bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification and Management of Obese Patients in a Pediatric Orthopaedic Clinic
Authors: Davila Natalia , Vess Joy , Johnson Emily E. 
Published: May 2017

BACKGROUND:
Childhood obesity is a complex healthcare problem that affects all aspects of a child's health. The American Academy of Pediatrics and the Expert Committee recommends that all children be evaluated for current medical conditions including the risk for obesity by identifying elevated body mass index (BMI), physical activity habits, and diet. Childhood obesity is defined as a BMI of 95th percentile or greater on standardized age-based growth charts. Abdominal and visceral fat mass has a negative effect on bone formation during childhood and adolescence. Effective interventions are aimed at prevention and treatment and include collection and assessment of obesity, eating habits, physical activity, and family history. At a local outpatient pediatric orthopaedic practice, few patients had a diagnosis of childhood obesity and weight management varied by providers.

PURPOSE:
The purpose of this quality improvement project was to improve identification of obese children and increase referrals to a weight management program.

METHODS:

Setting:
A hospital-affiliated pediatric orthopaedic clinic staffed with 3 orthopaedic surgeons and 2 nurse practitioners.
Population:
6- to 18-year-olds with a BMI of greater than 95th percentile (N = 239).
Data Collection:
Electronic medical record chart review for documented obesity and referral to weight management program:
Intervention:
Provider educational in-service reviewing management guidelines and referral process.

RESULTS:
Average percentages of documented obesity diagnosis increased from 11% to 53%. The number of referrals to Heart Healthy weight management program increased by 400%.

CONCLUSION:
An educational-based intervention in a pediatric orthopaedic clinic was effective in increasing the number of patients with a diagnosis of obesity and referred to a weight management program.
Enhanced Recovery After Surgery for Hip and Knee Replacements
Authors: Gwynne-Jones David P. , Martin Ginny , Crane Chris 
Published: May 2017

BACKGROUND:
Enhanced recovery after surgery (ERAS) programs or hip and knee replacements have had a significant effect on streamlining patient care with shorter stays, no increase in complications, and improved outcomes including reduced mortality.

PURPOSE:
To compare outcomes following the introduction of an ERAS program for hip and knee replacements developed at our institution with a historical cohort of patients.

METHODS:
ERAS protocols were developed at our institution for patients undergoing hip and knee joint replacements. Key aspects were changes in preadmission, a new education session, improved management of perioperative anemia, standardized anesthetic guidelines, day of surgery mobilization, and improved discharge planning. The results of the first 18 months (528 consecutive patients) were compared with those of a historical cohort of 507 patients from the 18 months prior to their introduction.

RESULTS:
In the ERAS group, the mean age was 68.3 years for patients who underwent hip replacement and 70.4 years for patients who underwent knee replacement. Thirty-two percent of patients were ASA (American Society of Anesthesiologists) Grades III and IV. The average preoperative Oxford score was 11. The average length of stay (ALOS) fell from 5.6 to 4.3 days for patients who underwent hip replacement and from 5.7 to 4.8 days for patients who underwent knee replacement (p < .001). Ninety-six percent of patients were discharged home. The 30-day readmission rate increased from 3.2% to 5.5% (p = .065). Six-month Oxford knee scores were higher in the ERAS group (39.8 vs. 36.3, p = .03). There was no increase in mortality or early revision rate.

CONCLUSIONS:
Substantial reductions in ALOS can be gained with the introduction of ERAS protocols, with high patient satisfaction and no increase in complications in a consecutive unselected group of public hospital patients. This requires a multidisciplinary approach and a strong clinical input.
Developing a Logarithmic Chinese Reading Acuity Chart
Authors: Han Qi-Ming , Cong Lin-Juan , Yu Cong , Liu Lei 
Published: May 2017

ABSTRACT

Purpose
An individual’s reading ability cannot be reliably predicted from his/her letter acuity, contrast sensitivity, and visual field extent. We developed a set of Chinese reading acuity charts (C-READ) to assess the reading ability of Chinese readers, based on the collective wisdom of previously published reading acuity charts, especially the MNRead and the Radner Reading Charts.

Methods
The C-READ consists of three charts. Each consists sixteen 12-character simplified Chinese sentences crafted from first- to third-grade textbooks. One hundred eighteen native Chinese-speaking college students (aged 22.1 ± 2.1 years) with normal or corrected to normal near vision (−0.26 ± 0.05 logMAR) were included in the study to develop the C-READ charts, to test the homogeneity of the three charts, and to validate the C-READ against the text paragraphs from the International Reading Speed Texts (IReST) with corrected and uncorrected near vision.

Results
The reading acuity, critical print size, and maximum reading speed for young normal native Chinese-speaking readers were 0.16 ± 0.05 logMAR, 0.24 ± 0.06 logMAR, and 273.44 ± 34.37 characters per minute (mean ± SD), respectively. The reliability test revealed no significant differences among the three C-READ charts and no significant test order effect in the three reading parameters. Regression analyses showed that the IReST reading speed could be reliably predicted by the C-READ maximum reading speed under the corrected near-vision condition (adjusted R
2 = 0.72) and by C-READ maximum reading speed and critical print size under the uncorrected near-vision condition (adjusted R
2 = 0.69).

Conclusions
The three C-READ charts are very comparable to each other, and there is no significant order effect. Reading test results can accurately predict continuous text reading performance quantified by the IReST reading speed over a wide range of refractive errors. The C-READ is a reliable and valid clinical instrument for quantifying reading performance in simplified Chinese readers.
Influence of Optic Disc Size on Identifying Glaucomatous Optic Neuropathy
Authors: Nixon Gregory J. , Watanabe Ronald K. , Sullivan-Mee Michael , DeWilde Anthony , Young Lisa , Mitchell G. Lynn 
Published: May 2017

ABSTRACTPurposeThe aim of this study was to use a large group of observers to test prior research findings that suggest optic disc size, clinical evaluation of the neuroretinal rim (ISNT rule), and practitioner characteristics influence the accuracy of differentiating normal from glaucomatous optic nerves.MethodsParticipant observers were optometrists, optometry students, and vision scientists/researchers attending the 2013 American Academy of Optometry Annual Meeting. Each observer viewed and judged six sets of stereoscopic photographs of normal and clinically confirmed glaucomatous optic nerves of different sizes presented in random order. Observers were queried on whether each nerve was glaucomatous or normal, whether the nerve followed the ISNT rule, and whether further evaluation with advanced imaging techniques was indicated.ResultsOf the 261 observers who participated, 59% were practicing optometrists, 7% were vision scientists, and 34% were residents or students. Of practicing optometrists and vision scientists, half (49%) had more than 15 years of experience, whereas 11% had less than 2 years of experience. Diagnostic accuracy differed based on optic nerve size: average-sized nerves were correctly identified by 90% of subjects, whereas small nerves and large nerves were correctly identified by 42% and 62%, respectively. Notably, only 9% of subjects correctly identified the small glaucomatous nerve, and only 34% correctly identified the large normal nerve. No practitioner characteristics were associated with diagnostic accuracy.ConclusionsAccurate identification of glaucomatous optic neuropathy was significantly influenced by optic disc size. This was particularly evident for the large normal nerve and the small glaucomatous nerve. The ISNT rule provided value for differentiating normal from glaucomatous nerves, but its subjective interpretation resulted in considerable intergrader variability. These findings agree with other studies utilizing smaller numbers of observers but larger numbers of optic nerve presentations that disc size and the ISNT rule have value for enhancing accuracy of optic nerve assessment.
Impact of Dry Eye Symptoms and Daily Activities in a Modern Office
Authors: van Tilborg Mirjam M. , Murphy Paul J. , Evans Katharine S. 
Published: May 2017

ABSTRACT

Purpose
Modern offices and the use of electronic devices are increasing factors in work-related eye symptoms. However, symptoms of eye fatigue or dry eye sensation can be mixed and confusing. This study surveys the eye symptoms reported during a working day at modern offices to investigate the possible inhibition on daily work activities.

Methods
Two online digital surveys were sent to three different work locations, by direct e-mail. Survey A consisted of 14 questions that investigated eye symptoms experienced during daily activities at work and the impact on daily activities. Survey B consisted of four general questions, the Dutch Ocular Surface Disease Index, the Work Productivity and Activity Index, and the Illness Perception Questionnaire.

Results
A total of 505 participants completed survey A, and 213 completed survey B. The participants reported that a high proportion of their day was spent working on a computer (60%). The majority experienced an air draft (79.1%) and had no adjustable light (81.5%) at their workspace. Dry eye–related symptoms were reported at a significantly higher frequency at work than at home (P < .001). Up to 70% experienced some inhibition of daily activity at work due to eye symptoms, with more than 5% experiencing symptoms most or all of the time. Indoor environment, work environment, and general health were perceived as the main reasons for developing dry eye. Compared with males, females showed a statistically significant higher Ocular Surface Disease Index score (P < .001) and experienced more inhibition and adverse effects on daily life and work productivity.

Conclusions
This investigation shows that dry eye symptoms have a negative impact on daily activities at work. These findings suggest that multidisciplinary understanding of the negative impact of dry eye by a range of specialists will be of help in managing work-related dry eye.
Effects of Affordable Care Act Marketplaces and Medicaid Eligibility Expansion on Access to Cancer Care
Authors: Graves John A. , Swartz Katherine 
Published: May 2017

Purpose
The aim of this study was to inform oncologists about how repealing the Affordable Care Act (ACA) may affect their ability to provide cancer therapies for people with cancer enrolled in ACA health plans and why proposals to change Medicaid funding may make it even more difficult for Medicaid beneficiaries to access cancer treatments.

Methods
We examined the regulations and provisions of the ACA related to how health insurance impacts access to diagnostic testing and treatments for people with cancer, including access to clinical trials. Similarly, we examined federal and state rules affecting Medicaid beneficiaries’ access to cancer treatments.

Results
Repealing various provisions of the ACA will restrict who has access to both current and new cancer treatments. Such changes also will impact oncology research that depends on having heterogeneous people in clinical trials.

Conclusions
Significant changes to the ACA will affect oncology treatment choices of everyone with health insurance—not only the 10 million people newly covered by ACA health plans and the 70 million people with Medicaid coverage.
Seven-Tesla MRI of Hippocampal Sclerosis
Authors: Stefanits Harald , Springer Elisabeth , Pataraia Ekaterina , Baumgartner Christoph , Hainfellner Johannes A. , Prayer Daniela , Weisstanner Christian , Czech Thomas , Trattnig Siegfried 
Published: May 2017

Introduction
Temporal lobe epilepsy (TLE) is the most frequent form of focal epilepsy in adults. Because approximately half of these patients develop drug resistance, epilepsy surgery designed to remove the epileptogenic zone is an excellent option in selected patients. Histopathological analyses of hippocampal specimens in TLE patients revealed 4 types of Ammon's horn sclerosis, which are correlated with long-term epileptological outcome. The aim of this study was the correlation of noninvasive, high-resolution, morphological magnetic resonance imaging (MRI) at an ultra-high-field (7 T) of the hippocampus in TLE patients with histopathological findings.

Methods
High-resolution, T2-weighted FSE MRI in 14 patients with drug-resistant temporal lobe epilepsy was performed on a 7 T Magnetom using a 32-channel coil. Four independent investigators assessed the delineation and semiquantitative evaluation of volume, signal intensity, internal architecture, and overall grading of the hippocampal subfields CA1-4, as well as the presence of the dentate granule cell layer (DGCL), on MRI scans. Results were compared with semiquantitative evaluation of neuronal loss and astrogliosis in the histological sections of the surgical specimens.

Results
Seven-tesla MR examinations were evaluable in 13 cases. Volume loss and signal intensity, as well as overall grading, showed a strong correlation between MRI and histology in individual CA regions. Furthermore, sensitivity and specificity values up to 100% were found for the detection of pathology in the CA subfields. The prediction of Ammon's horn sclerosis type was correct in up to 12 of 13 cases, whereas the dentate gyrus could not be delineated on MRI.

Discussion
High-resolution, ultra-high-field MRI is a promising tool for the detection of subtle changes in the hippocampus in patients with temporal lobe epilepsy. Large cohorts will be necessary to confirm the predictive value of 7 T MRI in the preoperative evaluation of TLE patients.
Sphingosine-1-Phosphate Receptor-1 Agonist Sew2871 Causes Severe Cardiac Side Effects and Does Not Improve Microvascular Barrier Breakdown in Sepsis
Authors: Flemming Sven , Burkard Natalie , Meir Michael , Schick Martin Alexander , Germer Christoph-Thomas , Schlegel Nicolas 
Published: May 2017

ABSTRACT

Background:
Endothelial barrier dysfunction is a hallmark in the pathogenesis of sepsis. Sphingosine-1-phosphate (S1P) has been proposed to be critically involved in the maintenance of endothelial barrier function predominately by activating S1P receptor-1 (S1P1). Previous studies have shown that the specific S1P1 agonist SEW2871 improves endothelial barrier function under inflammatory conditions. However, the effectiveness of SEW2871 and potential side effects remained largely unexplored in a clinically relevant model of sepsis. Therefore, this study aimed to evaluate the effects of SEW2871 in the Colon ascendens stent peritonitis (CASP) model.

Methods:
Polymicrobial sepsis was induced in Sprague–Dawley rats using CASP model that enabled the monitoring of macro-hemodynamic parameters. Twelve hours after surgery, animals received either SEW2871 or sodium chloride. Mesenteric endothelial barrier function was evaluated 24 h after sepsis induction by intravital microscopy. Organ pathology was assessed in lungs. S1P levels, blood gas analyses, and blood values were measured at different time points. In parallel the effect of SEW2871 was evaluated in human dermal microvascular endothelial cells.

Result:

In vitro SEW2871 partially stabilized TNF-α-induced endothelial barrier breakdown. However, in vivo SEW2871 caused severe cardiac side effects in septic animals leading to an increased lethality. Sepsis-induced endothelial barrier dysfunction was not attenuated by SEW2871 as revealed by increased FITC-albumin extra-vasation, requirement of intravasal fluid replacement, and pulmonary edema. Interestingly, Sham-operated animals did not present any side effects after SEW2871 treatment.

Conclusion:
Our study demonstrates that the application of SEW2871 causes severe cardiac side effects and cannot attenuate the inflammation-induced endothelial barrier breakdown in a clinically relevant sepsis model, suggesting that the time point of administration and the pro-inflammatory milieu play a pivotal role in the therapeutic benefit of SEW2871.
Defining the gastroesophageal junction in trauma: Epidemiology and management of a challenging injury
Authors: Schellenberg Morgan , Inaba Kenji , Bardes James M. , O'Brien Daniel , Lam Lydia , Benjamin Elizabeth , Grabo Daniel , Demetriades Demetrios 
Published: May 2017

BACKGROUND
Injuries to the gastroesophageal (GE) junction are infrequently encountered because of the high mortality of associated injuries. Consequently, there is a paucity of literature on the patient demographics and treatment options. The aim of this study was to examine the epidemiology, surgical management, and outcomes of these rare injuries.

METHODS
Patients presenting to LAC + USC Medical Center (January 2008 to August 2016) with traumatic esophageal or gastric injury (DRG International Classification of Diseases—9th Rev.—Clinical Modification and 10th Rev. codes) were extracted from the trauma registry. Patient charts were reviewed, and all patients who sustained an injury to the GE junction were enrolled. Patient demographics, injury characteristics, procedures, and outcomes were analyzed.

RESULTS
Of the 238 patients who sustained an injury to the esophagus or stomach during the study period, 28 (12%) were found to have a GE junction injury. Mean age was 26 years (range, 14–57 years), 89% male. Mechanism of injury was penetrating in 96% (n = 27), the majority of which were gunshot wounds (n = 22, 81%). Most patients (n = 18, 64%) were taken directly to the operating room. Ten (36%) underwent computed tomography scan before going to the operating room, all demonstrating a GE junction injury. All patients underwent repair via laparotomy. One (4%) also required thoracotomy to facilitate delayed reconstruction. GE junction injuries were typically managed with primary repair (n = 22, 79%). Associated injuries were frequent (n = 26, 93%), and injury severity was high (mean Injury Severity Score, 25 [9–75]). Mortality was 25% (n = 7), and all patients required intensive care unit admission. Most did not require total parenteral nutrition (n = 25, 89%) or a surgically placed feeding tube (n = 26, 93%). Of the 13 patients who presented for clinical follow-up, all but one (n = 12, 92%) were eating independently by the first clinic visit.

CONCLUSION
GE junction injuries are uncommon and occur almost exclusively after penetrating trauma. Patients are severely injured with a high mortality rate and frequently have associated intracavitary injuries. Most can be fixed through the abdomen alone and do not require thoracotomy for repair. Despite the severity of injuries, the majority of survivors are eating independently by the first clinic visit.

LEVEL OF EVIDENCE
Epidemiological, level V.
Factors associated with intimate partner homicide in Illinois, 2005–2010: Findings from the Illinois Violent Death Reporting System
Authors: Yousuf Sana , McLone Suzanne , Mason Maryann , Snow Lisa , Gall Carol , Sheehan Karen 
Published: May 2017

BACKGROUND
Critical elements in intimate partner homicides (IPH) often go undocumented. Previous studies have highlighted precipitating causes, but few have examined the place of injury that led to the victim’s death. We sought to describe IPH cases in Illinois and in particular to examine factors surrounding the location of injury that led to the victim’s death.

METHODS
We analyzed data collected in the Illinois Violent Death Reporting System to assess victim demographics, perpetrator characteristics, the victim/perpetrator relationship, and circumstances surrounding the location of injury that led to the victim’s death.

RESULTS
From 2005 to 2010, 275 cases were identified as IPH. Women comprised 60.4% of victims and men 39.6%. Among perpetrators, 78.5% were identified as male and 21.5% as female. Of the 31 corollary victims, 54.8% were less than 18 years and 58.1% were injured in front of a family member. Females were 1.6 times more likely to have the injury that led to their death occur at their residence, as compared to males (OR 1.6, 95% CI 1.1–2.9). Cases in which the perpetrator had documented history of abuse were 2.4 times more likely to have the fatal injury occur at the victim’s residence compared to those that did not have previous history (OR 2.4, 95% CI 1.2–4.8). IPH cases in which the perpetrator was the current partner of the victim were twice as likely to have the injury leading to the victim’s death occur at the victim’s residence compared to those perpetrators who were not a current partner (OR 2.1, 95% CI 1.2–3.5).

CONCLUSIONS
Considering the increased risk of IPH occurring at the place of residence for women at the hands of current intimate partners and by perpetrators with a previous history of abuse, prevention efforts may wish to prioritize in-home and relocation intervention strategies.

LEVEL OF EVIDENCE
Epidemiologic, level IV.
Development of the emergency preservation and resuscitation for cardiac arrest from trauma clinical trial
Authors: Tisherman Samuel A. , Alam Hasan B. , Rhee Peter M. , Scalea Thomas M. , Drabek Tomas , Forsythe Raquel M. , Kochanek Patrick M. 
Published: May 2017

BACKGROUND
Patients who suffer a cardiac arrest from trauma rarely survive, even with aggressive resuscitation attempts, including an emergency department thoracotomy. Emergency Preservation and Resuscitation (EPR) was developed to utilize hypothermia to buy time to obtain hemostasis before irreversible organ damage occurs. Large animal studies have demonstrated that cooling to tympanic membrane temperature 10°C during exsanguination cardiac arrest can allow up to 2 hours of circulatory arrest and repair of simulated injuries with normal neurologic recovery.

STUDY DESIGN
The Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma trial has been developed to test the feasibility and safety of initiating EPR. Select surgeons will be trained in the EPR technique. If a trained surgeon is available, the subject will undergo EPR. If not, the subject will be followed as a control subject. For this feasibility study, 10 EPR and 10 control subjects will be enrolled.

STUDY PARTICIPANTS
Study participants will be those with penetrating trauma who remain pulseless despite an emergency department thoracotomy.

INTERVENTIONS
Emergency Preservation and Resuscitation will be initiated via an intra-aortic flush of a large volume of ice-cold saline solution. Following surgical hemostasis, delayed resuscitation will be accomplished with cardiopulmonary bypass.

OUTCOME MEASURES
The primary outcome will be survival to hospital discharge without significant neurologic deficits. Secondary outcomes include long-term survival and functional outcome.

IMPLICATIONS
Once data from these 20 subjects are reviewed, revisions to the inclusion criteria and/or the EPR technique may then be tested in a second set of EPR and control subjects.