bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gaps Between Self-Rated Job Importance and Abilities for Community Health Workers in Massachusetts
Authors: Rataj Suzanne , Weber Luise , DiFulvio Gloria , Heffernan Dawn , Gerber Dan , Chipkin Stuart R. 
Published: October 2016

Introduction Community health workers (CHWs) serve increasingly active roles in clinical care and population health. To identify priorities for training programs, we developed a training needs assessment (TNA) tool by integrating and distilling core competencies previously identified by various national and state agencies. Methods CHWs were asked to self-rate, using a 4-point scale, the importance to their work and their ability to perform 49 competencies categorized under 10 domains. A difference score—Ability minus Importance—was calculated to determine relative Need. Results The 96 CHWs who completed the TNA were mostly female (80%) and Latino (40%). While CHWs indicated training was needed for all competencies, the scores ranged from −0.04 to −0.45, on a scale running from 0 to −3, where larger negative numbers indicate higher need. In general, there was a high level of congruence between individual competencies with high Need and domains with Need, with few outliers. Competencies with high Need scores related to culture, case assessment and coordination, and behavior change. CHWs rated client-based competencies higher than population health competencies in Ability scores (3.43 vs. 3.05, respectively) and Importance scores (3.70 vs. 3.35, respectively). However, overall Need scores showed no difference between client-based and public health-based competencies. Conclusion CHWs can successfully rate the importance of core competencies to their work and rank their ability to perform these competencies. Training needs generally favored clinical individual client-focused skills over prevention and public health competencies. Using scales that incorporate self-rated measures of core competency ability and importance can inform priorities for CHW training programs and contribute to successful curriculum development.
Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls
Authors: Fältström Anne , Hägglund Martin , Kvist Joanna 
Published: October 2016

Background: Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR). Purpose: This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)–reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses. Results: The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players’ matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended guidelines for all 5 tests ( P = .837). Conclusion: The reconstructed and uninvolved limbs did not differ, and players with an ACL-reconstructed knee and controls differed only minimally on the functional performance tests, indicating similar function. It is worth noting that many players with an ACL-reconstructed knee and controls had movement asymmetries and a high pKAM pattern, which have previously been associated with an increased risk for both primary and secondary ACL injury in female athletes.
Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis
Authors: Sun Yaying , Zhang Peng , Liu Shaohua , Li Hong , Jiang Jia , Chen Shiyi , Chen Jiwu 
Published: October 2016

Background: Intra-articular steroid injection is a common intervention for frozen shoulder (FS). Purpose: This review aimed to illustrate the effects of intra-articular steroid injection for FS. Study Design: Systematic review and meta-analysis. Methods: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing intra-articular steroid injection with no injection or sham injections for FS. Visual analog scale (VAS) pain scores were the primary outcome measure. Secondary outcome measures included passive external rotation, abduction, flexion, internal rotation, and functional scores. Complication rates were the safety outcome measure. Comparisons were performed with mean differences (MDs) and 95% confidence intervals (95% CIs). Three time intervals were analyzed: 4 to 6 weeks, 12 to 16 weeks, and 24 to 26 weeks postintervention. Trial sequential analysis was used to verify the pooled results. Line charts were drawn to view the recovery trend in both the intervention and control groups. Results: Eight RCTs with 416 patients were included. Compared with controls, patients who received intra-articular steroid injection had significantly reduced VAS pain scores at 4 to 6 weeks (MD, 1.28 cm [95% CI, 0.75 to 1.82]), 12 to 16 weeks (MD, 1.00 cm [95% CI, 0.47 to 1.52]), and 24 to 26 weeks (MD, 0.65 cm [95% CI, 0.19 to 1.10]) postinjection. Trial sequential analysis confirmed the pooled results at 4 to 6 weeks and 12 to 16 weeks but not at 24 to 26 weeks. Patients who received intra-articular steroid injection had improved passive external rotation, abduction, and flexion and Shoulder Pain and Disability Index (SPADI) scores at all 3 time intervals, as well as improved American Shoulder and Elbow Surgeons (ASES) scores at 12 to 16 weeks (MD, 12.20 [95% CI, 2.55 to 21.85]). No difference was noticed in Constant scores (MD, 5.70 [95% CI, –0.59 to 11.99]) or internal rotation except at 12 to 16 weeks (MD, 0.81° [95% CI, 0.18° to 1.44°]) and 24 to 26 weeks (MD, 3.88° [95% CI, 0.51° to 7.25°]) between steroid injection and placebo. Complication rates were 1.78% for facial flushing, 0.71% for dizziness owing to vasovagal reactions during injection, 1.07% for chest or shoulder pain, and 0.36% for nausea. Line charts improved in both groups. Conclusion: Intra-articular steroid injection is effective and safe for FS and relieves pain, improves functional performance, and increases range of motion. The effects are significant at 4 to 6 and 12 to 16 weeks postintervention and may last as long as 24 to 26 weeks.
Implication of alcohol consumption on aggregate wellbeing
Authors: Parackal Mathew , Parackal Sherly 
Published: October 2016

Aims: The effects of drinking alcohol extend beyond the individuals concerned to the wider community. While there is recognition of such a global implication, currently no study has quantified the impact of alcohol consumption on aggregate wellbeing. This study aims to address this gap and attempts to investigate the impact of various levels of alcohol consumption on aggregate happiness. Methods: The study was carried out on a random selection of participants ( n = 1,817) drawn from the 3Di consumer panel, comprising over 170,000 New Zealanders aged 18 and above. Using a subjective happiness scale (SHS) in conjunction with the Alcohol Use Disorders Identification Test (AUDIT), investigation was carried out to find whether drinking behaviour affected aggregate happiness. Results: SHS and AUDIT scores were negatively correlated and the strength of the correlation increased with the intensity of problematic drinking. Regression analysis showed that the beta coefficient was positive for the low-risk (.074) and negative for the high-risk (−.081) category, suggesting approaches to intervene with the growing problem of alcohol consumption in modern societies. Conclusion: Measurements of happiness can explain the global implication of alcohol in wellbeing terms. The findings of this study indicated that low-risk drinkers affected aggregate happiness positively, whereas high-risk drinkers affected aggregate happiness negatively. While the latter observation is not new, the former raises the need to promote moderation in drinking alcohol for the common good of everyone.
Endoscopic removal of over‐the‐scope clips: Clinical experience with a bipolar cutting device
Authors: Bauder Markus , Meier Benjamin , Caca Karel , Schmidt Arthur 
Published: October 2016

BackgroundOver‐the‐scope clips (OTSCs) are increasingly used for the closure of perforations/fistulae, hemostasis and endoscopic full‐thickness resection (FTRD system). When OTSC‐associated complications occur or re‐therapy at the OTSC site is needed, OTSC removal may be indicated. An experimental study in an animal model and a case series have shown good results for OTSC removal with a bipolar cutting device. We present a larger clinical study using this device.MethodsData of all consecutive patients with indication for OTSC removal were collected and analyzed retrospectively. OTSCs were cut at two opposing sites using a bipolar grasping device to apply short direct current impulses. OTSC fragments were extracted with a standard forceps and a cap at the tip of the endoscope to avoid tissue damage.ResultsBetween December 2012 and February 2016 a total of 42 OTSC removals in the upper (n  = 25) and lower (n  = 17) gastrointestinal tract have been performed at our department. Overall technical success, defined as cutting the OTSC at two opposing sites and extraction of both fragments, was achieved in 92.9% (39/42) of all cases. Successful fragmentation of the OTSC was achieved in 97.6% (41/42). Minor bleedings were rare and could be managed endoscopically in all cases. There were no perforations and no major or delayed bleedings.ConclusionEndoscopic OTSC removal with a bipolar cutting device is feasible, effective and safe. This technique can be applied in the upper and lower gastrointestinal tract.
Evaluation of rapid diagnostic test kits for feline leukemia virus infection using samples from naturally infected cats
Authors: Liu Jiayou , O’Connor Thomas , Beall Melissa , Chandrashekar Ramaswamy , Lappin Michael 
Published: October 2016

Objectives Feline leukemia virus (FeLV) is a potentially life-threatening oncogenic retrovirus. The p27 viral core protein is produced by the virus in infected feline cells, is found in the cytoplasm in several blood cells and can be free in the serum and plasma. ELISA or particle-based immunoassay are commonly used to detect the presence of the p27 core protein in samples obtained from blood. The objective of this study was to compare the performance of several in-clinic tests: the SNAP Feline Triple Test (IDEXX Laboratories), the WITNESS FeLV-FIV Test (Zoetis) and the VetScan Feline FeLV/FIV Rapid Test (Abaxis). Methods The sample population (100 positive, 105 negative samples) consisted of serum and plasma samples submitted to IDEXX’s worldwide reference laboratory for feline retrovirus testing. Virus isolation and reverse transcriptase PCR results were not available and so samples were judged to be positive or negative based on the results of the ViraCHEK FeLV (Zoetis) microtiter plate assay. Results The percentage of samples positive and negative for FeLV p27 antigen using the three in-clinic tests compared with the ViraCHEK method were as follows: IDEXX Feline Triple (positive 98.0%, negative 100%); Zoetis WITNESS (positive 79.0%, negative 97.1%); Abaxis VetScan (positive 73.0%, negative 97.1%). Conclusions and relevance The SNAP Feline Triple Test demonstrated a high level of agreement for FeLV-positive and FeLV-negative samples when assessed in this model. Results of FeLV assays can vary among tests.
Can Fifth Metatarsal Morphology Predict Proximal Fifth Metatarsal Fracture Risk? A Radiographic Analysis of National Football League Players
Authors: Rosenbaum Andrew J. , DeSandis Bridget A. , Warren Russel , Taylor Samuel A. , Murphy Conor , Drakos Mark C. 
Published: October 2016

Category: Sports. Introduction/Purpose: Fractures of the proximal fifth metatarsal are one of the most common foot injuries in athletes. Unfortunately, optimal treatment is often challenging, as the repetitive stresses endured by the fifth metatarsal can lead to delayed union and refracture following treatment. We therefore performed a radiographic analysis of fifth metatarsal morphology and foot type in NFL players, in search of morphologic risk factors for these injuries. Methods: NFL players treated by the senior authors between 1992 and 2012, as well as participants in the 2014 NFL Combine were evaluated. A total of 96 feet (51 athletes) were included. Fractures were present in 15 of the feet. Two reviewers assessed fifth metatarsal morphology and foot type on anteroposterior (AP), lateral and oblique radiographs, after receiving measurement training by the senior authors. Table 1 lists the specific parameters studied. Reviewers’ measurements were averaged, as were those from the radiographic series for each athlete. Differences in foot type and metatarsal morphology between athletes with and without fractures were determined via Student’s t-test analysis. Results: Athletes had an average height of 6’2” (range 5’8” to 6’8”) ft’in”, weight of 251 (range 184 to 336) lbs, and age of 22.4 (range 21.0 to 26.0) years. Reviewers’ inter-observer reliability was generally good to very good. On AP radiographs, statistically significant differences in apex medullary canal width, 4-5 intermetatarsal angle, 5th metatarsal angle, and talar head uncovering were observed between fractured and non-fractured feet (p=0.001, 0.003, 0.004, 0.008, respectively; Table 1). On lateral radiographs, statistically significant differences in the 5th metatarsal length, distance to apex, apex height, 5th metatarsal angle, and talocalcaneal angle were observed between fractured and non-fractured feet (p=0.04, 0.01, 0.02, 0.01, 0.01, respectively; Table 1). On oblique radiographs, a statistically significant difference was observed in apex height between fractured and non-fractured feet (p=0.002; Table 1). Conclusion: This investigation elucidates the relationship between fifth metatarsal morphology, foot type and proximal fifth metatarsal fractures. Specifically, individuals with long, straight and narrow fifth metatarsals, with an adducted forefoot are most at risk. Given athletes’ predisposition to refracture and nonunion following treatment of proximal fifth metatarsal fractures, which is at times career threatening, we believe that these findings are clinically relevant. With such insight, attempts at fracture prevention can be implemented via footwear modifications, orthoses, and off-loading braces that account for those aforementioned morphologic attributes that place athletes at-risk. Admittedly, future research must evaluate the utility of such interventions.
Operative Treatment of Fifth Metatarsal Jones Fractures (Zones II and III) in the NBA
Authors: O’Malley Martin , DeSandis Bridget A. , Allen Answorth , Levitsky Matthew M. , O’Malley Quinn , Williams Riley 
Published: October 2016

Category: Sports. Introduction/Purpose: Proximal fractures (Zones II and III) of the fifth metatarsal are common in the elite athlete population with basketball players being especially prone to developing these injuries. Fractures in Zones II and III of the fifth metatarsal can be difficult to treat due to tendency toward delayed union, nonunion, or refracture. The purpose of this case series is to report our experience in treating 10 professional basketball players from the National Basketball Association (NBA) for proximal fifth metatarsal fractures and determine the healing rate, return to play, refracture rate and role of foot type in these athletes. Methods: The records of 10 professional basketball players who were treated for fifth metatarsal fractures between September 2008 and October 2014 were retrospectively reviewed. Seven athletes underwent standard percutaneous internal fixation with bone marrow aspirate concentrate (BMAC) while the other 3 had open bone grafting primarily in addition to fixation and BMAC. Radiographic features associated with recurrent fifth metatarsal fractures were reported including fourth-fifth intermetatarsal (IMA4-5), fifth metatarsal lateral deviation (MT5-LD), calcaneal pitch (CP), and metatarsus adductus (MAA) angles. Differences in clinical and radiographic features were assessed between athletes who refractured (n=3) and those who did not (n=7). Results: Radiographic healing was observed at an overall average of 7.5 weeks and return to play was 9.8 weeks. Three athletes experienced refractures. When comparing the refracture group (n=3) with the control group (n=7), there were no significant differences in clinical features or radiographic measurements except that the refracture group had the highest measured MAA. Four of 10 fit the criteria for having metatarsus adductus as measured by the Sgarlato method (MAA greater than 14 degrees) while 5 of 10 had metatarsus adductus using the Engel method (greater than 24 degrees). All refractures had an abnormal angle using the Engel method. Seven of the 10 athletes were classified as pes planus and 9/10 had a bony prominence under the proximal base of their fifth metatarsals styloid. Conclusion: This is the largest series of operatively treated professional basketball players that possess a unique foot type that seems to be associated with increased risk of fifth metatarsal fracture and refracture. This foot type is one which has forefoot metatarsus adductus and a fifth metatarsal that is curved with a prominent base. We continue to use standard internal fixation with bone marrow aspirate but advocate additional prophylactic open bone grafting in patients with high IMA4-5, MT5-LD and MAA angles as well as prominent fifth metatarsal styloids in order to improve fracture healing and potentially decrease the risk of refracture.
Is Total Ankle Arthroplasty Justified in Stiff Ankles?
Authors: Kane Justin M. , Brodsky James W. , Coleman Scott C. , Daoud Yahya 
Published: October 2016

Category: Ankle Arthritis. Introduction/Purpose: Although recent studies have shown comparability of gait function following total ankle arthroplasty (TAA) and ankle arthrodesis, TAA is regarded to be functionally advantageous by preserving tibiotalar motion. However, it is unknown whether arthritic ankles with severe loss of sagittal plane motion are appropriate surgical candidates for arthroplasty. This study was undertaken to address the question: Is there a rationale for motion-preserving surgery in patients with little or no preoperative sagittal plane motion? Methods: A retrospective review of 76 patients who underwent isolated TAA with a minimum one-year follow-up, including patient demographics and pre and postoperative gait studies was conducted. Using a linear regression model, an effect size for total preoperative sagittal ROM was calculated, as well as effects of age, and patient demographics. Gait function was evaluated for postoperative improvement using multivariate analysis to determine the influence the variable on parameters of gait. P-values of < 0.05 were considered statistically significant. Results: Outcomes/p-values are listed in table 1. Temporal Spatial Older patients had slower preoperative/postoperative walking speeds, and increased age resulted in diminished function. Increased preoperative ROM predicted greater preoperative and trended towards greater postoperative step length. Greater preoperative ROM predicted less total improvement. Kinematic Age was predictive of improved postoperative plantarflexion with negligible clinical significance. Preoperative ROM predicted greater postoperative ROM although less improvement was noted. Preoperative/postoperative sagittal angle at toe off was greater with increased preoperative ROM. No improvement was detected. Preoperative and postoperative plantarflexion/dorsiflexion were both greater with increased preoperative ROM. Less overall improvement in plantarflexion was noted with greater preoperative ROM. Kinetic Preoperative ROM was predictive of greater preoperative/postoperative ankle power. Greater preoperative ROM resulted in less improvement in power. Conclusion: Irrespective of preoperative total sagittal range of motion, there was a statistically and clinically significant improvement in function as measured by multiple, objective parameters of gait. While pre-operative range of motion was predictive of overall post-operative gait function, patients with greater pre-operative range of motion experienced less overall improvement in gait. The data show that TAA can offer statistically significant, and clinically meaningful improvement in gait function and is a reasonable treatment alternative even in patients with end-stage tibiotalar arthritis who have very limited preoperative sagittal range of motion.
Effect of Facility on the Operative Costs of Total Ankle Arthroplasty
Authors: Gross Christopher E. , Scott Daniel J. , Adams Samuel B. , Parekh Selene G. , Mather Richard , Nunley James A. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Cost containment is increasingly important in health care. Currently, Medicare does not reimburse for total ankle replacement (TAR) in the outpatient, ambulatory setting. Therefore, TAR in Medicare patients must be performed in the inpatient setting. The purpose of this study was to investigate if ambulatory surgery centers (ASC) can deliver lower-cost care and to identify sources of those cost savings in total ankle replacement (TAR). We hypothesize that total ankle arthroplasties cost significantly less than when performed in an inpatient setting. Methods: We performed a cost identification analysis of primary TAR at a single academic medical center. Multiple costs and time measures were taken from 574 consecutive patients over 4 years at either an inpatient facility or ASC. The relationships between total cost and operative time and multiple variables, including patient age, gender, comorbidities, type of implant used, and concurrent procedures performed were examined, using multivariate analysis and regression modeling to identify cost drivers or explanatory variables. Results: The mean operative cost over 4 years was significantly greater at the inpatient facility ($50,460) than at the outpatient facility ($46,283) (p < 0.0001, CI $3,752-$4,685). Significant cost drivers of this difference were in-patient ($1,759), physical/occupational therapy ($346), pharmacy ($233), and operating room costs ($2,752). If we were to perform all total ankle replacements in the four-year period at the ASC, the hospital system would have saved $1,445,242.00. Conclusion: The most significant predictor of cost was facility type. This study supports the use of ASC facilities to achieve efficient resource utilization in the operative treatment of total ankle arthroplasties. We also identified several specific costs and time measurements that can serve as potential targets to improve utilization.