bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Climatology of Operational Storm-Based Warnings: A Geospatial Analysis
Authors: Harrison David R. , Karstens Christopher D. 
Published: October 2016

Abstract
This study provides a quantitative climatological analysis of the fundamental geospatial components of storm-based warnings and offers insight into how the National Weather Service (NWS) uses the current storm-based warning system under the established directives and policies. From October 2007 through May 2016, the NWS issued over 500 000 storm-based warnings and severe weather statements (SVSs), primarily concentrated east of the Rocky Mountains. A geospatial analysis of these warning counts by county warning area (CWA) shows local maxima in the lower Mississippi valley, southern plains, central plains, and the southern Appalachians. Regional uniformity exists in the patterns of average speed and direction provided by the time/motion/location tags, while the mean duration and polygon area varies significantly by CWA and region. These observed consistencies and inconsistencies may be indicative of how local weather forecast office (WFO) policy and end-user needs factor into the warning issuance and update process. This research concludes with a comparison of storm-based warnings to NWS policy and an analysis of CWAs with the greatest number of warnings issued during a single convective day.
Application-Based Hearing Screening in the Elderly Population
Authors: Livshitz Leonid , Ghanayim Reem , Kraus Carmi , Farah Raymond , Even-Tov Ella , Avraham Yaniv , Sharabi-Nov Adi , Gilbey Peter 
Published: October 2016

Objectives: The effects of age-related hearing loss are severe. Early detection is essential for maximum benefit. However, most hearing-impaired adults delay obtaining treatment. Diagnostic hearing testing at an appropriate facility is impractical, and new methods for screening audiometry aim to provide easy access for patients and reliable outcomes. The purpose of this study was to examine the accuracy of application-based hearing screening in an elderly population. Methods: The uHear application was downloaded to an iPad. Application-based hearing screening was performed in a non-soundproofed quiet room, and subsequently all participants underwent full diagnostic audiometry in a soundproof booth. Results: Sixty patients were recruited and completed both tests. Significant differences were observed between the hearing results obtained with the application and the standard audiogram at all frequencies and in both ears. Following subtraction of a constant factor of 25 dB from the application-based results in order to compensate for ambient noise, no significant differences in pure tone average were found between the 2 methods. Conclusions: The uHear application is inaccurate in assessing hearing thresholds for screening in the elderly. However, when site-specifically corrected, the uHear application may be used as a screening tool for hearing loss in an elderly population.
Impact of a Multidisciplinary Round Visit for the Management of Dysphagia Utilizing a Wi-Fi–Based Wireless Flexible Endoscopic Evaluation of Swallowing
Authors: Sakakura Koichi , Tazawa Masayuki , Otani Natsuko , Takagi Masato , Morita Mariko , Kurosaki Minori , Chiyoda Tomoko , Kanai Yuri , Endo Ayaka , Murata Takaaki , Shino Masato , Yokobori Yuki , Shirakura Kenji , Wada Naoki , Chikamatsu Kazuaki 
Published: October 2016

Objectives: The management of dysphagia requires a multidisciplinary approach, especially in large-scale hospitals. We introduce a novel protocol using a Wi-Fi–based flexible endoscopic evaluation of swallowing (FEES) system and aim to verify its effectiveness in evaluation and rehabilitation of inpatients with dysphagia. Method: We conducted novel Wi-Fi–based FEES at the bedside using 3 iPads as monitors and recorders. Functional outcomes of swallowing in 2 different hospitals for acute care with conventional wired or wireless FEES were compared retrospectively. Results: Using the wireless system, we could visit more patients in a short period of time. Furthermore, a large multidisciplinary team was able to be present at the bedside, which made it easy to hold discussions and rapidly devise appropriate rehabilitation strategies. Aspiration pneumonia recurred in a few cases following our intervention with wireless FEES. Functional oral intake score was significantly increased following the intervention. Moreover, the number of deaths during hospitalization using wireless FEES evaluation was lower than those observed using the conventional system. Conclusion: Wi-Fi–based wireless FEES system, the first of its kind, allowed our multidisciplinary team to easily and effectively assess inpatients with dysphagia by facilitating simple examinations and intensive transprofessional discussions for patient rehabilitation.
The Utility of the MAUDE Database for Osseointegrated Auditory Implants
Authors: Coelho Daniel H. , Tampio Alex J. 
Published: October 2016

Objective: To determine the utility of Manufacturer and User Friendly Device Experience (MAUDE) database in studying osseointegrated auditory implant (OAI)–related complications. Methods: The MAUDE database was searched for all reports involving OAIs (ie, Baha, Ponto, Sophono). Complications were classified into 1 or more of 6 categories—implant, abutment, processor, skin, surgery, and other. Subcategories were generated to prevent overgeneralization. Other variables recorded included date of report, number of complications per report, manufacturer, and time from complication to report. Results: Over the study period, there were 269 complications listed from 238 reports divided into the following categories: implant related (n = 145), abutment related (n = 16), processor related (n = 13), skin and soft tissue related (n = 79), surgery related (n = 11), and other (n = 5). No demographic data were available. There were no discernible trends from the data, and when compared to published literature, MAUDE data appear to under- or misrepresent complications. Conclusion: The MAUDE database is limited in its design and given fairly disparate reporting quality may not be ideally suited for quantifying risks of OAIs. These findings suggest the necessity for a substantially improved central registry for otologic implants and highlight the need for further research to investigate the root causes of their associated complication
Human Error as an Emergent Property of Action Selection and Task Place-Holding
Authors: Tamborello Franklin P. , Trafton J. Gregory 
Published: October 2016

Objective: A computational process model could explain how the dynamic interaction of human cognitive mechanisms produces each of multiple error types. Background: With increasing capability and complexity of technological systems, the potential severity of consequences of human error is magnified. Interruption greatly increases people’s error rates, as does the presence of other information to maintain in an active state. Method: The model executed as a software-instantiated Monte Carlo simulation. It drew on theoretical constructs such as associative spreading activation for prospective memory, explicit rehearsal strategies as a deliberate cognitive operation to aid retrospective memory, and decay. Results: The model replicated the 30% effect of interruptions on postcompletion error in Ratwani and Trafton’s Stock Trader task, the 45% interaction effect on postcompletion error of working memory capacity and working memory load from Byrne and Bovair’s Phaser Task, as well as the 5% perseveration and 3% omission effects of interruption from the UNRAVEL Task. Conclusion: Error classes including perseveration, omission, and postcompletion error fall naturally out of the theory. Application: The model explains post-interruption error in terms of task state representation and priming for recall of subsequent steps. Its performance suggests that task environments providing more cues to current task state will mitigate error caused by interruption. For example, interfaces could provide labeled progress indicators or facilities for operators to quickly write notes about their task states when interrupted.
Issues using linkage of hospital records and death certificate data to determine the size of a potential palliative care population
Authors: Brameld Kate , Spilsbury Katrina , Rosenwax Lorna , Murray Kevin , Semmens James 
Published: October 2016

Background: Studies aiming to identify palliative care populations have used data from death certificates and in some cases hospital records. The size and characteristics of the identified populations can show considerable variation depending on the data sources used. It is important that service planners and researchers are aware of this. Aim: To illustrate the differences in the size and characteristics of a potential palliative care population depending on the differential use of linked hospital records and death certificate data. Design: Retrospective cohort study. Setting/participants: The cohort consisted of 23,852 people aged 20 years and over who died in Western Australia between 1 January 2009 and 31 December 2010 after excluding deaths related to pregnancy or trauma. Within this cohort, the number, proportion and characteristics of people who died from one or more of 10 medical conditions considered amenable to palliative care were identified using linked hospital records and death certificate data. Results: Depending on the information source(s) used, between 43% and 73% of the 23,852 people who died had a condition potentially amenable to palliative care identified. The median age at death and the sex distribution of the decedents by condition also varied with the information source. Conclusion: Health service planners and researchers need to be aware of the limitations when using hospital records and death certificate data to determine a potential palliative care population. The use of Emergency Department and other administrative data sources could further exacerbate this variation.
Comparison of Diabetic Charcot Patients With and Without Foot Wounds
Authors: Wukich Dane K. , Sadoskas David , Vaudreuil Nicholas J. , Fourman Mitchell 
Published: October 2016

Background: The primary aim of this study was to evaluate the outcomes of a series of patients with Charcot neuroarthropathy (CN) who were evaluated in a tertiary care setting. We hypothesized that those patients with CN who presented with a Charcot-related foot wound would have lower rates of successful limb salvage than patients who presented without a wound. Methods: Two hundred forty-five patients (280 feet) were identified with diabetic CN during the time period from January 1, 2005, to June 1, 2015. This consecutive cohort of patients was treated by a single surgeon and had a mean age of 57.9 ± 10.0 years. Our CN patients were divided into 2 groups for the purpose of our analysis. Our study group included those patients who presented to our clinic with a Charcot-related foot wound. Our control group was composed of CN patients who presented without a Charcot-related foot wound. Results: Overall, 78 feet (27.9%) were successfully treated nonoperatively and 202 feet (72.1%) required some type of surgery. Of the 202 feet that received surgery, 22 (10.9%) were not felt to be suitable for reconstruction and underwent a definitive transtibial amputation without an attempt at reconstruction. An additional 18 patients underwent soft tissue surgery, which included drainage of infection, posterior muscle group lengthening, or soft tissue reconstructive flap surgery. The remaining 162 feet underwent osseous surgery, which included ostectomies for osteomyelitis, exostectomies, osteotomies, and arthrodesis. Eighteen of the 180 limbs (10.0%) that underwent soft tissue or osseous reconstruction ultimately required a transtibial amputation, resulting in a successful limb salvage rate of 90.0%. Thirty-five amputations were performed in 164 feet (21.3%) with Charcot-related foot wounds compared with 5 amputations in 116 feet (4.5%) without Charcot-related foot wounds (OR 6.02, 95% CI 2.28-15.91, P < .0001). Conclusion: The presence of a Charcot-related foot wound at presentation increased the likelihood of a major lower extremity amputation by a factor of 6. Other risk factors that were associated with major amputation in patients included active infection at presentation, nonunion/instability after reconstruction, and a postoperative wound problem. The overall rate of successful limb salvage in patients deemed reconstructive candidates was 90%. Level of Clinical Evidence: Level III, retrospective, case-control study.
Proximity of the Lateral Calcaneal Artery With a Modified Extensile Lateral Approach Compared to Standard Extensile Approach
Authors: Kwon John Y. , Gonzalez Tyler , Riedel Matthew D. , Nazarian Ara , Ghorbanhoseini Mohammad 
Published: October 2016

Background: The extensile lateral approach (EL) has been associated with increased wound complications such as apical necrosis which may be due partially from violation of the lateral calcaneal artery (LCA). Traditionally, the vertical limb has been placed half-way between the fibula and Achilles tendon, which may be suboptimal given the proximity to the LCA. We hypothesized that placing the vertical limb further posterior (ie, modified EL [MEL]) would increase the distance from the LCA. The purposes of this study were to quantify the location of the LCA in relation to the vertical limb of the traditional EL approach and to determine if utilizing the MEL approach endangered the LCA to a lesser extent. Methods: 20 cadavers were used. For the EL approach, the fibula and Achilles tendon were palpated and a line parallel to the plantar foot was drawn between the two. A vertical line (VL), representing the vertical limb of the approach, was drawn at the midway point as a perpendicular extending proximally from the junction of the glabrous/non-glabrous skin (JGNG). For the MEL approach, the anterior border of the Achilles tendon was palpated and a similar vertical line (MVL) was drawn 0.75 cm anterior. Dissection was performed and if the LCA was identified crossing the line VL/MVL, the distance from the JGNG was documented. Results: For the EL approach, the LCA was identified in 17/20 (85%) cadavers at an average distance of 5.0 cm (range 3-7 cm, SD = 1.3 cm) from JGNG. For the ML approach, the LCA was identified in 4/20 (20%) cadavers at an average distance of 5.9 cm (range 3-6.5 cm, SD = 1.7 cm) from the JGNG ( P < .001). Conclusions: The LCA was encountered 4 times more often during the EL approach as compared to the MEL approach. Clinical Relevance: A modification of the EL approach may decrease iatrogenic injury to the LCA and may decrease wound complications.
Timing of Antibiotic Prophylaxis for Preventing Surgical Site Infections in Foot and Ankle Surgery
Authors: Tantigate Direk , Jang Eugene , Seetharaman Mani , Noback Peter C. , Heijne A. M. , Greisberg Justin K. , Vosseller J. Turner 
Published: October 2016

Background: Surgical site infections (SSIs) are one of the most troublesome complications after foot and ankle surgery. Previous literature has emphasized the significance of appropriate timing of antibiotic prophylaxis. However, the optimal timing of antibiotic prophylaxis for SSI prevention is still inconclusive. Our study aimed to investigate the optimal timing of antibiotic administration and to elucidate the risk factors for SSIs in foot and ankle surgery. Methods: A retrospective review of 1933 foot and ankle procedures in 1632 patients from January 1, 2011, through August 31, 2015, was performed. Demographic data; type, amount, and timing of antibiotic administration; incision; and closure time were recorded. Subsequent wound infection and incision and drainage procedure (I&D) within 30 days and 90 days were documented. Outcomes and demographic variables were compared between procedures in which antibiotics were administered less than 15 minutes and between 15 to 60 minutes prior to incision. A total of 1569 procedures met inclusion criteria. Results: There were 17 cases (1.1%) of subsequent wound infection, of which 6 required a subsequent I&D within 30 days. There were 63 additional cases (4%) of wound complications, which did not meet SSI criteria. When comparing SSI and non-SSI groups, the only significant independent predictors were longer surgeries and nonambulatory surgeries (both P < .05). Stepwise multivariate logistic regression analysis demonstrated that 91.8% of the risk of an SSI could be predicted by ASA score and length of surgery alone. Conclusion: In foot and ankle surgeries, the timing of intravenous antibiotic prophylaxis did not appear to play a significant role in the risk of SSI. Host factors and duration of surgery appear to have played a much larger role in SSI than the timing of antibiotic prophylaxis. Level of Evidence: Level III, retrospective comparative study.
Efficacy of a Cellular Bone Allograft for Foot and Ankle Arthrodesis and Revision Nonunion Procedures
Authors: Dekker Travis J. , White Peter , Adams Samuel B. 
Published: October 2016

Background: Bone graft substitutes are often required in patients at risk for nonunion, and therefore, an allograft that most closely mimics an autograft is highly sought after. This study explored the utility and efficacy of a cellular bone allograft used for foot and ankle arthrodesis and revision nonunion procedures in a patient population at risk for nonunion. Methods: An institutional review board–approved retrospective review of consecutive patients who underwent arthrodesis and revision nonunion procedures with a cellular bone allograft was performed at a single academic institution. No external sources of funding were provided for this study. Inclusion criteria included patients who were more than 1 year after surgery or less than 1 year after surgery if they had undergone a second operative procedure for nonunion or if they had computed tomography–documented union. Forty operative procedures in 36 patients with a mean follow-up of 13 months (range, 6-25 months) were included for data analysis. All patients had at least one of the following risk factors associated with nonunion: current smoker, diabetes, avascular necrosis (AVN) of the involved bone, active same-site operative infection, history of nonunion, previous same-site surgery, or gap of 5 mm or greater after joint preparation. The primary outcome was radiographic union. Results: The union rate in this high-risk population was 83% (33/40). Univariate analysis demonstrated that the use of a cellular bone allograft helped mitigate the presence of risk factors known to cause nonunion. There was no significant difference in fusion rates among groups with current smoking, AVN of the involved bone, active same-site operative infections, history of nonunion, rheumatoid arthritis on medication, previous same-site operative procedures or infections, or a gap of 5 mm or greater after joint preparation. However, in this population, diabetic and female patients remained at a high risk of recurrent nonunion ( P = .0015), despite the use of a cellular bone allograft. Chi-square analysis of patients with increasing numbers of risk factors directly correlated with an increased risk of nonunion ( P = .025). Four wound complications were reported in this cohort that required irrigation and debridement (10%). Conclusion: These data demonstrated a union rate of 83% in patients with risk factors known to cause nonunion. The benefits of the use of a cellular bone allograft allowed for the avoidance of morbidity associated with autograft harvesting while still improving the local biology to facilitate fusion in a difficult patient population to attain a successful fusion mass. Level of Evidence: Level IV, retrospective case series.
Evaluation of the dosing strategies of biologic agents and the theoretical impact of dose rounding
Authors: Lindsey Savannah , Parsons Laura Beth , Figg Lindsay Rosenbeck , Rhodes Jill 
Published: October 2016

Introduction Monoclonal antibodies possess unique pharmacokinetic properties that permit flexible dosing. Increased use and high costs of these medications have led to the development of cost-containing strategies. This study aims to quantify the cost savings and clinical impact associated with dose rounding monoclonal antibodies to the nearest vial size. Methods This study was a single-arm, retrospective chart review assessing all monoclonal antibody doses dispensed at an outpatient community infusion center associated with an academic medical center between August 2014 and August 2015. All monoclonal antibody doses were reviewed to determine the cost of drug wasted using two methods. The waste-cost analysis described the amount of drug disposed of due to the use of partial vials. The theoretical dose savings described potential cost avoidance based on rounding the ordered dose to the nearest vial size. The theoretical rounded dose was compared to the actual ordered dose to explore clinical implications. Results A total of 436 doses were included. Of these, 237 were not rounded to the nearest vial size and included in the analysis. The cost of waste associated with these doses was $108,013.64 using actual wholesale price. The potential cost avoidance associated with the theoretical dose calculation was $83,595.53. Rounding these doses to the nearest vial size resulted in a median 6.7% (range, 1.4–20%) deviation from ordered dose. Conclusions Rounding monoclonal antibodies to the nearest vial size could lead to significant cost and waste savings with minimal deviation from the actual ordered dose.
Midwifery perspectives: The consent process in the context of patient safety and medico-legal issues
Authors: Cook Angela M 
Published: October 2016

Obtaining consent is a legal and ethical necessity prior to midwifery care provision. Furthermore, midwives must act in the best interests of women at all times and make sure that properly informed consent is obtained and documented prior to carrying out any action. Although the judgment made at the Supreme Court, in Montgomery v Lanarkshire Health Board, involved an obstetrician, the recommendations of this case will have far reaching implications for midwives within the consent process. Midwives will be required to consider informing women of any material risks involved in any recommended care and treatment, including how likely women are to attach significance to such risk. The risk discourse that pervades maternity care is well cited and midwives need to strive to achieve a safe, holistic, woman-centred approach to care whilst implementing the recommendations of Montgomery. Challenges exist for midwives in obtaining informed consent particularly resulting from sub-standard communication issues. This clearly impacts negatively upon patient safety issues. Ultimately, NICE advocate that pregnant women should be offered evidence based information and support to enable them to make informed decisions about their care and treatment. Montgomery provides the highest level of legal support for this position.