bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective time-series quality improvement trial of a standardized analgesia protocol to reduce postoperative pain among neurosurgery patients
Authors: Titsworth W. Lee , Abram Justine , Guin Peggy , Herman Mary A. , West Jennifer , Davis Nicolle W. , Bushwitz Jennifer , Hurley Robert W. , Seubert Christoph N. 
Published: March 2016

OBJECTIVE
The inclusion of the pain management domain in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey now ties patients' perceptions of pain and analgesia to financial reimbursement for inpatient stays. Therefore, the authors wanted to determine if a quality improvement initiative centered on a standardized analgesia protocol could significantly reduce postoperative pain among neurosurgery patients.

METHODS
The authors implemented a 10-month, prospective, interrupted time-series trial of a quality improvement initiative. The intervention consisted of a multimodal, interdepartmental, standardized analgesia protocol with process improvements from preadmission to discharge. All neurosurgical-floor patients participated in the quality improvement intervention, with data collected on a systematically randomly sampled subset of 96 patients for detailed analysis. Patient-reported numeric rating scale pain on the first postoperative day (POD) served as the primary outcome.

RESULTS
Implementation of the analgesia protocol resulted in improved preoperative and postoperative documentation of pain (p < 0.001) and improved use of multimodal analgesia, including use of NSAIDs (p < 0.009) and gabapentin (p < 0.027). This intervention also correlated with a 32% reduction in reported pain on the 1st POD for all neurosurgical patients (mean pain scale scores 4.31 vs 2.94; p = 0.000) and a 43% reduction among spinal surgery patients (mean pain scale scores 5.45 vs 3.10; p = 0.036). After controlling for covariates, implementation of the protocol was a significant predictor of lowered postoperative pain (p = 0.05) on the 1st POD. This reduction in pain correlated with protocol compliance (p = 0.028), and a significant decrease in the monthly number of naloxone doses suggests improved safety (mean dose ± SD 1.5 ± 1.0 vs 0.33 ± 0.5; p = 0.04). Furthermore, a significant and persistent reduction in the pain management component of the HCAHPS scores suggests a durability of results extending beyond the life of the study (72.1% vs 82.0%; p = 0.033).

CONCLUSIONS
The implementation of a standardized analgesia protocol can significantly reduce postoperative pain among neurosurgical patients while increasing safety. Given the current climate of patient-centered outcomes, this study has broad implications for the continuum of care model proposed in the Affordable Care Act.
Clinical trial registration no.: NCT01693588 (clincaltrials.gov)
A comparison of commercially available demineralized bone matrices with and without human mesenchymal stem cells in a rodent spinal fusion model
Authors: Hayashi Tetsuo , Lord Elizabeth L. , Suzuki Akinobu , Takahashi Shinji , Scott Trevor P. , Phan Kevin , Tian Haijun , Daubs Michael D. , Shiba Keiichiro , Wang Jeffrey C. 
Published: March 2016

OBJECTIVE
The efficacy of some demineralized bone matrix (DBM) substances has been demonstrated in the spinal fusion of rats; however, no previous comparative study has reported the efficacy of DBM with human mesenchymal stem cells (hMSCs). There is an added cost to the products with stem cells, which should be justified by improved osteogenic potential. The purpose of this study is to prospectively compare the fusion rates of 3 different commercially available DBM substances, both with and without hMSCs.

METHODS
Posterolateral fusion was performed in 32 mature athymic nude rats. Three groups of 8 rats were implanted with 1 of 3 DBMs: Trinity Evolution (DBM with stem cells), Grafton (DBM without stem cells), or DBX (DBM without stem cells). A fourth group with no implanted material was used as a control group. Radiographs were obtained at 2, 4, and 8 weeks. The rats were euthanized at 8 weeks. Overall fusion was determined by manual palpation and micro-CT.

RESULTS
The fusion rates at 8 weeks on the radiographs for Trinity Evolution, Grafton, and DBX were 8 of 8 rats, 3 of 8 rats, and 5 of 8 rats, respectively. A significant difference was found between Trinity Evolution and Grafton (p = 0.01). The overall fusion rates as determined by micro-CT and manual palpation for Trinity Evolution, Grafton, and DBX were 4 of 8 rats, 3 of 8 rats, and 3 of 8 rats, respectively. The Trinity Evolution substance had the highest overall fusion rate, however no significant difference was found between groups.

CONCLUSIONS
The efficacies of these DBM substances are demonstrated; however, the advantage of DBM with hMSCs could not be found in terms of posterolateral fusion. When evaluating spinal fusion using DBM substances, CT analysis is necessary in order to not overestimate fusion.
Impact of acute stress on psychomotor bimanual performance during a simulated tumor resection task
Authors: Bajunaid Khalid , Mullah Muhammad Abu Shadeque , Winkler-Schwartz Alexander , Alotaibi Fahad E. , Fares Jawad , Baggiani Marta , Azarnoush Hamed , Christie Sommer , Al-Zhrani Gmaan , Marwa Ibrahim , Sabbagh Abdulrahman Jafar , Werthner Penny , Del Maestro Rolando F. 
Published: March 2016

OBJECTIVE
Severe bleeding during neurosurgical operations can result in acute stress affecting the bimanual psychomotor performance of the operator, leading to surgical error and an adverse patient outcome. Objective methods to assess the influence of acute stress on neurosurgical bimanual psychomotor performance have not been developed. Virtual reality simulators, such as NeuroTouch, allow the testing of acute stress on psychomotor performance in risk-free environments. Thus, the purpose of this study was to explore the impact of a simulated stressful virtual reality tumor resection scenario by utilizing NeuroTouch to answer 2 questions: 1) What is the impact of acute stress on bimanual psychomotor performance during the resection of simulated tumors? 2) Does acute stress influence bimanual psychomotor performance immediately following the stressful episode?

METHODS
Study participants included 6 neurosurgeons, 6 senior and 6 junior neurosurgical residents, and 6 medical students. Participants resected a total of 6 simulated tumors, 1 of which (Tumor 4) involved uncontrollable “intraoperative” bleeding resulting in simulated cardiac arrest and thus providing the acute stress scenario. Tier 1 metrics included extent of blood loss, percentage of tumor resected, and “normal” brain tissue volume removed. Tier 2 metrics included simulated suction device (sucker) and ultrasonic aspirator total tip path length, as well as the sum and maximum forces applied in using these instruments. Advanced Tier 2 metrics included efficiency index, coordination index, ultrasonic aspirator path length index, and ultrasonic aspirator bimanual forces ratio. All metrics were assessed before, during, and after the stressful scenario.

RESULTS
The stress scenario caused expected significant increases in blood loss in all participant groups. Extent of tumor resected and brain volume removed decreased in the junior resident and medical student groups. Sucker total tip path length increased in the neurosurgeon group, whereas sucker forces increased in the senior resident group. Psychomotor performance on advanced Tier 2 metrics was altered during the stress scenario in all participant groups. Performance on all advanced Tier 2 metrics returned to pre-stress levels in the post–stress scenario tumor resections.

CONCLUSIONS
Results demonstrated that acute stress initiated by simulated severe intraoperative bleeding significantly decreases bimanual psychomotor performance during the acute stressful episode. The simulated intraoperative bleeding event had no significant influence on the advanced Tier 2 metrics monitored during the immediate post-stress operative performance.
Impact of the 2006 Massachusetts health care insurance reform on neurosurgical procedures and patient insurance status
Authors: Villelli Nicolas W. , Das Rohit , Yan Hong , Huff Wei , Zou Jian , Barbaro Nicholas M. 
Published: March 2016

OBJECTIVE
The Massachusetts health care insurance reform law passed in 2006 has many similarities to the federal Affordable Care Act (ACA). To address concerns that the ACA might negatively impact case volume and reimbursement for physicians, the authors analyzed trends in the number of neurosurgical procedures by type and patient insurance status in Massachusetts before and after the implementation of the state's health care insurance reform. The results can provide insight into the future of neurosurgery in the American health care system.

METHODS
The authors analyzed data from the Massachusetts State Inpatient Database on patients who underwent neurosurgical procedures in Massachusetts from 2001 through 2012. These data included patients' insurance status (insured or uninsured) and the numbers of procedures performed classified by neurosurgical procedural codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Each neurosurgical procedure was grouped into 1 of 4 categories based on ICD-9-CM codes: 1) tumor, 2) other cranial/vascular, 3) shunts, and 4) spine. Comparisons were performed of the numbers of procedures performed and uninsured patients, before and after the implementation of the reform law. Data from the state of New York were used as a control. All data were controlled for population differences.

RESULTS
After 2008, there were declines in the numbers of uninsured patients who underwent neurosurgical procedures in Massachusetts in all 4 categories. The number of procedures performed for tumor and spine were unchanged, whereas other cranial/vascular procedures increased. Shunt procedures decreased after implementation of the reform law but exhibited a similar trend to the control group. In New York, the number of spine surgeries increased, as did the percentage of procedures performed on uninsured patients. Other cranial/vascular procedures decreased.

CONCLUSIONS
After the Massachusetts health care insurance reform, the number of uninsured individuals undergoing neurosurgical procedures significantly decreased for all categories, but more importantly, the total number of surgeries performed did not change dramatically. To the extent that trends in Massachusetts can predict the overall US experience, we can expect that some aspects of reimbursement may be positively impacted by the ACA. Neurosurgeons, who often treat patients with urgent conditions, may be affected differently than other specialists.
Corrigendum: Investigating the contribution of physician assistants to primary care in England: a mixed-methods study
Authors: Drennan Vari M , Halter Mary , Brearley Sally , Carneiro Wilfred , Gabe Jonathan , Gage Heather , Grant Robert , Joly Louise , de Lusignan Simon 
Published: March 2016

AbstractCorrection to the table footnote in Table 28.
Salter-Harris type II metacarpal and metatarsal fracture in three foals
Authors: Fürst Anton , Kircher Patrick , Kluge Katharina , Kummer Martin , Klopfenstein Bregger Micaël 
Published: March 2016

SummaryObjectives: To describe minimally-invasive lag screw osteosynthesis combined with external coaptation for the treatment of Salter-Harris type II third metacarpal and third metatarsal bone fractures.Methods: Three foals aged two weeks to four months with a Salter-Harris type II third metacarpal or third metatarsal fracture. Surgery was carried out under general anaesthesia in lateral recumbency. After fracture reduction, the metaphyseal fragment was stabilized with two cortical screws placed in lag fashion under fluoroscopic control. A cast was applied for at least two weeks.Results: All foals had a good outcome with complete fracture healing and return to complete soundness without any angular limb deformity. All foals had moderate transient digital hyperextension after cast removal.Clinical significance: Internal fixation of Salter-Harris type II third metacarpal or third metatarsal fractures with two cortical screws in lag fashion, combined with external coaptation provided good stabilization and preserved the longitudinal growth potential of the injured physis.
GAMMA-RAY AND OPTICAL OSCILLATIONS IN PKS 0537–441
Authors: Sandrinelli A. , Covino S. , Treves A. 
Published: March 2016

ABSTRACT
We have considered the Fermi γ-ray light curve of the blazar PKS 0537–441 during a high state extending from 2008 August 10 to 2011 August 27. The periodogram exhibits a peak at T ∼ 280 days, with a significance of ∼99.7%. A peak of similar relevance at

is found in the optical light curves. Considering the entire duration of the Fermi light curve 2008–2015, no significant peak is revealed, while the optical one remains meaningful. Comparing with recent observations of PKS 2155–304 and PG 1553+113 it seems that month–year oscillations can characterize some blazars. Month-scale oscillations can also show up only during phases of enhanced or bursting emission, such as in the case of PKS 0537–441.
ION ACCELERATION AT THE QUASI-PARALLEL BOW SHOCK: DECODING THE SIGNATURE OF INJECTION
Authors: Sundberg Torbjörn , Haynes Christopher T. , Burgess D. , Mazelle Christian X. 
Published: March 2016

ABSTRACT
Collisionless shocks are efficient particle accelerators. At Earth, ions with energies exceeding 100 keV are seen upstream of the bow shock when the magnetic geometry is quasi-parallel, and large-scale supernova remnant shocks can accelerate ions into cosmic-ray energies. This energization is attributed to diffusive shock acceleration; however, for this process to become active, the ions must first be sufficiently energized. How and where this initial acceleration takes place has been one of the key unresolved issues in shock acceleration theory. Using Cluster spacecraft observations, we study the signatures of ion reflection events in the turbulent transition layer upstream of the terrestrial bow shock, and with the support of a hybrid simulation of the shock, we show that these reflection signatures are characteristic of the first step in the ion injection process. These reflection events develop in particular in the region where the trailing edge of large-amplitude upstream waves intercept the local shock ramp and the upstream magnetic field changes from quasi-perpendicular to quasi-parallel. The dispersed ion velocity signature observed can be attributed to a rapid succession of ion reflections at this wave boundary. After the ions’ initial interaction with the shock, they flow upstream along the quasi-parallel magnetic field. Each subsequent wavefront in the upstream region will sweep the ions back toward the shock, where they gain energy with each transition between the upstream and the shock wave frames. Within three to five gyroperiods, some ions have gained enough parallel velocity to escape upstream, thus completing the injection process.
Le community organizing en France : quel projet politique ?
Authors: Carrel Marion , de Lépinay Adeline 
Published: March 2016

Alors que des campagnes inspirées du community organizing commencent à se développer en France, la curiosité et les attentes sont grandes. En quoi ces expériences constituent-elles des démarches de politisation, d’éducation populaire dans les quartiers populaires ? La question démocratique dans le mouvement social est-elle renouvelée ? Au-delà du pragmatisme clairement revendiqué, quel est le projet politique ? Quel est le levier utilisé pour mobiliser : injustices sociales, discriminations ? Nous avons souhaité donner la parole à trois pionniers du community organizing en France : Laëtitia Nonone, présidente de l’association Zonzon 93 à Villepinte, L. Real, consultant à Studio Praxis et l’un des organisateurs de la campagne nationale Stop le contrôle au faciès , et Adrien Roux, co-fondateur et organisateur au sein de l’Alliance citoyenne de l’agglomération grenobloise et du Réseau pour l’action collective transnationale (ReACT).
Joseph Wresinski : pionnier de l’ empowerment radical made in France
Authors: Roy Alex 
Published: March 2016

L’engouement actuel pour les pratiques d’ empowerment et de community organizing pose la question de la filiation américaine des stratégies d’émancipation radicale. Pourtant, n’existe-t-il pas des initiatives d’ empowerment radical made in France ? La mise en parallèle du projet de société et des principes d’action développés par Joseph Wresinski avec ceux de Saul Alinsky et de Paulo Freire permet de répondre positivement à cette question. Le fondateur d’ATD Quart Monde (Aide à Toute Détresse, devenu Agir Tous pour la Dignité Quart Monde) défend en effet une révolution culturelle et démocratique à partir de l’émancipation politique des plus pauvres. À l’heure où beaucoup s’interrogent sur la transposition à large échelle des pratiques de community organizing en France, l’expérience des pionniers français de l’ empowerment radical mériterait ainsi plus d’attention.
Améliorer le quartier ou changer la société ?
Authors: Talpin Julien 
Published: March 2016

L’histoire du community organizing est pleine de récits héroïques et de victoires improbables. Pourtant, plus de soixante-dix ans après son émergence, les inégalités sont plus fortes que jamais aux États-Unis et la pauvreté n’a jamais été aussi importante. En se concentrant sur des campagnes gagnables, les organisations communautaires ne laissent-elles pas de côté les questions plus structurelles, à l’origine de la marginalisation sociale des habitants des quartiers populaires ? Ne sont-elles pas d’énièmes agents de la paix sociale, améliorant à la marge le sort des plus déshérités sans le transformer en profondeur ? Ces interrogations conduisent surtout à mettre en cause le localisme qui a parfois caractérisé le community organizing . Les deux campagnes présentées dans cet article indiquent de quelle façon de vastes coalitions se structurent au-delà de l’échelle locale pour s’attaquer à certains enjeux structurants. Un dilemme semble pourtant apparaître : la prise de distance avec le localisme s’accompagne également d’une plus faible prise des participants sur le devenir des revendications. Faudrait-il faire l’économie de la démocratie pour exercer un réel pouvoir ?
Saproxylic beetle (Coleoptera) diversity in subalpine whitebark pine and lodgepole pine (Pinaceae) trees killed by mountain pine beetles (Coleoptera: Curculionidae)
Authors: Esch Evan D. , Spence John R. , Langor David W. 
Published: March 2016

AbstractWhitebark pine,Pinus albicaulisEngelmann (Pinaceae), a foundational species of North American subalpine ecosystems, is endangered across its range and continued decline is inevitable. Little is known about the invertebrate fauna associated with this species which, if specific to whitebark pine, may also be threatened or endangered. We compared the composition of saproxylic beetle assemblages associated with whitebark pine and co-occurring lodgepole pine,Pinus contorta latifolia(Engelmann) Critchfield (Pinaceae), recently killed by mountain pine beetle (MPB),Dendroctonus ponderosaeHopkins (Coleoptera: Curculionidae), in subalpine forests in Alberta, Canada. Redundancy and rarefaction analyses revealed that beetle assemblage composition was influenced by snag class (i.e., time since death) but differed little among the two pine species within snag classes. However, a subset of the assemblage known to be associated with the MPB differed significantly in composition between the two pines. No common species were exclusively associated with whitebark pines; however, seven species were rarely collected only on whitebark pine. With the possible exception of these rare species, felling and burning infested whitebark pines to control the MPB will not likely endanger saproxylic beetles associated with this tree.
Complex ecological relationships among an assemblage of indigenous hymenopteran parasitoids, the exotic European woodwasp (Sirex noctilio; Hymenoptera: Siricidae), and a native congener
Authors: Foelker Christopher J. , Standley Christopher R. , Parry Dylan , Fierke Melissa K. 
Published: March 2016

AbstractWe collected naturally infested Pinus resinosa Aiton (Pinaceae) and P. sylvestris Linnaeus to investigate phenological patterns and quantify parasitism by a suite of native hymenopteran parasitoids on two woodwasps (Hymenoptera: Siricidae): the invading non-native European woodwasp, Sirex noctilio Fabricius, and a co-colonising native, S. nigricornis Fabricius. We sampled a total of 76 trees from two field sites in 2010 and seven sites in 2011. In raw abundance, S. noctilio outnumbered S. nigricornis by 2:1 in 2010 and by 7.5:1 in 2011. We collected the egg/early instar parasitoid, Ibalia leucospoides ensiger Norton (Hymenoptera: Ibaliidae); four species of Rhyssinae (Hymenoptera: Ichneumonidae) late larval parasitoids; and Pseudorhyssa nigricornis (Ratzeburg) (Hymenoptera: Ichneumonidae), a cleptoparasitoid of rhyssines. Variation in siricid and parasitoid species assemblage and abundance was explained primarily by site, with tree-level factors playing a secondary role. Parasitism was significantly lower in P. sylvestris (13.6%±4.1 SE), a naturalised pine from Europe, than in the native P. resinosa (28.5%±5.0). Total parasitism was 27.6%±5.0 in 2010 and 20.9%±4.7 in 2011. This study represents the most robust analysis of the diverse woodwasp and parasitoid assemblage infesting pines in North America.