bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Varying Tension of a Suture Button Construct in Fixation of the Tibiofibular Syndesmosis—Evaluation Using Stress Computed Tomography
Authors: Morellato John , Louati Hakim , Bodrogi Andrew , Stewart Andrew , Papp Steven , Liew Allan , Gofton Wade 
Published: October 2016

Background/Purpose:
There have been no studies assessing the optimal biomechanical tension of suture button constructs. The purpose of this study was to assess optimal tensioning of suture button fixation and its ability to maintain reduction under loaded conditions using a stress computed tomography (CT) model.

Methods:
Ten cadaveric lower limbs disarticulated at the knee were used. The limbs were placed in a modified ankle load frame that allowed for the application of sustained torsional axial or combined torsional/axial loads. The syndesmosis and the deep deltoid ligaments complex were sectioned and the limbs were randomized to receive a suture button construct tightened at 4, 8, or 12 kg. The specimens were loaded under the 3 loading scenarios with CT scans performed after each and at the conclusion of testing. Multiple measurements of translation and rotation were compared with baseline CT scan taken before sectioning.

Results:
Significant lateral (maximum 5.26 mm) and posterior translation (maximum 6.42 mm) and external rotation (maximum 11.71 degrees) was noted with the 4 kg repair. Significant translation was also seen with both the 8 and the 12 kg repairs; however, the incidence was less than with the 4 kg repair. Significant overcompression (ML = 1.69 mm, B = 2.69 mm) was noted with the 12 kg repair and also with the 8 kg repair (B = 2.01 mm).

Conclusion:
Suture button constructs must be appropriately tensioned to maintain reduction and re-approximate the degree of physiological motion at the distal tibiofibular joint. These constructs also demonstrate overcompression of the syndesmosis; however, the clinical effect of this remains to be determined.
Reliability and Reproducibility of the OTA/AO Classification for Humeral Shaft Fractures
Authors: Mahabier Kiran C. , Van Lieshout Esther M. M. , Van Der Schaaf Boyd C. , Roukema Gert R. , Punt Bas J. , Verhofstad Michael H. J. , Den Hartog Dennis ,   on behalf of the HUMMER trial investigators
Published: October 2016

Objectives:
This study aimed to determine interobserver reliability and intraobserver reproducibility of the OTA/AO classification for humeral shaft fractures, and to evaluate differences between fracture types, fracture groups, and surgical specializations.

Methods:
Thirty observers (25 orthopaedic trauma surgeons and 5 general orthopaedic surgeons) independently classified 90 humeral shaft fractures according to the OTA/AO classification. Patients of 16 years and older were included. Periprosthetic, recurrent, and pathological fractures were excluded. Radiographs were provided in random order, and observers were blinded to clinical information. To determine intraobserver agreement, radiographs were reviewed again after 2 months in a different random order. Agreement was assessed using kappa statistics.

Results:
Interobserver agreement for the 3 fracture types was moderate (κ = 0.60; 0.59–0.61). It was substantial for type A (κ = 0.77; 0.70–0.84) and moderate for type B (κ = 0.52; 0.46–0.58) and type C fractures (κ = 0.46; 0.42–0.50). Interobserver agreement for the 9 fracture groups was moderate (κ = 0.48; 95% CI, 0.48–0.48). Orthopaedic trauma surgeons had better overall agreement for fracture types, and general orthopaedic surgeons had better overall agreement for fracture groups. Observers classified 64% of fractures identically in both rounds. Intraobserver agreement was substantial for the 3 types (κ = 0.80; 0.77–0.81) and 9 groups (κ = 0.80; 0.77–0.82). Intraobserver agreement showed no differences between surgical disciplines.

Conclusions:
The OTA/AO classification for humeral shaft fractures has a moderate interobserver and substantial intraobserver agreement for fracture types and groups.
Biomechanical Evaluation of the Femoral Neck System in Unstable Pauwels III Femoral Neck Fractures: A Comparison with the Dynamic Hip Screw and Cannulated Screws
Authors: Stoffel Karl , Zderic Ivan , Gras Florian , Sommer Christoph , Eberli Ursula , Mueller David , Oswald Martin , Gueorguiev Boyko 
Published: October 2016

Objectives:
To evaluate the biomechanical performance of femoral neck system (FNS) in comparison with established methods for fixation of femoral neck fractures in a cadaveric model.

Methods:
Twenty pairs of fresh-frozen human cadaveric femora were instrumented either with dynamic hip screw and antirotation screw (DHS-screw), DHS-blade, 3 cannulated screws (3CS) or with FNS in a partially paired design. The specimens were randomized to 2 paired treatment groups based on the bone mineral density (BMD), namely DHS-screw/DHS-blade and FNS/3CS. A reduced unstable femoral neck fracture with postero-caudal comminution, OTA/AO 31–B2.3, 70 degrees Pauwels III, was simulated by cutting 30 degrees distal and 15 degrees posterior wedges. Cyclic axial loading was applied in 16 degrees adduction, starting at 500 N and with progressive peak force increase of 0.1 N/cycle until construct failure. Axial stiffness was measured in the third loading cycle. Femoral neck and leg shortening, and varus tilting and implant migration were calculated by means of optical motion tracking.

Results:
Mean axial stiffness was 688.8 ± 132.6 N/mm for DHS-screw, 629.1 ± 94.1 N/mm for DHS-blade, 748.9 ± 211.4 N/mm for FNS, and 584.1 ± 156.6 N/mm for 3CS, with no statistical significances. Cycles until 15-mm leg shortening were comparable for DHS-Screw (20,542 ± 7465), DHS-blade (19,161 ± 3793) and FNS (17,372 ± 2996), however significantly higher than for 3CS (7293 ± 2819), P < 0.001. Similarly, cycles until 15 mm femoral neck shortening were comparable between DHS-screw (20,846 ± 7339), DHS-blade (18,974 ± 4032) and FNS (18,171 ± 2585), and significantly higher than 3CS (8039 ± 2778), P < 0.001.

Conclusions:
From a biomechanical point of view, the femoral neck system is a valid alternative to treat unstable femoral neck fractures, representing the advantages of a minimally invasive implant with comparable stability to the 2 DHS systems and superior to cannulated screws.
Effectiveness of Extracorporeal Life Support for Patients With Cardiogenic Shock Due To Intractable Arrhythmic Storm
Authors: Le Pennec-Prigent Solène , Flecher Erwan , Auffret Vincent , Leurent Guillaume , Daubert Jean-Claude , Leclercq Christophe , Mabo Philippe , Verhoye Jean-Philippe , Martins Raphael P. 
Published: October 2016

Objectives:
Extracorporeal life support is used for patients with severe heart failure as a bridge to heart transplantation or recovery. We aimed at analyzing the efficacy and safety of extracorporeal life support to treat refractory arrhythmic storm responsible for cardiogenic shock in patients resistant to antiarrhythmic drugs.

Design:
Retrospective study.

Setting:
University Hospital of Rennes, France.

Patients:
Patients with refractory arrhythmic storm admitted between January 2005 and March 2015.

Interventions:
Patients with intractable refractory arrhythmic storm and cardiogenic shock despite optimal medical therapy were implanted with an extracorporeal life support. Patients’ characteristics and outcomes after extracorporeal life support implantation were analyzed.

Measurements and Main Results:
Twenty-six patients (23 men, 52.4 ± 9.2 yr old) were included, most of them having ischemic cardiomyopathy (65.4%). Stable sinus rhythm restoration was immediate in 61.5% of patients and occurred after a median time of 3 hours after extracorporeal life support implantation for the remaining ones. Thirteen patients (50%) eventually died, none of them due to extracorporeal life support–related complications, but mostly due to the occurrence of multiple organ failure, and occurred after a median time of 4 days. The remaining 13 patients (50%) had extracorporeal life support withdrawn after 6.7 ± 3.6 days and were discharged after 34.7 ± 14.7 days after admission. Patients with repetitive ventricular tachycardia/ventricular fibrillation episodes alternating with periods of sinus rhythm at the time of implantation had a better survival than those in refractory ventricular fibrillation (p = 0.017).

Conclusions:
This is the largest database of patients temporary implanted with extracorporeal life support for refractory arrhythmic storm responsible for cardiogenic shock resistant to antiarrhythmic drugs. It provides efficient hemodynamic support and survival rate after the implantation is 50%.
An update on the status of nerve monitoring for thyroid/parathyroid surgery
Authors: Lin Ho-Sheng , Terris David J. 
Published: October 2016

Purpose of review
Recurrent laryngeal nerve (RLN) injury is one of the most common and serious complications associated with thyroid and parathyroid surgery. Although routine visual identification of the RLN is considered the current standard of care, the role of intraoperative neuromonitoring (IONM) of the RLN is more controversial.

Recent findings
Despite initial enthusiasm that IONM might substantially reduce the rate of RLN injury, most studies failed to show a significant difference in the rate of RLN injury when the use of IONM was compared with visualization of the RLN alone. However, a small number of investigators have reported statistically significant differences in the rates of nerve injury when IONM is used to augment visualization alone, particularly in certain high-risk situations. Despite a lack of conclusive data showing benefit, the use of IONM as an adjunct to visual identification of the RLN has gained increasing acceptance among surgeons. IONM remains an excellent tool to help verify the identity of the RLN, confirm its functional integrity, and pinpoint the site of nerve injury in the event of dysfunction.

Summary
The utility of IONM in reducing the rate of RLN injury is largely unproven and remains controversial. However, the use of IONM may be helpful in certain high-risk cases. Promising new technology, such as vagal nerve monitoring, may allow more real-time monitoring of the functional integrity of the RLN and allow the surgeon to react in a timely manner to evolving dysfunction in order to abort maneuvers that may risk definitive injury.
Do flame retardant chemicals increase the risk for thyroid dysregulation and cancer?
Authors: Hoffman Kate , Sosa Julie A. , Stapleton Heather M. 
Published: October 2016

Purpose of review
Flame retardant chemicals are added to consumer products to reduce fire incidence and severity; approximately 1.5 million tons of these chemicals are used annually. However, their widespread use has led to their ubiquitous presence in the environment and chronic accumulation in human tissues. We summarize current trends in human flame retardant chemical exposure, and review recent data highlighting concerns for thyroid dysregulation and cancer risk in human populations.

Recent findings
Polybrominated diphenyl ethers were once commonly used as flame retardant chemicals, but recently were phased out. Exposure is associated with thyroid dysregulation (mainly T4 reductions) in animals, with new work focusing on specific mechanisms of action. Polybrominated diphenyl ethers also impact human thyroid regulation and are related to clinical thyroid disease, but associations appear both dose and life-stage dependent. Emerging data suggest that common alternate flame retardant chemicals may be more potent thyroid disruptors than their predecessors, which is particularly concerning given increasing levels of exposure.

Summary
Potential health impacts of flame retardant chemicals are only beginning to be understood for ‘legacy flame retardant chemicals’ (i.e., polybrominated diphenyl ethers), and are largely unevaluated for newer-use chemicals. Cumulatively, current data suggest impact on thyroid regulation is likely, potentially implicating flame retardant chemicals in thyroid disease and cancers for which thyroid dysregulation impacts risk or prognosis.
Cutaneous Metastasis From Sacral Chordoma
Authors: Gleghorn Kristyna , Goodwin Brandon , Sanchez Ramon 
Published: October 2016

Abstract:
Chordoma is a rare primary bone malignancy of notochord origin, representing 1-4% of malignant bone tumors.
1,2
Typically, chordomas follow a slow progressive course with aggressive local extension, multiple recurrences, and metastases.
1
Of particular interest to this case, cutaneous metastasis is exceedingly rare. Diagnosis of this entity can be a challenge due to the rarity of chordoma, as well as the infrequent presentation of distant cutaneous metastasis and non-specific clinical skin findings. We report a case of a 61-year-old male with a history of sacral chordoma treated by wide local excision 8 years prior to presentation developed a nodule on his scalp for 6 weeks. Physical examination revealed a 1 cm rubbery, pink, shiny dome-shaped nodule on his left occipital scalp. Hematoxylin and eosin sections revealed a lobular dermal proliferation of small ovoid cells and larger physaliferous cells with hyperchromatic, displaced nuclei and finely vacuolated “soap-bubble” cytoplasm in a myxoid stroma. Immunohistochemistry of tumor cells showed positivity for both S-100 protein and pancytokeratin (AE1/AE3), while smooth muscle actin (SMA), P63, and CK7 were negative. Additionally, tumor cells stained positive for brachyury. The medical history, clinical presentation, histopathological appearance and immunohistochemical profile are consistent with cutaneous metastasis from sacral chordoma, known as chordoma cutis. This case illustrates the integral role of dermatopathology in the diagnosis of a rare and critical condition.
Cardiac Rehabilitation After Heart Valve Surgery
Authors: Pollmann Agathe Gerwina Elena , Frederiksen Marianne , Prescott Eva 
Published: October 2016

PURPOSE:
Evidence of the effect of cardiac rehabilitation (CR) after heart valve surgery is scarce, but nevertheless CR is recommended for this group of patients. Therefore, this study assessed the effect of CR on exercise capacity, cardiovascular risk factors, and long-term mortality and morbidity, as well as predictors for enrolment in or failing to complete CR.

METHODS:
A review of medical records identified 250 patients who underwent heart valve surgery between January 2009 and August 2013. Of these, 211 patients eligible for CR were identified. Effect of CR was assessed by peak oxygen uptake (

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2
peak) or 6-minute walk test (6MWT). A composite endpoint of all-cause mortality and hospital admission due to myocardial infarction, stroke, heart failure, endocarditis, revascularization, or reoperation was used to assess the hazard ratio between CR attenders and nonattenders. Multivariable logistic regression was used to find predictors for CR attendance and CR completion.

RESULTS:
A total of 146 patients completed CR.

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o
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peak improved by 16% from 21.6 to 24.8 mL/kg/min (P < .0001) and 6MWT distance by 13% from 349 to 393 m (P = .0016). Rate of clinical events was higher among nonattenders with an adjusted hazard ratio of 2.46 (95% CI, 1.26-4.80). Age >75 years was predictive for not attending (adjusted OR, 2.99; 95% CI, .37-6.53), whereas ethnic minorities were less likely to complete CR (adjusted OR, 4.88; 95% CI, 1.58-15.06).

CONCLUSIONS:
CR after heart valve surgery improved exercise capacity and was associated with reduced morbidity. Elderly and ethnic minorities were less likely to attend or complete CR and deserve special attention.
Exercise Training Workloads Upon Exit From Cardiac Rehabilitation in Men and Women
Authors: Keteyian Steven J. , Kerrigan Dennis J. , Ehrman Jonathan K. , Brawner Clinton A. 
Published: October 2016

Purpose:
To describe exercise training workloads, estimated as metabolic equivalents of task (METs) both upon exit from cardiac rehabilitation (CR) and as the change in MET level following CR, stratified by age, sex, initial MET level, number of sessions completed, and qualifying event at entry into CR.

Methods:
A retrospective study involving 8319 (31% female) patients who completed ≥9 exercise training sessions in the early outpatient CR program at Henry Ford Hospital. Exercise training MET levels achieved during CR were estimated on the basis of the speed and grade recorded from a treadmill. Exercise training METs at the start of CR were defined as the average of the second and third sessions, whereas MET level upon exit from CR was determined from the average of the last 2 patient encounters.

Results:
The overall mean MET level while training just prior to exit from CR was 3.9 ± 1.4 (4.1 ± 1.4 and 3.3 ± 1.0 in men and women, respectively). The mean change in METs after CR was 1.3 ± 1.1 (+45% ± 37%) and 0.9 ± 0.7 (+40% ± 32%) in men and women, respectively.

Conclusions:
In a large and demographically diverse cohort of patients who participated in CR, increases in mean workload (ie, METs) during exercise training were observed that approximated 45% in men and 40% in women. These data could be considered when establishing benchmarks for program-related performance outcome measures.
Measurement of Functional Capacity Requirements of Farmers
Authors: Jordan Shannon , Karcher Justin , Rogers Rebecca , Kennedy Kathleen , Lawrence Anne , Adams Jenny 
Published: October 2016

PURPOSE:
Updated cardiac rehabilitation (CR) and return-to-work guidelines from the American College of Sports Medicine (ACSM) now include specificity of training for industrial athletes (exercise training that involves the muscle groups, movements, and energy systems that these patients use during occupational tasks). However, many CR facilities do not apply this principle, relying instead on the traditional protocol that consists primarily of aerobic exercise. This study was conducted to measure the metabolic cost of typical farming tasks and to compare 2 methods of calculating training intensities.

METHODS:
Metabolic data were collected from 28 participants (23 men and 5 women, aged 18 to 57 years) while they loaded 10 hay bales, dug a fence posthole, filled 8 seed hoppers, and shoveled grain.

RESULTS:
Mean metabolic equivalent levels during these activities were 5.9 to 7.6 and participants reached 60% to 70% of heart rate reserve (HRR). By comparison, their mean resting heart rate + 30 beats per minute (RHR+30, a traditional CR intensity level) represented only 28% of HRR.

CONCLUSIONS:
Participants in the current study performed farming tasks within the ACSM's recommended range of 40% to 80% of HRR, and the results suggest that training at RHR+30 would have been inadequate for helping a farmer return to work after a cardiac event. Using the study tasks as a basis, we described exercises that would be appropriate for the supervised resistance training of farmers in a CR setting.
The protective role of self-efficacy against workplace incivility and burnout in nursing
Authors: Fida Roberta , Laschinger Heather K. Spence , Leiter Michael P. 
Published: October 2016

Background:
Incivility has negative consequences in the workplace and remains a prevalent issue in nursing. Research has consistently linked incivility to nurse burnout and, in turn, to poor mental health and turnover intentions. To retain high-quality nurses, it is important to understand what factors might protect nurses from the negative effects of workplace mistreatment.

Purpose:
The aim of the study was to investigate the role of relational occupational coping self-efficacy in protecting nurses from workplace incivility and related burnout and turnover intentions.

Methodology:
A two-wave national sample of 596 Canadian nurses completed mail surveys both at Time 1 and one year later at Time 2. Structural equation modeling was used to test the hypothesized model.

Results:
The model showed a good fit, and most of the hypothesized paths were significant. Overall, the results supported the hypothesized protective effect of relational occupational coping self-efficacy against incivility and later burnout, mental health, and turnover intentions.

Conclusion:
Relational occupational coping self-efficacy is an important protective factor against negative work behavior.

Practice Implications:
Organizations should provide nurses with opportunities to build their coping strategies for managing job demands and difficult interpersonal interactions. Similarly, providing exposure to effective role models and providing meaningful verbal encouragement are other sources of efficacy information for building nurses’ relational coping self-efficacy.
Leadership development programs for health care middle managers: An exploration of the top management team member perspective
Authors: Whaley Alan , Gillis William E. 
Published: October 2016

Background:
Hospitals throughout the United States establish leadership and management programs for their middle managers. Despite their pervasiveness and an increased emphasis on physician leadership, there is limited research regarding the development programs designed for clinical and nonclinical health care middle managers.

Purpose:
Using two theoretical lenses, signaling and institutional theory, this exploratory study investigates mid-sized hospital development programs from the perspective of top management team (TMT) members. Our objective is to find out what types of programs hospitals have, how they are developed, and how they are evaluated.

Methodology/Approach:
We conducted semistructured interviews with 13 TMT members in six purposefully selected hospitals and matched these interviews with program curricula. Careful coding of the data allowed us not only to show our data in a meaningful visual representation but also to show the progression of the data from raw form to aggregate themes in the qualitative research process.

Findings:
We identified four types of development programs used in the selected hospitals: (a) ongoing series, (b) curriculum-based, (c) management orientation, and (d) mentoring. Challenges existed in aligning the need for the program with program content. Communication occurred both through direct messaging regarding policies and procedures and through hidden signals. TMT members referenced other programs for guidance but were not always clear about what it is they wanted the programs to accomplish. Finally, there was limited program outcome measurement.

Practice Implications:
Our small sample indicates that specific, structured, and comprehensive programs perform best. The better programs were always trying to improve but that most needed better accountability of tracking outcomes. In setting up a program, a collaborative approach among TMT members to establish what the needs are and how to measure outcomes worked well. Successful programs also tied in their leadership development with overall employee development.