bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Burden and Epidemiology of Eustachian Tube Dysfunction in Adults
Authors: Vila Peter M. , Thomas Tom , Liu Carrie , Poe Dennis , Shin Jennifer J. 
Published: January 2017

ObjectivesPediatric eustachian tube dysfunction (ETD), otitis media with effusion (OME), and tympanic membrane retraction (TMR) have been well studied, but no large analyses have described the associated burden beyond childhood. The potential impact and feasibility of prospective trials designed to optimize management of affected adults are thus unclear. Our objectives were therefore (1) to determine the national visit burden associated with ETD/OME/TMR beyond childhood and (2) to examine risk factors specific to adults, highlighting differences in comparison with children.Study DesignCross‐sectional analysis of a national database.SettingAmbulatory visits in the United States.MethodsEpidemiologic analysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (2005‐2012) included data from 761,291 observations representing 9,369,388,092 visits. Chi‐square test with Bonferroni adjustment for multiple comparisons was utilized for hypothesis testing.ResultsVisits related to ETD/OME/TMR exceeded 2 million per annum in patients 0 to 20 years of age (mean 2,625,965; range 2,239,288‐3,329,858). Among those >20 years old, visits also exceeded 2 million (mean, 2,025,050; range, 1,550,669‐2,353,799). Characteristics differed according to age: whereas ETD/OME/TMR affected more males <20 years, females were more frequently diagnosed in the older age group (P <. 0001). Patients >20 to 40 years of age were the most likely to visit the emergency department (P =. 0022). There were no statistically significant differences per season or region. The related diagnoses of cholesteatoma and chronic otitis media prompted additional visits.ConclusionsETD/OME/TMR is associated with a visit burden for adults that extends beyond childhood. Among adults, there may also be age‐related differences in patient characteristics.
Dynamic Optical Contrast Imaging: A Technique to Differentiate Parathyroid Tissue from Surrounding Tissues
Authors: Kim Irene A. , Taylor Zachary D. , Cheng Harrison , Sebastian Christine , Maccabi Ashkan , Garritano James , Tajudeen Bobby , Razfar Ali , Palma Diaz Fernando , Yeh Michael , Stafsudd Oscar , Grundfest Warren , St. John Maie 
Published: January 2017

The variable location and indistinct features of parathyroid glands can make their intraoperative identification challenging. Currently, there exists no routine use of localization methods during surgery. Dynamic optical contrast imaging (DOCI) leverages a novel realization of temporally dependent measurements of tissue autofluorescence that allows the acquisition of specific tissue properties. A prospective series of patients with primary hyperparathyroidism was examined. Parathyroid lesions and surrounding tissues were collected; fluorescence decay images were acquired via DOCI. Ex vivo samples (81 patients) were processed for histologic assessment. DOCI extracts relative fluorescence decay information in a surgically relevant field of view with a clinically accessible acquisition time <2 minutes. Analysis of DOCI revealed microscopic characterization sufficient for tissue type identification consistent with histology (P <. 05). DOCI is capable of efficiently distinguishing parathyroid tissue from adjacent tissues. Such an intraoperative tool would be transformative, helping surgeons to identify lesions, preserve healthy tissue, and improve patient outcomes.
Digging into Debt: The Financial Burden Associated with the Otolaryngology Match
Authors: Polacco Marc A. , Lally Jack , Walls Andrew , Harrold Linnea R. , Malekzadeh Sonya , Chen Eunice Y. 
Published: January 2017

ObjectiveTo quantify the cost incurred during the match process for otolaryngology applicants, determine sources of expenditures, and highlight potential methods to alleviate financial burden of the match process.Study DesignCross‐sectional.Study SettingOnline survey.Subjects and MethodsAn electronic survey was sent via email to those who applied to the otolaryngology residency programs at Dartmouth‐Hitchcock Medical Center and MedStar Georgetown University Hospital during the 2016 application cycle. Questions regarding demographics and experiences with the match were multiple choice, and questions regarding cost were open answer. Data were downloaded and analyzed on Excel and Minitab software.ResultsTwenty‐eight percent of the total 370 applicants completed the survey. The mean cost of away rotations was $2500 (95% confidence interval [CI], $2224‐$2776). With application fees and the cost of interviewing, the mean total cost of applying for the 2016 otolaryngology match was $6400 (95% CI, $5710‐$7090), with a total range of $1200 to $20,000. Twenty‐eight percent of students did not have sufficient funds for applying and interviewing despite seeking out additional monetary resources.ConclusionIn 2016, otolaryngology applicants spent a mean of $8900 (95% CI, $7935‐$9865) on away rotations, applications, and interviewing. Half of the applicants obtained additional funding to cover this cost, while 28% still did not have sufficient funding. Methods of decreasing cost may include instituting a cap on application number, videoconferencing interviews, regionalizing interviews, and adjusting the interview timeline.
Complications Associated with Mortality after Head and Neck Surgery: An Analysis of the NSQIP Database
Authors: Mulvey Carolyn L. , Brant Jason A. , Bur Andrés M. , Chen Jinbo , Fischer John P. , Cannady Steven B. , Newman Jason G. 
Published: January 2017

ObjectiveTo determine which complications, as defined by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, correlate with 30‐day mortality in surgery for malignancies of the head and neck.Study DesignRetrospective review of prospectively collected national database.SettingNSQIP.Subjects and MethodsNSQIP data from 2005 to 2014 were queried for ICD‐9 codes head and neck malignancies. Multivariate logistic regression was used to examine the correlation of individual complications with 30‐day mortality.ResultsIn total, 15,410 cases met criteria with 3499 complications in 2235 cases. After controlling for patient and surgical variables, postoperative pneumonia (P =. 02; odds ratio [OR], 2.39; 95% confidence interval [CI], 1.15‐4.72), progressive renal insufficiency (P <. 001; OR, 21.28; 95% CI, 4.22‐87.94), bleeding requiring transfusion (P =. 02; OR, 2.10; 95% CI, 1.12‐3.84), sepsis (P =. 02; OR, 2.86; 95% CI, 1.15‐6.46), septic shock (P =. 045; OR, 2.87; 95% CI, 0.98‐7.81), stroke (P <. 001; OR, 19.81; 95% CI, 6.23‐56.03), and cardiac arrest (P <. 001; OR, 135.59; 95% CI, 65.00‐286.48) were independently associated with increased odds of 30‐day mortality.ConclusionThe NSQIP database has been extensively validated and used to examine surgical complications, yet there is little analysis on which complications are associated with death. This study identified complications associated with increased risk of 30‐day mortality following head and neck cancer surgery. These associations may be used as a measure of complication severity and should be considered when using the NSQIP database to evaluate outcomes in head and neck surgery.
Smartphone‐Enabled Otoscopy in Neurotology/Otology
Authors: Moshtaghi Omid , Sahyouni Ronald , Haidar Yarah M. , Huang Melissa , Moshtaghi Afsheen , Ghavami Yaser , Lin Harrison W. , Djalilian Hamid R. 
Published: January 2017

ObjectiveA smartphone‐enabled otoscope (SEO) can capture tympanic membrane (TM) images. We sought to compare a SEO to microscopic otoscopy in the detection and evaluation of TM pathology in an otology/neurotology practice.Study DesignProspective single‐site study in adults presenting over a 3‐month period.SettingNeurotology clinic within a tertiary care academic medical center.Subjects and MethodsFollowing consent, 57 patients underwent a medical and microscopic ear examination. Afterward, clinicians photographed bilateral TMs using a SEO. A second “blinded” neurotologist received a SEO‐acquired image of each TM and a brief patient history. Our primary end point was identification of TM pathology (or lack thereof) and the blinded neurotologists’ corresponding diagnosis. Secondary end points included patient‐reported SEO comfort levels.ResultsA single SEO‐acquired TM image and brief patient history resulted in correct diagnosis of 96% (23/24) of normal TMs and identification of 100% (33/33) of microscope‐confirmed abnormal TMs. When pathology was identified by the “blinded” physician, the diagnosis was identical to that made by the primary treating physician 82% (27/33) of the time. On patient surveys, 93% (53/57) of patients felt “very comfortable” with SEO utilization, and 88% (50/57) reported viewing acquired images was “very useful” in understanding their condition.ConclusionA SEO is 96% specific in identifying normal TMs and 100% sensitive in identifying pathology. Its 97% positive predictive value and small false‐positive rate makes it a useful screening tool. Furthermore, patients are receptive to this technology and felt comfortable with its utilization in a health care or possible telemedicine setting.
The Utility of In‐Office Ultrasound in the Diagnosis of Parotid Lesions
Authors: Haidar Yarah M. , Moshtaghi Omid , Mahmoodi Amin , Helmy Mohammad , Goddard Julie A. , Armstrong William B. 
Published: January 2017

ObjectiveTo determine whether the use of in‐office ultrasound (US) by a head and neck surgeon is a useful adjunct to clinical assessment of parotid lesions and decrease the need of additional imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT).Study DesignCase series with chart review.SettingTertiary care academic center.SubjectsSeventy patients presenting with a parotid lesion who obtained an in‐office US and ultrasound‐guided fine‐needle aspiration (USGFNA) from a head and neck surgeon from 2006 to 2015.MethodsUS images were retrospectively reviewed for 70 patients and characterized by a radiologist and a head and neck surgeon.ResultsOf the 70 patients, 6 had US characteristics that demonstrated a statistically significant association with a benign/malignant diagnosis: depth from surface; irregular borders; presence of calcifications, which included either micro‐ or macro‐calcifications; posterior echogenicity enhancement; irregular shape; and homogeneous/heterogeneous echotexture. Imaging was performed prior to referral in 25 cases (35.7%); of those, 17 (68%) were for superficial, small (<2 cm) tumors where prereferral imaging studies did not provide additional information to that obtained with US. Of the 55 patients without MRI or CT performed prior to referral, MRI or positron emission tomography–CT scan was obtained in only 4 patients (7.3%) in cases involving recurrent parotid lesions, large tumors, or workup of a malignant neoplasm.ConclusionsSeveral US characteristics individually assist in lesion characterization. In‐office US and USGFNA are an appropriate first‐line modality in the assessment of parotid lesions, can allow for immediate parotid lesion assessment, and can decrease the need for additional imaging.
An Interhospital, Interdisciplinary Needs Assessment of Palliative Care in a Community Critical Care Context
Authors: Sarti Aimee J. , Bourbonnais Frances Fothergill , Landriault Angèle , Sutherland Stephanie , Cardinal Pierre 
Published: January 2017

Aim: There is a paucity of data on the provision of palliative care in the critical care settings of smaller community hospitals. This study aimed to identify the gaps that affect the provision of palliative care in a community critical care setting. Setting: The study was set in a 10-bed, open intensive care unit and emergency department at a community hospital. Methods: Mixed methods were used. Quantitative data included those drawn from databases and surveys; qualitative data included those collected from interviews, focus groups, and onsite walk-throughs and were analyzed with inductive coding techniques. Results: Gaps were identified in palliative care, goals of care and end-of-life discussions, and resources. Community hospital healthcare professionals did not fully appreciate their essential contribution to the provision of palliative care in the intensive care unit. In addition, there was a lack of expertise, and a lack of interest in gaining expertise, in palliative/end-of-life care. Conclusion: Interrelated needs in a complex interprofessional, interhospital context were captured. Further studies are required to obtain data on palliative practice in the care of critically ill patients in various community hospital contexts.
Training and Educational Development for “Vetrepreneurs”
Authors: Cumberland Denise M. 
Published: January 2017

The Problem Over the last decade, specialized training programs have emerged to assist veterans in launching their own businesses. An initial search for information on entrepreneurship training programs for veterans, however, reveals that there has been no systematic research undertaken to summarize programs available and no comparison of what these various training efforts include. In addition, there has been no examination of whether these programs provide the requisite skills to engage in venture creation, result in the launch of veteran start-ups, and improve the odds of long-term venture success. The lack of empirical studies reporting on the assessment of these programs makes it difficult to judge the relevancy of the curriculum in meeting the nascent veteran entrepreneurs’ needs. The Solution This article brings together a wide range of information on veteran entrepreneurial training programs offered by the government, academia, and nonprofits in the United States. Data were gathered through websites and other literatures. Concern about the lack of reported results of these programs is noted, and a framework is proposed for the systematic evaluation of learning outcomes that could be used across veteran entrepreneurial education programs. The Stakeholders The article is aimed at training development professionals, universities, policy makers, veterans, and human resource development (HRD) professionals.
Transcriptomic effects of metformin in skeletal muscle arteries of obese insulin-resistant rats
Authors: Padilla Jaume , Thorne Pamela K , Martin Jeffrey S , Rector R Scott , Akter Sadia , Davis J Wade , Laughlin M Harold , Jenkins Nathan T 
Published: January 2017

We examined the effects of metformin, a commonly used antidiabetic drug, on gene expression in multiple arteries. Specifically, transcriptional profiles of feed arteries and second branch order arterioles in the soleus, gastrocnemius, and diaphragm muscles as well as aortic endothelial scrapes were examined from obese insulin-resistant Otsuka Long-Evans Tokushima Fatty rats treated with ( n = 9) or without ( n = 10) metformin from 20 to 32 weeks of age. Metformin-treated rats exhibited a reduction in body weight, adiposity, and HbA1c ( P < 0.05). The greatest number of differentially expressed genes (FDR < 15%) between those treated with and without metformin was found in the red gastrocnemius 2a arterioles (93 genes), followed by the diaphragm 2a arterioles (62 genes), and soleus 2a arterioles (15 genes). We also found that two genes were differentially expressed in aortic endothelial cells (LETMD1 and HMGCS2, both downregulated), one gene in the gastrocnemius feed artery (BLNK, downregulated), and no genes in the soleus and diaphragm feed arteries and white gastrocnemius 2a arterioles. No single gene was altered by metformin across all vessels examined. This study provides evidence that metformin treatment produces distinct gene expression effects throughout the arterial tree in a rat model of obesity and insulin resistance. Genes whose expression was modulated with metformin do not appear to have a clear connection with its known mechanisms of action. These findings support the notion that vascular gene regulation in response to oral pharmacological therapy, such as metformin, is vessel specific.Impact statementThis study provides evidence that metformin treatment produces artery-specific gene expression effects. The genes whose expression was modulated with metformin do not appear to have a clear connection with its known mechanisms of action.
Primary adrenal lymphoma causing hypoaldosteronism in a cat
Authors: Romine Jessica F , Kozicki Angela R , Elie Marc S 
Published: January 2017

Case summary A 10-year-old, 5.1 kg (11.2 lb), male castrated cat was presented with signs of lethargy and decreased appetite at home after being previously healthy. Serum biochemical analysis identified normokalemia (5.1 mmol/l; reference interval [RI] 3.4–5.6 mmol/l) and severe hyponatremia (123 mmol/l; RI 145–158 mmol/l), with an Na/K ratio of 24 (RI 32–41). Baseline serum cortisol was low to normal, but serum aldosterone was markedly decreased with a pre-adrenocorticotropic hormone stimulation concentration of 13 pmol/l (RI 194–388 pmol/l) and post-adrenocorticotropic hormone stimulation concentration of 21 pmol/l (RI 277–721 pmol/l). Hematologic and biochemical analyses were otherwise unremarkable. Abdominal ultrasound revealed bilaterally enlarged adrenal glands with no other abnormalities noted; thoracic radiographs also did not identify any signs of metastasis. Fine-needle aspiration was strongly suggestive of lymphoma of the adrenal glands, and PCR for antigen receptor rearrangement was positive for B-cell clonal expansion; based on these findings, a diagnosis of primary adrenal B-cell lymphoma was made. Stable disease was achieved for a short period of time following vincristine, cyclophosphamide, prednisolone and fludrocortisone therapy, followed by progressive adrenal enlargement and electrolyte derangements that responded to neither doxorubicin nor adjustments in fludrocortisone dosage. Ultrasonographic metastasis was not identified at any time, and other organ derangements were not noted on hematologic or biochemical analyses. The cat was euthanized 55 days after initial presentation. Relevance and novel information This is the first report of primary adrenal lymphoma in a cat, with presenting signs compatible with hypoaldosteronism. Lymphoma should be a differential for cats presenting with adrenal enlargement or clinical signs and biochemical changes consistent with hypoaldosteronism or hypoadrenocorticism.
Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery
Authors: Baskan Semih , Cankaya Deniz , Unal Hidayet , Yoldas Burak , Taspinar Vildan , Deveci Alper , Tabak Yalcin , Baydar Mustafa 
Published: January 2017

Purpose: This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. Methods: This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. Results: A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. Conclusion: The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.
Return to Play and Prior Performance in Major League Baseball Pitchers After Repair of Superior Labral Anterior-Posterior Tears
Authors: Smith Ryan , Lombardo Daniel J. , Petersen-Fitts Graysen R. , Frank Charles , Tenbrunsel Troy , Curtis Gannon , Whaley James , Sabesan Vani J. 
Published: January 2017

Background: The published return-to-play (RTP) rates for Major League Baseball (MLB) pitchers who have undergone surgical repair of superior labrum anterior-posterior (SLAP) tears vary widely and are generally accepted to be lower in the subset of competitive throwers. The efficacy of surgical treatment for MLB players is largely unknown. Purpose: To examine the RTP rate and performance of MLB pitchers who have undergone SLAP tear repair between 2003 and 2010. Study Design: Descriptive epidemiological study. Methods: A retrospective review of MLB pitchers undergoing SLAP repair was performed using the MLB disabled list. Data collected included the following player statistics: earned run average (ERA), walks plus hits per inning pitched (WHIP), and innings pitched (IP). The mean values for performance variables both before and after surgery were compared. A definition of return to prior performance (RTPP) was established as an ERA within 2.00 and WHIP within 0.500 of preoperative values. Results: Twenty-four MLB players met inclusion criteria, of which 62.5% were able to RTP at the MLB level after SLAP repair surgery. Of those able to RTP, 86.7% were able to RTPP. However, the overall rate of RTPP, including those unable to RTP, was 54.2%. Mean performance analysis of the RTP group revealed a statistically significant decrease in IP for MLB pitchers throwing a mean 101.8 innings before injury and 65.53 innings after injury ( P = .004). Conclusion: Of those pitchers able to RTP, chances of a full recovery were good (86.7%). Our results indicate the need for future research aimed at proper surgical selection of who will return to play, as they will likely achieve full recovery. We believe this information can help surgeons advise high-level overhead-throwing athletes about expected outcomes for surgical treatment of SLAP tears.