bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of Chinese Martial Arts and Philosophy to Reduce Reactive and Proactive Aggression in Schoolchildren
Authors: Fung Annis Lai Chu , Lee Toney Ka Hung 
Published: April 2018

ABSTRACT:

Objective:
This study examined the effectiveness of Chinese martial arts in reducing reactive and proactive aggressive behavior among schoolchildren with a cluster-randomized trial.

Methods:
A screening questionnaire was completed by 3511 schoolchildren of Grades 2 to 5 from 13 sites in Hong Kong. We shortlisted 298 children who scored z ≥ 1 on the total score of the Reactive-Proactive Aggression Questionnaire in their respective sites to participate in the experiment. They were divided into 31 clusters that were blinded and randomly assigned to one of the 4 conditions: skills only, philosophy only, skills and philosophy, and physical fitness (placebo). Subjects were assessed at baseline, posttraining, and 6 months after training using aggression scales.

Results:
Results from the linear mixed model indicated that the time × training interaction effects were significant for aggressive behavior (reactive and proactive), delinquent behavior, anxiety/depression, and attention problems. Although all measures declined in all conditions over time, only the skills-and-philosophy condition showed a significant reduction at posttraining and/or 6-month follow-up compared with the placebo.

Conclusion:
The results provided a theoretical proof for the relationship between aggression and sport involvement combined with children's moral reasoning. This study gives practical implications to intervention that solely playing sports or teaching moral lessons is not effective enough for high-risk schoolchildren with aggressive behavior. However, combined traditional Chinese martial arts skills and moral philosophy training could be considered in the school curriculum to reduce school violence and facilitate creation of harmonious schools.
A Descriptive Analysis of the American Society for Dermatologic Surgery Presidents
Authors: MacArthur Kelly M. , Hruza George J. 
Published: April 2018

BACKGROUND
The American Society of Dermatologic Surgery (ASDS) is the major educational organization for dermatologic surgery in the United States. Presidents are elected annually from among their members.

OBJECTIVE
The authors investigated the demographics, training, and achievements of the ASDS presidents.

MATERIALS AND METHODS
All ASDS presidents (1970–2017) were included. Data were gathered using publicly available information from websites, curriculum vitae, and PubMed. Living presidents were contacted by email (if available) to verify the collected data.

RESULTS
Of 46 ASDS presidents, 87% are male, with the first female president elected in 1994. Fifty-nine percent are members of the American College of Mohs Surgery. Seven presidents received dual fellowship training. Four presidents received a second graduate degree. Mean duration from residency to presidency was 22 years, with the mean age being 53 years. PubMed publication average was 34. All presidents have been affiliated with academic institutions, with 26% appointed as department chair and 30% serving as academic dermatologic surgery director.

CONCLUSION
The authors report that most of the ASDS presidents have been male with over half receiving Mohs surgery fellowship training. All have had academic affiliations at some point in their careers, with some named department chairs and/or elected as presidents of other national dermatologic societies.
Comparison of CYP3A4-Inducing Capacity of Enzyme-Inducing Antiepileptic Drugs Using 4β-Hydroxycholesterol as Biomarker
Authors: Hole Kristine , Wollmann Birgit M. , Nguyen Camilla , Haslemo Tore , Molden Espen 
Published: April 2018

Background:
Enzyme-inducing antiepileptic drugs (EIAEDs) are among the clinically most important inducers of cytochrome P450 (CYP) 3A4, but there is limited evidence regarding the comparative potency of each EIAED in raising CYP3A4 activity. The aim of this study was to estimate CYP3A4-inductive potency of EIAEDs by comparing CYP3A4 activity in patients treated with carbamazepine, phenobarbital, or phenytoin.

Methods:
Residual serum samples from patients treated with EIAEDs or levetiracetam were collected from a therapeutic drug monitoring service for analysis of 4β-hydroxycholesterol (4βOHC), which is an indicator of CYP3A4 activity. The samples were collected between January and September 2016 at Diakonhjemmet Hospital, Oslo, Norway. Concentration of 4βOHC, EIAEDs, and levetiracetam was measured by ultra-performance liquid chromatography tandem mass spectrometry. Kruskal–Wallis and Mann–Whitney tests were used for comparison of 4βOHC levels between the subgroups.

Results:
In total, 4βOHC measurements for 343 and 339 patients treated with EIAEDs and levetiracetam, respectively, were included in the study. Compared with levetiracetam-treated patients, the median 4βOHC concentration was 3.3-fold, 5.8-fold, and 6.9-fold higher in patients using phenobarbital, phenytoin, or carbamazepine, respectively (P < 0.0001). Phenytoin users (n = 65) and carbamazepine users (n = 225) had 1.8- and 2.1-fold higher median 4βOHC concentration than phenobarbital users (n = 28), respectively (P ≤ 0.0001).

Conclusions:
This study shows that phenytoin and carbamazepine have approximately twice the CYP3A4-inducing potency of phenobarbital. The results indicate that 2-fold higher doses of CYP3A4-metabolized drugs may generally be required during concurrent treatment with phenytoin or carbamazepine compared with phenobarbital.
Methadone Maintenance Treatment: A 15-year Retrospective Study in Split-Dalmatia County, Croatia
Authors: Sutlovic Davorka , Kljucevic Zeljko , Sliskovic Livia , Susnjar Helena , Viskovic Ivo , Definis-Gojanovic Marija 
Published: April 2018

Background:
The aim of this retrospective study is to use existing epidemiological data on patients in methadone maintenance treatment in Split-Dalmatia County from 2001 to 2015 to evaluate the substitution treatment system and policy of opiate addicts treatment, the epidemiological trend, and risk of overdose mortality. In addition, we would like to highlight the problem of poor control of methadone therapy and thus the possibility of selling methadone. The result is a greater number of deaths caused by methadone in people who were not in methadone therapy.

Methods:
The research included data collected from 3189 patients who had been in the drug abuse treatment program in Split-Dalmatia County during 2001–2015 and data gathered from autopsy examinations of patients in Split-Dalmatia County with emphasis on data for 186 overdosed patients during research period.

Results:
The total number of patients in the methadone treatment program in Split-Dalmatia County during the research period, except in 2005 and 2006, has been stable, while the number of new opiate patients, being in first-time treatment, decreased by 62.5%. The number of addicts who were in a long-term maintenance program has increased by 198%, whereas the number of addicts who were in a short-term detoxification treatment has decreased by 96.4%. According to results obtained from performed autopsies, 186 death cases were determined as overdoses. Methadone was found in 56 of those cases and was declared as the cause of death in 39 cases (70%). Of the total number of autopsied patients with diagnosed methadone overdose, only 23 (59%) had been recorded to receive methadone therapy in Public Health Institute of Split-Dalmatia County database.

Conclusions:
The results of this study show the favorable epidemiological trend because of the decreasing number of new opiate patients in treatment. The retention of opiate patients in substitution therapy indicates the effectiveness of methadone maintenance programs. Our research did not determine any influence of methadone substitution therapy on an increasing risk of specific (overdose) mortality.
Effect of Inspiratory Muscle Training in the Management of Patients With Asthma
Authors: Duruturk Neslihan , Acar Manolya , Doğrul Mustafa Ilgaz 
Published: April 2018

Purpose:
The aim of this study was to investigate the effects of inspiratory muscle training (IMT) on respiratory muscle strength, exercise capacity, dyspnea, fatigue, quality of life, and daily living activities of asthmatic patients.

Methods:
Thirty-eight asthmatic patients, between 18 and 65 years of age, were enrolled in the study and randomly divided into 2 groups; IMT (n = 20) or control (n = 18). Participants in the IMT group performed 30 breaths using a patient-specific threshold pressure device, twice daily for 6 wk at 50% maximal inspiratory pressure (MIP), in addition to “breathing training” during this period. Participants in the control group performed only the “breathing training” (sham or no threshold pressure device). Outcome measurements, performed before and after the intervention, included pulmonary function test, respiratory muscle strength, 6-min walk test, modified Medical Research Council dyspnea scale, St George's Respiratory Questionnaire, Fatigue Severity Scale, and London Chest Activity of Daily Living scale.

Results:
Among the outcomes in the study, changes to key variables including MIP (P < .01); MIP, percent predicted (P < .01); maximal expiratory pressure (MEP), percent predicted (P < .01); 6-min walk test walking distance (P = .001); modified Medical Research Council scale (P =<.001); Fatigue Severity Scale (P = .03); St George's Respiratory Questionnaire symptoms (P = .03); London Chest Activity of Daily Living domestic (P = .03); and London Chest Activity of Daily Living leisure (P = .01) were significantly different in favor of IMT versus control.

Conclusion:
These findings suggest that IMT may be an effective modality to enhance respiratory muscle strength, exercise capacity, quality of life, daily living activities, reduced perception of dyspnea, and fatigue in asthmatic patients.
Nursing Sensitive Outcomes After Severe Traumatic Brain Injury: A Nationwide Study
Authors: Odgaard Lene , Aadal Lena , Eskildsen Marianne , Poulsen Ingrid 
Published: April 2018

ABSTRACT

Background: Complications such as infections and conditions after immobilization are frequent after severe traumatic brain injury (TBI) due to compromised bodily functions. Traditionally, bodily functions are core elements in nursing, and therefore nurses in the rehabilitation departments are pivotal in the prevention of complications. Hence, the frequency of complications is an indicator of nursing care quality, which can be included in nursing-sensitive outcome indicators. To do so, it is necessary to know the frequency of the selected complications. Objective: The aim of this study was to quantify complications during the first year after severe TBI. Participants: This study included patients 15 years or older who received subacute neurorehabilitation after severe TBI from 2011 to 2015 (N = 469). Design: This is a register-based follow-up study using data from the Danish Head Trauma Database, a national clinical quality database aimed at monitoring and improving the quality of rehabilitation for patients with severe TBI. Main Measures: The following complications were assessed: urinary tract infection, pneumonia, pressure ulcers, joint contractures, and deep venous thrombosis. The prevalence of each complication was calculated at admission, discharge, and 1 year postinjury and for the period from admission and during subacute rehabilitation. In addition, the frequency of complications that certainly developed during subacute rehabilitation was calculated. Complications were compared between age-specific subgroups using multivariable binominal regression analyses. Results: Urinary tract infections (53%) and pneumonia (32%) were the most common complications in the period from admission and during subacute rehabilitation. Pressure ulcers (18%), joint contractures (18%), and deep venous thrombosis (4%) were less frequent. At discharge and 1 year postinjury, the prevalence was less than 4% for all complications, except for joint contractures (16% and 13% at discharge and 1 year postinjury, respectively). Conclusion: The prevalence of complications was high. The findings are important for future quality improvement of the rehabilitation trajectory and for further studies that explore the high frequency of complications.
Anorectal Manometry May Reduce the Number of Rectal Suction Biopsy Procedures Needed to Diagnose Hirschsprung Disease
Authors: Meinds Rob J. , Trzpis Monika , Broens Paul M.A. 
Published: April 2018

ABSTRACTObjectives:The aim of the study was to evaluate whether anorectal manometry (ARM), which is used to test the rectoanal inhibitory reflex (RAIR), is a safe alternative for reducing the number of invasive rectal suction biopsy (RSB) procedures needed to diagnose Hirschsprung disease (HD).Methods:Between 2010 and 2017, we prospectively collected the ARM results of 105 patients suspected of having HD. Following the outcome, the patients either underwent additional tests to confirm HD or they were treated conservatively. Primary ARM‐based diagnoses were compared with the definitive diagnoses based on the pathology reports and/or clinical follow‐ups. Additionally, we analyzed whether modifications to our ARM protocol improved diagnostic accuracy.Results:The sensitivity of ARM and RSB was comparable (97% vs 97%). The specificity of ARM, performed according to our initial protocol, was significantly lower than that of RSB. After we modified the protocol the difference between the specificity of ARM and RSB was no longer statistically significant (74% vs 84%, respectively, P = 0.260). The negative predictive value of ARM was 100%, while their positive predictive value was significantly lower than that of RSB (56% vs 97%, P < 0.001).Conclusions:ARM is a viable screening tool for HD and, provided it is performed properly, it can be used to exclude HD with absolute certainty. By contrast, an absent rectoanal inhibitory reflex on ARM should always be followed by an RSB to confirm the diagnosis of HD. Using ARM as the diagnostic of first choice could reduce the number of invasive biopsies.
National Mortality Rates after Outpatient Cosmetic Surgery and Low Rates of Perioperative Deep Vein Thrombosis Screening and Prophylaxis
Authors: Bucknor Alexandra , Egeler Sabine A. , Chen Austin D. , Chattha Anmol , Kamali Parisa , Brownstein Gary , Reed Lawrence , Watts David , Lin Samuel J. 
Published: April 2018

Background:
Concerns have arisen over reports of deaths occurring after certain outpatient plastic surgery procedures. Here, the authors present a national analysis, reporting on deaths occurring after outpatient cosmetic surgical procedures and venous thromboembolism screening.

Methods:
A retrospective analysis of the American Association for Accreditation of Ambulatory Surgical Facilities database was performed for the years 2012 to 2017. The authors retrieved data for all deaths occurring in association with cosmetic plastic surgery procedures. Patient demographics, procedural data, venous thromboembolism risk factor assessment, and cause of death were analyzed. Deidentified medical records, including coroner’s reports, were reviewed where available.

Results:
Data for 42 deaths were retrieved. Of these, 90.5 percent (n=38) were female, and 61.9 percent were Caucasian (n=26). Mean age was 51.6 years, while mean body mass index was 29.5 kg/m2. Overall, 54.8 percent of these deaths occurred after abdominoplasty: 42.9 percent in isolation, 9.5 percent in combination with breast surgery, and 2.4 percent with facial surgery. Of the causes of death, most (38.1 percent) were thromboembolic in origin. Notably, in 25 of 42 cases, venous thromboembolism risk factor assessment was incorrect or absent (59.5 percent).

Conclusions:
Accreditation agencies provide transparency and insight into outpatient surgical mortality on a national scale. Results suggest that adoption of venous thromboembolism screening techniques may not be universal despite an existing large body of published evidence. Optimization of thromboembolism prevention pathways remains vital, and consideration of anticoagulation in those undergoing abdominoplasty may be important in lowering outpatient mortality.
The Impact of Once- versus Twice-Daily Enoxaparin Prophylaxis on Risk for Venous Thromboembolism and Clinically Relevant Bleeding
Authors: Pannucci Christopher J. , Fleming Kory I. , Agarwal Jayant , Rockwell W. Bradford , Prazak Ann Marie , Momeni Arash 
Published: April 2018

Background:
Venous thromboembolism is a life- or limb-threatening complication that occurs in plastic surgery patients. At present, the optimal dose of enoxaparin that balances the risk of venous thromboembolism and the risk of medication-related adverse drug events—specifically, bleeding—remains unknown.

Methods:
This study compared pharmacodynamic and clinical outcomes, including 90-day venous thromboembolism and 90-day clinically relevant bleeding, between two prospectively performed clinical trials whose sole difference was postoperative anticoagulation strategy. Patients in trial 1 received enoxaparin 40 mg once daily for the duration of inpatient stay, and patients in trial 2 received enoxaparin 40 mg twice daily for the duration of inpatient stay. The study also examined the potential impact of a weight-based twice-daily prophylaxis strategy to achieve in-range anti–factor Xa levels.

Results:
The study compared 94 patients who received once-daily enoxaparin to 118 patients who received twice-daily enoxaparin. Twice-daily enoxaparin was associated with a significant decrease in 90-day acute venous thromboembolism (0 percent versus 5.3 percent; p = 0.012) and a nonsignificant increase in 90-day clinically relevant bleeding (6.8 percent versus 3.2 percent; p = 0.25). Twice-daily enoxaparin at 0.4 to 0.5 mg/kg may allow an increased proportion of patients to avoid both inadequate anticoagulation and overanticoagulation, based on anti–factor Xa levels.

Conclusions:
Twice-daily enoxaparin is superior to once-daily enoxaparin for 90-day acute venous thromboembolism risk reduction. Twice-daily enoxaparin may increase clinically relevant bleeding, although observed differences in this study were not significant. Weight-based twice-daily enoxaparin dosing may optimize the risks and benefits of prophylactic anticoagulation after plastic and reconstructive surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Asymptomatic Deep Vein Thrombosis during Free Flap: Concerns in Free Flap Surgery
Authors: Jung Jae-A , Park Bo Young , Kang So Ra , Kim Min Ji 
Published: April 2018

Background:
Venous insufficiency is the most frequent cause of failure in free flap reconstruction of the lower extremity. When deep vein thrombosis is detected during preoperative assessment of the lower extremity, decisions regarding treatment plans become difficult, and no relevant guidelines regarding surgery and preoperative treatment of patients with deep vein thrombosis who need a free flap transfer are currently available.

Methods:
To find a relevant guideline in decision-making regarding surgery and preoperative treatment of patients with deep vein thrombosis who require free flap reconstruction, a systematic literature review was conducted searching MEDLINE, PubMed Central, Cochrane, and Embase databases for articles published between 1996 and 2015. In addition, the authors introduced six of their cases of deep vein thrombosis diagnosed before free flap surgery in which the flap survived.

Results:
The literature review identified two articles that discussed intraoperative deep vein thrombosis diagnosed in three patients, including the reported cases. Analyses included epidemiology, cause, and management strategy. A consensus for the management of asymptomatic deep vein thrombosis before free flap surgery is still lacking. In the authors’ cases, successful flap transfer was possible by proceeding with an appropriate preoperative evaluation, intensive anticoagulation treatment, intraoperative reperfusion procedure, and postoperative care.

Conclusion:
Preoperatively detected asymptomatic deep vein thrombosis is not a contraindication for free flap reconstruction, and a flap transfer can be successfully performed with suitable planning and management.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
In Search of Mobile Applications for Urogynecology Providers
Authors: Wallace Shannon L. , Mehta Shailja , Farag Sara , Kelley Robert S. , Chen Katherine T. 
Published: April 2018

Introduction
Thousands of medical applications (apps) are available for mobile devices. Finding accurate, health care provider–centered apps may be time consuming and frustrating for urogynecologists. The objective of this study was to identify and evaluate urogynecology (urogyn) apps using a modified APPLICATIONS scoring system.

Materials and Methods
Urogyn apps were identified from the Apple iTunes and Google Play Stores using the following 10 MeSH terms: urogynecology, incontinence, prolapse, urinary tract infection, pelvic surgery, fecal incontinence, defecation disorder, voiding disorder, urethral diverticulum, and fistula. Patient-centered and inaccurate apps were excluded. The remaining apps were evaluated with a modified APPLICATIONS scoring system, which included both objective and subjective criteria to determine each app’s ability to aid in clinical decision making and to provide informational data. Objective rating components were price, paid subscription, literature referenced, in-app purchases, Internet connectivity, advertisements, text search field, interplatform compatibility and incorporated images, figures, videos, and special features. Subjective rating components were ease of navigation and presentation.

Results
Our search yielded 133 and 235 apps in the Apple iTunes and Google Play Stores, respectively. Only 8 apps (4 of which were in both stores) were determined to be accurate and useful; these were evaluated using the modified APPLICATIONS scoring system. The top-rated app was Practical Urology.

Conclusion
Few accurate clinical decision-making and informational apps exist for urogynecologists. Apps varied by comprehensiveness and quality. This study highlights the importance of systematically reviewing and rating medical apps. It also emphasizes the need for developing accurate apps for urogynecologists that improve health care provider performance and patient outcomes.
The ERBB-STAT3 Axis Drives Tasmanian Devil Facial Tumor Disease
Authors: Kosack Lindsay , Wingelhofer Bettina , Popa Alexandra , Vilagos Bojan , Orlova Anna , Majek Peter , Parapatics Katja , Lercher Alexander , Agerer Benedikt , Ringler Anna , Klughammer Johanna , Smyth Mark , Khamina Kseniya , Baazim Hatoon , Rosa David A. , Park Jisung , Gunning Patrick T. , Bock Christoph , Siddle Hannah V. , Kubicek Stefan , Murchison Elizabeth P. , Bennett Keiryn L. , Moriggl Richard , Bergthaler Andreas 
Published: April 2018

SummaryThe marsupial Tasmanian devil (Sarcophilus harrisii) faces extinction due to transmissible devil facial tumor disease (DFTD). To unveil the molecular underpinnings of DFTD, we designed an approach that combines sensitivity to drugs with an integrated systems-biology characterization. Sensitivity to inhibitors of the ERBB family of receptor tyrosine kinases correlated with their overexpression, suggesting a causative link. Proteomic and DNA methylation analyses revealed tumor-specific signatures linked to oncogenic signaling hubs including evolutionary conserved STAT3. Indeed, ERBB inhibition blocked phosphorylation of STAT3 and arrested cancer cells. Pharmacological blockade of ERBB signaling prevented tumor growth in a xenograft model and resulted in recovery of MHC class I gene expression. This link between the hyperactive ERBB-STAT3 axis and MHC class I mediated tumor immunosurveillance provides mechanistic insights into horizontal transmissibility and led us to the proposition of a dual chemo-immunotherapeutic strategy to save Tasmanian devils from DFTD.