bluuebunny/crossref_metadata_2025_split huggingface dataset:
Apps for Older People’s Pain Self-Management: Perspectives of Primary Care and Allied Health Clinicians
Authors: Bhattarai Priyanka , Newton-John Toby , Phillips Jane L 
Published: July 2019

Abstract

Background
Chronic arthritic pain is one of the major causes of physical suffering and disability among older people. Primary care and allied health clinicians use various approaches to help their older clients better manage their arthritic pain. The growing uptake of technology among older people offers the potential for clinicians to integrate an arthritic pain app into their patients’ self-management plans. This study explored the perspectives of Australian primary care and allied health clinicians regarding the use of pain self-management apps to help their older patients/clients better manage their arthritic pain.

Methods
Qualitative design using a semistructured interview approach. Interviews were conducted via telephone with primary and allied health clinicians (N = 17) across Australia.

Results
The overarching theme underlying participants’ views on integration of apps into older people’s pain self-management strategy was that this approach is an idealistic but uniquely challenging endeavor. Four subthemes emerged, namely: 1) self-management apps are a potentially useful tool but require careful consideration; 2) clinicians’ involvement is crucial yet potentially onerous; 3) no single app is right for every older person with arthritic pain; and 4) patient data access is beneficial, but caution is needed for real-time data access.

Discussion
The predominant clinician perspective of integrating apps into their older patients/clients’ pain self-management strategies was that this approach is an idealistic but uniquely challenging endeavor. Apps were seen as having potential to support various aspects of patients’ self-management behaviors; however, there were notable concerns with regards to the challenges inherent in this approach for both clinicians and older users (patients/clients).
Creative Yoga Intervention Improves Motor and Imitation Skills of Children With Autism Spectrum Disorder
Authors: Kaur Maninderjit , Bhat Anjana 
Published: July 2019

Abstract

Background
There is growing evidence for motor impairments in children with autism spectrum disorder (ASD), including poor gross and fine motor performance, poor balance, and incoordination. However, there is limited evidence on the effects of motor interventions for this population.

Objective
In the present study, the effects of a physical therapy intervention using creative yoga on the motor and imitation skills of children with ASD were evaluated.

Design
This study had a pretest-posttest control group design.

Methods
Twenty-four children with ASD aged between 5 and 13 years received 8 weeks of a physical therapist-delivered yoga or academic intervention. Children were tested before and after the intervention using a standardized motor measure, the Bruininks-Oseretsky Test of Motor Performance–2nd Edition (BOT-2). The imitation skills of children using familiar training-specific actions (ie, poses for the yoga group and building actions for the academic group) were also assessed.

Results
After the intervention, children in the yoga group improved gross motor performance on the BOT-2 and displayed fewer imitation/praxis errors when copying training-specific yoga poses. In contrast, children in the academic group improved their fine motor performance on the BOT-2 and performed fewer imitation errors while completing the training-specific building actions.

Limitations
The study limitations include small sample size and lack of long-term follow-up.

Conclusions
Overall, creative interventions, such as yoga, are promising tools for enhancing the motor and imitation skills of children with ASD.
The Utility of the Early Postoperative Follow-up and Radiographs After Operative Treatment of Supracondylar Humerus Fractures in Children
Authors: Acosta Anna M. , Li Yi-Ju , Bompadre Viviana , Mortimer Alex , Trask Michael , Steinman Suzanne E. 
Published: July 2019

Background:
Supracondylar humerus (SCH) fractures are common elbow injuries in pediatric patients. The American Academy of Orthopedic Surgeons published guidelines for the standard of care in the treatment of displaced SCH fractures, however, no recommendations for follow-up care were made. With the recent push to eliminate unnecessary radiographs and decrease health care costs, many are questioning postoperative protocols. The purpose of our study was to evaluate the utility of the 1-week follow-up appointment after closed reduction and percutaneous pinning (CRPP) of displaced SCH fractures.

Methods:
A retrospective review performed at a single institution from 2014 to 2016 included patients under 14 years of age with a closed, displaced SCH fracture treated with CRPP. Exclusion criteria included patients without complete clinical or radiographic follow-up. Variables examined included time to initial follow-up, change in treatment plan after 1-week x-rays, complications, demographics, fracture type, pin number and configuration, reduction parameters, immobilization, time to pin removal, duration of casting, and clinical outcome.

Results:
A total of 412 patients were divided into 2 groups based on time to initial follow-up. Overall, 368 had an initial follow-up at 7 to 10 days (group 1) and 44 at 21 to 28 days (group 2). There was no difference in age, sex, fracture type, pin configuration, or a number of pins between groups. Statistically significant findings included time to initial follow-up and days to pin removal (group 1 at 26.2 d vs. group 2 at 23.8 d), type of immobilization (group 1 with 5% circumferential casts and group 2 with 70%), and time to surgery (26.2 vs. 62.9 h, respectively). There was no significant difference in complication rates and only a 0.5% rate of change in management in group 1.

Conclusions:
Early postoperative follow-up and radiographs did not change the patient outcome and might be eliminated in children with displaced SCH fractures treated with CRPP. Given the current focus of on efficiency and cost-effective care, eliminating the 1-week postoperative appointment would improve appointment availability and decrease medical cost.

Level of Evidence:
Level III—Therapeutic.
Long-term Outcome of Anterior Cervical Decompression With Fusion for Cervical Ossification of Posterior Longitudinal Ligament Including Postsurgical Remnant Ossified Spinal Lesion
Authors: Nakajima Hideaki , Watanabe Shuji , Honjoh Kazuya , Kitade Ippei , Sugita Daisuke , Matsumine Akihiko 
Published: July 2019

Study Design.
A retrospective study.

Objective.
The aim of this study was to assess the outcome, perioperative complications, and prognostic factors of anterior cervical decompression and fusion (ACDF) in patients with cervical ossification of posterior longitudinal ligament (OPLL).

Summary of Background Data.
There is little information on the long-term surgical outcome of ACDF including postsurgical remnant ossified spinal lesion.

Methods.
Between 1993 and 2013, 80 patients with cervical myelopathy towing to OPLL underwent ACDF at our hospital. Among these, 42 patients were followed-up for at least 5 years and their data were analyzed.

Results.
The mean follow-up period was 7.9 ± 2.8 years, and the overall improvement rate was 59.2% ± 15.0%. Although 12 (15.0%) perioperative complications were observed in 6 patients, accompanied by neurological deterioration, none of the patients had chronic complications. Multivariate logistic regression analysis that included the preoperative Japanese Orthopaedic Association (JOA) score, type of OPLL, occupying ratio of OPLL, and number of fused segments and increase in the transverse area of the cord identified the latter parameter as the only independent and significant determinant of radiological and clinical improvement of >50%. Among the patients with remaining ossified spinal lesions out of the decompressed range (16 patients), postoperative progression was observed in 6 cases (14.3%) who were all of the mixed type; floated lesions within the decompressed range did not show progression during the follow-up. Adjacent segment degeneration was seen in nine (21.4%) patients, and neurological signs and symptoms were seen in only three of the nine patients and only one patient required revision surgery.

Conclusion.
The long-term clinical outcome of patients with cervical OPLL after ACDF is considered satisfactory. Surgery-related complications and adjacent segment diseases should not be reasons to avoid ACDF. Care should be taken in selecting ACDF with postsurgical remnant ossified spinal lesion, as it could progress postoperatively especially in the mixed type OPLL.

Level of Evidence: 4
The Impact of Radiotherapy Facility Volume on the Survival and Guideline Concordance of Patients With Muscle-invasive Bladder Cancer Receiving Bladder-preservation Therapy
Authors: D’Rummo Kevin A. , TenNapel Mindi J. , Shen Xinglei 
Published: July 2019

Objectives:
Higher facility surgical volume predicts for improved outcomes in patients with muscle-invasive bladder cancer (MIBC) who undergo radical cystectomy. We investigated the association between facility radiotherapy (RT) case volume and overall survival (OS) for patients with MIBC who received bladder-preserving RT, and the relationship with adherence to National Comprehensive Cancer Network (NCCN) guidelines for bladder preservation.

Methods:
The National Cancer Database was used to identify patients diagnosed with nonmetastatic MIBC from 2004 to 2015 and received RT at the reporting center. Facility case volume was defined as the total MIBC patients treated with RT during the period. Facilities were stratified into high-volume facility (HVF) or low-volume facility at the 80th percentile of RT case volume. OS was assessed using Kaplan-Meier analysis. Rates of compliance with NCCN guidelines regarding the use of transurethral resection of the bladder tumor before RT, planned use of concurrent chemotherapy, and total RT dose were compared. Cox proportional hazard model was used to evaluate predictors of OS.

Results:
There were 7562 patients included. No differences in age, Charlson-Deyo score, T stage, or node-positive rates were observed between groups. HVFs exhibited greater compliance with NCCN guidelines for bladder preservation (P<0.0001). Treatment at an HVF was associated with the improved OS for all patients (P=0.001) and for the subset of patients receiving NCCN-recommended RT doses (P=0.0081). Volume was an independent predictor of OS (P=0.002).

Conclusions:
Treatment at an HVF is associated with improved OS and greater guideline-concordant management among patients with MIBC.
Preclinical Validation of a Novel Device Designed to Reduce Biofilms on Percutaneous Osseointegrated Abutments
Authors: Sammons Rachel , East Matthew , Grant Melissa , Proops David 
Published: July 2019

Aim:
To assess the efficacy of a prototype cleaning device in removing biofilm from skin-penetrating abutments.

Background:
Adverse skin reactions around percutaneous osseointegrated implants have been linked to poor hygiene and infection. A cleaning device made from open-cell polyfoam has been developed to facilitate manual cleaning of abutments by the patient.

Methods:

Serratia biofilm was grown on clean and sterile conical bone-anchored hearing system abutments including both pre-2007 (straight sided) and post-2007 (conical-sided) designs. Eighteen were photographed and then subjected to cleaning using a toothbrush or the cleaning device soaked in water or a proprietary mouthwash. Biofilm on a further group of 10 conical abutments was recorded using a scanning electron microscope before and after cleaning with the test device soaked in water. Quantitative analysis of the efficiency of the cleaning was made using image analysis.

Results:
Removal of biofilm using a dry or wet toothbrush was not as effective as cleaning with the device. In 10 cases subjected to image analysis, approximately 90% of the biofilm was removed from the top third of the abutments, 85% from the middle third, and 48% from the basal third.

Conclusion:
The cleaning device is effective in removing most biofilm from the test abutments and represents a significant improvement in comparison with traditional methods such as a toothbrush.
Diagnosis and management of spontaneous cerebrospinal fluid fistula and encephaloceles
Authors: Kutz Joe Walter , Tolisano Anthony M. 
Published: July 2019

Purpose of review
To describe the current state in the diagnosis and management of spontaneous cerebrospinal fluid (sCSF) fistula and encephaloceles.

Recent findings
The increased incidence of obesity has resulted in more cases of sCSF fistula and encephaloceles. Obesity results in increased intracranial pressure and a greater chance of developing a sCSF fistula or encephalocele. Obstructive sleep apnea can also result in transient increase in intracranial pressure and has been shown to be common in patients with sCSF fistula. Treatment of CSF fistula is usually necessary because of the increased risk of meningitis. The use of hydroxyapatite bone cements to repair the temporal bone defects has been described with a high success rate of closing the fistula and a low complication rate. Concurrent superior semicircular canal dehiscent can be seen in up to 15% of cases and should be suspected during the surgical approach to avoid potential sensorineural hearing loss and chronic imbalance.

Summary
sCSF fistula and encephaloceles are an uncommon cause of hearing loss, middle ear effusion, and otorrhea, but should be recognized and repaired because of the risk of meningitis.
Riding the Roller Coaster
Authors: Phillips Carolyn S. , Volker Deborah L. 
Published: July 2019

Background
Rates of burnout and compassion fatigue among oncology nurses are rising, and the emotional impact of the work increases the risk. This study examined how oncology nurses describe the evolution of emotions from first significant patient loss through cumulative patient death.

Objective
To explore the emotional evolution of being an oncology nurse.

Methods
Semistructured interviews with 7 oncology nurses. Thematic analysis was used to analyze the data.

Results
Participant’s mean age was 41.3 years, with 13.9 years of nursing experience and 10.6 years of oncology experience. One metatheme, “riding the roller coaster,” described the overall emotional experience of the nurses. Three subthemes, “all in and then,” “finding your way,” and “impact on self,” further outlined the process taken to cope with workplace emotions.

Conclusions
Oncology nurses are frequently exposed to loss and suffering. Findings from this study suggest that new nurses are underprepared for the emotional experience of being an oncology nurse. Further, they define their emotional boundaries in isolation and without guidance on how to develop healthy coping skills. Changing the culture of silence around mental health and well-being among healthcare professionals can provide space for important conversations to occur.

Implications for Practice
Oncology nurses have few resources to teach them how to cope with the emotions experienced while caring for oncology patients. These findings suggest that alternative approaches to the traditional bereavement programs and innovative interventions offered to new oncology nurses within their first few years are needed.
Quality Control Measures and Validation in Gene Association Studies: Lessons for Acute Illness
Authors: Cohen Maria , Lamparello Ashley J. , Schimunek Lukas , El-Dehaibi Fayten , Namas Rami A. , Xu Yan , Kaynar A Murat , Billiar Timothy R. , Vodovotz Yoram 
Published: July 2019

ABSTRACT
Acute illness is a complex constellation of responses involving dysregulated inflammatory and immune responses, which are ultimately associated with multiple organ dysfunction. Gene association studies have associated single-nucleotide polymorphisms (SNPs) with clinical and pharmacological outcomes in a variety of disease states, including acute illness. With approximately 4 to 5 million SNPs in the human genome and recent studies suggesting that a large portion of SNP studies are not reproducible, we suggest that the ultimate clinical utility of SNPs in acute illness depends on validation and quality control measures. To investigate this issue, in December 2018 and January 2019 we searched the literature for peer-reviewed studies reporting data on associations between SNPs and clinical outcomes and between SNPs and pharmaceuticals (i.e., pharmacogenomics) published between January 2011 to February 2019. We review key methodologies and results from a variety of clinical and pharmacological gene association studies, including trauma and sepsis studies, as illustrative examples on current SNP association studies. In this review article, we have found three key points which strengthen the potential accuracy of SNP association studies in acute illness and other diseases: providing evidence of following a protocol quality control method such as the one in Nature Protocols or the OncoArray QC Guidelines; enrolling enough patients to have large cohort groups; and validating the SNPs using an independent technique such as a second study using the same SNPs with new patient cohorts. Our survey suggests the need to standardize validation methods and SNP quality control measures in medicine in general, and specifically in the context of complex disease states such as acute illness.
A Predictive Model for Nodal Metastases in Patients With Appendiceal Cancers
Authors: Day Ryan W. , Chang Yu-Hui , Stucky Chee-Chee , Gray Richard , Pockaj Barbara , Wasif Nabil 
Published: July 2019

Background:
Histologic subtypes of appendiceal cancer vary in their propensity for metastases to regional lymph nodes (LN). A predictive model would help direct subsequent surgical therapy.

Methods:
The National Cancer Database was queried for patients with appendiceal cancer undergoing surgery between 1998 and 2012. Multivariable logistic regression was used to develop a predictive model of LN metastases which was internally validated using Brier score and Area under the Curve (AUC).

Results:
A total of 21,647 patients were identified, of whom 9079 (41.9%) had node negative disease, 4575 (21.1%) node positive disease, and 7993 (36.9%) unknown LN status. The strongest predictors of LN positivity were histology (carcinoid tumors OR 12.78, 95% CI 9.01–18.12), increasing T Stage (T3 OR 3.36, 95% CI 2.52–4.50, T4 OR 6.30, 95% CI 4.71–8.42), and tumor grade (G3 OR 5.55, 95% CI 4.78–6.45, G4 OR 5.98, 95% CI 4.30–8.31). The coefficients from the regression analysis were used to construct a calculator that generated predicted probabilities of LN metastases given certain inputs. Internal validation of the overall model showed an AUC of 0.75 (95% CI 0.74–0.76) and Brier score of 0.188. Histology-specific predictive models were also constructed with an AUC that varied from 0.669 for signet cell to 0.75 for goblet cell tumors.

Conclusions:
The risk for nodal metastases in patients with appendiceal cancers can be quantified with reasonable accuracy using a predictive model incorporating patient age, sex, tumor histology, T-stage, and grade. This can help inform clinical decision making regarding the need for a right hemicolectomy following appendectomy.
Priapism With Methylphenidate Use in a Preschool-Aged Boy Resolved With Switching to Atomoxetine
Authors: Ekinci Ozalp , Üstündağ Büşra , Tunali Bilge Didem , Abdulrazzaq Al-Bayati Mohammad B. , Demir Hüseyin , Adak İbrahim 
Published: July 2019

Background
Priapism is a persistent unwanted erection that is not linked with sexual stimulation. A number of previous case reports have shown priapism with methylphenidate (MPH) use, especially in adolescence and preadolescence period. In all of these cases, the unwanted erections ceased after the medication was discontinued and no further attention-deficit hyperactivity disorder medication was initiated. Hereby, we present the case of a boy who had priapism episodes with MPH, which resolved with switching to atomoxetine (ATX).

Case Report
A 5-year, 10-month-old medically healthy boy was diagnosed with attention-deficit hyperactivity disorder and was prescribed methylphenidate immediate-release (10 mg/d). Two weeks later, his family communicated and reported penile erection episodes since the initiation of MPH. With the suspect of a medication-induced adverse reaction, MPH was discontinued and priapism resolved within a week. Thereafter, 10 mg/d of ATX was initiated. Four-week follow-up with ATX treatment revealed that the medication was tolerated well, and priapism or any other adverse effect was not reported.

Conclusions
This case report suggests that ATX may be safely used in some children who experienced priapism with MPH. Future studies are needed to clarify the risk factors and etiologic mechanisms of this adverse reaction.
Non-cell autonomous OTX2 transcription factor regulates anxiety-related behavior in the mouse
Authors: Vincent C. , Gilabert-Juan J. , Gibel-Russo R. , Alvarez-Fischer D. , Krebs M.-O. , Le Pen G. , Prochiantz A. , Di Nardo A.A. 
Published: July 2019

SUMMARYThe Otx2 homeoprotein transcription factor is expressed in the dopaminergic neurons of the ventral tegmental area, a mesencephalic nucleus involved in the control of complex behaviors through its projections to limbic structures, including the ventral hippocampus, amygdala, nucleus accumbens and medial prefrontal cortex. We find adult mice heterozygous forOtx2show anxiolysis-like phenotype in light-dark box and elevated plus maze paradigms. However, the number of dopaminergic neurons, the integrity of their axons, their projection patterns in target structures, and the amounts of dopamine and dopamine metabolites in targets structures were not modified. Because OTX2 is expressed by the choroid plexus, secreted into cerebrospinal fluid and transferred to parvalbumin interneurons of the cortex, hippocampus, and amygdala, we investigated if this phenotype could result from the decreased synthesis of OTX2 in the choroid plexus. Indeed, the anxiolysis-like phenotype was partially recapitulated in theOtx2+/AAandscFvOtx2tg/0choroid-plexus dependent non-cell-autonomous OTX2 loss of function mouse models. Furthermore, the phenotype was reversed by the overexpression ofOtx2specifically in choroid plexus of adultOtx2heterozygous mice. Taken together, OTX2 synthesis by the choroid plexus followed by its secretion into the cerebrospinal fluid is an important regulator of the anxiety phenotype in the mouse.
Structure of the bacterial flagellar rotor MS-ring: a minimum inventory/maximum diversity system
Authors: Johnson Steven , Fong Yu Hang , Deme Justin , Furlong Emily , Kuhlen Lucas , Lea Susan M. 
Published: July 2019

AbstractThe bacterial flagellum is a complex, self-assembling, nanomachine that confers motility on the cell. Despite great variation across species, all flagella are ultimately constructed from a helical propellor attached to a motor embedded in the inner membrane. The motor consists of a series of stator units surrounding a central rotor made up of two ring complexes, the MS-ring and the C-ring. Despite many studies, high resolution structural information is still completely lacking for the MS-ring of the rotor, and proposed mismatches in stoichiometry between the two rings have long provided a source of confusion for the field. We here present structures of the Salmonella MS-ring, revealing an unprecedented level of inter- and intra-chain symmetry variation that provides a structural explanation for the ability of the MS-ring to function as a complex and elegant interface between the two main functions of the flagellum, protein secretion and rotation.