bluuebunny/crossref_metadata_2025_split huggingface dataset:
Positional Change in Displacement of Midshaft Clavicle Fractures: An Aid to Initial Evaluation
Authors: Malik Awais , Jazini Ehsan , Song Xuyang , Johal Herman , O'Hara Nathan , Slobogean Gerard , Abzug Joshua M. 
Published: October 2016

Objectives:To determine how change in position affects displacement of midshaft clavicle fractures.Design:Retrospective review.Setting:Level I Trauma Center.Patients:Eighty patients with displaced midshaft clavicle fractures and presence of supine and semiupright or upright chest radiographs taken within 2 weeks of each other.Intervention:Supine, semiupright, and upright chest radiographs.Main Outcome Measurements:Fracture shortening and vertical displacement on supine, semiupright, and upright radiographs.Results:Mean vertical displacement was 9.42 mm [95% confidence interval (95% CI), 8.07–10.77 mm], 11.78 mm (95% CI, 10.25–13.32 mm), and 15.72 mm (95% CI, 13.71–17.72 mm) in supine, semiupright, and upright positions, respectively. Fracture shortening was −0.41 mm (95% CI, −2.53 to 1.70 mm), 2.11 mm (95% CI, −0.84 to 5.07), and 4.86 mm (95% CI, 1.66–8.06 mm) in supine, semiupright, and upright positions, respectively. Change in position from supine to upright significantly increased both vertical displacement and fracture shortening (P< 0.001). In the upright position, the proportion of patients who met operative indications (fracture shortening >20 mm) was 3 times greater when compared with that in the supine position (upright 17.65%; supine 5.88%,P= 0.06). Positional changes in fracture displacement were not associated with body mass index, age, or gender.Conclusions:Patient position is associated with significant changes in fracture displacement. Over 3 times more patients meet operative indications when placed in the upright versus supine position. An upright chest radiograph should be obtained to evaluate midshaft clavicle fracture displacement, as it represents the physiologic stress across the fracture when considering nonoperative management.Level of Evidence:Prognostic level IV. See Instructions for Authors for a complete description of levels of evidence.
Effect of Free and Nanoencapsulated Copaiba Oil on Monocrotaline-induced Pulmonary Arterial Hypertension
Authors: Campos Cristina , de Castro Alexandre Luz , Tavares Angela Maria Vicente , Fernandes Rafael Oliveira , Ortiz Vanessa Duarte , Barboza Tatiane Evelyn , Pereira Cláudio , Apel Miriam , da Silva Onilda Santos , Llesuy Susana , Araujo Alex Sander da Rosa , Belló-Klein Adriane 
Published: October 2016

Abstract:
Copaiba oil comes from an Amazonian tree and has been used as an alternative medicine in Brazil. However, it has not been investigated yet in the treatment of cardiovascular diseases. This study was designed to test whether copaiba oil or nanocapsules containing this oil could modulate monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH). Male Wistar rats (170 ± 20 g) received oil or nanocapsules containing this oil (400 mg/kg) by gavage daily for 1 week. At the end of this period, a single injection of MCT (60 mg/kg i.p.) was administered and measurements were performed after 3 weeks. The animals were divided into 6 groups: control, copaiba oil, nanocapsules with copaiba oil, MCT, oil + MCT, and nanocapsules + MCT. Afterward, echocardiographic assessments were performed, and rats were killed to collect hearts for morphometry and oxidative stress. MCT promoted a significant increase in pulmonary vascular resistance, right ventricle (RV) hypertrophy, and RV oxidative stress. Both oil and copaiba nanocapsules significantly reduced RV hypertrophy and oxidative stress. Pulmonary vascular resistance was reduced by copaiba oil in natura but not by nanocapsules. In conclusion, copaiba oil seems to offer protection against MCT-induced PAH. Our preliminary results suggest that copaiba oil may be an important adjuvant treatment for PAH.
Digital Analysis of Eyelid Features and Eyebrow Position Following CO2 Laser-assisted Blepharoptosis Surgery
Authors: Zheng Xiaodong , Kakizaki Hirohiko , Goto Tomoko , Shiraishi Atsushi 
Published: October 2016

Background:
To compare the margin reflex distance of the upper (MRD-1) and lower (MRD-2) eyelids and the eyebrow height (EBH) in patients with involutional and hard contact lens wear--induced blepharoptosis before and after ptosis surgery.

Methods:
Sixty patients with acquired blepharoptosis were studied. Group 1 consisted of 30 patients with involutional ptosis (age, 75.8 ± 6.4 years), and group 2 consisted of 30 patients with hard contact lens wear–induced ptosis (age, 50.2 ± 7.1 years). All patients underwent bilateral, CO2 laser–assisted levator aponeurosis advancement surgery. A digital image was taken in the primary position before and 2 months after the surgery. The image was analyzed by the ImageJ (NIH, Bethesda, Md.) software. Parameters included MRD-1, MRD-2, EBH, and ocular surface area (OSA).

Results:
After surgery, all patients had a significant increase in the MRD-1 and OSA and a decrease in the EBH (all P < 0.001). The increase in MRD-1 was significantly larger in group 1 than in group 2 (P = 0.028). The decrease of EBH was significantly greater in group 1 than in group 2 (P = 0.007). Group 1 had a slight decrease in the MRD-2, but group 2 had a significant increase after surgery (P = 0.026). The change in the OSA was not significantly different between the 2 groups.

Conclusions:
Digital image analyses can be used for precise measurements of the eyelid features. The disparity in the changes of eyelid and eyebrow features between the 2 groups may suggest different responses of the external eyelid muscles to surgery between cases of different etiology.
Reconstructive Approach to an Acquired Absence of Multiple Facial Components: A Case Report
Authors: Oliver Lauren N. , Chaiyasate Kongkrit 
Published: October 2016

Summary:
The subject of our case report is a young girl who was attacked by a raccoon when she was 5 months old. She lost the majority of her nose, her entire right ear, and part of her upper lip. She had previous attempts at reconstructive surgery with poor results. Our collective goals were to provide lifelong reconstruction without the use of synthetic implants and to organize the steps in a way that provided psychological benefit early on while allowing her to continue education and childhood activities with minimal disruptions. We approached the patient’s many problems in stages by starting with the most obvious deformity and progressing to the least severe deformity. A radial forearm free flap and a forehead flap with rib cartilage were used in stages for nasal reconstruction. An Abbé flap was utilized for lip reconstruction, and a prelaminated radial forearm free flap with a costal cartilage frame was selected to form a new ear. She had neither lasting complications nor any morbidity from her donor sites. She and her family report a drastic improvement in her self-confidence and in her interactions with her peers. A stepwise approach to reconstruction of acquired absence of multiple facial components achieves the benefit of early positive psychological results with necessary breaks from surgery to allow her normal childhood activities and education. Judicious utilization of free flaps negates the need of synthetic implants for lifelong reconstruction.
Psychosocial Determinants of Weight Loss Among Young Adults With Overweight and Obesity
Authors: Falck Ryan S. , Best John R. , Drenowatz Clemens , Hand Gregory A. , Shook Robin P. , Lavie Carl J. , Blair Steven N. 
Published: October 2016

Purpose:
The ardent wish to lose weight, drive for thinness (DT), might be 1 psychosocial contributor to weight loss (WL) in adults with overweight and obesity. In examining DT as a predictor of WL, it is important to determine whether its predictive value is equal in males and females and whether it exerts its effects primarily through changes in diet or physical activity (PA).

Methods:
Two-hundred three men and women with overweight and obesity (body mass index >25 kg/m2; aged 21-35 years; 47% female) participated in this 12-month observational study. DT score and demographic information were collected at baseline. Participants were measured at quarterly intervals for objectively measured PA, energy intake, and anthropometrics. Linear mixed regression analyses determined whether DT predicted WL over time and whether these effects were moderated by sex. Followup mediation analyses determined whether the effects of DT on WL could be explained by either changes in diet or PA.

Results:
Females reported higher DT as compared with males at baseline (P < .001). We observed a significant sex × time × DT interaction on WL (P < .04), such that higher DT predicted WL in males (P < .04), but not in females (P = .54). This effect of DT on WL in overweight and obese males was mediated by changes in PA (indirect effect, −0.43; 95% CI, −1.52 to −0.05), but not changes in energy intake.

Conclusions:
Among young adults with overweight and obesity who have higher DT, PA appears to be more important to WL than caloric restriction, particularly in males.
Measured Physical Activity and 30-Day Rehospitalization in Heart Failure Patients
Authors: Waring Thomas , Gross Katherine , Soucier Richard , ZuWallack Richard 
Published: October 2016

BACKGROUND:
Patients hospitalized with decompensated heart failure are at high risk for readmission within 30 days of discharge. Since physical inactivity is associated with increased health care utilization in other diseases, it may predict rehospitalization in heart failure.

METHODS:
In a single-center, prospective study, physical activity was measured following hospital discharge using an accelerometer on the wrist. We then related this activity to the 30-day all-cause rehospitalization rate in heart failure. Each minute of activity was dichotomized into higher or lower intensity, based on a threshold of 3000 vector magnitude units. Counts above this threshold corresponded to a higher level of physical activity. Logistic regression and Kaplan-Meier survival analyses were used to relate the activity group to 30-day readmissions.

RESULTS:
Ninety-five patients admitted to a heart failure unit were screened; 61 met inclusion criteria and provided consent. Fifty patients were evaluated. Forty-six percent were male, mean age was 71 ± 15 years, and 46% had left ventricular ejection fraction <40%. Thirty-day all-cause hospitalizations occurred in 13 of these 50 patients (26%). Sixty-six percent and 34% were dichotomized into the higher and lower physical activity groups, respectively, over the first week; the latter were more likely to be readmitted within 30 days, with an OR = 5.0 (95% CI, 1.3-19.1), P = .02.

CONCLUSION:
Physical inactivity is related to 30-day all-cause readmissions for heart failure. Further studies are necessary to assess causality and to determine whether treatments directed at increasing physical activity could reduce readmission rate.
Multicenter Study of Temporal Trends in the Achievement of Atherosclerotic Cardiovascular Disease Risk Factor Goals During Cardiac Rehabilitation
Authors: Gordon Neil F. , Salmon Richard D. , Sperling Laurence S. , Wright Brenda S. , Faircloth George C. , Gordon Terri L. , Berk Martin R. , Rubenfire Melvyn , Franklin Barry A. 
Published: October 2016

PURPOSE:
Secondary prevention risk factor goals have been established by the American Heart Association/American College of Cardiology, and the American Heart Association has further delineated ideal cardiovascular health metrics. We evaluated risk factor goal achievement during early-outpatient cardiac rehabilitation (CR) and temporal trends in risk factor control.

METHODS:
Patients completed assessments on entry into and exit from CR at 35 centers between 2000 and 2009 and were categorized into 3 cohorts: entire (N = 12 984), 2000-2004 (n = 5468), and 2005-2009 (n = 7516) cohorts.

RESULTS:
Improvements occurred in multiple risk factors during CR. For the entire cohort, the percentages of patients at goal at CR completion ranged from 95.5% for smoking to 21.9% for body mass index (BMI) of <25.0 kg/m2. Compared with 2000-2004, the percentage of the 2005-2009 cohort at goal was higher (P < .001) for blood pressure, low-density lipoprotein cholesterol, and physical activity, lower (P = .005) for BMI, and not significantly different (P > .05) for fasting glucose and smoking. At CR completion, of those in the entire, 2000-2004, and 2005-2009 cohorts, 4.4%, 3.9%, and 4.8% (P = .219 vs 2000-2004), respectively, had all biomarkers at the goal for ideal cardiovascular health and, of those with atherosclerotic cardiovascular disease, 70.8%, 71.5%, and 70.3% (P = .165 vs 2000-2004), respectively, were receiving statins.

CONCLUSIONS:
The percentage of patients at goal at CR completion increased for some, but not all, risk factors during 2005-2009 versus 2000-2004. Despite the benefits of CR, risk factor profiles are often suboptimal after CR. There remains room for improvement in risk factor management during CR and a need for continued intervention thereafter.
EN FACE OPTICAL COHERENCE TOMOGRAPHY OF MULTIPLE EVANESCENT WHITE DOT SYNDROME
Authors: Su Daniel , Xu David , Phasukkijwatana Nopasak , Sarraf David 
Published: November 2016

Purpose:
To report novel en face imaging findings of multiple evanescent white dot syndrome.

Methods:
A 25-year-old woman presented with photopsia and vision loss affecting the left eye. Ophthalmic examination, color fundus photography, fluorescein angiography, spectral domain optical coherence tomography (SD-OCT), fundus autofluorescence, en face OCT, and OCT angiography were performed.

Results:
The diagnosis of multiple evanescent white dot syndrome was made based on clinical examination and multimodal imaging findings. Fundus autofluorescence demonstrated numerous hyperautofluorescent spots that corresponded to multifocal areas of ellipsoid loss with SD-OCT. En face OCT illustrated multiple small round hyperreflective “dots” at the level of the outer nuclear layer that precisely colocalized over numerous hyporeflective “spots” at the level of the ellipsoid zone. Optical coherence tomography angiography demonstrated normal flow within the superficial and deep retinal capillary plexus and the choroid in the left eye.

Conclusion:
We report the unique en face OCT pattern of hyperreflective dots (at the level of the outer nuclear layer) that precisely colocalized over larger hyporeflective spots (at the level of the ellipsoid zone) in multiple evanescent white dot syndrome. This finding may provide a signature pattern of recognition for this elusive disorder.
Nurse Practitioners’ Knowledge of Prevention Guidelines and Counseling Practices Related to Primary Prevention of Skin Cancer Among Adolescents in Arizona
Authors: Lucas Maxine A. , Loescher Lois J. , Pacheco Christy L. 
Published: October 2016

ABSTRACT
Skin cancer is the most common cancer worldwide and one of the most preventable. Skin cancer incidence continues to rise among adolescents. The inconsistent practice guidelines for skin cancer prevention create challenges for counseling. The purposes of this study were to investigate skin cancer knowledge, attitudes, and primary prevention counseling practices by Arizona nurse practitioners caring for adolescents on an outpatient basis and to determine congruency of counseling with evidence-based guidelines. Participants completed a quantitative, descriptive, cross-sectional study using an online survey. The main variables were knowledge of skin cancer, skin cancer prevention, attitudes regarding counseling, current practice guideline use, and recommendations. Of the 67 participants who responded to the survey, 51 were eligible, and 44 completed the survey. Participant knowledge regarding skin cancer was moderate to low, and less was known about skin cancer in adolescents. Despite positive attitudes toward skin cancer prevention, participants reported low rates of counseling in practice, similar to previous interdisciplinary research. Reported recommendations used in practice were not reflective of any one particular guideline. Future research should explore barriers to incorporating primary prevention counseling practices and aim to educate nurse practitioners on skin cancer prevention.
The Psychosocial, Economic, and Occupational Impacts of Psoriasis
Authors: Cyr Melissa E. 
Published: October 2016

ABSTRACT
Psoriasis is a chronic, autoimmune, and inflammatory disorder that impacts the skin and joints, with the propensity to produce devastating psychosocial, economic, and occupational effects. These are often not solitary; for example, psychological manifestations may impact one’s occupational and economic statuses. The purpose of this review is to raise awareness of these consequences of disease that clinicians may consider incorporating into a patient-centered model of care.
Herpes Zoster
Authors: Nassaji Mohammad , Ghorbani Raheb , Taheri Ramin , Azizzadeh Maryam , Zolfaghari Sheida 
Published: October 2016

ABSTRACT
Herpes zoster results from the reactivation of the varicella-zoster virus. Pain is the most common manifestation of the disease and has a substantial impact on health-related quality of life. Acute pain and its correlated risk factors have been less investigated in previous studies. This study was designed to evaluate the relationships between acute pain severity and some demographic and clinical features of the patients. Two hundred twenty-three adult patients with a diagnosis of herpes zoster were enrolled. Herpes zoster was diagnosed by a dermatologist and an infectious diseases specialist. Severity of acute pain was measured using the visual analog scale. Data about the medical and demographic characteristics of participants were collected. The mean (±SD) severity of acute pain in patients was 56.8 (±24.6). Acute pain severity was significantly associated with age (p = .045), female gender (p = .048), smoking (p = .021), immunosuppression (p = .022), and presence (p = .001) and duration (p = .028) of prodromal phase. Body mass index, diabetes mellitus, and location of dermatomes did not correlate with the intensity of pain. This study suggests that age, gender, cigarette smoking, immunosuppressed state, and presence and duration of prodromal phase are the major correlates of acute pain intensity in herpes zoster.
Pediatric Minor Traumatic Brain Injury With Intracranial Hemorrhage
Authors: Burns Erin Comer , Burns Beech , Newgard Craig D. , Laurie Amber , Fu Rongwei , Graif Theresa , Ward Casey S. , Bauer Abbie , Steinhardt David , Ibsen Laura M. , Spiro David M. 
Published: October 2016

Background
Pediatric patients with any severity of traumatic intracranial hemorrhage (tICH) are often admitted to intensive care units (ICUs) for early detection of secondary injury. We hypothesize that there is a subset of these patients with mild injury and tICH for whom ICU care is unnecessary.

Objectives
To quantify tICH frequency and describe disposition and to identify patients at low risk of inpatient critical care intervention (CCI).

Methods
We retrospectively reviewed patients aged 0 to 17 years with tICH at a single level I trauma center from 2008 to 2013. The CCI included mechanical ventilation, invasive monitoring, blood product transfusion, hyperosmolar therapy, and neurosurgery. Binary recursive partitioning analysis led to a clinical decision instrument classifying patients as low risk for CCI.

Results
Of 296 tICH admissions without prior CCI in the field or emergency department, 29 had an inpatient CCI. The decision instrument classified patients as low risk for CCI when patients had absence of the following: midline shift, depressed skull fracture, unwitnessed/unknown mechanism, and other nonextremity injuries. This clinical decision instrument produced a high likelihood of excluding patients with CCI (sensitivity, 96.6%; 95% confidence interval, 82.2%–99.9%) from the low-risk group, with a negative likelihood ratio of 0.056 (95% confidence interval, −0.053–0.166). The decision instrument misclassified 1 patient with CCI into the low-risk group, but would have impacted disposition of 164 pediatric ICU admissions through 5 years (55% of the sample).

Conclusions
A subset of low-risk patients may not require ICU admission. The proposed decision rule identified low-risk children with tICH who may be observable outside an ICU, although this rule requires external validation before implementation.
Compartment Syndrome Secondary to Group A Streptococcus Infection in the Presence of a Congenital Hemangioma
Authors: Kracoff Sharon L. 
Published: October 2016

Objectives
Nontraumatic compartment syndrome is frequently difficult to diagnose but this is especially troublesome in infants. Pain is the most sensitive sign and is characteristically severe and refractory to routine analgesia. Failure to diagnose and treat can lead to disability, multiorgan failure, and death. Surgical intervention is crucial and includes emergent fasciotomy, debridement, nerve decompression, and later skin grafting. Streptococcal myositis causing compartment syndrome is more likely in the immunocompromised patient.
Congenital hemangiomas are rare, benign vascular tumors that present fully grown at birth.

Methods
Case report and literature review.

Results
This case report details a healthy child, with a resolving congenital hemangioma of the forearm, presenting with toxic shock syndrome and a streptococcal myositis creating a compartment syndrome in the same forearm after an upper respiratory tract infection. The child underwent an emergent fasciotomy and debridement of the arm. Profound systemic effects necessitated transfer to intensive care unit and continuing postoperative mechanical ventilation, inotropic support, intravenous antibiotics, and immunoglobulin administration. Postoperatively, blood cultures and wound biopsies were all positive for Beta Hemolytic Group A Streptococci. Several days later, after a course of antibiotics, the volar forearm was closed with meshed split thickness skin grafts with good graft take. In our patient, we concluded that the hemangioma may have acted as a locus to attract the hematogenous spread of the streptococcal infection from the throat and caused a soft tissue infection that led to massive edema of the limb and consequently to compartment syndrome.
Use of Comparative Case Study Methodology for US Public Health Policy Analysis: A Review
Authors: Dinour Lauren M. , Kwan Amy , Freudenberg Nicholas 
Published: October 2016

Context:
There is growing recognition that policies influence population health, highlighting the need for evidence to inform future policy development and reform.

Objectives:
This review describes how comparative case study methodology has been applied to public health policy research and discusses the methodology's potential to contribute to this evidence.

Methods:
English-language, peer-reviewed articles published between 1995 and 2012 were sought from 4 databases. Articles were included if they described comparative case studies addressing US public health policy. Two researchers independently assessed the 20 articles meeting review criteria.

Main Outcome Measures:
Case-related characteristics and research design tactics utilized to minimize threats to reliability and validity, such as the use of multiple sources of evidence and a case study protocol, were extracted from each article.

Results:
Although comparative case study methodology has been used to analyze a range of public health policies at all stages and levels, articles reported an average use of only 3.65 (out of 10) research design tactics.

Conclusion:
By expanding the use of accepted research design tactics, public health policy researchers can contribute to expanding the evidence needed to advance health-promoting policies.