bluuebunny/crossref_metadata_2025_split huggingface dataset:
Value of Public Health Funding in Preventing Hospital Bloodstream Infections in the United States
Authors: Whittington Melanie D. , Bradley Cathy J. , Atherly Adam J. , Campbell Jonathan D. , Lindrooth Richard C. 
Published: September 2017

Objectives. To estimate the association of 1 activity of the Prevention and Public Health Fund with hospital bloodstream infections and calculate the return on investment (ROI). Methods. The activity was funded for 1 year (2013). A difference-in-differences specification evaluated hospital standardized infection ratios (SIRs) before funding allocation (years 2011 and 2012) and after funding allocation (years 2013 and 2014) in the 15 US states that received the funding compared with hospital SIRs in states that did not receive the funding. We estimated the association of the funded public health activity with SIRs for bloodstream infections. We calculated the ROI by dividing cost offsets from infections averted by the amount invested. Results. The funding was associated with a 33% (P < .05) reduction in SIRs and an ROI of $1.10 to $11.20 per $1 invested in the year of funding allocation (2013). In 2014, after the funding stopped, significant reductions were no longer evident. Conclusions. This activity was associated with a reduction in bloodstream infections large enough to recoup the investment. Public health funding of carefully targeted areas may improve health and reduce health care costs.
Emergency Medical Service Personnel’s Risk From Violence While Serving the Community
Authors: Maguire Brian J. , O’Neill Barbara J. 
Published: September 2017

Objectives. To determine the risks of violence-related injury among emergency medical services (EMS) personnel in the United States. Methods. We analyzed 1630 violence-related occupational injury cases reported to the US Bureau of Labor Statistics for the years 2012 to 2015 and conducted secondary searches within the Bureau of Labor Statistics Web site. Results. The number of cases per year varied between 250 and 560. Perpetrators included patients (77%) and coworkers (8%). Female EMS personnel had a disproportionately greater risk of violence-related injuries. The most common (35%) injury type was “sprains–strains–tears”; about 4% of the assault cases resulted in fractures, 13% resulted in surface wounds, and 190 were head injuries. About a third of the cases were classified as intentional. Conclusions. The findings indicate a clear need for reliable interventions. The differences in risk for women indicate that some interventions may need to be demographic-specific. Because of the limitations of national data, future researchers will need access to agency-level data that include hours worked and call volume by demographic factors such as gender.
The Changing Pattern of Nutrition Intake by Social Class in Contemporary China, 1991–2011
Authors: Xu Zhun , Zhang Wei 
Published: September 2017

Objectives. To explore the changing pattern of nutrition intake by social class in contemporary China. Methods. We defined social class in 2 ways. The first definition was based on employment, and the second definition was based on per capita household income levels. We used China Health and Nutrition Survey data from 1991 to 2011 to show the changes in the relation between social class and nutrition intake. Results. The relation between social class and nutrition intake in China changed significantly within the 2 decades. For example, in the early 1990s, the lowest social class (defined by employment or income) had more caloric intake than did the highest social class; 20 years later, however, the relation reversed, and the lowest social class consumed significantly fewer calories. Conclusions. China has seen a great reversal in its social class–nutrition relationship since the early 1990s. Our study calls for wider recognition that insufficient consumption of food and nutrition is increasingly an issue for people in the lower social classes in China.
Autism Spectrum Disorder Among US Children (2002–2010): Socioeconomic, Racial, and Ethnic Disparities
Authors: Durkin Maureen S. , Maenner Matthew J. , Baio Jon , Christensen Deborah , Daniels Julie , Fitzgerald Robert , Imm Pamela , Lee Li-Ching , Schieve Laura A. , Van Naarden Braun Kim , Wingate Martha S. , Yeargin-Allsopp Marshalyn 
Published: September 2017

Objectives. To describe the association between indicators of socioeconomic status (SES) and the prevalence of autism spectrum disorder (ASD) in the United States during the period 2002 to 2010, when overall ASD prevalence among children more than doubled, and to determine whether SES disparities account for ongoing racial and ethnic disparities in ASD prevalence. Methods. We computed ASD prevalence and 95% confidence intervals (CIs) from population-based surveillance, census, and survey data. We defined SES categories by using area-level education, income, and poverty indicators. We ascertained ASD in 13 396 of 1 308 641 8-year-old children under surveillance. Results. The prevalence of ASD increased with increasing SES during each surveillance year among White, Black, and Hispanic children. The prevalence difference between high- and low-SES groups was relatively constant over time (3.9/1000 [95% CI = 3.3, 4.5] in 2002 and 4.1/1000 [95% CI = 3.6, 4.6] in the period 2006–2010). Significant racial/ethnic differences in ASD prevalence remained after stratification by SES. Conclusions. A positive SES gradient in ASD prevalence according to US surveillance data prevailed between 2002 and 2010, and racial and ethnic disparities in prevalence persisted during this time among low-SES children.
Diagnostic Accuracy of Two Food Insecurity Screeners Recommended for Use in Health Care Settings
Authors: Makelarski Jennifer A. , Abramsohn Emily , Benjamin Jasmine H. , Du Senxi , Lindau Stacy Tessler 
Published: September 2017

Objectives. To test the diagnostic accuracy of the American Academy of Pediatrics (AAP) recommended food insecurity screener. Methods. We conducted prospective diagnostic accuracy studies between July and November 2016 in Chicago, Illinois. We recruited convenience samples of adults from adult and pediatric emergency departments (12-month recall study: n = 188; 30-day recall study: n = 154). A self-administered survey included the 6-item Household Food Security Screen (gold standard), the validated 2-item Hunger Vital Sign (HVS; often, sometimes, never response categories), and the 2-item AAP tool (yes-or-no response categories). Results. Food insecurity was prevalent (12-month recall group: 46%; 30-day group: 39%). Sensitivity of the AAP tool using 12-month and 30-day recall was, respectively, 76% (95% confidence interval [CI] = 65%, 85%) and 72% (95% CI = 57%, 84%). The HVS sensitivity was significantly higher than the AAP tool (12-month: 94% [95% CI = 86%, 98%; P = .002]; 30-day: 92% [95% CI = 79%, 98%; P = .02]). Conclusions. The AAP tool missed nearly a quarter of food-insecure adults screened in the hospital; the HVS screening tool was more sensitive. Public health implications. Health care systems adopting food insecurity screening should optimize ease of administration and sensitivity of the screening tool.
Effect of Surgeon and Hospital Volume on Morbidity and Mortality After Hip Fracture
Authors: Okike Kanu , Chan Priscilla H. , Paxton Elizabeth W. 
Published: September 2017

Background:
Prior studies have examined the relationship between surgeon and hospital volumes and outcome following hip fracture surgical procedures, but the results have been inconclusive. The purpose of this study was to assess the hip fracture volume-outcome relationship by analyzing data from a large, managed care registry.

Methods:
The Kaiser Permanente Hip Fracture Registry prospectively records information on surgically treated hip fractures within the managed health-care system. Using this registry, all surgically treated hip fractures in patients 60 years of age or older were identified. Surgeon and hospital volume were defined as the number of hip fracture surgical procedures performed in the preceding 12 months and were divided into tertiles (low, medium, and high). The primary outcome was mortality at 1 year postoperatively. Secondary outcomes were mortality at 30 and 90 days postoperatively as well as reoperation (lifetime), medical complications (90-day), and unplanned readmission (30-day). To determine the relationship between volume and these outcome measures, multivariate logistic and Cox proportional hazards regression were performed, controlling for potentially confounding variables.

Results:
Of 14,294 patients in the study sample, the majority were female (71%) and white (79%), and the mean age was 81 years. The overall mortality rate was 6% at 30 days, 11% at 90 days, and 21% at 1 year. We did not find an association between surgeon or hospital volume and mortality at 30 days, 90 days, or 1 year (p > 0.05). There was also no association between surgeon or hospital volume and reoperation, medical complications, or unplanned readmission (p > 0.05).

Conclusions:
In this analysis of hip fractures treated in a large integrated health-care system, the observed rates of mortality, reoperation, medical complications, and unplanned readmission did not differ by surgeon or hospital volume. In contrast to other orthopaedic procedures, such as total joint arthroplasty, our data do not suggest that hip fractures need to be preferentially directed toward high-volume surgeons or hospitals for treatment.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Flexible Adult Acquired Flatfoot Deformity
Authors: de Cesar Netto Cesar , Schon Lew C. , Thawait Gaurav K. , da Fonseca Lucas Furtado , Chinanuvathana Apisan , Zbijewski Wojciech B. , Siewerdsen Jeffrey H. , Demehri Shadpour 
Published: September 2017

Background:
The 3-dimensional nature of adult acquired flatfoot deformity can be challenging to characterize using radiographs. We tested the hypothesis that measurements on weight-bearing (WB) cone-beam computed tomography (CT) images were more useful for demonstrating the severity of the deformity than non-weight-bearing (NWB) measurements.

Methods:
We prospectively enrolled 12 men and 8 women (mean age, 52 years; range, 20 to 88 years) with flexible adult acquired flatfoot deformity. The subjects underwent cone-beam CT while standing (WB) and seated (NWB), and images were assessed in the sagittal, coronal, and axial planes by 3 independent observers who performed multiple measurements. Intraobserver and interobserver reliabilities were assessed with the Pearson or Spearman correlation and the intraclass correlation coefficient (ICC), respectively. Measurements were compared using paired Student t tests or Wilcoxon rank-sum tests. P < 0.05 was considered significant.

Results:
We found that overall the measurements had substantial intraobserver and interobserver reliability on both the NWB images (mean ICC, 0.80; range, 0.49 to 0.99) and the WB images (mean ICC, 0.81; range, 0.39 to 0.99). Eighteen of 19 measurements differed between WB and NWB cone-beam CT images, with more pronounced deformities on the WB images. The most reliable measurements, based on intraobserver and interobserver reliabilities and the difference between WB and NWB images, were the medial cuneiform-to-floor distance, which averaged 29 mm (95% confidence interval [CI] = 28 to 31 mm) on the NWB images and 18 mm (95% CI = 17 to 19 mm) on the WB images, and the forefoot arch angle (mean, 13° [95% CI = 12° to 15°] and 3.0° [95% CI = 1.4° to 4.6°], respectively) in the coronal view and the cuboid-to-floor distance (mean, 22 mm [95% CI = 21 to 23 mm] and 17 mm [95% CI = 16 to 18 mm], respectively) and the navicular-to-floor distance (mean, 38 mm [95% CI = 36 to 40 mm] and 23 mm [95% CI = 22 to 25 mm], respectively) in the sagittal view.

Conclusions:
Measurements analogous to traditional radiographic parameters of adult acquired flatfoot deformity are obtainable using high-resolution cone-beam CT. Compared with NWB images, WB images better demonstrated the severity of osseous derangement in patients with flexible adult acquired flatfoot deformity.

Level of Evidence:
Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Tendon Length, Calf Muscle Atrophy, and Strength Deficit After Acute Achilles Tendon Rupture
Authors: Heikkinen Juuso , Lantto Iikka , Piilonen Juuso , Flinkkilä Tapio , Ohtonen Pasi , Siira Pertti , Laine Vesa , Niinimäki Jaakko , Pajala Ari , Leppilahti Juhana 
Published: September 2017

Background:
In this prospective study, we used magnetic resonance imaging (MRI) to assess long-term Achilles tendon length, calf muscle volume, and muscle fatty degeneration after surgery for acute Achilles tendon rupture.

Methods:
From 1998 to 2001, 60 patients at our center underwent surgery for acute Achilles tendon rupture followed by early functional postoperative rehabilitation. Fifty-five patients were reexamined after a minimum duration of follow-up of 13 years (mean, 14 years), and 52 of them were included in the present study. Outcome measures included Achilles tendon length, calf muscle volume, and fatty degeneration measured with MRI of both the affected and the uninjured leg. The isokinetic plantar flexion strength of both calves was measured and was correlated with the structural findings.

Results:
The Achilles tendon was, on average, 12 mm (95% confidence interval [CI] = 8.6 to 15.6 mm; p < 0.001) longer (6% longer) in the affected leg than in the uninjured leg. The mean volumes of the soleus and medial and lateral gastrocnemius muscles were 63 cm3 (13%; p < 0.001), 30 cm3 (13%; p < 0.001), and 16 cm3 (11%; p < 0.001) lower in the affected leg than in the uninjured leg, whereas the mean volume of the flexor hallucis longus (FHL) was 5 cm3 (5%; p = 0.002) greater in the affected leg, indicating FHL compensatory hypertrophy. The median plantar flexion strength for the whole range of motion ranged from 12% to 18% less than that on the uninjured side. Finally, the side-to-side difference in Achilles tendon length correlated substantially with the strength deficit (ρ = 0.51, p < 0.001) and with medial gastrocnemius (ρ = 0.46, p = 0.001) and soleus (ρ = 0.42, p = 0.002) muscle atrophy.

Conclusions:
Increased Achilles tendon length is associated with smaller calf muscle volumes and persistent plantar flexion strength deficits after surgical repair of Achilles tendon rupture. Strength deficits and muscle volume deficits are partly compensated for by FHL hypertrophy, but 11% to 13% deficits in soleus and gastrocnemius muscle volumes and 12% to 18% deficits in plantar flexion strength persist even after long-term follow-up.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Graduation Protocol After Growing-Rod Treatment: Removal of Implants without New Instrumentation Is Not a Realistic Approach
Authors: Kocyigit Ismail Aykut , Olgun Z. Deniz , Demirkiran H. Gokhan , Ayvaz Mehmet , Yazici Muharrem 
Published: September 2017

Background:
The growing rod remains an effective option in the treatment of early-onset scoliosis, and has previously been likened to an internal brace. While details of growing-rod treatment have been largely agreed on, the appropriate end point remains a matter of controversy. A decision was made in 2004, at the beginning of growing-rod treatment at our institution, to remove longitudinal instrumentation when the period of lengthening concluded and, similar to discontinuing a brace, leave the spine free.

Methods:
From 2004, patients managed with a growing rod who were ≤10 years old at the time of the index surgery and had no previous surgery were enrolled in the prospective treatment pathway. For this report, the inclusion criteria were complete records and radiographs; regular lengthenings; no complications defined as SV (severity grade) IIA, IIB, III, or IV; and a minimum follow-up of 2 years after reaching the age of 14 years. At the age of 14 years, the patients were reevaluated and 1 of 3 treatments was undertaken. In Group 1, which included patients with adequate correction and no requirement for extension of fusion, the growing rods were removed. In Group 2, which included patients with inadequate correction and/or interval changes, the growing rods were removed and instrumented fusion was performed. In Group 3, which included patients with a Risser sign of 0 or who were otherwise immature, lengthening was continued.

Results:
Twenty-six patients met the inclusion criteria. The mean age at the time of the index operation was 82.6 months. There were 10 patients in Group 1, 9 patients in Group 2, and 7 patients in Group 3. Of the 10 patients whose rods were removed without additional instrumentation, 9 had clinically important worsening of the deformity and required reimplantation with fusion.

Conclusions:
Despite the initial intention to remove the implants, allow the spine to regain motion, and observe patients when they turned 14, the results of this report reveal that only 10 of the initially included 26 patients met the criteria to do so. In 9 of these patients, the deformity worsened after removal, confirming that prolonged growing-rod treatment does not necessarily result in spontaneous, reliable fusion. Removal of spinal implants without new instrumentation is not a realistic graduation protocol following growing-rod treatment, and implants should be retained, or if extension is required, another procedure should be undertaken.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Does 20 Years of Tillage and N Fertilization Influence Properties of a Claypan Soil in the Eastern Great Plains?
Authors: Sweeney Daniel W. 
Published: September 2017

Core Ideas
Claypan soil properties were minimally affected by tillage and N fertilization after 20 years.
Soil organic matter distribution was affected by tillage, but with no apparent net difference.
Long‐term tillage and N fertilization did not affect soil bulk density or penetration resistance.
Subtle long‐term soil changes may not influence producer choices for tillage and N fertilization.
Tillage and nitrogen (N) fertilization systems may affect soil chemical and physical properties, especially long term. This study's objective was to examine the effect of three tillage systems (conventional tillage, reduced tillage, and no‐till) with four N fertilizer treatments on properties of a claypan soil in the eastern Great Plains after 20 yr of cropping. Soil chemical and physical properties were little affected by long‐term tillage and N fertilization. The lack of tillage to distribute soil phosphorus (P) and potassium (K) nutrients within no‐till treatments resulted in lower P and K values below the surface. In no‐till, the accumulation of organic matter in the surface soil (0 to 7.5 cm) was countered by lower organic matter in the 7.5‐ to 15 ‐cm zone, resulting in no net increase compared with the other two tillage systems. Soil bulk density and penetration resistance in the surface 30 cm were unaffected by tillage or N fertilization.
Nitrogen Management for Seed Production from Endophyte‐Free Tall Fescue Grown on Claypan Soil
Authors: Sweeney Daniel W. , Moyer Joseph L. 
Published: September 2017

Core Ideas
Pastures may be replanted with endophyte‐free seed to avoid harmful alkaloids.
Better N management may be required for endophyte‐free fescue seed production.
Nitrogen fertilizer placement has little effect on endophyte‐free seed production.
Fescue seed yield may be maximized with 150 lb N/acre applied in late winter.
Nitrogen fertilization affects tall fescue [Schedonorus arundinaceus (Schreb.) Dumort.] forage production, but data are limited regarding seed production from endophyte‐free tall fescue grown on the claypan soils of the eastern Great Plains. A field study was conducted from fall 1998 to spring 2001 to determine the effects of N fertilizer timing (late fall or late winter), N placement (surface broadcast, spoke [point injection at 3 inches deep], and knife [subsurface band at 4 inches deep]), and N rate (0, 50, 100, 150, and 200 lb/acre) on endophyte‐free tall fescue seed yield, yield components, and harvested seed germination. The soil was a Parsons silt loam (fine, mixed, thermic Mollic Albaqualf), which is a typical claypan soil of the area. Seed yield response to N rates to 100 lb N/acre was similar regardless of application timing, but in two of three years, greater N rates applied in late fall improved seed production to about 400 lb/acre. Even though all components of seed yield responded to N fertilization, panicles/ft2 had the highest correlation (r = 0.83) with seed yield and showed greater response in 1999 to N applied in late fall at a higher rate compared with fewer panicles/ft2 at lower rates of N applied in late winter. The effect of N fertilization on germination of harvested seed was small. Fertilizer N placement had little effect on measured variables. In summary, increasing N rate to 150 lb/acre and applying it in late winter has the potential to maximize production of endophyte‐free tall fescue seed.
Comparison of N2O Emissions and Gene Abundances between Wastewater Nitrogen Removal Systems
Authors: Brannon Elizabeth Quinn , Moseman‐Valtierra Serena M. , Lancellotti Brittany V. , Wigginton Sara K. , Amador Jose A. , McCaughey James C. , Loomis George W. 
Published: September 2017

Biological nitrogen removal (BNR) systems are increasingly used in the United States in both centralized wastewater treatment plants (WWTPs) and decentralized advanced onsite wastewater treatment systems (OWTS) to reduce N discharged in wastewater effluent. However, the potential for BNR systems to be sources of nitrous oxide (N2O), a potent greenhouse gas, needs to be evaluated to assess their environmental impact. We quantified and compared N2O emissions from BNR systems at a WWTP (Field's Point, Providence, RI) and three types of advanced OWTS (Orenco Advantex AX 20, SeptiTech Series D, and Bio‐Microbics MicroFAST) in nine Rhode Island residences (n = 3 per type) using cavity ring‐down spectroscopy. We also used quantitative polymerase chain reaction to determine the abundance of genes from nitrifying (amoA) and denitrifying (nosZ) microorganisms that may be producing N2O in these systems. Nitrous oxide fluxes ranged from −4 × 10−3 to 3 × 10−1 µmol N2O m−2 s−1 and in general followed the order: centralized WWTP > Advantex > SeptiTech > FAST. In contrast, when N2O emissions were normalized by population served and area of treatment tanks, all systems had overlapping ranges. In general, the emissions of N2O accounted for a small fraction (<1%) of N removed. There was no significant relationship between the abundance of nosZ or amoA genes and N2O emissions. This preliminary analysis highlights the need to evaluate N2O emissions from wastewater systems as a wider range of technologies are adopted. A better understanding of the mechanisms of N2O emissions will also allow us to better manage systems to minimize emissions.Core Ideas
First direct comparison of N2O emissions from N removal at a WWTP and advanced OWTS.
N2O emissions (mol area−1) from OWTS were generally lower relative to BNR at WWTP.
N2O emissions normalized per capita and area were similar between WWTP and OWTS.
N2O emissions generally represented <1% of N removed.
N2O emissions were not related to amoA or nosZ gene abundance.