bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anterior Extension of Tumor is as Important as Tumor Size to Facial Nerve Outcome and Extent of Resection for Vestibular Schwannomas
Authors: Wong Ricky , Copeland William , Jacob Jeffrey , Sivakanthan Sananthan , Van Gompel Jamie , van Loveren Harry , Link Michael , Agazzi Siviero 
Published: July 2017

Objectives We examined vestibular schwannoma tumor dimension and direction of growth to determine whether these correlate with facial nerve outcome as well as extent of resection (EOR).
Design Retrospective review of prospectively maintained databases.
Participants 206 patients were a part of this study.
Main Outcome Measures Tumor dimensions were measured using preoperative magnetic resonance imaging, and a series of ratios were then calculated to further characterize tumor dimension. Regression analyses were performed to investigate correlation with facial nerve outcome and EOR.
Results Patients with tumor extending >1.5 cm anterior to the internal auditory canal (IAC) (AB measurement) were three times more likely to have postoperative House-Brackman grades of 3 or worse. We also found that an EB/BF ratio (representing elongated growth parallel to the IAC axis) ≥1.1 was associated with half the risk of poor facial nerve outcome. Tumors with anterior-posterior diameter (AC measurement) >1.9 cm were five times less likely to undergo gross total resection (GTR). Furthermore, an increased degree of tumor extension into the IAC (DE measurement >2.4 cm) or an increased amount of brainstem compression (EB measurement >1.1 cm) were each associated with a nearly 3-fold decrease in the likelihood of GTR.
Conclusion Our study demonstrates that anterior extent of the tumor is as important as tumor size to facial nerve outcome and degree of resection for vestibular schwannomas.
Alarm-Fatigue – wieviel Alarm verträgt der Mensch?
Authors: Lorenz Benedikt , Peters Jürgen , Frey Ulrich 
Published: July 2017

ZusammenfassungDurch zunehmende Technisierung in der Anästhesiologie und Intensivmedizin steigen sowohl Anzahl der Geräte als auch deren visuelle und akustische Alarme. Die meisten aller Alarme sind jedoch Fehlalarme, was bei den Mitarbeitern zu Frustration, Aggression und Fehlverhalten führt. Dieser Übersichtsartikel fasst die Risikofaktoren für die Entstehung von „Alarm-Fatigue“ zusammen und gibt einen Ausblick auf mögliche Lösungsstrategien.
Anästhesie und Outcome: Einfluss bei Kindern
Authors: Fideler Frank , Grasshoff Christian 
Published: July 2017

ZusammenfassungDie operative Versorgung von Kindern birgt ein erhöhtes Risiko schwerer perioperativer Komplikationen und stellt hohe Anforderungen an die beteiligten Berufsgruppen. Um das perioperative Outcome von Kindern vonseiten der Anästhesie positiv zu beeinflussen, sind neben der Optimierung institutioneller Faktoren individuelle Möglichkeiten innerhalb der intraoperativen Phase der Narkoseeinleitung und -aufrechterhaltung bedeutend, insbesondere die Einstellung des adäquaten Blutdrucks.
Begegnung auf Augenhöhe
Authors: Özkan Ibrahim , Simmelbauer Laura , Wenderott Katharina 
Published: July 2017

Zusammenfassung
Transkulturalität in der Versorgung Da die Zahl von Menschen mit
Migrationshintergrund stetig zunimmt, müssen sich auch Kliniken auf eine
interkulturelle Patientenversorgung einstellen. Für eine angemessene Pflege ist
es wichtig, dass Patienten nicht kulturspezifisch, sondern störungsspezifisch
behandelt werden und die Begegnung mit ihnen offen und wertschätzend ist. Wir
geben Ihnen Tipps, wie Sie Hemmschwellen abbauen können, um eine handlungsfähige
Beziehung mit dem Patienten aufzubauen.
Zuhören oder medikamentieren?
Authors: Matthies Daniel 
Published: July 2017

Zusammenfassung
Deeskalationstechniken versus Psychopharmaka in der Langzeitpflege
Deeskalationstechniken sind ein wichtiger Bestandteil des pflegerischen
Arbeitsalltags. Ziel ist es, körperliche Auseinandersetzungen und
Zwangsmaßnahmen zu vermeiden oder zu verringern. Aber auch Psychopharmaka kommen
zum Einsatz, um Eskalationen schnell und ohne größeren Aufwand zu verhindern.
Unser Autor hat im Rahmen seiner Studienarbeit beide Methoden miteinander
verglichen.
Genetics and Juvenile Abundance Dynamics Show Congruent Patterns of Population Structure for Depleted River Herring Populations in the Upper Chesapeake Bay
Authors: Ogburn Matthew B. , Hasselman Daniel J. , Schultz Thomas F. , Palkovacs Eric P. 
Published: July 2017

Abstract
River herring (Alewife Alosa pseudoharengus and Blueback Herring A. aestivalis) populations have declined dramatically along the U.S. Atlantic coast. Conservation efforts are currently inhibited by an incomplete understanding of stock structure for the upper Chesapeake Bay, which once supported some of the largest spawning runs across the species’ ranges. We collected genetic samples from 512 adult river herring from five rivers and used microsatellites to explore genetic differentiation and population structure. Juvenile abundance indices were also evaluated for spatiotemporal patterns using time series analyses. Statistically significant allelic heterogeneity was observed among most collections, and we identified genetically distinguishable groups for each species. Regression analysis indicated stable or declining juvenile abundance, and empirical orthogonal function analysis supported groupings of tributaries based on temporal patterns in abundance. Results suggest a divide between eastern shore and western shore tributaries, with the Susquehanna River and the head of the bay showing similarities to both groups and possible temporal shifts in genetic structure due to straying. The Patuxent River likely represents a third genetic group for Blueback Herring. Cumulatively, our results suggest at least two genetically distinguishable groups of spawning populations for Alewives and at least three for Blueback Herring; these groups should be considered separately for conservation and management.
Received December 22, 2016; accepted June 3, 2017 Published online August 31, 2017
A novel expression of the spherical-wave reflection coefficient at a plane interface
Authors: Li Jingnan , Wang Shangxu , Tao Yonghui , Dong Chunhui , Tang Genyang 
Published: July 2017

Abstract
The spherical-wave reflection coefficient (SRC) describes the reflection strength when seismic waves emanating from a point source impinge on an interface. In this study, the SRC at a plane interface between two infinite half-spaces is investigated. We derive an analytical equation of the SRC when kR → 0 (k is the wave number and R is the wave propagation distance). It only depends on the density ratio; it is independent of the velocity ratio and incidence angle. On the other hand, we find that the SRCs at different kR lie along an elliptical curve on the complex plane (the complex plane is a geometric representation of the complex numbers established by the real axis and perpendicular imaginary axis). Based on this feature, we construct a new analytical equation for the reflected spherical wave with high accuracy, which is applicable to both small and large kR. Using the elliptical distribution of the SRCs for a series of frequencies recorded at only one spatial location, the density and velocity ratios can be extracted. This study complements the spherical-wave reflection theory and provides a new basis for acoustic parameters inversion, particularly density inversion.
The formation and coalescence sites of the first gravitational wave events
Authors: Schneider Raffaella , Graziani Luca , Marassi Stefania , Spera Mario , Mapelli Michela , Alparone Matteo , Bennassuti Matteo de 
Published: July 2017

Abstract
We present a novel theoretical model to characterize the formation and coalescence sites of compact binaries in a cosmological context. This is based on the coupling between the binary population synthesis code SeBa with a simulation following the formation of a Milky Way-like halo in a well-resolved cosmic volume of 4 cMpc, performed with the GAMESH pipeline. We have applied this technique to investigate when and where systems with properties similar to the recently observed LIGO/VIRGO events are more likely to form and where they are more likely to reside when they coalesce. We find that more than 70 per cent of GW151226 and LVT151012-like systems form in galaxies with stellar mass M* &gt; 108 M⊙ in the redshift range [0.06–3] and [0.14–11.3], respectively. All GW150914-like systems form in low-metallicity dwarfs with M* &lt; 5 × 106 M⊙ at 2.4 ≤ z ≤ 4.2. Despite these initial differences, by the time they reach coalescence the observed events are most likely hosted by star-forming galaxies with M* &gt; 1010 M⊙. Due to tidal stripping and radiative feedback, a non-negligible fraction of GW150914-like candidates end-up in galaxies with properties similar to dwarf spheroidals and ultrafaint satellites.
Three-Dimensional Endoscopic Magnification for Treatment of Thoracic Spinal Dural Arteriovenous Fistulas: Technical Note
Authors: Weil Alexander G , Obaid Sami , Chaalala Chiraz , Shedid Daniel , Magro Elsa , Seizeur Romuald , Bojanowski Michel W 
Published: July 2017

Abstract

BACKGROUND
Treatment of thoracic spinal dural arteriovenous fistulas (DAVFs) by microsurgery has recently been approached using minimally invasive spine surgery (MISS). The advantages of such an approach are offset by difficult maneuverability within the tubular retractor and by the creation of “tunnel vision” with reduced luminosity to a remote surgical target.

OBJECTIVE
To demonstrate how the pitfalls of MISS can be addressed by applying 3-D endoscopy to the minimally invasive approach of spinal DAVFs.

METHODS
We present 2 cases of symptomatic thoracic DAVFs that were not amenable to endovascular treatment. The DAVFs were excluded solely via a minimally invasive approach using a 3-D endoscope.

RESULTS
Two patients underwent exclusion of a DAVF following laminotomy, one through a midline 5-cm incision and the other through a paramedian 3-cm incision using minimally invasive nonexpandable tubular retractors. The dura opening, intradural exploration, fistula exclusion, and closure were performed solely under endoscopic 3-D magnification. No incidents were recorded and the postoperative course was marked by clinical improvement. Postoperative imaging confirmed the exclusion of the DAVFs. Anatomical details are exposed using intraoperative videos.

CONCLUSION
When approaching DAVFs via MISS, replacing the microscope with the endoscope remedies the limitations related to the “tunnel vision” created by the tubular retractor, but at the expense of losing binocular vision. We show that the 3-D endoscope resolves this latter limitation and provides an interesting option for the exclusion of spinal DAVFs.
Endoscopic Approach of the Insula Through the Anterior Middle Temporal Gyrus: A Feasibility Study in the Laboratory
Authors: Corrivetti Francesco , Froelich Sébastien , Mandonnet Emmanuel 
Published: July 2017

Abstract

BACKGROUND
Insular glioma surgery still represents a challenge. Nonetheless, advances in microsurgical anatomy and brain mapping techniques have allowed an increase in the extent of resection with acceptable morbidity rates. Transsylvian and transcortical approaches constitute the main surgical corridors, the latter providing considerable advantages and a high degree of reliability. Nevertheless, both surgical corridors yield remarkable difficulties in reaching the most posterior insular region.

OBJECTIVE
To study the feasibility of an endoscopic transtemporal approach in brain specimens, with the aim to provide a suitable access for posterior insular region.

METHODS
Four postmortem human hemispheres, embalmed using Klingler's technique, were dissected by means of a 30° rigid endoscope. The specimens underwent magnetic resonance imaging scans and, using the neuronavigation system, we were able to design a safe cortical window and an optimized endoscopic trajectory for the posterior insular dissection.

RESULTS
Insular dissection was led subpially through a small 2-cm cortical access, located in the anterior part of the middle temporal gyrus. During the posterior insula dissection, the endoscope allowed for optimized surgical view all along the long gyri, up to the posterior insular point. Anterior insular dissection was accomplished with more difficulties, as the endoscopic trajectory was not aligned to the axis of the short gyri.

CONCLUSION
This new surgical approach provides a favorable transcortical access to reach the most posterior insular portion. It seems to be a promising tool, in combination with intraoperative functional brain mapping, to further improve extent of resection rates in insular glioma surgery.
Accreditation of Medical Education Programs: Moving From Student Outcomes to Continuous Quality Improvement Measures
Authors: Blouin Danielle , Tekian Ara 
Published: July 2017

Accreditation of undergraduate medical education programs aims to ensure the quality of medical education and promote quality improvement, with the ultimate goal of providing optimal patient care. Direct linkages between accreditation and education quality are, however, difficult to establish. The literature examining the impact of accreditation predominantly focuses on student outcomes, such as performances on national examinations. However, student outcomes present challenges with regard to data availability, comparability, and contamination.
The true impact of accreditation may well rest in its ability to promote continuous quality improvement (CQI) within medical education programs. The conceptual model grounding this paper suggests accreditation leads medical schools to commit resources to and engage in self-assessment activities that represent best practices of CQI, leading to the development within schools of a culture of CQI. In line with this model, measures of the impact of accreditation on medical schools need to include CQI-related markers. The CQI orientation of organizations can be measured using validated instruments from the business and management fields. Repeated determinations of medical schools’ CQI orientation at various points throughout their accreditation cycles could provide additional evidence of the impact of accreditation on medical education. Strong CQI orientation should lead to high-quality medical education and would serve as a proxy marker for the quality of graduates and possibly for the quality of care they provide.
It is time to move away from a focus on student outcomes as measures of the impact of accreditation and embrace additional markers, such as indicators of organizational CQI orientation.
Impact of a Mandated Change in Buprenorphine Formulation
Authors: Graddy Ryan , Rastegar Darius A. 
Published: July 2017

Objective:
This study examines the impact of an insurance-mandated change in formulation of buprenorphine/naloxone (BNX) for patients with opioid use disorder treated in a primary care clinic.

Methods:
A retrospective cohort study was conducted to determine the proportion of patients who were switched back to the previous BNX formulation and rates of aberrant urine drug tests for the 3 months before and 3 months after a mandated change in BNX from the sublingual film to the rapidly dissolving tablet (BNX-RDT). Aberrant urine drug tests were defined as the presence of cocaine, nonprescribed opioids/benzodiazepines, or the absence of buprenorphine.

Results:
In all, 186 patients were included in the analysis. At 3 months after the change, 36.0% of patients remained on BNX-RDT at equivalent dose, 9.1% were prescribed a higher dose of BNX-RDT, 52.7% were switched back to their previous formulation after a trial of BNX-RDT, and 2.2% dropped out of care. There was no significant change in the rates of aberrant urine drug tests pre and postchange (36.6% vs 33.7%; P = 0.27) or in any individual component of urine drug testing. Age, sex, and starting dose were not associated with remaining on BNX-RDT at equivalent dose, compared with increasing dose or changing formulation.

Conclusions:
Most patients were dissatisfied with the change in formulation and requested a return to the previous formulation. This change did not appear to impact drug use; however, the flexibility that permitted patients to switch back to their previous BNX formulation likely attenuated the policy's impact.
Radiographic and clinical results of iliosacral screw fixation of posterior pelvic ring injuries
Authors: Jawed Abdulla , El-Bakoury Ahmed , Williams Mark Rees 
Published: July 2017

Background:
Percutaneous iliosacral screw fixation is now the preferred option for posterior pelvic ring stabilization. Outcome reporting for this procedure remains inconsistent and unstandardized. We sought to evaluate the early outcomes of iliosacral screw fixation of unstable posterior pelvic ring injuries, with particular reference to leg-length differences.

Methods:
We retrospectively reviewed 28 patients who underwent percutaneous iliosacral screw fixation of posterior pelvic ring injuries between 2008 and 2012 at our trauma center. Only those with a minimum of 1-year follow-up, were included. Clinical outcomes were measured with EuroQol (EQ5D) and Majeed pelvic scores, and the radiographic outcomes were measured by the method of Matta and Tornetta.

Results:
The mean Majeed score was 83, mean EQ-Visual Analog Score (EQ-VAS) was 75; and the two scores correlated with statistical significance. Measured reductions of these injuries were good to excellent. Leg-length discrepancies improved initially but increased on further follow-up. This did not negatively affect the clinical outcome measures. The incidence of multiple surgical procedures in these patients was significantly associated with worse outcomes.

Conclusions:
Percutaneous iliosacral screw fixation of unstable posterior pelvic ring is performed with high patient-reported outcomes and excellent radiographically measured reductions at this center. We detected a trend towards increased leg-length difference on longer follow-up, but there was no detrimental effect on the clinical progress. We also found a previously unreported correlation between the Majeed score and the EQVAS score in our patient population.
Personal economic impact of performing elective Saturday hand surgery
Authors: Katz Jonathan S. , O’Callaghan Patrick K. , Patel Dil D. , Peterson Ann M. , Angermeier Eric W. , Kokko Kyle P. 
Published: July 2017

Background:
The economic impact of performing elective hand surgery on Saturdays has yet to be studied. The purpose of this study was to evaluate patient preferences and factors for Saturday hand surgery and to analyze the personal economic and societal costs regarding missed days of work for elective hand surgery.

Methods:
An anonymous quality improvement survey was distributed to 125 consecutive patients who were planning to undergo elective outpatient hand surgery. Demographics included age, gender, zip code, education, occupation, income level, and interest in Saturday hand surgery. IBM-SPSS Statistics 20 for Windows (SPSS, Chicago, IL) was used for data analysis.

Results:
Seventy-eight (62.4%) patients responded they would want elective hand surgery performed on a Saturday. Of those who reported income (n=66), the average daily salary was estimated to be $269.50. If these patients had been given the opportunity to have Saturday hand surgery, a total of $17,787 in lost income or paid leave could have been saved. We did not identify any significant factors that correlated with a patient’s decision to undergo elective Saturday hand surgery.

Conclusions:
Over half (62.4%) of our respondents would request Saturday elective hand surgery if offered at our institution. If 62.4% of patients requiring hand surgery at our institution were to elect for Saturday surgery, we estimated a savings of over $100,000 in lost wages or paid leave annually. This study shows that there is a patient population that would be interested in elective Saturday surgery, and providing availability could help to take care of this market.
Association Between Survival and Time of Day for Rapid Response Team Calls in a National Registry
Authors: Churpek Matthew Michael , Edelson Dana P. , Lee Ji Yeon , Carey Kyle , Snyder Ashley 
Published: July 2017

Objectives:
Decreased staffing at nighttime is associated with worse outcomes in hospitalized patients. Rapid response teams were developed to decrease preventable harm by providing additional critical care resources to patients with clinical deterioration. We sought to determine whether rapid response team call frequency suffers from decreased utilization at night and how this is associated with patient outcomes.

Design:
Retrospective analysis of a prospectively collected registry database.

Setting:
National registry database of inpatient rapid response team calls.

Patients:
Index rapid response team calls occurring on the general wards in the American Heart Association Get With The Guidelines-Medical Emergency Team database between 2005 and 2015 were analyzed.

Interventions:
None.

Measurements and Main Results:
The primary outcome was inhospital mortality. Patient and event characteristics between the hours with the highest and lowest mortality were compared, and multivariable models adjusting for patient characteristics were fit. A total of 282,710 rapid response team calls from 274 hospitals were included. The lowest frequency of calls occurred in the consecutive 1 am to 6:59 am period, with 266 of 274 (97%) hospitals having lower than expected call volumes during those hours. Mortality was highest during the 7 am hour and lowest during the noon hour (18.8% vs 13.8%; adjusted odds ratio, 1.41 [1.31–1.52]; p < 0.001). Compared with calls at the noon hour, those during the 7 am hour had more deranged vital signs, were more likely to have a respiratory trigger, and were more likely to have greater than two simultaneous triggers.

Conclusions:
Rapid response team activation is less frequent during the early morning and is followed by a spike in mortality in the 7 am hour. These findings suggest that failure to rescue deteriorating patients is more common overnight. Strategies aimed at improving rapid response team utilization during these vulnerable hours may improve patient outcomes.
Nutritional Deficiency–Related Oral and Cutaneous Lesions in an Obese Patient
Authors: Esquivel-Pedraza Lilly , Méndez-Flores Silvia , Cicero-Casarrubias Alba , Saeb-Lima Marcela , Domínguez-Cherit Judith , Fernández-Cuevas Laura 
Published: July 2017

Abstract:
The cutaneous and oral lesions related to nutritional deficiencies are scarcely reported. Micronutrient deficiencies may significantly affect mouth mucosa and skin, causing great morbidity. We report an extraordinary case with detailed clinical and microscopic findings affecting the oral cavity and skin. Physicians must be familiar with these manifestations to suspect the diagnosis.