bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting respiratory hospital admissions in young people with cerebral palsy
Authors: Blackmore Amanda Marie , Bear Natasha , Blair Eve , Langdon Katherine , Moshovis Lisa , Steer Kellie , Wilson Andrew C 
Published: March 2018

ObjectiveTo determine the early predictors of respiratory hospital admissions in young people with cerebral palsy (CP).DesignA 3-year prospective cohort study using linked data.PatientsChildren and young people with CP, aged 1 to 26 years.Main outcome measuresSelf-reported and carer-reported respiratory symptoms were linked to respiratory hospital admissions (as defined by the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes) during the following 3 years.Results482 participants (including 289 males) were recruited. They were aged 1 to 26 years (mean 10 years, 10 months; SD 5 years, 11 months) at the commencement of the study, and represented all Gross Motor Function Classification Scale (GMFCS) levels. During the 3-year period, 55 (11.4%) participants had a total of 186 respiratory hospital admissions, and spent a total of 1475 days in hospital. Statistically significant risk factors for subsequent respiratory hospital admissions over 3 years in univariate analyses were GMFCS level V, at least one respiratory hospital admission in the year preceding the survey, oropharyngeal dysphagia, seizures, frequent respiratory symptoms, gastro-oesophageal reflux disease, at least two courses of antibiotics in the year preceding the survey, mealtime respiratory symptoms and nightly snoring.ConclusionsMost risk factors for respiratory hospital admissions are potentially modifiable. Early identification of oropharyngeal dysphagia and the management of seizures may help prevent serious respiratory illness. One respiratory hospital admission should trigger further evaluation and management to prevent subsequent respiratory illness.
‘It feels like being trapped in an abusive relationship’: bullying prevalence and consequences in the New Zealand senior medical workforce: a cross-sectional study
Authors: Chambers Charlotte N L , Frampton Christopher M A , McKee Martin , Barclay Murray 
Published: March 2018

ObjectivesTo estimate prevalence of and factors contributing to bullying among senior doctors and dentists in New Zealand’s public health system, to ascertain rates of reporting bullying behaviour, perceived barriers to reporting and the effects of bullying professionally and personally.DesignCross-sectional, mixed methods study.SettingNew Zealand.ParticipantsMembers of the Association of Salaried Medical Specialists (40.8% response rate).Main outcome measuresPrevalence of bullying was measured using the Negative Acts Questionnaire (revised) (NAQ-r). Workplace demands and level of peer and managerial support were measured with the Health and Safety Executive Management Standards Analysis tool. Categories of perpetrators for self-reported and witnessed bullying and barriers to reporting bullying were obtained and qualitative data detailing the consequence of bullying were analysed thematically.ResultsThe overall prevalence of bullying, measured by the NAQ-r, was 38% (at least one negative act on a weekly or daily basis), 37.2% self-reported and 67.5% witnessed. There were significant differences in rates of bullying by specialty (P=0.001) with emergency medicine reporting the highest bullying prevalence (47.9%). The most commonly cited perpetrators were other senior medical or dental specialists. 69.6% declined to report their bullying. Bullying across all measures was significantly associated with increasing work demands and lower peer and managerial support (P=0.001). Consequences of bullying were wide ranging, affecting workplace environments, personal well-being and subjective quality of patient care.ConclusionsBullying is prevalent in New Zealand’s senior medical workforce and is associated with high workloads and low peer and managerial support. These findings help identify conditions and pressures that may encourage bullying and highlight the significant risk of bullying for individuals and their patients.
Do NHS GP surgeries employing GPs additionally trained in integrative or complementary medicine have lower antibiotic prescribing rates? Retrospective cross-sectional analysis of national primary care prescribing data in England in 2016
Authors: van der Werf Esther T , Duncan Lorna J , Flotow Paschen von , Baars Erik W 
Published: March 2018

ObjectiveTo determine differences in antibiotic prescription rates between conventional General Practice (GP) surgeries and GP surgeries employing general practitioners (GPs) additionally trained in integrative medicine (IM) or complementary and alternative medicine (CAM) (referred to as IM GPs) working within National Health Service (NHS) England.DesignRetrospective study on antibiotic prescription rates per STAR-PU (Specific Therapeutic group Age–sex weighting Related Prescribing Unit) using NHS Digital data over 2016. Publicly available data were used on prevalence of relevant comorbidities, demographics of patient populations and deprivation scores.SettingPrimary Care.Participants7283 NHS GP surgeries in England.Primary outcome measureThe association between IM GPs and antibiotic prescribing rates per STAR-PU with the number of antibiotic prescriptions (total, and for respiratory tract infection (RTI) and urinary tract infection (UTI) separately) as outcome.ResultsIM GP surgeries (n=9) were comparable to conventional GP surgeries in terms of list sizes, demographics, deprivation scores and comorbidity prevalence. Negative binomial regression models showed that statistically significant fewer total antibiotics (relative risk (RR) 0.78, 95% CI 0.64 to 0.97) and RTI antibiotics (RR 0.74, 95% CI 0.59 to 0.94) were prescribed at NHS IM GP surgeries compared with conventional NHS GP surgeries. In contrast, the number of antibiotics prescribed for UTI were similar between both practices.ConclusionNHS England GP surgeries employing GPs additionally trained in IM/CAM have lower antibiotic prescribing rates. Accessibility of IM/CAM within NHS England primary care is limited. Main study limitation is the lack of consultation data. Future research should include the differences in consultation behaviour of patients self-selecting to consult an IM GP or conventional surgery, and its effect on antibiotic prescription. Additional treatment strategies for common primary care infections used by IM GPs should be explored to see if they could be used to assist in the fight against antimicrobial resistance.
Can diffusion- and perfusion-weighted imaging alone accurately triage anterior circulation acute ischemic stroke patients to endovascular therapy?
Authors: Wolman Dylan N , Iv Michael , Wintermark Max , Zaharchuk Gregory , Marks Michael P , Do Huy M , Dodd Robert L , Albers Gregory W , Lansberg Maarten G , Heit Jeremy J 
Published: March 2018

Background and purposeAcute ischemic stroke (AIS) patients who benefit from endovascular treatment have a large vessel occlusion (LVO), small core infarction, and salvageable brain. We determined if diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) alone can correctly identify and localize anterior circulation LVO and accurately triage patients to endovascular thrombectomy (ET).Materials and methodsThis retrospective cohort study included patients undergoing MRI for the evaluation of AIS symptoms. DWI and PWI images alone were anonymized and scored for cerebral infarction, LVO presence and LVO location, DWI-PWI mismatch, and ET candidacy. Readers were blinded to clinical data. The primary outcome measure was accurate ET triage. Secondary outcomes were detection of LVO and LVO location.ResultsTwo hundred and nineteen patients were included. Seventy-three patients (33%) underwent endovascular AIS treatment. Readers correctly and concordantly triaged 70 of 73 patients (96%) to ET (κ=0.938; P=0.855) and correctly excluded 143 of 146 patients (98%; P=0.942). DWI and PWI alone had a 95.9% sensitivity and a 98.4% specificity for accurate endovascular triage. LVO were accurately localized to the ICA/M1 segment in 65 of 68 patients (96%; κ=0.922; P=0.817) and the M2 segment in 18 of 20 patients (90%; κ=0.830; P=0.529).ConclusionAIS patients with anterior circulation LVO are accurately identified using DWI and PWI alone, and LVO location may be correctly inferred from PWI. MRA omission may be considered to expedite AIS triage in hyperacute scenarios or may confidently supplant non-diagnostic or artifact-limited MRA.
Examining the influence of tectonic inheritance on the evolution of the North Atlantic using a palinspastic deformable plate reconstruction
Authors: Ady Bridget E. , Whittaker Richard C. 
Published: March 2018

Abstract
To accurately reconstruct plate configurations, there is a need for a quantitative method to calculate the amount and timing of crustal extension independent of any one model for the formation of rifted margins. This paper evaluates the suitability of the various plate modelling methods for structural inheritance studies and proposes a classification scheme for the methods that are currently in use. A palinspastic deformable margin plate kinematic model is most suitable for tectonic inheritance studies, particularly at hyperextended margins. This type of plate model provides a valuable analytical tool that can be used to show the temporal and spatial relationship between pre-existing orogenic structures, evolving rift axes and global plate reorganization events. We use a palinspastic deformable margin plate model for the southern North Atlantic and Labrador Sea to quantitatively restore up to 350 km of Mesozoic–Cenozoic extension. This provides us with a pre-rift restoration of the Proterozoic and Paleozoic terranes and structural lineaments on the conjugate margins that helps us to analyse their relationship to evolving rift axes and global plate reorganization events through time. Interpretation of these modelling results has led to a clearer understanding of the relationship between inherited structural features and their control on rifting and the break-up history.
Crustal structure of the conjugate Equatorial Atlantic Margins, derived by gravity anomaly inversion
Authors: Kusznir Nick J. , Roberts Alan M. , Alvey Andrew D. 
Published: March 2018

Abstract

The crustal structure of the Equatorial Atlantic conjugate margins (South America and West Africa) has been investigated using 3D gravity anomaly inversion, which allows for (1) the elevated geothermal gradient of the lithosphere following rifting and break-up and (2) magmatic addition to the crust during rifting and break-up. It is therefore particularly suitable for the analysis of rifted margins and their associated ocean basins. Maps of crustal thickness and conjugate-margin stretching, derived from gravity anomaly inversion, are used to illustrate how the Equatorial Atlantic opened as a set of stepped rift-transform segments, rather than as a simple orthogonal rifted margin. The influence of the transform faults and associated oceanic fracture zones is particularly clear when the results of the gravity anomaly inversion are combined with a shaded-relief display of the free-air gravity anomaly. A set of crustal cross-sections has been extracted from the results of the gravity inversion along both equatorial margins. These illustrate the crustal structure of both rifted-margin segments and transform-margin segments. The maps and cross-sections are used to delineate crustal type on the margins as (1) inboard, entirely continental, (2) outboard, entirely oceanic and (3) the ocean–continent transition in between where mixed continental and magmatic crust is likely to be present. For a given parameterization of melt generation the amount of magmatic addition within the ocean–continent transition is predicted by the gravity inversion. One of the strengths of the gravity-inversion technique is that these predictions can be made in the absence of any other directly acquired data. On both margins anomalously thick crust is resolved close to a number of oceanic fracture zones. On the South American margin we believe that this thick crust is probably the result of post-break-up magmatism within what was originally normal-thickness oceanic crust. On the West African margin, however, three possible origins are discussed: (1) continental crust extended oceanwards along the fracture zones; (2) oceanic crust magmatically thickened at the fracture zones; and (3) oceanic crust thickened by transpression along the fracture zones. Gravity inversion alone cannot discriminate between these possibilities. The cross-sections also show that, while ‘normal thickness’ oceanic crust (
c.
7 km) predominates regionally, local areas of thinner (
c.
5 km) and thicker (
c.
10 km) oceanic crust are also present along both margins. Finally, using maps of crustal thickness and thinning factor as input to plate reconstructions, the regional palaeogeography of the Equatorial Atlantic during and after break-up is displayed at 10 Ma increments.
Does Greater Trochanter Decortication Affect Suture Anchor Pullout Strength in Abductor Tendon Repairs? A Biomechanical Study
Authors: Putnam Jill G. , Chhabra Anikar , Castañeda Paulo , Walker J. Brock , Barber Collin C. , Lendrum James A. , Hartigan David E. 
Published: March 2018

Background: Greater trochanter decortication is frequently performed at the time of abductor tendon repair to theoretically increase healing potential. No previous studies have determined the effect that greater trochanter decortication has on the pullout strength of suture anchors. Hypothesis/Purpose: The purpose of this study is to determine whether greater trochanter decortication and bone mineral density affect suture anchor pullout strength in abductor tendon repair. The authors hypothesize that both will have a significant detrimental effect on suture anchor pullout strength. Study Design: Controlled laboratory study. Methods: Nineteen cadaveric proximal femurs with accompanying demographic data and computed tomography scans were skeletonized to expose the greater trochanter. Bone density measurements were acquired by converting Hounsfield units to T-score, based on a standardized volumetric sample in the intertrochanteric region of the femur. The gluteus medius insertion site on the lateral facet of the greater trochanter was evenly divided into 2 regions, anterior-distal and posterior-proximal, and each region was randomly assigned to receive either no decortication or 2 mm of bone decortication. A single biocomposite anchor was implanted in each region and initially tested with cyclic loading for 10 cycles at 0-50 N, 0-100 N, 0-150 N, and 0-200 N, followed by load to failure (LTF) tested at 1 mm/s. For each trial, the number of cycles endured, LTF, mechanism of failure, and stiffness were recorded. Results: Greater trochanters with no decortication and 2 mm of decortication survived a mean ± SD 35.1 ± 6.4 and 28.5 ± 10.6 cycles, respectively ( P < .01). Load to failure for nondecorticated specimens was 206.7 ± 75.0 N versus 152.3 ± 60.2 N for decorticated specimens ( P < .001). In a multivariate analysis, decortication and bone density were determinants in LTF ( P < .05). Conclusion: Decortication and decreased bone mineral density significantly decreased the pullout strength of suture anchors in the lateral facet of the greater trochanter. Clinical Relevance: Bone density should be considered when determining whether to perform greater trochanter decortication in abductor tendon repairs.
Hospitalization Outcomes of Cleft Lip Repair in Neonates Across the United States
Authors: Lee Min Kyeong , Yen Stephen L-K. , Allareddy Veerasathpurush 
Published: March 2018

Objective: Cleft lip repair surgeries in neonates have shown to be effective and safe, resulting in less scarring and excellent aesthetic outcomes. However, existing studies are based on single-center experiences with limited numbers of patients and surgeons. Complication rates and hospital outcomes of neonatal lip repair have not yet been established at the national level. The objective of this study was to examine the association between age at cleft lip repair and hospital outcomes. Design: Retrospective analysis of hospital discharge database. Setting: Nationwide Inpatient Sample for years 2004 through 2010. Patients: Patients under 12 months of age diagnosed with cleft lip with or without cleft palate. Interventions: Surgical repair for cleft lip. Main outcome measures: Occurrence of complications. Results: There were 10 132 cleft lip repair procedures in 2004-2010 in the United States. Mean age was 144 days with 2.1 days of hospital stay and $22 037 charges. Less than 2% were performed in neonates (0-28 days). The overall complication rate was 2.1%. Compared to 2-4 months, cleft lip procedures in neonates were associated with longer length of stay ( P = .001) and hospital charges ( P = .03). Cleft lip repair among neonates were 15 times more likely to develop complications ( P = .0004) even after adjusting for confounding factors. Conclusions: Cleft lip repair in neonates is associated with significantly higher complication rates as well as longer length of stay and more hospital charges. Purported benefits of neonatal cleft lip repair may not outweigh significant safety issues and hospitalization outcomes.
Body Esteem in a Western Australian Cleft Lip and/or Palate Cohort Across 3 Age Groups
Authors: Nicholls Wendy , Harper Craig , Selvey Linda A. , Robinson Suzanne , Hartig Gerald , Persson Martin 
Published: March 2018

Objectives: To determine if patients with cleft lip and/or palate (CL/P) from a Western Australian (WA) cohort were more dissatisfied with their body esteem than a normative non-cleft cohort, and identify demographic variables that may have significant associations with body esteem. Design: Questionnaire study using the Body-Esteem Scale (BES) and Cleft Research Questionnaire (CRQ). Participants: Self-selected participants from a Western Australian CL/P population across 3 age groups (n=359). Main outcome measures: The BES is comprised of 3 factors: BE-Appearance, BE-Weight and BE-Attribution. Study mean BES factor scores were compared to normative non-cleft scores. Regression analysis was used to determine significant associations within each age group between BES factor scores and CRQ variables of: gender, self-reported body weight category, cleft type and importance of facial appearance rating. Results: Study mean BE-Attribution scores were significantly lower than the normative scores and significantly lower than the mean BE-Appearance and BE-Weight factor scores within the same age groups of this study. Having a cleft type of lip and palate, being overweight, and placing a high importance on facial appearance had significant negative associations with BES scores. Maintaining a normal body weight and placing a lower level of importance on facial appearance had significant positive associations. Gender had no significant associations. Conclusion: In this study, the attribution aspect of body esteem had a greater negative impact on patients than their appearance and body weight. This has important implications for clinical treatment and support of patients.
Changes in the Height of Velopharyngeal Closure Relative to the Cervical Spine From Infancy Through Adolescence in Patients With Cleft Palate
Authors: Mason Kazlin N. , Riski John E. , Perry Jamie L. 
Published: March 2018

Objective: Palpation is often used to identify C1, an intraoperative landmark, for placement of the pharyngoplasty. However, little is known about the relationship between the palatal plane (PP) and this cervical spine landmark across select variables. This study seeks to analyze variations in the height of velopharyngeal closure relative to C1 across differing cleft types and age groups. Design: Retrospective, cross-sectional analysis. Setting: Large, multidisciplinary center for craniofacial disorders. Methods: Clinical lateral cephalograms were analyzed in nonsyndromic patients who underwent primary palatoplasty. Regression analysis and analysis of covariance were completed to determine how age and cleft type impact underlying cervical and velopharyngeal measures. Results: Age ( P < .001) and cleft type ( P = .036) were significant predictors of the distance between the height of velopharyngeal closure and C1. Those with greater severity of clefting demonstrated larger distances between the height of velopharyngeal closure and C1. Compared to normative data, children with cleft palate have significantly larger distances between the PP and C1. The height of velopharyngeal closure above C1 was observed to range from 3.6 to 12.6 mm across cleft populations. Conclusions: This study demonstrates the variability in C1 as a landmark across variables including cleft type and age. Because of differences in the height of velopharyngeal closure across cleft types relative to C1, it is necessary to preoperatively quantify the vertical distance between the PP and palpable intraoperative landmark, C1, to determine the appropriate height of pharyngoplasty insertion.
Clinical and Epidemiologic Description of Orofacial Clefts in Bogota and Cali, Colombia, 2001-2015
Authors: Sarmiento K. , Valencia S. , Gracia G. , Hurtado-Villa P. , Zarante I. 
Published: March 2018

Objectives: Among congenital craniofacial anomalies, orofacial clefts (OFCs) are the most common. Global prevalence is 2 in 1000 and in Colombia, 1 in 700. Our goal was to describe cleft palate (CP) prevalence and cleft lip with or without cleft palate (CL±P) from 2001 to 2015 in Bogota and Cali, Colombia. Method: Using the ECLAMC case-control design method, information was obtained from the Congenital Anomalies Monitoring and Surveillance Programs in Bogota and Cali. We describe the prevalence of cases classified into the following groups: isolated, polymalformed, and syndromic. The proportion of cases and controls was 1:4. Data were analyzed using frequency distribution and Student t test to compare means and 95% confidence intervals (CIs). Results: We identified 529 OFC cases and 2116 controls from 448,930 births: a rate of 11.8 per 10,000 (CI = 10.80-12.83). From the total cases, 73% were identified with CL/CP compared to 27% with CP. Males had higher CL±P (59%) prevalence, whereas the highest neonatal mortality was observed among polymalformed cases (7%). The most common anomaly identified among our cases was cleft lip without isolated cleft palate (58%). We found that OFCs are linked to birthweight, size, and gestational age and higher parity with statistically significant differences in all variables compared to controls. Conclusions: OFC is a highly prevalent anomaly in Colombia, with a range of maternal and infant differences across case subgroups. The identification of important OFC subgroups that follow certain patterns of prevalence may prove useful to primary and tertiary care facilities with the goal of reducing further disability.