bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiographic Analysis of Feet With and Without Morton’s Neuroma
Authors: Naraghi Reza , Bremner Alexandra , Slack-Smith Linda , Bryant Alan 
Published: November 2016

Background: The aim of this research was to investigate the association of various structural measurements of the forefoot with Morton’s neuroma (MN). Methods: Weightbearing anteroposterior and lateral foot radiographs of subjects attending the University of Western Australia (UWA) Podiatry Clinic and the first author’s private practice were included in this study. A single assessor measured the following angles: lateral intermetatarsal angle (LIMA), intermetatarsal angle (IMA), hallux valgus angle (HVA), digital divergence between the second and third digits (DD23), digital divergence between the third and fourth digits (DD34) and relative metatarsal lengths of the first to fifth metatarsals (Met1-5), and the effect of MN size as measured by ultrasonograph on digital divergence. Intratester reliability of all radiographic measurements was assessed on all radiographic measurements. The study included 101 subjects, of whom 69 were diagnosed with MN and 32 were control subjects without MN. The mean (± standard deviation) age of MN subjects was 52 (±15) years and for control subjects, 48 (±12) years. Results: When comparing all feet, there were no significant differences in the LIMA, HVA, IMA, digital divergence angles and the relative metatarsal distances between subjects with MN and control subjects. No relationship between MN size and digital divergence was found in either foot, or in either neuroma location. Conclusion: We were unable to demonstrate any relationship in this study between radiographic metatarsal length and angular measurements in a symptomatic MN group compared to a control group. In addition, we did not find any correlation between the size of MN as measured from ultrasonographic images and radiographic evidence of digital divergence. Level of Evidence: Level III, case control study.
Development of a systematic approach to pharmaceutical industry’s patient assistance programs on accessing unfunded cancer drugs
Authors: Kletas Victoria , de Lemos Mario 
Published: November 2016

Background New oncology drugs usually become commercially available several months before the funding decisions are made by provincial public payers. Increasingly, patient assistance programs are being set up by pharmaceutical companies in order to facilitate access of their new cancer drugs before public funding decisions are finalized. We discovered that there is a need to keep this information up to date and available in a central repository, thus we have created a centralized patient assistance chart for use by all who require information on accessing unfunded drugs in our province. Methodology The project was carried out at a publicly funded provincial cancer care organization that oversees parenteral and oral chemotherapy treatments across our province. The drug information pharmacist at this organization developed a method of scoping information on upcoming therapies by reviewing a series of recommendations made by various organizations that review oncology treatments. A standard process was developed for including information on the patient assistance chart that is available on the organizations website. Results As of May 2016, the repository contains information on 47 patient assistance programs involving 24 unfunded antineoplastic drugs for various indications. This compared to (7) when it was maintained by a single centre in 2004 and 10 when the process was first centralized in 2009. Conclusion The benefit of patient assistance program availability allows patients to access medications when provincial funding is not available. A standardized approach and methodology to evaluating information was established by our drug information pharmacist; thus allowing for a consistent approach to dissemination of information on assessing unfunded cancer drugs in our province.
Development of a Quality-of-Life Measure for Hidradenitis Suppurativa
Authors: Sisic Mia , Kirby Joslyn S. , Boyal Sanwarjit , Plant Lisa , McLellan Chelsea , Tan Jerry 
Published: November 2016

Background: Hidradenitis suppurativa (HS) is a chronic skin disorder with adverse impacts on both physical and psychosocial well-being. There is presently no validated HS-specific quality-of-life (QoL) measure. Objective: The objective of this study is to develop a QoL instrument for HS (HS-QoL) in accordance with recommended standards. Methods: Patient interviews (concept elicitation) and expert input were used to develop the conceptual framework for outcomes perceived important to patients with HS. A HS-QoL-v1 measure was developed, and cognitive interviews with patients were conducted for pilot testing. Results: Concept elicitation interviews with patients with HS (n = 21) generated 12 themes. Most frequently reported were impacts on daily activities and symptoms due to HS. These themes, along with literature review and input from clinical experts, informed development of the HS-QoL-v1. Nine cognitive interviews were conducted in a pilot test and resulted in the HS-QoL-v2 measure. Conclusion: The HS-QoL-v2 is a preliminary QoL instrument for which further psychometric validation and establishment of clinimetric properties will be undertaken.
Case Report of Patient With Erythropoietic Protoporphyria and Basal Cell Carcinoma Diagnoses
Authors: Reitmeier Shayne D. , Schacter Brent , Wiseman Marni C. 
Published: November 2016

Background: Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer. There is a clear association between BCC development and ultraviolet (UV) radiation. Erythropoietic protoporphyria (EPP) is an inherited porphyria disorder that is a result of protoporphyrin accumulation, typically manifesting with phototoxicity. Case Summary: We report a case of a 24 year-old man with both EPP and BCC diagnoses. At the age of 4 years, the patient was diagnosed with EPP. The patient presented with a BCC on his nose at age 24 years, despite sun avoidance as the primary treatment for his EPP diagnosis. Conclusion: Consider the diagnosis of BCC in a patient with EPP, despite sun avoidance.
The impact of minor trauma on pregnancy
Authors: Schuster Meike , Jaramillo L , Wild J , Mackeen AD , Paglia MJ 
Published: November 2016

Purpose To determine the impact of a single episode of minor trauma during pregnancy on maternal and fetal outcomes. Methods This is a retrospective cohort study of pregnant women who experienced minor trauma at ≥24 weeks gestation between 2004 and 2014. The subjects who experienced minor trauma (minor trauma group) were matched by gestational age at the time of minor trauma, body mass index, and age to a cohort of women who did not experience trauma in pregnancy (control group). The primary obstetrical outcome was preterm delivery and the primary neonatal outcomes were APGAR scores and neonatal intensive care unit admission. Results There were no significant differences between the two groups with respect to demographics or other risk factors for preterm delivery. Average gestational age at the time of delivery was 39 weeks regardless of whether a woman experienced minor trauma. Preterm delivery occurred more often in the control group (11.8% versus 7.9%, p = 0.0428) as did the rate of neonatal intensive care unit admissions (8.6% versus 5%, p = 0.0273). A subgroup analysis was performed excluding patients with a medically indicated delivery and there was no difference in the rate of preterm delivery (6.4% in the control group, 4% in the minor trauma group, p-value 0.9052). Among women with a spontaneous preterm delivery, the rates of preterm labor (3.0% control versus 2.0% minor trauma, p-value 0.75) and preterm premature rupture of membranes were found to be similar between the two groups (3.8% control versus 2.0% minor trauma PPROM, p-value 0.75). Conclusions One episode of minor trauma in pregnancy does not increase the risk for preterm delivery, premature rupture of membranes, or poor neonatal outcomes.
Pre-hospital and emergency department management of pelvic fractures and major trauma centre status: Has practice changed?
Authors: Barnes Jonathan , Thomas Philip , Refaie Ramsay , Gray Andrew 
Published: November 2016

Introduction Pelvic fractures are indicative of high-energy injuries and carry a significant morbidity and mortality and pelvic binders are used to stabilise them in both the pre-hospital and emergency department setting. Our unit gained major trauma centre status in April 2012 as part of a national programme to centralise trauma care and improve outcomes. This study investigated whether major trauma centre status led to a change in workload and clinical practice at our centre. Methods A retrospective analysis of all patients admitted with a pelvic fracture for the six-month periods before, after and at one-year following major trauma centre status designation. Data were retrospectively collected from electronic patient records and binder placement assessed using an accepted method. Patients with isolated pubic rami fractures were excluded. Results Overall, 6/16 (37.5%) pelvic fracture admissions had a binder placed pre-major trauma centre status, rising to 14/34 (41.2%) immediately post-major trauma centre status and 22/32 (68.8%) ( p = 0.025) one year later. Binders were positioned accurately in 4 patients (80%, one exclusion) pre-major trauma centre status, 12 (92.4%) post-major trauma centre status and 22 (100%) at one year. CT imaging was the initial imaging used in 9 (56.3%) patients pre-major trauma centre status, 29 (85.3%) ( p = 0.04) post-major trauma centre status and 27 (84.4%) at one year. Discussion Pelvic fracture admissions doubled following major trauma centre status. Computed tomography, as the initial imaging modality, increased significantly with major trauma centre status, likely a reflection of the increased resources made available with this change. Although binder application rates did not change immediately, a significant improvement was seen after one year, with binder accuracy increasing to 100%. This suggests that although changes in clinical practice often do not occur immediately, with the increased infrastructure and clinical exposure afforded through centralisation of trauma services, they will occur, ultimately leading to improvements in trauma patient care.
Hospitalization costs and estimates of direct and indirect economic losses due to injury sustained in road traffic crashes: Results from a one-year cohort study in three European countries (The REHABILAID project)
Authors: Papadakaki Maria , Stamouli Maria-Aggeliki , Ferraro Ottavia E , Orsi Chiara , Otte Dietmar , Tzamalouka Georgia , von der Geest Marco , Lajunen Timo , Özkan Türker , Morandi Anna , Kotsyfos Vangelis , Chliaoutakis Joannes 
Published: November 2016

Introduction The financial cost of injuries sustained in road traffic crashes is high for victims, families and national budgets, but there is limited information on the cost of injury from the victims’ perspective, especially in terms of the hard-to-reach multi-trauma patient population such as those admitted to the intensive care units of hospitals. Materials and methods The current study received funding by the European Commission Directorate-General Mobility and Transport. It is a prospective, prevalence-based, cost-of-illness study. Participants admitted in the intensive care units of seven public hospitals in Greece, Germany and Italy because of injuries from road traffic crashes, during one year, were enrolled in the study. Patients were followed-up for one year after the intensive care unit admission to report emerging direct and indirect costs related to their injury. Results A total of 120 people were enrolled. Males, those aged 25–49, motorcyclists and those severely injured (Maximum Abbreviated Injury Scale (MAIS) 3+) with highest severity located at the central part of the body, accounted for the highest percentages of both the direct and indirect injury costs. The highest average direct costs were for females, those aged 50–64, pedestrians and those slightly injured (MAIS 1 or 2) with highest severity at the central region of the body. Males, patients aged 25–49, car passengers and truck drivers as well as those slightly injured (MAIS 1 or 2) with highest severity at multiple locations were over-represented in the average indirect costs. Conclusions Those groups that account for a high percentage of injury costs should be targeted in health policy initiatives.
Results of Ultrasound-Guided Foam Sclerotherapy of the Great Saphenous Vein With New Parameters of the Technique
Authors: Baeshko A. , Shestak N. , Korytko S. 
Published: November 2016

Aim: To report the outcome of a series of patients with chronic venous disease due to incompetence of the great saphenous vein (GSV) managed by ultrasound-guided foam sclerotherapy (USGFS). Design: Controlled clinical trial with maximum 5-year follow-up of results of USGFS of the GSV with new parameters of the procedure. Materials and Methods: This research analyzes the results of USGFS of the GSV (395 GSV) and its tributaries in 326 patients with varicose veins of the lower extremities over the period from January 2009 to January 2014 with the following parameters of the procedure: 60° limb elevation, calf bandage, and cooled foam injection. Results: Ultrasound control of 395 GSV after the first injection of sclerosant from the sixth to the eighth day revealed GSV occlusion in the femoral segment with the absence of reflux in 94.9% of cases (375 GSV). After 5-year follow-up, GSV occlusion was diagnosed in 91.9% of cases. Conclusion: Our improved technique of foam sclerotherapy allows improving immediate and long-term results. This technique is characterized by the low incidence of side effects and complications.
Design of Hack-Resistant Diabetes Devices and Disclosure of Their Cyber Safety
Authors: Sackner-Bernstein Jonathan 
Published: November 2016

Background: The focus of the medical device industry and regulatory bodies on cyber security parallels that in other industries, primarily on risk assessment and user education as well as the recognition and response to infiltration. However, transparency of the safety of marketed devices is lacking and developers are not embracing optimal design practices with new devices. Achieving cyber safe diabetes devices: To improve understanding of cyber safety by clinicians and patients, and inform decision making on use practices of medical devices requires disclosure by device manufacturers of the results of their cyber security testing. Furthermore, developers should immediately shift their design processes to deliver better cyber safety, exemplified by use of state of the art encryption, secure operating systems, and memory protections from malware.
Comparison of Locking Plate with Interfragmentary Screw Versus Plantarly Applied Anatomic Locking Plate for Lapidus Arthrodesis: A Biomechanical Cadaveric Study
Authors: Cottom James M. , Baker Joseph S. 
Published: November 2016

Arthrodesis of the first metatarsal cuneiform joint, or Lapidus procedure, is a widely accepted treatment for hallux valgus. Recent studies have focused on comparing various constructs for this procedure both in the laboratory and clinical settings. The current study compared in a cadaveric model the strength of 2 constructs. The first construct utilized a medially applied low-profile locking plate and an interfragmentary screw directed from plantar-distal to dorsal-proximal. The second construct consisted of a plantarly applied plate with a compression screw placed through the plate from plantar-distal to dorsal-proximal. The ultimate load to failure for the 2 groups tested was 255.38 ± 155.38 N and 197.48 ± 108.61 N, respectively (P = .402). There was no significant difference found between the 2 groups with respect to ultimate load to failure, stiffness of the construct, or moment at time of failure. In conclusion, the medially applied plate with plantar interfragmentary screw appears to be stronger than the plantar Lapidus plate tested for first metatarsal cuneiform arthrodesis, though this difference did not reach statistical significance. Levels of Evidence: Level V: Biomechanical Study
Foot and Ankle Fellowship Websites: An Assessment of Accessibility and Quality
Authors: Hinds Richard M. , Danna Natalie R. , Capo John T. , Mroczek Kenneth J. 
Published: November 2016

Background. The Internet has been reported to be the first informational resource for many fellowship applicants. The objective of this study was to assess the accessibility of orthopaedic foot and ankle fellowship websites and to evaluate the quality of information provided via program websites. Methods. The American Orthopaedic Foot and Ankle Society (AOFAS) and the Fellowship and Residency Electronic Interactive Database (FREIDA) fellowship databases were accessed to generate a comprehensive list of orthopaedic foot and ankle fellowship programs. The databases were reviewed for links to fellowship program websites and compared with program websites accessed from a Google search. Accessible fellowship websites were then analyzed for the quality of recruitment and educational content pertinent to fellowship applicants. Results. Forty-seven orthopaedic foot and ankle fellowship programs were identified. The AOFAS database featured direct links to 7 (15%) fellowship websites with the independent Google search yielding direct links to 29 (62%) websites. No direct website links were provided in the FREIDA database. Thirty-six accessible websites were analyzed for content. Program websites featured a mean 44% (range = 5% to 75%) of the total assessed content. The most commonly presented recruitment and educational content was a program description (94%) and description of fellow operative experience (83%), respectively. Conclusions. There is substantial variability in the accessibility and quality of orthopaedic foot and ankle fellowship websites. Clinical Relevance. Recognition of deficits in accessibility and content quality may assist foot and ankle fellowships in improving program information online. Levels of Evidence: Level IV
Quantitative estimation of a ratio of intracranial cerebrospinal fluid volume to brain volume based on segmentation of CT images in patients with extra-axial hematoma
Authors: Nguyen Ha Son , Patel Mohit , Li Luyuan , Kurpad Shekar , Mueller Wade 
Published: November 2016

Background Diminishing volume of intracranial cerebrospinal fluid (CSF) in patients with space-occupying masses have been attributed to unfavorable outcome associated with reduction of cerebral perfusion pressure and subsequent brain ischemia. Objective The objective of this article is to employ a ratio of CSF volume to brain volume for longitudinal assessment of space-volume relationships in patients with extra-axial hematoma and to determine variability of the ratio among patients with different types and stages of hematoma. Patients and methods In our retrospective study, we reviewed 113 patients with surgical extra-axial hematomas. We included 28 patients (age 61.7 +/− 17.7 years; 19 males, nine females) with an acute epidural hematoma (EDH) ( n = 5) and subacute/chronic subdural hematoma (SDH) ( n = 23). We excluded 85 patients, in order, due to acute SDH ( n = 76), concurrent intraparenchymal pathology ( n = 6), and bilateral pathology ( n = 3). Noncontrast CT images of the head were obtained using a CT scanner (2004 GE LightSpeed VCT CT system, tube voltage 140 kVp, tube current 310 mA, 5 mm section thickness) preoperatively, postoperatively (3.8 ± 5.8 hours from surgery), and at follow-up clinic visit (48.2 ± 27.7 days after surgery). Each CT scan was loaded into an OsiriX (Pixmeo, Switzerland) workstation to segment pixels based on radiodensity properties measured in Hounsfield units (HU). Based on HU values from −30 to 100, brain, CSF spaces, vascular structures, hematoma, and/or postsurgical fluid were segregated from bony structures, and subsequently hematoma and/or postsurgical fluid were manually selected and removed from the images. The remaining images represented overall brain volume—containing only CSF spaces, vascular structures, and brain parenchyma. Thereafter, the ratio between the total number of voxels representing CSF volume (based on values between 0 and 15 HU) to the total number of voxels representing overall brain volume was calculated. Results CSF/brain volume ratio varied significantly during the course of the disease, being the lowest preoperatively, 0.051 ± 0.032; higher after surgical evacuation of hematoma, 0.067 ± 0.040; and highest at follow-up visit, 0.083 ± 0.040 ( p < 0.01). Using a repeated regression analysis, we found a significant association ( p < 0.01) of the ratio with age (odds ratio, 1.019; 95% CI, 1.009–1.029) and type of hematoma (odds ratio, 0.405; 95% CI, 0.303–0.540). Conclusion CSF/brain volume ratio calculated from CT images has potential to reflect dynamics of intracranial volume changes in patients with space-occupying mass.
Metabolomic biomarkers predictive of early structural lung disease in cystic fibrosis
Authors: Esther Charles R. , Turkovic Lidija , Rosenow Tim , Muhlebach Marianne S. , Boucher Richard C. , Ranganathan Sarath , Stick Stephen M. 
Published: November 2016

Neutrophilic airway inflammation plays a role in early structural lung disease in cystic fibrosis, but the mechanisms underlying this pathway are incompletely understood.Metabolites associated with neutrophilic inflammation were identified by discovery metabolomics on bronchoalveolar lavage fluid supernatant from 20 preschool children (2.9±1.3 years) with cystic fibrosis. Targeted mass-spectrometric detection of relevant metabolites was then applied to 34 children (3.5±1.5 years) enrolled in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) who underwent chest computed tomography and bronchoalveolar lavage from two separate lobes during 42 visits. Relationships between metabolites and localised structural lung disease were assessed using multivariate analyses.Discovery metabolomics identified 93 metabolites associated with neutrophilic inflammation, including pathways involved in metabolism of adenyl purines, amino acids and small peptides, cellular energy and lipids. In targeted mass spectrometry, products of adenosine metabolism, protein catabolism and oxidative stress were associated with structural lung disease and predicted future bronchiectasis, and activities of enzymes associated with adenosine metabolism were elevated in the samples with early disease.Metabolomics analyses revealed metabolites and pathways altered with neutrophilic inflammation and destructive lung disease. These pathways can serve as biomarkers and potential therapeutic targets for early cystic fibrosis lung disease.