bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post-traumatic Spinal Hygroma Causing Cord Compression in Type III Odontoid Fracture With Vertical Atlantoaxial Instability
Authors: Russo Salvatore , Belli Antonio , Eynon Andy , Nader-Sepahi Ali 
Published: January 2017

Study Design.
Case report.

Objective.
To report the first case in the literature of a traumatic cervical spine subdural cerebrospinal fluid (CSF) collection (hygroma) under tension causing cord compression. We suggest etiopathogenesis and modality of treatment.

Summary of Background Data.
Hygromas are subdural cranial CSF collection. A literature review showed no previous published case of post-traumatic spinal hygroma. This was a potential life-threatening sequelae of a high cervical injury that warranted early diagnosis and emergency treatment.

Methods.
We present a case of a young adult who sustained a traumatic vertical atlantoaxial dislocation associated with a type III odontoid fracture. He was initially scored C6 ASIA D. Magnetic resonance imaging (MRI) demonstrated cord contusion at the craniocervical junction and a small fluid collection anterior to the cervical cord. On day 5 after his injury he developed complete paraplegia and priapism. An urgent MRI of his spine revealed expansion of the intraspinal fluid collection with distortion of the cord. He was treated with an emergency surgical decompression. The cervical fluid collection was found to be subdural extra-arachnoidal CSF. A subdural-pleural shunt was inserted. The atlantoaxial injury was reduced and fixed with posterior instrumentation.

Results.
At 1 year from the injury the patient was independent and fully ambulant. MRI and computed tomography images of his spine demonstrated complete resolution of the cervical hygroma, appropriate placement of the cervical-pleural shunt, and stability of the atlantoaxial injury.

Conclusion.
We describe a unique case of post-traumatic spinal hygroma causing cord compression in a patient with an unstable craniocervical injury. The early recognition and correction of this dangerous complication is of paramount importance to savage cord function.

Level of Evidence: 5
Measurement of Clozapine, Norclozapine, and Amisulpride in Plasma and in Oral Fluid Obtained Using 2 Different Sampling Systems
Authors: Fisher Danielle S. , Beyer Chad , van Schalkwyk Gerrit , Seedat Soraya , Flanagan Robert J. 
Published: January 2017

Background:There is a poor correlation between total concentrations of proton-accepting compounds (most basic drugs) in unstimulated oral fluid and in plasma. The aim of this study was to compare clozapine, norclozapine, and amisulpride concentrations in plasma and in oral fluid collected using commercially available collection devices [Thermo Fisher Scientific Oral-Eze and Greiner Bio-One (GBO)].Methods:Oral-Eze and GBO samples and plasma were collected in that order from patients prescribed clozapine. Analyte concentrations were measured by liquid chromatography–tandem mass spectrometry.Results:There were 112 participants [96 men, aged (median, range) 47 (21–65) years and 16 women, aged 44 (21–65) years]: 74 participants provided 2 sets of samples and 7 provided 3 sets (overall 2 GBO samples not collected). Twenty-three patients were co-prescribed amisulpride, of whom 17 provided 2 sets of samples and 1 provided 3 sets. The median (range) oral fluid within the GBO samples was 52 (13%–86%). Nonadherence to clozapine was identified in all 3 samples in one instance. After correction for oral fluid content, analyte concentrations in the GBO and Oral-Eze samples were poorly correlated with plasma clozapine and norclozapine (R2= 0.57–0.63) and plasma amisulpride (R2= 0.65–0.72). Analyte concentrations in the 2 sets of oral fluid samples were likewise poorly correlated (R2= 0.68–0.84). Mean (SD) plasma clozapine and norclozapine were 0.60 (0.46) and 0.25 (0.21) mg/L, respectively. Mean clozapine and norclozapine concentrations in the 2 sets of oral fluid samples were similar to those in plasma (0.9–1.8 times higher), that is, approximately 2- to 3-fold higher than those in unstimulated oral fluid. The mean (±SD) amisulpride concentrations (microgram per liter) in plasma (446 ± 297) and in the Oral-Eze samples (501 ± 461) were comparable and much higher than those in the GBO samples (233 ± 318).Conclusions:Oral fluid collected using either the GBO system or the Oral-Eze system cannot be used for quantitative clozapine and/or amisulpride therapeutic drug monitoring.
Coping with interdependencies related to patient choice: Boundary-spanning at four accountable care organizations
Authors: Hilligoss Brian , McAlearney Ann Scheck , Song Paula H. 
Published: January 2017

Background:
Accountable care organizations (ACOs) are responsible for outcomes that are only partially under their control because patients may choose to self-refer outside the ACO, overuse resource-intensive services, or underuse evidence-based care. ACOs must devise boundary-spanning practices to manage these interdependencies related to patient choice.

Purpose:
The aim of this study was to identify, conceptualize, and categorize ACO efforts to cope with interdependencies related to patient choice.

Approach:
We conducted qualitative organizational case studies of four ACOs. We interviewed 89 executives, mid-level managers, and physicians and analyzed the data through multiple rounds of inductive coding.

Results:
We identified 15 boundary-spanning practices, in which two or more ACOs engaged in efforts to understand, cope with, or alter interdependencies related to patient choice. Analysis of these practices revealed five categories of factors that appeared to shape patient choices in ways that may impact ACO performance: the availability of services, interactions with patients, system complexities, care provided to ACO patients by non-ACO providers, and uncertainties related to the environment. Our findings provide a process theory of ACO boundary-spanning: Each individual boundary-spanning practice contributes to a broader strategic goal, through which it may impact a particular aspect of interdependence and thereby reduce underuse, overuse, or leakage (i.e., provision of services outside the ACO).

Practice Implications:
In identifying ACO boundary-spanning practices and proposing how they may impact interdependence, our theory highlights conceptual relationships that researchers can study and test. Similarly, in identifying key aspects of interdependencies related to patient choice and a broad assortment of ACO boundary-spanning practices, our findings provide managers with a tool for evaluating and developing their own boundary-spanning efforts.
Age-Related Change in Vestibular Ganglion Cell Populations in Individuals With Presbycusis and Normal Hearing
Authors: Gluth Michael B. , Nelson Erik G. 
Published: January 2017

Hypothesis:
We sought to establish that the decline of vestibular ganglion cell counts uniquely correlates with spiral ganglion cell counts, cochlear hair cell counts, and hearing phenotype in individuals with presbycusis.

Background:
The relationship between aging in the vestibular system and aging in the cochlea is a topic of ongoing investigation. Histopathologic age-related changes the vestibular system may mirror what is seen in the cochlea, but correlations with hearing phenotype and the impact of presbycusis are not well understood.

Methods:
Vestibular ganglion cells, spiral ganglion cells, and cochlear hair cells were counted in specimens from individuals with presbycusis and normal hearing. These were taken from within a large collection of processed human temporal bones. Correlations between histopathology and hearing phenotype were investigated.

Results:
Vestibular ganglion cell counts were positively correlated with spiral ganglion cell counts and cochlear hair cell counts and were negatively correlated with hearing phenotype. There was no statistical evidence on linear regression to suggest that the relationship between age and cell populations differed significantly according to whether presbycusis was present or not. Superior vestibular ganglion cells were more negatively correlated with age than inferior ganglion cells. No difference in vestibular ganglion cells was noted based on sex.

Conclusion:
Vestibular ganglion cell counts progressively deteriorate with age, and this loss correlates closely with changes in the cochlea, as well as hearing phenotype. However, these correlations do not appear to be unique in individuals with presbycusis as compared with those with normal hearing.
Pao 2/Fio 2 Ratio Derived From the Spo 2/Fio 2 Ratio to Improve Mortality Prediction Using the Pediatric Index of Mortality-3 Score in Transported Intensive Care Admissions*
Authors: Ray Samiran , Rogers Libby , Pagel Christina , Raman Sainath , Peters Mark J. , Ramnarayan Padmanabhan 
Published: January 2017

Objectives:
To derive a relationship between the Spo
2/Fio
2 ratio and Pao
2/Fio
2 ratio across the entire range of Spo
2 values (0–100%) and to evaluate whether mortality prediction using the Pediatric Index of Mortality-3 can be improved by the use of Pao
2/Fio
2 values derived from Spo
2/Fio
2.

Design:
Retrospective analysis of prospectively collected data.

Setting:
A regional PICU transport service.

Patients:
Children transported to a PICU.

Interventions:
None.

Measurements and Main Results:
The relationship between Spo
2/Fio
2 and Pao
2/Fio
2 across the entire range of Spo
2 values was first studied using several mathematical models in a derivation cohort (n = 1,235) and then validated in a separate cohort (n = 306). The best Spo
2/Fio
2-Pao
2/Fio
2 relationship was chosen according to the ability to detect respiratory failure (Pao
2/Fio
2 ≤ 200). The discrimination of the original Pediatric Index of Mortality-3 score and a derived Pediatric Index of Mortality-3 score (where Spo
2/Fio
2-derived Pao
2/Fio
2 values were used in place of missing Pao
2/Fio
2 values) were compared in a different cohort (n = 1,205). The best Spo
2/Fio
2-Pao
2/Fio
2 relationship in 1,703 Spo
2/Fio
2-to-Pao
2/Fio
2 data pairs was a linear regression equation of ln[PF] regressed on ln[SF]. This equation identified children with a Pao
2/Fio
2 less than or equal to 200 with a specificity of 73% and sensitivity of 61% in children with Spo
2 less than 97% (92% and 33%, respectively, when Spo
2 ≥ 97%) in the validation cohort. Pao
2/Fio
2 derived from Spo
2/Fio
2 (derived Pao
2/Fio
2) was better at predicting PICU mortality (area under receiver operating characteristic curve, 0.64; 95% CI, 0.55–0.73) compared with the original Pao
2/Fio
2 (area under receiver operating characteristic curve, 0.54; 95% CI, 0.49–0.59; p = 0.02). However, there was no difference in the original and derived Pediatric Index of Mortality-3 scores and their discriminatory ability for mortality.

Conclusions:
Spo
2-based metrics perform no worse than arterial blood gas–based metrics in mortality prediction models. Future Pediatric Index of Mortality score versions may be improved by the inclusion of risk factors based on oxygen saturation values, especially in settings where Pao
2 values are missing in a significant proportion of cases.
Epidemiology of Pediatric Critical Illness in a Population-Based Birth Cohort in Olmsted County, MN
Authors: Crow Sheri S. , Undavalli Chaitanya , Warner David O. , Katusic Slavica K. , Kandel Pujan , Murphy Sinead L. , Schroeder Darrell R. , Watson R. Scott 
Published: January 2017

Objectives:
Investigations of pediatric critical illness typically focus on inpatient cohorts drawn from wide referral areas and diverse healthcare systems. Cohorts amenable to investigating the full spectrum of critical illness as it develops within a community have yet to be studied in the United States. Our objective was to provide the first epidemiologic report of the incidence and presentation of pediatric critical illness within a U.S. population-based birth cohort.

Design:
Retrospective cohort study.

Setting:
A geographically defined community (Olmsted, MN) with medical record linkage across all health systems. All ICU services are provided within a single children’s hospital.

Patients:
A birth cohort of children (n =9,441) born 2003–2007 in Olmsted County, MN.

Measurements and Main Results:
During the study period, there were a total of 15,277 ICU admissions to Mayo Clinic Children’s Hospital. A total of 577 birth cohort children accounted for 824 of these admissions during the 61,770 person-years of follow-up accumulated. Incidence of first-time ICU admission was 9.3 admits per 1,000 person-years. Admission rates were highest in the first year of life and then declined steadily. Respiratory problems were among the most common reasons for admission at any age and diagnoses reflect changes in health risk factors as children grow and develop over time. After 1 year old, a majority of children admitted have preexisting chronic comorbidities and/or prior ICU stays. In-hospital mortality occurred exclusively in children admitted prior to 5 days of age (n = 4). Seven children died after hospital discharge.

Conclusions:
This is the first report characterizing critical illness within a population-based birth cohort of U.S. children. The results demonstrate the changing incidence, presentation, and healthcare requirements associated with critical illness across the developmental spectrum as a population of children ages.
Central Venous to Arterial Co 2 Difference After Cardiac Surgery in Infants and Neonates*
Authors: Rhodes Leslie A. , Erwin W. Clinton , Borasino Santiago , Cleveland David C. , Alten Jeffrey A. 
Published: January 2017

Objectives:Venous to arterial Co2difference correlates with cardiac output in critically ill adults, but its utility in pediatric patients is unclear. We sought to correlate venous to arterial Co2difference with other cardiac output surrogates (arteriovenous oxygen saturation difference, central venous oxygen saturation, and lactate) and investigate its capacity to predict poor outcomes associated with low cardiac output (low cardiac output syndrome) in infants after cardiac surgery with cardiopulmonary bypass.Design:Retrospective chart review. Poor outcome was defined as any inotrope score greater than 15; death, cardiac arrest, extracorporeal membrane oxygenation; and unplanned surgical reintervention.Setting:Pediatric cardiovascular ICU.Patients:One hundred thirty-nine infants less than 90 days who underwent cardiopulmonary bypass, from October 2012 to May 2015.Intervention:None.Measurements and Main Results:Two hundred ninety-six arterial and venous blood gas pairs from admission (n= 139), 6 (n= 62), 12 (n= 73), and 24 hours (n= 22) were included in analysis. For all pairs, venous to arterial Co2difference was moderately correlated with arteriovenous oxygen saturation difference (R2= 0.53;p< 0.01) and central venous oxygen saturation (R2= –0.43;p< 0.01), but not lactate. At admission, venous to arterial Co2difference was also moderately correlated with central venous oxygen saturation (R2= –0.40;p< 0.01) and arteriovenous oxygen saturation difference (R2= 0.55;p< 0.01), but not lactate. Thirty-four of 139 neonates (24.5%) had poor outcome. Median admission venous to arterial Co2difference was 5.9 mm Hg (3.8–9.2 mm Hg). Patients with poor outcome had median admission venous to arterial Co2difference 8.3 (5.6–14.9) versus 5.4 mm Hg (3.0–8.4 mm Hg) in those without poor outcome. Venous to arterial Co2difference (area under the curve = 0.69;p< 0.01), serum lactate (area under the curve = 0.64;p= 0.02), and central venous oxygen saturation (area under the curve = 0.74;p< 0.01) were predictive of poor outcome. After controlling for covariates, admission venous to arterial Co2difference remained significantly associated with poor outcome (odds ratio, 1.3; 95% CI, 1.1–1.45), including independent association with mortality (odds ratio, 1.2; 95% CI, 1.07–1.31).Conclusions:Venous to arterial Co2difference is correlated with important surrogates of cardiac output, and is associated with poor outcome and mortality related to low cardiac output syndrome after cardiac surgery in infants. Prospective validation of these findings, including confirmation that venous to arterial Co2difference can identify low cardiac output syndrome in real time, is warranted.
International Epidemiological Differences in Acute Poisonings in Pediatric Emergency Departments
Authors: Mintegi Santiago , Azkunaga Beatriz , Prego Javier , Qureshi Nadeem , Dalziel Stuart R. , Arana-Arri Eunate , Acedo Yordana , Martinez-Indart Lorea , Urkaregi Arantza , Salmon Nerea , Benito Javier , Kuppermann Nathan 
Published: January 2017

Background and Objective
Identifying international differences in the epidemiology of acute poisonings in children may help in improving prevention. We sought to evaluate the international epidemiological differences in acute poisonings in children presenting to emergency departments (EDs) from 8 different global regions.

Methods
This was an international multicenter cross-sectional prospective study including children younger than 18 years with acute poisonings presenting to 105 EDs in 20 countries was conducted. Data collection started at each ED between January and September 2013, and continued for 1 year.

Results
During the study period, we registered 363,245 pediatric ED presentations, of which 1727 were for poisoning (0.47%; 95% confidence interval, 0.45%–0.50%), with a significant variation in incidence between the regions. Full data were obtained for 1688 presentations. Most poisonings (1361 [80.6%]) occurred at home with either ingestion (1504 [89.0%]) or inhalation of the toxin (126 [7.6%]). Nonintentional exposures accounted for 1157 poisonings (68.5%; mainly in South America and Eastern Mediterranean region), with therapeutic drugs (494 [42.7%]), household products (310 [26.8%]), and pesticides (59 [5.1%]) being the most common toxins. Suicide attempts accounted for 233 exposures (13.8%; mainly in the Western Pacific region and North America), with therapeutic drugs (214 [91.8%], mainly psychotropics and acetaminophen) being the most common toxins. Significant differences between regions were found in both types of poisonings. Recreational poisonings were more common in Europe and Western Pacific region. No patient died.

Conclusions
There are substantial epidemiological differences in acute poisonings among children in different countries and regions of the globe. International best practices need to be identified for prevention of acute poisonings in childhood.
Variation in Pediatric Care Between Academic and Nonacademic US Emergency Departments, 1995–2010
Authors: Li Joyce , Monuteaux Michael C. , Bachur Richard G. 
Published: January 2017

Objectives
The aim of this study was to describe the resource utilization for children with common pediatric conditions treated in academic and nonacademic emergency departments (EDs).

Methods
We performed a retrospective, cross-sectional descriptive study using the National Hospital Ambulatory Medical Care Survey Data from 1995 to 2010 including children less than 18 years old with a diagnosis of asthma, bronchiolitis, croup, gastroenteritis, fever, febrile seizure, or afebrile seizure. Academic EDs (A-ED) were those with greater than 25% of patients seen by a trainee. For each condition, we reported the proportion of testing, medications, and disposition between A-ED and nonacademic EDs (NA-ED).

Results
From 1995 to 2010, approximately 450,000,000 estimated pediatric visits are represented by the survey based on 122,811 actual visits. For most common conditions, testing and disposition were comparable; however, some variation was noted. Among patients with bronchiolitis, a higher proportion of patients was admitted and had radiographs in NA-EDs (18% vs 10% and 56% vs 45%, respectively). For children with croup, radiographs were performed more often at NA-EDs (27% vs 6%). Among those with febrile seizures, more lumbar punctures were performed in NA-EDs (14% vs 0%). In children with afebrile seizures, more head computed tomography scans were obtained at NA-EDs (34% vs 21%).

Conclusion
Among pediatric patients with croup, bronchiolitis, and febrile and afebrile seizure, higher resource utilization and admissions were observed in NA-EDs. These preliminary findings from a national survey require a more detailed investigation into the variation in care between A-ED and NA-ED settings.
Sex differences in the epidemiology of tattoo skin disease in captive common bottlenose dolphins (Tursiops truncatus): are males more vulnerable than females?
Authors: Van Bressem Marie-Françoise , Van Waerebeek Koen , Duignan Pádraig J. 
Published: January 2017

AbstractThe clinical and epidemiological features of tattoo skin disease (TSD), caused by cetacean poxviruses, are reported in 257 common bottlenose dolphins (Tursiops truncatus) held in 31 facilities in the USA and Europe. Photographs and biological data of 146 females and 111 males were analyzed. Dolphins were classified into three age classes (0-3; 4-8; over 9 years), approximating the life stages of ‘calves and young juveniles’, ‘juveniles and sub-adults’ and ‘adults’. The youngest dolphins with tattoos were 14 and 15 months old. Minimal TSD persistence varied between 4 and 65 months in 30 dolphins and was over 22 months in those with very large lesions (> 115 mm). In 2012-2014, 20.6% of the 257 dolphins had TSD. Prevalence varied between facilities from 5.6% (n= 18) to 60% (n= 20), possibly reflecting variation in environmental conditions. Prevalence was significantly higher in males (31.5%) than in females (12.3%), a pattern which departs from that observed in free-ranging Delphinidae where there is no gender bias. As with free-ranging Delphinidae, TSD prevalence in captive females varied with age category, being the highest in the 4 to 8 year old. By contrast, prevalence levels in males were high in all age classes. Prevalence of very large tattoos was also higher in males (28.6%, n= 35) than in females (11.1%, n= 18). Combined, these data suggest that captive maleT. truncatusare more vulnerable to TSD than females possibly because of differences in immune response and because males may be more susceptible to captivity-related stress than females.