bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time From Injury to Surgical Fixation of Diaphyseal Humerus Fractures Is Not Associated With an Increased Risk of Iatrogenic Radial Nerve Palsy
Authors: Shoji Kristin , Heng Marilyn , Harris Mitchel B. , Appleton Paul T. , Vrahas Mark S. , Weaver Michael J. 
Published: April 2017

Objectives:
To determine whether time from injury to fixation of diaphyseal humeral fractures and nonunions is associated with the risk of iatrogenic radial nerve palsy.

Design:
Retrospective review.

Setting:
Two Level 1 trauma centers.

Patients/Participants:
Between 2001 and 2015, 325 patients who had documented intact radial nerve function preoperatively were treated with fixation of a humerus fracture or humerus nonunion.

Intervention:
Open reduction and internal fixation.

Main Outcome Measurements:
Development of an iatrogenic radial nerve injury. Those with an injury were followed to either resolution of the nerve palsy or definitive treatment.

Results:
The risk of iatrogenic radial nerve palsy was 7.7% (25/325). Time to surgery was not significantly associated with iatrogenic radial nerve palsy. In a multiple variable analysis, when comparing patients treated within 4 weeks to those treated 4–8 weeks (P = 0.41), 8–12 weeks (P = 0.94), and over 12 weeks (0.20), there were no significant associations. Independent risk factors for iatrogenic radial nerve palsy included distal location of fracture (P = 0.04, odds ratio 3.71) and previous fixation (P = 0.03, odds ratio 3.80). Of the 25 iatrogenic nerve injuries, 22 recovered fully with expectant management, 1 was lost to follow-up, and 2 required either nerve graft or tendon transfers.

Conclusions:
Time from injury to surgery does not seem to be a risk factor for developing an iatrogenic radial nerve palsy when treating diaphyseal humerus fractures. Patients with distal fractures, and those with previous fracture implants, are at increased risk of iatrogenic radial nerve palsy.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
HEALTH CONDITIONS LINKED TO AGE-RELATED MACULAR DEGENERATION ASSOCIATED WITH DARK ADAPTATION
Authors: Laíns Inês , Miller John B. , Mukai Ryo , Mach Steven , Vavvas Demetrios , Kim Ivana K. , Miller Joan W. , Husain Deeba 
Published: April 2017

Purpose:
To determine the association between dark adaption (DA) and different health conditions linked with age-related macular degeneration (AMD).

Methods:
Cross-sectional study, including patients with AMD and a control group. Age-related macular degeneration was graded according to the Age-Related Eye Disease Study (AREDS) classification. We obtained data on medical history, medications, and lifestyle. Dark adaption was assessed with the extended protocol (20 minutes) of AdaptDx (MacuLogix). For analyses, the right eye or the eye with more advanced AMD was selected. Multivariate linear and logistic regressions were performed, accounting for age and AMD stage.

Results:
Seventy-eight subjects (75.6% AMD; 24.4% controls) were included. Multivariate assessments revealed that body mass index (BMI; β = 0.30, P = 0.045), taking AREDS vitamins (β = 5.51, P < 0.001), and family history of AMD (β = 2.68, P = 0.039) were significantly associated with worse rod intercept times. Abnormal DA (rod intercept time ≥ 6.5 minutes) was significantly associated with family history of AMD (β = 1.84, P = 0.006), taking AREDS supplements (β = 1.67, P = 0.021) and alcohol intake (β = 0.07, P = 0.017).

Conclusion:
Besides age and AMD stage, a higher body mass index, higher alcohol intake, and a family history of AMD seem to impair DA. In this cohort, the use of AREDS vitamins was also statistically linked with impaired DA, most likely because of an increased severity of disease in subjects taking them.
Shoulder Dynamic Control Ratio and Rotation Range of Motion in Female Junior Elite Handball Players and Controls
Authors: van Cingel Robert , Habets Bas , Willemsen Linn , Staal Bart 
Published: April 2017

Objective:
To compare glenohumeral range of motion and shoulder rotator muscle strength in healthy female junior elite handball players and controls.

Design:
Cross-sectional case–control study.

Setting:
Sports medical center.

Participants:
Forty elite female handball players and 30 controls active in nonoverhead sports participated in this study.

Main Outcome Measures:
Passive external rotator (ER), internal rotator (IR), and total range of motion (TROM) of the dominant and nondominant arm were examined with a goniometer. An isokinetic dynamometer was used to evaluate concentric and eccentric rotator muscle strength at 60 and 120 degrees/s with dynamic control ratio (DCR = ERecc:IRcon) as the main outcome parameter.

Results:
Except for the ER range of motion in the nondominant arm, no significant differences were found between groups for IR, ER of the dominant arm, and the TROM. Within the handball group, the side-to-side difference for IR of the dominant arm was −1.4 degrees. The ER and the TROM of the dominant arm were significantly larger, 6.3 and 4.9 degrees, respectively. For both groups, the DCR values were above 1 and no significant differences were found between the dominant and nondominant arm. The DCR values in the handball group were significantly lower than in the control group.

Conclusions:
Based on the adopted definitions for muscle imbalance, glenohumeral internal range of motion deficit and TROM deficit our elite female handball players seem not at risk for shoulder injuries. Prospective studies are needed to support the belief that a DCR below 1 places the shoulder at risk for injury.
Telephone Encounters Predict Future High Financial Expenditures in Inflammatory Bowel Disease Patients
Authors: Click Benjamin , Anderson Alyce M. , Ramos Rivers Claudia , Koutroubakis Ioannis E. , Hashash Jana G. , Dunn Michael A. , Schwartz Marc , Swoger Jason , Barrie Arthur , Szigethy Eva , Regueiro Miguel , Schoen Robert E. , Binion David G. 
Published: April 2017

Background:
Telephone activity is essential in management of complex chronic diseases including inflammatory bowel disease (IBD). Telephone encounters logged in the electronic medical record have recently been proposed as a surrogate marker of disease activity and impending health care utilization; however, the association between telephone calls and financial expenditures has not been evaluated.

Study:
We performed a 3-year prospective observational study of telephone encounters logged at a tertiary referral IBD center. We analyzed patient demographics, disease characteristics, comorbidities, clinical activity, and health care financial charges by telephone encounter frequency.

Results:
Eight hundred one patients met inclusion criteria (52.3% female; mean age, 44.1 y), accounted for 12,669 telephone encounters, and accrued $70,513,449 in charges over 3 years. High telephone encounter frequency was associated with female gender (P=0.003), anxiety/depression (P<0.001), and prior IBD surgery (P<0.001). High telephone encounter categories had significantly more hospitalizations (P<0.001), IBD surgery (P<0.001), worse quality of life (P<0.001), more corticosteroid (P<0.001), biological (P<0.001), and opiate prescriptions (P<0.001). High telephone encounter frequency patients amassed higher total available charges in each year (P<0.001) and over the 3 years (P<0.001). Telephone encounters in 2009 (P=0.02) and 2010 (P<0.001) were significantly associated with financial charges the following year after controlling for demographic, utilization, and medication covariates.

Conclusions:
Increased telephone encounters are associated with significantly higher health care utilization and financial expenditures. Increased call frequency is predictive of future health care spending. Telephone encounters are a useful tool to identify patients at risk of clinical deterioration and large financial expense.
Salivary cortisol and cortisone in the clinical setting
Authors: Blair Joanne , Adaway Jo , Keevil Brian , Ross Richard 
Published: April 2017

Purpose of review
A resurgence of interest in salivary biomarkers has generated evidence for their value in assessing adrenal function. The advantages of salivary measurements include only free hormone is detected, samples can be collected during normal daily routines and stress-induced cortisol release is less likely to occur than during venepuncture. We review the use of salivary biomarkers to diagnose and monitor patients for conditions of cortisol excess and deficiency and discuss the value of measuring salivary cortisone versus salivary cortisol.

Recent findings
Developments in laboratory techniques have enabled the measurement of salivary hormones with a high level of sensitivity and specificity. In states of altered cortisol binding, salivary biomarkers are more accurate measures of adrenal reserve than serum cortisol. Salivary cortisone is a superior marker of serum cortisol compared with salivary cortisol, specifically when serum cortisol is low and during hydrocortisone therapy when contamination of saliva may result in misleading salivary cortisol concentrations.

Summary
Salivary cortisol and cortisone can be used to assess cortisol excess, deficiency and hydrocortisone replacement, with salivary cortisone having the advantage of detection when serum cortisol levels are low and there is no interference from oral hydrocortisone.
Leapfrog Hospital Safety Score, Magnet Designation, and Healthcare-Associated Infections in United States Hospitals
Authors: Pakyz Amy L. , Wang Hui , Ozcan Yasar A. , Edmond Michael B. , Vogus Timothy J. 
Published: April 2017

Objective
Healthcare-associated infections (HAIs) pose a challenge to patient safety. Although studies have explored individual level, few have focused on organizational factors such as a hospital’s safety infrastructure (indicated by Leapfrog Hospital Safety Score) or workplace quality (Magnet recognition). The aim of the study was to determine whether Magnet and hospitals with better Leapfrog Hospital Safety Scores have fewer HAIs.

Methods
Ordered probit regression analyses tested associations between Safety Score, Magnet status, and standardized infection ratios, depicting whether a hospital had a Clostridium difficile infection (CDI) and methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection standardized infection ratio that was “better,” “no different,” or “worse” than a National Benchmark as per Centers for Disease Control and Prevention’s National Healthcare Safety Network definitions.

Results
Accounting for confounders, relative to “A” hospitals, “B” and “C” hospitals had significant and negative relationships with CDI (−0.16, P < 0.01, and −0.14, P < 0.05, respectively) but not MRSA bacteremia. Magnet hospitals had a significant and positive relationship with MRSA bloodstream infections (0.74, P < 0.001) but a significant negative relationship with CDI (−0.21, P < 0.01) compared with non-Magnet.

Conclusions
A hospitals performed better on CDI but not MRSA bloodstream infections. In contrast, Magnet designation was associated with fewer than expected MRSA infections but more than expected CDIs. These mixed results indicate that hospital global assessments of safety and workplace quality differentially and imperfectly predict its level of HAIs, suggesting the need for more precise organizational measures of safety and more nuanced approaches to infection prevention and reduction.
Measurement of Oxygen Consumption Variations in Critically Ill Burns Patients: Are the Fick Method and Indirect Calorimetry Interchangeable?
Authors: Soussi Sabri , Vallée Fabrice , Roquet Florian , Bevilacqua Vincent , Benyamina Mourad , Ferry Axelle , Cupaciu Alexandru , Chaussard Maïté , De Tymowski Christian , Boccara David , Mimoun Maurice , Chaouat Marc , Anstey James , Mebazaa Alexandre , Legrand Matthieu 
Published: April 2017

ABSTRACT

Objectives:
To evaluate the interchangeability of oxygen consumption variations measured with the Fick equation (ΔVO2Fick) and indirect calorimetry (ΔVO2Haldane) in critically ill burns patients.

Methods:
Prospective observational single-center study conducted in a university hospital. Twenty-two consecutive burns patients with circulatory insufficiency and hyperlactatemia (>2 mmol/L) who required a fluid challenge (FC) were included. All patients had cardiac output monitoring (transpulmonary thermodilution technique) and were ventilated and sedated. Simultaneous measurements of VO2Fick and VO2Haldane were performed before and immediately after the FC, at rest, and in hemodynamic conditions stabilized for at least 1 h. VO2Fick and VO2Haldane were measured, respectively, with the standard formulae (using arterial and central venous saturation measured with a blood gas analyzer) and with a metabolic monitor.

Results:
Forty-four paired measurements of VO2 were obtained. At each timepoint, the median (interquartile range, 25–75) VO2Haldane values were significantly higher than the median VO2Fick values (126 (103–192) vs. 90 (66–149) mL O2/min/m2 (P = 0.004) before FC and 129 (105–189) vs. 80 (54–119) mL O2/min/m2 (P = 0.001) after FC). Correlation between the ΔVO2Fick and the ΔVO2Haldane (%) measurements was poor, with an r = 0.06, (P = 0.77). The mean bias was 8.6% [limits of agreement (LOA): −75.7%, 92.9%].

Conclusions:
Analysis of agreement showed poor concordance for the ΔVO2Haldane and the ΔVO2Fick (%) with a low mean bias but large and clinically unacceptable LOA. ΔVO2Haldane and ΔVO2Fick (%) are not interchangeable in these conditions.
Exploring the Predictive Ability of Dysfunctional High-Density Lipoprotein for Adverse Outcomes in Emergency Department Patients with Sepsis: A Preliminary Investigation
Authors: Guirgis Faheem W. , Dodani Sunita , Moldawer Lyle , Leeuwenburgh Christiaan , Bowman Jennifer , Kalynych Colleen , Jones Alan E. , Reddy Srinivasa T. , Moore Frederick A. 
Published: April 2017

ABSTRACT

Background:
High density lipoprotein (HDL) can be readily oxidized in inflammatory conditions and exhibit pro-inflammatory and dysfunctional (Dys-HDL) characteristics. We hypothesize that Dys-HDL may predict adverse outcomes and correlate with inflammatory cytokines in sepsis.

Methods:
Emergency department (ED) patients with sepsis were enrolled. Blood was drawn at enrollment and after 48 h. Dys-HDL, expressed as HDL inflammatory index (HII), and cytokines were measured. Multivariable logistic regression was used to determine the predictive ability of Dys-HDL for adverse outcomes (death, discharge to hospice, or nursing home).

Results:
Thirty-five patients were included in the study. HII was not significantly different at baseline or 48 h between patients with adverse outcomes versus those without. However, there was a significant difference in change in HII over the first 48 h between those with adverse outcomes (+0.21, 95% CI −0.13 to 0.31) versus those without (−0.11, 95% CI −1 to 0.11) (P = 0.025). Logistic regression revealed increasing HII to be an independent predictor of adverse outcomes (OR 5.2, 95% CI 1.1–25.1 P = 0.040). Of the 24 patents with cytokine measurements at both time points, significant inverse correlations between change in HII and change in GRO (rs = −0.52, P = 0.0088) and monocyte chemotactic protein-1 (rs = −0.61, P = 0.0014) concentrations over 48 h were observed.

Conclusion:
Increasing Dys-HDL concentrations in the first 48 h of sepsis are associated with an ongoing inflammatory response and adverse clinical outcomes. Early changes in HII may be a potential biomarker in ED patients admitted with sepsis.
Child seat belt guidelines: Examining the 4 feet 9 inches rule as the standard
Authors: Morse Amber M. , Aitken Mary E. , Mullins Samantha H. , Miller Beverly K. , Pomtree Mindy M. , Ulloa Erin M. , Montgomery Jeffrey S. , Saylors Marie E. 
Published: April 2017

BACKGROUND
Current American Academy of Pediatrics recommendations regarding transition from child safety/booster seat to adult safety belt use indicate that children should be at least 4 feet 9 inches, 8 years old, or 80 pounds. Proper fit in the vehicle seat, assessed with a five-point fit test, should also be met. Although most children reach 4 feet 9 inches around age 8 years, each child and vehicle presents a unique combination; thus a child may not fit appropriately in all vehicle types using only the 4 feet 9 inches requirement.

METHODS
We enrolled children, aged 7 years to 12 years, into our study. Height, weight, and demographic data were obtained. A Child Passenger Safety Technician then performed the five-point fit test in each of a uniform lineup of five vehicles. Data were collected on fit in the standard vehicle seat and also in a booster seat. We set 90% as the threshold proportion of children who meet all criteria for proper fit to validate current recommendations of a height of 4 feet 9 inches.

RESULTS
Data were collected on 388 children. The percentage of 90% proper fit was met in the compact car and small sport-utility vehicle (SUV). However, only 80 (77%) of 104 students (p < 0.0001) that were 4 feet 9 inches or higher fit properly in the large SUV, only 87 (83%) of 105 students (p = 0.02) fit properly in the pickup truck, and only 91 (89%) of 102 students (p = 0.74) fit properly in the minivan.

CONCLUSION
Substantial proportions of children meeting current height guidelines for an adult seat belt do not meet safety requirements for fit, especially in larger, commonly used vehicles (large SUVs and trucks). This emphasizes the need for evaluation of fit by a trained personnel and/or development of standard back seat dimensions in all vehicles for maximum safety.

LEVEL OF EVIDENCE
Epidemiologic level 1.
Extensive phenotypic plasticity in a seasonal butterfly limits potential for evolutionary responses to environmental change
Authors: Oostra Vicencio , Saastamoinen Marjo , Zwaan Bas J. , Wheat Christopher 
Published: April 2017

AbstractUnderstanding how populations adapt to changing environments is a major goal in evolutionary biology and ecology, and particularly urgent for predicting resilience to climate change. Phenotypic plasticity, the ability to express multiple phenotypes from the same genome, is a widespread adaptation to short-term environmental fluctuations, but whether it facilitates adaptation to environmental change on evolutionary timescales, such as those under climate change, remains contentious. Here, we investigate plasticity and adaptive potential in an African savannah butterfly displaying extensive plasticity as adaptation to predictable dry-wet seasonality. We assess the transcriptional architecture of seasonal plasticity and find pervasive gene expression differences between the seasonal phenotypes, reflecting a genome-wide plasticity programme. Strikingly, intra-population genetic variation for this response is highly depleted, possibly reflecting strong purifying selection in its savannah habitat where an environmental cue (temperature) reliably predicts seasonal transitions and the cost of a mismatched phenotype is high. Under climate change the accuracy of such cues may deteriorate, rendering dominant reactions norm maladaptive. Therefore, depleted variation for plasticity as reported here may crucially limit evolutionary potential when conditions change, and seasonally plastic species may in fact be especially vulnerable to climate change.
Gradients of Rac1 nanoclusters support spatial patterns of Rac1 signaling
Authors: Remorino Amanda , Beco Simon De , Cayrac Fanny , Federico Fahima Di , Cornilleau Gaetan , Gautreau Alexis , Parrini Maria Carla , Masson Jean-Baptiste , Dahan Maxime , Coppey Mathieu 
Published: April 2017

AbstractThe dynamics of the cytoskeleton and cell shape relies on the coordinated activation of RhoGTPase molecular switches. Among them, Rac1 participates to the orchestration in space and time of actin branching and protrusion/retraction cycles of the lamellipodia at the cell front during mesenchymal migration. Biosensor imaging has revealed a graded concentration of active GTP-loaded Rac1 in protruding regions of the cell. Here, using single molecule imaging and super-resolution microscopy, we reveal an additional supramolecular organization of Rac1. We find that, similarly to H-Ras, Rac1 partitions and is immobilized into nanoclusters of 50-100 molecules each. These nanoclusters assemble due to the interaction of the polybasic tail of Rac1 with the phosphoinositide lipids PIP2 and PIP3. The additional interactions with GEFs, GAPs, downstream effectors, and possibly other partners are responsible for an enrichment of Rac1 nanoclusters in protruding regions of the cell. Using optogenetics and micropatterning tools, we find that activation of Rac1 leads to its immobilization in nanoclusters and that the local level of Rac1 activity matches the local density of nanoclusters. Altogether, our results show that subcellular patterns of Rac1 activity are supported by gradients of signaling nanodomains of heterogeneous molecular composition, which presumably act as discrete signaling platforms. This finding implies that graded distributions of nanoclusters might encode spatial information.Significance statementThe plasma membrane of eukaryotic cells is a highly organized surface where hundreds of incoming signals are transduced to the intracellular space. How cells encode faithfully this myriad of signals is a fundamental question. Here we show that Rac1, a critical membrane-bound protein involved in the regulation of cytoskeletal dynamics, forms small aggregates together with other regulating proteins. These supramolecular assemblies, called nanoclusters, are the “quantal” units of signaling. By increasing the local concentration, nanoclusters set thresholds for downstream signaling and ensure the fidelity of information transduction. We found that Rac1 nanoclusters are distributed as spatial gradients matching the patterns of Rac1 activity. We propose that cells can encode positional information through distributed signaling quanta, hereby ensuring spatial fidelity.
Avoiding Math on a Rapid Timescale: Emotional Responsivity and Anxious Attention in Math Anxiety
Authors: Pizzie Rachel G. , Kraemer David J.M. 
Published: April 2017

AbstractMath anxiety (MA) is characterized by negative feelings towards mathematics, resulting in avoidance of math classes and of careers that rely on mathematical skills. Focused on a long timescale, this research may miss important cognitive and affective processes that operate moment-to-moment, changing rapid reactions even when a student simply sees a math problem. Here, using fMRI with an attentional deployment paradigm, we show that MA influences rapid spontaneous emotional and attentional responses to mathematical stimuli upon brief presentation. Critically, participants viewed but did not attempt to solve the problems. Indicating increased threat reactivity to even brief presentations of math problems, increased MA was associated with increased amygdala response during math viewing trials. Functionally and anatomically defined amygdala ROIs yielded similar results, indicating robustness of the finding. Similar to the pattern of vigilance and avoidance observed in specific phobia, behavioral results of the attentional paradigm demonstrated that MA is associated with attentional disengagement for mathematical symbols. This attentional avoidance is specific to math stimuli; when viewing negatively-valenced images, MA is correlated with attentional engagement, similar to other forms of anxiety. These results indicate that even brief exposure to mathematics triggers a neural response related to threat avoidance in highly MA individuals.