bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Brain Resting-state Functional Connectivity Associated with Peripheral Nerve Block
Authors: Melton M. Stephen , Browndyke Jeffrey N. , Harshbarger Todd B. , Madden David J. , Nielsen Karen C. , Klein Stephen M. 
Published: June 2016

Abstract

Background
Limited information exists on the effects of temporary functional deafferentation (TFD) on brain activity after peripheral nerve block (PNB) in healthy humans. Increasingly, resting-state functional connectivity (RSFC) is being used to study brain activity and organization. The purpose of this study was to test the hypothesis that TFD through PNB will influence changes in RSFC plasticity in central sensorimotor functional brain networks in healthy human participants.

Methods
The authors achieved TFD using a supraclavicular PNB model with 10 healthy human participants undergoing functional connectivity magnetic resonance imaging before PNB, during active PNB, and during PNB recovery. RSFC differences among study conditions were determined by multiple-comparison–corrected (false discovery rate–corrected P value less than 0.05) random-effects, between-condition, and seed-to-voxel analyses using the left and right manual motor regions.

Results
The results of this pilot study demonstrated disruption of interhemispheric left-to-right manual motor region RSFC (e.g., mean Fisher-transformed z [effect size] at pre-PNB 1.05 vs. 0.55 during PNB) but preservation of intrahemispheric RSFC of these regions during PNB. Additionally, there was increased RSFC between the left motor region of interest (PNB-affected area) and bilateral higher order visual cortex regions after clinical PNB resolution (e.g., Fisher z between left motor region of interest and right and left lingual gyrus regions during PNB, −0.1 and −0.6 vs. 0.22 and 0.18 after PNB resolution, respectively).

Conclusions
This pilot study provides evidence that PNB has features consistent with other models of deafferentation, making it a potentially useful approach to investigate brain plasticity. The findings provide insight into RSFC of sensorimotor functional brain networks during PNB and PNB recovery and support modulation of the sensory–motor integration feedback loop as a mechanism for explaining the behavioral correlates of peripherally induced TFD through PNB.
The Effect of Position on PaCO2 and PETCO2 in Patients Undergoing Cervical Spine Surgery in Supine and Prone Position
Authors: Yadav Monu , Reddy Elmati Praveen , Sharma Ashima , Kulkarni Dilip Kumar , Gopinath Ramachandran 
Published: June 2016

Background:
As per American Society of Anesthesiologists guidelines, continuous monitoring of end tidal carbon dioxide (PETCO2) is recommended as standard II basics of anesthetic monitoring especially to ensure adequate ventilation during all anesthetics. Continuous monitoring of PETCO2 can also be used as a guide to maintain the partial pressure of carbon dioxide in arterial blood (PaCO2) to desired level during the surgery.

Aims and Objectives:
To study the effect of position on PaCO2 and PETCO2 during cervical spine surgery in prone position.

Materials and Methods:
Following institutional ethical committee approval and written informed consent, a prospective study was conducted in 40 patients of 18 to 60 years and of American Society of Anesthesiologists I and II scheduled for cervical spine surgery in prone position. In operating room, the patient is connected to standard monitoring and intravenous access was secured. A 20 G arterial cannula was placed. General anesthesia administered and oral endotracheal intubation done. Baseline values of systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, temperature, SpO2, P
peak, P
mean, and P
plateau were measured in supine position. For each patient the capnometer was calibrated before use. The P(a-ET)CO2 was calculated in supine position (S1). The PaCO2 and ETCO2 were measured after prone positioning P1, at each subsequent hour (P2, P3, P4), and on completion of the procedure in supine position (S2). The mean values were used for further analysis.

Results:
The PETCO2 and PaCO2 decreased significantly in cervical spine surgery patients with change of position from supine to prone with no significant change in arterial to end tidal CO2 gradient (P(a-ET)CO2).

Conclusions:
PETCO2 can be used as a reliable guide to estimate PaCO2 during cervical spine procedures in prone position.
The Alternative Peer Group
Authors: Nash Angela , Collier Crystal 
Published: June 2016

Abstract
Recovery as the goal for substance use disorder treatment has been a key component of the Substance Abuse and Mental Health Services Administration’s mission for the past decade. Consistent with their mission, there is a call for research and development of recovery-oriented systems of care to support affected individuals through all stages of the recovery process. Evidence is emerging to support recovery practice and research for adults, but recovery-oriented models for adolescents are scant. The Alternative Peer Group (APG) is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice. Employing APG participants’ own words, this article will describe the essential elements and three theoretical frameworks underlying the APG model to illustrate how the APG serves as a developmentally appropriate recovery support service for adolescents with substance use disorder.
Health Promotion in an Opioid Treatment Program
Authors: Gadbois Christine , Chin Elizabeth D. , Dalphonse Lee 
Published: June 2016

Abstract
Community assessment and review of the literature indicate that individuals supported in opioid treatment programs are at a significant disadvantage for access to preventative and primary healthcare. In addition, this population faces increased comorbidities and chronic disease. Finally, access to housing, nutritious food, and other social determinants of health is also a challenge for these individuals. This project, aimed at addressing healthcare disparities and improving health outcomes for the opioid treatment program client, was undertaken at a large, private, not-for-profit, community mental health center in an urban area. An education–practice partnership was created between the center and the local university’s College of Nursing, which includes undergraduate and graduate programs. Working with administration, nurses, medical staff, and clinicians, the advanced practice nurse guided nursing practice change within the context of an interdisciplinary team to increase attention to clients’ health needs. Outcomes included a more comprehensive nursing health assessment and increased attention to nursing care coordination. The partnership between the university and the facility continues with the goal of addressing clients’ unmet healthcare needs and improving wellness via on-site intervention, referral, and education.
Recovery in the 21st Century
Authors: Gumbley Stephen J. 
Published: June 2016

Abstract
Through the “war on drugs,” the just-say-no campaign, and into the early years of this century, the overarching approach to substance use disorders (SUDs) called for a single outcome (abstinence) and a single methodology (spiritual connection with a higher power) as the remedy for SUDs. Those who did not become permanently abstinent or rejected the spiritual approach were seen as “not ready” or “in denial.”
A seismic shift in thinking about “addiction” and “recovery” began in earnest in the 1990s. In 2005, the Substance Abuse and Mental Health Services Administration brought together leaders of the treatment and recovery field for the historic National Summit on Recovery to develop broad-based consensus on guiding principles for recovery and elements of recovery-oriented systems of care.
Major changes associated with the recovery-oriented approach include viewing SUDs as chronic, rather than acute, problems that require long-term support and focusing on recovery management rather than disease management. Complete abstinence is not an absolute requirement for wellness for all persons with SUDs. There are “many pathways to recovery,” not only the 12-Step approach (White & Kurtz, 2006). Sustained recovery is self-directed and requires personal choices, the support of peers and allies, and community reinforcement as well as a strength-based approach and the use of research-based interventions. This Perspectives column addresses the historical context for the transformation toward a recovery-oriented system of care, highlights federal efforts to promote recovery-oriented approaches, and describes recovery-oriented terminology to reduce misconceptions, labeling, and stigmatization and promote recovery for individuals, families, and communities.
The Eponyms and Inheritance of the Genetic Disorders of Pigmentation
Authors: Chow Maggie L. , Jacob Sharon E. 
Published: June 2016

ABSTRACT
In clinical practice, the genetic disorders of pigmentation are often referred to by their eponyms, which are terms named after people or, occasionally, places or things (“Eponym,” 2014). This article will describe the eponyms, inheritance patterns, and key clinical features of the diseases and genetic disorders associated with aberrant pigmentation.
Atypical Kawasaki Disease
Authors: Rholdon Roger D. , Rholdon Frankie G. 
Published: June 2016

ABSTRACT
Kawasaki disease is one of the most common vasculitic syndromes occurring in childhood. Typically, the disease is a self-limited condition consisting of fever and acute inflammation lasting an average of 12 days without therapy. However, complications such as coronary artery aneurysms can lead to significant morbidity and mortality. We present the case of a 6-year-old boy whose course of illness led to four diagnoses until ultimately an accurate diagnosis was established leading to appropriate treatment. This case shows the importance of executing an accurate identification of a disease that is at times atypical in presentation.
Site of Bronchoalveolar Lavage Via Flexible Bronchoscopy and Fluid Return in Children
Authors: Rosas-Salazar Christian , Walczak Stephen A. , Kurland Geoffrey , Spahr Jonathan E. 
Published: June 2016

Background:
Despite its widespread use as a diagnostic tool, the procedure for bronchoalveolar lavage (BAL) via flexible bronchoscopy is not standardized in children. Our objective was to examine the dissimilarities in fluid return between the different lobes in children undergoing flexible bronchoscopies with BAL.

Methods:
We conducted a review of all pediatric flexible bronchoscopies with BAL conducted at a single institution over a 2-year period. Our predictor of interest was the site of the BAL. Our outcome of interest was the percent of fluid return. We used 1-way analysis of variance with subsequent pairwise comparisons for unadjusted analyses and multivariable linear regression for adjusted analyses.

Results:
We identified 529 procedures that met prespecified criteria. The mean (SD) percent of fluid return was 52.1 (14.4) for the right middle lobe, 50.7 (16.0) for the lingula (LIN), 50.5 (18.6) for the right or left upper lobes other than LIN (R/L-UL), and 42.2 (18.7) for the right or left lower lobes (R/L-LL). The R/L-LL had significantly lower fluid return when compared with each of the other lobes (P<0.05 for all pairwise comparisons); in contrast, there was no significant difference in fluid return between the other lobes. In our main analysis adjusting for potential confounders, performing the BAL in the right middle lobe, LIN, or R/L-UL increased the fluid return by 11.1% [95% confidence interval (CI), 6.2-16.1], 9.5% (95% CI, 3.2-15.8), and 8.7% (95% CI, 0.9-16.5%), respectively, when compared with the R/L-LL.

Conclusion:
Our results suggest that the lower lobes provide the lowest BAL fluid return in children, whereas the other lobes seem to perform similarly.
The Effects of the Transition From Medicaid to Medicare on Health Care Use for Adults With Mental Illness
Authors: Burns Marguerite E. , Huskamp Haiden A. , Smith Jessica C. , Madden Jeanne M. , Soumerai Stephen B. 
Published: June 2016

Background:
The transition from Medicaid-only to dual Medicare/Medicaid coverage has the potential to reduce financial barriers to health care for patients with serious mental illness through increased coverage or expanded access to clinicians as their reimbursement increases.

Aims:
To estimate the effect of dual coverage after Medicaid enrollment during the required waiting period among adults with serious mental illness on health care use, overall and related to mental health and substance use disorders (MHSUD).

Methods:
Data include enrollment and claims from Medicaid and Medicare in Missouri and South Carolina, from January 2004 to December 2007. We used an interrupted time-series design to estimate the effect of dual coverage on average use of outpatient, emergency department (ED), and inpatient care/month.

Results:
After 12 months of dual coverage, the probability of outpatient care use increased in both states from 4% to 9%. In Missouri, the mean probability and frequency of ED visits, total and MHSUD related, increased by 21%–32%; the probability of all-cause and MHSUD-related inpatient admissions increased by 10% and 19%, respectively. In South Carolina, the mean probability of any inpatient admission increased by 27% and of any MHSUD-related inpatient admission by 42%.

Discussion:
The increase in use of outpatient care is consistent with the expected increase in coverage of, and payment for, outpatient services under dual coverage relative to Medicaid-only. Sustained increases in ED and inpatient admissions raise questions regarding the complexity of obtaining care under 2 programs, pent-up demand among beneficiaries pretransition, and the complementarity of outpatient and inpatient service use.
Effects of Orthokeratology on Choroidal Thickness and Axial Length
Authors: Chen Zhi , Xue Feng , Zhou Jiaqi , Qu Xiaomei , Zhou Xingtao 
Published: June 2016

ABSTRACT

Purpose
To investigate the effect of orthokeratology (ortho-k) treatment on choroidal thickness and its relationship with axial length change.

Methods
Seventy-seven myopic subjects aged between 7 and 17 years were treated with ortho-k lenses (n = 39) or single-vision spectacle lenses (SVL, n = 38). Choroidal thickness and axial length measurements were taken at baseline and repeated 1 week and 3 weeks after lens wear for the ortho-k group and at 3 weeks for the SVL group. Parafoveal choroidal thickness was assessed using optical coherence tomography and segmented into nine regions according to the Early Treatment Diabetic Retinopathy Study (ETDRS) within a 6 × 6 mm circular zone centered on the fovea. Axial length was measured using partial coherence interferometry. The changes in subfoveal choroidal thickness were compared to the changes in axial length in both study groups.

Results
The change in axial length was significantly correlated with the change in choroidal thickness in both groups at 3 weeks (ortho-k, r = −0.351, p = 0.028 vs. SVL, r = −0.408, p = 0.011). Parafoveal choroidal thickness increased after 3 weeks of lens wear in the ortho-k group (mean, 21.8 ± 25.2 μm) but did not change in the SVL group (mean, 0.1 ± 19.7 μm). Choroidal thickness significantly varied across the posterior retinal regions (F = 82.14, p < 0.001), with the temporal regions being thickest and nasal regions being thinnest. After 3 weeks of ortho-k treatment, the magnitude of change (range, 14.1–27.6 μm) in choroidal thickness of the nine ETDRS regions was proportional to the baseline choroidal thickness in those regions (r = 0.88, p = 0.002). Axial length did not significantly change over time (F = 0.001, p = 0.975) and did not differ between the two treatment modalities (F = 0.305, p = 0.582).

Conclusions
Choroidal thickness increases after short-term ortho-k treatment. Regional choroidal thickening after ortho-k treatment may be attributable to the altered retinal defocus profile associated with ortho-k lens wear.
Eyelid Margin and Meibomian Gland Characteristics and Symptoms in Lens Wearers
Authors: Cox Stephanie M. , Berntsen David A. , Chatterjee Neil , Hickson-Curran Sheila B. , Jones Lyndon W. , Moezzi Amir M. , Morgan Philip B. , Nichols Jason J. 
Published: June 2016

ABSTRACT

Purpose
To describe the lid margin characteristics of contact lens wearers and relate them to comfort during lens wear.

Methods
Three study sites enrolled habitual contact lens wearers. Subjects completed the Comfort domain of the Contact Lens User Experience (CLUE) questionnaire, and each eye was graded for the presence of mucocutaneous junction (MCJ) displacement, lid margin irregularity, and lid margin vascularity. Examiners counted the number of meibomian gland (MG) orifices in the central centimeter of the lower eyelid and the number of those that showed pouting/plugging and vascular invasion. MG expressibility was graded according to the Shimazaki schema. Subjects were grouped based on presence/absence of each characteristic, total number of orifices (≥5 vs. <5), and expressibility (grade 0 vs. >0). Descriptive statistics are reported. A linear model was used to assess the fixed effect of each characteristic on combined CLUE score and each CLUE statement, if the effect on combined CLUE score showed p < 0.10.

Results
The study included 203 subjects (67.5% female) with mean age (±SD) of 30.3 ± 9.6 years. The most commonly observed characteristics were orifice pouting/plugging, compromised MG expressibility, and lid margin vascularity (35.0, 30.3, and 20.4%, respectively). MCJ displacement and MG expressibility had an effect on the combined CLUE score such that individual CLUE statements were analyzed (p = 0.01 and p = 0.06, respectively). MCJ displacement had an effect on comfort upon insertion (p = 0.01), comfort after 5 minutes (p = 0.03), end-of-day comfort (p = 0.01), and ability to maintain ocular moisture (p = 0.030). MG expressibility had a significant effect on general comfort (p = 0.01), comfort throughout the day (p = 0.02), and the ability to maintain ocular moisture (p = 0.02).

Conclusions
MCJ displacement and MG expressibility have an effect on contact lens comfort.
Description of PICU Unplanned Readmission*
Authors: Kotsakis Afrothite , Stevens Derek , Frndova Helena , Neal Richard , Williamson Grace , Mohseni-Bod Hadi , Parshuram Christopher S. 
Published: June 2016

Objectives:
ICU readmission within 48 hours of discharge is associated with increased mortality. The objectives of this study were to describe the frequency of, factors associated with, and outcomes associated with unplanned PICU readmission.

Design:
A retrospective case-control study was performed. We evaluated 13 candidate risk factors and report patient outcomes following readmission. Subgroup analyses were performed for patients discharged from the cardiac PICU and medical-surgical PICU.

Setting:
The study was undertaken at the Hospital for Sick Children, Department of Critical Care Medicine.

Patients:
Eligible patients were discharged from the PICU to an inpatient ward between December 2006 and January 2013. Case patients were readmitted to the PICU within 48 hours of discharge.

Measurements and Main Results:
There were 10,422 eligible patient discharges; 264 (2.5%) were readmitted within 48 hours. In the univariable analysis, unplanned readmission was associated with PICU patient admissions of younger age, lower weight, greater duration of PICU stay, greater cumulative stay in PICU in the past 2 years, higher Pediatric Logistic Organ Dysfunction score on PICU discharge, discharge outside goal discharge time (06:00–11:59 hr), use of extracorporeal organ support during ICU stay, greater Bedside Pediatric Early Warning Score, at discharge and discharge from the cardiac PICU. In the multivariable analysis, the factors most significantly associated with unplanned PICU readmission were length of stay more than 48 hours, greater cumulative length of PICU stay in the past 2 years, discharge from cardiac PICU, and higher Pediatric Logistic Organ Dysfunction and Bedside Pediatric Early Warning Scores on index discharge. Mortality was 1.8 times (p = 0.03) higher in patients with an unplanned PICU readmission compared with patients during their index PICU admission.

Conclusions:
The only potentially modifiable factors we found associated with PICU readmission within 48 hours of discharge were discharge time of day and the Pediatric Logistic Organ Dysfunction and Bedside Pediatric Early Warning Scores at the time of PICU discharge.
Iodine Concentration and Optimization in Computed Tomography Angiography
Authors: Faggioni Lorenzo , Gabelloni Michela 
Published: June 2016

Abstract
Computed tomography (CT) technology has seen a dramatic evolution in the recent past that has deeply changed the face of this diagnostic modality. Since the early days of helical single-slice and then multislice CT, CT angiography (CTA) has been one of the most technically demanding applications, both in terms of scanning technique and contrast medium (CM) injection protocol, due to the need to acquire a large amount of high-resolution data over a limited period corresponding to the peak contrast enhancement of the arterial system. Iodine concentration is one of the main determinants of arterial enhancement in CTA, and current low-osmolar and iso-osmolar nonionic CM for intravascular administration still come in a handful of molecules, but a relatively wide range of different iodine concentrations. This gives the opportunity to optimize CTA protocols as a function of several factors such as patient characteristics, CT technology, and CM features in an attempt to maximize the diagnostic yield of CTA examinations while considering patient safety and avoiding unnecessary extra costs. Our aim is to provide an up-to-date overview of the existing evidence on how changing iodine concentration can have an impact on CTA performance, especially with the use of state-of-the-art CT and power injector technology, in the perspective of improving patient care while minimizing overall exposure to iodinated CM and ionizing radiation.
Automated Quantitative Plaque Analysis for Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion in Computed Tomography Angiography
Authors: Staruch Adam D. , Opolski Maksymilian P. , Slomka Piotr J. , Staruch Michal , Kepka Cezary , Witkowski Adam , Kruk Mariusz , Dey Damini 
Published: June 2016

Purpose:
The aim of this study was to evaluate the utility of automated plaque analysis in differentiating chronic total occlusion (CTO) from subtotal occlusion (SO) in patients with ambiguous coronary lesions on coronary computed tomography angiography (CTA).

Materials and Methods:
A total of 63 patients with 63 ambiguous coronary lesions on CTA were included. The lesion length (LL), diameter stenosis, plaque volume and composition, remodeling index, and contrast density difference (CDD) (reflecting intraluminal contrast kinetics over the lesion) were assessed using an automatic software tool. All patients underwent invasive coronary angiography.

Results:
Coronary angiography confirmed 28 CTOs and 35 SOs. CTOs showed significantly longer LL (6.4±12.3 vs. 1.0±2.2 mm, P=0.03) and higher CDD (74%±31% vs. 55%±32%, P=0.02) compared with SO. The optimal thresholds for prediction of CTO for CDD and LL were ≥43% and ≥1 mm, respectively (max. sensitivity: 82% for CDD, max. specificity: 77% for LL). The guidewire manipulation time correlated with LL (r=0.529, P=0.004) and CDD (r=0.435, P=0.021) in lesions attempted by percutaneous coronary intervention.

Conclusions:
Automated computed tomography plaque analysis may be applied as a noninvasive tool to differentiate CTO from SO.