bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acoustic Analysis of Voice in Singers: A Systematic Review
Authors: Gunjawate Dhanshree R. , Ravi Rohit , Bellur Rajashekhar 
Published: January 2018

Purpose
Singers are vocal athletes having specific demands from their voice and require special consideration during voice evaluation. Presently, there is a lack of standards for acoustic evaluation in them. The aim of the present study was to systematically review the available literature on the acoustic analysis of voice in singers.

Method
A systematic review of studies on acoustic analysis of voice in singers (PubMed/MEDLINE, CINAHL, Scopus, ProQuest, Cochrane, Ovid, Science Direct, and Shodhganga) was carried out. Key words based on PIO (population–investigation–outcome) were used to develop search strings. Titles and abstracts were screened independently, and appropriate studies were read in full for data extraction.

Results
Of the 895 studies, 26 studies met the inclusion criteria. Great variability was noted in the instruments and task used. Different acoustic measures were employed, such as fundamental frequency, perturbation, cepstral, spectral, dysphonia severity index, singing power ratio, and so forth.

Conclusion
Overall, a great heterogeneity was noted regarding population, tasks, instruments, and parameters. There is a lack of standardized criteria for the evaluation of singing voice. In order to implement acoustic analysis as a part of comprehensive voice evaluation exclusively for singers, there is a certain need for methodical sound studies.
Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record
Authors: Joukes Erik , Abu-Hanna Ameen , Cornet Ronald , de Keizer Nicolette 
Published: January 2018

Background Physicians spend around 35% of their time documenting patient data. They are concerned that adopting a structured and standardized electronic health record (EHR) will lead to more time documenting and less time for patient care, especially during consultations.
Objective This study measures the effect of the introduction of a structured and standardized EHR on documentation time and time for dedicated patient care during outpatient consultations.
Methods We measured physicians' time spent on four task categories during outpatient consultations: documentation, patient care, peer communication, and other activities. Physicians covered various specialties from two university hospitals that jointly implemented a structured and standardized EHR. Preimplementation, one hospital used a legacy-EHR, and one primarily paper-based records. The same physicians were observed 2 to 6 months before and 6 to 8 months after implementation.We analyzed consultation duration, and percentage of time spent on each task category. Differences in time distribution before and after implementation were tested using multilevel linear regression.
Results We observed 24 physicians (162 hours, 439 consultations). We found no significant difference in consultation duration or number of consultations per hour. In the legacy-EHR center, we found the implementation associated with a significant decrease in time spent on dedicated patient care (−8.5%). In contrast, in the previously paper-based center, we found a significant increase in dedicated time spent on documentation (8.3%) and decrease in time on combined patient care and documentation (−4.6%). The effect on dedicated documentation time significantly differed between centers.
Conclusion Implementation of a structured and standardized EHR was associated with 8.5% decrease in time for dedicated patient care during consultations in one center and 8.3% increase in dedicated documentation time in another center. These results are in line with physicians' concerns that the introduction of a structured and standardized EHR might lead to more documentation burden and less time for dedicated patient care.
How Does the Patient React After Reading the Informed Consent Form of a Gynecological Surgery? A Qualitative Study
Authors: Amorim Andrea Cristina , Santos Luis Guilherme Teixeira dos , Poli-Neto Omero Benedicto , Brito Luiz Gustavo Oliveira 
Published: January 2018

Objective To analyze the reaction of women after reading the Informed Consent Form (ICF) before undergoing elective gynecological/urogynecological surgeries.
Methods A qualitative study with 53 women was conducted between September 2014 and May 2015. The analysis of the content was conducted after a scripted interview was made in a reserved room and transcribed verbatim. We read the ICF once more in front of the patient, and then she was interviewed according to a script of questions about emotions and reactions that occurred about the procedure and her expectations about the intra- and postoperative period.
Results The women had a mean age of 52 years, they were multiparous, and most had only a few years of schooling (54.7%). The majority (60.4%) of them had undergone urogynecological surgeries. Hysterectomy and colpoperineoplasty were the most frequent procedures. Ten women had not undergone any previous abdominal surgery. Fear (34.6%) was the feeling that emerged most frequently from the interviews after reading the ICF, followed by indifference (30.8%) and resignation (13.5%). Nine women considered their reaction unexpected after reading the ICF. Three patients did not consider the information contained in the ICF to be sufficient, and 3 had questions about the surgery after reading the document.
Conclusion Reading the ICF generates fear in most women; however, they believe this feeling did not interfere in their decision-making process.
Medikamentenassoziierte Kiefernekrosen – von der Diagnose zur Therapie
Authors: Ristow Oliver , Hoffmann Jürgen , Freudlsperger Christian 
Published: January 2018

ZusammenfassungBisphosphonate und Denosumab spielen eine bedeutende Rolle bei der medikamentösen Therapie von Erkrankungen des Skelettsystems, insbesondere der Osteoporose und ossär metastasierenden Tumorerkrankungen. Grundsätzlich werden diese antiresorptiv wirksamen Medikamente sehr gut vertragen und ihre Anwendung gilt als nebenwirkungsarm. Jedoch haben sich die medikamentenassoziierten Kiefernekrosen in den vergangenen Jahren zu einer bedeutsamen, die Lebensqualität des Patienten einschränkenden Nebenwirkung dieser osteotropen Pharmaka herauskristallisiert. Bei einer verspäteten Diagnose oder Behandlung kann die medikamentenassoziierte Kiefernekrose einen komplikationsträchtigen und behandlungsintensiven Verlauf zeigen. Daher ist es das Ziel, die nötigen prophylaktischen, präventiven und therapeutischen Maßnahmen zu ergreifen, um deren Einnahme zu optimieren und das Auftreten dieser Nebenwirkung zu minimieren.
Die proximale Humerusfraktur des geriatrischen Patienten
Authors: Plecko Michael 
Published: January 2018

ZusammenfassungFrakturen am proximalen Humerus stellen beim alten Patienten mit erheblicher Osteoporose auch heute noch, trotz der stark verbesserten Implantate und der verfeinerten Operationstechnik, eine große Herausforderung dar. In Abhängigkeit von den persönlichen Bedürfnissen eines geriatrischen Patienten, der Erwartungshaltung, dem Aktivitätsniveau, den kognitiven Fähigkeiten sowie der Frakturform, der Knochendurchblutung, dem Grad der Osteoporose, dem Zustand der Rotatorenmanschette und dem Grad der Arthrose ist heute ein individuell angepasstes Behandlungskonzept zu favorisieren. Dabei spielt auch die konservative Therapie eine zunehmende Rolle, da bei manchen Patienten weniger die weitgehende Wiederherstellung der Beweglichkeit als vielmehr die Schmerzfreiheit im Vordergrund steht. Es ist also eine individuelle Nutzen-Risiko-Abwägung notwendig und das Behandlungsziel und die notwendige Behandlungsstrategie mit dem Patienten bzw. seinen Angehörigen zu diskutieren und festzulegen. Die winkelstabile Plattenosteosynthese sollte im Bedarfsfall mit Zusatzmaßnahmen wie einer Zementaugmentation oder einem Knochengraft kombiniert werden, um ein sekundäres Nachsinken mit sekundärer Schraubenperforation zu vermeiden. Bei nicht sinnvoll rekonstruierbaren Frakturen hat die inverse Schulterprothese im geriatrischen Patientengut die Frakturhemiprothese weitgehend abgelöst und bietet eine gute Möglichkeit, rasch Schmerzfreiheit und eine brauchbare Alltagsfunktion zu erreichen.
Detection of early neoplasia in Barrett’s esophagus using lectin-based near-infrared imaging: an ex vivo study on human tissue
Authors: Neves André , Di Pietro Massimiliano , O’Donovan Maria , Waterhouse Dale , Bohndiek Sarah , Brindle Kevin , Fitzgerald Rebecca 
Published: January 2018

Abstract
Background and study aims Endoscopic surveillance for Barrett’s esophagus (BE) is limited by long procedure times and sampling error. Near-infrared (NIR) fluorescence imaging minimizes tissue autofluorescence and optical scattering. We assessed the feasibility of a topically applied NIR dye-labeled lectin for the detection of early neoplasia in BE in an ex vivo setting.
Methods Consecutive patients undergoing endoscopic mucosal resection (EMR) for BE-related early neoplasia were recruited. Freshly collected EMR specimens were sprayed at the bedside with fluorescent lectin and then imaged. Punch biopsies were collected from each EMR under NIR light guidance. We compared the fluorescence intensity from dysplastic and nondysplastic areas within EMRs and from punch biopsies with different histological grades.
Results 29 EMR specimens were included from 17 patients. A significantly lower fluorescence was found for dysplastic regions across whole EMR specimens (P < 0.001). We found a 41 % reduction in the fluorescence of dysplastic compared to nondysplastic punch biopsies (P < 0.001), with a sensitivity and specificity for dysplasia detection of 80 % and 82.9 %, respectively.
Conclusion Lectin-based NIR imaging can differentiate dysplastic from nondysplastic Barrett’s mucosa ex vivo.
Neue Herausforderungen: Feststellung des irreversiblen Ausfalls der Hirnfunktion bei Neugeborenen, Kindern und Jugendlichen
Authors: Masuhr Florian , Dame Christof , Gratopp Alexander , Hoffmann Olaf 
Published: January 2018

Zusammenfassung
Hintergrund Gemäß der 4. Fortschreibung der Richtlinie zur Feststellung des irreversiblen Ausfalls der Gesamtfunktion des Großhirns, des Kleinhirns und des Hirnstamms muss bis zum vollendeten 14. Lebensjahr ein Facharzt für Kinder- und Jugendmedizin mit entsprechender Zusatzqualifikation an der Diagnostik mitwirken. In dieser retrospektiven Analyse soll untersucht werden, wer die Diagnostik bislang durchführte und welche Herausforderungen sich aus der aktuellen Richtlinie ergeben.
Patienten und Methode Retrospektive Auswertung des Patientenregisters der Deutschen Stiftung Organtransplantation (Organisationszentrale Nordost) aus den Jahren 2001–2010 unter Berücksichtigung der Vorgaben der 4. Fortschreibung vom 01. Juli 2015.
Ergebnisse 133 Patienten im Alter von 0–17 Jahren erhielten Diagnostik zur Feststellung des irreversiblen Ausfalls der Hirnfunktion. Ätiologisch dominierten in den ersten 6 Lebensmonaten sekundäre Hirnschädigungen, während danach traumatische und andere primäre Hirnschäden überwogen. Mit zunehmendem Alter sank der Anteil der Patienten, die auf neonatologischen/pädiatrischen Intensivstationen behandelt wurden bzw. Diagnostik durch Fachärzte für Kinder- und Jugendmedizin erhielten, kontinuierlich ab. Diese Fachärzte waren bei mehr als zwei Dritteln der pädiatrischen Patienten nicht an der abschließenden Feststellung des irreversiblen Hirnfunktionsausfalls beteiligt.
Diskussion und Schlussfolgerung Seit Inkrafttreten der 4. Fortschreibung müssen intensivmedizinisch ausgebildete und mit dem diagnostischen Vorgehen vertraute Fachärzte für Kinder- und Jugendmedizin wesentlich häufiger an der Feststellung des irreversiblen Ausfalls der Hirnfunktion mitwirken. Diesbezüglich sollten die ärztlichen Weiterbildungsordnungen weiterentwickelt, die Versorgungsstrukturen angepasst und Konsiliardienste etabliert werden.
Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis
Authors: Tringali Alberto , Hassan Cesare , Rota Matteo , Rossi Marta , Mutignani Massimiliano , Aabakken Lars 
Published: January 2018

Abstract
Background Self-expandable metal stents (SEMS) are used for palliation of distal malignant biliary strictures, but the role of covered SEMS is less clear. We performed an up-to-date meta-analysis to compare the performance of covered and uncovered SEMS in patients with unresectable distal malignant biliary strictures.
Methods A computerized medical search was performed using MEDLINE, EMBASE, and the Cochrane Library between 2000 and December 2016 to identify all randomized trials that compared covered with uncovered SEMS in patients with distal malignant biliary strictures. Primary outcomes were stent failure and patient mortality; secondary outcomes were stent dysfunction and adverse events. Pooled estimates were computed using the random effects model.
Results Overall, 11 RCTs involving 1272 patients were included. The primary outcomes of stent failure and patient mortality did not differ significantly between covered and uncovered SEMS (hazard ratio [HR] 0.68, 95 % confidence interval [CI] 0.40 – 1.17; HR 0.89, 95 %CI 0.76 – 1.05, respectively). However, stent migration and sludge formation were much more common with covered SEMS (odds ratio [OR] 5.11, 95 %CI 1.84 – 14.17; OR 2.46, 95 %CI 1.37 – 4.43). The use of covered SEMS was associated with a lower rate of tumor ingrowth (OR 0.21, 95 %CI 0.09 – 0.50) but a higher rate of tumor overgrowth (OR 2.00, 95 %CI 1.15 – 3.48) compared with uncovered stents. The rates of procedure-related adverse events were similar in both groups.
Conclusion There was a risk reduction of about 32 % for both stent failure and patient mortality with covered SEMS but this difference was not significant. Migration and sludge rates were higher with covered SEMS, whereas tumor ingrowth was more likely with uncovered SEMS. The data show no added benefit of covered SEMS; further stent evolution is desirable.
On optimal Scott sentences of finitely generated algebraic structures
Authors: Harrison-Trainor Matthew , Ho Meng-Che 
Published: January 2018

Scott showed that for every countable structure

A

\mathcal {A}

, there is a sentence of the infinitary logic

L

ω
1

ω

\mathcal {L}_{\omega _1\omega }

, called a Scott sentence for

A

\mathcal {A}

, whose countable models are exactly the isomorphic copies of

A

\mathcal {A}

. Thus, the least quantifier complexity of a Scott sentence of a structure is an invariant that measures the complexity “describing” the structure. Knight et al. have studied the Scott sentences of many structures. In particular, Knight and Saraph showed that a finitely generated structure always has a

Σ
3
0

\Sigma ^0_3

Scott sentence. We give a characterization of the finitely generated structures for which the

Σ
3
0

\Sigma ^0_3

Scott sentence is optimal. One application of this result is to give a construction of a finitely generated group where the

Σ
3
0

\Sigma ^0_3

Scott sentence is optimal.
Effect of a Postpartum Training Program on the Prevalence of Diastasis Recti Abdominis in Postpartum Primiparous Women: A Randomized Controlled Trial
Authors: Gluppe Sandra L , Hilde Gunvor , Tennfjord Merete K , Engh Marie E , Bø Kari 
Published: January 2018

Abstract

Background
Diastasis recti abdominis affects a significant number of women during the prenatal and postnatal period.

Objective
The objective was to evaluate the effect of a postpartum training program on the prevalence of diastasis recti abdominis.

Design
The design was a secondary analysis of an assessor-masked randomized controlled trial.

Methods
One hundred seventy-five primiparous women (mean age = 29.8 ± 4.1 years) were randomized to an exercise or control group. The interrectus distance was palpated using finger widths, with a cutoff point for diastasis as ≥2 finger widths. Measures were taken 4.5 cm above, at, and 4.5 cm below the umbilicus. The 4-month intervention started 6 weeks postpartum and consisted of a weekly, supervised exercise class focusing on strength training of the pelvic floor muscles. In addition, the women were asked to perform daily pelvic floor muscle training at home. The control group received no intervention. Analyses were based on intention to treat. The Mantel-Haenszel test (relative risk [RR] ratio) and the chi-square test for independence were used to evaluate between-group differences on categorical data.

Results
At 6 weeks postpartum, 55.2% and 54.5% of the participants were diagnosed with diastasis in the intervention and control groups, respectively. No significant differences between groups in prevalence were found at baseline (RR: 1.01 [0.77–1.32]), at 6 months postpartum (RR: 0.99 [0.71–1.38]), or at 12 months postpartum (RR: 1.04 [0.73–1.49]).

Limitations
The interrecti distance was palpated using finger widths, and the sample included women with and without diastasis.

Conclusions
A weekly, postpartum, supervised exercise program, including strength training of the pelvic floor and abdominal muscles, in addition to daily home training of the pelvic floor muscles, did not reduce the prevalence of diastasis.
The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use?
Authors: Sargeant Joan , Lockyer Jocelyn M. , Mann Karen , Armson Heather , Warren Andrew , Zetkulic Marygrace , Soklaridis Sophie , Könings Karen D. , Ross Kathryn , Silver Ivan , Holmboe Eric , Shearer Cindy , Boudreau Michelle 
Published: January 2018

Purpose
The authors previously developed and tested a reflective model for facilitating performance feedback for practice improvement, the R2C2 model. It consists of four phases: relationship building, exploring reactions, exploring content, and coaching. This research studied the use and effectiveness of the model across different residency programs and the factors that influenced its effectiveness and use.

Method
From July 2014–October 2016, case study methodology was used to study R2C2 model use and the influence of context on use within and across five cases. Five residency programs (family medicine, psychiatry, internal medicine, surgery, and anesthesia) from three countries (Canada, the United States, and the Netherlands) were recruited. Data collection included audiotaped site assessment interviews, feedback sessions, and debriefing interviews with residents and supervisors, and completed learning change plans (LCPs). Content, thematic, template, and cross-case analysis were conducted.

Results
An average of nine resident–supervisor dyads per site were recruited. The R2C2 feedback model, used with an LCP, was reported to be effective in engaging residents in a reflective, goal-oriented discussion about performance data, supporting coaching, and enabling collaborative development of a change plan. Use varied across cases, influenced by six general factors: supervisor characteristics, resident characteristics, qualities of the resident–supervisor relationship, assessment approaches, program culture and context, and supports provided by the authors.

Conclusions
The R2C2 model was reported to be effective in fostering a productive, reflective feedback conversation focused on resident development and in facilitating collaborative development of a change plan. Factors contributing to successful use were identified.
Utility of a High-Resolution Superficial Diagnostic Ultrasound System for Assessing Skin Thickness: A Cross-Sectional Study
Authors: Iyengar Sanjana , Makin Inder R. , Sadhwani Divya , Moon Esther , Yanes Arianna F. , Geisler Amelia , Silapunt Sirunya , Servaes Sabah , Weil Alexandra , Poon Emily , Alam Murad 
Published: January 2018

BACKGROUND
Compared with other imaging modalities, ultrasound is relatively deeply penetrating and can be used to evaluate deep dermal and subcutaneous structures.

OBJECTIVE
Image skin thickness of the face and neck using high-frequency diagnostic ultrasound devices.

MATERIALS AND METHODS
Skin overlying 20 different predesignated face and neck anatomic sites in 32 individuals was imaged using 2 commercially available high-frequency diagnostic ultrasound devices, a dedicated imaging device and a diagnostic device bundled with a therapeutic device. At each site, the subcutaneous and combined epidermal and dermal layer thicknesses were assessed by blinded expert raters.

RESULTS
Similar skin thickness measurements were obtained. Notably, subcutaneous fat depth was measured to be 0.2 cm at the forehead; 0.5 cm at the mental eminence; and 0.6 cm at the submental, supraglenoid, and temporal regions. The combined epidermal and dermal thickness was approximately 0.1 cm at the zygomatic process, suborbital area, inferior malar region, gonion, supraglenoid area, and nasolabial-buccal, and nasolabial fold regions.

CONCLUSION
This is the first study using high-resolution superficial diagnostic ultrasound to map skin thickness of the face and neck at standard anatomic locations. Ultrasound is an inexpensive, noninvasive, and convenient means to monitor dermatologic conditions and guide their treatment.
Treatment of Previously Treated Facial Capillary Malformations: Results of Single-Center Retrospective Objective 3-Dimensional Analysis of the Efficacy of Large Spot 532 nm Lasers
Authors: Kwiek Bartłomiej , Ambroziak Marcin , Osipowicz Katarzyna , Kowalewski Cezary , Rożalski Michał 
Published: January 2018

BACKGROUND
Current treatment of facial capillary malformations (CM) has limited efficacy.

OBJECTIVE
To assess the efficacy of large spot 532 nm lasers for the treatment of previously treated facial CM with the use of 3-dimensional (3D) image analysis.

PATIENTS AND METHODS
Forty-three white patients aged 6 to 59 were included in this study. Patients had 3D photography performed before and after treatment with a 532 nm Nd:YAG laser with large spot and contact cooling. Objective analysis of percentage improvement based on 3D digital assessment of combined color and area improvement (global clearance effect [GCE]) were performed.

RESULTS
The median maximal improvement achieved during the treatment (GCEmax) was 59.1%. The mean number of laser procedures required to achieve this improvement was 6.2 (range 1–16). Improvement of minimum 25% (GCE25) was achieved by 88.4% of patients, a minimum of 50% (GCE50) by 61.1%, a minimum of 75% (GCE75) by 25.6%, and a minimum of 90% (GCE90) by 4.6%. Patients previously treated with pulsed dye lasers had a significantly less response than those treated with other modalities (GCEmax 37.3% vs 61.8%, respectively).

CONCLUSION
A large spot 532 nm laser is effective in previously treated patients with facial CM.