bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multidisciplinary Team Learning in the Management of the Morbidly Adherent Placenta: Outcome Improvements Over Time
Authors: Shamshirsaz Alireza A. , Fox Karin A. , Erfani Hadi , Clark Steven L. , Salmanian Bahram , Baker B. Wycke , Coburn Michael , Shamshirsaz Amir A. , Bateni Zhoobin H. , Espinoza Jimmy , Nassr Ahmed A. , Popek Edwina J. , Hui Shiu-Ki , Teruya Jun , Tung Celestine Shauching , Jones Jeffery A. , Rac Martha , Dildy Gary A. , Belfort Michael A. 
Published: October 2017

(Abstracted from Am J Obstet Gynecol 2017;216:612.e1–612.e5)
Placenta accreta, increta, and percreta are described as a group as morbidly adherent placentas (MAPs), are increasing in incidence, and contribute to the morbidity and mortality related to pregnancy. The preparation and surgical approach to MAP vary by institution, and specific best practices have not been fully identified.
Effects and Unforeseen Consequences of Accessing References on a Maintenance of Certification Examination: Findings From a National Study
Authors: Feinberg Richard A. , Jurich Daniel P. , Foster Lauren M. 
Published: October 2017

Purpose
Increasing criticism of maintenance of certification (MOC) examinations has prompted certifying boards to explore alternative assessment formats. The purpose of this study was to examine the effect of allowing test takers to access reference material while completing their MOC Part III standardized examination.

Method
Item response data were obtained from 546 physicians who completed a medical subspecialty MOC examination between 2013 and 2016. To investigate whether accessing references was related to better performance, an analysis of covariance was conducted on the MOC examination scores with references (access or no access) as the between-groups factor and scores from the physicians’ initial certification examination as a covariate. Descriptive analyses were conducted to investigate how the new feature of accessing references influenced time management within the test day.

Results
Physicians scored significantly higher when references were allowed (mean = 534.44, standard error = 6.83) compared with when they were not (mean = 472.75, standard error = 4.87), F(1, 543) = 60.18, P < .001, ω
2 = 0.09. However, accessing references affected pacing behavior; physicians were 13.47 times more likely to finish with less than a minute of test time remaining per section when reference material was accessible.

Conclusions
Permitting references caused an increase in performance, but also a decrease in the perception that the test has sufficient time limits. Implications for allowing references are discussed, including physician time management, impact on the construct assessed by the test, and the importance of providing validity evidence for all test design decisions.
Psoriatic arthritis: new evidence for old concepts
Authors: Soriano Enrique R. , Marin Josefina , Acosta-Felquer Maria L. 
Published: October 2017

Purpose of reviewThe review gives an updated overview of some of the new concepts in the management of psoriatic arthritis (PsA): early diagnosis, remission as an objective, treat-to-target, and treatment guidelines.Recent findingsEarly diagnosis, targeting remission as part of a treatment strategy, and new guidelines providing evidence-based support to these concepts are main topics in recent publications.SummaryDermatologists and rheumatologists should work together to reduce the number of patients remaining undiagnosed, and the time to do so.Remission definition in PsA is still controversial. There is good evidence and convincing arguments for both multidimensional measures, such as minimal disease activity, or unidimensional ones, as disease activity index for PsA. New data on the analysis of tight control of inflammation in early PsA trial showed that the strategy might not be cost-effective on the short term, and that oligoarthritis is less benefited.The new European League Against Rheumatism and Group for Research and Assessment of Psoriasis and PsA recommendations exhibit differences. Methotrexate and tumor necrosis factor inhibitors are favored in European League Against Rheumatism guidelines, whereas other conventional synthetic disease-modifying antirheumatic drugs and biologics are equally positioned in Group for Research and Assessment of Psoriasis and PsA recommendations.
Which Domains of the ODI Best Predict Change in Physical Function in Patients After Surgery for Degenerative Lumbar Spondylolisthesis?
Authors: Murphy Hamadi A. , Warnick Eugene , McEntee Richard , Nicholson Kristen , Hollern Douglas A. , Stawicki Christie , Tarazona Daniel , Schroeder Gregory D. , Woods Barrett I. , Kurd Mark F. , Rihn Jeffrey A. , Anderson Greg D. , Kepler Christopher K. , Hilibrand Alan S. , Vaccaro Alexander R. , Radcliff Kris E. 
Published: October 2017

Study Design.
A retrospective review.

Objective.
The purpose of this study is to determine the differential improvement of the various individual items of the Oswestry Disability Index (ODI) and to determine their relationship to other measures of Health Related Quality of Life (HRQOL).

Summary of Background Data.
The ODI is an easily scored, common, 10-item questionnaire about symptoms relevant to lumbar spine pathology. It is not clear if all of the items can be reliably applied to spine surgery. The purpose of this study is to determine the differential improvement of the various individual items of the ODI and to determine their relationship to other measures of HRQOL.

Methods.
Analysis of a prospective registry of patients treated at an academic medical center was undertaken. At baseline, standardized outcome measures including ODI and SF12 PCS were collected on all patients undergoing elective fusion surgery for degenerative spondylolisthesis. Multiple linear regressions were performed using change in SF12 PCS as the dependent variable and change in ODI components as the independent variables.

Results.
Baseline and 1-year follow-up data were collected on 196 patients (mean age 60.4 years). There were statistically significant differences in improvement among ODI items. Surprisingly, the most improvement after surgery was noted in the standing, sex life, and social life domains. The least improvement was noted in the personal care, sleeping, and sitting domains. Linear regression for change in ODI components versus change in SF-12 PCS revealed a significant correlation (R
2 = 0.353, P ≤ 0.001). The only retained domains in the final model were change in lifting, standing, and traveling as predictors for ΔPCS.

Conclusion.
All domains of the ODI do not improve equally after surgery for degenerative spondylolisthesis. Some of the domains that improve most (e.g., sex life) have no discernible relationship to the known pathophysiology of degenerative spondylolisthesis. Based upon these results, we conclude that the item bank and composite scoring of the ODI are inappropriate for evaluating quality of life in studies of surgically treated degenerative spondylolisthesis patients.

Level of Evidence: 3
Advances in understanding the molecular underpinnings of adrenocortical tumors
Authors: Nicolson Norman G. , Man Jianling , Carling Tobias 
Published: October 2017

Purpose of review
Adrenocortical tumors are divided into benign adenomas and malignant carcinomas. The former is relatively common and carries a favorable prognosis, whereas the latter is rare and frequently presents at an advanced stage, with poor outcomes. Advances in next-generation sequencing, genome analysis, and bioinformatics have allowed for high-throughput molecular characterization of adrenal tumorigenesis.

Recent findings
Although recent genomic, epigenomic, and transcriptomic studies in large tumor cohorts have confirmed the central roles of aberrant Wnt/ß-catenin signaling, constitutive protein kinase A pathway activation, cell cycle dysregulation, and ion channelopathies in adrenal tumorigenesis, these studies also revealed novel signature events underlying malignant differentiation of adrenocortical carcinomas.

Summary
Recent advances in understanding of the molecular mechanisms underlying adrenocortical tumorigenesis provide new molecular diagnostic and prognostic tools and opportunities for novel therapeutic approaches. These findings are particularly important in adrenocortical carcinoma, for which current treatment options are limited.
SUPERFICIAL AND DEEP CAPILLARY ISCHEMIA AS A PRESENTING SIGN OF RETINAL VASCULOPATHY WITH CEREBRAL LEUKOENCEPHALOPATHY AND SYSTEMIC MANIFESTATIONS
Authors: Nagiel Aaron , Lalane Robert A. , Jen Joanna C. , Kreiger Allan E. 
Published: October 2017

Purpose:
The aim of this study was to investigate the presenting sign of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations, a rare autosomal dominant condition caused by mutations in the TREX1 gene, and to explore the potential efficacy of bevacizumab in preventing capillary occlusions.

Methods:
Observational case report with the use of ultra–widefield fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography.

Results:
A 31-year-old man with a family history of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations presented with a scotoma in his left eye. The visual acuity was 20/20 in both eyes, and his examination was notable for scattered cotton wool spots in the retina of both eyes as well as an area of paracentral acute middle maculopathy in the left eye. Ultra–widefield fluorescein angiography revealed peripheral capillary nonperfusion and vascular leakage corresponding to the cotton wool spots. Spectral domain optical coherence tomography and optical coherence tomography angiography confirmed the presence and distribution of superficial capillary plexus and deep capillary plexus ischemia. Neurologic examination and imaging were normal. A trial of monthly intravitreal bevacizumab injections to the left eye over 6 months resulted in diminished capillary leakage.

Conclusion:
Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations is a rare genetic condition manifested most commonly by cerebral and retinal ischemia. This retinal vasculopathy leads to occlusions of small-caliber retinal vessels in the superficial plexus and deep plexus with resulting cotton wool spots and paracentral acute middle maculopathy, respectively. Recognition of the retinal findings by ophthalmologists and neurologists may avoid unnecessary brain biopsies in diagnosing this rare disorder.
“It Doesn't Make Sense for Us Not to Have One”—Understanding Reasons Why Community Sports Organizations Chose to Participate in a Funded Automated External Defibrillator Program
Authors: Fortington Lauren V. , Bekker Sheree , Morgan Damian , Finch Caroline F. 
Published: October 2017

Objective:
Implementation of automated external defibrillators (AEDs) in community sports settings is an important component of emergency medical planning. This study aimed to understand motivations for why sports organizations participated in a government-funded program that provided AEDs and associated first-aid training.

Design:
Face-to-face interviews.

Setting:
Community sports organizations in Victoria, Australia.

Participants:
Representatives from 14 organizations who participated in a government-funded AED program.

Main Outcome Measures:
Motivations to participate in the AED program were explored using a qualitative descriptive approach.

Results:
Two overarching themes emerged: awareness of the program and decision to apply. Awareness was gained indirectly through grant advertising in newsletters/emails/web sites and directly through their sporting associations. For most organizations, there was no decision process per se, rather, the opportunity to apply was the key determinant for participating in the program. A duty of care also emerged as a key driving factor, with recognition of AEDs as a valuable asset to communities broadly, not just the participants' immediate sports setting. Reflecting on participation in the program, these participants identified that it was important to increase awareness about AED ownership and use. The program benefits were clearly summed up as being best prepared for a worst-case scenario.

Discussion:
This study provides new understanding of why community sports organizations apply for an AED and training. The strongest reason was simply the opportunity to acquire this at no cost. Therefore, for wider implementation of AEDs, additional funding opportunities, targeted awareness of these opportunities, and continued promotion of AED importance are recommended.
Effect of a Commercially Available Footwear Insole on Biomechanical Variables Associated With Common Running Injuries
Authors: Lewinson Ryan T. , Stefanyshyn Darren J. 
Published: October 2017

Objective:
To determine whether Dr. Scholl's Active Series (DSAS) footwear insoles alter biomechanical variables associated with running injuries.

Design:
Randomized, controlled experiment.

Setting:
Sport medicine and biomechanics gait analysis laboratory.

Participants:
Fifteen healthy adults.

Interventions:
The control condition was the participant's own athletic footwear. The experimental condition was the participant's own athletic footwear plus a DSAS insole. Participants completed running gait analysis trials with each condition.

Main Outcome Measures:
Peak vertical loading rates (VLRs), peak ankle eversion velocities (AEVs), peak ankle eversion angles (AEAs), and knee abduction angular impulses (KAAIs) were calculated and compared between the control and DSAS conditions because these variables have been associated with plantar fasciitis (VLRs), tibial stress syndrome (AEVs, AEAs), and patellofemoral pain syndrome (KAAIs).

Results:
Dr. Scholl's Active Series insoles reduced VLRs across participants by 16% (P < 0.001) but had no consistent influence on AEVs, AEAs, or KAAIs. Participant-specific responses showed that most runners either experienced AEA and KAAI reductions or no change with the DSAS insole, whereas AEVs commonly increased with the DSAS insole.

Conclusions:
Dr. Scholl's Active Series insoles demonstrate efficacy in reducing VLRs, which are associated with plantar fasciitis. Biomechanical changes to variables associated with tibial stress syndrome (AEVs, AEAs) and patellofemoral pain syndrome (KAAIs) were inconsistent.
The Impact of Obesity on Mortality and Other Outcomes in Patients With Nonvariceal Upper Gastrointestinal Hemorrhage in the United States
Authors: Abougergi Marwan S. , Peluso Heather , Mrad Chebli , Saltzman John R. 
Published: October 2017

Goals:
To quantify in patients with nonvariceal upper gastrointestinal hemorrhage (NVUGIH) the relationship between obesity and mortality, disease severity, treatment modalities, and resource utilization.

Background:
NVUGIH is the most common gastrointestinal emergency.

Study:
Adults with a principal diagnosis of NVUGIH were selected from the 2014 National Inpatient Sample. The primary outcome was in-hospital mortality. Secondary outcomes were hemorrhagic shock, prolonged mechanical ventilation (PMV), upper endoscopy [esophagogastroduodenoscopy (EGD)], radiologic treatment, surgery, length of hospital stay (LOS), and total hospitalization costs and charges. Confounders were adjusted for using multivariable regression analyses.

Results:
In total, 227,480 admissions with NVUGIH were included, 11.70% of whom were obese. Obese and nonobese patients had similar odds of mortality (aOR: 0.88; 95% confidence interval [CI]: 0.69-1.12; P=0.30), EGD within 24 hours of admission (aOR: 0.95; CI: 0.89-1.01; P=0.10), radiologic treatment (aOR: 1.06; CI: 0.82-1.35; P=0.66), and surgery (aOR: 1.27; CI: 0.94-1.70; P=0.11). However, obese patients had higher odds of shock (aOR: 1.30; CI: 1.14-1.49; P<0.01), PMV (aOR: 1.39; CI: 1.18-1.62; P<0.01), undergoing an EGD (aOR: 1.27; CI: 1.16-1.40; P<0.01), needing endoscopic therapy (aOR: 1.18; CI: 1.09-1.27; P<0.01), a longer LOS (0.31 d; CI: 0.16-0.46 d; P<0.01), higher costs ($1075; CI: $636-$1514; P<0.01), and higher charges ($4084; CI: $2060-$6110; P<0.01) compared with nonobese patients.

Conclusions:
Obesity is not an independent predictor of NVUGIH mortality. However, obesity is associated with a more severe disease course (shock and PMV), higher rates of EGD and endoscopic therapy use, and significant increases in resource utilization (hospital LOS, total hospitalization costs, and charges).
Dysregulated myelopoiesis and hematopoietic function following acute physiologic insult
Authors: Loftus Tyler J. , Mohr Alicia M. , Moldawer Lyle L. 
Published: October 2017

Purpose of review
The purpose of this review is to describe recent findings in the context of previous work regarding dysregulated myelopoiesis and hematopoietic function following an acute physiologic insult, focusing on the expansion and persistence of myeloid-deriver suppressor cells, the deterioration of lymphocyte number and function, and the inadequacy of stress erythropoiesis.

Recent findings
Persistent myeloid-derived suppressor cell (MDSC) expansion among critically ill septic patients is associated with T-cell suppression, vulnerability to nosocomial infection, chronic critical illness, and poor long-term functional status. Multiple approaches targeting MDSC expansion and suppressor cell activity may serve as a primary or adjunctive therapeutic intervention. Traumatic injury and the neuroendocrine stress response suppress bone marrow erythropoietin receptor expression in a process that may be reversed by nonselective beta-adrenergic receptor blockade. Hepcidin-mediated iron-restricted anemia of critical illness requires further investigation of novel approaches involving erythropoiesis-stimulating agents, iron administration, and hepcidin modulation.

Summary
Emergency myelopoiesis is a dynamic process with unique phenotypes for different physiologic insults and host factors. Following an acute physiologic insult, critically ill patients are subject to persistent MDSC expansion, deterioration of lymphocyte number and function, and inadequate stress erythropoiesis. Better strategies are required to identify patients who are most likely to benefit from targeted therapies.
First-Trimester Crown-Rump Length and Risk of Chromosomal Aberrations—A Systematic Review and Meta-analysis
Authors: Sagi-Dain Lena , Peleg Amir , Sagi Shlomi 
Published: October 2017

Importance
Lower than expected first-trimester crown-rump length (CRL) is a common sonographic finding, usually leading to reassessment of gestational age.

Objective
The aim of this study was to perform a meta-analysis defining the risk of chromosomal aberrations in pregnancies with decreased first-trimester CRL.

Evidence Acquisition
A search was conducted by a research librarian in 5 databases, with no time or language restrictions. Original researches examining the risk of chromosomal aberrations in pregnancies with low CRL were selected. The effect estimates were presented as odds ratios with 95% confidence intervals).

Results
Following screening of 3894 references, 12 articles were selected. Only 2 articles directly fulfilled the review goals, comparing the rates of chromosomal aberrations in small-CRL versus normal-CRL fetuses. Combined analysis of these 2 studies, encompassing a total of 403 fetuses with small CRL and 4047 control pregnancies, yielded an odds ratio of 5.54 (95% confidence interval, 1.2–26.1) for abnormal karyotype in small-CRL fetuses. Ten studies compared CRL in fetuses with specific chromosomal aberrations to pregnancies with normal karyotype, yielding a significant growth delay in fetuses with trisomy 18 (6 of 7 articles) and triploidy, but not in fetuses with trisomy 21. Overall quality of evidence was rated as “very low” using Grading of Recommendations Assessment, Development and Evaluation criteria.

Conclusions and Relevance
Our review results indicate that low first-trimester CRL might be associated with a significantly increased risk of chromosomal anomalies. Thus, invasive prenatal testing or cell-free DNA screening might be offered in such pregnancies, particularly if dating is certain.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to describe the paucity of existing literature examining the risk of chromosomal aberrations in pregnancies with decreased first-trimester CRL, discuss the questionability of routine recommendation for gestational age correction in such pregnancies, and recall the appropriate management of such cases, including frequent sonographic fetal growth follow-up and detailed scan for sonographic anomalies, with possible consideration of invasive prenatal testing.
What's New in Prenatal Genetics? A Review of Current Recommendations and Guidelines
Authors: Post Annalisa L. , Mottola Amy T. , Kuller Jeffrey A. 
Published: October 2017

Importance
The rapid development of prenatal genetic testing and screening tools and choices constantly challenges clinicians to stay up to date on current best practice.

Objective
We sought to review, compare, and summarize recent national society guidelines on prepregnancy genetic screening and prenatal diagnosis for aneuploidy with a focus on changes and additions to previous guidelines.

Evidence Acquisition
We performed a descriptive review of 8 recently published (2016–2017) national guidelines and updates on prenatal genetic screening and testing including American Congress of Obstetricians and Gynecologists committee opinions and practice bulletins, Society for Maternal-Fetal Medicine consult series publications, and an American College of Medical Genetics and Genomics position statement. Topics included carrier screening, cell-free DNA screening, chromosomal microarray analysis, next-generation sequencing, and prenatal diagnostic testing. The recommendations in these publications were compared, and the additions and changes to previous recommendations and guidelines were summarized.

Results
Recent publications contain many updates and changes to previous screening and testing strategies, most of which are consistent between professional societies. Although many new technologies have been integrated into prenatal diagnosis, some newer technologies are not yet routinely recommended for widespread use, often because of lack of clinical trials and validation studies.

Conclusions
Prenatal screening and testing options are rapidly expanding. To provide best-practice prenatal care, obstetric care providers should educate themselves about the most up-to-date recommendations and be prepared to interpret and apply these guidelines to their patients. Society guidelines are largely in agreement.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be able to identify best practice guidelines regarding prenatal carrier screening and genetic diagnosis, including recent changes in recommendations; specific topics include carrier screening, use of cell-free fetal DNA screening, microarray testing, next-generation sequencing, and invasive testing; and use these guidelines by offering appropriate strategies to their patients, including referral to a specialist when appropriate.
Chromosomal Polymorphisms Are Associated With Female Infertility and Adverse Reproductive Outcomes After Infertility Treatment: A 7-Year Retrospective Study
Authors: Cheng Ran , Ma Yaxian , Nie Ying , Qiao Xiaoyong , Yang Zhilan , Zeng Rujun , Xu Liangzhi 
Published: October 2017

(Abstracted from Reprod Biomed Online 2017;35:72–80)
It was believed for a long time that chromosomal polymorphisms—most of which have no effect on phenotypes—had no clinical significance. However, a large number of studies have shown that chromosomal polymorphisms are associated with an increased frequency of polymorphic variations in infertile patients.