bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparative Study of Radon Levels in Federal Buildings and Residential Homes in Canada
Authors: Whyte Jeffrey , Falcomer Renato , Chen Jing 
Published: March 2019

Abstract
Shortly after revision of the Canadian radon guideline from 800 to 200 Bq m−3, Health Canada established the Federal Building Testing Program in 2007 to demonstrate federal leadership in raising awareness about radon risk and the need for testing. By the end of 2017, more than 7,600 federal workplaces had been tested for radon. As is the case in all radon surveys, radon levels vary widely; federal building results ranged from below the detection limit to more than 2,500 Bq m−3 in a few rooms of a few buildings. Weighted by the population of federal public servants across Canada, the average radon distribution in federal workplaces has a geometric mean of 22.0 Bq m−3 with a geometric standard deviation of 2.3. The population-weighted arithmetic mean is 34.3 Bq m−3, significantly lower than the population-weighted average radon concentration of 72.9 Bq m−3 in residential homes across Canada. On average, 2% of federal workplaces have radon concentrations above 200 Bq m−3, which is also significantly lower than the 7% of residential homes that tested above 200 Bq m−3. This comparative study demonstrated clearly that radon education and awareness in Canada should focus more on residential testing and remediation actions to effectively reduce the burden of radon-induced lung cancer.
Virtual Grand Rounds: A Curricular Model for Translating Evidence-Based Practice From the Classroom to the Clinic
Authors: Fay Deanne , Bordenave Lori M. , Wilkinson Tawna 
Published: March 2019

Background and Purpose.
The physical therapy profession supports educating physical therapist graduates to use evidence-based practice (EBP) skills in the clinical environment. Educational interventions to teach EBP include a variety of formats, but most focus on changing student and clinician knowledge and skills rather than changing actual clinician behavior. The literature suggests that for clinician behavior to change, educational interventions must be integrated into clinical practice. To describe the restructuring of the ATSU research and EBP curriculum including the development of a course, Virtual Grand Rounds (VGR), that focused on EBP skills and took place during clinical experiences.

Method/Model Description and Evaluation.
The curriculum and VGR course were designed for students to learn EBP skills, develop tolerance for uncertainty, implement EBP within time demands of the clinic, and use workplace supports. All physical therapy students completed both the Evidence-Based Practice Beliefs (EBPB) scale and the Evidence-Based Practice Implementation (EBPI) scale at program entry and at the end of years 1, 2, and 3 (graduation).

Outcomes.
A total of 727 EBPB and 719 EBPI surveys were completed and analyzed. Using an analysis of variance with Scheffe post hoc analyses, significant differences (P < .05) were found between the EBPB and EBPI scores for each year of data collection with the exception of a nonsignificant change between year 1 and year 2 (P = .998 and P = .702). The overall EBPI score at graduation indicated that during the final clinical year, students performed each EBP skill somewhere between 1 and 5 times during the clinical experience. Changes in individual question scores indicated increases in students' skills, knowledge, and application throughout all years.

Discussion and Conclusion.
Evidence-based practice implementation increased throughout the 3 years and was at the highest following the final clinical year when students participated in the newly developed VGR. By situating practice of EBP within the time constraints of the clinical environment, the setting where EBP takes place, students are equipped to move away from the reliance on clinical expertise to evidence-based physical therapy. The development of the VGR course described in this article shifts EBP from an academic exercise in the classroom to an activity imbedded in real clinical practice. Other programs may find this integrated course helpful in removing barriers to EBP and developing graduates equipped to integrate EBP in the clinical environment.
Collaboration in Health Care and Social Service Networks for Older Adults
Authors: Brewster Amanda L. , Yuan Christina T. , Tan Annabel X. , Tangoren Caroline G. , Curry Leslie A. 
Published: March 2019

Background:
Services targeting social determinants of health—such as income support, housing, and nutrition—have been shown to improve health outcomes and reduce health care costs for older adults. Nevertheless, evidence on the properties of effective collaborative networks across health care and social services sectors is limited.

Objectives:
The main objectives of this study were to identify features of collaborative networks of health care and social services organizations associated with avoidable health care use and spending for older adults.

Research Design:
Through a 2017 survey, we collected data on collaborative ties among health care and social service organizations in 20 US communities with either high or low performance on avoidable health care use and spending for Medicare beneficiaries. Six types of ties were measured: any collaboration, referrals, sharing information, cosponsoring projects, financial contracts, and joint needs assessment. We examined how characteristics of collaborative networks were associated with performance.

Results:
High-performing networks were distinguished from low-performing networks by 2 features: (1) health care organizations occupied positions of significantly greater centrality (P<0.01), and (2) subnetworks of cosponsorship ties were more cohesive, as measured by centralization (P=0.05) and density (P=0.06). Across all networks, Area Agencies on Aging were more centrally positioned than any other type of organization (P<0.05).

Conclusions:
Cross-sector engagement by health care organizations, particularly development of deeper types of collaborative ties such as cosponsorship, may reduce preventable health care use and spending. Efforts to foster effective partnerships could leverage the Area Agencies on Aging, which are already positioned as network brokers.
The Significance of Ascites in Patients With Pancreatic Ductal Adenocarcinoma
Authors: Baretti Marina , Pulluri Bhargavi , Tsai Hua-Ling , Blackford Amanda L. , Wolfgang Christopher L. , Laheru Daniel , Zheng Lei , Herman Joseph , Le Dung T. , Narang Amol K. , de Jesus-Acosta Ana 
Published: March 2019

Objective
Limited data exist on the impact of ascites in pancreatic ductal adenocarcinoma (PDAC). We evaluated the survival outcomes of patients with PDAC and ascites.

Methods
Retrospective, single-institution, case-control study including patients with newly diagnosed PDAC from 2007 to 2016. One hundred fifty-four patients with ascites at diagnosis (case group) and 154 controls were matched on age, sex, stage, Eastern Cooperative Oncology Group performance, surgical treatment, lymph node, and margin status. Ascites was defined as computed tomography–detected fluid in the pelvic/peritoneal cavity. Overall survival was compared between groups via Cox proportional hazards models with a gamma frailty term to account for the correlation between matched pairs on entire cohort and by disease stages for subgroup analysis.

Results
The 154 matched cases included 24 resectable, 19 borderline resectable, 51 locally advanced, and 60 metastatic disease. Patients with ascites had higher risk of death compared with those without (conditional hazard ratio, 1.58; 95% confidence interval, 1.23–2.03; P < 0.001). Stratified analysis showed a significant association between ascites and poor prognosis in patients with localized disease (conditional hazard ratio, 1.62; 95% confidence interval, 1.18–2.24; P = 0.003).

Conclusions
Radiographic ascites is a poor prognostic factor in PDAC. Our findings may aid physicians in considering systemic therapy prior to attempting local treatments.
Comparison of Measures to Predict Mortality and Length of Stay in Hospitalized Patients
Authors: Liu Jianfang , Larson Elaine , Hessels Amanda , Cohen Bevin , Zachariah Philip , Caplan David , Shang Jingjing 
Published: March 2019

Background
Patient risk adjustment is critical for hospital benchmarking and allocation of healthcare resources. However, considerable heterogeneity exists among measures.

Objectives
The performance of five measures was compared to predict mortality and length of stay (LOS) in hospitalized adults using claims data; these include three comorbidity composite scores (Charlson/Deyo age-comorbidity score, V W Elixhauser comorbidity score, and V W Elixhauser age-comorbidity score), 3 M risk of mortality (3 M ROM), and 3 M severity of illness (3 M SOI) subclasses.

Methods
Binary logistic and zero-truncated negative binomial regression models were applied to a 2-year retrospective dataset (2013–2014) with 123,641 adult inpatient admissions from a large hospital system in New York City.

Results
All five measures demonstrated good to strong model fit for predicting in-hospital mortality, with C-statistics of 0.74 (95% confidence interval [CI] [0.74, 0.75]), 0.80 (95% CI [0.80, 0.81]), 0.81(95% CI [0.81, 0.82]), 0.94 (95% CI [0.93, 0.94]), and 0.90 (95% CI [0.90, 0.91]) for Charlson/Deyo age-comorbidity score, V W Elixhauser comorbidity score, V W Elixhauser age-comorbidity score, 3 M ROM, and 3 M SOI, respectively. The model fit statistics to predict hospital LOS measured by the likelihood ratio index were 0.3%, 1.2%, 1.1%, 6.2%, and 4.3%, respectively.

Discussion
The measures tested in this study can guide nurse managers in the assignment of nursing care and coordination of needed patient services and administrators to effectively and efficiently support optimal nursing care.
Prevalence and Risk Factors of Trichomonas vaginalis Among Female Sexual Workers in Nairobi, Kenya
Authors: Lockhart Alexandre , Senkomago Virginia , Ting Jie , Chitwa Michael , Kimani Joshua , Gakure Hannah , Kwatampora Jessie , Patel Suha , Mugo Nelly , Smith Jennifer S. 
Published: March 2019

Background

Trichomonas vaginalis (TV) is the most common curable sexually transmitted infection (STI) worldwide. Trichomonas vaginalis infection is associated with an increased risk of pelvic inflammatory disease, human immunodeficiency virus transmission, and preterm birth in women. Data on the prevalence and risk factors for TV infection in sub-Saharan African countries remain scarce.

Methods
A total of 350 Kenyan female sex workers, aged 18 to 50 years, participated in a 2-year longitudinal study of the acquisition of STIs, including TV infection. Every 3 months, cervical and vaginal brush samples were collected for STI testing. At baseline, a sociodemographic and behavior questionnaire was administered. Testing for TV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Mycoplasma genitalium, and high-risk human papillomavirus was performed using APTIMA assays.

Results
The TV baseline prevalence was 9.2% (95% confidence interval [95% CI], 6.3–12.7%) and 2-year cumulative TV incidence was 8.1 per 1000 person months (6.9–9.3). Risk factors for higher TV prevalence at baseline were CT infection (adjusted prevalence ratio [PR], 8.53; 95% CI, 3.35–21.71), human immunodeficiency virus seropositivity (PR, 3.01; 95% CI, 1.45, 6.24) and greater than 4 years of sex work (PR, 2.66; 95% CI, 1.07–6.60). Risk factors for elevated 2-year TV incidence were CT (hazard ratio [HR], 4.28; 95% CI, 1.36–13.50), high-risk human papillomavirus infection (HR, 1.91; 95% CI, 1.06–3.45) and history of smoking (HR, 2.66; 95% CI, 1.24–5.73).

Discussion
CT infection was positively associated with both prevalent and 2-year incident TV infections.
Central Macular Thickness in Diabetic Patients: A Sex-based Analysis
Authors: Arthur Edmund , Young Stuart B. , Elsner Ann E. , Baskaran Karthikeyan , Papay Joel A. , Muller Matthew S. , Gast Thomas J. , Haggerty Bryan P. , Clark Christopher A. , Malinovsky Victor E. , Brahm Shane G. , Litvin Taras V. , Ozawa Glen Y. , Cuadros Jorge A. 
Published: March 2019

SIGNIFICANCE
The pathological changes in clinically significant diabetic macular edema lead to greater retinal thickening in men than in women. Therefore, male sex should be considered a potential risk factor for identifying individuals with the most severe pathological changes. Understanding this excessive retinal thickening in men may help preserve vision.

PURPOSE
The purpose of this study was to investigate the sex differences in retinal thickness in diabetic patients. We tested whether men with clinically significant macular edema had even greater central macular thickness than expected from sex differences without significant pathological changes. This study also aimed to determine which retinal layers contribute to abnormal retinal thickness.

METHODS
From 2047 underserved adult diabetic patients from Alameda County, CA, 142 patients with clinically significant macular edema were identified by EyePACS-certified graders using color fundus images (Canon CR6-45NM). First, central macular thickness from spectral domain optical coherence tomography (iVue; Optovue Inc.) was compared in 21 men versus 21 women without clinically significant macular edema. Then, a planned comparison contrasted the greater values of central macular thickness in men versus women with clinically significant macular edema as compared with those without. Mean retinal thickness and variability of central macular layers were compared in men versus women.

RESULTS
Men without clinically significant macular edema had a 12-μm greater central macular thickness than did women (245 ± 21.3 and 233 ± 13.4 μm, respectively; t
40 = −2.18, P = .04). Men with clinically significant macular edema had a 67-μm greater central macular thickness than did women (383 ± 48.7 and 316 ± 60.4 μm, P < .001); that is, men had 55 μm or more than five times more (t
20 = 2.35, P = .02). In men, the outer-nuclear-layer thickness was more variable, F
10,10 = 9.34.

CONCLUSIONS
Underserved diabetic men had thicker retinas than did women, exacerbated by clinically significant macular edema.
Varied Clinical Presentations of Acute Dystonic Reaction Due to Metoclopramide
Authors: EL Çiğdem , Çelikkaya Mehmet Emin 
Published: March 2019

Objectives
In this article, in light of the literature, we aimed at discussing data obtained from patients in which extrapyramidal adverse effects that are misdiagnosed as varied clinical presentations developed due to metoclopramide, which is frequently prescribed in pediatric emergency services and in family practice centers for its powerful and rapid antiemetic action.

Methods
The files of patients who presented to a pediatric clinic at the research hospital of Mustafa Kemal University between January 2017 and January 2018 and who were diagnosed as having acute dystonic reaction were reviewed retrospectively.

Results
Generalized hypertonicity in 4 patients, abnormal involuntary movements in 2 patients, oculogyric crisis in 2 patients, local hypertonia in the wrist and fingers in 2 patients, spasmodic cervical hypertonicity in 2 patients, and trismus in 1 patient were found. Of the patients, 2 were directed to our clinic with early diagnosis of hypocalcemia, 2 with conversion, 3 with meningitis, 1 with epileptic seizure, 1 with status, 1 with mandibular luxation, 1 with tetanus, and 2 with intracranial pathology.

Conclusions
The extrapyramidal adverse effects of metoclopramide, which is frequently prescribed in pediatric emergency services and in family practice centers, are highly terrifying for children and parents. Furthermore, it may cause severe anxiety especially in pediatric emergency services because it may mimic many serious diseases.
Long-Term Serial Measurement of Muscle Volume in TRAM Flaps Using the Eclipse Treatment Planning System
Authors: Han Woo Yeon , Lee Sumin , Kim Eun Key , Lee Taik Jong 
Published: March 2019

Background:
Muscle flaps used in reconstructive surgery are known to lose volume over time because of denervation and disuse atrophy. However, there is currently no agreement on a quantitative approach to evaluating volume changes. Here, long-term serial measurement of muscle volume in transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction has been conducted using the Eclipse treatment planning system.

Methods:
This was a retrospective review of the medical records of patients who underwent unilateral immediate breast reconstruction using a pedicled TRAM flap between January of 2004 and December of 2007. Patients who completed three serial follow-up computed tomographic scans and did not have history of recurrence and/or radiation therapy were included. Eclipse software was used for segmentation and three-dimensional reconstruction of the computed tomographic images; the volume of the pedicled rectus abdominis muscle was calculated, and the contralateral side served as the control.

Results:
Among 451 patients undergoing TRAM flap surgery during the study period, 35 met the inclusion requirements. Serial measurement of rectus abdominis muscle volume of the flap showed a mean volume ratio of 27.1 percent, 22.1 percent, and 19.8 percent at 15, 30, and 51 months, respectively. The extrapolated volume ratio finally converged at 19.4 percent. Contralateral muscle volume did not change significantly over time.

Conclusions:
The muscle of a TRAM flap loses more than 70 percent of its volume in the first 15 months, ultimately reducing to approximately 20 percent of its original size. Eclipse can be used retrospectively for volume measurement after a variety of reconstructive procedures using computed tomographic or magnetic resonance images.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Twenty-Five Years of Experience with the Submental Flap in Facial Reconstruction: Evolution and Technical Refinements following 311 Cases in Europe and Africa
Authors: Bertrand Baptiste , Honeyman Calum Sinclair , Emparanza Angel , McGurk Mark , Ousmane Hamady Issa Elh , Schmidt Andreas , Sinna Raphael , Pittet-Cuénod Brigitte , Zwetyenga Narcisse , Martin Dominique 
Published: March 2019

Background:
The submental flap is a pedicled island flap with excellent color match for facial reconstruction. The flap can be raised with muscle, submandibular gland, or bone and can be transposed to reach defects up to two-thirds of the face. The authors report the primary author’s (D.M.) experience of 25 years using the submental flap from its original description to most recent technical evolutions in both Europe and Africa.

Methods:
This is a retrospective study including all patients with facial defects who underwent reconstruction using a submental flap between 1991 and 2016. This study included the use of all four variations of the submental flap: platysmal, digastric, extended, and superextended. The authors report technical adaptations and complications encountered.

Results:
The authors performed 311 facial reconstructions using submental flaps: 32 platysmal, 133 digastric, 91 extended, and 45 superextended variations. In conjunction with these reconstructions, the authors performed 10 osteocutaneous submental flaps and two free flaps. The authors report two cases of total flap necrosis (0.6 percent) and 28 minor complications, including 23 cases of distal skin necrosis (7 percent), one reversible mandibular facial nerve palsy (0.3 percent), and three hematomas (1 percent).

Conclusions:
The submental flap has proven to be a reliable flap for head and neck reconstruction. The four technical modifications described use varying amounts of soft tissue to replace tissue lost and can include vascularized bone from the mandibular margin. This flap exemplifies Gillies’ principle of “replacing like with like” and should be discussed as an alternative to free tissue transfer in facial reconstruction, especially in settings where resources are limited.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Sonographic Diagnosis of Velamentous and Marginal Placental Cord Insertion
Authors: Kelley Brendan P. , Klochko Chad L. , Atkinson Sarah , Hillman Daniel , Craig Brian M. , Sandberg Sharon A. , Gaba Arthur R. , Halabi Safwan S. 
Published: March 2019

Abstract
Routine second trimester ultrasound (US) examinations include an assessment of the umbilical cord given its vital role as a vascular conduit between the maternal placenta and fetus during fetal development. Placental cord insertion abnormalities can be identified during prenatal US screening and are increasingly recognized as independent risk factors for various complications during pregnancy and delivery. The purpose of this pictorial review is to illustrate examples of velamentous and marginal placental cord insertion with an emphasis on how to differentiate their morphology using color Doppler US.
Selenoprotein P in Myocardial Infarction With Cardiogenic Shock
Authors: Büttner Petra , Obradovic Danilo , Wunderlich Sebastian , Feistritzer Hans-Josef , Holzwirth Erik , Lauten Philipp , Fuernau Georg , de Waha-Thiele Suzanne , Desch Steffen , Thiele Holger 
Published: March 2019

ABSTRACT

Background:
Reperfusion strategies in acute myocardial infarction (AMI) may result in ischemia reperfusion injury characterized by increased oxidative stress, inflammation, and ultimately death of myocardial tissue which may be of particular importance in infarct-related cardiogenic shock (CS). Many anti-oxidative and immune regulatory processes depend on selenium which in large proportions is bound to circulating selenoprotein P (SelP). Individual SelP patterns may therefore be associated with inflammatory response and possibly mortality in patients with CS post AMI.

Methods:
In the randomized Intra-Aortic Balloon Pump in cardiogenic Shock II (IABP-SHOCK II)-trial, 600 patients with CS complicating AMI were assigned to therapy with or without IABP. In a predefined biomarker substudy of 147 patients, we analyzed SelP levels 1 and 3 days following randomization. Samples were compared with healthy controls and associations with the unspecific inflammatory marker C-reactive protein (CRP) were analyzed.

Results:
Compared with controls SelP levels in patients with infarct-related CS were markedly higher (2.7-fold at day 1 and 5.7-fold at day 3 following AMI, all P < 0.001). Thirty-day mortality was significantly higher in patients with SelP levels above the 75th percentile at day 3 following AMI (26% vs. 46%, P = 0.045). SelP was significantly proportionally correlated with CRP 1 (R2 = 0.762, P < 0.0001) and 3 days (R2 = 0.777 P < 0.0001) following AMI.

Conclusion:
SelP levels are significantly increased post AMI with CS. Higher SelP levels are associated with increased CRP levels indicative for inflammatory processes. Future studies should focus on the characterization of SelP profiles following AMI and the identification of pathomechanisms affected by SelP.