bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Pain Course
Authors: Dear Blake F. , Courtney Catherine , Khor Kok Eng , McDonald Sarah , Ricciardi Tahlia , Gandy Milena , Fogliati Vincent J. , Titov Nick 
Published: October 2017

Background:
This study examined the acceptability and preliminary outcomes of an internet-delivered pain management program, the Pain Course, when offered by a specialist pain management clinic in a large public hospital.

Methods:
A single-group feasibility open-trial design was used and 39 patients participated in the program, which ran for 8 weeks. Participants were supported through the program with weekly contact from a Clinical Psychologist at the clinic.

Results:
All participants provided data at posttreatment and >90% of participants completed all 5 lessons of the course. High levels of satisfaction were observed and relatively little clinician time (M=71.99 min/participant; SD=32.82 min) was required to support patients through the program. Preliminary evidence of clinical improvements in depression symptoms (avg. improvement=38%; Cohen d=0.74), but not disability levels or anxiety symptoms, was observed in the overall sample. However, evidence of improvements was observed across all the primary outcomes among patients who had clinical levels of difficulties with disability (n=20; avg. improvement=11%; Cohen d=0.64), depression (n=17; avg. improvement=35%; Cohen d=1.24) and anxiety (n=8; avg. improvement=29%; Cohen d=0.57).

Conclusions:
These findings highlight the potential value of internet-delivered programs when provided by specialist pain management clinics as a part of their services and the value of larger scale studies in this area.
Internet-Delivered Exposure Therapy for Fibromyalgia
Authors: Hedman-Lagerlöf Maria , Hedman-Lagerlöf Erik , Axelsson Erland , Ljótsson Brjánn , Engelbrektsson Johanna , Hultkrantz Sofia , Lundbäck Karolina , Björkander Daniel , Wicksell Rikard K. , Flink Ida , Andersson Erik 
Published: October 2017

Background:
Fibromyalgia (FM) is a common and disabling chronic pain disorder, for which existing pharmacological and psychological treatments have yet yielded insufficient effects. Previous literature has shown that exposure therapy may be an effective treatment for chronic pain. This study constitutes the first randomized controlled trial evaluating exposure therapy for FM.

Methods:
A total of 140 participants with diagnosed FM were randomized to a 10-week Internet-delivered exposure treatment (iExp; n=70) or a waitlist control condition (WLC; n=70). Primary outcome measure were FM symptoms and impact, and secondary outcome measures were fatigue, disability, quality of life, pain-related distress and avoidance behaviors, insomnia, depression, and anxiety.

Results:
Data retention was high (100% data completion at posttreatment for primary outcome, 96% at 6-month follow-up and 94% at 12-month follow-up). Results showed that participants in the iExp group made large and superior improvements compared with WLC on FM symptoms and impact (B, −1.93; z, −10.14; P<0.001, between-group Cohen d=0.90), as well as all secondary outcomes (between-group Cohen d ranging from 0.44 to 1.38) with sustained results.

Conclusions:
We conclude that iExp seems to be an efficacious treatment for FM compared with no treatment, and the results also highlight the potential increase of accessibility by using the Internet format to deliver psychological treatments for these patients. Future trials with active control conditions are warranted.
Systematic Changes to Help Parentsof Medically Complex Infants Manage Medical Expenses
Authors: Carter Judith , Dwyer Noel , Roselund Julie , Cote Karen , Chase Phoebe , Martorana Kathleen , Gustafson Kathryn , Bergling Emily , Kamalia Radhika , DeGrazia Michele 
Published: October 2017

Background:
Financial obligations serve as an added source of stress and burden for parents of medically complex infants that have extended hospitalizations in the neonatal intensive care unit. Financial resources and support personnel are available to assist parents, but systems must be in place to help access these services. When neonatal intensive care unit nurses work collaboratively with financial support personnel, they improve families' access to financial resources.

Purpose:
The purpose of this quality improvement initiative was to increase and facilitate timely parent referrals to health benefits coordinators (HBCs).

Methods/Search Strategy:
Utilizing the Plan-Do-Study Act framework, the hospital's current system for HBC referrals was revised utilizing 3 Plan-Do-Study Act cycles.

Findings/Results:
A substantial increase in the percentage of HBC referrals, from preimplementation of less than 5% to a sustained average of 90% was observed.

Implications for Practice:
A simple, sustainable screening process was successfully created to identify families with primary health insurance who qualified for coordination of benefits. This resulted in a significant increase in the number of HBC referrals. Minimal time is now required for the multidisciplinary team to ensure that parents, eligible for referral, are identified as soon as possible. Early identification and timely referral to the HBC may lessen the financial burden for families caring for children with medically complex long-term care needs by securing secondary insurance and other resources.

Implications for Research:
Research focused on the financial impact of the HBC role is needed.
Correlation of Functional Outcomes and Sagittal Alignment After Long Instrumented Fusion for Degenerative Thoracolumbar Spinal Disease
Authors: Yeh Kuang-Ting , Lee Ru-Ping , Chen Ing-Ho , Yu Tzai-Chiu , Liu Kuan-Lin , Peng Cheng-Huan , Wang Jen-Hung , Wu Wen-Tien 
Published: October 2017

Study Design.
A retrospective function and radiography study of the patients who have received long instrumented thoracolumbar fusion.

Objective.
To investigate the correlation between the sagittal spinopelvic alignment and the functional outcomes after long instrumented fusion for degenerative thoracolumbar spinal disease.

Summary of Background Data.
Restoring better sagittal alignment is known as a key factor to spine fusion surgeries. The relationship between function and radiographic results in the elderly group is barely known.

Methods.
Between 2009 and 2013, data of 120 patients with multilevel degenerative thoracolumbar spinal disease who underwent long instrumented fusion were collected retrospectively. Perioperative radiographic and functional parameters were measured and analyzed for their correlations. Receiver operating characteristic (ROC) method was used to define ideal cutoff points of postoperative spinopelvic alignment to avoid poor outcome.

Results.
Oswestry disability index (ODI) more than or equal to 20 or Visual analogue scale (VAS) more than or equal to 4 were defined as poor functional outcomes. The optimal cutoff points of the radiographic parameters were found as below: the mismatch between pelvic incidence and lumbar lordosis was 16.2°, sagittal vertical axis was 38.5 mm, and pelvic tilt was 23.4°. Poor functional outcomes were significantly correlated with bad sagittal alignment, older age, and poor preoperative function.

Conclusion.
Postoperative functional outcomes were highly impacted by the spinopelvic sagittal alignment.

Level of Evidence: 4
Thermal Stimulation Changes Diffusivity of the Spinothalamic Tract
Authors: Lin Joanne C. , Mueller Christina , Younger Jarred W. 
Published: October 2017

Study Design.
An experimental study.

Objective.
This study aimed to investigate task-dependent changes in fractional anisotropy (FA) within the spinal cord during painful stimulation.

Summary of Background Data.
Earlier experiments by Mandl et al (2008, 2013) used non-invasive functional diffusion tensor imaging (fDTI) to detect white matter fibers that were active during functional tasks. In two studies, it was observed that FA of involved white matter tracts exhibited repeatable task-related increases. In this study, we attempted to extend the fDTI work in the spinal cord.

Methods.
Twenty-three healthy, right-handed men (mean age 22 yrs, standard deviation [SD] = 4) were invited to participate in this study. Diffusion-weighted images were collected over spinal levels C2 to T4 during a painful thermal stimulus applied to the left thenar eminence. In order to investigate task-related activity, FA values within the contralateral (right) spinothalamic tract were analyzed using a generalized estimating equations (GEE) procedure. As a control, we also examined activity in the ipsilateral and contralateral corticospinal tracts, which are not considered to be involved in nociception.

Results.
Significant task-related decreases in FA were observed in the right spinothalamic tract at vertebral levels C2–C5 (Wald X
2(1) = 17.754, P < 0.001). There was no change in control regions at levels C7–T2 of the same tract, which are located below the level of input from dermatome C6, Wald X
2(1) = 0.185, P = 0.667. Results in all other regions assessed, that is, the left spinothalamic tract and bilateral corticospinal tract, were also not significant (P > 0.05).

Conclusion.
The current findings suggest that task-related changes in FA associated with the transmission of pain signals along the spinal cord can be detected using fDTI. We observed decreased FA values in the contralateral (right) spinothalamic tract following painful stimulation, while no such activity was apparent in control regions.

Level of Evidence: 5
Anatomical Analysis of Cutaneous Perforator Distribution in the Forearm
Authors: Kimura Tomomi , Ebisudani Shogo , Osugi Ikuko , Inagawa Kiichi 
Published: October 2017

Background:
Few reports describe the distribution of cutaneous perforators from the radial and ulnar arteries in the forearm. This study aimed to map the location of the cutaneous perforators that arise directly from the radial and ulnar arteries in cadavers.

Methods:
Twenty-nine human cadaveric forearms were dissected. All radial and ulnar arteries cutaneous perforators were analyzed for total number and distribution. To define the distribution of each cutaneous perforator, the forearm was divided into 10 sections, with the sections labeled as 10%, 20%, 30%, and so on, beginning at the wrist.

Results:
From the radial artery, there were a total of 262 skin perforators with an average of 9.03 ± 2.28 (mean ± SD) per limb, whereas the total was 159 from the ulnar artery, with an average of 5.48 ± 1.49 per limb. Additionally, 128 (49%) radial artery cutaneous perforators and 75 (47%) from the ulnar artery were concentrated in the 0–30% section of the forearm. Both the radial and ulnar arteries had many cutaneous perforators in the forearm section labeled 70%, with 32 of 262 (12%) cutaneous perforators of the radial artery and 27 of 159 (17%) cutaneous perforators of the ulnar artery located here.

Conclusions:
There were more cutaneous perforators from the radial artery than from the ulnar artery, and both were concentrated in the distal one-third of the forearm and in the forearm section labeled 70%. This information could be helpful when harvesting forearm flaps.
Neuroimaging in the Diagnosis of Chronic Traumatic Encephalopathy: A Systematic Review
Authors: Sparks Philip , Lawrence Tim , Hinze Stephan 
Published: October 2017

Objective:
Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repeated subconcussive and concussive head injury. Clinical features include cognitive, behavioral, mood, and motor impairments. Definitive diagnosis is only possible at postmortem. Here, the utility of neuroimaging in the diagnosis of CTE is evaluated by systematically reviewing recent evidence for changes in neuroimaging biomarkers in suspected cases of CTE compared with controls.

Data Sources:
Providing an update on a previous systematic review of articles published until December 2014, we searched for articles published between December 2014 and July 2016. We searched PubMed for studies assessing neuroimaging changes in symptomatic suspected cases of CTE with a history of repeated subconcussive or concussive head injury or participation in contact sports involving direct impact to the head. Exclusion criteria were case studies, review articles, and articles focusing on repetitive head trauma from military service, head banging, epilepsy, physical abuse, or animal models.

Main Results:
Seven articles met the review criteria, almost all of which studied professional athletes. The range of modalities were categorized into structural magnetic resonance imaging (MRI), diffusion MRI, and radionuclide studies. Biomarkers which differed significantly between suspected CTE and controls were Evans index (P = 0.05), cavum septum pellucidum (CSP) rate (P < 0.0006), length (P < 0.03) and ratio of CSP length to septum length (P < 0.03), regional differences in axial diffusivity (P < 0.05) and free/intracellular water fractions (P < 0.005), single-photon emission computed tomography perfusion abnormalities (P < 0.01), positron emission tomography (PET) signals from tau-binding, glucose-binding, and GABA receptor–binding radionuclides (P < 0.0001, P < 0.005, and P < 0.005, respectively). Important limitations include low specificity in identification of suspected cases of CTE across studies, the need for postmortem validation, and a lack of generalizability to nonprofessional athletes.

Conclusions:
The most promising biomarker is tau-binding radionuclide PET signal because it is most specific to the underlying neuropathology and differentiated CTE from both controls and patients with Alzheimer disease (P < 0.0001). Multimodal imaging will improve specificity further. Future research should minimize variability in identification of suspected cases of CTE using published clinical criteria.
Odontogenic sinusitis: developments in diagnosis, microbiology, and treatment
Authors: Workman Alan D. , Granquist Eric J. , Adappa Nithin D. 
Published: October 2017

Purpose of review
Odontogenic causes of sinusitis are frequently missed; clinicians often overlook odontogenic disease whenever examining individuals with symptomatic rhinosinusitis. Conventional treatments for chronic rhinosinusitis (CRS) will often fail in odontogenic sinusitis. There have been several recent developments in the understanding of mechanisms, diagnosis, and treatment of odontogenic sinusitis, and clinicians should be aware of these advances to best treat this patient population.

Recent findings
The majority of odontogenic disease is caused by periodontitis and iatrogenesis. Notably, dental pain or dental hypersensitivity is very commonly absent in odontogenic sinusitis, and symptoms are very similar to those seen in CRS overall. Unilaterality of nasal obstruction and foul nasal drainage are most suggestive of odontogenic sinusitis, but computed tomography is the gold standard for diagnosis. Conventional panoramic radiographs are very poorly suited to rule out odontogenic sinusitis, and cannot be relied on to identify disease. There does not appear to be an optimal sequence of treatment for odontogenic sinusitis; the dental source should be addressed and ESS is frequently also necessary to alleviate symptoms.

Summary
Odontogenic sinusitis has distinct pathophysiology, diagnostic considerations, microbiology, and treatment strategies whenever compared with chronic rhinosinusitis. Clinicians who can accurately identify odontogenic sources can increase efficacy of medical and surgical treatments and improve patient outcomes.
Lack of Correlation of Liver Tests With Fibrosis Stage at Diagnosis in Pediatric Primary Sclerosing Cholangitis
Authors: Cotter Jillian M. , Browne Lorna P. , Capocelli Kelley E. , McCoy Annette , Mack Cara L. 
Published: October 2017

ABSTRACTObjectives:The aims of this study were to characterize pediatric primary sclerosing cholangitis (PSC) at a regional referral‐based institution, including scoring of biliary stricturing and liver fibrosis and correlation analyses of scores with serum liver tests, to identify biomarkers of disease severity.Methods:A retrospective review of 39 PSC subjects was performed, with collection of demographic and outcomes data. Magnetic resonance cholangiopancreaticogram (MRCP) and liver biopsies were re‐reviewed and scores of stricturing and fibrosis were correlated with serum liver tests.Results:Average age at PSC diagnosis was 11.2 years, 74% had inflammatory bowel disease and 51% had autoimmune hepatitis. Despite 83% with symptoms at presentation, only ~1/3 were symptomatic at a mean follow‐up of 4.1 years. Using a validated MRCP biliary scoring system, the mean intrahepatic score was 1.1 (out of 4) and extrahepatic score was 1.0 (out of 3). The mean Ishak liver fibrosis stage was 3.5 (out of 6) and 33% had cirrhosis. 92% were alive with their native liver and 5% had a liver transplant. Serum biomarker analyses revealed no correlation between Ishak liver fibrosis stage or MRCP score and laboratory values.Conclusions:Pediatric PSC patients cared for at a regional referral center had relatively mild disease compared with previously published reports, with low MRCP stricture scores despite significant liver fibrosis. Liver tests at presentation did not correlate with MRCP stricture score or liver fibrosis stage, suggesting the need for future studies to identify potential biomarkers of disease severity.
Family Health‐related Quality of Life in Pediatric Cyclic Vomiting Syndrome
Authors: Wang‐Hall Jennifer , Li B.U.K. , Tarbell Sally E. 
Published: October 2017

ABSTRACTObjective:The aim of the study was to evaluate the relationship of disease characteristics and child anxiety symptoms to family health‐related quality of life (FHRQoL) in youth with cyclic vomiting syndrome (CVS).Methods:Forty‐two parents of youth ages 8 to 18 years diagnosed with CVS completed the Family Impact Module of the PedsQL, a measure of the impact of the child's illness on the family. We evaluated the relationship of disease characteristics and child and parent proxy reports of anxiety symptoms on the Screen for Childhood Anxiety and Related Emotional Disorders to FHRQoL.Results:Parent report of child anxiety symptoms and missed school days (mean = 11.93, standard deviation = 14.62) were the strongest predictors of FHRQoL (r2 = 0.33, df = 1.39, F = 8.51, P = 0.006). Other disease characteristics, including frequency, duration, chronicity of CVS episodes, and delay in initial CVS diagnosis were not significantly associated with the FHRQoL total score. Child anxiety symptoms by either parent and/or child report were associated with subscales of the FHRQoL, including family physical functioning, family communication, and family daily activities.Conclusions:HRQoL for the families assessed in this study was associated with anxiety symptoms to a greater extent than disease characteristics, indexing the importance of a biopsychosocial approach to CVS management. Screening for anxiety symptoms and support for school absences due to illness are indicated to help lessen the impact of CVS on the family as a whole.
Methods for Sexually Transmitted Disease Prevention Programs to Estimate the Health and Medical Cost Impact of Changes in Their Budget
Authors: Chesson Harrell W. , Ludovic Jennifer A. , Berruti Andrés A. , Gift Thomas L. 
Published: October 2017

Background
The purpose of this article was to describe methods that sexually transmitted disease (STD) programs can use to estimate the potential effects of changes in their budgets in terms of disease burden and direct medical costs.

Methods
We proposed 2 distinct approaches to estimate the potential effect of changes in funding on subsequent STD burden, one based on an analysis of state-level STD prevention funding and gonorrhea case rates and one based on analyses of the effect of Disease Intervention Specialist (DIS) activities on gonorrhea case rates. We also illustrated how programs can estimate the impact of budget changes on intermediate outcomes, such as partner services. Finally, we provided an example of the application of these methods for a hypothetical state STD prevention program.

Results
The methods we proposed can provide general approximations of how a change in STD prevention funding might affect the level of STD prevention services provided, STD incidence rates, and the direct medical cost burden of STDs. In applying these methods to a hypothetical state, a reduction in annual funding of US $200,000 was estimated to lead to subsequent increases in STDs of 1.6% to 3.6%. Over 10 years, the reduction in funding totaled US $2.0 million, whereas the cumulative, additional direct medical costs of the increase in STDs totaled US $3.7 to US $8.4 million.

Conclusions
The methods we proposed, though subject to important limitations, can allow STD prevention personnel to calculate evidence-based estimates of the effects of changes in their budget.
Achieving Public Health Standards and Increasing Accreditation Readiness: Findings From the National Public Health Improvement Initiative
Authors: Rider Nikki , Frazier Cassandra M. , McKasson Sarah , Corso Liza , McKeever Jennifer 
Published: October 2017

Objectives:
During 2010-2014, the Centers for Disease Control and Prevention implemented the National Public Health Improvement Initiative (NPHII) to assist 73 public health agencies in conducting activities to increase accreditation readiness, improve efficiency and effectiveness through quality improvement, and increase performance management capacity. A summative evaluation of NPHII was conducted to examine whether awardees met the initiative's objectives, including increasing readiness for accreditation.

Design:
A nonexperimental, utilization-focused evaluation with a multistrand, sequential mixed-methods approach was conducted to monitor awardee accomplishments and activities. Data analysis included descriptive statistics, as well as subanalyses of data by awardee characteristics. Thematic analysis using deductive a priori codes was used for qualitative analysis.

Results:
Ninety percent of awardees reported completing at least 1 accreditation prerequisite during NPHII, and more than half reported completing all 3 prerequisites by the end of the program. Three-fourths of awardees that completed a self-assessment reported closing gaps for at least 1 Public Health Accreditation Board (PHAB) standard. Within 3 years of the launch of PHAB accreditation, 7 NPHII awardees were accredited; another 38 had formally applied for accreditation.

Conclusions:
Through NPHII, awardees increased collaborative efforts around accreditation readiness, accelerated timelines for preparing for accreditation, and prioritized the completion of required accreditation activities.