bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hearing Difficulty Is Associated With Injuries Requiring Medical Care
Authors: Mick Paul , Foley Danielle , Lin Frank , Pichora-Fuller M. Kathleen 
Published: January 2018

Objective:
Injuries are responsible for 11% of global disability-adjusted life years. Hearing difficulty may be a modifiable risk factor for injury. The primary aim was to determine whether subjective hearing difficulty is associated with increased incidence of injuries (all-type, workplace, and nonworkplace) serious enough to require health care among Americans aged 18 years and older. The secondary aim was to determine whether hearing difficulty is associated with increased use of health care for injuries.

Design:
The analysis was performed using data from the 1999 to 2012 Medical Expenditure Panel Surveys–Household Component (MEPS-HC). Multivariable estimates are generalizable to the American noninstitutionalized adult population in 2006. Hearing difficulty was determined by computer-assisted personal interview. The primary outcome was number of separate injuries requiring health care (emergency department visits, hospital inpatient admissions, or medical office visits) during the follow-up period. Crude injury incidence rates were calculated with 95% confidence intervals (CIs). Multivariable negative binomial regression was performed to determine the relative incidence rate of injuries among the group reporting hearing difficulties relative to the group reporting no difficulty in hearing, adjusting for relevant confounders. Variance estimates were adjusted to take into account the complex sample design. Results were stratified by sex.

Results:
Of the 121,453 participants in MEPS-HC panels 6-16, 107,352 (88.4%) had complete data and were included in the analysis. The average follow-up was 1.27 years. Seven thousand six hundred and twenty-four participants (7.1%) reported hearing difficulty at baseline. During the follow-up period, 10,727 participants (10.0%) had one or more injuries. In multivariable analyses, hearing difficulty was significantly associated with increased incidence of all-type (males: incidence rate ratio [IRR] 1.31, 95% CI 1.18–1.45, p value < 0.001; females: IRR 1.21, 95% CI 1.07–1.36, p value < 0.001), workplace (males: IRR 1.42, 95% CI 1.16–1.75, p value 0.001; females: IRR 1.61, 95% CI 1.12–2.31, p value 0.010), and nonworkplace injuries (males: IRR 1.24, 95% CI 1.09–1.42, p value 0.001; females: IRR 1.17, 95% CI, 1.02–1.34, p value 0.023). In multivariable analyses, hearing difficulty was associated with increased incidence of emergency department use in males (IRR 1.36, 95% CI 1.13–1.62, p value 0.001) and medical office visits in females (IRR 1.52, 95% CI 1.12–2.05, p value 0.007).

Conclusions:
The study results suggest the need to investigate the mechanisms underlying the measured associations so that efforts may be directed toward reducing the risk of injury for individuals with hearing difficulties.
Prediction of Distal Radius Fracture Redisplacement: A Validation Study
Authors: Walenkamp Monique M. J. , Mulders Marjolein A. M. , van Hilst Jony , Goslings J. Carel , Schep Niels W. L. 
Published: January 2018

Objective:
To externally validate the Edinburgh Wrist Calculator (EWC) in a population of patients with distal radius fractures at risk of loss of threshold alignment.

Design:
A retrospective cohort study.

Setting:
One academic hospital.

Patients/Participants:
All consecutive adult patients with a displaced distal radius fracture with initial dorsal angulation >10 degree and/or an ulnar variance of >3 mm who were treated with closed reduction and cast immobilization between 2009 and 2014.

Main Outcome Measurement:
The sensitivity and specificity for diagnosis of loss of threshold alignment within 2 weeks of injury was calculated at the 10%, 40%, and the original 70% probability thresholds. The area under receiver operating characteristic curve was calculated using 2 different thresholds for loss of alignment: Mackenney et al and the Dutch consensus standards.

Results:
The EWC predicted a greater than 70% chance of redisplacement for only 3 fractures. Redisplacement within 2 weeks occurred in 61 of 99 (62%) fractures according to the thresholds of Mackenney et al and in 18 of 99 (18%) fractures according to the Dutch thresholds. The sensitivity increased and the specificity decreased using a lower probability threshold for redisplacement. The area under the receiver operating characteristic curve of the EWC was poor the Mackenney's thresholds [0.47; 95% confidence interval (CI): 0.36–0.59] and adequate for the Dutch thresholds (0.71; 95% CI: 0.58–0.84).

Conclusions:
The EWC was a poor predictor of fracture redisplacement greater than threshold in displaced distal radius fractures in our patient population.
Objective Methodology to Assess Meaningful Research Productivity by Orthopaedic Residency Departments: Validation Against Widely Distributed Ranking Metrics and Published Surrogates
Authors: Jones Louis B. , Goel Sameer , Hung Leroy Y. , Graves Matthew L. , Spitler Clay A. , Russell George V. , Bergin Patrick F. 
Published: January 2018

Summary:
The mission of any academic orthopaedic training program can be divided into 3 general areas of focus: clinical care, academic performance, and research. Clinical care is evaluated on clinical volume, patient outcomes, patient satisfaction, and becoming increasingly focused on data-driven quality metrics. Academic performance of a department can be used to motivate individual surgeons, but objective measures are used to define a residency program. Annual in-service examinations serve as a marker of resident knowledge base, and board pass rates are clearly scrutinized. Research productivity, however, has proven harder to objectively quantify. In an effort to improve transparency and better account for conflicts of interest, bias, and self-citation, multiple bibliometric measures have been developed. Rather than using individuals' research productivity as a surrogate for departmental research, we sought to establish an objective methodology to better assess a residency program's ability to conduct meaningful research. In this study, we describe a process to assess the number and quality of publications produced by an orthopaedic residency department. This would allow chairmen and program directors to benchmark their current production and make measurable goals for future research investment. The main goal of the benchmarking system is to create an “h-index” for residency programs. To do this, we needed to create a list of relevant articles in the orthopaedic literature. We used the Journal Citation Reports. This publication lists all orthopaedic journals that are given an impact factor rating every year. When we accessed the Journal Citation Reports database, there were 72 journals included in the orthopaedic literature section. To ensure only relevant, impactful journals were included, we selected journals with an impact factor greater than 0.95 and an Eigenfactor Score greater than 0.00095. After excluding journals not meeting these criteria, we were left with 45 journals. We performed a Scopus search over a 10-year period of these journals and created a database of articles and their affiliated institutions. We performed several iterations of this to maximize the capture of articles attributed to institutions with multiple names. Based off of this extensive database, we were able to analyze all allopathic US residency programs based on their quality research productivity. We believe this as a novel methodology to create a system by which residency program chairmen and directors can assess progress over time and accurate comparison with other programs.
Toe Walking: A Neurological Perspective After Referral From Pediatric Orthopaedic Surgeons
Authors: Haynes Katherine B. , Wimberly Robert L. , VanPelt Jonathan M. , Jo Chan-Hee , Riccio Anthony I. , Delgado Mauricio R. 
Published: January 2018

Background:
Toe walking (TW) in children is often idiopathic in origin. Our purpose was to determine the incidence of a neurological etiology for TW in patients seen in the neurology clinic after referral from pediatric orthopaedic surgeons.

Methods:
We performed an Institutional Review Board approved retrospective review of 174 patients referred to the neurology clinic from orthopaedic surgeons at an academic pediatric tertiary care center between January 2010 and September 2015. Medical records were reviewed and data recorded including pertinent family history, birth history, age of initial ambulation, physical examination findings, and workup results including neuroimaging, neurophysiological studies, and findings of genetic testing and tissue biopsy.

Results:
Sixty-two percent (108/174) of patients were found to have a neurological etiology for TW. Final pathologic diagnoses were: 37% (40/108) previously undiagnosed cerebral palsy (CP), 16.7% (18/108) peripheral neuropathy, 15.7% (17/108) autism spectrum disorder, 13.9% (15/108) hereditary spastic paraparesis, 8.3% (9/108) attention deficit hyperactivity disorder, 5.6% (6/108) syndromic diagnosis, and 2.8% (3/108) spinal cord abnormality. Ankle equinus contractures were noted in idiopathic and neurological patients and did not indicate a pathologic origin. Seventy-one percent of unilateral toe walkers and 32% of bilateral but asymmetric toe walkers were diagnosed with CP (P<0.001). Twenty-six percent of 145 brain magnetic resonance imaging studies diagnosed CP. Of the 125 (72%) with spinal imaging, 3 had spinal pathology to account for TW. Fourteen percent of 87 subjects with an electromyography/nerve conduction study had abnormal results indicating a peripheral polyneuropathy.

Conclusions:
An underlying pathologic diagnosis was found in 62% of patients referred to neurology for TW. A concerning birth history, delayed initial ambulation, unilateral TW, upper or lower motor neuron signs on examination, or behavioral features may suggest a pathologic diagnosis. Ankle contracture is not predictive of an abnormal diagnosis and can be found in idiopathic patients. CP, peripheral neuropathy, autism spectrum disorder, and hereditary spastic paraparesis are the most common pathologic diagnoses identified in our population.

Level of Evidence:
Level III—retrospective cohort.
The Prevalence and Treatment of Hip Dysplasia in Prader-Willi Syndrome (PWS)
Authors: Trizno Anastasiya A. , Jones Alexander S. , Carry Patrick M. , Georgopoulos Gaia 
Published: January 2018

Background:
Prader-Willi syndrome (PWS) is a genetic disorder with multisystem involvement. There are a number of associated orthopaedic manifestations, the most recognized of which is scoliosis. The aim of this study was to assess the prevalence of hip dysplasia and to investigate its treatment in patients with PWS.

Methods:
Following IRB approval, all patients seen at our institution’s Prader-Willi multidisciplinary clinic were retrospectively reviewed. Only patients with an ultrasound, anteroposterior (AP) spine, AP abdomen, AP hip radiograph, and/or skeletal survey were included in the study. The presence of hip dysplasia was determined based on ultrasonographic and/or radiographic measurements performed by a single fellowship trained pediatric orthopaedic surgeon. A multivariable logistic regression analysis was used to test the association between patient demographics and the prevalence of hip dysplasia. Age at diagnosis, treatment type, and outcomes were recorded for patients that underwent treatment for hip dysplasia.

Results:
Hip dysplasia was identified in 30% (27/90) of the patient population. Two of the 27 patients (7.4%) had normal films but had a history of resolved hip dysplasia. Prevalence was not associated with sex (P=0.7072), genetic subtype (P=0.5504), race (P=0.8537), ethnicity (P=0.2191), or duration of follow-up (P=0.4421). Eight of the 27 patients (30%) underwent hip treatment by Pavlik harness (2/8), Pavlik harness and closed reduction (1/8), closed reduction (3/8), open reduction (1/8), and unspecified hip surgery (1/8). The mean age at diagnosis was 2 months for the patients that were successfully treated for hip dysplasia (3/8) and 12 months for those who had residual dysplasia following the treatment (5/8).

Conclusions:
Our study demonstrates a higher prevalence of hip dysplasia in patients with PWS than previously documented. The age at which hip dysplasia develops remains unknown; therefore, we recommend an ultrasound screening for all infants with PWS at 6 weeks of age and subsequent radiographic studies at 1, 2, 5, 10, and 15 years of age to allow for early diagnosis and intervention.

Level of Evidence:
Level III—retrospective comparative study.
Nonmelanoma Skin Cancer Risk in Patients With Inflammatory Bowel Disease Undergoing Thiopurine Therapy: A Systematic Review of the Literature
Authors: Hagen Joshua W. , Pugliano-Mauro Melissa A. 
Published: January 2018

BACKGROUND
Azathioprine and 6-mercaptopurine (thiopurines) are common adjunct treatments for inflammatory bowel disease (IBD). Although thiopurine therapy in organ transplant recipients is known to increase nonmelanoma skin cancers (NMSCs), dermatologic literature yields less data regarding NMSC risk of thiopurine use in IBD.

OBJECTIVE
The aim of this study was to systematically review current literature on NMSC risk in patients with IBD using thiopurine therapy.

METHODS
Systematic review of PubMed was performed with keywords “inflammatory bowel disease,” “ulcerative colitis,” “Crohn's disease,” “thiopurine,” “azathioprine,” “6-mercaptopurine,” “skin cancer,” “non-melanoma,” “squamous cell carcinoma,” and “basal cell carcinoma.” All available publication years were included. Publications were evaluated using PRISMA guidelines.

RESULTS
The systematic review yielded 67 articles; 18 met final inclusion criteria.

LIMITATIONS
Heterogeneity of study designs limited direct comparisons of thiopurine exposure and NMSC risk.

CONCLUSION
Patients with IBD using thiopurines seem to have a moderately increased risk of NMSC that is proportional to therapy duration. Risk of NMSC seems to decrease or return to baseline after discontinuing therapy, although additional data are needed to support this trend. Younger patients with IBD using thiopurines seem to be at greater risk of NMSC. Appreciating NMSC risk in patients with IBD undergoing thiopurine therapy should help direct skin cancer screening recommendations and sun protective measures.
The Effect of Chronic Musculoskeletal Pain on Sexual Function and Quality of Life of Cardiac Rehabilitation Patients
Authors: Wittkopf Pricilla Geraldine , Cardoso Allana Alexandre , de Carvalho Tales , Cardoso Fernando Luiz 
Published: January 2018

Background:
Comorbidities are stressors to the body and have a negative impact on quality of life and sexual function.

Objective:
The objective of this study was to investigate the effect of the coexistence of coronary heart disease and chronic musculoskeletal pain on sexual function and quality of life of patients undergoing an exercise-based cardiac rehabilitation program.

Methods:
This cross-sectional observational study included 105 patients. Instruments used were the musculoskeletal system assessment inventory, Short-Form Health Survey quality-of-life questionnaire, International Index of Erectile Function, and Female Sexual Function Index.

Results:
There were no differences in male sexual function compared between participants with and without pain. Participants with pain had lower quality-of-life scores related to socioemotional aspects.

Conclusions:
The coexistence of coronary heart disease and musculoskeletal pain does not seem to affect patients' sexual function, but it negatively affects Patients' quality of life. This study emphasizes the importance of a multidisciplinary team working in a cardiac rehabilitation program addressing issues related to pain, sexual function, and quality of life.
Decreasing Radiation Exposure in Pediatric Trauma Related to Cervical Spine Clearance: A Quality Improvement Project
Authors: Waddell Valerie Ann , Connelly Susan 
Published: January 2018

Study Design:
Quality improvement project.

Objectives:
Reduce the amount of radiation exposure in the pediatric trauma population 5 years of age and older in relation to cervical spine clearance.

Background:
The evaluation of pediatric cervical spine injuries must be accurate and timely to avoid missed injuries. The difficult clinical examination in pediatric trauma patients necessitates the use of radiologic examinations to avoid missing catastrophic injuries. However, exposure to radiation at an early age increases the pediatric patients' risk of developing cancer (R. A. Kleinerman, 2006).

Methods:
A retrospective chart review was conducted to assess radiation exposure in pediatric patients requiring evaluation for cervical spine clearance. Surgical staff and emergency department physicians received education on the risks related to pediatric radiation exposure and information related to the institution's diagnostic trends for cervical spine clearance. An algorithm was then developed to assist with determining the necessary imaging study for cervical spine clearance. Radiation exposure was monitored following initial education and use of the algorithm to determine its effect on radiation exposure.

Results:
The retrospective chart review identified cervical spine computed tomography (CT) in 34%, with an average radiation exposure of 3.5 mSv. Following education and introduction of an algorithm, 18% of patients underwent CT for cervical spine clearance with an average radiation exposure of 3.2 mSv, representing a 47% decrease in the use of CT.

Conclusion:
Staff education and the use of an algorithm show promise in the reduction of radiation exposure and provide safe, effective clearance of the cervical spine in pediatric trauma.
Ten-year experience of transjugular intrahepatic portosystemic shunt for noncirrhotic portal hypertension
Authors: Regnault David , d’Alteroche Louis , Nicolas Charlotte , Dujardin Fanny , Ayoub Jean , Perarnau Jean Marc 
Published: January 2018

Background
Transjugular intrahepatic portosystemic shunt (TIPS) is considered to be well suited for the treatment of noncirrhotic portal hypertension (NCPHT) because of a usually severe portal hypertension (PHT) and a mild liver failure, but very less data are available.

Patients and methods
Records of patients referred for TIPS between 2004 and 2015 for NCPHT were reviewed. No patient should have clinical or biological or histological features of cirrhosis.

Results
Twenty-five patients with a wide variety of histological lesions (sinusoidal dilatations, granulomatosis, regenerative nodular hyperplasia, obliterative portal venopathy, or subnormal liver) and a wide variety of associated diseases (thrombophilia, sarcoidosis, common variable immunodeficiency, scleroderma, Castleman’s disease, early primitive biliary cirrhosis, congenital liver fibrosis, chemotherapy, purinethol intake, and congenital varices) were included. Two complications occurred during the procedure: one periprosthetic hematoma and the other misposition of a covered stent. During the first month, two other patients had an early thrombosis, another had induced encephalopathy, and one died of early rebleeding. Two of these complications occurred in patients with cavernoma. With a mean follow-up of 39 months, 10 patients experienced at least one episode of spontaneous encephalopathy, with three of these patients requiring a stent reduction. Five patients had a recurrence of their initial symptoms, and one had an asymptomatic hemodynamic dysfunction.

Conclusion
TIPS is effective in NCPHT but can be technically difficult, especially in the case of cavernoma. Good liver function does not prevent the occurrence of long-term encephalopathy.
Iron oxidation by a fused cytochrome-porin common to diverse iron-oxidizing bacteria
Authors: Keffer Jessica L. , McAllister Sean M. , Garber Arkadiy , Hallahan Beverly J. , Sutherland Molly C. , Rozovsky Sharon , Chan Clara S. 
Published: January 2018

AbstractIron (Fe) oxidation is one of Earth’s major biogeochemical processes, key to weathering, soil formation, water quality, and corrosion. However, our understanding of microbial contribution is limited by incomplete knowledge of microbial iron oxidation mechanisms, particularly in neutrophilic iron-oxidizers. The genomes of many, diverse iron-oxidizers encode a homolog to an outer-membrane cytochrome (Cyc2) shown to oxidize iron in two acidophiles. Phylogenetic analyses show Cyc2 sequences from neutrophiles cluster together, suggesting a common function, though this function has not been verified in these organisms. Therefore, we investigated the iron oxidase function of heterologously expressed Cyc2 from a neutrophilic iron-oxidizerMariprofundus ferrooxydansPV-1. Cyc2PV-1 is capable of oxidizing iron, and its redox potential is 208 ± 20 mV, consistent with the ability to accept electrons from Fe2+at neutral pH. These results support the hypothesis that Cyc2 functions as an iron oxidase in neutrophilic iron-oxidizing organisms. Sequence analysis and modeling reveal the entire Cyc2 family share a unique fused cytochrome-porin structure, with a defining consensus motif in the cytochrome region. Based on structural analyses, we predict that the monoheme cytochrome Cyc2 specifically oxidizes dissolved Fe2+, in contrast to multiheme iron oxidases, which may oxidize solid Fe(II). With our results, there is now functional validation for diverse representatives of Cyc2 sequences. We present a comprehensive Cyc2 phylogenetic tree and offer a roadmap for identifyingcyc2/Cyc2 homologs and interpreting their function. The occurrence ofcyc2in many genomes beyond known iron-oxidizers presents the possibility that microbial iron oxidation may be a widespread metabolism.ImportanceIron is practically ubiquitous across Earth’s environments, central to both life and geochemical processes, which depend heavily on the redox state of iron. Although iron oxidation, or “rusting,” can occur abiotically at near neutral pH, we find neutrophilic iron-oxidizing bacteria (FeOB) are widespread, including in aquifers, sediments, hydrothermal vents, pipes, and water treatment systems. FeOB produce highly reactive Fe(III) oxyhydroxides that bind a variety of nutrients and toxins, thus these microbes are likely a controlling force in iron and other biogeochemical cycles. There has been mounting evidence that Cyc2 functions as an iron oxidase in neutrophiles, but definitive proof of its function has long eluded us. This work provides conclusive biochemical evidence of iron oxidation by Cyc2 from neutrophiles. Cyc2 is common to a wide variety of iron-oxidizers, including acidophilic and phototrophic iron-oxidizers, suggesting that this fused cytochrome-porin structure is especially well-adapted for iron oxidation.
A quantitative map of human Condensins provides new insights into mitotic chromosome architecture
Authors: Walther Nike , Hossain M. Julius , Politi Antonio Z. , Koch Birgit , Kueblbeck Moritz , Ødegård-Fougner Øyvind , Lampe Marko , Ellenberg Jan 
Published: January 2018

AbstractThe two Condensin complexes in human cells are essential for mitotic chromosome structure. We used homozygous genome editing to fluorescently tag Condensin I and II subunits and mapped their absolute abundance, spacing and dynamic localization during mitosis by fluorescence correlation spectroscopy-calibrated live cell imaging and super-resolution microscopy. While ∼35,000 Condensin II complexes are stably bound to chromosomes throughout mitosis, ∼195,000 Condensin I complexes dynamically bind in two steps, in prometaphase and early anaphase. The two Condensins rarely co-localize at the chromatid axis, where Condensin II is centrally confined but Condensin I reaches ∼50% of the chromatid diameter from its center. Based on our comprehensive quantitative data, we propose a three-step hierarchical loop model of mitotic chromosome compaction: Condensin II initially fixes loops of a maximum size of ∼450 kb at the chromatid axis whose size is then reduced by Condensin I binding to ∼90 kb in prometaphase and ∼70 kb in anaphase, achieving maximum chromosome compaction upon sister chromatid segregation.