bluuebunny/crossref_metadata_2025_split huggingface dataset:
Importance–performance analysis as a strategic tool for tourism marketers: The case of Taiwan’s Destination Image
Authors: Jeng Chi-Ruey , Snyder Adam T , Chen Ching-Fu 
Published: May 2017

Today’s travelers, facilitated by increased leisure time, rising levels of disposable income and more efficient transportation networks, have the means to choose from among this much larger variety of destinations. As a result, tourism marketers are now faced with influencing consumer decision-making in an increasingly complex and competitive global marketplace. The purpose of this study is to engage discussion of different perceptions of travel to Taiwan particularly as a travel destination. It also will try to understand tourist’s grievances and shortcomings of Taiwan as a travel destination and attempt to offer suggestions on improving these things. This study investigated international perceptions of Taiwan as a tourist destination and examined holistic attributes of a destination according to positive and negative contexts to determine the relation between travel customer satisfaction and travel attribute importance and performance. We also researched the level of difference in the perceived travel attributes of importance and performance as an indicator of service quality strengths and weaknesses. Our study results reveal the overall image of Taiwan to be a fun, free, hospitable place with friendly locals and an interesting culture. Climate, opportunity to increase knowledge, safety, political stability, relaxation, and scenery all scored as positive aspects of Taiwan. Free elicitation also corroborates this with the top four physiological attributes as friendly, fun, safe, and relaxing. Taiwan could use these attributes to its marketing advantage.
Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: A review of the literature
Authors: Patel Tejal , Slonim Karen , Lee Linda 
Published: May 2017

Background: Older adults with dementia are at high risk for drug-related adverse outcomes. While much is known about potentially inappropriate medication use in older adults, its prevalence and characteristics among those with dementia are not as well elucidated. We conducted a literature review to examine the prevalence of potentially inappropriate medication use among home-dwelling older adults with dementia. Our secondary aim was to determine the most frequently implicated medications and factors associated with potentially inappropriate medication use. Methods: MEDLINE, EMBASE, CINAHL, and International Pharmaceutical Abstracts were searched between 1946 and 2014 for articles that referenced potentially inappropriate medication use and types of dementia. One reviewer screened all titles and abstracts from the initial search and full-text articles after the initial screen for eligibility, then 2 reviewers independently abstracted data from included studies. Results: Searches yielded 81 articles, of which 7 met inclusion criteria. Prevalence of potentially inappropriate medication use varied from 15% to 46.8%. No single drug or drug class was reported consistently across all studies as the most frequent potentially inappropriate medication, but anticholinergics and benzodiazepines, drugs that affect cognition, were among the most common medications or pharmacological classes listed. Discussion: Older adults with dementia may be particularly vulnerable to potentially inappropriate medications because of cognitive impairment from their condition and the greater likelihood of experiencing adverse events from medications. Given this population’s greater susceptibility to adverse events, more intense medication and patient monitoring may be warranted, especially among those taking anticholinergics and benzodiazepines, as these drugs can contribute to cognitive impairment.
A Comparison of Time Delay in Three Continuous Glucose Monitors for Adolescents and Adults
Authors: Sinha Manasi , McKeon Katherine M. , Parker Savan , Goergen Laura G. , Zheng Hui , El-Khatib Firas H. , Russell Steven J. 
Published: May 2017

Background: The physiologic delay in glucose diffusion from the blood to the interstitial fluid and instrumental factors contribute to the delay between changes in plasma glucose (PG) and measurements made by continuous glucose monitors (CGMs). This study compared the duration of this delay for three CGMs. Methods: A total of 24 healthy adolescent and adult subjects with type 1 diabetes wore three CGM devices simultaneously for 48 hours: Dexcom G4 Platinum, Abbott Navigator, and Medtronic Enlite. The time delay between PG and CGM-estimated plasma glucose (CGMG) was estimated by comparing time-shifted CGMG with reference PG taken every 15 minutes. Results: The delay estimated by our approach was larger for the Navigator than for the G4 Platinum in adolescents (7.7 ± 1.1 versus 5.6 ± 0.9 min, P = .0396) and adults (10.9 ± 1.1 versus 8.1 ± 0.7 min, P = .0107). The delay was nominally longer for the Navigator than for the Enlite in both the adolescent (7.7 ± 1.1 versus 4.3 ± 1.0 min, P = .0728) and adult (10.9 ± 1.1 versus 8.3 ± 0.9 min, P = .111) populations, but these differences were not statistically significant. There was no difference in the delay between G4 Platinum and Enlite. Adolescents had shorter delays than adults for all three devices. There was a significant correlation between longer delay and increasing age for the G4 Platinum and Navigator. Conclusions: There are differences in the estimated PG to CGMG time delays between CGM devices in the same subjects. The delay between PG and CGMG is smaller for adolescents than for adults. The PG–to–CGMG time delay is influenced by both instrument and host factors.
A meta-analysis of antibacterial envelope use in prevention of cardiovascular implantable electronic device infection
Authors: Ali Sajid , Kanjwal Yousuf , Bruhl Steven R. , Alo Mohammed , Taleb Mohammed , Ali Syed S. , Kabour Ameer , Khawaja Owais 
Published: May 2017

Objectives: Cardiac implantable electronic device (CIED) infection has been a major clinical problem in addition to being a major financial burden. In spite of antimicrobial prophylaxis, CIED infection rates have been increasing disproportionately. We therefore conducted this meta-analysis to assess the role of TYRX antibiotic envelope for the prevention of CIED infection. Methods: Using extensive online search, we conducted a meta-analysis of studies reporting CIED infections with versus without the use of TYRX antibiotic envelope. A random-effect model was used, and between studies heterogeneity was estimated with I2. All analyses were performed with RevMan (version 5.0.20). Results: Five cohort studies were included in this meta-analysis. The pooled odds ratio (OR) of included studies was 0.29 [95% confidence interval (CI): 0.09–0.94; p < 0.004]. There was evidence of heterogeneity with I2 of 58%. There was also evidence of publication bias on funnel plot analysis. On sensitivity analysis, no statistically significant difference was noted when stratified by study design or duration of follow-up. Conclusion: The results of our study demonstrate a significant beneficial effect of TYRX antibiotic envelope for the prevention of CIED infections.
Racial Disparities in Elderly Patients Receiving Lumbar Spinal Stenosis Surgery
Authors: Drazin Doniel , Shweikeh Faris , Lagman Carlito , Ugiliweneza Beatrice , Boakye Maxwell 
Published: May 2017

Study Design: Retrospective cohort study. Objective: To evaluate for racial disparities in elderly patients having undergone lumbar spinal stenosis surgery. Methods: The US Medicare Provider Analysis and Review database (records from 2005 to 2011) was used to identify patients over the age of 65 years, diagnosed with lumbar spinal stenosis, and having undergone lumbar laminectomy or fusion surgery. Blacks were compared to Whites in both unmatched and propensity score-matched populations. The data was analyzed with univariate (χ2 and Wilcoxon rank sum tests for unmatched comparison, and McNemar exact and signed rank sum tests for matched comparison) and multivariate models. Results: Query of the data resulted in a study sample of 12 807 patients; 514 (4.0%) were identified as Black and 12 293 (96%) as White. Blacks were less likely to be discharged home (42.4% vs 58.9%, P < .0001) and had lower repeat operation rates (6.81% vs 11.5%, P = .0009); both remained significant in the propensity score-matched comparison. Finally, Blacks experienced more postoperative complications, higher median Medicare costs, but lower out-of-pocket expenses ( P = .0113). Blacks had higher rates of diabetes (33.7% vs 21.5%, P < .0001) and obesity (9.92% vs 6.85%, P = .0074), when compared to Whites, but these comorbidities did not significantly affect odds of 30-day complications. Conclusions: Black patients having undergone lumbar spinal stenosis surgery were more likely to have received fusion at initial operation, had shorter pre- and postoperative follow-up intervals and displayed variances in discharge disposition. Reasons for these differences are not entirely understood; however, educational and socioeconomic factors and possibly ethnic/cultural biases may have contributed. Racial disparities in health care continue to be identified and should be further explored in order to eliminate them.
Effectiveness of Operative and Nonoperative Care for Adult Spinal Deformity: Systematic Review of the Literature
Authors: Teles Alisson R. , Mattei Tobias A. , Righesso Orlando , Falavigna Asdrubal 
Published: May 2017

Study Design: Systematic review. Objective: There is a need for synthesizing data on effectiveness of treatments for patients with adult spinal deformity (ASD) due to its increasing prevalence and health care costs for these patients. The objective of this review was to estimate the effectiveness of surgery versus nonoperative care in patients with ASD. Methods: A systematic review of articles in published in English using PubMed between 2005 and 2015. Surgical and nonsurgical series that reported baseline and follow-up health-related quality of life measures of patients with ASD with a minimum 2 years of follow-up were selected. Independent extraction of articles by 2 authors using predefined data fields, including risk of bias assessment. Results: Surgery significantly reduces disability, pain, and improves patients’ quality of life. The average postoperative improvement in Oswestry Disability Index was −19.1 (±9.0), Numerical Rating Scale back pain −4.14 (±1.38), Numerical Rating Scale leg pain −3.36 (±1.33), Short-Form Health Survey 36-SF36-Physical Component score 11.2 (±5.07), and Short-Form Health Survey 36-Mental Component score 9.93 (±4.96). The complication rate ranged from 9.52% to 81.52% (mean = 39.62%), and the need for revision surgery ranged from 1.72% to 40.0% (mean = 15.71%). The best existing evidence about nonoperative care of ASD is provided from observational studies with very high risk of bias. Quantitative analyses of nonsurgical cohorts did not demonstrate significant changes in quality of life of patients after 2 years of observation. Conclusions: This data may assist clinicians to counsel patients, as well as to inform health care providers and policymakers about what to expect from the treatment for ASD.
The fate of Baker’s cyst after total knee arthroplasty
Authors: Hommel Hagen 
Published: May 2017

Aims and Objectives: Baker’s cysts are common in knees with degenerative changes. Common opinion is that most them vanish after treatment of the intraarticular knee disorder. The present study aimed to evaluate the fate of Baker’s cyst and its associated symptoms after TKA. Materials and Methods: In this prospective study, 105 patients with a MRI verified Baker’s cyst, primary OA and an appointment for TKA were included. Three patients were lost to follow-up (two died and one septic TKA removal). Mean age was 70.1 ± 7 years. Ultrasound was performed to evaluate the existing and the gross size of the cyst was performed before and one year (mean 12.3 ± 1.1 months) after TKA. Additionally, Baker’s cyst associated symptoms were recorded Results: After one year, Baker’s cysts were still detected in 85.3% of the patients (n = 87). There was a significant reduction in Baker’s cyst associated symptoms from before (70.6%) to after surgery (31.4%; p < 0.0001). No patients developed new Baker’s cyst associated symptoms. However, out of the 72 patients that reported preoperatively about Baker’s cyst associated symptoms, one year after surgery 44.4% (n = 32) of the patients still complained about Baker’s cyst associated symptoms. The size of Baker’s cysts decreased significantly from pre- (mean 1447 mm2) to postoperative (969 mm2) ultrasound assessment (p < 0.0001). Conclusion: Baker’s cysts vanished only in a small amount of patients (15%) one year after TKA. Nevertheless in this in general considered successful surgery, in close to half of the patients (44.4%) with preoperative Baker’s cyst associated symptoms, these symptoms did not vanish until one year after TKA. Thus, it might be worthwhile to evaluate its treatment options and include them in future treatment plans.
A new surgical technique for functional implant alignment in varus osteoarthritis using patient-specific instrumentation (PSI)
Authors: Hommel Hagen 
Published: May 2017

Aims and Objectives: The use of patient-specific instruments (PSI) in total knee arthroplasty (TKA) has seen growing interest over the past years. A potential disadvantage of PSI is that functional implant alignment is not applicable in this technique. This study therefore aimed to develop a surgical technique for ligament-balanced implant alignment based on PSI, and to present the results obtained using this technique. Materials and Methods: 25 patients were included in this prospective study. PSI was used for the resection of the extension gap. Ligament tension was measured after removal of all accessible osteophytes. In the event of asymmetry, the distal femur resection was adjusted up to 2.5° using an adjustable cutting block. The aim was to achieve a symmetrical extension gap without release, not a neutral leg axis. Femoral rotation was aligned on the basis of ligament tension. Patients were followed up 3 months postoperatively. Results: The postoperative whole-leg axis was 2.8°±1.6° varus. Patients achieved a flexion of 118.9°±9°, a Knee Score of 91.5±3.2 and a Function Score of 86.8±8.3 points. Conclusion: For the first time, the new surgical technique described here permits a functional, ligament-balanced implant alignment based on PSI. It was shown to be safe, with encouraging clinical and radiological results.
Prospective Short-term MRI controlled investigation of the healing properties of the Meniscus
Authors: Willinger Lukas , Förschner Felix , Imhoff Andreas , Herbst Elmar 
Published: May 2017

Aims and Objectives: The purpose of the study was to prospectively investigate signal alterations in short-term follow-up after acute meniscus repair on specific magnetic resonance imaging (MRI) scan sequences. It was hypothesized that 1) there are different meniscus healing properties depending on lesion configuration and size, and 2) the tear zone has an influence on the healing properties of the meniscus. Materials and Methods: We conducted this prospective short-term clinical and radiological study to investigate the healing properties of acute meniscus tears. Inclusion criteria were patients (age 18-45 years) with traumatic meniscus lesion, subsequent arthroscopic meniscus repair within 6 weeks and preoperative MRI. Exclusion criteria were age < 18 or >45 years, arthrosis > grade III and multiligamentous knee injuries. Clinical examination and outcome scores (IKDC, KOOS, Lysholm Score) were surveyed preoperatively and 12 weeks after surgery. Meniscus tears were classified according to the ISAKOS meniscus classification system on MRI scans. Radiological assessment using a 3T-MRI was performed preoperatively and 2, 4, 6 and 12 weeks after operation. Meniscus healing were classified according to Henning’s criteria in A) healed, B) partially healed (> 50%) and C) not healed. Data were analyzed using SPSS statistics software version 21 (IBM, New York, USA). Statistical significance was set at a p value of < 0.05. Results: These are preliminary results of 14 patients (13 m, 1w) with a total of 16 meniscus tears. According to the ISAKOS meniscus classification system 9 medial and 7 lateral meniscus tears were included and average tear length was 21.5 mm (6 - 40 mm). 12 tears were located in the rim zone 1 and 4 tears were more medially in zone 2. In 8 (57%) patients an additional anterior cruciate ligament (ACL) reconstruction was performed. Six weeks postoperatively 8 menisci (50%) were deemed healed, 6 menisci (37%) partially healed whereas 2 menisci were not healed (13%). After 12 weeks 9 menisci (56%) were considered healed, 4 menisci (25%) partially healed and 3 menisci (19%) showed intrameniscal joint fluid in more than 50% of meniscus thickness. Two bucket handle tears of the medial meniscus and one radial tear of the lateral meniscus, all located in the red-red zone sized 35 mm, 25 mm and 12 mm, were not healed after 12 weeks. Clinical scores improved significantly 12 weeks after surgery: IKDC Score (preOP: 46.7, postOP: 67.8), KOOS (preOP: 49.7, postOP: 79.1) and Lysholm Score (preOP: 49.5, postOP: 77.7) (p < 0.05). Conclusion: Clinical and radiological follow-up showed good short-term results after meniscus repair. MRI revealed signal alteration in all menisci after 12 weeks, in most instances considered as scar tissue without intrameniscal joint fluid. In this cohohrt tear size and location was not correlated with non-healing. Arthroscopic meniscus repair achieves a high healing response of the meniscus and good clinical outcomes.
Tunnel-enlargement after MPFL reconstruction with a free gracilis graft does correlation with proximal tunnel malposition
Authors: Turgay Efe , Höger Almut , Figiel Jens , Roessler Philip , Schüttler Karl-Friedrich , Seif Ali 
Published: May 2017

Aims and Objectives: In current literature only one study investigates femoral tunnel enlargement after medial patello-femoral ligament (MPFL) reconstruction. Aim of the present study was to investigate the occurrence of femoral tunnel enlargement after MPFL reconstruction and a possible correlation to femoral tunnel position as well as clinical outcome. Materials and Methods: Patients with a minimum follow-up of at least 24 months after MPFL reconstruction with a free gracilis graft and without concomitant procedures were identified by reviewing patient files. Patients meeting the inclusion criteria were contacted and invited to participate in the study. After informed consent a clinical examination as well as magnetic resonance imaging (MRI) were performed. Tegner activity scale, Kujala score as well as the IKDC were evaluated. On MR images tunnel position in frontal and saggital planes, tunnel diameter as well as possible confounders such as cartilage damage were assessed. Results: 31 consecutive Patients (23 female, 8 male) were identified and took part in this ongoing investigation. Mean follow-up was 4.1 years. A femoral tunnel enlargement was noted in 12 patients. In 9 of these 12 patients the femoral tunnel was positioned too proximal. In the 19 patients that showed no tunnel enlargement only 6 tunnels were placed too proximal. Clinical results did not differ significantly between patient groups with or without tunnel enlargement regarding range of motion of the knee joint, Tegner, Kujala or IKDC score. Conclusion: Proximal malposition of the femoral tunnel was significantly more often in patients with femoral tunnel enlargement implying a biomechanical reason for tunnel enlargement after MPFL reconstruction. An impact on clinical outcome could not be perceived.
MicroRNA-223 demonstrated experimentally in exosome-like vesicles is associated with decreased risk of persistent pain after lumbar disc herniation
Authors: Moen Aurora , Jacobsen Daniel , Phuyal Santosh , Legfeldt Anna , Haugen Fred , Røe Cecilie , Gjerstad Johannes 
Published: May 2017

Abstract
Background
Previous findings have demonstrated that lumbar radicular pain after disc herniation may be associated with up-regulation of inflammatory mediators. In the present study we examined the possible role of extracellular microRNAs (miRs) in this process.

Methods
Single unit recordings, isolation of exosome-like vesicles, electron microscopy, nanoparticle tracking analysis, western blot analysis and qPCR were used in rats to demonstrate the effect of nucleus pulposus (NP) applied onto the dorsal nerve roots. ELISA and qPCR were used to measure the level of circulating IL-6 and miRs in a 1-year observational study in patients after disc herniation.

Results
In the rats, enhanced spinal cord nociceptive responses were displayed after NP applied onto the dorsal nerve roots. An increased release of small non-coding RNAs, including miR-223, miR-760 and miR-145, from NP in exosome-like vesicles was demonstrated. In particular, the NP expression of miR-223, which inhibited the nociceptive spinal signalling, was increased. In the patients, increased extracellular miR-223 was also verified in the acute phase after disc herniation. The increased miR-223 expression was, however, only observed in those who recovered (sex, age and smoking were included as covariates).

Conclusions
Our findings suggest that miR-223, which can be released from the NP after disc herniation, attenuates the neuronal activity in the pain pathways. Dysregulation of miR-223 may predict chronic lumbar radicular pain.
Trial registration/ethics REK 2014/1725
In-patient suicide: Selection of people at risk, failure of protection and the possibility of causation
Authors: Large Matthew Michael , Chung Daniel Thomas , Davidson Michael , Weiser Mark , Ryan Christopher James 
Published: May 2017

BackgroundBeing a current psychiatric in-patient is one of the strongest statistical risk factors for suicide. It is usually assumed that this strong association is not causal but is a result of the combination of the selection of high-risk patients for admission and the imperfect protection from suicide afforded by psychiatric wards. Logically, a third factor, which is causal, might play a role in the association. It has recently been suggested that adverse experiences in psychiatric units such as trauma, stigma and loss of social role might precipitate some in-patient suicides.AimsTo consider whether there is a causal association between psychiatric hospitalisation and suicide.MethodWe used the framework of Austin Bradford Hill's criteria for assessing causality in epidemiology to consider the possibility that psychiatric hospitalisation might causally contribute to the extent and variation in in-patient suicide rates.ResultsThe association between psychiatric hospitalisation and suicide clearly meets five of the nine Hill's criteria (strength of association, consistency, plausibility, coherence and analogy) and partially meets three of the remaining four criteria (gradient of exposure, temporality and experimental evidence).ConclusionsAdmission to hospital itself might play a causal role in a proportion of in-patient suicides. The safety of being in hospital with respect to suicide could be examined with a large-scale randomised controlled trial (RCT). In the absence of an RCT, the possibility of a causal role provides further impetus to calls to make care in the community more available and psychiatric hospitals more acceptable to patients.