:
Tertiary PICU and cardiac ICUs within the Collaborative Pediatric Critical Care Research Network.

Patients:
Patients with invasive arterial catheters during cardiopulmonary resuscitation and surgical cardiac or medical cardiac illness category.

Interventions:
None.

Measurements and Main Results:
Hemodynamic waveforms during cardiopulmonary resuscitation were analyzed on 113 patients, 88 surgical cardiac and 25 medical cardiac. A similar percent of surgical cardiac (51/88; 58%) and medical cardiac (17/25; 68%) patients reached the diastolic blood pressure targets (p = 0.488). Achievement of diastolic blood pressure target was associated with improved survival to hospital discharge in surgical cardiac patients (p = 0.018), but not medical cardiac patients (p = 0.359). Fifty-three percent (16/30) of patients with single ventricles attained the target diastolic blood pressure. In patients with an open chest at the start of chest compressions, 11 of 20 (55%) attained the target diastolic blood pressure. In the 33 extracorporeal cardiopulmonary resuscitation patients, 16 patients (48%) met the diastolic blood pressure target with no difference between survivors and nonsurvivors (p = 0.296).

Conclusions:
During resuscitation in an ICU, with invasive monitoring in place, diastolic blood pressure targets of greater than or equal to 25 mm Hg in infants and greater than or equal to 30 mm Hg in children can be achieved in patients with both surgical and medical heart disease. Achievement of diastolic blood pressure target was associated with improved survival to hospital discharge in surgical cardiac patients, but not medical cardiac patients. Diastolic blood pressure targets were feasible to achieve in 1) single ventricle patients, 2) open chest physiology, and 3) extracorporeal cardiopulmonary resuscitation patients.
Preoperative Risk Assessment for Loss of Independence Following Hepatic Resection in Elderly Patients
Authors: Tanaka Shogo , Iida Hiroya , Ueno Masaki , Hirokawa Fumitoshi , Nomi Takeo , Nakai Takuya , Kaibori Masaki , Ikoma Hisashi , Eguchi Hidetoshi , Shinkawa Hiroji , Maehira Hiromitsu , Hayami Shinya , Kubo Shoji 
Published: August 2019

Objective:
To establish a preoperative risk assessment method for loss of independence after hepatic resection.

Summary Background Data:
Hepatic resection often results in loss of independence in preoperatively self-sufficient elderly people. Elderly patients should therefore be carefully selected for surgery.

Methods:
In this prospective, multicenter study, 347 independently-living patients aged ≥65 years, scheduled for hepatic resection, were divided into study (n = 232) and validation (n = 115) cohorts. We investigated the risk factors for postoperative loss of independence in the study cohort and verified our findings with the validation cohort. Loss of independence was defined as transfer to a rehabilitation facility, discharge to residence with home-based healthcare, 30-day readmission for poor functionality, and 90-day mortality (except for cancer-related deaths).

Results:
In the study cohort, univariate and multivariate analyses indicated that frailty, age ≥ 76 years, and open surgery were independent risk factors for postoperative loss of independence. Proportions of patients with postoperative loss of independence in the study and validation cohorts were respectively 3.0% and 0% among those with no applicable risk factors, 8.1% and 12.5% among those with 1 applicable risk factor, 25.5% and 25.0% among those with 2 applicable risk factors, and 56.3% and 50.0% among those with all 3 factors applicable (P < 0.001 for both cohorts). Areas under the receiver operating characteristic curves for the study and validation groups were 0.777 and 0.783, respectively.

Conclusions:
Preoperative risk assessments using these 3 factors may be effective in predicting and planning for postoperative loss of independence after hepatic resection in elderly patients.