bluuebunny/crossref_metadata_2025_split huggingface dataset:
OneFlorida Clinical Research Consortium: Linking a Clinical and Translational Science Institute With a Community-Based Distributive Medical Education Model
Authors: Shenkman Elizabeth , Hurt Myra , Hogan William , Carrasquillo Olveen , Smith Steven , Brickman Andrew , Nelson David 
Published: October 2017

Problem
Developing a national pragmatic clinical trial infrastructure is central to understanding the effectiveness of interventions applied under usual conditions and where people receive health care. To address this challenge, three Florida universities—the University of Florida Clinical and Translational Science Institute, Florida State University (with its community-based distributive medical education model), and the University of Miami—created (2010–2013) a statewide consortium, the OneFlorida Clinical Research Consortium, to support the conduct of pragmatic clinical trials and provide mentored research experiences for medical and graduate students in real-world practice settings.

Approach
OneFlorida has four programs, which report to a steering committee with membership from each partner, community members, and the state Medicaid agency and Department of Health to ensure shared governance. The Clinical Research Program provides support to conduct research in the network and uses champions to engage community clinicians. The Citizen Scientist Program has community members who provide input on health topics of importance to them, study design, recruitment and retention strategies, and the interpretation of findings. The Data Trust Program contains electronic health record and health care claims data for 10.6 million Floridians. The Minority Education Program, in collaboration with three historically black colleges and universities, offers minority junior faculty mentoring in pragmatic clinical trials and implementation science.

Outcomes
OneFlorida has implemented 27 studies with diverse patient populations and in diverse community practice settings.

Next Steps
To identify evidence-based best practices from the clinical trials conducted in the network, foster their implementation, and expand research training opportunities.
Patient and Parent Satisfaction With Sling Use After Pediatric Upper Extremity Fractures: A Randomized Controlled Trial of a Customized Cast-Sling Versus Standard Cast and Sling
Authors: Cruz Aristides I. , DeFroda Steven F. , Gil Joseph A. , Hansen Heather , Bolous Alexandre , Procaccini Michaela , Zonfrillo Mark R. 
Published: October 2017

Background:
Long arm cast immobilization after operative and nonoperative treatment of pediatric upper extremity fractures is common. The use of a sling to aid in carrying the casted extremity as well as provide further immobilization is also common practice. Off-the-shelf slings vary in quality and fit, can be confusing for parents/patients to apply, and lead to frustration and dissatisfaction with its use. The purpose of this investigation was to compare patient/parent centered outcomes after the use of a customized sling compared with a standard sling by utilizing a prospective, randomized-controlled trial. We hypothesized that patients and their parents would find the “Providence” Pedi Cast-Sling (PPCS) to be more convenient and be more satisfied with its use compare with a standard sling.

Methods:
Eligible subjects included patients 0 to 18 years old, evaluated at an urban, tertiary care pediatric emergency department (ED), who sustained an upper extremity fracture that required placement of a long-arm cast. Exclusion criteria were: open fractures; fractures at multiple levels; fractures requiring urgent/emergent surgery; admitted patients; bivalved casts. Patients were randomized to receive a standard sling or a PPCS. Questionnaires assessing patient/parent satisfaction, preferences, sling-use, and pain level were collected at patients’ first follow-up visit.

Results:
A total of 100 patients were randomized with 71 questionnaires available for analysis (39 standard sling vs. 32 PPCS). There were statistically significant differences for satisfaction scores for all related questions between patients who received a PPCS compared with a standard sling. Patients and their parents were more likely to choose the PPCS (P=0.001), were more satisfied with the PPCS (P<0.006), and reported the PPCS to be more convenient than a standard sling (P<0.001). Patients who received a PPCS wore the sling for a greater number of hours during the day (10.3±7.1 h) compared with those who received a standard sling (5.9±5.0 h) (P=0.004).

Conclusions:
The “Providence” Pedi Cast-Sling is a superior alternative to an off-the-shelf sling when used after the application of a long-arm cast providing greater convenience, compliance, and satisfaction to both patients and families.

Level of Evidence:
Level I—Prospective randomized-controlled trial.
Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures
Authors: Hughes Meghan , Dua Karan , O’Hara Nathan N. , Brighton Brian K. , Ganley Theodore J. , Hennrikus William L. , Herman Martin J. , Hyman Joshua E. , Lawrence J. Todd , Mehlman Charles T. , Noonan Kenneth J. , Otsuka Norman Y. , Schwend Richard M. , Shrader M. Wade , Smith Brian G. , Sponseller Paul D. , Abzug Joshua M. 
Published: October 2017

Background:
Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures.

Methods:
A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making.

Results:
Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=−0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making.

Conclusions:
There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes.

Level of Evidence:
Level V.
Early Behavioral Risks of Childhood and Adolescent Daytime Urinary Incontinence and Nocturnal Enuresis
Authors: Vasconcelos Monica M. A. , East Patricia , Blanco Estela , Lukacz Emily S. , Caballero Gabriela , Lozoff Betsy , Gahagan Sheila 
Published: October 2017

ABSTRACT:

Objective:
To investigate whether infant temperament and childhood internalizing, externalizing, and inattention symptoms increase the likelihood of daytime urinary incontinence or nocturnal enuresis at 10 years and adolescence (11.9–17.8 years).

Method:
Data were from a longitudinal cohort of 1119 healthy Chilean children. We assessed behavioral symptoms at infancy, 5 years, and 10 years and their relationship with subsequent daytime urinary incontinence and nocturnal enuresis.

Results:
Daytime urinary incontinence and nocturnal enuresis occurred in, respectively, 3.3% and 11.4% at 10 years and 1.1% and 2.7% at adolescence. Difficult infant temperament was associated with increased odds of 10-year daytime urinary incontinence. Inattention at 5 years was associated with increased odds for nocturnal enuresis at 10 years and adolescence. Internalizing and externalizing symptoms at 5 years were associated with increased odds of 10-year daytime urinary incontinence and nocturnal enuresis. Internalizing and externalizing symptoms at 10 years were associated with adolescent nocturnal enuresis.

Conclusion:
Temperament and internal/externalizing symptoms may be risk factors for school-age and adolescent urinary incontinence.
Encopresis Plus?
Authors: Cormier DePorres , Reilly Marie , Young Amy , Augustyn Marilyn 
Published: October 2017

CASE:
Dexter is a 12-year-old boy who presents with his maternal grandmother for follow-up to primary care for secondary encopresis. Dexter presented, 18 months ago, with a 3-month history of secondary encopresis. At that time, a comprehensive assessment revealed functional constipation resulting in encopresis. Dexter's symptoms resolved with a combination of medication management and behavioral strategies; laxatives were discontinued 12 months ago.
Dexter's grandmother reports that for the past 6 months, her grandson developed encopresis once again. However, she notes that, although Dexter had small-volume episodes of soiling in the past, he is now passing fully formed stools into his underwear. These episodes usually occur once a day, either at home or at school. Frustrated, Dexter's grandmother has transitioned him to adult diapers.
Dexter denies hematochezia, pain, dysuria, hematuria, urinary incontinence, dietary changes, or weight loss. He passes soft stool in his underwear once daily without blood or pain. When interviewed alone, Dexter denies drug use, depression, or significant social stressors. Surprisingly, he seems unconcerned about depression, drugs and social stress, and frequently laughs when discussing them. His physical examination, including a rectal examination, is normal.
Dexter's medical history is notable for attention-deficit hyperactivity disorder, treated with stimulant medication. He was toilet trained at 3 years without any difficulty. He lives with his grandmother, who is his legal guardian; his mother has chronic mental health problems and substance abuse. Dexter maintains regular contact with his mother and reports that their relationship is positive.
Dexter's grandmother is extremely distressed by his current presentation and notably, Dexter is not. What would you do next?
Riluzole Serum Concentration in Pediatric Patients Treated for Obsessive-Compulsive Disorder
Authors: Grant Paul , Farmer Cristan , Song Jane , Kish Timothy , Swedo Susan 
Published: October 2017

Abstract

Purpose/Background
The goals of this study were to determine whether pediatric serum concentration of riluzole is similar to that observed in adults and to determine whether riluzole serum concentration is associated with adverse effects or efficacy in children and adolescents with treatment-refractory obsessive-compulsive disorder.

Methods/Procedures
Data were drawn from previously published studies: 1 open-label trial and 1 randomized controlled trial with an open-label extension phase. Serum was drawn at 24, 36, and 52 weeks in 37 patients who were taking approximately 100 mg riluzole daily (mean dose at 24 weeks, 99 ± 28 mg).

Findings/Results
Across all samples, serum riluzole concentration ranged from 7 to 963 ng/mL. At week 24 (n = 37), the median concentration was 76 ng/mL (interquartile range, 53–172 ng/mL). Within-patient concentration was relatively stable. One subject who had the highest serum concentration levels during the study developed pancreatitis after exiting the study. The patient had recently added fluvoxamine to the riluzole regimen. Controlling for concomitant fluvoxamine (in 6 participants) and time of draw, serum riluzole concentration was not associated with obsessive-compulsive disorder symptom severity, nor was it associated with adverse effect profile.

Implications/Conclusions
The dose of riluzole used in these pediatric subjects seems to have achieved serum concentration levels similar to those observed in adults. However, as previously reported in adults, the serum concentration had no discernable relationship to efficacy or adverse effects.
Hepatitis C virus infection and risk of Parkinson’s disease: a systematic review and meta-analysis
Authors: Wijarnpreecha Karn , Chesdachai Supavit , Jaruvongvanich Veeravich , Ungprasert Patompong 
Published: October 2017

Background/objective
Hepatitis C virus (HCV) infection is one of the most common infections worldwide. Recent epidemiologic studies have suggested that patients with HCV infection might be at an increased risk of Parkinson’s disease. However, the data on this relationship remain inconclusive. This meta-analysis was conducted with the aim to summarize all available evidence.

Patients and methods
A literature search was performed using MEDLINE and EMBASE database from inception to May 2017. Studies that reported relative risks, odd ratios (ORs), or hazard ratios comparing the risk of Parkinson’s disease among HCV-infected patients versus participants without HCV infection were included. Pooled OR and 95% confidence interval were calculated using a random-effect, generic inverse variance method.

Results
Of 468 studies, five studies with 323 974 participants met our eligibility criteria and were included in the analysis. We found a higher risk of Parkinson’s disease among patients with chronic HCV infection compared with participants without HCV infection with the pooled OR of 1.35 (95% confidence interval: 1.19–1.52). The statistical heterogeneity of this study was insignificant (I
2=3%). The main limitation of this meta-analysis was the limited accuracy of diagnosis in the primary studies as they were coding-based studies.

Conclusion
This study demonstrated a higher risk of Parkinson’s disease among HCV-infected patients. Further studies are required to clarify how this risk should be addressed in the clinical picture.
Shear-wave elastography for the assessment of liver fibrosis in liver transplant recipients treated for hepatitis C virus recurrence
Authors: Korda David , Lenard Zsuzsanna M. , Gerlei Zsuzsanna , Jakab Zsuzsanna , Haboub-Sandil Anita , Wagner Laszlo , Varga Marina , Cseprekal Orsolya , Marton Adrienn , Horvathy Denes , Takacs Szabolcs , Doros Attila , Mathe Zoltan 
Published: October 2017

Objectives
Direct-acting antiviral agents have revolutionized hepatitis C therapy, and are also found to be effective in the liver transplant setting. The extent of liver fibrosis influences patient management and is used to monitor therapeutic effects. Shear-wave elastography (SWE) is a relatively new imaging-based method that has not yet been studied extensively in liver transplant patients. Our aim was to study the effect of direct-acting antivirals in heaptitis C recurrence on liver stiffness determined by SWE.

Patients and methods
A total of 23 liver transplant patients with hepatitis C recurrence were enrolled in this prospective study. The patients underwent 24 weeks of ombitasvir/paritaprevir/ritonavir+dasabuvir±ribavirin combination therapy. Elastographic examinations, serological tests and laboratory tests were performed, and serum biomarkers of liver fibrosis were calculated the day before treatment (baseline) and at the end of the treatment.

Results
All our patients became hepatitis C virus RNA negative by the end of the treatment. Median liver stiffness values decreased significantly after treatment compared with baseline (8.72±3.77 vs. 7.19±2.4 kPa; P<0.001). Among the studied laboratory values, a significant decrease was observed in the levels of alanine aminotransferase, aspartate aminotransferase and γ-glutamyltransferase, whereas international normalized ratio levels increased. Serum biomarkers, namely aspartate aminotransferase-to-platelet ratio index and Fibrosis-4, decreased significantly after treatment compared with baseline.

Conclusion
In the present study, SWE was succesfully used to monitor the beneficial therapeutic effects of direct-acting antivirals in hepatitis C recurrence following liver transplantation. We believe that SWE is a useful noninvasive diagnostic tool in the follow-up of hepatitis C treatment in liver transplant patients.
13-93B3 Bioactive Glass: a New Scaffold for Transplantation of Stem Cell-Derived Chondrocytes
Authors: Gunhan Kivanc , Bariskan Serkan , Uz Uzdan , Vatansever Seda , Kivanc Mujde 
Published: October 2017

AbstractResearch using animal models gives human trials hope for recovery in many fields of regenerative medicine, although they are sometimes poor predictors for human experiences. Our goal was to investigate whether rat chondrocytes, differentiated from adipose-derived stem cells, could be transplanted using a new, easily shaped, bioactive glass scaffold, and to show the immunohistochemical results. Intraperitoneal and retroperitoneal adipose tissue was extracted from 6 male Wistar albino type rats. The fatty tissue samples were fragmented and incubated. Chondrogenic differentiation was carried out and collagen type II, bFGF, and Sox-9 immunohistochemical characterization analysis was performed. Differentiated chondrocytes were implanted on 13-93B3 bioactive glass scaffolds and transplanted into the right ears of the rats. As control, only the biomaterial was transplanted into the left ears of the rats. After 1 month, the rats were sacrificed and transplantation areas were examined immunohistochemically. Histological examination of control samples from the left ears revealed that the biomaterial was covered with connective tissue, its general structure was preserved, and resorption of the scaffold had started. In specimens from the right ears, the biomaterial was covered with connective tissue, its structure was preserved, cartilage cells were present around the biomaterial, and the presence of cartilage tissue was demonstrated immunohistochemically. In conclusion, 13-93B3 bioactive glass scaffold contributed to the formation of new collagen and the survival of chondrocytes, and is a promising new biomaterial that will prove very useful in regenerative medicine.
The Etiology of Neuronal Development in Craniosynostosis: A Working Hypothesis
Authors: Brooks Eric D. , Beckett Joel S. , Yang Jenny , Timberlake Andrew T. , Sun Alexander H. , Chuang Carolyn , Persing John A. 
Published: October 2017

Abstract
Craniosynostosis is one of the most common craniofacial conditions treated by neurologic and plastic surgeons. In addition to disfigurement, children with craniosynostosis experience significant cognitive dysfunction later in life. Surgery is performed in infancy to correct skull deformity; however, the field is at a crossroads regarding the best approach for correction. Since the cause of brain dysfunction in these patients has remained uncertain, the role and type of surgery might have in attenuating the later-observed cognitive deficits through impact on the brain has been unclear. Recently, however, advances in imaging such as event-related potentials, diffusion tensor imaging, and functional MRI, in conjunction with more robust clinical studies, are providing important insight into the potential etiologies of brain dysfunction in syndromic and nonsyndromic craniosynostosis patients. This review aims to outline the cause(s) of such brain dysfunction including the role extrinsic vault constriction might have on brain development and the current evidence for an intrinsic modular developmental error in brain development. Illuminating the cause of brain dysfunction will identify the role of surgery can play in improving observed functional deficits and thus direct optimal primary and adjuvant treatment.
Outcomes of Titanium Mesh Cranioplasty in Pediatric Patients
Authors: Ma Irene T. , Symon Melissa R. , Bristol Ruth E. , Beals Stephen P. , Joganic Edward F. , Adelson P. David , Shafron David H. , Singh Davinder J. 
Published: October 2017

Purpose:
Cranial defects in children have been repaired with various materials ranging from autologous bone to synthetic materials. There is little published literature on the outcomes of titanium mesh cranioplasty (TMC) in calvarial reconstruction in the pediatric population. This study evaluates a pediatric cohort who underwent calvarial defect reconstruction with titanium mesh and assesses the efficacy and outcomes of TMC.

Methods:
An Institutional Review Board approved retrospective review of patients ≤18 years of age who underwent cranioplasty from 1999 to 2014 at 2 centers was performed. The cohort undergoing TMC was studied.

Results:
A total of 159 cranioplasties were performed. Autologous reconstruction included 84 bone flap replacements and 36 split calvarial bone graft reconstructions. Six patients underwent PEEK implant reconstruction. Titanium mesh cranioplasty was performed on 33 patients. Two patients underwent 2 separate cranioplasties. The median age of patients was 6 years (19 months to 18 years). The most common underlying etiologies were congenital syndromes/craniosynostosis (13 patients), and trauma (11). The majority of patients had prior cranial surgeries (85%). Various types of titanium mesh were used with sizes ranging from 2×3 cm to 19×20 cm, with some patients requiring distinct areas of defect reconstruction. Perioperative complications were noted in 2 patients that subsequently improved. Two patients had late soft tissue problems with complications of wound infections requiring resection of a portion of the mesh. Patients were followed an average of 4 years (range 13 days to 6.8 years), with 2 patients lost to follow-up. Overall, all patients with follow-up achieved a cranial contour with good symmetry to the unaffected side, as well as effective protection to the brain.

Conclusions:
Titanium mesh cranioplasty is an effective option for correcting pediatric cranial defects when autologous bone availability is limited and soft tissue coverage allows placement of an implant. The interim outcome for these patients is favorable with few complications and no evidence of growth restriction in the authors’ series. Follow-up will be ongoing for these patients.
Mentor Tutoring: An Efficient Method for Teaching Laparoscopic Colorectal Surgical Skills in a General Hospital
Authors: Ichikawa Nobuki , Homma Shigenori , Yoshida Tadashi , Ohno Yosuke , Kawamura Hideki , Wakizaka Kazuki , Nakanishi Kazuaki , Kazui Keizo , Iijima Hiroaki , Shomura Hiroki , Funakoshi Tohru , Nakano Shiro , Taketomi Akinobu 
Published: October 2017

Objective:
We retrospectively assessed the efficacy of our mentor tutoring system for teaching laparoscopic colorectal surgical skills in a general hospital.

Materials and Methods:
A series of 55 laparoscopic colectomies performed by 1 trainee were evaluated. Next, the learning curves for high anterior resection performed by the trainee (n=20) were compared with those of a self-trained surgeon (n=19).

Results:
Cumulative sum analysis and multivariate regression analyses showed that 38 completed cases were needed to reduce the operative time. In high anterior resection, the mean operative times were significantly shorter after the seventh average for the tutored surgeon compared with that for the self-trained surgeon. In cumulative sum charting, the curve reached a plateau by the seventh case for the tutored surgeon, but continued to increase for the self-trained surgeon.

Conclusions:
Mentor tutoring effectively teaches laparoscopic colorectal surgical skills in a general hospital setting.