bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraarticular Distal Radius Fracture Open Reduction Internal Fixation
Authors: Nydick Jason A. , Streufert Benjamin D. , Stone Jeffrey D. 
Published: July 2017

Purpose:
Intraarticular distal radius fractures are often treated with open reduction and internal fixation (ORIF) through a volar approach. This common approach, however, is technically demanding to restore the articular surface of the radiocarpal joint while respecting soft tissue integrity. The purpose of this video is to demonstrate the surgical technique of volar plate fixation of an intraarticular distal radius fracture.

Methods:
A 32-year-old patient who sustained multiple injuries including an intraarticular distal radius fracture was treated with ORIF by a volar approach.

Results:
Exposure is performed through a standard flexor carpi radialis approach. The intraarticular fracture of the distal radius is reduced, and a volar plate is applied. Careful measurement of screw length is described in detail to minimize postoperative tendon irritation. Closure of the soft tissues is completed and early postoperative rehabilitation is emphasized.

Discussion:
Multiple, varied techniques for fixation of intraarticular distal radius fractures are described in the literature. As demonstrated in this video of ORIF with a volar plate, attention to articular reduction, soft-tissue protection, and postoperative rehabilitation are key components used to achieve good clinical outcomes.
Defining a Ventilation Strategy for Flexible Bronchoscopy on Mechanically Ventilated Patients in the Medical Intensive Care Unit
Authors: Greenstein Yonatan Y. , Shakespeare Eric , Doelken Peter , Mayo Paul H. 
Published: July 2017

Background:
Flexible bronchoscopy (FB) in intubated patients on mechanical ventilation increases airway resistance. During FB, two ventilatory strategies are possible: maintaining tidal volume (V
T) while maintaining baseline CO2 or allowing reduction of V
T. The former strategy carries risk of hyperinflation due to expiratory flow limitation with FB. The aim of the authors was too study end expiratory lung volume (EELV) during FB of intubated subjects while limiting V
T.

Methods:
We studied 16 subjects who were intubated on mechanical ventilation and required FB. Changes in EELV were measured by respiratory inductance plethysmography. Ventilator mechanics, EELV, and arterial blood gases, were measured.

Results:
FB insertions decreased EELV in 64% of cases (−325±371 mL) and increased it in 32% of cases (65±59 mL). Suctioning decreased EELV in 76% of cases (−120±104 mL) and increased it in 16% of cases (29±33 mL). Respiratory mechanics were unchanged. Pre-FB and post-FB, PaO2 decreased by 61±96 mm Hg and PaCO2 increased by 15±7 mm Hg.

Conclusions:
There was no clinically significant increase in EELV in any subject during FB. Decreases in EELV coincided with FB-suctioning maneuvers. Peak pressure limiting ventilation protected the subject against hyperinflation with a consequent, well-tolerated reduction in V
T, and hypercapnea. Suctioning should be limited, especially in patients vulnerable to derecruitment effect.
Helicobacter pylori infection among patients with liver cirrhosis
Authors: Pogorzelska Joanna , Łapińska Magda , Kalinowska Alicja , Łapiński Tadeusz W. , Flisiak Robert 
Published: July 2017

Background and aim
Inflammatory changes in the stomach caused by Helicobacter pylori indirectly and directly affect liver function. Moreover, the bacteria may worsen the course of the liver cirrhosis. The study aimed at evaluating the incidence of H. pylori infection among patients with liver cirrhosis, depending on the etiology and injury stage, scored according to Child–Pugh classification. Stage of esophageal varices and endoscopic inflammatory lesions in the stomach were evaluated, depending on the presence of H. pylori infection.

Patients and methods
The study included 147 patients with liver cirrhosis: 42 were infected with hepatitis C virus, 31 were infected with hepatitis B virus, 56 had alcoholic liver cirrhosis, and 18 had primary biliary cirrhosis. Diagnosis of H. pylori infection was performed based on the presence of immunoglobulin G antibodies in serum.

Results

H. pylori infection was found in 46.9% of patients. The incidence of H. pylori infection among patients with postinflammatory liver cirrhosis was significantly higher (P=0.001), as compared with patients with alcoholic liver cirrhosis. Ammonia concentration was significantly higher in patients infected with H. pylori, compared with noninfected individuals (129 vs. 112 μmol/l; P=0.002). Incidence of H. pylori infection in patients without esophageal varices was significantly lower compared with patients with esophageal varices (14 vs. 60%; P<0.001).

Conclusion

H. pylori infection is significantly more frequent among patients with postinflammatory liver cirrhosis (infected with hepatitis C virus or hepatitis B virus) than in patients with alcoholic liver cirrhosis or primary biliary cirrhosis. H. pylori infection correlates with elevated concentration of blood ammonia and the incidence of esophageal varices.
Reliability of Smartphone-Based Instant Messaging Application for Diagnosis, Classification, and Decision-making in Pediatric Orthopedic Trauma
Authors: Stahl Ido , Katsman Alexander , Zaidman Michael , Keshet Doron , Sigal Amit , Eidelman Mark 
Published: July 2017

Objective
Smartphones have the ability to capture and send images, and their use has become common in the emergency setting for transmitting radiographic images with the intent to consult an off-site specialist. Our objective was to evaluate the reliability of smartphone-based instant messaging applications for the evaluation of various pediatric limb traumas, as compared with the standard method of viewing images of a workstation-based picture archiving and communication system (PACS).

Methods
X-ray images of 73 representative cases of pediatric limb trauma were captured and transmitted to 5 pediatric orthopedic surgeons by the Whatsapp instant messaging application on an iPhone 6 smartphone. Evaluators were asked to diagnose, classify, and determine the course of treatment for each case over their personal smartphones. Following a 4-week interval, revaluation was conducted using the PACS. Intraobserver agreement was calculated for overall agreement and per fracture site.

Results
The overall results indicate “near perfect agreement” between interpretations of the radiographs on smartphones compared with computer-based PACS, with κ of 0.84, 0.82, and 0.89 for diagnosis, classification, and treatment planning, respectively. Looking at the results per fracture site, we also found substantial to near perfect agreement.

Conclusions
Smartphone-based instant messaging applications are reliable for evaluation of a wide range of pediatric limb fractures. This method of obtaining an expert opinion from the off-site specialist is immediately accessible and inexpensive, making smartphones a powerful tool for doctors in the emergency department, primary care clinics, or remote medical centers, enabling timely and appropriate treatment for the injured child. This method is not a substitution for evaluation of the images in the standard method over computer-based PACS, which should be performed before final decision-making.
How Accurate Are Pediatric Emergency Tapes? A Comparison of 4 Emergency Tapes With Different Length-Based Weight Categorization
Authors: Both Christian P. , Schmitz Achim , Buehler Philipp K. , Weiss Markus , Schmidt Alexander R. 
Published: July 2017

Objective
Pediatric emergency tapes have been developed to support paramedics and emergency physicians when dosing drugs and selecting medical equipment in pediatric emergency situations. The aim of this study was to compare the accuracy of 4 pediatric emergency tapes to correctly estimate patient's weight based on a large population of patients.

Methods
Patients undergoing general anesthesia between January 2012 and March 2015 with documented age, sex, body weight, and length were identified from the electronic anesthesia patient data management system of the Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland. Weight estimation by means of the Broselow-Tape, the Pädiatrisches Notfalllineal, the Paulino System, and the Kinder-Sicher were compared with true patient's weight. Percentages of estimated body weight within a ±10% and ±20% interval were calculated. Data are median (interquartile range) or count (percent); statistical calculations were done with McNemar and Bonferroni correction.

Results
A total of 3307 patients were identified with complete data sets, 1930 (58.4%) were male, median age was 4.1 years (1.1–8.2 years), median length 101.0 cm (74.0–126.0 cm) and median patient weight 15.8 kg (9.2–25.0 kg). The proportion weight estimation within the ±10% and the ±20% interval was the highest in the Broselow-Tape with 54.0% and 81.5% (P < 0.001 and P = 0.003), followed by the Pädiatrisches Notfalllineal (50.5% and 79.8%), Paulino System (49.9% and 78.0%) and Kinder-Sicher (48.2% and 77.5%).

Conclusions
The overall accuracy of all 4 emergency tapes tested is poor and including a larger number of weight categories does not necessarily increase accuracy. Other strategies have to be developed to improve weight estimation in pediatric emergency situations.
The Use, Safety, and Efficacy of Olanzapine in a Level I Pediatric Trauma Center Emergency Department Over a 10-Year Period
Authors: Cole Jon B. , Klein Lauren R. , Strobel Ashley M. , Blanchard Stephane R. , Nahum Rebecca , Martel Marc L. 
Published: July 2017

Objectives
Olanzapine is a second-generation antipsychotic increasingly used in emergency medicine for many indications. Literature on its use in children is sparse. Our objectives were to describe the use, safety, and efficacy of olanzapine in pediatric emergency patients.

Methods
A structured chart review was performed of patients 18 years old or younger receiving olanzapine from 2007 to 2016 in the emergency department of a pediatric level I trauma center.

Results
A total of 285 children received olanzapine. Mean age was 16.4 years (range, 9–18 years); 121 were male (42.8%). Primary indications for olanzapine included agitation (n = 166, 58.3%), headache (n = 58, 20.4%), nausea/vomiting/abdominal pain (n = 37, 12.5%), unspecified pain (n = 20, 7%), and other (n = 4, 1.4%). Route of olanzapine administration was intramuscular (n = 160, 56%; median dose, 10 mg; range, 2.5–20), intravenous (n = 101, 36%; median dose, 5 mg; range, 1.25–5), and oral (n = 24, 8%; median dose, 10 mg; range, 5–10). For agitated patients, 28 (17%) received another sedative within 1 hour. For headache patients, 5 (8.6%) received another analgesic. For gastrointestinal complaints, 5 patients (13.5%) received another analgesic/antiemetic. Adverse respiratory events were hypoxia (pulse oximetry reading, in percentage, <92%; n = 7, 2.4%), supplemental oxygen placement (n = 9, 3.2%), and intubation (n = 2, 0.7%). No patient died or had a dysrhythmia. One patient experienced dystonia.

Conclusions
Olanzapine seems safe when used for a variety of conditions in pediatric emergency patients. It may be effective for acute agitation, primary headache, and gastrointestinal complaints.
Experimental Models of Endotheliopathy: Impact of Shock Severity
Authors: Hofmann Nikolaus , Zipperle Johannes , Jafarmadar Mohammad , Ashmwe Mostafa , Keibl Claudia , Penzenstadler Carina , Ponschab Martin , Jafarmadar Behnaz , Redl Heinz , Bahrami Soheyl , Schöchl Herbert 
Published: July 2017

ABSTRACT

Background:
Hemorrhagic shock (HS) followed by resuscitation is often associated with sympathoadrenal activation (SAA) and endothelial damage (ED).

Objective:
We aimed to evaluate the impact of HS alone on the magnitude of SAA and consecutive ED, and to characterize potential targets for a standardized and reproducible model of HS-induced endotheliopathy in rats.

Methods:
Rats were subjected either to a volume-controlled HS (40% of total blood volume: v-HS group) or to a laboratory-guided HS (l-HS) targeting base deficit (BD) more than 5.5 mmol/L and/or lactate more than 2.2 mmol/L using a pressure-controlled volume loss.

Results:
At the end of shock, mean arterial pressure was significantly higher in the v-HS than the l-HS group (36 ± 5.6 vs. 30 ± 3.0 mmHg; P < 0.01). Base deficit and lactate were higher in l-HS than the v-HS group (BD: 9.5 ± 2.5 vs. 3.0 ± 1.0 mmol/L; P < 0.001; lactate: 4.1 ± 1.3 vs. 1.6 ± 0.6 mmol/L; P < 0.001). sVEGFR-1 and syndecan-1 were approximately 50% higher in the l-HS than the v-HS group (% changes vs. baseline: 160 ± 10 vs. 116 ± 36; P < 0.01; 170 ± 37 vs. 113 ± 27; P < 0.001). Adrenaline was 2-fold higher in l-HS than the v-HS group (1964 ± 961% vs. 855 ± 451%; P < 0.02, respectively). Moreover, linear regression analysis revealed an independent association of shock severity BD with syndecan-1 (rho = 0.55, P = 0.0005), sVEGFR1 (rho = 0.25, P < 0.05), and adrenaline (rho = 0.31, P = 0.021).

Conclusions:
Our findings indicate that ED has already occurred during HS without reperfusion; intensity is strongly related to the severity of HS and consecutive SAA; and severity may appropriately be targeted and standardized in a HS model controlled by biological endpoints such as BD and/or lactate.
Science Game Lab: tool for the unification of biomedical games with a purpose
Authors: Good Benjamin M. , Santini Sarah , Wallace Margaret , Fortugno Nicholas , Szeder John , Mooney Patrick , Waldispuhl Jerome , Tsueng Ginger , Su Andrew I 
Published: July 2017

AbstractGames with a purpose and other kinds of citizen science initiatives demonstrate great potential for advancing biomedical science and improving STEM education. Articles documenting the success of projects such as Fold.it and Eyewire in high impact journals have raised wide interest in new applications of the distributed human intelligence that these systems have tapped into. However, the path from a good idea to a successful citizen science game remains highly challenging. Apart from the scientific difficulties of identifying suitable problems and appropriate human-powered solutions, the games still need to be created, need to be fun, and need to reach a large audience that remain engaged for the long-term. Here, we describe Science Game Lab (SGL) (https://sciencegamelab.org), a platform for bootstrapping the production, facilitating the publication, and boosting both the fun and the value of the user experience for scientific games with a purpose.
Developmental constraints on genome evolution in four bilaterian model species
Authors: Liu Jialin , Robinson-Rechavi Marc 
Published: July 2017

AbstractDevelopmental constraints on genome evolution have been suggested to follow either an early conservation model or an “hourglass” model. Both models agree that late development strongly diverges between species, but debate on which developmental period is the most conserved. Here, based on a modified “Transcriptome Age Index” approach, i.e. weighting trait measures by expression level, we analyzed the constraints acting on three evolutionary traits of protein coding genes (strength of purifying selection on protein sequences, phyletic age, and duplicability) in four species: nematode wormCaenorhabditis elegans, flyDrosophila melanogaster, zebrafishDanio rerio, and mouseMus musculus. In general, we found that both models can be supported by different genomic properties. Sequence evolution follows an hourglass model, but the evolution of phyletic age and of duplicability follow an early conservation model. Further analyses indicate that stronger purifying selection on sequences in the middle development are driven by temporal pleiotropy of these genes. In addition, we report evidence that expression in late development is enriched with retrogenes, which usually lack efficient regulatory elements. This implies that expression in late development could facilitate transcription of new genes, and provide opportunities for acquisition of function. Finally, inC. elegans, we suggest that dosage imbalance could be one of the main factors that cause depleted expression of high duplicability genes in early development.
Institutional drivers of land mobility
Authors: Geoghegan Cathal , Kinsella Anne , O’Donoghue Catahl 
Published: July 2017

PurposeThe purpose of this paper is to examine the role of institutional factors in agricultural structural change in the European Union (EU) using the case study of land mobility in Ireland. A range of agricultural land use options are compared in order to examine the effect of domestic and EU policy instruments on land mobility.Design/methodology/approachUsing socio-economic data from the Teagasc National Farm Survey, three hypothetical farms are created using a microsimulation approach to compare incomes across farm systems and land use options. Tax and subsidy policies are applied to derive returns for the hypothetical farms under a variety of land use scenarios.FindingsThe analysis finds that in comparing four hypothetical scenarios, leasing out agricultural land on a long-term basis can prove more profitable for cattle and tillage farmers than farming the land. Only dairy farmers derive consistently higher disposable incomes from farming their land as opposed to leasing it out. Changes in CAP rules can also negatively affect farmers taking advantage of Ireland’s tax-based leasing incentives.Originality/valueA gap in the literature exists in terms of how institutional factors may act to prevent either land supply or demand channels from functioning properly. This paper addresses that gap, using Ireland as a case study.
Circumventing the predatory state
Authors: C. Besenhard Petra , G. Wenzel Nikolai 
Published: July 2017

Purpose
The purpose of this paper is to study the decline of the Tuareg, and explore the emergence of traditional elements of Tuareg culture to circumvent formal barriers to trade.

Design/methodology/approach
This paper examines the history of the Tuareg through the lens of the New Development Economics.

Findings
This paper examines three elements of past Tuareg wealth: the caravan trade as spontaneous order; the unintended consequences of forced modernization policies under colonization and post-colonial states; and contemporary problems from hindered freedom of trade. The bad news is that the Tuareg are facing impediments from failed states with low economic and political freedom. The good news is that traditional elements in the Tuareg’s entrepreneurial culture are re-emerging to circumvent formal barriers.

Research limitations/implications
The literature on the Tuareg is largely pessimistic, as the Tuareg’s traditions have largely been quashed by post-colonial boundaries and failed states. The New Development Economics offers a new perspective, with two implications. First, there is hope for the Tuareg, and a possible win-win, if the local states adopt a policy of laissez faire and international trade, rather than assimilation or repression. Second, this theoretical lens can be used in other cases throughout Africa (and the world) involving post-colonial borders.

Originality/value
There already exists a rich literature on the Tuareg. This paper uses the New Development Economics to examine the history of the Tuareg’s decline – and to find hope in traditional elements of Tuareg entrepreneurship emerging to circumvent local failed (and predatory) states.
Evaluating health service quality: using importance performance analysis
Authors: Izadi Azar , Jahani Younes , Rafiei Sima , Masoud Ali , Vali Leila 
Published: July 2017

Purpose
Measuring healthcare service quality provides an objective guide for managers and policy makers to improve their services and patient satisfaction. Consequently, the purpose of this paper is to measure service quality provided to surgical and medical inpatients at Kerman Medical Sciences University (KUMS) in 2015.

Design/methodology/approach
A descriptive-analytic study, using a cross-sectional method in the KUMS training hospitals, was implemented between October 2 and March 15, 2015. Using stratified random sampling, 268 patients were selected. Data were collected using an importance-performance analysis (IPA) questionnaire, which measures current performance and determines each item’s importance from the patients’ perspectives. These data indicate overall satisfaction and appropriate practical strategies for managers to plan accordingly.

Findings
Findings revealed a significant gap between service importance and performance. From the patients’ viewpoint, tangibility was the highest priority (mean=3.54), while reliability was given the highest performance (mean=3.02). The least important and lowest performance level was social accountability (mean=1.91 and 1.98, respectively).

Practical implications
Healthcare managers should focus on patient viewpoints and apply patient comments to solve problems, improve service quality and patient satisfaction.

Originality/value
The authors applied an IPA questionnaire to measure service quality provided to surgical and medical ward patients. This method identifies and corrects service quality shortcomings and improving service recipient perceptions.
The nursing quality indicator framework tool
Authors: Connolly Dawn , Wright Fiona 
Published: July 2017

Purpose
The purpose of this paper is to develop a nursing quality indicator (NQI) framework and provide a comprehensive reporting mechanism for nursing care.

Design/methodology/approach
Mixed method, including patient records audit, patient experience questionnaire, nurse self-report questionnaire and collecting ward-level information. The sample was 53 patients and 22 nurses.

Findings
Outputs from the NQI framework domains offer a more comprehensive understanding of nursing quality compared to when domains are analysed separately. The NQI framework also provides a more inclusive mechanism for assuring nursing care.

Research limitations/implications
Sample size was limited to 53 English-speaking patients who consented to participating in the study.

Originality/value
One design strength was the ability to describe individual patient care across the four domains and subsequently show relationships between nursing knowledge, nursing interventions and patient outcomes/experiences. Additionally, corroborated information from three sources (documentation review, patient and nurse responses) strengthened the conclusion that the NQI framework could provide more comprehensive assurances on nursing quality and identify care improvements.
State space approach with FEM for the determination of structural behaviour of composite plates
Authors: Albostami Asad Shukri , Wu Zhangjian , Zou Zhenmin 
Published: July 2017

PurposeAn analytical investigation has been carried out for a simply supported rectangular plate with two different loading conditions by using 3D state space approach (SSA). Also, the accurate location of the neutral plane (N.P.) through the thickness of the plate can be identified: the N.P. is shifted away from the middle plane according to the loading condition. The paper aims to discuss these issues.Design/methodology/approachSSA and finite element method are used for the determination of structural behaviour of simply supported orthotropic composite plates under different types of loading. The numerical results from a finite element model developed in ABAQUS.FindingsThe effect of the plate thickness on displacements and stresses is described quantitatively. It is found that the N.P. of the plate, identified according to the values of the in-plane stresses through the thickness direction, is shifted away from the middle plane. Further investigation shows that the position of the N.P. is loading dependant.Originality/valueThis paper describe the effect of the plate thickness on displacements and stresses quantitatively by using an exact solution called SSA. Also, it is found that the N.P. of the plate, identified according to the values of the in-plane stresses through the thickness direction, is shifted away from the middle plane. Further investigation shows that the position of the N.P. is loading dependant.