bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of increased inclusion of dried distillers grain supplement on adaptation, intake, digestibility, and rumen parameters in steers consuming bermudagrass round bale silage
Authors: Alava Erin N , Alava Eduardo I , Welchons Cody A , Yelich Joel V , Hersom Matthew J 
Published: March 2019

Abstract
Eight ruminally cannulated beef steers were used to evaluate forage intake and physiological response during adaptation to a diet consisting of bermudagrass round bale silage (RBS) and dried distillers grains (DDG) and in a second experiment the effect of level of DDG supplementation on RBS forage intake, digestibility, and rumen parameters. The adaptation experiment was designed to simulate a 14-d step-up process. Initially steers received ad libitum RBS, on d 4 steers were offered 1.13 kg of DDG daily and every 4 d daily DDG offered was increased by 1.13 kg. Blood and rumen fluid samples were collected before feeding (0 h) and 6, 12, 24 (before feeding), and 36 h after every diet change. The digestibility experiment was conducted as an 8 × 4 Latin square with four periods. Treatments included RBS only and DDG supplement levels of 0.33%, 0.66%, and 1.0% of body weight (RBS + 0.33, +0.66, and 1.0, respectively). Collection periods consisted of 21 d to determine dry matter intake [DMI], digestibility, and collect rumen fluid samples. During adaptation, level of DDG did not (P = 0.42) affect RBS DMI. Mean ruminal pH was greater (P &lt; 0.05) for RBS only compared with diets with DDG. When steers were offered 3.39 or 4.52 kg/d of DDG rumen NH3-N concentration was greater (P ≤ 0.05) compared with other levels of DDG or RBS alone. Mean nonesterified fatty acid and plasma urea N concentrations varied among levels of DDG offered. In the digestibility experiment forage DMI, total DMI, and total tract apparent digestibility exhibited a quadratic (P ≤ 0.05) response to level of DDG offered. Mean ruminal pH responded in a quadratic manner (P = 0.03) and was greater for RBS only compared with RBS plus DDG at any level. Mean ruminal NH3-N concentration tended (P = 0.07) to respond in a cubic manner as DDG amount offered increased. Physiological responses during adaptation to DDG over 14 d resembled responses previously observed after long-term DDG supplementation. Offering DDG up to 1% of body weight did depress forage DMI and ruminal pH but increased total DMI, diet digestibility, and ruminal NH3-N concentration.
Embryo and cow factors affecting pregnancy per embryo transfer for multiple-service, lactating Holstein recipients
Authors: Estrada-Cortés Eliab , Ortiz William G , Chebel Ricardo C , Jannaman Elizabeth A , Moss James I , de Castro Fernanda Cavallari , Zolini Adriana M , Staples Charles R , Hansen Peter J 
Published: March 2019

Abstract
The objective was to determine whether pregnancy success after embryo transfer (ET) during heat stress in multi-service Holstein cows depends upon characteristics of the embryo or recipient. Female embryos produced in vitro were cultured with either 0.0 (control) or 1.8 mM choline chloride and transferred fresh. Fresh embryos of undetermined breed and frozen Holstein embryos were used when experimental embryos were insufficient. Embryos were transferred 8 d after the last GnRH injection of an ovulation synchronization program. Embryo type [frozen vs. fresh, choline vs. control, unknown breed vs. (control + choline)] and characteristics of recipients (average of 190 d in milk at transfer) were evaluated. Pregnancy per ET was lower for cows receiving frozen embryos (7.0%; 3/43) than for cows receiving fresh embryos (26.7%; 32/120) but there were no differences between various types of fresh embryo. Pregnancy per ET was lower for cows diagnosed with metritis in the early postpartum period (7.1%; 2/28) than for cows without metritis (24.4%; 33/135). In conclusion, the use of frozen/thawed embryos produced in vitro and recipients which had metritis in the early postpartum period reduced the success of ET in multiple-service Holstein cows.
Urinary Tract Infection After Hysterectomy for Benign Gynecologic Conditions or Pelvic Reconstructive Surgery
Authors: El-Nashar Sherif A. , Singh Ruchira , Schmitt Jennifer J. , Leon Daniel Carranza , Arora Chetna , Gebhart John B. , Occhino John A. 
Published: March 2019

(Abstracted from Obstet Gynecol 2018;132:1347–1357)
About half of all women will experience at least 1 urinary tract infection (UTI) in their lifetimes, and the infection will recur in more than 10% of postmenopausal women. Pelvic surgery increases risk of UTI.
Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial Analgesia: A Randomized Clinical Trial
Authors: Cahill Alison G. , Srinivas Sindhu K. , Tita Alan T. N. , Caughey Aaron B. , Richter Holly E. , Gregory W. Thomas , Liu Jingxia , Woolfolk Candice , Weinstein David L. , Mathur Amit M. , Macones George A. , Tuuli Methodius G. 
Published: March 2019

(Abstracted from JAMA 2018;320(14):1444–1454)
Despite the frequency of childbirth, many aspects of labor management lack an evidence-based approach. The second stage of labor, defined as the interval from complete cervical dilation through delivery of the fetus, is the most physiologically demanding period of labor for both the mother and the fetus.
An Evaluation of Fetal Heart Rate Characteristics Associated With Neonatal Encephalopathy: A Case-Control Study
Authors: Frey H. A. , Liu X. , Lynch C. D. , Musindi W. , Samuels P. , Rood K. M. , Thung S. F. , Bakk J. M. , Cheng W. , Landon M. B. 
Published: March 2019

(Abstracted from BJOG 2018;125:1480–1487)
Neonatal encephalopathy is a clinical condition identified shortly after birth in term or near-term infants that is characterized by abnormal neurological function. Affected infants often present with a decreased level of consciousness or seizures, as well as difficulty initiating and maintaining respirations and abnormal reflexes or tone.
Maternal Mortality After Cesarean Section in the Netherlands
Authors: Kallianidis Athanasios F. , Schutte Joke M. , van Roosmalen Jos , van den Akker Thomas 
Published: March 2019

(Abstracted from Eur J Obstet Gynecol Reprod Biol 2018;229:148–152)
Cesarean delivery rates have increased worldwide, despite several recommendations by the World Health Organization to curb this increase. A World Health Organization ecological study found that rates above 10% are not associated with improved maternal and perinatal outcomes.
Pregnancy Outcome of Autosomal Aneuploidies Other Than Common Trisomies Detected by Noninvasive Prenatal Testing in Routine Clinical Practice
Authors: Wan Junhui , Li Ru , Zhang Yongling , Jing Xiangyi , Yu Qiuxia , Li Fatao , Li Yan , Zhang Lina , Yi Cuixing , Li Jian , Li Dongzhi , Liao Can 
Published: March 2019

(Abstracted from Prenat Diagn 2018;38:849–857)
The discovery of cell-free fetal DNA in maternal plasma and the invention of massively parallel sequencing have made noninvasive prenatal testing (NIPT) for fetal common aneuploidies (trisomies 13, 18, and 21) a clinical reality. Noninvasive prenatal testing has been recommended as a first-tier or second-tier screening test for common fetal trisomies, with lower false-positive rates and higher positive predictive values than serum biochemical screening.
Evidence-Based Guidelines for Vaginal Hysterectomy of the International Society for Gynecologic Endoscopy (ISGE)
Authors: Chrysostomou Andreas , Djokovic Dusan , Edridge William , van Herendael Bruno J. 
Published: March 2019

(Abstracted from Eur J Obstet Gynecol Reprod Biol 2018;231:262–267)
Hysterectomy can be performed abdominally, vaginally, or laparoscopically, with or without robotic assistance. Abdominal hysterectomy (AH) for benign uterine conditions is the most commonly chosen route worldwide.
Neoadjuvant Chemotherapy Versus Debulking Surgery in Advanced Tubo-Ovarian Cancers: Pooled Analysis of Individual Patient Data From the EORTC 55971 and CHORUS Trials
Authors: Vergote Ignace , Coens Corneel , Nankivell Matthew , Kristensen Gunnar B. , Parmar Mahesh K. B. , Ehlen Tom , Jayson Gordon C. , Johnson Nick , Swart Ann Marie , Verheijen René , McCluggage W. Glenn , Perren Tim , Panici Pierluigi Benedetti , Kenter Gemma , Casado Antonio , Mendiola Cesar , Stuart Gavin , Reed Nick S. , Kehoe Sean 
Published: March 2019

(Abstracted from Lancet Oncol 2018;19:1680–1687)
Most women with carcinoma of the ovary, fallopian tube, or peritoneum (tubo-ovarian cancer) present with advanced disease and have a very poor prognosis. An essential therapeutic strategy in these women has been primary debulking surgery (PDS), but no randomized controlled trials have demonstrated an improved prognosis of patients with this strategy.
Using Electronic Health Record Data to Assess Residents’ Clinical Performance in the Workplace: The Good, the Bad, and the Unthinkable
Authors: Sebok-Syer Stefanie S. , Goldszmidt Mark , Watling Christopher J. , Chahine Saad , Venance Shannon L. , Lingard Lorelei 
Published: March 2019

Purpose
Novel approaches are required to meet assessment demands and cultivate authentic feedback in competency-based medical education. One potential source of data to help meet these demands is the electronic health record (EHR). However, the literature offers limited guidance regarding how EHR data could be used to support workplace teaching and learning. Furthermore, given its sheer volume and availability, there exists a risk of exploiting the educational potential of EHR data. This qualitative study examined how EHR data might be effectively integrated and used to support meaningful assessments of residents’ clinical performance.

Method
Following constructivist grounded theory, using both purposive and theoretical sampling, in 2016–2017 the authors conducted individual interviews with 11 clinical teaching faculty and 10 senior residents across 12 postgraduate specialties within the Schulich School of Medicine and Dentistry at Western University. Constant comparative inductive analysis was conducted.

Results
Analysis identified key issues related to affordances and challenges of using EHRs to assess resident performance. These include the nature of EHR data; the potential of using EHR data for assessment; and the dangers of using EHR data for assessment. Findings offer considerations for using EHR data to assess resident performance in appropriate and meaningful ways.

Conclusions
EHR data have potential to support formative assessment practices and guide feedback discussions with residents, but evaluators must take context into account. The EHR was not designed with the purpose of assessing resident performance; therefore, adoption and use of these data for educational purposes require careful thought, consideration, and care.
Envisioning a True Continuum of Competency-Based Medical Education, Training, and Practice
Authors: Cate Olle ten , Carraccio Carol 
Published: March 2019

The existing structure of physician education has developed in siloed stages, with consecutive degrees and certifications and progressively longer training programs. As further fragmentation of health care and training systems will not improve the quality of care and education, the authors argue that a new vision of education, training, and practice as a continuum is needed.
They advocate for a model of competency-based medical education that merges with competency-based medical practice. In this system, education and training will result in individual, dynamic portfolios of valid entrustable professional activities (EPAs) for which physicians are certified. Physicians can maintain and renew that entrustment as long as the EPAs remain within their scope of practice. Entrustment occurs initially during training but is then granted for new activities as physicians’ careers evolve.
This model accounts for the need to keep pace with changes in population health needs and expectations of competence over time. It de-emphasizes the divides between the stages of training and views the continuum from undergraduate medical education until retirement as a whole. Key obligations of self-regulating medical professionals include both the reception and the provision of supervision from and for others, respectively. Learning must be embedded in practice to address expectations regarding new knowledge and skills as they evolve with scientific and technological advances.
Entrusting physicians to deliver effective and safe care, based on their performance of the requisite EPAs without supervision, should ensure that they provide high-value, quality care to patients.
Attitudes and Habits of Highly Humanistic Surgeons: A Single-Institution, Mixed-Methods Study
Authors: Swendiman Robert A. , Marcaccio Christina L. , Han Jason , Hoffman Daniel I. , Weiner Timothy M. , Nance Michael L. , Chou Carol M. 
Published: March 2019

Purpose
Humanism in medicine is associated with increased patient satisfaction, trust of patients in their doctors, and better outcomes. The authors sought to identify attitudes, habits, and other factors that sustain humanism in academic surgical faculty, and compare these with attributes determined from a previous study of internal medicine faculty.

Method
A mixed-methods study design at University of Pennsylvania Health System was employed from 2016 to 2018 using a survey instrument and semistructured interviews. Surgical residents nominated faculty who exemplified humanism. In-depth interviews were then conducted with surgeons receiving the most nominations. The interviews were transcribed, and common themes were identified using the grounded theory method. These were compared with findings from a previous internal medicine study.

Results
Ten faculty described three strongly shared attitudes: humility, responsibility, and a desire to live up to a high standard of professional behavior. Five habits were found important to sustaining these attitudes and their practice: self-reflection, finding deep connections with patients, maintaining personal and professional relationships, “having fun” at work, and paying it forward to surgical trainees. Surgeons also cited the importance of past role models in developing humanistic attitudes and sustaining practice. Responses were compared with previously documented attitudes and habits of humanistic internal medicine faculty at the institution.

Conclusions
This study identified recurring attitudes and habits that characterize humanistic behaviors in a cohort of academic surgeons. Learning from these exemplary humanistic surgeons may inform the development of future educational programs for residents and faculty in sustaining humanism.
Eat, Sleep, Console Approach
Authors: Grisham Lisa M. , Stephen Meryl M. , Coykendall Mary R. , Kane Maureen F. , Maurer Jocelyn A. , Bader Mohammed Y. 
Published: March 2019

Background:
The opioid epidemic in the United States has resulted in an increased number of drug-exposed infants who are at risk for developing neonatal abstinence syndrome (NAS). Historically, these infants have been treated with the introduction and slow weaning of pharmaceuticals. Recently, a new model called Eat, Sleep, Console (ESC) has been developed that focuses on the comfort and care of these infants by maximizing nonpharmacologic methods, increasing family involvement in the treatment of their infant, and prn or “as needed” use of morphine.

Purpose:
The purpose of this evidenced-based practice brief was to summarize and critically review emerging research on the ESC method of managing NAS and develop a recommendation for implementing an ESC model.

Methods:
A literature review was conducted using PubMed, Cochrane, and Google Scholar with a focus on ESC programs developed for treating infants with NAS.

Finding/Results:
Several studies were found with successful development and implementation of the ESC model. Studies supported the use of ESC to decrease length of stay, exposure to pharmacologic agents, and overall cost of treatment.

Video Abstract Available at
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=32&autoPlay=true.
Excision of Physeal Bars of the Distal Femur, Proximal and Distal Tibia Followed to Maturity
Authors: Yuan Brandon J. , Stans Anthony A. , Larson Dirk R. , Peterson Hamlet A. 
Published: March 2019

Objective:
In the 50 years since a premature partial physeal arrest (a physeal bar) was first excised from an epiphysis there have been no large in-depth studies reporting the results in patients followed to skeletal maturity. This paper reports the results of physeal bar resection surgery in a group of patients followed to skeletal maturity, documenting the restored growth of the affected physis, the affected bone, and the final limb-length discrepancy.

Methods:
Forty-eight patients underwent physeal bar resection of the distal femur (21), proximal tibia (9), and distal tibia (18) by 1 surgeon (H.A.P.) from 1968 through 1996, and were followed prospectively to skeletal maturity with clinical and radiologic examinations. Factors such as sex, age at time of injury, etiology of the bar, physeal bar location and size, age at time of bar excision, interposition material, and additional surgical procedures were analyzed with respect to physis, bone, and limb growth following bar resection.

Results:
The mean growth for the entire bone following physeal bar excision was 7.6 cm for the distal femur, 4.7 cm for the proximal tibia, and 7.5 cm for the distal tibia, compared with growth in the contralateral control bone of 6.8 cm in the femur, 5.0 cm in the proximal tibia, and 7.8 cm in the distal tibia. The maximum bone growth following bar excision in a single patient was 21.3 cm for the distal femur, 10.3 cm for the proximal tibia, and 18.6 cm for the distal tibia. The mean limb-length discrepancy at maturity was −1.7 cm for the distal femur, −1.3 cm for the proximal tibia, and −1.1 cm for the distal tibia (all sites combined −1.4 cm). Fourteen patients (29%) had only the 1 bar excision with no other accompanying or subsequent surgery. Thirty-four patients (71%) had 1 to 4 accompanying or subsequent leg length or angular correcting procedures.

Conclusions:
Physeal bar excision to restore growth when applied to the appropriate patient is a useful, rewarding procedure, reducing the number of surgical limb length equalizing procedures. It is a demanding surgical procedure and requires diligent and careful follow-up until maturity. Additional limb length equalizing surgery is frequently needed.

Level of Evidence:
Case series, level IV.
Are Constant Pain, Night Pain, or Abnormal Neurological Examination Adequate Predictors of the Presence of a Significant Pathology Associated With Pediatric Back Pain?
Authors: Ramírez Norman , Olivella Gerardo , Valentín Pablo , Feneque José , Lugo Soniely , Iriarte Iván 
Published: March 2019

Introduction:
Previous studies have suggested that most cases of pediatric back pain do not have an identifiable cause. No reliable sign or indication differentiates between a benign or serious cause of the symptom. Constant pain, night pain, and abnormal neurological examination have been suggested as adequate predictors of an identifiable cause, when plain radiographs could not explain the symptoms. The purpose of this study is to determine the sensitivity, specificity, and likelihood ratios of constant pain, night pain, and abnormal neurological examination to predict the presence of an underlying positive finding as a cause of back pain.

Method:
From 2010 to 2016, all patients who presented with a chief complaint of back pain were included in the study. Magnetic Resonance Image was performed to all patients presenting with back pain without identifiable cause lasting >4 weeks. Patients who presented with spondylolysis were treated accordingly base on radiographic findings and were excluded as study protocol.

Results:
A total of 388 patients were evaluated during the study period. The mean age of the subjects was 14.5 years; 69.7% being female. An underlying pathologic condition was identified in 56 of 132 (42%) of patients with constant pain, 61 of 162 (38%) with night pain, and 8 of 9 (89%) with abnormal neurological examination. Probability to have an underlying pathology correlated directly with the amount of clinical markers.

Discussion:
An abnormal neurological examination was found as a strong predictor for an underlying pathologic condition. Further imaging of a pediatric patient with back pain without clear explanation for their symptoms on plain radiographs should not be limited to constant pain, or night pain because clinicians could be missing important diagnosis. Therefore, the clinician cannot be assured by absence of these clinical markers, that there is no underlying spinal pathology.

Level of Evidence:
Level III.
Developmental Patterns of the Greater Trochanter in Skeletally Immature Patients
Authors: Knapik Derrick M. , McCarthy Conor , Liu Raymond W. 
Published: March 2019

Background:
Trochanteric entry femoral nailing in immature patients is controversial. Although it has become increasingly accepted in pediatric patients aged 8 years and older, complications related to physeal violation have been reported. To date, the appropriate minimum age for safe antegrade nailing in skeletally immature patients remains to be unknown. The purpose of this investigation was to determine the degree of trochanteric bony and cartilage growth with increasing age to provide normative growth values.

Methods:
A total of 408 serial digitized radiographs of the left hip in 45 healthy children (n=26 female individuals, n=19 male individuals) between the ages of 6 and 14 were retrospectively reviewed by 2 independent authors. Radiographs were examined to measure the changing height of the bony greater trochanter with increasing age. Magnetic resonance imaging (MRI) scans of 55 (n=29 male individuals, n=26 female individuals) contemporary children between the ages of 6 and 14 were evaluated to measure bony greater trochanteric and the overlying cartilage cap height.

Results:
Intraclass correlation coefficient values for both radiographic and MRI measurements were excellent. Longitudinal radiographs demonstrated that the bony growth was largely complete by age 11 in male and female individuals. MRI measurements demonstrated that bony trochanteric and overlying cartilage cap height was maximal by age 7 in female individuals and age 8 in male individuals, while no significant difference in bony and cartilage height was appreciated with increasing age in male, female individuals or male+female individuals.

Conclusions:
Combined bony and cartilaginous trochanteric growth is largely complete by age 7 in female individuals and age 8 in male individuals, with increases in the height of the trochanter beyond this age likely coming from ossification of the cartilaginous portions. As such, antegrade intramedullary nailing for closed femoral shaft fractures is reasonable in male and female individuals aged 8 years and older.

Level of Evidence:
Level II—retrospective study.