bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors
Authors: Stubblefield Michael D. , Ibanez Katarzyna , Riedel Elyn R. , Barzilai Ori , Laufer Ilya , Lis Eric , Yamada Yoshiya , Bilsky Mark H. 
Published: March 2017

OBJECTIVE
The object of this study was to determine the percentage of high-dose (1800–2600 cGy) single-fraction stereotactic radiosurgery (SF-SRS) treatments to the spine that result in peripheral nervous system (PNS) injury.

METHODS
All patients treated with SF-SRS for primary or metastatic spine tumors between January 2004 and May 2013 and referred to the Rehabilitation Medicine Service for evaluation and treatment of neuromuscular, musculoskeletal, or functional impairments or pain were retrospectively identified.

RESULTS
Five hundred fifty-seven SF-SRS treatments in 447 patients resulted in 14 PNS injuries in 13 patients. All injures resulted from SF-SRS delivered to the cervical or lumbosacral spine at 2400 cGy. The overall percentage of SF-SRS treatments resulting in PNS injury was 2.5%, increasing to 4.5% when the thoracic spine was excluded from analysis. The median time to symptom onset following SF-SRS was 10 months (range 4–32 months). The plexus (cervical, brachial, and/or lumbosacral) was affected clinically and/or electrophysiologically in 12 (86%) of 14 cases, the nerve root in 2 (14%) of 14, and both in 6 (43%) of 14 cases. All patients experienced pain and most (93%) developed weakness. Peripheral nervous system injuries were CTCAE Grade 1 in 14% of cases, 2 in 64%, and 3 in 21%. No dose relationship between SF-SRS dose and PNS injury was detected.

CONCLUSIONS
Single-fraction SRS to the spine can result in PNS injury with major implications for function and quality of life.
Cortical plasticity after brachial plexus injury and repair: a resting-state functional MRI study
Authors: Bhat Dhananjaya I. , Indira Devi B. , Bharti Komal , Panda Rajanikant 
Published: March 2017

OBJECTIVE
The authors aimed to understand the alterations of brain resting-state networks (RSNs) in patients with pan–brachial plexus injury (BPI) before and after surgery, which might provide insight into cortical plasticity after peripheral nerve injury and regeneration.

METHODS
Thirty-five patients with left pan-BPI before surgery, 30 patients after surgery, and 25 healthy controls underwent resting-state functional MRI (rs-fMRI). The 30 postoperative patients were subdivided into 2 groups: 14 patients with improvement in muscle power and 16 patients with no improvement in muscle power after surgery. RSNs were extracted using independent component analysis to evaluate connectivity at a significance level of p < 0.05 (familywise error corrected).

RESULTS
The patients with BPI had lower connectivity in their sensorimotor network (SMN) and salience network (SN) and greater connectivity in their default mode network (DMN) before surgery than the controls. Connectivity of the left supplementary motor cortex in the SMN and medial frontal gyrus and in the anterior cingulate cortex in the SN increased in patients whose muscle power had improved after surgery, whereas no significant changes were noted in the unimproved patients. There was a trend toward reduction in DMN connectivity in all the patients after surgery compared with that in the preoperative patients; however, this result was not statistically significant.

CONCLUSIONS
The results of this study highlight the fact that peripheral nerve injury, its management, and successful treatment cause dynamic changes within the brain's RSNs, which includes not only the obvious SMN but also the higher cognitive networks such as the SN and DMN, which indicates brain plasticity and compensatory mechanisms at work.
Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes
Authors: Socolovsky Mariano , Malessy Martijn , Lopez Dan , Guedes Fernando , Flores Leandro 
Published: March 2017

OBJECTIVE
Neuroplasticity is analyzed in this article as the capacity of the CNS to adapt to external and internal stimuli. It is being increasingly recognized as an important factor for the successful outcome of nerve transfers. Better-known factors are the number of axons that cross the coaptation site, the time interval between trauma and repair, and age. Neuroplasticity is mediated initially by synaptic and neurotransmitter changes. Over time, the activation of previously existing but lowly active connections in the brain cortex contributes further. Dendritic sprouting and axonal elongation might also take place but are less likely to be prominent.

METHODS
The authors reviewed different factors that play roles in neuroplasticity and functional regeneration after specific nerve transfers.

RESULTS
The authors found that these different factors include, among others, the distance between cortical areas of the donor and receptor neurons, the presence versus absence of preexisting lowly active interneuronal connections, gross versus fine movement restoration, rehabilitation, brain trauma, and age.

CONCLUSIONS
The potential for plasticity should be taken into consideration by surgeons when planning surgical strategy and postoperative rehabilitation, because its influence on results cannot be denied.
First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up
Authors: Gersey Zachary C. , Burks S. Shelby , Anderson Kim D. , Dididze Marine , Khan Aisha , Dietrich W. Dalton , Levi Allan D. 
Published: March 2017

OBJECTIVE
Long-segment injuries to large peripheral nerves present a challenge to surgeons because insufficient donor tissue limits repair. Multiple supplemental approaches have been investigated, including the use of Schwann cells (SCs). The authors present the first 2 cases using autologous SCs to supplement a peripheral nerve graft repair in humans with long-term follow-up data.

METHODS
Two patients were enrolled in an FDA-approved trial to assess the safety of using expanded populations of autologous SCs to supplement the repair of long-segment injuries to the sciatic nerve. The mechanism of injury included a boat propeller and a gunshot wound. The SCs were obtained from both the sural nerve and damaged sciatic nerve stump. The SCs were expanded and purified in culture by using heregulin β1 and forskolin. Repair was performed with sural nerve grafts, SCs in suspension, and a Duragen graft to house the construct. Follow-up was 36 and 12 months for the patients in Cases 1 and 2, respectively.

RESULTS
The patient in Case 1 had a boat propeller injury with complete transection of both sciatic divisions at midthigh. The graft length was approximately 7.5 cm. In the postoperative period the patient regained motor function (Medical Research Council [MRC] Grade 5/5) in the tibial distribution, with partial function in peroneal distribution (MRC Grade 2/5 on dorsiflexion). Partial return of sensory function was also achieved, and neuropathic pain was completely resolved. The patient in Case 2 sustained a gunshot wound to the leg, with partial disruption of the tibial division of the sciatic nerve at the midthigh. The graft length was 5 cm. Postoperatively the patient regained complete motor function of the tibial nerve, with partial return of sensation. Long-term follow-up with both MRI and ultrasound demonstrated nerve graft continuity and the absence of tumor formation at the repair site.

CONCLUSIONS
Presented here are the first 2 cases in which autologous SCs were used to supplement human peripheral nerve repair in long-segment injury. Both patients had significant improvement in both motor and sensory function with correlative imaging. This study demonstrates preliminary safety and efficacy of SC transplantation for peripheral nerve repair.
Opiate addiction and overdose: experiences, attitudes, and appetite for community naloxone provision
Authors: Barry Tomás , Klimas Jan , Tobin Helen , Egan Mairead , Bury Gerard 
Published: March 2017

BackgroundMore than 200 opiate overdose deaths occur annually in Ireland. Overdose prevention and management, including naloxone prescription, should be a priority for healthcare services. Naloxone is an effective overdose treatment and is now being considered for wider lay use.Aim To establish GPs’ views and experiences of opiate addiction, overdose care, and naloxone provision.Design and setting An anonymous postal survey to GPs affiliated with the Department of Academic General Practice, University College Dublin, Ireland.MethodA total of 714 GPs were invited to complete an anonymous postal survey. Results were compared with a parallel GP trainee survey.ResultsA total of 448/714 (62.7%) GPs responded. Approximately one-third of GPs were based in urban, rural, and mixed areas. Over 75% of GPs who responded had patients who used illicit opiates, and 25% prescribed methadone. Two-thirds of GPs were in favour of increased naloxone availability in the community; almost one-third would take part in such a scheme. A higher proportion of GP trainees had used naloxone to treat opiate overdose than qualified GPs. In addition, a higher proportion of GP trainees were willing to be involved in naloxone distribution than qualified GPs. Intranasal naloxone was much preferred to single (P<0.001) or multiple dose (P<0.001) intramuscular naloxone. Few GPs objected to wider naloxone availability, with 66.1% (n = 292) being in favour.ConclusionGPs report extensive contact with people who have opiate use disorders but provide limited opiate agonist treatment. They support wider availability of naloxone and would participate in its expansion. Development and evaluation of an implementation strategy to support GP-based distribution is urgently needed.
Mean platelet volume in the differential diagnosis of tuberculous and bacterial meningitis
Authors: Camara-Lemarroy Carlos Rodrigo , Delgado-Garcia Guillermo , De la Cruz-Gonzalez Juan Gilberto , Villareal-Velazquez Hector Jorge , Gongora-Rivera Fernando 
Published: March 2017

Introduction: Mean platelet volume (MPV) has been shown to reflect the inflammatory burden in different inflammatory and autoimmune diseases. Our objective was to analyze the MPV in patients with tuberculous (TBM) and bacterial meningitis (BM). Methodology: The demographic and clinical data of 73 consecutive patients that presented with either BM (n = 35) or TBM (n = 38) were retrospectively analyzed, as well as that of 28 age- and sex-matched controls. Results: MPV was 8.78 ± 1.58 fL in patients with BM and 6.42 ± 1.39 fL in the TBM group (p < 0.05). In the control group, MPV was 7.4 ± 0.66 fL, significantly higher and lower when compared with TBM and BM, respectively. MPV was significantly associated with diagnosis (adjusted OR: 5.15, 95% CI: 1.090–23.7; p = 0.03). With the optimal cut-off value of 7.62 fL, MPV had 82% sensibility and 78% specificity for the differential diagnosis of TBM versus BM. Lower platelet counts, higher serum creatinine, higher white blood cell counts, and higher blood-cerebrospinal fluid glucose ratio were also predictive of BM. Conclusions: Platelet counts were lower and MPV was higher in patients with BM compared to patients with TBM. Platelet indices, available in routine bloodwork, could be useful in the early differential diagnosis of these entities.
Healthcare and Research Priorities of Adolescents and Young Adults with Systemic Lupus Erythematosus: A Mixed-methods Study
Authors: Tunnicliffe David J. , Singh-Grewal Davinder , Craig Jonathan C. , Howell Martin , Tugwell Peter , Mackie Fiona , Lin Ming-Wei , O’Neill Sean G. , Ralph Angelique F. , Tong Allison 
Published: March 2017

Objective.Managing juvenile-onset systemic lupus erythematosus (SLE) is particularly challenging. The disease may be severe, adolescent patients have complex medical and psychosocial needs, and patients must navigate the transition to adult services. To inform patient-centered care, we aimed to identify the healthcare and research priorities of young patients with SLE and describe the reasons underpinning their priorities.Methods.Face-to-face, semistructured interviews and focus groups were conducted with patients with SLE, aged from 14 to 26 years, from 5 centers in Australia. For each of the 5 allocation exercises, participants allocated 10 votes to (1) research topics; research questions on (2) medical management, (3) prevention and diagnosis, (4) lifestyle and psychosocial; and (5) healthcare specialties, and discussed the reasons for their choices. Descriptive statistics were calculated for votes and qualitative data were analyzed thematically.Results.The 26 participants prioritized research that alleviated the psychological burden of SLE. They allocated their votes toward medical and mental health specialties in the management of SLE, while fewer votes were given to physiotherapy/occupational therapy and dietetics. The following 7 themes underpinned the participants’ priorities: improving service shortfalls, strengthening well-being, ensuring cost efficiency, minimizing family/community burden, severity of comorbidity or complications, reducing lifestyle disruption, and fulfilling future goals.Conclusion.Young patients with SLE value comprehensive care with greater coordination among specialties. They prioritized research focused on alleviating poor psychological outcomes. The healthcare and research agenda for patients with SLE should include everyone involved, to ensure that the agenda aligns with patient priorities, needs, and values.
Update on Effectiveness of an Electromagnetic Feeding Tube–Placement Device in Detecting Respiratory Placements
Authors: Metheny Norma A. , Meert Kathleen L. 
Published: March 2017

Background
Radiography is the accepted gold standard for testing feeding tube placement; however, an electromagnetic tube-placement device (ETPD) is sometimes used in lieu of radiography for this purpose. High success rates have been reported when the device was used by well-trained individuals. However, authors previously described 20 cases that occurred between 2007 and 2012 in which clinicians voluntarily reported inability to detect inadvertent tube insertions in the respiratory tract while using an ETPD.

Objective
To describe case reports to the US Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database between 2013 and 2015 regarding inadvertent respiratory placement of feeding tubes by operators using an ETPD.

Methods
The MAUDE database was searched for cases dated from January 1, 2013, through December 31, 2015, along with selected brand names. A total of 34 cases (25 after removal of duplicates) were located in which a feeding tube was inserted into the respiratory tract during insertions assisted by an ETPD.

Results
Sites of the malpositioned tubes included the right lung (n = 13), left lung (n = 6), unspecified lung (n = 4), and bronchus (n = 2). A pneumothorax occurred in 17 of the 25 misplacements; feedings were administered in 6 cases.

Conclusions
Many case reports involved clinicians failing to recognize tube misplacements in the respiratory tract while using an ETPD. These reports provide evidence that not all clinicians can use the device effectively to detect malpositioned tubes. Thus, one must continue to question the wisdom of eliminating radiographic confirmation of tube position before starting feedings.
Perceptions of Adult Hospitalized Patients on Family Presence During Cardiopulmonary Resuscitation
Authors: Bradley Carolyn , Keithline Michelle , Petrocelli Meghan , Scanlon Mary , Parkosewich Janet 
Published: March 2017

BackgroundFamily presence during cardiopulmonary resuscitation in acute care is not widespread. Patients are not likely to be asked about their wishes for family presence or if they wish to be the decision makers about who should be present.ObjectiveTo explore the perceptions of patients on general medical units and to find factors independently associated with family presence during cardiopulmonary resuscitation.MethodsA cross-sectional study of 117 randomly selected adult patients was conducted at an academic medical center. Participants were interviewed via a survey to obtain information on demographics, knowledge of cardiopulmonary resuscitation, sources of information on resuscitation, and preferences for family presence.ResultsAbout half of the participants agreed or strongly agreed that family presence during cardiopulmonary resuscitation was important (52.1%), that the participant should be the decision maker about who should be present (50.4%), and that the patient should give consent ahead of time (47.0%). Participants indicated that they would want an adult sibling, parents, or others (20.5%); spouse (14.5%); adult child (8.5%); close friend (5.1%); or companion (4.3%) present during cardiopulmonary resuscitation. Younger participants (20–45 years old) were 6.28 times more likely than those ≥ 66 years old (P = .01) and nonwhite participants were 2.7 times more likely than white participants (P = .049) to want family presence.ConclusionPatients have strong preferences about family presence during cardiopulmonary resuscitation, and they should have the opportunity to make the decision about having family present.
Evaluation of motivation and attitude for Telehomecare among caregivers of elderly patients affected with congestive heart failure
Authors: Kaladjurdjevic Milica , Antonicelli Roberto 
Published: March 2017

ABSTRACT

Background:
The development of telemedicine has become a solution to provide healthcare service to the elderly while they remain in their homes. The unit of cost of healthcare service provided at home is lower than the unit of cost of Institutional Healthcare Service. The healthcare users' attitude and motivation are a fundamental factor for the acceptance of technology and behavior change. Still, motivation and attitude toward telemedicine, especially among elderly and their caregivers is not satisfactory.

Objectives:
The object of this study is to investigate the utilization of Telehomecare and its effect on user's attitude and motivation among caregivers of elderly population who are affected by chronic heart failure.

Materials and Methods:
Observational trial and quasi-experimental design with duration of 6 months were adopted. Intervention with the telemedicine platform that supports multispecialty teleconsultation and questionnaire for evaluating the effect of intervention “Use and attitude of current technology” were used.

Results:
The results after 6 months showed that expectations and attitude were improved, and the user's opinion about barriers was positive.

Conclusion:
We evaluated readiness and responsiveness of naïve user before and after 6 months during observational trial. The trial has demonstrated a unified user's opinion that the barriers to telemedicine's use are not so high that they cannot be overcome.
Satisfaction and Improvements in Peritoneal Dialysis Outcomes Associated with Telehealth
Authors: Magnus Manya , Sikka Neal , Cherian Teena , Lew Susie 
Published: March 2017

SummaryBackground and Significance: End stage renal disease (ESRD) affects approximately 660,000 persons in the US each year, representing a significant financial burden to the health care system and affected individuals. Telehealth approaches to care offer an important means of reducing costs as well as increasing autonomy for patients. Understanding patient satisfaction with telehealth provides a key towards eventual scalability.Materials and Methods: Quarterly surveys were conducted to characterize satisfaction with remote biometric monitoring (RBM) for blood pressure, weight, glucose and peritoneal dialysis (PD)-specific educational online videos for ESRD patients using PD.Results: Of 300 participants, 67% participated in the surveys and provided baseline and at least one follow-up assessment. The majority were 45 to 64 years of age (50.5%), Black (64.5%), married or living with significant other (52.0%), and had more than a high school degree (73.0%). RBM was associated with perceived autonomy and confidence in health care activities and decreased negative perceptions of PD care and ESRD. The majority of participants (80.1%) indicated that they were satisfied or completely satisfied with the system. Participants found that the interface increased confidence, reduced frustration, and related perceptions were significantly and positively altered (p<0.05) for each of the separate telehealth components. Educational videos were well utilized with nearly half of the participants (42.5%) reporting that they watched at least one of the videos, and the majority reporting that the videos seen had an overall positive impact on health. Discussion and Conclusions: Supplementing PD with telehealth has the potential to have a positive impact on patient perceptions of PD care and consequently improve clinical outcomes.
The nitrate/(per)chlorate relationship on Mars
Authors: Stern Jennifer C. , Sutter Brad , Jackson W. Andrew , Navarro‐González Rafael , McKay Christopher P. , Ming Douglas W. , Archer P. Douglas , Mahaffy Paul R. 
Published: March 2017

AbstractNitrate was recently detected in Gale Crater sediments on Mars at abundances up to ~600 mg/kg, confirming predictions of its presence at abundances consistent with models based on impact‐generated nitrate and other sources of fixed nitrogen. Terrestrial Mars analogs, Mars meteorites, and other solar system materials help establish a context for interpreting in situ nitrate measurements on Mars, particularly in relation to other cooccuring salts. We compare the relative abundance of nitrates to oxychlorine (chlorate and/or perchlorate, hereafter (per)chlorate) salts on Mars and Earth. The nitrate/(per)chlorate ratio on Mars is < 1, significantly lower than on Earth (nitrate/(per)chlorate > 103), suggesting not only the absence of biological activity but also different (per)chlorate formation mechanisms on Mars than on Earth.
Factors controlling the permeability distribution in fault vein zones surrounding granitic intrusions (Ore Mountains/Germany)
Authors: Achtziger‐Zupančič P. , Loew S. , Hiller A. 
Published: March 2017

AbstractAn outstanding legacy data set has been compiled from underground excavations mostly prospected and mined by the former Soviet (German) Stock Company Wismut describing the hydrology of faulted basement rocks in the Ore Mountains (SE Germany). It consists of more than 5000 detailed descriptions of groundwater inflows to about 660 km of tunnels and 57 km of drillings measured during or shortly after excavation. Inflow measurements (recorded between 1E−8 and 4E−2 m3/s) have been converted to fracture transmissivities using a simplified analytical solution. Discarding site specific effects, the median log transmissivity decreases from 1E−7 to 1E−10 m2/s within the studied depth interval of 0–2000 meters below ground surface (mbgs), and the spacing of conductive fracture increases from 0.1 to 2500 m. This general trend is overprinted at three mining sites by a clear reversal of fracture transmissivity which correlates with contact metamorphic aureoles around Variscan granite intrusions (327–295 Ma). We hypothesize that this transmissivity increase is caused by processes accompanying granite intrusion and contact metamorphism. The thickness of these hydraulically active aureoles is greater in lower‐grade metamorphic schist than in higher‐grade metamorphic gneisses. Rock mass equivalent continuum conductivities have been estimated by arithmetic averaging of fracture and matrix transmissivities over 100 m intervals and have been converted to permeabilities. The median equivalent continuum permeability decreases with depth according to log(k) = − 1.7 * log(z) − 17.3 (k in m2 and increasing depth z in kilometer being positive). Matrix conductivity controls the bulk conductivity below about 1000 mbgs and is less sensitive to the occurrence of contact metamorphic aureoles.