bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Reoperation Risk Vary for Different Types of Pediatric Scoliosis?
Authors: Paul Justin C. , Lonner Baron S. , Vira Shaleen , Feldman David , Errico Thomas J. 
Published: September 2016

Study Design:
Retrospective cohort study of spine fusion surgery utilizing the New York State Inpatient Database.

Objective:
The objective was to determine whether there were differences in reoperation rates among pediatric scoliosis associated with various etiologies compared with idiopathic scoliosis.

Summary of Background Data:
The incidence of postoperative complications and reoperations is known to vary among patients with diverse scoliosis pathologies. As these are heterogeneous conditions and often with rare occurrence, it is difficult to compare them in a single study. We aimed to assess reoperation events after fusion for several etiologies of pediatric scoliosis.

Methods:
The 2008 to 2011 New York State Inpatient Database was queried using International Classification of Diseases (ICD-9-CM) codes for patients with in-hospital stays including a spine arthrodesis for scoliosis. All approaches, all fusion lengths, and ages 10 to 21 were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk of reoperation was calculated for several rare conditions associated with scoliosis.

Results:
Two thousand three hundred fifty-six pediatric scoliosis fusion surgeries were identified in 2008 in the state of New York. The 1- and 4-year reoperation rate for idiopathic scoliosis was 0.9% and 1.6%, respectively. For nonidiopathic scoliosis, the 1- and 4-year rates were 4.2% and 20.4%, respectively. Of the nonidiopathic scoliosis subtypes, congenital scoliosis (4.7% risk at 1 y, 41.6% at 4 y), the neuromuscular disease arthrogryposis (7.3% risk at 1 y, 28.6% at 4 y), and syndrome neurofibromatosis (9.1% at 1 y, 32.3% at 4 y) showed the highest risk for reoperation. Length of stay and hospital charges were higher for reoperations.

Conclusions:
Using a large administrative database, we identified neuromuscular, syndromic, and congenital forms of scoliosis that have the highest relative risk for a reoperation within 1 year. At-risk populations should be identified and resources allocated and preventative measures instituted accordingly to prevent these costly events.

Level of Evidence:
Level III.
Significance of the Lateral Humeral Line for Evaluating Radiocapitellar Alignment in Children
Authors: Souder Christopher D. , Roocroft Joanna H. , Edmonds Eric W. 
Published: September 2016

Background:
The radiocapitellar line (RCL) was originally described for evaluation of the alignment of the RC joint on lateral images of the elbow. Although, many authors have translated the utilization of RCL into coronal imaging, previous studies have not been performed to confirm validity. The purpose of this paper was to identify an accurate way of evaluating pediatric RC alignment in the coronal plane.

Methods:
Thirty-seven anteroposterior (AP) radiographs of 37 children were evaluated to determine the position of the RC joint in the coronal plane. All had acceptable magnetic resonance imaging (MRI) studies available for comparison. The lateral humeral line (LHL), consisting of a line along the lateral edge of the ossified condyle of the distal humerus parallel to the axis of the distal humeral shaft, was studied as it related to the lateral cortex of the radial neck. Three children with a confirmed diagnosis of a Bado III, lateral displaced radius, Monteggia fracture were also evaluated.

Results:
The LHL passed along the edge of or lateral to the radial neck on all AP radiographs and all MRI studies. The RCL failed to intersect the capitellum on 2 AP radiographs. On MRI, the RCL also passed lateral to the capitellar ossification center in 3 patients. In addition, the RCL was seen passing through the capitellum at a mean of the lateral 30% (range, 0% to 64%) on AP radiographs and 26% (range, 0% to 48%) on MRI. For all 3 children with a Bado III Monteggia fracture, the LHL crossed the radial neck and the RCL did not intersect the capitellum.

Conclusions:
The RCL can fail to intersect the capitellar ossification center on AP radiographs and MRI in pediatric elbows without injury. The LHL consistently lies lateral to the radial neck in normal elbows and medial to the lateral aspect of the radial neck on all Bado III fracture-dislocations. It, therefore, can be used as an adjunct in evaluating the RC joint on AP imaging. The RCL most commonly intersects the lateral one third of the ossification center on both plain radiographs and MRIs.

Level of Evidence:
Level III—diagnostic.
Can a Made-for-Consumer Activity Monitor Assess Physical Activity in Adolescents and Young Adults After Lower Extremity Limb Salvage for Osseous Tumors?
Authors: Gundle Kenneth R. , Punt Stephanie E. , Mattioli-Lewis Tressa , Conrad Ernest U. 
Published: September 2016

Background:
The purpose of this study was to test the validity of a consumer-oriented activity monitor in adolescents and young adults undergoing limb salvage for primary bone malignancies.

Methods:
A cross-sectional population of participants with an average age of 16 (range 12 to 22) years produced 472 days of activity monitoring during 25 evaluations periods alongside patient-reported outcome measures.

Results:
Average daily steps ranged from 557 to 12,756 (mean=4711) and was moderately associated with the short-form (SF) 36 physical component subscale (r=0.46, P=0.04) as well as the SF6D health state utility measure (r=0.48, P=0.04), but not the SF36 mental component subscale (P=0.66) or Toronto extremity salvage score (P=0.07). Time from surgery was strongly correlated with average daily steps (r=0.7, P<0.001).

Conclusions:
A made-for-consumer activity monitor provided real-world data regarding the outcome of adolescent and young adult limb salvage, and evidence of validity in this population. Such lower cost, user-friendly devices may facilitate assessment of free-living activity and allow novel comparisons of treatment strategies.

Level of Evidence:
Level II—diagnostic.
Outcome of Pelvic Bone Sarcomas in Children
Authors: Laitinen Minna , Parry Michael , Albergo Jose I. , Jeys Lee , Sumathi Vaiyapuri , Grimer Robert 
Published: September 2016

Background:
Malignant bone tumors of the pelvis in children are rare and knowledge of their behavior is limited.

Methods:
A total of 113 skeletally immature patients under 16 years of age, comprising 58 females and 55 males were treated between 1983 and 2014. Tumors comprised Ewing’s sarcoma (ES) in 88 (77.9%) or osteosarcoma (OS) in 25 (22.1%). Metastases at diagnosis were present in 36 (31.9%). The mean follow-up was 5.2 years (2 to 16).

Results:
For patients with ES, the overall survival was 37.1% at 5-years and 33.5% at 10-years and 31.7% at 5- and 10-years in patients with OS. Local recurrence occurred in 24 patients with ES (27.3%) and 7 patients with OS (43.7%). Chemotherapy response was a predictor of local recurrence in ES with the lowest incidence seen in those with a good response to chemotherapy treated with a combination of radiotherapy and surgery. In patients with OS, both surgical margin and chemotherapy response influenced local control.

Conclusions:
Attaining a wide surgical margin should be the aim of treatment for all children with primary bone tumors of the pelvis. In ES, chemotherapy response has a greater influence on disease free and overall survival. Patients who demonstrate a poor response to chemotherapy should be considered for subsequent radiotherapy. Effort should be directed toward identifying nonhistologic methods of assessing chemotherapy response.

Level of Evidence:
Level IV—retrospective case study.
In-Transit Metastasis From Squamous Cell Carcinoma
Authors: Ma Joyce H.Y. , Wu Albert , Veness Michael , Estall Vanessa , Hong Angela , Borg Martin , James Craig , Ibbetson Jan , Ooi Colin , Weightman Warren , McColl Ian , Hamann Ian , Grieve Noel , Ozluer Selim , Salmon Paul , Nikitins Markus , Caplash Yugesh , Marshall Nicholas , Edwards Timothy , Patterson Ian , Selva Dinesh , Huilgol Shyamala C. 
Published: September 2016

BACKGROUND
In-transit metastasis from cutaneous squamous cell carcinoma (SCC) is an uncommon form of metastasis through lymphatics and occurs more commonly in immunosuppressed patients.

OBJECTIVE
To identify cases of in-transit SCC and determine patient characteristics, tumor features, management, and prognosis.

METHODS AND MATERIALS
A multicenter case series treated by Australian and New Zealand clinicians.

RESULTS
In 31 patients, median age was 72 years (range 52–99) and 68% were immunocompetent. Tumors occurred on the head and neck in 94% of cases, with 71% of all tumors occurring on the scalp, forehead, or temple. The median time to presentation with in-transit SCC from treatment of the initial tumor was 5 months. Management included surgery (94%), radiotherapy (77%), chemotherapy (10%), and reduction of immunosuppression (3%). Median follow-up was 12 months. Overall survival at 3 and 5 years were 27% and 13%, respectively.

CONCLUSION
In-transit metastases are described in 31 patients, of whom the majority was immunocompetent. The scalp, forehead, and temple were the most common sites. New clinical and histological diagnostic criteria are proposed. Prognosis was poor with 5-year survival of 13%. Recommended management is a combination of surgery and adjuvant radiotherapy. Reduction of any iatrogenic immunosuppression should be considered.
The Readability of Online Patient Information About Mohs Micrographic Surgery
Authors: Vargas Christina R. , DePry Jennifer , Lee Bernard T. , Bordeaux Jeremy S. 
Published: September 2016

BACKGROUND
Mohs micrographic surgery has become increasingly used in the treatment of cutaneous malignancies over the past decade. Concurrently, more patients are using the Internet as a resource for medical information than ever before. The average American adult reads at an eighth grade level. The American Medical Association and National Institutes of Health have recommended a sixth grade target reading level for patient health materials.

OBJECTIVE
This study evaluates the readability of currently available online information about Mohs micrographic surgery in the context of these recommendations.

METHODS
An Internet search for the term “Mohs surgery” was performed and the first 10 results were identified. Patient information from each primary site was downloaded and formatted into plain text. Readability was assessed using 9 established tests; text was analyzed both overall and by Web site for comparison.

RESULTS
A total of 101 articles were collected from the first 10 Web site search results; the overall average reading level was 14.4. All articles exceeded the recommended sixth grade reading level.

CONCLUSION
Online resources about Mohs micrographic surgery are too difficult for many patients to read. The paucity of appropriately written patient information available on the Internet may hinder informed decision-making, participation, and subsequent postoperative satisfaction.
Scalp Closures With Pulley Sutures Reduce Time and Cost Compared to Traditional Layered Technique—A Prospective, Randomized, Observer-Blinded Study
Authors: Kannan Swati , Mehta Dhwani , Ozog David 
Published: September 2016

BACKGROUND
Reconstruction of postsurgical scalp defects can be difficult and time-consuming using a conventional bilayered technique. A specialized closure using a pulley suture can assist in closing wounds under high tension and can decrease time and cost for the surgeon.

OBJECTIVE
To determine if closing scalp defects with a single-layered closure using pulley sutures would result in decreased time but equivalent scar cosmesis compared to bilayered closures.

MATERIALS AND METHODS
A total of 21 patients with postsurgical scalp defects were randomized to a bilayered or a pulley group, and time was measured for each closure. Scar appearance was assessed using the Patient and Observer Scar Assessment Scale at 2 weeks, 2 months, and 6 months postsurgery. Before and after photographs were also assessed by a blinded dermatologist using the visual analog scale.

RESULTS
Compared to a bilayered closure, the pulley technique resulted in significantly reduced closure time (p < .001). Even though patient overall scores at 2 weeks and observer total score at 6 months were superior in the pulley group, the visual analog scale scores were similar between the 2 groups.

CONCLUSION
Scalp reconstructions using a single layer of pulley sutures result in time and cost reduction and similar scar appearance compared to bilayered closures.
Magnetic Resonance Imaging of Cyclodialysis Cleft Before and After Cyclopexy
Authors: Jeong Jae Hoon , Jeoung Jin Wook , Moon Nam Ju 
Published: September 2016

Purpose:
To report the magnetic resonance imaging (MRI) appearance of a man with chronic hypotony caused by unexplained cyclodialysis clefts and the change after laser photocoagulation.

Methods:
A 19-year-old man with hypotonous maculopathy caused by cyclodialysis clefts in the right eye presented to our institution. The etiology and time of onset of the cyclodialysis clefts were obscure, and a MRI was performed to assess the possibility of compressive optic neuropathy.

Results:
MRI of the right eye showed a relative decrease in globe volume and diffuse enhancement of the ocular wall compared with the left eye. Conservative management showed no further improvement, and the patient underwent laser photocoagulation within the cyclodialysis clefts. During the 9-month follow-up period, both functional and anatomic reversal and an increase in total globe volume were observed, and the enhancement of the ocular wall was resolved.

Conclusions:
This case demonstrates the specific magnetic resonance appearance of hypotony status caused by a cyclodialysis cleft and the change after laser photocoagulation cyclopexy.
Repeatability and Agreement of Swept Source and Spectral Domain Optical Coherence Tomography Evaluations of Thickness Sectors in Normal Eyes
Authors: Lee Sang Yeop , Bae Hyoung Won , Kwon Hee Jung , Seong Gong Je , Kim Chan Yun 
Published: September 2016

Purpose of the Study:
The purpose of the study was to evaluate the clinical efficacy of swept-source optical coherence tomography (SS-OCT), we compared the intradevice repeatability of thickness measurements obtained using SS-OCT to that of measurements obtained using spectral domain OCT (SD-OCT), and assessed the interdevice agreement of thickness measurements.

Materials and Methods:
This cross-sectional prospective study involved 3 consecutive measurements of peripapillary retinal nerve fiber layer (PP-RNFL) and ganglion cell-inner plexiform layer thickness in healthy subjects, using 2 different OCT systems. Intraclass correlation coefficients (ICCs) and coefficients of variability were calculated and compared for repeatability and agreement between study groups. Intradevice ICCs for each OCT system were compared, and Bland-Altman plots were used to evaluate their agreement.

Results:
Fifty-eight eyes from 58 healthy subjects (25 men and 33 women) were analyzed. SS-OCT images yielded larger PP-RNFL thickness values than SD-OCT images in every sector examined. In contrast, SD-OCT images yielded larger macular ganglion cell-inner plexiform layer thickness values than SS-OCT images. For SS-OCT, intradevice ICCs were ≥0.9 for all sectors. However, for SD-OCT, the 3 PP-RNFL measurement sectors had correlation coefficients <0.9. Interdevice ICCs varied more and were lower than intradevice values, because thickness measurement values differed between the OCT devices.

Conclusions:
Measurements differed between systems even for the same subject. SS-OCT had an intradevice repeatability similar to that of SD-OCT. These findings support the clinical application of SS-OCT.
Short-term to Long-term Results of Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease
Authors: Yakin Mehmet , Eksioglu Umit , Sungur Gulten , Satana Banu , Demirok Gulizar , Ornek Firdevs 
Published: September 2016

Purpose:
To evaluate short-term to long-term outcomes of Ahmed glaucoma valve (AGV) implantation in the management of uveitic glaucoma (UG) secondary to Behçet disease (BD).

Patients and Methods:
A retrospective chart review of 47 eyes of 35 patients with UG secondary to BD who underwent AGV implantation was conducted. Success was defined as having an intraocular pressure (IOP) between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucomatous medications and without need for further glaucoma surgery.

Results:
Mean postoperative follow-up was 57.72±26.13 months. Mean preoperative IOP was 35.40±8.33 mm Hg versus 12.28±2.90 mm Hg at the last follow-up visit (P<0.001). Mean number of preoperative topical antiglaucomatous medications was 2.96±0.29 versus 0.68±1.12 at the last follow-up visit (P<0.001). In all eyes, IOP could be maintained between 6 and 21 mm Hg with or without antiglaucomatous medications during follow-up. The cumulative probability of complete success was 46.8% at 6 months, 40.4% at 12 months, and 35.9% at 36 months, and the cumulative probability of eyes without complication was 53.2% at 6 months, 46.5% at 12 months, and 39.6% at 24 months postoperatively based on Kaplan-Meier survival analysis. No persistent or irreparable complications were observed.

Conclusions:
This study includes one of the largest series of AGV implantation in the management of UG with the longest follow-up reported. AGV implantation can be considered as a primary surgical option in the management of UG secondary to BD with 100% total success rate (with or without medications).
Incidence of renal cell carcinoma in inflammatory bowel disease patients with and without anti-TNF treatment
Authors: Wauters Lucas , Billiet Thomas , Papamichael Konstantinos , Ballet Vera , Joniau Steven , Verschueren Patrick , Silversmit Geert , Van Assche Gert , Vermeire Séverine , Ferrante Marc 
Published: September 2016

Objective
We aimed to study the risk of renal cell carcinoma (RCC) with anti-tumor necrosis factor (anti-TNF) therapy in inflammatory bowel disease (IBD) and rheumatic diseases (RD) and calculate standardized incidence ratios (SIRs) in IBD.

Materials and methods
This was a retrospective case–control and cohort study spanning 25 years, including IBD and RD patients with a diagnosis of RCC (1990–2014) identified through the electronic database of a tertiary referral center.

Results
RCC was confirmed in seven anti-TNF-exposed (TNF+) and 21 anti-TNF-naive (TNF−) IBD and one TNF+ and 26 TNF− RD patients. In IBD-RCC, younger age at RCC diagnosis [median (interquartile range) 46 (42–58) vs. 63 (52–75) years; P=0.02], immunosuppressive therapy (100 vs. 24%; P<0.0004), partial nephrectomy (86 vs. 33%; P=0.02), and surgery less than 1 month after diagnosis of RCC (71 vs. 14%; P=0.004) were associated with anti-TNF. Compared with IBD, RD patients were older at RCC diagnosis [70 (60–77) vs. 59 (47–69) years; P=0.02] with less nephron-sparing surgery (26 vs. 54%; P=0.04) and more symptomatic (44 vs. 14%; P=0.02) and advanced tumors (30 vs. 7%; P=0.04). SIRs in IBD-RCC TNF− and TNF+ were 5.4 (95% confidence interval 2.9–9.2) and 7.1 (2.3–16.5) in male patients and 8.5 (3.7–16.8) and 4.8 (0.6–17.3) in female patients, respectively. The risk for RCC associated with anti-TNF in IBD was 0.8 (0.3–2.5) in men and 1.4 (0.2–5.5) in women.

Conclusion
The favorable patient and tumor profiles in IBD with anti-TNF may suggest incidentally discovered RCC on abdominal imaging. SIRs for IBD-RCC were not increased after anti-TNF exposure.
Leadership Training and the Problems of Competency Development
Authors: Reid W. Michael , Dold Claudia Jennifer 
Published: September 2016

Context:
An important workforce development effort during the past 25 years has been developing competency sets. Several of the sets rely on the concepts of Senge's Learning Organization and Burns' Transformational Leadership. The authors' experiences and study in designing and implementing a curriculum for a public health leadership institute based on these concepts raised several important questions about competency development and application.

Objectives:
To summarize the use of the Senge and Burns frameworks in several competency sets and the practice literature and to assess the status of competency development for those frameworks and for competency development generally.

Design:
The authors reviewed several commonly used competency sets and textbooks and searched 3 leading public health practice journals (Journal of Public Health Management and Practice, Public Health Reports, and American Journal of Public Health) for Senge and Burns framework terms. They also reviewed efforts to implement competency sets in public health education and practice.

Main Outcome Measures:
(1) The extent to which the articles and texts demonstrated understanding of the frameworks and reported their implementation and (2) whether competency statements and their uses in the literature contained precise definitions of competencies (knowledge, skills, behaviors, and attitudes associated with them), the standards by which competence is to be measured, and the means for measuring their attainment.

Results:
“Learning Organization” and “Transformational Leadership” terms were used often and viewed favorably. However, the terms were rarely defined as Senge and Burns had, the uses generally did not indicate the complexity and difficulty of implementation, and there was only one report of even partial implementation. The review of competency development efforts found there is virtually no attention to the definitional and measurement issues in the literature.

Conclusion:
Unless public health organizations recognize the need for a common understanding of competencies and how to measure their attainment and act on that understanding, it will be impossible to say with confidence that there is agreement on which individuals are competent, whether public health agencies have competent personnel, or that the public health workforce itself is competent.