bluuebunny/crossref_metadata_2025_split huggingface dataset:
QUANTITATIVE ESTIMATION OF EXPOSURE INHOMOGENEITY IN TERMS OF EYE LENS AND EXTREMITY MONITORING FOR RADIATION WORKERS IN THE NUCLEAR INDUSTRY
Authors: Yoshitomi H , Kowatari M , Hagiwara M , Nagaguro S , Nakamura H 
Published: October 2018

Abstract
To manage the equivalent doses for radiation workers, exposure inhomogeneity is an important factor in the decision-making process related to protection measures and additional monitoring. Our previous study proposed the methodology to evaluate the inhomogeneity of exposure quantitatively. In this study, we applied proposed method to five different types of actual exposure situations encountered in the nuclear industry. Two of them were conventionally characterized as homogeneous exposure, and the other three were conventionally characterized as inhomogeneous exposure. The evaluation of homogeneity exposure was conducted using Monte Carlo calculations with two simplified models, which were then verified with phantom experiments. Consequently, all of the evaluations reproduced the experimental results, implying that our proposed method would be applicable for actual work conditions in the nuclear industry. Furthermore, the two presumed homogeneous exposure situations were found to be rather inhomogeneous because of the contribution of positrons and the limited source region. The results also show that the worker’s posture has an impact on the inhomogeneity rather than the energy of incident radiation in nuclear works. The investigation also implies that obtaining the information on the most probable posture of the exposed worker, as well as the existence of the weekly penetrating radiation such as β± ray as a main source of exposure would be the key for more precise estimation.
The Impact of 3 Different Distraction Techniques on the Pain and Anxiety Levels of Children During Venipuncture
Authors: Inan Gamze , Inal Sevil 
Published: October 2018

Objectives:Invasive procedures are important causes of pain and anxiety during hospitalization. This study aimed to evaluate the effect of 3 different distraction methods on the pain and anxiety levels of children during venipuncture.Methods:This was a randomized controlled trial conducted with 180 children of 6 to 10 years of age; data were collected in the months of August to November 2016. Participants were randomized in 4 groups; the children in group 1 watched cartoon movies (CM), the children in group 2 played video games (VG), the children in group 3 were distracted by their parents’ verbal interactions (PI), whereas no distraction method was used on the children in group 4 (control group). The levels of anxiety and pain perception were evaluated independently based on the feedback from the children, the nurse observer, and the parents. The Children Fear Scale was used to evaluate anxiety levels and the Wong-Baker Pain Scale was used to evaluate the pain levels of the children.Result:The difference between the groups based on both the anxiety levels and pain scores during venipuncture was statistically significant (P<0.05). The lowest level of anxiety and pain perception was reported in the VG group. The scores observed both in the CM group and the PI group were significantly lower than in the control group (P<0.05).Discussion:The distraction techniques of playing VG, watching CM, and PI appear to be effective in reducing anxiety and pain perception in children during the procedure of venipuncture. The most effective method was playing VG.
Parent Factors are Associated With Pain and Activity Limitations in Youth With Acute Musculoskeletal Pain
Authors: Clementi Michelle A. , Faraji Pari , Poppert Cordts Katrina , MacDougall Kelsey , Wilson Anna , Palermo Tonya M. , Lewandowski Holley Amy 
Published: October 2018

Objectives:
Biopsychosocial models emphasize the influence of parent/family factors on pediatric chronic pain. Little is known about how parent factors differ across the acute to chronic pain continuum, or contribute to youths’ pain experience in the acute pain period. The purpose of the study was to describe parent factors in youth with acute musculoskeletal pain (n=84) compared with youth with chronic pain (n=60) and youth without pain (n=61). Further, within the acute pain sample, we tested parent factors as predictors of child pain characteristics, as well as the moderating role of child sex on associations.

Methods:
Participants were 205 youth (age, 10 to 17) and one biological parent per child. Children reported on their own pain and activity limitations. Parents reported on their own chronic pain, somatization, and protective pain responses.

Results:
Parents of youth with acute pain had higher prevalence of chronic pain and greater somatization than parents of youth without pain. Parents of youth with acute and chronic pain did not differ. Linear regressions within the acute pain sample revealed presence of parent chronic pain and protective behavior were associated with child pain. Moreover, parent somatization was associated with child activity limitations. Within the acute pain sample, associations between parent protectiveness and child pain were moderated by child sex, with relationships stronger for female children.

Discussion:
Findings highlight the importance of parent factors on pain experiences of youth with acute musculoskeletal pain. Future longitudinal research can elucidate temporal associations that underlie how parent factors may impact transition from acute to chronic pain.
Comparison of Short-term Outcomes After Lumbar Fusion Between an Orthopedic Specialty Hospital and Tertiary Referral Center
Authors: Kreitz Tyler M. , Tarazona Daniel , Padegimas Eric M. , Foltz Carol , Kepler Christopher K. , Anderson David Greg , Vaccaro Alexander R. , Hilibrand Alan S. , Schroeder Gregory D. 
Published: October 2018

Study Design.
A retrospective review of all elective single-level lumbar fusions performed at a single orthopedic specialty hospital (OSH) and tertiary referral center (TRC).

Objective.
This study compared the perioperative outcomes for lumbar fusion procedures performed at an OSH and TRC.

Summary of Background Data.
The role of an OSH for lumbar fusion procedures has not been defined.

Methods.
A large institutional database was searched for single-level lumbar fusions performed between 2013 and 2016. Comparisons were made between procedures performed at the OSH and TRC in terms of operative time, total operating room (OR) time, length of stay (LOS), inpatient rehabilitation utilization, postoperative 90-day readmission, reoperation, and mortality rates.

Results.
A total of 101 patients at the OSH and 481 at the TRC were included. There was no difference in gender, age, age adjusted Charlson comorbidity Index (AACCI), body mass index, mean number of concomitant levels decompressed, and use of interbody fusion between OSH and TRC patients. The mean operative time (149.5 vs. 179.7 minutes, P < 0.001), total OR time (195.1 vs. 247.9 minutes, P < 0.001), and postoperative LOS (2.61 vs. 3.73 days, P < 0.001) were significantly shorter at the OSH. More patients required postoperative inpatient rehabilitation at the TRC (7.1% vs. 2%, P < 0.001). There was no difference in 90-day readmission or reoperation rates. There was one mortality at the TRC and two patients required transfer from the OSH to the TRC due to medical complications. Regression analysis demonstrated that procedures performed at the TRC (P < 0.001), total OR time (P = 0.004), AACCI (P < 0.001), current smokers (P = 0.048), and number of decompressed levels (P = 0.032) were independent predictors of LOS.

Conclusion.
Lumbar fusion procedures may be safely performed at both the OSH and TRC. OSH utilization may demonstrate safe reduction in operative time, total OR time, and postoperative LOS in the appropriately selected patients.

Level of Evidence: 3
A systematic review of the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause
Authors: Biehl Colton , Plotsker Olivia , Mirkin Sebastian 
Published: October 2018

AbstractObjective:We updated a systematic review to evaluate the totality of evidence available for the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause (GSM) based on published randomized controlled trials.Methods:We searched theCochrane Library,Ovid,PubMed,Medline,Embase, andClinicaltrials.govfor English-language articles from database inception to June 2018. Our search consolidated 2,086 potential sources to 53 full-text articles that were reviewed and found relevant to our systematic review.Results:We identified 53 studies that met the inclusion criteria that evaluated the efficacy and safety of vaginal estrogen versus placebo or other hormone and nonhormone controls. Compared with placebo, all vaginal estrogens demonstrated superiority in objective endpoints and subjective endpoints of GSM, whereas some trials demonstrated superiority versus placebo in urogenital symptoms. No significant difference was observed between various dosages and dosage forms of vaginal estrogen products. Vaginal estrogen showed superiority over vaginal lubricants and moisturizers for the improvement of objective clinical endpoints of vulvovaginal atrophy but not for subjective endpoints. Unopposed vaginal estrogens seemed safe, although studies were not powered to detect a long-term estrogenic side effect.Conclusion:Estrogen products were found to be clinically effective for the treatment of GSM with doses as low as 4 μg. Vaginal estrogen products seem to be safe with few adverse effects, although there is a lack of long-term controlled clinical trial safety data. This review supports the use of commercially available vaginal estrogen therapies as an effective and safe first-line therapy for the treatment of moderate-to-severe GSM.
Anatomically Based Optimization of Outcomes in Middle Eastern Rhinoplasy
Authors: Ghareeb Fouad Mohammed , Nassar Ahmed Tharwat , Talaab Ahmed Abdelaziz , Alkashty Sherief 
Published: October 2018

Background:
The predominant character in the Middle Eastern noses is the thick skin, weak cartilages, amorphous bulbous nasal tip, and high incidence of postoperative supra-tip swelling, compared with the Caucasian noses. The purpose of this study was to describe some anatomical findings and find techniques to improve outcomes in these patients.

Methods:
This is retrospective study in 624 patients of Middle Eastern origin, where the characteristic anatomical findings are described and the surgical endeavors to combat their detrimental effect on the outcomes of rhinoplasty are explained.

Results:
The results have shown that in these 624 patients, 365 patients had excellent results, 223 patients had average results, while 36 patients had poor results.

Conclusion:
The nasal shape depends on the skin (skin barring) or the cartilages (cartilage barring), or both (skin and cartilage sharing). Middle Eastern patients are toward the skin barring category with the lateral crus of the lower lateral cartilage very broad with a lateral fibrous attachment replacing the minor (sesamoid) cartilages leading to ill definition of the alae from the sides of the nose. Outcomes in these patients were improved by identification and release of these lateral attachment to improve the bulbous tip and define the alar subunit from the side of the nose. Cephalic rotation is achieved mainly by M-shaped excision of the inner lining of the vestibule and the caudal part of the septum. Other methods described to combat the strong skin memory and allow skin to configure after surgery.
MACULAR DEHISCENCE–ASSOCIATED EPIRETINAL PROLIFERATION IN EYES WITH FULL-THICKNESS MACULAR HOLE
Authors: Takahashi Hiroyuki , Inoue Makoto , Itoh Yuji , Koto Takashi , Hirota Kazunari , Kita Yoshiyuki , Hirakata Akito 
Published: October 2018

Purpose:
To determine the characteristics of the macular dehiscence–associated epiretinal proliferations (EPs) in eyes with full-thickness macular holes (MHs).

Methods:
The presence of EPs and the integrity of the retinal microstructures in eyes with MHs were determined by spectral domain optical coherence tomography in 390 eyes of 379 patients (29–89 years). The clinical findings, closure of the MH, the preoperative and postoperative best-corrected visual acuity, and the microstructural changes were compared between eyes with and without EPs.

Results:
Epiretinal proliferations were detected in 31 of 390 eyes (7.9%). The preoperative best-corrected visual acuity and duration of reduced vision were not significantly different in the group with and without EPs (P = 0.09, P = 0.28). The axial lengths were significantly longer (P = 0.001), MH stage more advanced (P = 0.006), and the incidence of epiretinal membranes (P < 0.001) and intraretinal splitting (P < 0.001) were higher in eyes with EP. The EP was significantly correlated with the length of the ellipsoid zone defects (P < 0.001) and medium-reflective bridging tissue over the closed MH (P < 0.001). The closure rates and postoperative best-corrected visual acuities were not significantly different between the two groups (P > 0.99, P = 0.99).

Conclusion:
The presence of EP was correlated with retinal microstructural changes and may support postoperative visual improvements with medium-reflective bridging tissue over the closed MH.
Machine learning–based prediction of clinical pain using multimodal neuroimaging and autonomic metrics
Authors: Lee Jeungchan , Mawla Ishtiaq , Kim Jieun , Loggia Marco L. , Ortiz Ana , Jung Changjin , Chan Suk-Tak , Gerber Jessica , Schmithorst Vincent J. , Edwards Robert R. , Wasan Ajay D. , Berna Chantal , Kong Jian , Kaptchuk Ted J. , Gollub Randy L. , Rosen Bruce R. , Napadow Vitaly 
Published: October 2018

Abstract
Although self-report pain ratings are the gold standard in clinical pain assessment, they are inherently subjective in nature and significantly influenced by multidimensional contextual variables. Although objective biomarkers for pain could substantially aid pain diagnosis and development of novel therapies, reliable markers for clinical pain have been elusive. In this study, individualized physical maneuvers were used to exacerbate clinical pain in patients with chronic low back pain (N = 53), thereby experimentally producing lower and higher pain states. Multivariate machine-learning models were then built from brain imaging (resting-state blood-oxygenation-level-dependent and arterial spin labeling functional imaging) and autonomic activity (heart rate variability) features to predict within-patient clinical pain intensity states (ie, lower vs higher pain) and were then applied to predict between-patient clinical pain ratings with independent training and testing data sets. Within-patient classification between lower and higher clinical pain intensity states showed best performance (accuracy = 92.45%, area under the curve = 0.97) when all 3 multimodal parameters were combined. Between-patient prediction of clinical pain intensity using independent training and testing data sets also demonstrated significant prediction across pain ratings using the combined model (Pearson's r = 0.63). Classification of increased pain was weighted by elevated cerebral blood flow in the thalamus, and prefrontal and posterior cingulate cortices, and increased primary somatosensory connectivity to frontoinsular cortex. Our machine-learning approach introduces a model with putative biomarkers for clinical pain and multiple clinical applications alongside self-report, from pain assessment in noncommunicative patients to identification of objective pain endophenotypes that can be used in future longitudinal research aimed at discovery of new approaches to combat chronic pain.
Cardiovascular outcome trials in type 2 diabetes: A nurse practitioner perspective
Authors: Kruger Davida F. 
Published: October 2018

ABSTRACT
To provide an overview of cardiovascular outcome trials (CVOT) with once-weekly glucagon-like peptide-1 receptor agonists (GLP-1RAs), and other recent CVOTs, and to discuss the implications for the management of patients with type 2 diabetes (T2D). Details of completed and ongoing CVOTs of glucose-lowering drugs from primary articles and ClinicalTrials.gov were collated and critically reviewed for information relating to patient populations and primary outcomes. Cardiovascular outcome trials have demonstrated the cardiovascular (CV) safety of a number of new glucose-lowering drugs. Recent trials suggest that some glucose-lowering drugs—including the once-weekly GLP-1RA semaglutide (post hoc analysis) and once-daily liraglutide—may reduce the risk of CV events in patients with T2D and high CV risk. Given their prime role in managing treatment choices for patients with T2D, nurse practitioners should strongly consider prescribing therapies, such as GLP-1RAs, that offer improved glycemic control, weight loss, a low risk of hypoglycemia, and beneficial CV outcomes.
Hepatitis B surface antigen loss after discontinuing nucleos(t)ide analogue for treatment of chronic hepatitis B patients is persistent in White patients
Authors: Suárez Emilio , Buti María , Rodríguez Manuel , Prieto Martín , Pascasio-Acevedo Juan M. , Casanovas Teresa , Crespo Javier , Tapiador Juan Arenas Ruiz , Gómez-Rodríguez Rafael , Figueruela Blanca , Diago Moisés , Morillas Rosa M. , Zozaya José M. , Calleja José L. , Casado Marta , Molina Esther , Fuentes Javier , Simón Miguel A. 
Published: October 2018

Objective
The objective of this study was to determine the long-term clinical outcome and persistence of hepatitis B surface antigen (HBsAg) loss after discontinuation of treatment.

Background
The prognosis of patients with chronic hepatitis B (CHB) treated with nucleos(t)ide analogues (NAs) who discontinue treatment after loss of HBsAg remains largely unknown, particularly in White patients.

Patients and methods
We analysed a cohort of patients with CHB who discontinued NA treatment after loss of HBsAg. A total of 69 patients with hepatitis-B-e antigen-positive or hepatitis-B-e antigen-negative CHB with undetectable HBsAg during NA treatment were included after discontinuation of treatment, and followed up for a median period of 37.8 months (interquartile range: 23.8–54.6 months).

Results
At the end of follow-up, none of the patients showed spontaneous reappearance of HBsAg and only one patient had detectable hepatitis B virus DNA (22 IU/ml). Another patient negative for HBsAg and anti-HBs developed hepatitis B virus reactivation without elevated transaminases after treatment with corticosteroids and vincristine for dendritic cell neoplasm, 38 months after withdrawal of the antiviral treatment. Regarding clinical outcome, a patient with cirrhosis developed hepatocellular carcinoma, 6.6 years after discontinuing treatment. None of the patients had hepatic decompensation or underwent liver transplantation.

Conclusion
HBsAg clearance after discontinuing NAs in patients with CHB is persistent and associated with good prognosis. The risk for developing hepatocellular carcinoma persists among patients with cirrhosis.
The Impact of Chain Standardization on Nursing Home Staffing
Authors: Banaszak-Holl Jane , Intrator Orna , Li Jiejin , Zheng Qing , Stevenson David G. , Grabowski David C. , Hirth Richard A. 
Published: October 2018

Background:Standardization in production is common in multientity chain organizations. Although chains are prominent in the nursing home sector, standardization in care has not been studied. One way nursing home chains may standardize is by controlling the level and mix of staffing in member homes.Objectives:To examine the extent to which standardization occurred in staffing, its relative presence across different types of chains, and whether facilities became more standardized following acquisition by a chain.Research Design:We estimated predictors of the difference between facility and chain staffing using Generalized Estimating Equations with 2000–2010 data.Subjects:This study included nursing homes nationally, excluding hospital-based homes and homes in Alaska, Hawaii, and the District of Columbia.Measures:Chain ownership was coded from text identifying chain names. Two nurse staffing measures were used: staff hours per resident day and staff mix.Results:Very large for-profit chain nursing homes and large nonprofits had less variation in staff hours per resident day (P<0.001) but greater variation in staffing mix (P<0.001) compared with the chain average nationally. Large for-profit chains and medium nonprofit chains had greater dispersion on staff hours per resident day (P<0.001), while large nonprofit chains had greater dispersion in staffing mix (P<0.001). The difference between facility and chain staffing decreased over time.Conclusions:The largest chains (for-profit and nonprofit) had less staffing variation compared with national standards, suggesting they were best at implementing corporate practices. Following ownership changes, staffing converged towards chain averages over time, suggesting standardization takes time to implement.
Provision of Sexually Transmitted Infection Services in a Mobile Clinic Reveals High Unmet Need in Remote Areas of South Africa: A Cross-sectional Study
Authors: Hoffman Charlotte M. , Mbambazela Nontembeko , Sithole Phumzile , Morré Servaas A. , Dubbink Jan Henk , Railton Jean , McIntyre James A. , Kock Marleen M. , Peters Remco P.H. 
Published: October 2018

Background
The burden of sexually transmitted infections (STIs) in areas of sub-Saharan Africa with poor access to health care services is not well documented. In remote areas of South Africa, we investigated the prevalence of STIs and approaches to providing STI services through a mobile clinic.

Methods
We recruited 251 adult women visiting a mobile clinic that normally provides general health education and screening services, but not STI care. Clinical and sexual history was obtained and vaginal specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium infection and for Candida albicans and bacterial vaginosis.

Results
Laboratory test was positive for 133 (53%) of 251 women for at least 1 STI: C. trachomatis was observed in 52 (21%) women, N. gonorrhoeae in 39 (16%) women, T. vaginalis in 81 (32%) women and M. genitalium in 21 (8%) women. Eighty-one (32%) women met the criteria for vaginal discharge syndrome, of which 58% (47/81) would have been treated accurately. Among asymptomatic women 84 (49%) of 170 were diagnosed with an STI but untreated under the syndromic approach. We could not identify factors associated with asymptomatic STI infection.

Conclusions
There is a high unmet need for STI care in rural South African settings with poor access to health care services. Provision of STI services in a mobile clinic using the syndromic management approach provides a useful approach, but would have to be enhanced by targeted diagnostics to successfully address the burden of infection.