bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cervical cerclage for preterm birth prevention in twin gestation with short cervix: a retrospective cohort study
Authors: Houlihan C. , Poon L. C. Y. , Ciarlo M. , Kim E. , Guzman E. R. , Nicolaides K. H. 
Published: March 2016

ABSTRACTObjectiveTo determine if cervical cerclage reduces the rate of spontaneous early preterm birth in cases of dichorionic–diamniotic (DCDA) twin gestation with an ultrasound‐detected short cervix.MethodsThis was a retrospective cohort study of 40 consecutive DCDA twin gestations at Saint Peter's University Hospital from November 2006 to November 2014 in which cervical cerclage was performed for an ultrasound‐determined cervical length of 1–24 mm at 16–24 weeks' gestation. The cases were matched with 40 controls without cerclage for cervical length and gestational age at cervical assessment. The primary outcome measure was spontaneous birth < 32 weeks.ResultsThere was no difference between the two groups in maternal age, body mass index (BMI), cigarette smoking, use of in‐vitro fertilization (IVF), parity and prior spontaneous preterm birth. There were more Caucasian women among the controls compared with cases. In the cases, compared with controls, spontaneous delivery < 32 weeks was significantly less frequent (20.0% vs 50.0%; relative risk, 0.40 (95% CI, 0.20–0.80)). In the prediction of spontaneous delivery < 32 weeks, logistic regression analysis demonstrated that the risk was reduced with the insertion of cervical cerclage (odds ratio, 0.22 (95% CI, 0.058–0.835); P = 0.026), corrected for maternal age, BMI, racial origin, cigarette smoking, IVF, parity and previous preterm birth.ConclusionIn DCDA twin gestation with a short cervix, treatment with cervical cerclage may reduce the rate of early preterm birth. The findings suggest the need for adequate randomized controlled trials on cerclage in twin gestations with a short cervix. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
What are snow leopards really eating? Identifying bias in food‐habit studies
Authors: Weiskopf Sarah R. , Kachel Shannon M. , McCarthy Kyle P. 
Published: March 2016

ABSTRACTDeclining prey populations are widely recognized as a primary threat to snow leopard (Panthera uncia) populations throughout their range. Effective snow leopard conservation will depend upon reliable knowledge of food habits. Unfortunately, past food‐habit studies may be biased by inclusion of nontarget species in fecal analysis, potentially misinforming managers about snow leopard prey requirements. Differentiation between snow leopard and sympatric carnivore scat is now cost‐effective and reliable using genetics. We used fecal mitochondrial DNA sequencing to identify scat depositors and assessment bias in snow leopard food‐habit studies. We compared presumed, via field identification, and genetically confirmed snow leopard scats collected during 2005 and 2012 from 4 sites in Central Asia, using standard forensic microscopy to identify prey species. Field identification success varied across study sites, ranging from 21% to 64% genetically confirmed snow leopard scats. Our results confirm the importance of large ungulate prey for snow leopards. Studies that fail to account for potentially commonplace misidentification of snow leopard scat may mistakenly include a large percentage of scats originating from other carnivores and report inaccurate dietary assessments. Relying on field identification of scats led to overestimation of percent occurrence, biomass, and number of small mammals consumed, but underestimated values of these measures for large ungulates in snow leopard diet. This clarification suggests that the conservation value of secondary prey, such as marmots (Marmota spp.) and other small mammals, may be overstated in the literature; stable snow leopard populations are perhaps more reliant upon large ungulate prey than previously understood. © 2016 The Wildlife Society.
Evaluating Enhancements to a Perioperative Nurse Liaison Program
Authors: Hanson‐Heath Cathy Ann , Muller Linda M. , Cunningham Maureen F. 
Published: March 2016

AbstractThe impetus for the perioperative nurse liaison (PNL) program at our cancer center was to reduce anxiety for family members of patients undergoing surgery by improving communication between the family and the perioperative team. The purpose of our quality improvement project was to increase contact with family members during the patient's surgery and to support families and surgeons during the postoperative family consult when findings were unexpected. After implementing process changes, the PNLs evaluated the program using a short survey given to families after the postoperative consult. Families reported a reduction in stress and anxiety when intraoperative updates were received either in person or by telephone. In addition, when the PNL accompanied family members to the postoperative consult, the family felt supported when receiving unexpected findings. Further, family contact with the PNL increased from 77% to 98%, and the number of consults with surgeons that included the PNL rose from an average of 254 to 500 per year.
Bar Code‐Based Management to Enhance Efficiency of a Sterile Supply Unit in Singapore
Authors: Goh Meh Meh , Tan Agnes B.H. , Leong Mike H.W. 
Published: March 2016

AbstractSterile surgical instruments are essential for successful surgical outcomes. The Singapore General Hospital's Theatre Sterile Supplies Unit (TSSU) has faced many challenges, including increasing demand for instruments and the need to maintain instruments of greater complexity. To address these challenges, stakeholders from key departments at Singapore General Hospital formed a multidisciplinary team to transform operations in the TSSU. The team adopted and implemented the TSSU Instrument Management System (TIMS) in three phases over five years. The project included standardizing instrument‐naming conventions, implementing electronic integration of instrument tracking in the unit, extending traceability of instruments to the major ORs, initiating integrated web‐based instrument ordering, and extending the system management of instruments at ambulatory surgery and specialized OR facilities. The implementation of TIMS has improved inventory, supply, and quality management; reduced instrument repairs; and led to savings through increased productivity and lower expenses.
New horizon for infection prevention technology and implantable device
Authors: Kondo Yusuke , Ueda Marehiko , Kobayashi Yoshio , Schwab Joerg O. 
Published: March 2016

AbstractThere has been a significant increase in the number of patients receiving cardiovascular implantable electronic devices (CIED) over the last two decades. CIED infection represents a serious complication after CIED implantation and is associated with significant morbidity and mortality. Recently, newly advanced technologies have offered attractive and suitable therapeutic alternatives. Notably, the leadless pacemaker and anti‐bacterial envelope decrease the potential risk of CIED infection and the resulting mortality, when it does occur. A completely subcutaneous implantable cardioverter defibrillator is also an alternative to the transvenous implantable cardioverter defibrillator (ICD), as it does not require implantation of any transvenous or epicardial leads. Among the patients who require ICD removal and subsequent antibiotics secondary to infection, the wearable cardioverter defibrillator represents an alternative approach to inpatient monitoring for the prevention of sudden cardiac death. In this review paper, we aimed to introduce the advanced technologies and devices for prevention of CIED infection.
Phoneme and Word Scoring in Speech-in-Noise Audiometry
Authors: Billings Curtis J. , Penman Tina M. , Ellis Emily M. , Baltzell Lucas S. , McMillan Garnett P. 
Published: March 2016

Purpose
Understanding speech in background noise is difficult for many individuals; however, time constraints have limited its inclusion in the clinical audiology assessment battery. Phoneme scoring of words has been suggested as a method of reducing test time and variability. The purposes of this study were to establish a phoneme scoring rubric and use it in testing phoneme and word perception in noise in older individuals and individuals with hearing impairment.

Method
Words were presented to 3 participant groups at 80 dB in speech-shaped noise at 7 signal-to-noise ratios (−10 to 35 dB). Responses were scored for words and phonemes correct.

Results
It was not surprising to find that phoneme scores were up to about 30% better than word scores. Word scoring resulted in larger hearing loss effect sizes than phoneme scoring, whereas scoring method did not significantly modify age effect sizes. There were significant effects of hearing loss and some limited effects of age; age effect sizes of about 3 dB and hearing loss effect sizes of more than 10 dB were found.

Conclusion
Hearing loss is the major factor affecting word and phoneme recognition with a subtle contribution of age. Phoneme scoring may provide several advantages over word scoring. A set of recommended phoneme scoring guidelines is provided.
chopBAI: BAM index reduction solves I/O bottlenecks in the joint analysis of large sequencing cohorts
Authors: Kehr Birte , Melsted Páll 
Published: March 2016

Abstract
Summary: Advances in sequencing capacity have led to the generation of unprecedented amounts of genomic data. The processing of this data frequently leads to I/O bottlenecks, e. g. when analyzing a small genomic region across a large number of samples. The largest I/O burden is, however, often not imposed by the amount of data needed for the analysis but rather by index files that help retrieving this data. We have developed chopBAI, a program that can chop a BAM index (BAI) file into small pieces. The program outputs a list of BAI files each indexing a specified genomic interval. The output files are much smaller in size but maintain compatibility with existing software tools. We show how preprocessing BAI files with chopBAI can lead to a reduction of I/O by more than 95% during the analysis of 10 kb genomic regions, eventually enabling the joint analysis of more than 10 000 individuals.
Availability and Implementation: The software is implemented in C ++, GPL licensed and available at http://github.com/DecodeGenetics/chopBAI
Contact: birte.kehr@decode.is
Cerebral Gaseous Microemboli are Detectable During Continuous Venovenous Hemodialysis in Critically Ill Patients: An Observational Pilot Study
Authors: Erdoes Gabor , Kietaibl Clemens , Boehme Stefan , Ullrich Roman , Markstaller Klaus , Eberle Balthasar , Klein Klaus U. 
Published: March 2016

Background:
Continuous venovenous hemodialysis (CVVHD) may generate microemboli that cross the pulmonary circulation and reach the brain. The aim of the present study was to quantify (load per time interval) and qualify (gaseous vs. solid) cerebral microemboli (CME), detected as high-intensity transient signals, using transcranial Doppler ultrasound.

Materials and Methods:
Twenty intensive care unit (ICU group) patients requiring CVVHD were examined. CME were recorded in both middle cerebral arteries for 30 minutes during CVVHD and a CVVHD-free interval. Twenty additional patients, hospitalized for orthopedic surgery, served as a non-ICU control group. Statistical analyses were performed using the Mann-Whitney U test or the Wilcoxon matched-pairs signed-rank test, followed by Bonferroni corrections for multiple comparisons.

Results:
In the non-ICU group, 48 (14.5-169.5) (median [range]) gaseous CME were detected. In the ICU group, the 67.5 (14.5-588.5) gaseous CME detected during the CVVHD-free interval increased 5-fold to 344.5 (59-1019) during CVVHD (P<0.001). The number of solid CME was low in all groups (non-ICU group: 2 [0-5.5]; ICU group CVVHD-free interval: 1.5 [0-14.25]; ICU group during CVVHD: 7 [3-27.75]).

Conclusions:
This observational pilot study shows that CVVHD was associated with a higher gaseous but not solid CME burden in critically ill patients. Although the differentiation between gaseous and solid CME remains challenging, our finding may support the hypothesis of microbubble generation in the CVVHD circuit and its transpulmonary translocation toward the intracranial circulation. Importantly, the impact of gaseous and solid CME generated during CVVHD on brain integrity of critically ill patients currently remains unknown and is highly debated.
Lupus and fractures
Authors: Bultink Irene E.M. , Lems Willem F. 
Published: March 2016

Purpose of reviewThe article reviews recent advances in the research of fractures in patients with systemic lupus erythematosus (SLE), highlighting their clinical, scientific, and economic impact.Recent findingsRecent studies demonstrated an increased incidence of osteoporosis and symptomatic fractures in patients with SLE and age, disease duration, disease severity, and glucocorticoid use are important risk factors. A high prevalence of vertebral fractures was demonstrated, while one in three of these patients has normal bone density, which illustrates the multifactorial cause of fractures in SLE. Screening for vertebral fractures is important, as they often occur asymptomatically, but are associated with a reduced quality of life, increased future fracture risk, an increased mortality risk, and may have therapeutic implications. A recently developed Delphi consensus revealed the high economic burden of fractures as a glucocorticoid-related adverse event in SLE, whereas the majority of patients use glucocorticoids.SummaryRecent studies revealed an increased incidence of symptomatic fractures and a relatively high prevalence of vertebral fractures in patients with SLE, and provided new insights into their multifactorial aetiology. The clinical consequences and high economic burden of fractures as glucocorticoid-related adverse events underline the importance of reducing glucocorticoid therapy and use of steroid-sparing agents.
Infection and Nonunion After Fasciotomy for Compartment Syndrome Associated With Tibia Fractures: A Matched Cohort Comparison
Authors: Blair James A. , Stoops Thomas Kyle , Doarn Michael C. , Kemper Dan , Erdogan Murat , Griffing Rebecca , Sagi H. Claude 
Published: March 2016

Objectives:
The objective was to compare the rates of union and infection in patients treated with and without fasciotomy for acute compartment syndrome (ACS) in operatively managed tibia fractures.

Design:
This was a retrospective review.

Setting:
The study was conducted at both a Level 1 and Level II trauma center.

Patients/Participants:
Patients operated for tibial plateau fractures (group 1) and tibial shaft fractures (group 3) with ACS requiring fasciotomy were matched to patients without ACS (plateau: group 2, shaft: group 4) in a 1:3 ratio for age, sex, fracture pattern, and open/closed injury.

Intervention:
Surgical treatment was provided with plates/screws (plateau fractures) or intramedullary rod (shaft fractures). Patients with ACS were treated with a 2-incision 4-compartment fasciotomy.

Main Outcome Measurements:
Time to union and incidence of deep infection, nonunion, and delayed union.

Results:
One hundred eighty-four patients were included—group 1: 23 patients, group 2: 69 patients, group 3: 23 patients, and group 4: 69 patients. Time to union averaged 26.8 weeks for groups 1 and 3 and 21.5 weeks for groups 2 and 4 (P > 0.05). Nonunion occurred in 20% for groups 1 and 3 and in 5% for groups 2 and 4 (P = 0.003). Deep infection developed in 20% for groups 1 and 3 and in 4% for groups 2 and 4 (P = 0.001). There was a significant increase in infection in group 1 versus group 2 and nonunion in group 3 versus group 4. There were significantly more smokers for those with fasciotomies (46%) than without (20%, P < 0.001), though all statistical results remained similar after a binary regression analysis.

Conclusion:
Four-compartment fasciotomies in patients with tibial shaft or plateau fractures is associated with a significant increase in infection and nonunion.

Level of Evidence:
Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.
Does the Modified Gartland Classification Clarify Decision Making?
Authors: Leung Sophia , Paryavi Ebrahim , Herman Martin J. , Sponseller Paul D. , Abzug Joshua M. 
Published: March 2016

Hypothesis:
The modified Gartland classification system for pediatric supracondylar fractures is often utilized as a communication tool to aid in determining whether or not a fracture warrants operative intervention. This study sought to determine the interobserver and intraobserver reliability of the Gartland classification system, as well as to determine whether there was agreement that a fracture warranted operative intervention regardless of the classification system.

Methods:
A total of 200 anteroposterior and lateral radiographs of pediatric supracondylar humerus fractures were retrospectively reviewed by 3 fellowship-trained pediatric orthopaedic surgeons and 2 orthopaedic residents and then classified as type I, IIa, IIb, or III. The surgeons then recorded whether they would treat the fracture nonoperatively or operatively. The κ coefficients were calculated to determine interobserver and intraobserver reliability.

Results:
Overall, the Wilkins-modified Gartland classification has low-moderate interobserver reliability (κ=0.475) and high intraobserver reliability (κ=0.777). A low interobserver reliability was found when differentiating between type IIa and IIb (κ=0.240) among attendings. There was moderate-high interobserver reliability for the decision to operate (κ=0.691) and high intraobserver reliability (κ=0.760). Decreased interobserver reliability was present for decision to operate among residents. For fractures classified as type I, the decision to operate was made 3% of the time and 27% for type IIa. The decision was made to operate 99% of the time for type IIb and 100% for type III.

Summary:
There is almost full agreement for the nonoperative treatment of Type I fractures and operative treatment for type III fractures. There is agreement that type IIb fractures should be treated operatively and that the majority of type IIa fractures should be treated nonoperatively. However, the interobserver reliability for differentiating between type IIa and IIb fractures is low. Our results validate the Gartland classfication system as a method to help direct treatment of pediatric supracondylar humerus fractures, although the modification of the system, IIa versus IIb, seems to have limited reliability and utility. Terminology based on decision to treat may lead to a more clinically useful classification system in the evaluation and treatment of pediatric supracondylar humerus fractures.

Level of Evidence:
Level III—diagnostic studies.
Effects of Intraoperative Anesthetic Medications on Postoperative Urinary Retention After Single-Level Lumbar Fusion
Authors: Mayo Benjamin C. , Louie Philip K. , Bohl Daniel D. , Massel Dustin H. , Iantorno Stephanie E. , Ahn Junyoung , Tabaraee Ehsan , Modi Krishna D. , Long William W. , Singh Kern 
Published: March 2016

Study Design.
Retrospective cohort analysis.

Objective.
The aim of the study was to identify medications that may potentially contribute to developing postoperative urinary retention (POUR) after lumbar spinal fusion procedures.

Summary of Background Data.
POUR is a concerning event that may occur after routine orthopedic surgery. The relation between intraoperative medications and POUR after lumbar spine surgery has not been well characterized.

Methods.
A prospectively maintained database of patients who underwent a primary single-level, minimally invasive transforaminal lumbar interbody fusion between 2009 and 2013 was reviewed. POUR was defined as a bladder scan of 300 mL or higher, the postoperative necessity of a straight catheterization, or a urology consult for urinary retention. The use and dose-response of intraoperative medications between patients with and without POUR were compared. Potential risk factors for developing POUR were analyzed using multivariate analysis.

Results.
A total of 205 patients were included in the study, 17% of whom experienced POUR (n = 34). Administration of phenylephrine and neostigmine was associated with POUR (phenylephrine: 32.3% vs. 13.8%, P = 0.017; neostigmine: 19.5% vs. 6.5%, P = 0.042). Parametric analysis demonstrated an association of increasing dose of neostigmine with POUR (4.66 vs. 4.22 mg, P = 0.023). Similarly, a nonparametric analysis demonstrated an association of increasing doses of both neostigmine and phenylephrine with POUR (neostigmine: 4.25 vs. 3.16 mg, P = 0.02; phenylephrine: 105.88 vs. 40.64 mg, P = 0.008).

Conclusion.
Approximately 20% of patients may develop POUR after routine lumbar spine surgery. The use of certain intraoperative anesthetics such as phenylephrine and neostigmine is strongly associated with the development of POUR postoperatively. This finding suggests that there may be modifiable anesthetic risk factors to prevent the development of POUR in patients undergoing lumbar spine surgery. Future prospective, controlled studies specifically addressing these findings could lead to improved patient care and decreased healthcare costs.

Level of Evidence: 4
Sagittal Plane Correction Using the Lateral Transpsoas Approach
Authors: Melikian Rojeh , Yoon Sangwook Tim , Kim Jin Young , Park Kun Young , Yoon Caroline , Hutton William 
Published: March 2016

Study Design.
Cadaveric biomechanical study.

Objective.
To determine the degree of segmental correction that can be achieved through lateral transpsoas approach by varying cage angle and adding anterior longitudinal ligament (ALL) release and posterior element resection.

Summary of Background Data.
Lordotic cage insertion through the lateral transpsoas approach is being used increasingly for restoration of sagittal alignment. However, the degree of correction achieved by varying cage angle and ALL release and posterior element resection is not well defined.

Methods.
Thirteen lumbar motion segments between L1 and L5 were dissected into single motion segments. Segmental angles and disk heights were measured under both 50 N and 500 N compressive loads under the following conditions: intact specimen, discectomy (collapsed disk simulation), insertion of parallel cage, 10° cage, 30° cage with ALL release, 30° cage with ALL release and spinous process (SP) resection, 30° cage with ALL release, SP resection, facetectomy, and compression with pedicle screws.

Results.
Segmental lordosis was not increased by either parallel or 10° cages as compared with intact disks, and contributed small amounts of lordosis when compared with the collapsed disk condition. Placement of 30° cages with ALL release increased segmental lordosis by 10.5°. Adding SP resection increased lordosis to 12.4°. Facetectomy and compression with pedicle screws further increased lordosis to approximately 26°. No interventions resulted in a decrease in either anterior or posterior disk height.

Conclusion.
Insertion of a parallel or 10° cage has little effect on lordosis. A 30° cage insertion with ALL release resulted in a modest increase in lordosis (10.5°). The addition of SP resection and facetectomy was needed to obtain a larger amount of correction (26°). None of the cages, including the 30° lordotic cage, caused a decrease in posterior disk height suggesting hyperlordotic cages do not cause foraminal stenosis.

Level of Evidence: N/A