bluuebunny/crossref_metadata_2025_split huggingface dataset:
Operating Room Efficiency: Benefits of an Orthopaedic Traumatologist at a Level II Trauma Center
Authors: Althausen Peter L. , Kauk Justin R. , Shannon Steven , Lu Minggen , O’Mara Timothy J. , Bray Timothy J. 
Published: November 2016

Objectives:
Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to “best practice” outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center.

Design:
Retrospective review.

Setting:
Level II community-based trauma hospital.

Patients/Participants:
Patients who presented to the emergency room at our institution with fractures and orthopaedic conditions requiring surgical intervention from January 1, 2010, to December 31, 2011.

Intervention:
Operative fracture fixation by members of our orthopaedic trauma panel, including fellowship and nontrauma fellowship-trained orthopaedic surgeons.

Main Outcome Measurements:
Our institutional database was queried to determine operative times, surgical supply and implant costs, and surgery labor expenses. Patients were stratified according to those treated by our trauma panel’s 3 traumatologists and those treated by the 15 GOSs on our trauma panel. These 2 groups were then compared using standard statistical methods.

Results:
A total of 6449 orthopedic cases were identified and 2076 of these involved fracture care. One thousand one hundred ninety-nine patients were treated by traumatologists and 877 by GOSs. There was no statistical difference detected in American Society of Anesthesiologists score between trauma and nontrauma groups. Overall, the traumatologist group demonstrated significantly decreased procedure times when compared with the GOS group (55.6 vs. 75.8 minutes, P , 0.0001). In 16 of 18 most common procedure types, traumatologists were more efficient. This led to significantly decreased surgical labor costs ($381.4 vs. $484.8; P < 0.0001) and surgical supply and implant costs ($2567 vs. $3003; P < 0.0001).

Conclusions:
This study demonstrates that in our communitybased trauma system, fracture care provided by traumatologists results in improved utilization of hospital-based resources when compared with equivalent services provided by GOSs. Significantly decreased operative times, surgical labor expenses, and supply and implant costs by the fellowship-trained group represent enhanced control of the design, plan, execution, and monitoring of orthopaedic trauma care. Traumatologists can provide leadership recommendations for operating room efficiency in community-based orthopaedic trauma care models.

Level of Evidence:
Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Electrocochleography in Cochlear Implant Recipients With Residual Hearing: Comparison With Audiometric Thresholds
Authors: Koka Kanthaiah , Saoji Aniket A. , Litvak Leonid M. 
Published: November 2016

Objectives:
To determine whether electrocochleography (ECoG) thresholds, especially cochlear microphonic and auditory nerve neurophonic thresholds, measured using an intracochlear electrode, can be used to predict pure-tone audiometric thresholds following cochlear implantation in ears with residual hearing.

Design:
Pure-tone audiometric thresholds and ECoG waveforms were measured at test frequencies from 125 to 4000 Hz in 21 Advanced Bionics cochlear implant recipients with residual hearing in the implanted ear. The “difference” and “summation” responses were computed from the ECoG waveforms measured from two alternating phases of stimulation. The interpretation is that difference responses are largely from the cochlear microphonic while summating responses are largely from the auditory nerve neurophonic. The pure-tone audiometric thresholds were also measured with same equipment used for ECoG measurements.

Results:
Difference responses were observed in all 21 implanted ears, whereas summation response waveforms were observed in only 18 ears. The ECoG thresholds strongly correlated (r
2 = 0.87, n = 150 for difference response; r
2 = 0.82, n = 72 for summation response) with audiometric thresholds. The mean difference between the difference response and audiometric thresholds was −3.2 (±9.0) dB, while the mean difference between summation response and audiometric thresholds was −14 (±11) dB. In four out of 37 measurements, difference responses were measured to frequencies where no behavioral thresholds were present.

Conclusions:
ECoG thresholds may provide a useful metric for the assessment of residual hearing in cochlear implant subjects for whom it is not possible to perform behavioral audiometric testing.
Melanocytic Nevi of Special Sites
Authors: Ahn Christine S. , Guerra Analia , Sangüeza Omar P. 
Published: November 2016

Abstract:
Melanocytic nevi located on specific regions of the body can demonstrate unusual histopathological features such as asymmetry, irregular nesting patterns, pagetoid spread, cytologic atypia, and rarely, mitotic activity. However, despite these features that may raise concern for malignant melanoma, these lesions follow a benign clinical course and do not require intervention. Also known as nevi of special sites or nevi with site-related atypia, these melanocytic nevi were initially described on acral sites and genitalia. Now, additional anatomical sites with known site-related atypia include the ear, conjunctivae, scalp, breast, flexural skin, legs, and back and shoulder. This continuing medical education article presents a review of the histopathological characteristics of special site nevi based on anatomic location. It is imperative for dermatologists, pathologists, and dermatopathologists to distinguish benign melanocytic nevi with site-related atypia from malignant melanoma to avoid unnecessary surgical intervention or treatment.
A Comparative Study of the Water Drinking Test in Eyes With Open-Angle Glaucoma and Prior Trabeculectomy or Tube Shunt
Authors: Martinez Patricia , Trubnik Valerie , Leiby Benjamin E. , Hegarty Sarah E. , Razeghinejad Reza , Savant Shravan , Myers Jonathan S. 
Published: November 2016

Purpose:
To compare the intraocular pressure (IOP) response after the water drinking test (WDT) in patients who have undergone trabeculectomy or tube shunt surgery.

Methods:
This prospective study examined 40 eyes of 34 open-angle glaucoma subjects who had undergone trabeculectomy (n=20) or tube shunt surgery (n=20). Both groups were matched by IOP range and by number of topical antiglaucoma medications used. After a baseline IOP assessment, subjects drank 10 mL water per kg body weight over 15 minutes. IOP was then measured with a Goldman tonometer every 15 minutes over a 1-hour period. Outcomes measures were IOP peak, fluctuation, mean, and range.

Results:
No significant differences in baseline demographics, baseline clinical characteristics or IOP changes during the WDT were observed between the 2 surgical procedure groups. Mean baseline IOPs for the tube shunt and trabeculectomy groups were 12.55±4.23 and 12.3±4.28 mm Hg, respectively (P=0.854). In the trabeculectomy and tube shunt groups, respectively, peak IOP was 16.25±5.55 and 16.15±5.36 mm Hg (P=0.954); IOP fluctuation (IOP max—IOP baseline) was 3.95±2.17 and 3.6±2.23 mm Hg (P=0.618), and IOP range was 2.78±1.56 and 2.8±1.47 mm Hg (P=0.959). Statistical analysis of IOP fluctuation associations using multivariable linear regression determined that the use of systemic antihypertensive blood pressure medication was associated with an increase in IOP fluctuation of approximately 2 mm Hg.

Conclusions:
Subjects who had undergone either trabeculectomy or tube shunt surgery showed a similar IOP response to the WDT. Subjects on systemic antihypertensive medications experienced significantly greater IOP fluctuations during the test.
Novel Mutations in EPCAM Cause Congenital Tufting Enteropathy
Authors: Tang Wenjuan , Huang Taosheng , Xu Zhongyao , Huang Ying 
Published: November 2016

Background and Aims:
Congenital tufting enteropathy (CTE) is a rare autosomal recessive form of intractable diarrhea of infancy. Patients develop chronic diarrhea within days after birth, leading to severe malabsorption and significant mortality. CTE is characterized by subtotal villous atrophy with crypt hyperplasia. Typical features include abnormal villi in the intestinal epithelium and disorganization of surface enterocytes with focal crowding, resembling tufts. The pathogenesis of CTE remains poorly understood. CTE has been reported in Western populations, but until now had not been reported in China. The objective of this study was to identify the gene responsible for CTE in a Chinese individual.

Methods:
A 13-year-old girl with suspected CTE, whose parents were both healthy, was evaluated in our clinic. Tissues were obtained by endoscopy and examined by electron microscopy. Genomic DNA, extracted from the peripheral blood of the child and parents, was subjected to whole-exome sequencing. After mutations in the gene encoding epithelial cell adhesion molecule (EPCAM) were identified, expression of EPCAM was examined by immunohistochemistry staining.

Results:
Whole-exome sequencing revealed compound heterozygous mutations in EPCAM in the patient, with immunohistochemical analysis showing complete loss of EPCAM expression in the intestinal villi and crypts.

Conclusions:
We identified compound heterozygous mutations in EPCAM, with loss of EPCAM expression in duodenal enterocytes, in a patient with intractable diarrhea since infancy who was subsequently diagnosed with CTE. This is the first case of CTE to be reported in a Chinese patient.
Receipt of Caregiving and Fall Risk in US Community-dwelling Older Adults
Authors: Hoffman Geoffrey J. , Hays Ron D. , Wallace Steven P. , Shapiro Martin F. , Yakusheva Olga , Ettner Susan L. 
Published: November 2016

Background:
Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk.

Design:
Using the 2004–2012 waves of the Health and Retirement Study, we examined whether receipt of low (0–13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (≥3 activities of daily living) or cognitive limitations moderated this relationship.

Results:
Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (P<0.001) had stronger associations with reduced fall risk relative to low levels of informal care. Among individuals with ≥3 activities of daily living, fall risks were reduced by 21% for those receiving high levels of informal care; additionally, FRIs were reduced by 42% and 58% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54% FRI risk reduction among the cognitively impaired.

Conclusions:
Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.
Implications of molecular genetic diversity in myelodysplastic syndromes
Authors: Bejar Rafael 
Published: November 2016

Purpose of review
Myelodysplastic syndromes (MDS) have remarkably diverse somatic mutation patterns that can be challenging to interpret clinically. Yet, genetic information is increasingly available to physicians. This review will examine several implications of genetic diversity in MDS.

Recent findings
Somatic mutations can serve as clinically relevant biomarkers in MDS. Molecular subtypes may exist that share clinical features including risk of progression to acute myeloid leukemia, response to treatment, and overall survival. Several mutated genes are known to have prognostic value that is independent of common risk stratification tools. Mutations of several genes identify low-blast percentage patients with greater than predicted disease risk while only SF3B1 mutations predict lower disease risk than expected. Mutations of TP53 are associated with adverse features, yet demonstrate inferior outcomes than predicted by these risk factors. SF3B1 and TP53 mutations may identify clinically relevant subtypes of MDS and allow for better refinement of risk within these groups. Using somatic mutations to diagnose MDS is more challenging because they can occur in healthy individuals. Yet, patients with unexplained cytopenias have a high rate of clonal hematopoiesis that may be an important risk factor to identify clinically.

Summary
Patterns of somatic mutations are diverse in MDS, but can inform the prediction of prognosis and aid in its diagnosis.
Relationship Between HIV Infection, Antiretroviral Therapy, Inflammatory Markers, and Cerebrovascular Endothelial Function Among Adults in Urban China
Authors: Chow Felicia C. , Li Yanling , Hu Yinghuan , Chan Joy , Wang Huanling , Xu Weihai , Price Richard W. , Sorond Farzaneh A. , Li Taisheng 
Published: November 2016

Background:
Cerebrovascular risk is increased in people living with HIV infection compared with age-matched uninfected individuals. Cerebrovascular endothelial dysfunction related to antiretroviral therapy (ART) and inflammation may contribute to higher stroke risk in HIV infection.

Methods:
We compared cerebral vasoreactivity—a measure of cerebrovascular endothelial function assessed by the breath-holding index (BHI) using transcranial Doppler ultrasound—between virologically suppressed Chinese HIV-infected individuals followed in an HIV clinic in Beijing, China, and uninfected controls. We constructed mixed-effects models to evaluate the association of HIV, ART, and inflammatory markers with cerebral vasoreactivity.

Results:
In an unadjusted model, HIV infection was associated with a trend toward lower cerebral vasoreactivity (BHI 1.08 versus 1.26, P = 0.079). In multivariable analyses, cholesterol modified the association between HIV infection and cerebral vasoreactivity (P = 0.015 for interaction). At a lower total cholesterol of 4.15 mmol/L, HIV was associated with lower cerebral vasoreactivity (BHI −0.28, P = 0.019), whereas at a cholesterol of 5.15 mmol/L, the reduction in cerebral vasoreactivity associated with HIV was no longer statistically significant (BHI −0.05, P = 0.64). Among HIV-infected individuals, use of lopinavir/ritonavir compared with efavirenz was associated with lower cerebral vasoreactivity (BHI −0.24, P = 0.040). We did not find a significant association between inflammatory markers and cerebral vasoreactivity.

Conclusions:
Cerebrovascular endothelial dysfunction associated with HIV infection may be most relevant for individuals with less traditional vascular risk, such as those with lower cholesterol. Further study of the impact of ART on cerebrovascular endothelial function is warranted to aid with ART selection in individuals at high cerebrovascular risk.
Switching l-dopa Therapy from Pulsatile to Pulse Administration Reduces Motor Complications in Parkinson's Disease
Authors: Mostile Giovanni , Nicoletti Alessandra , Dibilio Valeria , Luca Antonina , Raciti Loredana , Sciacca Giorgia , Cicero Calogero Edoardo , Vasta Rosario , Donzuso Giulia , Contrafatto Donatella , Zappia Mario 
Published: November 2016

ObjectiveTo evaluate the severity of wearing-off and dyskinesia in patients with complicated Parkinson disease (PD) after switchingl-dopa oral therapy from a “pulsatile” administration, consisting in intermittent multiple daily small doses of the drug, to a “pulse” administration, consisting in standard oral doses given at specific interdose intervals.MethodsThirty-four PD patients with motor complications were monitored twice with standardized waking day motor status evaluations using the Unified Parkinson Disease Rating Scale-Motor Examination (UPDRS-ME) and the Abnormal Involuntary Movement Scale (AIMS) after switchingl-dopa administration modality from “pulsatile” to “pulse.” To quantify predictable motor fluctuations, a Wearing Off Index was computed based on changes in treatment response magnitude.ResultsOn the whole, after switching from “pulsatile” to “pulse” administration, there was a reduction in number ofl-dopa daily doses and an increase in the amount of the dosage of the single doses, AIMS maximum score decreased without increasing motor disability. More specifically, in predominant fluctuating patients, there was a significant reduction in UPDRS-ME average score as well as in Wearing Off Index. In predominant dyskinetic patients, there was a significant reduction in average and maximum AIMS scores with no changes in average and maximum UPDRS-ME scores.ConclusionsSwitchingl-dopa therapy from “pulsatile” to “pulse” modality may reduce the severity of wearing-off and dyskinesia in complicated PD.
Fingolimod Use for the Treatment of Multiple Sclerosis in a Clinical Practice Setting in Madrid
Authors: Galán Sánchez-Seco Victoria , Casanova-Peño Ignacio , Álvarez-Lafuente Roberto , Sánchez-Jiménez Mónica , García-Martínez Ángel , Domínguez-Mozo María Inmaculada , Arias-Leal Ana María , García-Montojo Marta , Arroyo-González Rafael 
Published: November 2016

Objective
To assess the effectiveness and safety of fingolimod use in a Spanish clinical practice setting.

Methods
Retrospective study with multiple sclerosis patients who received at least 1 fingolimod dose between January 2004 and January 2015. Effectiveness and safety data were collected during the entire treatment of each patient. Analysis was performed for the total population and stratified according to prior treatment, sex, and age at treatment initiation.

Results
A total of 167 patients were included, 50.9% had prior immunomodulator use, 33.5% natalizumab use, and 15.6% were naive patients. The annual relapse rate (ARR) decreased for the total population at month 12 (62%) and month 24 (84%) (P < 0.0001, in both cases); for naive patients (P < 0.05) and patients with prior immunomodulator use (P < 0.0001); for patients with prior natalizumab use, the ARR kept low after treatment initiation (0.23). After 24 months, the proportion of relapse-free patients was 70% or greater and disability progression-free patients was 80% or greater. No significant differences were observed when the results were compared by prior treatment, sex, or age. Thirty-two patients (19.2%) reported adverse drug reactions and 9.6% discontinued: 4.8% due to adverse drug reactions and 4.8% for lack of effectiveness.

Conclusions
The results support fingolimod use due to clinical effectiveness, tolerability, and ease of administration.
A Comparison of Magnetic Resonance Imaging and Electroneuromyography for Denervated Muscle Diagnosis
Authors: Tepeli Betül , Karataş Metin , Coşkun Mehmet , Yemişçi Oya Ümit 
Published: November 2016

Purpose:
The aim of this study was to evaluate the diagnostic value of magnetic resonance imaging (MRI) for muscle denervation due to focal lesions of the median nerve and to compare electrophysiological findings with MRI findings.

Methods:
Twenty-six patients with electrophysiological studies diagnosed for focal lesions of the median nerve were included in this study. Electrophysiological studies and MRI were conducted on 34 patients' hands. Patients' hands were divided into two groups based on edema findings revealed by the MRI: group 1 (edema-negative group; n = 24) and group 2 (edema-positive group; n = 10).

Results:
Positive correlations were found between the existence of edema in MRI and fibrillation, positive sharp waves, denervation, and the level of reduced recruitment pattern. In median nerve conduction studies, amplitude of compound muscle action potential and palm-to-wrist segment mixed-nerve action potentials were significantly lower, and also the third-digit wrist sensory nerve conduction velocity and mixed-nerve palm–wrist conduction velocity were significantly slower in group 2.

Conclusions:
For muscle denervation resulting from median nerve lesions, MRI findings correlated with electrophysiological findings; further study is required for the use of MRI.
Brief use of a specific gun in a violent game does not affect attitudes towards that gun
Authors: Hilgard Joseph , Engelhardt Christopher R. , Bartholow Bruce D. 
Published: November 2016

Although much attention has been paid to the question of whether violent video games increase aggressive behaviour, little attention has been paid to how such games might encourage antecedents of gun violence. In this study, we examined how product placement, the attractive in-game presentation of certain real-world firearm brands, might encourage gun ownership, a necessary antecedent of gun violence. We sought to study how the virtual portrayal of a real-world firearm (the Bushmaster AR-15) could influence players' attitudes towards the AR-15 specifically and gun ownership in general. College undergraduates (
N
= 176) played one of four modified video games in a 2 (gun: AR-15 or science-fiction control) × 2 (gun power: strong or weak) between-subjects design. Despite collecting many outcomes and examining many potential covariates and moderators, experimental assignment did little to influence outcomes of product evaluations or purchasing intentions with regard to the AR-15. Attitudes towards public policy and estimation of gun safety were also not influenced by experimental condition, although these might have been better tested by comparison against a no-violence control condition. By contrast, gender and political party had dramatic associations with all outcomes. We conclude that, if product placement shapes attitudes towards firearms, such effects will need to be studied with stronger manipulations or more sensitive measures.
Towards a theory of individual differences in statistical learning
Authors: Siegelman Noam , Bogaerts Louisa , Christiansen Morten H. , Frost Ram 
Published: November 2016

In recent years, statistical learning (SL) research has seen a growing interest in tracking individual performance in SL tasks, mainly as a predictor of linguistic abilities. We review studies from this line of research and outline three presuppositions underlying the experimental approach they employ: (i) that SL is a unified theoretical construct; (ii) that current SL tasks are interchangeable, and equally valid for assessing SL ability; and (iii) that performance in the standard forced-choice test in the task is a good proxy of SL ability. We argue that these three critical presuppositions are subject to a number of theoretical and empirical issues. First, SL shows patterns of modality- and informational-specificity, suggesting that SL cannot be treated as a unified construct. Second, different SL tasks may tap into separate sub-components of SL that are not necessarily interchangeable. Third, the commonly used forced-choice tests in most SL tasks are subject to inherent limitations and confounds. As a first step, we offer a methodological approach that explicitly spells out a potential set of different SL dimensions, allowing for better transparency in choosing a specific SL task as a predictor of a given linguistic outcome. We then offer possible methodological solutions for better tracking and measuring SL ability. Taken together, these discussions provide a novel theoretical and methodological approach for assessing individual differences in SL, with clear testable predictions.
This article is part of the themed issue ‘New frontiers for statistical learning in the cognitive sciences’.