bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Features and Outcomes of Post-Traumatic Silent Sinus Syndrome
Authors: Wladis Edward J. , Kersten Robert C. , Vagefi M. Reza , Pinheiro-Neto Carlos , Shinder Roman , Kim H. Jane 
Published: January 2018

Purpose:
To identify demographic features and clinical outcomes associated with post-traumatic silent sinus syndrome.

Methods:
A retrospective review was carried out at 3 academic medical centers to identify all cases of post-traumatic silent sinus syndrome. Clinical features and management strategies were recorded. Postoperative outcomes were assessed, and statistical analyses were performed via a dedicated computerized software package.

Results:
Twenty cases were identified (14 men and 6 women, mean age = 44.2 years). Seven patients underwent sinus surgery as the sole means of treatment, and the mean pre- and postoperative enophthalmos measurements were 2.86 and 1.93 mm. Alternatively, 13 patients underwent combined orbital reconstruction and sinus surgery, respectively; the mean pre- and postoperative enophthalmos measurements were 3.42 and 0.39 mm, respectively. The change in enophthalmos was statistically significantly greater in patients who underwent sinus surgery and orbital reconstruction (p = 0.00028). Among patients who underwent sinus surgery alone, one patients (14.2%) experienced complete resolution of enophthalmos, as compared with 10 patients (76.9%) who underwent combined procedures.

Conclusions:
This study represents the largest published cohort of patients with post-traumatic silent sinus syndrome. Combined orbital reconstruction and sinus surgery results in greater reductions of enophthalmos and a markedly improved chance of postoperative symmetry of globe position.
The Link Between Cerebrovascular Hemodynamics and Rehabilitation Outcomes After Aneurysmal Subarachnoid Hemorrhage
Authors: Brooks Forrest A. , Ughwanogho Uvieoghene , Henderson Galen V. , Black-Schaffer Randie , Sorond Farzaneh A. , Tan Can Ozan 
Published: January 2018

Objective
The aim of the study was to assess the relation between cerebrovascular function early after aneurysmal subarachnoid hemorrhage onset and functional and rehabilitation outcomes.

Design
Observational cohort study of subarachnoid hemorrhage patients (n = 133) admitted to rehabilitation (n = 49), discharged home (n = 52), or died before discharge (n = 10). We obtained hemodynamic markers of cerebral autoregulatory function from blood flow velocities in the middle cerebral artery and arterial pressure waveforms, recorded daily on days 2–4 after symptom onset, and functional independence measure (FIM) scores and FIM efficiency for those admitted to acute rehabilitation.

Results
Compared to those discharged home, the range of pressures within which autoregulation is effective was lower in patients admitted to rehabilitation (4.6 [0.2] vs. 3.9 [0.2] mm Hg) and those who died (2.7 [0.4], P = 0.04). For those admitted to rehabilitation, autoregulatory range and the ability of cerebrovasculature to increase flow were related to discharge FIM score (R
2 = 0.33 and 0.43, P < 0.01) and efficiency (R
2 = 0.33 and 0.47 P < 0.01). The latter marker, along with subarachnoid hemorrhage severity and admission FIM, explained 84% and 69% of the variability in discharge FIM score and efficiency, respectively, even after accounting for age.

Conclusions
Early cerebrovascular function is a major contributor to functional outcomes after subarachnoid hemorrhage and may represent a modifiable target to develop therapeutic approaches.

To Claim CME Credits
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives
Upon completion of this article, the reader should be able to: (1) Define cerebral autoregulation; (2) Explain the importance of the integrity of cerebral autoregulation for longer-term functional and rehabilitation outcomes after aneurysmal subarachnoid hemorrhage; and (3) Theorize why treatment strategies that may be effective in reducing large-vessel vasospasms after an aneurysmal subarachnoid hemorrhage might not always translate into improved functional outcomes.

Level
Advanced

Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Effect of Surgery First Orthognathic Approach on the Temporomandibular Joint
Authors: Pelo Sandro , Saponaro Gianmarco , De Angelis Paolo , Gasparini Giulio , Garagiola Umberto , Moro Alessandro 
Published: January 2018

Introduction:
Correction of severe malocclusions with skeletal discrepancies requires orthodontic treatment in combination with orthognathic surgery. Even though conventional orthognathic surgery (COS) is a common and well-accepted approach its influence on the signs and symptoms of temporomandibular disorders (TMDs) is still debated. Recently with the introduction of surgery first approach, a different timing for the management of dentoskeletal imbalances has been proposed. The present study is aimed at assessing the relationship between surgery first approach and temporomandibular joint (TMJ) disorders.

Methods:
The study sample consisted of 24 patients who were selected to be treated with surgery first approach. Clinical follow-ups after surgery were performed every week for the first month, at 3 months, 6 months, and at 1 year. A radiological follow-up was performed at 1 week and at 1 year after the operation with a panorex and a latero-lateral teleradiograph. To assess the effect of surgery first approach on the TMDs signs and symptoms, a clinical assessment was performed 4 days before surgery (T1), 6 months after surgery (T2), and 1 year postoperatively (T3).

Results:
The results of the authors’ study show that pain assessment revealed a general improvement of this symptom in correspondence to TMJ and masticatory muscles except in the masseter and neck region. Also joint noises, TMJ functioning, migraine, and headache underwent a considerable improvement.

Conclusion:
Surgery first approach is an innovative orthognathic procedure and, by undergoing surgery first approach, patients with pre-existing TMJ dysfunction may experience a significant improvement or even resolution of the TMDs signs and symptoms.
External Validation of University of Wisconsin's Clinical Criteria for Obtaining Maxillofacial Computed Tomography in Trauma
Authors: Harrington Amanda W. , Pei Kevin Y. , Assi Roland , Davis Kimberly A. 
Published: January 2018

Objectives:
Patients sustaining multisystem trauma are at risk for oral and maxillofacial fractures. Although the University of Wisconsin established criteria to help guide the clinician in obtaining additional cross-sectional imaging to evaluate possible facial fractures, it has not been externally validated. Our aim was to evaluate whether the University of Wisconsin's Criteria is generalizable to external institutions through validation and to report modern practice patterns at a level 1 trauma center.

Methods:
A retrospective case study was performed of all patients who had computed tomography of the facial bones (CT face) at a tertiary, academic, Level 1 trauma center over the 6-month period ending on June 30, 2015. The electronic medical record was reviewed for the 5 University of Wisconsin criteria (bony step off or instability, periorbital ecchymosis, malocclusion, tooth absence, and glasgow coma scale). Final interpretation of CT face findings by board-certified radiologists (facial fractures, intracranial hemorrhage, and cervical spine injury) were also captured. Our modeling was similar to that described by the reference study, the internal validation study. Sensitivity, specificity, negative, and positive predictive values with 95% confidence intervals were evaluated. A P < 0.05 was considered significant.

Results:
The presence of any ≥1 of the 5 criteria identified on physical examination resulted in 81% sensitivity for any facial fracture, which is lower than the sensitivity initially described (98%) and subsequently internally validated (97%). The absence of all 5 physical examination criteria had a negative predictive value of 60%, again lower than that initially described (87%) and then internally validated (81%).

Conclusion:
We were unable to validate the University of Wisconsin criteria for predicting facial fractures. These criteria may be institutionally specific and not generalizable to other trauma centers. Further research to refine the criteria for CT of the face is needed to improve resource allocation.
Non‐Negative Word Order In Breton: Maintaining Verb‐Second
Authors: Kennard Holly J. 
Published: January 2018

AbstractThis paper examines variation in Breton word order patterns in non‐negative utterances across speakers of different ages. Not only has there been some disagreement on how best to characterise unmarked word order in Breton, it has also been claimed that younger speakers of so‐called Neo‐Breton overuse subject‐initial word order under influence from French. Data from fieldwork provide a complex picture of word order variability. This seems to be driven by a number of factors, including the nature of the subject (lexical or pronominal), regional variation among older speakers, and a corresponding lack of regional features among younger speakers. Rather than overusing subject‐initial word order, the Neo‐Breton speakers tend to avoid this word order pattern when other word orders are available, such that the verb‐second pattern is being maintained.
A fast and reliable method for monitoring of prophage‐activating chemicals
Authors: Xu Juan , Kiesel Bärbel , Kallies René , Jiang Feng‐Lei , Liu Yi , Maskow Thomas 
Published: January 2018

SummaryBacteriophages, that is viruses that infect bacteria, either lyse bacteria directly or integrate their genome into the bacterial genome as so‐called prophages, where they remain at a silent state. Both phages and bacteria are able to survive in this state. However, prophages can be reactivated with the introduction of chemicals, followed by the release of a high number of phage particles, which could infect other bacteria, thus harming ecosystems by a viral bloom. The basics for a fast, automatable analytical method for the detection of prophage‐activating chemicals are developed and successfully tested here. The method exploits the differences in metabolic heat produced by Escherichia coli with (λ+) and without the lambda prophages (λ−). Since the metabolic heat primarily reflects opposing effects (i.e. the reduction of heat‐producing cells by lysis and enhanced heat production to deliver the energetic costs for the synthesis of phages), a systematic analysis of the influence of the different conditions (experimentally and in silico) was performed and revealed anoxic conditions to be best suited. The main advantages of the suggested monitoring method are not only the possibility of obtaining fast results (after only few hours), but also the option for automation, the low workload (requires only few minutes) and the suitability of using commercially available instruments. The future challenge following this proof of principle is the development of thermal transducers which allow for the electronic subtraction of the λ+ from the λ‐ signal.
Investigation of the effect of rapid and slow external pH increases on Enterococcus faecalis biofilm grown on dentine
Authors: Stenhouse M , Zilm P , Ratnayake J , Cathro P 
Published: January 2018

AbstractBackgroundCalcium hydroxide is a common endodontic medicament and has an antimicrobial effect by increasing the localized pH within the root canal. However, Enterococcus faecalis has shown some resistance to calcium hydroxide.MethodsA flow cell apparatus was used to grow an E. faecalis biofilm on dentine discs. Following 4 weeks growth in Todd Hewitt Broth, flow cells were exposed to either a rapid or slow increase to pH 11.5 or 12.5. Cellular viability was determined using serial plating and the number of colony‐forming units was normalized against the cellular protein content. Scanning electron microscopy was carried out to qualitatively observe the effects of the different rates of pH increase.ResultsA significant difference in viability between the pH rapid and slow groups was not shown in this study. Compared with pH 11.5 solutions, pH 12.5 solutions were more effective at killing bacteria although some E. faecalis still survived.ConclusionsEnterococcus faecalis did not adapt and develop a greater resistance to high pH following a slow rise in pH compared with a rapid rise in pH. As expected, pH 12.5 was more effective in reducing bacterial numbers compared with pH 11.5 although E. faecalis was not completely eliminated.
Adopting innovation in gynaecology: The introduction of e‐consult
Authors: Mann Rebecca , van de Weijer Peter H. M. 
Published: January 2018

ObjectiveTo describe the development of an e‐consultation service as part of the triaging and grading process of referrals and to report on the efficacy and safety of such a service.MethodsAll gynaecology e‐consults in the study period June 2015 to March 2016 were retrospectively reviewed. The outcomes of interest were the initial reduction in first face‐to‐face hospital visits, and the rate of re‐referrals. Acute admission for the same reason, a subsequent diagnosis of underlying (pre)‐malignancy, or patient death from the condition related to the index referral were selected as measures for patient safety.ResultsSeven thousand and forty‐two (7042) referrals were made to the gynaecology service in the 10 month study period. After exclusion of referrals to colposcopy and the early pregnancy clinic, 4738 e‐referrals remained. Of these, 1013 referrals (21.4%) were triaged for an e‐consult. One hundred and forty‐seven patients (14.5%) with an initial e‐consult were re‐referred within 6 months for the same condition. The reduction in face‐to‐face contacts was 18.2% (866/4738). No death and/or acute admission for the same reason as stated in the initial referral occurred among the patients with e‐consultation and none were later diagnosed with an underlying (pre)‐malignancy.ConclusionE‐consultation was effective at reducing the number of first outpatient face‐to‐face contacts without notable compromise of the quality of care or patient safety. E‐consultation allows specialists to provide expert clinical guidance, management and support to the referring provider when appropriate. Topics for further study include patient benefits and satisfaction, and further assessment of the social, economic and financial impacts on all parties involved.
A systematic review of population pharmacokinetics of valproic acid
Authors: Methaneethorn Janthima 
Published: January 2018

AimsPopulation pharmacokinetics is an essential tool that helps guide individualized dosing regimens. The aims of this systematic review are to provide knowledge concerning population pharmacokinetics of valproic acid (VPA) and to identify factors influencing VPA pharmacokinetic variability.MethodsPubMed and Embase databases were systematically searched from inception to June, 2017. Relevant articles from reference lists were also included. All population pharmacokinetic studies of VPA conducted in humans and that employed a nonlinear mixed effect modelling approach were included in this review.ResultsTwenty‐six studies were included in this review. Most studies characterized VPA pharmacokinetics as a one‐compartment model. Three studies reported a two‐compartment model. Body weight, dose and age were significant predictors for VPA volume of distribution (Vd). The estimated Vd for one‐compartment models ranged from 8.4 to 23.3 l. For two‐compartment models, peripheral volumes of distribution ranged from 4.08 to 42.1 l. Frequently reported significant predictors for VPA clearance (CLVPA) included body weight, VPA dose, concomitant medications, gender and age. The estimated CLVPA ranged from 0.206 to 1.154 l h−1 and the inter‐individual variability ranged from 13.40 to 35.90%. Two studies reported population pharmacokinetics/pharmacodynamics of VPA in patients with epilepsy. Seventeen studies evaluated the performance of their final models.ConclusionsSignificant predictors influencing VPA pharmacokinetics as well as model methodologies are highlighted in this review. For clinical application, CLVPA could be predicted using body weight, VPA dose, concomitant medications, gender or age. For future research, there is a knowledge gap regarding population pharmacokinetics/pharmacodynamics of VPA in a population other than epileptic patients.
Transforming identities through Transforming Care: How people with learning disabilities experience moving out of hospital
Authors: Head Annabel , Ellis‐Caird Helen , Rhodes Louisa , Parkinson Kathie 
Published: January 2018

Accessible Summary

People with learning disabilities talked about what it was like to move out of hospital.
People talked about how important their relationships with other people were. People wanted to feel comfortable with new members of staff so that they felt safe and happy in their new home.
People talked about how moving out of hospital changed how they thought about themselves. When they were in hospital, people sometimes thought that they were “bad.” But after they moved, some people started to think that they were a different person. It is important for everyone to think about how they talk to people when they are in hospital, and when they have moved out.
People can do really well living in their own home, rather than in hospital.
AbstractBackgroundPeople with learning disabilities are moving out of hospitals as part of the Transforming Care programme, although thus far their views on how they have experienced this have not been researched.Materials and MethodsA qualitative design was used to explore how people with learning disabilities experienced moving as part of Transforming Care. Eleven people took part in semi‐structured interviews; they were supported by Key Support People (n = 9) who knew them well. A social constructionist Grounded Theory approach was used in analysis.Results and DiscussionPeople reported that their relationships with other people, including friends, family and staff, played a significant role in how they experienced the move. Moving was also an opportunity for people to shift their ideas about who they were as a person and opened up a wider array of stories about their identity.ConclusionsA number of recommendations are discussed, relevant for staff working in this field to support positive transitions out of hospital.
Comparing impact on the family and insurance coverage in children with cerebral palsy and children with another special healthcare need
Authors: Schaible B. , Colquitt G. , Caciula M. C. , Carnes A. , Li L. , Moreau N. 
Published: January 2018

AbstractBackgroundFamilies and caregivers of children with special healthcare needs (CSHCN) often experience financial difficulties, have unmet physical and mental health needs, and are at increased risk of marital problems due to the stress caused by carrying for their child. Within the larger population of CHSCN, young people with cerebral palsy (CP) have more unmet needs due to the complexity and potential severity of the disability. The purpose of this study was to identify factors associated with differences in insurance coverage and impact on the family of children with CP and other CHSCN.MethodsThe data were taken from the National Survey of Children with Special Health Care Needs, which was designed to examine state‐ and national‐level estimates of CSHCN. Three variables examined differences in insurance coverage between those children diagnosed with CP versus all other CSHCN: insurance coverage for the previous year, current insurance coverage, and adequacy of insurance coverage. Four variables representing different indicators of family impact were used to assess differences between children with CP versus all other CSHCN: out‐of‐pocket expenses for healthcare, family financial burden, hours per week that family members spent caring for the child, and impact on family work life.ResultsThe results of this study showed significant differences between households with a child with CP and a child with another health special need in terms of insurance coverage, indicating a tendency of children with CP to be insured the entire year. As for the impact on the family in households with children with CP versus other CSHCN, there were significant differences in all four variables that were analysed.ConclusionsThere is limited evidence highlighting differences between the impact of caring for a child with CP and caring for other CSHCN. Caring for a child with CP has a significant impact on the family, despite insurance coverage.
Soluble ST2 in end‐stage heart failure, before and after support with a left ventricular assist device
Authors: Tseng Cheyenne C. S. , Huibers Manon M. H. , Gaykema Lonneke H. , Siera‐de Koning Erica , Ramjankhan Faiz Z. , Maisel Alan S. , de Jonge Nicolaas 
Published: January 2018

AbstractBackgroundThe interleukin‐33 (IL‐33)/suppressor of tumorigenicity 2 (ST2) pathway is suggested to play an important role in fibrosis, remodelling and the progression of heart failure (HF). Increased soluble (sST2) levels are associated with adverse outcome in the average HF population. Less is known about sST2 levels in end‐stage HF. Therefore, we studied sST2 levels in end‐stage HF and the effect of unloading by left ventricular assist device (LVAD) support on sST2 levels.Method and resultsSerial plasma measurements of sST2 were performed pre‐implantation and 1, 3 and 6 months after (LVAD) implantation in 38 patients. sST2 levels were elevated in end‐stage HF just prior to LVAD implantation (74.2 ng/mL [IQR 54.7‐116.9]; normal <35 ng/mL) and decreased substantially during LVAD support, to 29.5 ng/mL [IQR 24.7‐46.6](P< .001). Patients with INTERMACS profile I had significantly higher sST2 levels compared to patients in profile II and profile III. A moderate correlation was found between sST2 and C‐reactive protein (r= .580,P< .010).ConclusionLevels of sST2 are elevated in end‐stage HF patients with variability that suggests multiple inputs to a pro‐inflammatory and pro‐fibrotic pathway. Cardiogenic shock and increased C‐reactive protein levels are associated with higher sST2 levels. LVAD support results in a significant drop in sST2 levels with normalization within 3 months postimplantation. This suggests that LVAD support leads to lessening of fibrosis and inflammation, which might eventually be used to target medical policy: explantation of the LVAD versus permanent use or cardiac transplantation.