bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intramedullary Tibial Nail Fixation of Simple Intraarticular Distal Tibia Fractures
Authors: Scolaro John A. , Broghammer Francis H. , Donegan Derek J. 
Published: October 2016

Summary:
The optimal treatment strategy for distal tibia fractures, especially those with intraarticular extension, remains controversial. Although open reduction and internal fixation with a plate and screw device is commonly performed for these injuries, the risk of soft tissue complications using this approach is significant. Staged treatment protocols and alternative means of fixation have been proposed to address these undesired events. Although potentially more technically demanding than fixation of diaphyseal or extraarticular tibial fractures, intramedullary nail (IMN) fixation of simple intraarticular distal tibia fractures is a viable treatment alternative with unique advantages. This article presents a review of the literature and rationale for intramedullary tibial nail fixation of simple intraarticular distal tibia fractures and a surgical approach commonly utilized for successful implementation.
Intramedullary Nail and Plate Combination Fixation for Complex Distal Tibia Fractures: When and How?
Authors: Yoon Richard S. , Liporace Frank A. 
Published: October 2016

Summary:
Intramedullary nail and plate combination techniques have been described mostly for use in the proximal tibia. However, the nail and plate combination technique can also be used in the distal tibia, to counteract the deforming forces that cause construct failure and nonunion. In this article, we review pertinent anatomy and biomechanics and offer case examples that highlight the indications and applications of the nail and plate combination technique for distal tibia fractures.
Perceived Nonbeneficial Treatment of Patients, Burnout, and Intention to Leave the Job Among ICU Nurses and Junior and Senior Physicians
Authors: Schwarzkopf Daniel , Rüddel Hendrik , Thomas-Rüddel Daniel O. , Felfe Jörg , Poidinger Bernhard , Matthäus-Krämer Claudia T. , Hartog Christiane S. , Bloos Frank 
Published: October 2016

Objectives:
Perceiving nonbeneficial treatment is stressful for ICU staff and may be associated with burnout. We aimed to investigate predictors and consequences of perceived nonbeneficial treatment and to compare nurses and junior and senior physicians.

Design:
Cross-sectional, multicenter paper-pencil survey on personal and work-related characteristics, perceived nonbeneficial treatment, burnout, and intention to leave the job.

Setting:
Convenience sample of 23 German ICUs.

Subjects:
ICU nurses and physicians.

Interventions:
None.

Measurements and Main Results:
A total of 847 questionnaires were returned (51% response); 778 had complete data for final multivariate analyses. Nonbeneficial treatment was in median perceived “sometimes.” Adjusted for covariates, it was perceived more often by nurses and junior physicians (both p ≤ 0.001 in comparison to senior physicians), while emotional exhaustion was highest in junior physicians (p ≤ 0.015 in comparison to senior physicians and nurses), who also had a higher intention to leave than nurses (p = 0.024). Nonbeneficial treatment was predicted by high workload and low quality collaboration with other departments (both p ≤ 0.001). Poor nurse-physician collaboration predicted perception of nonbeneficial treatment among junior physicians and nurses (both p ≤ 0.001) but not among senior physicians (p = 0.753). Nonbeneficial treatment was independently associated with the core burnout dimension emotional exhaustion (p ≤ 0.001), which significantly mediated the effect between nonbeneficial treatment and intention to leave (indirect effect: 0.11 [95% CI, 0.06–0.18]).

Conclusions:
Perceiving nonbeneficial treatment is related to burnout and may increase intention to leave. Efforts to reduce perception of nonbeneficial treatment should improve the work environment and should be tailored to the different experiences of nurses and junior and senior physicians.
Paternal and Maternal Testosterone in Parents of NICU Infants Transitioning Home
Authors: Garfield Craig F. , Simon Clarissa D. , Rutsohn Joshua , Lee Young S. 
Published: October 2016

Lower testosterone during the transition to new parenthood is considered beneficial to help parents better engage with their infants. No data currently exist studying salivary testosterone of parents with infants in neonatal intensive care units (NICUs) during the transition to home. We examine testosterone levels for parents of very low-birth-weight infants, including links between salivary testosterone and infant factors (such as breast-feeding), psychosocial stress, and changes over time.
Testosterone salivary samples were assayed after self-collection by 86 parents (43 fathers and 43 mothers) with NICU infants at wakeup and bedtime prior to discharge and at 3 additional times at home. Self-reported survey measures, including psychosocial reports, were also collected at these times.
Using multilevel modeling approaches, we report significant associations between paternal testosterone by time and psychosocial adjustment and between both paternal and maternal testosterone and infant feeding mode (P < .05). Results were significant after accounting for covariates. Our study is the first to examine the time course of diurnal testosterone for parents of premature infants over the transition home; as such, we suggest further research into better understanding parental physiology in this vulnerable parent population.
Cost Analysis of Cerebrospinal Fluid Leaks and Cerebrospinal Fluid Leak Prevention in Patients Undergoing Cerebellopontine Angle Surgery
Authors: Chern Alexander , Hunter Jacob B. , Bennett Marc L. 
Published: October 2016

Objective:
To determine if cranioplasty techniques following translabyrinthine approaches to the cerebellopontine angle are cost-effective.

Study Design:
Retrospective case series.

Patients:
One hundred eighty patients with available financial data who underwent translabyrinthine approaches at a single academic referral center between 2005 and 2015.

Intervention:
Cranioplasty with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws Main Outcome Measures: billing data was obtained for each patient's hospital course for translabyrinthine approaches and postoperative cerebrospinal fluid (CSF) leaks.

Results:
One hundred nineteen patients underwent translabyrinthine approaches with an abdominal fat graft closure, with a median cost of $25759.89 (range, $15885.65–$136433.07). Sixty-one patients underwent translabyrinthine approaches with a dural substitute, abdominal fat graft, and a resorbable mesh for closure, with a median cost of $29314.97 (range, $17674.28–$111404.55). The median cost of a CSF leak was $50401.25 (range, $0–$384761.71). The additional cost of a CSF leak when shared by all patients who underwent translabyrinthine approaches is $6048.15. The addition of a dural substitute and a resorbable mesh plate after translabyrinthine approaches reduced the CSF leak from 12 to 1.9%, an 84.2% reduction, and a median savings per patient of $2932.23. Applying our cohort's billing data to previously published cranioplasty techniques, costs, and leak rate improvements after translabyrinthine approaches, all techniques were found to be cost-effective.

Conclusion:
Resorbable mesh cranioplasty is cost-effective at reducing CSF leaks after translabyrinthine approaches. Per our billing data and achieving the same CSF leak rate, cranioplasty costs exceeding $5090.53 are not cost-effective.
Gastroparesis
Authors: Lacy Brian E. , Crowell Michael D. , Mathis Carole , Bauer David , Heinberg Leslie J. 
Published: October 2016

Background and Aims:
Gastroparesis (GP) patients suffer from recurrent symptoms of nausea, vomiting, early satiety, and abdominal pain. The impact of GP on quality of life (QoL), health care utilization and daily activities is not well understood.

Materials and Methods:
Part 1: 398 adult patients (≥18 y) with documented GP (symptoms >6 mo) were surveyed to assess QoL and pain using the Short Form 36 and McGill pain questionnaires. Part 2: 491 adult GP patients were surveyed to evaluate employment status, work and daily activities, medication use, physician visits, diagnostic testing, emergency room visits, and hospitalizations related to their GP symptoms. Both protocols received Institutional Review Board approval.

Results:
Part 1: 250 fully evaluable surveys were returned (63%). The mean age was 46.8 years (range, 18 to 84 y); 78% were women. Mean Short Form 36 scores for mental health (56.9) and social functioning (68.1) were analogous to scores for patients with serious chronic medical disorders and depression. Pain scores were lower in patients with idiopathic GP compared with diabetic GP. Part 2: 228 evaluable surveys were analyzed (58.3% response rate). The mean age was 49.6 (19 to 86 y); 77.2% were women. GP symptoms reduced daily activities in 67.5% and lowered annual income in 28.5%. In total, 11% were disabled due to GP symptoms.

Conclusions:
GP reduces patients’ QoL and places a significant financial burden on the health care system. Treatment strategies for GP patients should be broad based and incorporate pain management, psychological evaluation and management, and strategies to improve overall well-being with a return to work and daily activities.
Predicting Efficacy of Plastic Stents for Posttransplantation Biliary Strictures
Authors: Santo Erwin , Itshak Anna , Mlynarsky Liat , Leshno Moshe , Gluck Nathan 
Published: October 2016

Background:
Biliary strictures (BS) are a common complication of liver transplantation. The standard treatment is sequential insertion of increasing numbers of plastic stents by endoscopic retrograde cholangiopancreatography (ERCP). Despite high success rates, some strictures fail to resolve and require surgery as definitive treatment.

Goals:
To identify predictors of response or failure of standard endoscopic treatment, allowing earlier referral to alternative modalities when needed and avoiding unnecessary procedures.

Study:
Database of Gastroenterology Department at Tel Aviv Medical Center was retrospectively reviewed, and data regarding patients who underwent liver transplantation and developed BS were analyzed.

Results:
Thirty-one patients met the study criteria. Twenty-four (77.4%) resolved with plastic stenting and 7 ultimately required surgery. There were no significant differences between stent responders and nonresponders regarding demographics, transplant and postoperative hospitalization data, time from transplantation to presentation with stricture, total number of ERCP sessions, or maximal number of stents.
A trend toward difference was noted in the time elapsed between the first and the second ERCP, whereby ERCP nonresponders required a second procedure sooner than responders. Patients presenting to their second procedure as scheduled ultimately had a 95% endoscopic success rate, whereas those presenting urgently with acute cholangitis had a 55% failure rate (P=0.02).

Conclusions:
Urgent repeat ERCP is a harbinger of ultimate failure of plastic stent treatment for BS after liver transplant. This finding may assist earlier triage of these patients toward alternative treatment such as metal stents or surgery, thus sparing needless procedures and complications.
A 13-year time trend analysis of 3724 small bowel video capsule endoscopies and a forecast model during the financial crisis in Greece
Authors: Triantafyllou Konstantinos , Gkolfakis Paraskevas , Viazis Nikos , Tsibouris Panagiotis , Tsigaridas Athanasios , Apostolopoulos Periklis , Anastasiou John , Hounda Eleni , Skianis Ioannis , Katopodi Konstantina , Ndini Xhoela , Alexandrakis George , Karamanolis Demetrios G. 
Published: October 2016

Introduction
Since its introduction, small bowel video capsule endoscopy (VCE) use has evolved considerably.

Aim
Evaluation of the temporal changes of small bowel VCE utilization in three tertiary centers in Greece in Era 1 (2002–2009) and Era 2 (2010–2014) and the development a forecast model for future VCE use during 2015–2017.

Materials and methods
Data from all small bowel VCE examinations were retrieved and analyzed in terms of the annual number of the performed examinations, their indications and the significance of their findings.

Results
Overall, we evaluated 3724 VCE examinations. The number of studies peaked in 2009 (n=595) and then decreased to reach 225 in 2014. Overall, more (53.8 vs. 51.4%) patients with iron-deficiency anemia and obscure gastrointestinal bleeding (IDA/OGIB) and fewer (10.7 vs. 14%) patients with chronic diarrhea were evaluated in Era 2 compared with Era 1 (P=0.046). In Era 2, there were more nondiagnostic examinations (39.5 vs. 29.3%, P<0.001), whereas the rate of cases with relevant findings decreased from 47.8 to 40.9%. According to the time trend analysis, we developed a forecast model with two scenarios: the pessimistic and the optimistic. Validation of the model with 2015 data showed that reality was close to the pessimistic scenario: the number of exams further decreased to 190, studies carried out for IDA/OGIB increased to 67%, and there were more negative than positive exams (40.7 vs. 39.2%).

Conclusion
The number of VCE studies carried out after the emergence of the financial crisis decreased significantly and VCE indications were optimized. Our forecast model predicts lower numbers of VCE studies, with IDA/OGIB being the dominant indication. However, the predicted increase of negative exams requires further evaluation.
Effect of Decentration on the Optical Quality of Two Intraocular Lenses
Authors: Ortiz Carolina , Esteve-Taboada José J. , Belda-Salmerón Lurdes , Monsálvez-Romín Daniel , Domínguez-Vicent Alberto 
Published: October 2016

ABSTRACT

Purpose
To analyze the effect of decentration on the optical quality of two diffractive-refractive intraocular lenses, a bifocal and a trifocal, when displaced laterally (horizontal direction) from the center.

Methods
The AT LISA 809M IOL (+3.75 D add) with two main foci and the AT LISA tri 839MP intraocular lens with three main foci (Carl Zeiss Meditec AG, Jena, Germany) were analyzed. The optical quality of the intraocular lenses was measured with the PMTF (power and modulation transfer function [MTF] measurement for refractive and diffractive intraocular lenses) optical bench (Lambda-X, Nivelles, Belgium). The optical quality of the lenses was evaluated by the MTF at different object vergences, the average modulation in the range of frequencies from 0 to 100 cycles/mm, and the through-focus MTF curves. All measures were recorded when the intraocular lenses were centered and decentered for 3.0- and 4.5-mm apertures. The Strehl ratio and the percentage of energy allocated at each focus at the centered position were also obtained.

Results
Our results showed a lower optical quality with increasing decentration. The MTFs for the diffractive-refractive intraocular lenses decreased when the intraocular lenses were decentered. Also, the relative percentages of light energy allocated at each object vergence, for both intraocular lenses, agreed well with theoretical specifications and were consistent with the overall design of each lens.

Conclusions
The optical quality of these diffractive-refractive multifocal intraocular lenses was slightly reduced when the induced decentration was less than 0.4 mm. For a decentration of 0.4 mm, the maximum difference in average modulation values was about 18% compared to the centered position.
Patterns of Postoperative Delirium in Children*
Authors: Meyburg Jochen , Dill Mona-Lisa , Traube Chani , Silver Gabrielle , von Haken Rebecca 
Published: October 2016

Objective:
Intensive care delirium is a substantial problem in adults. Intensive care delirium is increasingly recognized in pediatrics in parallel with the development of specific scoring systems for children. However, little is known about the fluctuating course of intensive care delirium in children after surgery and possible implications on diagnostic and therapeutic strategies.

Design:
Patients that needed treatment in the PICU following elective surgery were screened for intensive care delirium with the Cornell Assessment of Pediatric Delirium. When the patients were awake (Richmond Agitation and Sedation Score > -3), two trained investigators conducted the Cornell Assessment of Pediatric Delirium twice daily for five consecutive days.

Patients:
Ninety-three patients aged 0 to 17 years.

Interventions:
Eight hundred forty-five assessments completed.

Measurements and Main Results:
Of the 845 scores, 230 were consistent with delirium (27.2%). Sixty-one patients (65.5%) were diagnosed with intensive care delirium. Half of these patients (n = 30; 32.2%) had a short-lasting delirium that resolved within 24 hours, and half (n = 31; 33.3%) had delirium of longer duration. Delirium could be clearly distinguished from sedation by analysis of individual test items of the Cornell Assessment of Pediatric Delirium. Time spent delirious had a measurable effect on outcome variables, including hospital length of stay.

Conclusion:
Most postoperative PICU patients develop intensive care delirium. Some have a short-lasting course, which underlines the need for early screening. Our findings support the view of delirium as a continuum of acute neurocognitive disorder. Further research is needed to investigate prophylactic and treatment approaches for intensive care delirium.
Empirical Bayes estimation of semi-parametric hierarchical mixture models for unbiased characterization of polygenic disease architectures
Authors: Nishino Jo , Kochi Yuta , Shigemizu Daichi , Kato Mamoru , Ikari Katsunori , Ochi Hidenori , Noma Hisashi , Matsui Kota , Morizono Takashi , Boroevich Keith A , Tsunoda Tatsuhiko , Matsui Shigeyuki 
Published: October 2016

AbstractGenome-wide association studies (GWAS) suggest that the genetic architecture of complex diseases consists of unexpectedly numerous variants with small effect sizes. However, the polygenic architectures of many diseases have not been well characterized due to lack of simple and fast methods for unbiased estimation of the underlying proportion of disease-associated variants and their effect-size distribution. Applying empirical Bayes estimation of semi-parametric hierarchical mixture models to GWAS summary statistics, we confirmed that schizophrenia was extremely polygenic (∼ 40% risk variants of independent genome-wide SNPs, most within odds ratio (OR)=1.03), whereas rheumatoid arthritis was less polygenic (∼ 4 to 8% risk variants, significant portion reaching OR=1.05 to 1.1). For rheumatoid arthritis, stratified estimations revealed that expression quantitative loci in blood explained large genetic variance, and low- and high-frequency derived alleles were prone to be risk and protective, respectively, suggesting a predominance of deleterious-risk and advantageous-protective mutation. Despite genetic correlation, effect-size distributions for schizophrenia and bipolar disorder differed across allele frequency. These analyses distinguished disease polygenic architectures and provided clues for etiological differences in complex diseases.
Bees Without Flowers: Before Peak Bloom, Diverse Native Bees Visit Insect-produced Honeydew Sugars
Authors: Meiners Joan M. , Griswold Terry L. , Harris David J. , Ernest S.K. Morgan 
Published: October 2016

AbstractBee foragers respond to complex visual, olfactory, and extrasensory cues to optimize searches for floral rewards. Their abilities to detect and distinguish floral colors, shapes, volatiles, and ultraviolet signals, and even gauge nectar availability from changes in floral humidity or electric fields are well studied. Bee foraging behaviors in the absence of floral cues, however, are rarely considered. We observed forty-four species of wild bees visiting inconspicuous, non-flowering shrubs during early spring in a protected, Mediterranean habitat. We determined experimentally that these bees were accessing sugary honeydew secretions from scale insects without the aid of standard cues. While honeydew use is known among some social Hymenoptera, its use across a diverse community of mostly solitary bees is a novel observation. The widespread ability of native bees to locate and use unadvertised, non-floral sugars suggests unappreciated sensory mechanisms and/or the existence of a social foraging network among solitary bees that may influence how native bee communities cope with increasing environmental change.
Selection Corrected Statistical Inference for Region Detection with High-throughput Assays
Authors: Benjamini Yuval , Taylor Jonathan , Irizarry Rafael A. 
Published: October 2016

AbstractScientists use high-dimensional measurement assays to detect and prioritize regions of strong signal in a spatially organized domain. Examples include finding methylation enriched genomic regions using microarrays and identifying active cortical areas using brain-imaging. The most common procedure for detecting potential regions is to group together neighboring sites where the signal passed a threshold. However, one needs to account for the selection bias induced by this opportunistic procedure to avoid diminishing effects when generalizing to a population. In this paper, we present a model and a method that permit population inference for these detected regions. In particular, we provide non-asymptotic point and confidence interval estimates for mean effect in the region, which account for the local selection bias and the non-stationary covariance that is typical of these data. Such summaries allow researchers to better compare regions of different sizes and different correlation structures. Inference is provided within a conditional one-parameter exponential family for each region, with truncations that match the constraints of selection. A secondary screening-and-adjustment step allows pruning the set of detected regions, while controlling the false-coverage rate for the set of regions that are reported. We illustrate the benefits of the method by applying it to detected genomic regions with differing DNA-methylation rates across tissue types. Our method is shown to provide superior power compared to non-parametric approaches.
Shorter neural adaptation to sounds accounts for dyslexics’ abnormal perceptual and reading dynamics
Authors: Jaffe-Dax Sagi , Frenkel Orr , Ahissar Merav 
Published: October 2016

AbstractDyslexia is a prevalent reading disability whose underlying mechanisms are still disputed. We studied the neural mechanisms underlying dyslexia using a simple frequency-discrimination task. Though participants were asked to compare the 2-tones in each trial, implicit memory of previous trials affected their responses. We hypothesized that implicit memory decays faster among dyslexics. We tested this by increasing the temporal intervals between consecutive trials, and measuring the behavioral impact and ERP responses from the auditory cortex. Dyslexics showed a faster decay of implicit memory effects on both measures, with similar time constants. Finally, faster decay also characterized dyslexics’ benefits in oral reading rate. It decreased faster as a function of the time interval from the previous reading of the same non-word. We propose that dyslexics’ shorter neural adaptation paradoxically accounts for their longer reading times, since it induces noisier and less reliable predictions for both simple and complex stimuli.