bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers to Career Flexibility in Academic Medicine: A Qualitative Analysis of Reasons for the Underutilization of Family-Friendly Policies, and Implications for Institutional Change and Department Chair Leadership
Authors: Shauman Kimberlee , Howell Lydia P. , Paterniti Debora A. , Beckett Laurel A. , Villablanca Amparo C. 
Published: August 2017

Purpose
Academic medical and biomedical professionals need workplace flexibility to manage the demands of work and family roles and meet their commitments to both, but often fail to use the very programs and benefits that provide flexibility. This study investigated the reasons for faculty underutilization of work–life programs.

Method
As part of a National Institutes of Health–funded study, in 2010 the authors investigated attitudes of clinical and/or research biomedical faculty at the University of California, Davis, toward work–life policies, and the rationale behind their individual decisions regarding use of flexibility policies. The analysis used verbatim responses from 213 of 472 faculty (448 unstructured comments) to a series of open-ended survey questions. Questions elicited faculty members’ self-reports of policy use, attitudes, and evaluations of the policies, and their perceptions of barriers that limited full benefit utilization. Data were coded and analyzed using a grounded theory approach.

Results
Faculty described how their utilization of workplace flexibility benefits was inhibited by organizational influences: the absence of reliable information about program eligibility and benefits, workplace norms and cultures that stigmatized program participation, influence of uninformed/unsupportive department heads, and concerns about how participation might burden coworkers, damage collegial relationships, or adversely affect workflow and grant funding.

Conclusions
Understanding underuse of work–life programs is essential to maximize employee productivity and satisfaction, minimize turnover, and provide equal opportunities for career advancement to all faculty. The findings are discussed in relation to specific policy recommendations, implications for institutional change, and department chair leadership.
Characterizing the Age and Stimulus Frequency Interaction for Ocular Vestibular-Evoked Myogenic Potentials
Authors: Singh Niraj Kumar , Firdose Husna 
Published: August 2017

Objectives:
The normal process of aging is mostly associated with global decline in almost all sensory aspects of the human body. While aging affects the 500-Hz tone burst–evoked ocular vestibular-evoked myogenic potentials (oVEMPs) by reducing the amplitudes and prolonging the latencies, its interaction with oVEMP responses at other frequencies has not been studied. Therefore, the present study aimed at investigating the impact of advancing age on the frequency tuning of oVEMP.

Design:
Using a cross-sectional research design, oVEMPs were recorded for tone burst frequencies of 250, 500, 750, 1000, 1500, and 2000 Hz from 270 healthy individuals divided into six age groups (10–20, 20–30, 30–40, 40–50, 50–60, and >60 years).

Results:
The results revealed significantly lower response rates and amplitudes in age groups above 50 years of age than all the other groups at nearly all the frequencies (p < 0.05). Further, the frequency tuning was obtained at 500 or 750 Hz in majority of individuals below 60 years of age and at ≥1000 Hz in most of the individuals above 60 years of age (p < 0.05). Thus, there was a significant shift in frequency tuning of oVEMP from 500 or 750 Hz in the younger and the middle-aged adults to ≥1000 Hz in older adults, especially above 60 years of age.

Conclusions:
The results of the study showed significantly higher prevalence of frequency tuning at 1000 Hz in older adults above 60 years of age. Because the shift in frequency tuning to ≥1000 Hz is frequently used for identification of Meniere’s disease, it is suggested that age-related correction be used for the diagnosis of Meniere’s disease when using frequency tuning of oVEMP.
Application of AOSpine Subaxial Cervical Spine Injury Classification in Simple and Complex Cases
Authors: Aarabi Bizhan , Oner Cumhur , Vaccaro Alexander R. , Schroeder Gregory D. , Akhtar-Danesh Noori 
Published: August 2017

Introduction:
Cervical spine injury classification systems should be simple, easy to relate and remember, reliable guide for surgical planning, and predictor of outcome in clinical settings. We investigated whether the AOSpine subaxial cervical spine classification system predicted injury severity and neurologic outcome.

Material and Methods:
We analyzed the relevant clinical, imaging, management, and American Spinal Injury Association (ASIA) impairment scale (AIS) grade conversion of 92 AIS grades A–C patients with cervical spine injury. We correlated morphology class with age, injury severity score (ISS), follow-up ASIA motor score (AMS), intramedullary lesion length (IMLL), and AIS grade conversion at 6 months after injury.

Results:
The mean age of patients was 39.3 years, 83 were men, and 69 were injured during an automobile accident or after a fall. The AOSpine class was A4 in 8, B2 in 5, B2A4 in 16, B3 in 19, and C in 44 patients. The mean ISS was 29.7 and AMS was 17.1. AIS grade was A in 48, B in 25, and C in 19 patients. Mean IMLL on postoperative magnetic resonance imaging was 72 mm: A4 = 68.1; B2A4 = 86.5; B2 = 59.3; B3 = 46.8; and C = 79.9. At a mean follow-up of 6 months, the mean AMS was 39.6. Compared to patients with class B3 injuries, those with class C injuries were significantly younger (P < 0.0001), had longer IMLL (P < 0.002), and were less likely to have AIS grade conversion to a better grade (P < 0.02).

Conclusions:
The AOSpine subaxial cervical spine injury classification system successfully predicted injury severity (longer IMLL) and chances of neurologic recovery (AIS grade conversion) across different class subtypes.
Does Surgical Intervention or Timing of Surgery Have an Effect on Neurological Recovery in the Setting of a Thoracolumbar Burst Fracture?
Authors: Kato So , Murray Jean-Christophe , Kwon Brian K. , Schroeder Gregory D. , Vaccaro Alexander R. , Fehlings Michael G. 
Published: August 2017

Summary:
Traumatic thoracolumbar burst fractures are one of the most common forms of spinal trauma with the majority occurring at the junctional area where mechanical load is maximal (AOSpine Thoracolumbar Spine Injury Classification System Subtype A3 or A4). Burst fractures entail the involvement of the middle column, and therefore, they are typically associated with bone fragment in the spinal canal, which may cause compression of the spinal cord, conus medullaris, cauda equina, or a combination of these. Fortunately, approximately half of the patients with thoracolumbar burst fractures are neurologically intact due to the wide canal diameter. Recent evidences have revealed that functional outcomes in the long term may be equivalent between operative and nonoperative management for neurologically intact thoracolumbar burst fractures. Nevertheless, consensus has not been met regarding the optimal treatment strategy for those with neurological deficits. The present review article summarizes the contemporary evidences to discuss the role of nonoperative management in the presence of neurological deficits and the optimal timing of decompression surgery for neurological recovery. In summary, although operative management is generally recommended for thoracolumbar fracture with significant neurological deficits, the evidence is weak, and nonoperative management can also be an option for those with solitary radicular symptoms. With regards to timing of operative management, high-quality studies comparing early and delayed intervention are lacking. Extrapolating from the evidence in cervical spine injury leads to an assumption that early intervention would also be beneficial for neurological recovery, but further studies are warranted to answer these questions.
Osteoporotic Thoracolumbar Fractures—How Are They Different?—Classification and Treatment Algorithm
Authors: Rajasekaran Shanmuganathan , Kanna Rishi M. , Schnake Klaus J. , Vaccaro Alexander R. , Schroeder Gregory D. , Sadiqi Said , Oner Cumhur 
Published: August 2017

Summary:
Osteoporotic vertebral fractures constitute at least 50% of the osteoporotic fractures that happen worldwide. Occurrence of osteoporotic fractures make the elderly patient susceptible for further fractures and increases the morbidity due to kyphosis and pain; the mortality risk is also increased in these patients. Most fractures occur in the thoracic and thoracolumbar region and are often stable. Different descriptive and prognostic classification systems have been described, but none are universally accepted. Radiographs, computed tomography, and magnetic resonance imaging are useful in imaging the fracture and evaluating the bone density. In acute stages, the fractures are well treated with conservative measures including short bed rest, analgesics, bracing, and exercises. Although most fractures heal well, up to 30% of fractures can develop painful nonunion, progressive kyphosis, and neurological deficit. For patients who develop severe pain not responding to nonoperative measures and painful nonunion, percutaneous cement augmentation procedures including vertebroplasty or kyphoplasty have been suggested. For fractures with severe collapse and that lead to neurological deficit and increasing kyphosis, instrumented stabilization is advised. Prevention and management of osteoporosis is the key element in the management of osteoporotic fractures in the elderly. Guidelines for essential adequate dietary and supplemental calcium and vitamin D, and antiosteoporotic medications have been described.
Spine Trauma—What Are the Current Controversies?
Authors: Oner Cumhur , Rajasekaran Shanmuganathan , Chapman Jens R. , Fehlings Michael G. , Vaccaro Alexander R. , Schroeder Gregory D. , Sadiqi Said , Harrop James 
Published: August 2017

Summary:
Although less common than other musculoskeletal injuries, spinal trauma may lead to significantly more disability and costs. During the last 2 decades there was substantial improvement in our understanding of the basic patterns of spinal fractures leading to more reliable classification and injury severity assessment systems but also rapid developments in surgical techniques. Despite these advancements, there remain unresolved issues concerning the management of these injuries. At this moment there is persistent controversy within the spinal trauma community, which can be grouped under 6 headings. First of all there is still no unanimity on the role and timing of medical and surgical interventions for patients with associated neurologic injury. The same is also true for type and timing of surgical intervention in multiply injured patients. In some common injury types like odontoid fractures and burst type (A3-A4) fractures in thoracolumbar spine, there is wide variation in practice between operative versus nonoperative management without clear reasons. Also, the role of different surgical approaches and techniques in certain injury types are not clarified yet. Methods of nonoperative management and care of elderly patients with concurrent complex disorders are also areas where there is no consensus. In this overview article the main reasons for these controversies are reviewed and the possible ways for resolutions are discussed.
Management of Hangman's Fractures: A Systematic Review
Authors: Murphy Hamadi , Schroeder Gregory D. , Shi Weilong J. , Kepler Christopher K. , Kurd Mark F. , Fleischman Andrew N. , Kandziora Frank , Chapman Jens R. , Benneker Lorin M. , Vaccaro Alexander R. 
Published: August 2017

Background:
Traumatic spondylolisthesis of the axis, is a common cervical spine fracture; however, to date there is limited data available to guide the treatment of these injuries. The purpose of this review is to provide an evidence-based analysis of the literature and clinical outcomes associated with the surgical and nonsurgical management of hangman's fractures.

Methods:
A systematic literature search was conducted using PubMed (MEDLINE) and Scopus (EMBASE, MEDLINE, COMPENDEX) for all articles describing the treatment of hangman's fractures in 2 or more patients. Risk of nonunion, mortality, complications, and treatment failure (defined as the need for surgery in the nonsurgically managed patients and the need for revision surgery for any reason in the surgically managed patients) was compared for operative and nonoperative treatment methods using a generalized linear mixed model and odds ratio analysis.

Results:
Overall, 25 studies met the inclusion criteria and were included in our quantitative analysis. Bony union was the principal outcome measure used to assess successful treatment. All studies included documented fracture union and were included in statistical analyses. The overall union rate for 131 fractures treated nonsurgically was 94.14% [95% confidence interval (CI), 76.15–98.78]. The overall union rate for 417 fractures treated surgically was 99.35% (95% CI, 96.81–99.87). Chance of nonunion was lower in those patients treated surgically (odds ratio, 0.12; 95% CI, 0.02–0.71). There was not a significant difference in mortality between patients treated surgically (0.16%; 95% CI, 0.01%–2.89%) and nonsurgically (1.04%; 95% CI, 0.08%–11.4%) (odds ratio, 0.15; 95% CI, 0.01–2.11). Treatment failure was less likely in the surgical treatment group (0.12%; 95% CI, 0.01%–2.45%) than the nonsurgical treatment group (0.71%; 95% CI, 0.28%–15.75%) (odds ratio 0.07; 95% CI, 0.01–0.56).

Conclusion:
Hangman's fractures are common injuries, and surgical treatment leads to an increase in the rate of osteosynthesis/fusion without significantly increasing the rate of complication. Both an anterior and a posterior approach result in a high rate of fusion, and neither approach seems to be superior.
Patient Perceptions of the Use of Medical Marijuana in the Treatment of Pain After Musculoskeletal Trauma: A Survey of Patients at 2 Trauma Centers in Massachusetts
Authors: Heng Marilyn , McTague Michael F. , Lucas Robert C. , Harris Mitchel B. , Vrahas Mark S. , Weaver Michael J. 
Published: August 2017

Objective:To evaluate musculoskeletal trauma patients' beliefs regarding the usefulness of marijuana as a valid medical treatment for postinjury and postoperative pain and anxiety.Design:Prospective survey.Setting:Two academic Level 1 trauma centers.Patients/Participants:Five hundred patients in an orthopedic outpatient clinic.Intervention:Survey.Main Outcome Measurements:(1) Do patients believe that marijuana can be used as medicine? (2) Do patients believe that marijuana can help treat postinjury pain? (3) Are patients comfortable speaking with their health care providers about medical marijuana?Results:The majority of patients felt that marijuana could be used to treat pain (78%, 390) and anxiety (62%, 309). Most patients (60%, 302) had used marijuana at least once previously, whereas only 14% reported using marijuana after their injury. Of those who used marijuana during their recovery, 90% (63/70) believed that it reduced symptoms of pain, and 81% (57/70) believed that it reduced the amount of opioid pain medication they used.Conclusions:The majority of patients in this study believed that medical marijuana is a valid treatment and that it does have a role in reducing postinjury and postoperative pain. Those patients who used marijuana during their recovery felt that it alleviated symptoms of pain and reduced their opioid intake. Our results help inform clinicians regarding the perceptions of patients with trauma regarding the usefulness of marijuana in treating pain and support further study into the utility of medical marijuana in this population.
A Prospective Randomized Study on Operative Treatment for Simple Distal Tibial Fractures—Minimally Invasive Plate Osteosynthesis Versus Minimal Open Reduction and Internal Fixation
Authors: Kim Ji Wan , Kim Hyun Uk , Oh Chang-Wug , Kim Joon-Woo , Park Ki Chul 
Published: August 2017

Objectives:
To compare the radiologic and clinical results of minimally invasive plate osteosynthesis (MIPO) and minimal open reduction and internal fixation (ORIF) for simple distal tibial fractures.

Design:
Randomized prospective study.

Setting:
Three level 1 trauma centers.

Patients:
Fifty-eight patients with simple and distal tibial fractures were randomized into a MIPO group (treatment with MIPO; n = 29) or a minimal group (treatment with minimal ORIF; n = 29). These numbers were designed to define the rate of soft tissue complication; therefore, validation of superiority in union time or determination of differences in rates of delayed union was limited in this study.

Intervention:
Simple distal tibial fractures treated with MIPO or minimal ORIF.

Main Outcome Measurements:
The clinical outcome measurements included operative time, radiation exposure time, and soft tissue complications. To evaluate a patient's function, the American Orthopedic Foot and Ankle Society ankle score (AOFAS) was used. Radiologic measurements included fracture alignment, delayed union, and union time.

Results:
All patients acquired bone union without any secondary intervention. The mean union time was 17.4 weeks and 16.3 weeks in the MIPO and minimal groups, respectively. There was 1 case of delayed union and 1 case of superficial infection in each group. The radiation exposure time was shorter in the minimal group than in the MIPO group. Coronal angulation showed a difference between both groups. The American Orthopedic Foot and Ankle Society ankle scores were 86.0 and 86.7 in the MIPO and minimal groups, respectively. Minimal ORIF resulted in similar outcomes, with no increased rate of soft tissue problems compared to MIPO.

Conclusions:
Both MIPO and minimal ORIF have high union rates and good functional outcomes for simple distal tibial fractures. Minimal ORIF did not result in increased rates of infection and wound dehiscence.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Ewing Sarcoma of the Spine
Authors: Charest-Morin Raphaële , Dirks Michael S. , Patel Shreyaskumar , Boriani Stefano , Luzzati Alessandro , Fehlings Michael G. , Fisher Charles G. , Dekutoski Mark B. , Williams Richard , Quraishi Nasir A. , Gokaslan Ziya L. , Bettegowda Chetan , Germscheid Niccole M. , Varga Peter P. , Rhines Laurence D. 
Published: August 2017

Study Design.
Multicenter, ambispective observational study.

Objective.
To quantify mortality and local recurrence after surgical treatment of spinal Ewing sarcoma (ES) and to determine whether an Enneking appropriate procedure and surgical margins (en bloc resection with wide/marginal margins) are associated with improved prognosis.

Summary of Background Data.
Treatment of primary ES of the spine is complex. Ambiguity remains regarding the role and optimal type of surgery in the treatment of spinal ES.

Methods.
The AOSpine Knowledge Forum Tumor developed a multicenter database including demographics, diagnosis, treatment, mortality, and recurrence rate data for spinal ES. Patients were stratified based on surgical margins and Enneking appropriateness. Survival and recurrence were analyzed using Kaplan-Meier curves and log-rank tests.

Results.
Fifty-eight patients diagnosed with primary spinal ES underwent surgery. Enneking appropriateness of surgery was known for 55 patients; 24 (44%) treated Enneking appropriately (EA) and 31 (56%) treated Enneking inappropriately (EI). A statistically significant difference in favor of EA-treated patients was found with regards to survival (P = 0.034). Neoadjuvant and postoperative chemotherapy was significantly associated with increased survival (P = 0.008). Local recurrence occurred in 22% (N = 5) of patients with an EA procedure versus 38% (N = 11) of patients with an EI procedure. The timing of chemotherapy treatment was significantly different between the Enneking cohorts (P < 0.001) and all EA-treated patients received chemotherapy treatment. Although, local recurrence was not significantly different between Enneking cohorts (P = 0.140), intralesional surgical margins and patients who received a previous spine tumor operation were associated with increased local recurrence (P = 0.025 and P = 0.018, respectively).

Conclusion.
Surgery should be undertaken when an en bloc resection with wide/marginal margins is feasible. An EA surgery correlates with improved survival, but the impact of other prognostic factors needs to be evaluated. En bloc resection with wide/marginal margins is associated with local control.

Level of Evidence: 3
Hyperbaric Oxygen Therapy After Acute Thoracic Spinal Cord Injury
Authors: Falavigna Asdrubal , Figueiró Manuela Peletti , Silva Pedro Guarise da , Conzatti Lucas Piccoli , Rizkalla Elisa Braun , Santos Scheila Cardoso dos , Quadros Francine Würzius de , Radaelli Lucas 
Published: August 2017

Study Design.
A controlled laboratory study.

Objective.
The aim of this study was to analyze the effectiveness of hyperbaric therapy (HT) using mild and moderate models of spinal cord injury (SCI).

Summary of Background Data.
SCI can cause permanent impairment with socioeconomic consequences. The motor deficit occurs by two mechanisms: destruction of neuronal cells and local inflammatory response, resulting in hypoxia. HT acts by increasing oxygen in the injured area.

Methods.
Thoracic laminectomy was performed in 72 female Wistar rats. The MASCIS impactor was used at 12.5 mm (n = 35) and 25 mm (n = 35) of height to perform, respectively, mild and moderate SCI. Muscle strength was assessed through the Basso, Beattie, and Bresnahan scale (BBB) on days 1, 7, 14, 21, and 28 after SCI. The animals were randomized into five subgroups with seven animals each: (1) control group had SCI without HT; (2) HT 30 minutes after SCI; (3) HT 30 minutes after SCI and daily for 7 days; (4) HT 12 hours after SCI; and (5) HT 12 hours after SCI and daily for 7 days. HT was performed at 2.5 atm for 1 hour.

Results.
There was a linear relationship between injury severity and motor deficit until day 21, with similar BBB scores on day 28. A pattern of uniform lesions was observed in the mild SCI, with lower variation of BBB when compared with moderate SCI. All animals that underwent HT had significant improvement in motor function and histology when compared with control group. Regardless of the injury model, animals submitted to 7-day protocols had an early improvement in motor function and a smaller area of histological injury.

Conclusion.
The present study reported that the sooner HT is begun after mild and moderate SCI and the larger the number of sessions, the greater and earlier is the motor recovery and smaller is the tissue injury.

Level of Evidence: N/A