bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inner Ear Barotrauma from Scuba Diving
Authors: Sheridan Mark F. , Hetherington Hugh H. , Hull Jeffrey J. 
Published: May 2019

Inner ear barotrauma among scuba divers is believed to be caused by any of three conditions: a hemorrhage in the inner ear, a tear of the labyrinthine membrane, or a perilymphatic fistula. These injuries may occur concurrently or separately. Hemorrhage and membrane rupture are managed conservatively, while fistula requires surgical repair. In this report, we describe three cases of inner ear barotrauma in scuba divers. We also discuss the proposed etiologies of this injury and the controversy over whether or not divers who have suffered an inner ear trauma can safely resume scuba diving. Although the older literature clearly suggests otherwise, we believe that scuba divers who completely recover from inner (or middle) ear barotrauma may return to diving as long as they exercise caution and care.
Equilibrium and Balance in the Elderly
Authors: Hobeika Claude P. 
Published: May 2019

Complaints of dizziness and disequilibrium increase with age. Sixty-five percent of individuals older than 60 years of age experience dizziness or loss of balance, often on a daily basis. Some degree of imbalance is present in all individuals older than 60. This is the result of a generalized functional degradation. Initially, the imbalance is situational and manifests when the righting reflexes cannot meet the demands of a challenging environment, such as a slippery surface. As the functional degradation progresses, the imbalance occurs during everyday activities, independent ambulation becomes difficult, and the likelihood of falls increases. When instability is constant, the individual resorts to the use of a cane, a walker, or a wheelchair.
Outcomes after Laser Stapedotomy with and without Preservation of the Stapedius Tendon
Authors: Silverstein Herbert , Hester T. Oma , Deems Daniel , Rosenberg Seth , Crosby Noël , Kwiatkowski Terrence 
Published: May 2019

Our goal was to investigate the postoperative differences in hearing between patients who had had their stapedius tendon sacrificed and those whose stapedius tendon was preserved during laser stapes surgery for otosclerosis. To that end, we performed a retrospective review by mailing extensive questionnaires to patients who had been operated on between 1994 and 1997. We also performed routine and special audiometric testing to augment the subjective data. Seventy-nine of 124 questionnaires (64%) were returned. Of the respondents, 75 patients had undergone additional pre- and/or postoperative audiometric testing, including tests to evaluate “hearing in noise “ and to determine the “uncomfortable loudness level” (dynamic range). We found no statistically significant differences between the two groups with respect to their subjective responses and their audiologic test results. The responses to the questionnaire indicated that in most cases, hearing was improved by stapes surgery. We conclude that the stapedius tendon should be preserved whenever possible during stapes surgery, provided that it does not jeopardize the exposure or outcome.
How reliable is renal ultrasound to measure renal length and volume in patients with chronic kidney disease compared with magnetic resonance imaging?
Authors: Braconnier Philippe , Piskunowicz Maciej , Vakilzadeh Nima , Müller Marie-Eve , Zürcher Emilie , Burnier Michel , Pruijm Menno 
Published: May 2019

Background Renal length, volume, and parenchymal thickness are important clinical parameters, yet data concerning the accuracy and reproducibility of ultrasound (US)-based renal length and volume assessment in patients with chronic kidney disease (CKD) are scarce. Purpose To establish whether renal length, volume, and parenchymal thickness can be reliably measured with renal US in patients with CKD. Material and Methods All participants underwent renal US, immediately followed by 3-T magnetic resonance imaging (MRI). Renal length, width, transverse diameter, and parenchyma thickness were measured with both methods; renal volume was calculated using the ellipsoid formula. A total of 45 patients with CKD (eGFR [mean ± SD] 57.4 ± 4.4 mL/min/1.73 m2) and 46 participants without CKD (eGFR 97.0 ± 2.4 mL/min/1.73 m2) were included. Results US-measured renal length correlated strongly with MRI-measured renal length in no-CKD patients (Spearman’s r = 0.83 and 0.85 for the right and left kidney, respectively; P < 0.005) and CKD patients (r = 0.89 and 0.92 for the right and left kidney, respectively; P < 0.005). There was a significant but weaker correlation between MRI- and US-measured right and left renal volume (r = 0.72, P < 0.005) in no-CKD (r = 0.74 and r = 0.72, respectively; for both: P < 0.005) and CKD patients (r = 0.83 and 0.85, P < 0.005). Weak to moderate correlations were found for parenchyma thickness for the right (CKD group: r = 0.29, no-CKD: r = 0.23; for both: P < 0.05) and left kidney (CKD: r = 0.52, no-CKD group: r = 0.37, P < 0.05). Both intra-observer (Pearson’s correlations of 0.82 for the right and 0.89 for the left kidney) and inter-observer (Lin’s correlation coefficient of 0.90 for the right and 0.82 for the left kidney) reproducibility of US-assessed renal length was high. Conclusions US-based assessment of renal length in CKD patients is comparable to MRI measures. Both intra- and inter-observer reproducibility of US-assessed renal length in CKD patients are high. Measurements of US renal volume and parenchymal thickness should, however, be interpreted with caution.
Assessment of the testicular vascularity after inguinal herniotomy in children: a prospective color Doppler study
Authors: Basha Mohammad Abd Alkhalik , Saber Sameh , El-Hamid M Abdalla Ahmed A , Aly Sameh Abdelaziz , GObran T , Waly Amira , Arafa Ahmed Salah 
Published: May 2019

Background Knowing transient vascular perfusion abnormalities of testes after open inguinal herniotomy procedure is essential for the surgeon who is mainly responsible for the patient outcome. Purpose To assess the effect of open inguinal herniotomy procedure on the testicular blood supply in children using duplex ultrasonography (DUS). Material and Methods A prospective observational study included 60 boys (mean age = 9.46 ± 14.46 months; age range = 2 months–6 years) who underwent open inguinal herniotomy operation. Using DUS, the testicular volume, peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were calculated preoperatively and one week, one month, and six months postoperatively. The pre- and postoperative measurements were compared. Statistical analysis was performed using χ2 test, Fisher’s exact test, or Student’s t-test when appropriate. Results On physical examination, the hernias were unilateral in 57 boys and bilateral in three boys. Comparison between testicular volumes preoperatively and postoperatively showed no significant change ( P > 0.05). There was a statistically significant increase of PSV and RI one week and one month postoperatively ( P < 0.0001) but returned to be near to the preoperative values at six months. As regards EDV, there was a slight but non-significant postoperative increase ( P > 0.05) which did not return to the preoperative value. Conclusion The affection of testicular vascularity postoperatively is transient and returns to be near to the preoperative values in the late postoperative period (six months postoperatively). Additionally, no significant change in testicular volume postoperatively.
Allograft Augmentation of Hamstring Anterior Cruciate Ligament Autografts Is Associated With Increased Graft Failure in Children and Adolescents
Authors: Perkins Crystal A. , Busch Michael T. , Christino Melissa , Herzog Mackenzie M. , Willimon S. Clifton 
Published: May 2019

Background: Anterior cruciate ligament (ACL) reconstruction in adolescents is commonly performed with hamstring tendon autografts. Small graft diameter is one risk factor for graft failure and options to upsize the autologous hamstring graft include allograft augmentation and tripling one or both of the hamstring tendons. Purpose: To evaluate the association of upsized hamstring graft constructs and graft rupture after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed of patients 19 years of age and younger who underwent hamstring autograft ACL reconstruction with or without soft tissue allograft augmentation from 2012 to 2016. All patients were skeletally mature or had less than 2 years of growth remaining. Graft constructs included 4-strand doubled semitendinosus and gracilis autograft (4-STG), 5-strand tripled semitendinosus and doubled gracilis autograft (5-STG), and 6-strand doubled gracilis and semitendinosus autograft augmented with a soft tissue allograft (6-STGAllo). The primary outcome measure was graft rupture. Results: A total of 354 patients with a mean age of 15.3 years (range, 10-19 years) were included. Graft constructs included 4-STG (198 knees), 5-STG (91 knees), and 6-STGAllo (65 knees). The average diameter of the graft constructs was 8.3 mm for 4-STG, 8.9 mm for 5-STG, and 9.2 mm for 6-STGAllo ( P < .001). The mean follow-up was 26 months (range, 6-56 months). There were 50 (14%) graft ruptures and 24 (7%) contralateral ACL tears. The graft failure rates were 14% for 4-STG, 12% for 5-STG, and 20% for 6-STGAllo ( P = .51). The average time to graft failure was 16 months (range, 2-40 months). After adjusting for age and graft size, patients who had allograft-augmented grafts (6-STGAllo) had 2.6 (95% CI, 1.02, 6.50) times the odds of graft rupture compared with 4-STG. There was no significant difference in failure rate between patients who had 5-STG grafts compared with 4-STG (OR, 1.2; 95% CI, 0.5, 2.7). Conclusion: ACL reconstruction with hamstring tendon autografts augmented with allografts has a significantly increased risk of graft rupture compared with comparably sized hamstring tendon autografts. In situations where the surgeon harvests an inadequately sized 4-strand autograft, we recommend obtaining a larger graft diameter by tripling the semitendinosus rather than augmenting with an allograft.
A Collaborative Initiative for Reducing Operating Room Waste of Unused Refrigerated Medication
Authors: Tsang Dawn K. , Deng Jin , Enten Garrett , Coleman Debra , Dansby Mary , Pease Sonya , Camporesi Enrico M. 
Published: May 2019

Background: Inappropriate management of anesthetic medications requiring refrigeration creates waste and increases costs of intraoperative care. At Tampa General Hospital, pharmacy personnel refill medications in cardiovascular operating rooms (CVOR) nightly and noticed large amounts of unattended medications at room temperature for unknown periods of time. Per protocol, these medications were disposed. Objective: To effectively decrease pharmaceutical waste in the CVOR. Methods: A pharmacy-led anesthesia committee identified the most used intraoperative medications requiring refrigeration and implemented changes to decrease waste. As a result, norepinephrine intravenous piggyback (IVPB), norepinephrine vials, nitroglycerin vials, and epinephrine IVPB were physically relocated into preexisting mini-refrigerators inside each CVOR. Vasopressin vials and phenylephrine syringes/vials were relocated into automated anesthesia cabinets. Amounts and cost of wasted medication were analyzed before and after protocol implementation. Results: Average weekly cost of wasted medication was significantly reduced (preintervention: US$1188.59 vs postintervention: US$322.96; P < .001), despite a consistent caseload. Conclusion: Recorded weekly savings of US$865.63 (∼annual savings of >US$45 000) reflect only the explicit cost of waste. True savings are higher when including opportunity costs such as salary of pharmacy personnel and supplies needed to replace wasted medications. We demonstrate the benefits of a collaborative approach to improving inefficiencies in health care.
Compliant assembly analysis including initial deviations and geometric nonlinearity, part II: Plate structure
Authors: Liu Tao , Li Zhi-min , Jin Sun , Chen Wei 
Published: May 2019

Part I of this paper (Liu et al., “Compliant assembly analysis including initial deviations and geometric nonlinearity, part I: Beam structure”) has studied the variation propagation of beam structures with consideration of initial deviations and geometric nonlinearity. In practices, plate structures are more commonly used in manufacturing fields, and the attempt of this paper is to expand previous methodology for the assembly process of orthotropic composite plate structures. Similarly, initial deviations and von Kármán-type geometric nonlinearity are introduced into variation analysis model, with Mindlin plate theory accounting for shear effect. The analyzed plates are set as orthotropic composite materials, which also preserve the compatibility with isotropic metal materials. Governing equations and corresponding finite element expressions can be obtained by applying the principle of virtual work. Also, a linearized model or noninitial model can be regarded as a degradation of origin governing equations. A variation analysis approach for plate structures is proposed to make more refined assembly variation predictions with consideration of initial deviations, fixture errors, and matching deviations. The verification of the developed method is implemented with case studies on springback prediction of two composite plates assembly.
Using the K-SADS psychosis screen to identify people with early psychosis or psychosis risk syndromes
Authors: Tsuji Thomas , Phalen Peter , Rakhshan Rouhakhtar Pamela , Millman Zachary , Bussell Kristin , Thompson Elizabeth , Demro Caroline , Roemer Caroline , Reeves Gloria , Schiffman Jason 
Published: May 2019

Background: Current methods to identify people with psychosis risk involve administration of specialized tools such as the Structured Interview for Psychosis-Risk Syndromes (SIPS), but these methods have not been widely adopted. Validation of a more multipurpose assessment tool—such as the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS)—may increase the scope of identification efforts. Methods: We assessed the correspondence between SIPS-determined clinical high risk/early psychosis (CHR/early psychosis) status and K-SADS psychosis screen (child and parent reports and their combination) in a sample of 147 help-seeking individuals aged 12–25. Detailed classification results are reported. Results: Both the child and parent interviews on the K-SADS psychosis screen were strongly predictive of CHR/early psychosis status, although parent reports contributed no significant additional information beyond child reports. Across informants, the presence of either subthreshold hallucinations or subthreshold delusions was highly suggestive of CHR/early psychosis status as determined by SIPS interview (78% (child) and 74% (parent) accuracy). Conclusions: Subthreshold scores on the two-item K-SADS psychosis screen may be good indicators of the presence or absence of early signs of psychosis. The option of using a non-specialized assessment such as the K-SADS as a staged approach to assess for CHR/early psychosis status could increase rates of early psychosis screening and treatment.
Arabic as a heritage language: A scoping review
Authors: Visonà Mark Winston , Plonsky Luke 
Published: May 2019

Aims and Objectives/Purpose/Research Questions: Second language researchers have focused increasingly in recent years on “heritage language learners,” or adult learners who wish to learn, relearn, or improve their linguistic proficiency in a family language they spoke while growing up. The present study examines this domain with a particular focus on Arabic. Design/Methodology/Approach: We present in this paper a “scoping review” that systematically examines the theoretical approaches, methods, contexts, instruments, and linguistic foci found in empirical research on Arabic heritage language learning and learners. Following a comprehensive search, 34 empirical studies (27 journal articles and seven dissertations/theses) were identified that met our criteria. Data and Analysis: Each study was coded for the samples, designs, theoretical approaches, data collection instruments, and a number of other substantive and methodological features and practices. Frequencies and percentages of study features were then calculated. Findings/Conclusions: Among other results, the study revealed a variety of approaches to defining heritage learners/learning. Although studies in this domain most often employed cross-sectional designs and interviews to collect data, a variety of theoretical approaches both socially and cognitively oriented can be found. Originality: This study presents the first attempt to apply synthetic research techniques to the growing body of research on heritage language learning/learners. Significance/Implications: Our results describe this growing domain, identifying current trends and potentially fruitful directions for future research.
Pharmacists’ lack of profession-hood: Professional identity formation and its implications for practice
Authors: Gregory Paul , Austin Zubin 
Published: May 2019

Background: Understanding the internalized, psychological sense of being a professional may provide important insight into understanding pharmacists’ behaviours and attitudes in practice. Methods: It is difficult to directly or quantitatively measure an internalized psychological state such as profession-hood. An indirect method was selected in which pharmacists who were themselves patients or caregivers were identified and invited to discuss their experiences, as a vehicle for better understanding how they relied upon personal and professional identities during high-stress, impactful times. Results: A total of 17 community pharmacists from southern Ontario participated in this study. Regardless of demographic background, participants reported little reliance on professional identity, knowledge or role as a pharmacist when advocating for themselves or a loved one. Interpretation: These findings suggest that community pharmacists have incomplete, separated or functional (rather than existential) professional identities. This lack of professional identity may influence behaviours in practice such as interactions with other health care professionals or patients or self-confidence in clinical decision-making. Conclusions: Further work is necessary to better understand the socialization and professional identity formation of pharmacists to help support them through the current evolution of pharmacy towards more interdependent and complex clinical roles and decision-making.
Estimated treatment effect of ticagrelor versus aspirin by investigator-assessed events compared with judgement by an independent event adjudication committee in the SOCRATES trial
Authors: Easton J Donald , Denison Hans , Evans Scott R , Knutsson Mikael , Amarenco Pierre , Albers Gregory W , Ladenvall Per , Minematsu Kazuo , Molina Carlos A , Wang Yongjun , Wong KS Lawrence , Johnston S Claiborne ,   for the SOCRATES Steering Committee and Investigators
Published: May 2019

Background Adjudication of endpoints is a standard procedure in cardiovascular clinical trials. However, several studies indicate that the benefit of adjudication in estimating treatment effect may be limited. Aims This post hoc analysis of SOCRATES (NCT01994720) compared the treatment effects and investigated the agreement of clinical event assessment by site investigators and independent adjudicators. Methods SOCRATES compared ticagrelor and aspirin in 13,199 patients with acute minor stroke or high-risk transient ischemic attack. The primary endpoint was stroke, myocardial infarction, or death. Stroke was the major component of the primary endpoint and a secondary endpoint. The endpoints were adjudicated by a blinded independent committee. We compared the treatment effect on the primary endpoint and stroke alone based on the investigators' and adjudicators' assessments, and investigated the agreement rate on the stroke endpoint and major hemorrhages. Results The hazard ratios (95% confidence interval) for ticagrelor versus aspirin therapy for the primary endpoint were 0.89 (0.78–1.01) when calculated on adjudicator-assessed events and 0.88 (0.78–1.00) for investigator-assessed events. The hazard ratios (95% confidence intervals) for stroke were 0.86 (0.75–0.99) based on the adjudicators' diagnoses and 0.85 (0.75–0.97) based on the investigators' diagnoses. The overall agreement between adjudicator- and investigator-diagnosed stroke was 91%, and for major hemorrhages was 88%. Conclusions In SOCRATES, there was no clinically meaningful difference in the estimated treatment effect, on either the primary endpoint or stroke, by using investigator- or adjudicator-assessed events. Double-blind treatment outcome studies with stroke endpoints may not benefit from adjudication. Trial Registration ClinicalTrials.gov Identifier: NCT01994720.
Acute ischemic myelopathy treated with intravenous thrombolysis: Four new cases and literature review
Authors: Jankovic Jeremy , Rey Bataillard Vincianne , Mercier Noëlle , Bonvin Christophe , Michel Patrik 
Published: May 2019

Background Intravenous thrombolysis is a well-established treatment of ischemic stroke within 4.5 h. However, its effectiveness in acute ischemic myelopathy is unknown. Purpose We describe a series of four acute ischemic myelopathy patients treated with intravenous thrombolysis within 4.5 h and review the current literature to explore this treatment feasibility, potential safety, and efficacy. Methods We reviewed all routinely collected clinical, radiological, and follow-up data of patients with a final acute ischemic myelopathy diagnosis who received acute intravenous thrombolysis in our stroke network. We also reviewed thrombolyzed acute ischemic myelopathy patients in the literature. Results Four patients (three women) aged 57 to 83 years presented with acute uni- or bilateral extremity paresis, considered initially as cerebral strokes in two of them. After excluding contraindications by brain imaging in three, spinal computed tomography in one and confirmation of acute ischemic myelopathy on spinal magnetic resonance imaging in one patient, intravenous thrombolysis was administered at 135, 190, 240, and 245 min accordingly. Subacute diffusion-weighted imaging-magnetic resonance imaging confirmed acute ischemic myelopathy in all but one patient. Favorable outcome was achieved in two patients rapidly and in three patients at three-month follow-up. We identified seven other thrombolyzed acute ischemic myelopathy patients in the literature, who showed variable recovery and no hemorrhagic complications. Conclusions With appropriate acute imaging, intravenous thrombolysis after acute ischemic myelopathy is feasible and potentially safe within 4.5 h. Given the potential of benefit of thrombolysis in acute ischemic myelopathy, this treatment warrants further efficacy and safety studies.