bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reporting for Duty During Mass Casualty Events: A Survey of Factors Influencing Emergency Medicine Physicians
Authors: Snipes Carly , Miramonti Charles , Chisholm Carey , Chisholm Robin 
Published: July 2013

Abstract

Background
Academic medical centers play a major role in disaster response, and residents frequently serve as key resources in these situations. Studies examining health care professionals' willingness to report for duty in mass casualty situations have varying response rates, and studies of emergency medicine (EM) residents' willingness to report for duty in disaster events and factors that affect these responses are lacking.

Objective
We sought to determine EM resident and faculty willingness to report for duty during 4 disaster scenarios (natural, explosive, nuclear, and communicable), to identify factors that affect willingness to work, and to assess opinions regarding disciplinary action for physicians unwilling to work in a disaster situation.

Methods
We surveyed residents and faculty at 7 US teaching institutions with accredited EM residency programs between April and November 2010.

Results
A total of 229 faculty and 259 residents responded (overall response rate, 75.4%). Willingness to report for duty ranged from 54.1% for faculty in a natural disaster to 94.2% for residents in a nonnuclear explosive disaster. The 3 most important factors influencing disaster response were concern for the safety of the family, belief in the physician's duty to provide care, and availability of protective equipment. Faculty and residents recommended minimal or no disciplinary action for individuals unwilling to work, except in the infectious disease scenario.

Conclusions
Most EM residents and faculty indicated they would report for duty. Residents and faculty responses were similar in all but 1 scenario. Disciplinary action for individuals unwilling to work generally was not recommended.
Overweight Physicians During Residency: A Cross-Sectional and Longitudinal Study
Authors: Leventer-Roberts Maya , Zonfrillo Mark R. , Yu Sunkyung , Dziura James D. , Spiro David M. 
Published: July 2013

Abstract

Background
Resident physicians are at risk for increasing weight status given their changes in environment, resources, and stress level.

Objective
To describe body mass index (BMI), blood pressure, eating habits, and physical activity during postgraduate training and to compare the findings to data for nationally matched controls.

Methods
This was a combined cross-sectional study and longitudinal cohort, with a comparison to matched controls in 2 academic hospital centers in the eastern and western United States. BMI and blood pressure were objectively measured, and an eating and exercise habits recall was obtained for 375 enrolled medical and surgical residents (93 longitudinally) at the onset of each postgraduate year (PGY) in 2006, 2007, and 2008.

Results
Nearly half (43%) of overweight residents described themselves as normal weight. Residents were more likely to be overweight (BMI ≥25) at the beginning of PGY-3 than at the beginning of PGY-1 (49% versus 30%; odds ratio 2.26; 95% confidence interval 1.19–4.28). The average BMI of residents at PGY-1 was lower than that of their matched controls, but the magnitude of this difference decreased with increasing PGY (P  =  .02).

Conclusions
Overweight status is underacknowledged by overweight residents and increases by PGY of training. These changes differ significantly from that of controls and may affect overweight physicians' long-term health.
Early Prospective Results of the Salto-Talaris™ Total Ankle Prosthesis
Authors: Schweitzer Karl M , Adams Samuel B , Viens Nicholas A , Queen Robin M , Easley Mark E , DeOrio James K , Nunley James A 
Published: July 2013

ABSTRACT

Background
Several fixed-bearing total ankle arthroplasty (TAA) systems are available in the United States (US). We report on the early clinical results of the largest known US cohort of patients who received a Salto-Talaris total ankle replacement for end-stage ankle arthritis.

Methods
We prospectively followed 67 TAA patients with a minimum clinical follow-up of 2 years. Patients completed standardized assessments, including visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot score, short form (36) health survey (SF-36), and the short musculoskeletal function assessment (SMFA), along with physical examination, functional assessment, and radiographic evaluation, preoperatively and yearly thereafter through most recent follow-up.

Results
Implant survival was 96% using metallic component revision, removal, or impending failure as endpoints, with a mean follow-up of 2.81 years. Three patients developed aseptic loosening, all involving the tibial component. Of these, one underwent revision to another fixed-bearing TAA system, one patient is awaiting revision surgery, and the other patient has remained minimally symptomatic and fully functional without additional surgery. Forty-five patients underwent at least one additional procedure at the time of their index surgery. The most common concurrent procedure performed was a deltoid ligament release (n = 21), followed by removal of previous hardware (n = 16) and gastrocnemius recession (n = 11). Eight patients underwent additional surgery following their index TAA, most commonly debridement for medial and/or lateral impingement (n = 4). Patients demonstrated significant improvement in VAS, AOFAS hindfoot, several SF-36 subscales, SMFA, and functional scores at most recent follow-up (p < 0.001).

Conclusion
Early clinical results indicate that the Salto-Talaris fixed-bearing TAA system can provide significant improvement in pain, quality of life, and standard functional measures in patients suffering from end-stage ankle arthritis. The majority of patients underwent at least one concurrent procedure, most commonly to address varus hindfoot deformity, hardware removal, or equinus contracture.
Schweitzer Jr KM, Adams Jr SB, Viens NA, Queen RM, Easley ME, DeOrio JK, Nunley II JA. Early Prospective Results of the Salto-Talaris™ Total Ankle Prosthesis. The Duke Orthop J 2012;2(1):23-34.
Screw Orientation and Foam Density Interaction in Pullout of Anterior Lumbar Interbody Fusion Plates
Authors: Patacxil Wyzscx Merfil , Palmer Daniel Kyle , Rios David , Inceoglu Serkan , Williams Paul Allen , Cheng Wayne K 
Published: July 2013

ABSTRACT

Introduction
Previous studies demonstrated increases in single screw pullout strength with increases in material density. Recent anterior cervical interbody fusion plate pullout studies utilizing a polyurethane foam block model have shown that alterations in screw insertion angle from straight-in are not associated with an increase in pullout strength. The purpose of this study is to characterize the pullout strength of an anterior lumber interbody fusion (ALIF) plate when installed at various screw angles in different simulated bone densities.
Materials and methods: Ninety ALIF plate pullout tests were performed using three common screw insertion angles in polyurethane (PU) foam blocks of three densities: 0.08 g/cm3, 0.16 g/cm3 and 0.24 g/cm3, simulating severely, mildly and nonosteoporotic cancellous bone, respectively. Plates were pulled out axially at 1 mm/min and pullout strength and stiffness compared.

Results
Doubling foam density yielded 2.6-fold and 3.0-fold increases (p < 0.05) in mean pullout strength and stiffness, respectively. Tripling foam density yielded 4.5-fold and 5.3-fold increases (p < 0.05) in mean pullout strength and stiffness, respectively. Screw angle placement contributed relatively less to pullout strength and stiffness compared to PU foam density.

Conclusion
In our model, ALIF plate pullout strength and stiffness appear to be more associated with increased foam block density than screw trajectory. Vertebral bone density should be a strong consideration in preoperative planning for ALIF with plating. Screw trajectory should be based on vascular anatomy and screw placement safety, rather than the classic lateral-to-medial trajectory.
Patacxil WM, Palmer DK, Rios D, Inceoglu S, Williams PA, Cheng WK. Screw Orientation and Foam Density Interaction in Pullout of Anterior Lumbar Interbody Fusion Plates. The Duke Orthop J 2012;2(1):35-39.
Posterior Tibial Tendon Excision and Postoperative Pain in Adult Flatfoot Reconstruction: A Preliminary Report
Authors: DeOrio James K , Nunley James A , Demetracopoulos Constantine A 
Published: July 2013

ABSTRACT

Background
Posterior tibial tendon insufficiency plays a large role in the pathogenesis of adult acquired flatfoot deformity (AAFD) in select patients. Transfer of the flexor digitorum longus is indicated to compensate for the loss of posterior tibial tendon function; however the role of resection of the degenerated posterior tibial tendon remains unclear. The aim of this study was to determine the effect of posterior tibial tendon resection on pain relief following surgical treatment of stage II AAFD.

Methods
All patients who underwent surgical treatment for stage II AAFD and posterior tibial tendon insufficiency were retrospectively reviewed. Patients were divided into two groups based on whether the degenerated posterior tibial tendon was resected or left in situ. Twenty-seven patients with a mean follow-up of 13.3 months were included in the study. A visual analog scale (VAS) score for pain was recorded for each patient pre-operatively and at final follow-up. Concomitant surgical procedures and the incidence of postoperative medial arch pain were also reported. Preoperative deformity and postoperative deformity correction were assessed by measuring the anteroposterior talar-first metatarsal angle, the talonavicular (TN) coverage angle, the lateral talar-first metatarsal angle, and the calcaneal pitch onstandard weight bearing radiographs.

Results
Eleven patients underwent FDL transfer and resection of the posterior tibial tendon (PTT resection group), and 16 patients underwent FDL transfer without resection of the posterior tibial tendon (PTT in situ group). A greater percentage of patients in the PTT resection group underwent lateral column lengthening (100 vs 18.8%, p < 0.001), and a greater percentage of patients in the PTT in situ group had a medial displacement calcaneal osteotomy performed (93.8 vs 18.2%, p < 0.001). There was no difference in preoperative VAS pain scores between groups, and all patients demonstrated excellent pain relief postoperatively. No patient in either group reported medial arch pain postoperatively. Radiographic assessment revealed similar deformity preoperatively in both groups, and patients in the PTT resection group demonstrated a greater correction of the TN coverage angle (9.8 ± 4.6 vs 6.0 ± 4.1 degrees, p = 0.041).

Conclusion
Resection of the PTT did not significantly affect postoperative VAS scores at final follow-up. It did however, correlate with a slightly greater correction of the TN coverage angle. There were no instances of pain along the medial ankle or medial arch of the foot in either group postoperatively. Future prospective studies are needed to determine whether resection of the PTT is necessary at the time of surgery for stage II AAFD.
Demetracopoulos CA, DeOrio JK, Nunley JA II. Posterior Tibial Tendon Excision and Postoperative Pain in Adult Flatfoot Reconstruction: A Preliminary Report. The Duke Orthop J 2013;3(1):20-24.
Setting Time Comparison of Four Antimicrobial Laden Calcium Sulfate Plasters
Authors: Inceoglu Serkan , Kroger Jared , Beaufond Pierre , Maskiewicz Victoria , Cheng Wayne , Brier-Jones Justin Eugene 
Published: July 2013

ABSTRACT

Background
The surgeon may implant calcium sulfate pellets (aka gypsum) as a resorbable antimicrobial vehicle at the surgical site in severe cases of osteomyelitis. Gypsum setting times with or without antibiotic additives are found scattered throughout the literature, but often factors known to alter setting time are either not disclosed or not held constant between experiments. To our knowledge, no prior study compares the setting time of calcium sulfate plaster mixed with the four commonly used antibiotics under constant conditions as presented here.

Purpose
To compare the setting times of calcium sulfate hemihydrate mixtures containing vancomycin, cefazolin, tobramycin, or amphotericin B.

Materials and methods
Groups consisted of samples comprised of 6.3 gm calcium sulfate hemihydrate (CSH) mixed with approximately 1/4th a vial of lyophilized antimicrobial (vancomycin, cefazolin, tobramycin or amphotericin B) with CSH powder to normal saline ratio of 1.7 gm/ml and mixed for 30 seconds at controlled speed and humidity. Each sample initial setting time (Ti) and final setting time (Tf) were established by Gillmore needles method according to ASTM standard C266- 08 apparatus specifications.

Results
Kruskal-Wallis one-way analysis of variance by ranks revealed that antibiotic type affected the initial and final setting times of gypsum (p < 0.05). Post hoc analysis using Dunn's multiple comparisons indicated that there was no difference between control Ti (7.2 ± 1.1 min) and that of vancomycin or cefazolin group (9.8 ± 1.7 or 14.2 ± 1.3 min, respectively, p > 0.05), but the Ti of the tobramycin and amphotericin B groups (31.8 ± 5.7 and 140.4 ± 18.0 min) differed from the control Ti (p < 0.05). Likewise, there was no difference of control Tf (p > 0.05, 12.2 ± 1.1 min) when compared to vancomycin or cefazolin groups (22.2 ± 6.9 or 25.7 ± 4.1 min), but that the Tf of tobramycin and amphotericin B groups (76.3 ± 5.9 and 200.0 ± 21.1 min) each differed from the control group (p < 0.05).

Conclusion
This experiment is aimed to help surgeons plan when they should begin preparing their calcium sulfate antibiotic beads during surgery. As a general guideline, allow 15 minutes to set when adding a 1 gm vial of vancomycin or cefazolin, 30 minutes for adding a 1.2 gm vial tobramycin, and 2.5 hours for adding a 50 mg vial of amphotericin B.
Kroger J, Beaufond P, Inceoglu S, Maskiewicz V, Cheng W, Brier-Jones JE. Setting Time Comparison of Four Antimicrobial Laden Calcium Sulfate Plasters. The Duke Orthop J 2013;3(1):36-40.
Impaired Function and in vivo Imaging of NF-κB Activation in a Mouse Model of Knee Joint Inflammation
Authors: Mata Brian A , Bowles Robby , Mwangi Timothy K , Setton Lori A 
Published: July 2013

ABSTRACT

Objective
Osteoarthritis (OA) is a consequence of not only mechanical events such as joint instability, but also biological events that result in the upregulation of proinflammatory and catabolic mediators. The intra-articular injection of monoiodoacetate (MIA) has been widely used to induce OA. NF-κB activity has been linked to increased expression of proinflammatory cytokines (IL-1β, TNF-α, IL-6, etc), metalloproteinases (MMPs), chemokines and inducible enzymes, which all contribute to cartilage degradation and subsequent OA. The goal of this study was to use in vivo imaging (IVIS) of NF-κB activation to track longitudinal changes due to inflammation in a rodent model of OA.

Design
Twenty-four (24) NF-κB-luc reporter transgenic mice [BALB/C-Tg (NF-κB-RE-luc)-Xen, age 7-8 weeks] were given intra-articular knee injections with either MIA (n = 12) or normal saline (n = 12) to serve as a control. IVIS and ex vivo imaging of NF-κB and tactile allodynia measurements were performed, and correlations were recorded preoperatively and on days 1, 3, 7, 14, 21 and 28. Animals were euthanized on days 3 and 28 for ex vivo imaging, and tissues were stored for future immunohistochemical evaluation.

Results
NF-κB activity was significantly elevated in the MIA group on days 1 and 3 (p < 0.05) when compared to preoperative levels and was significantly elevated compared to the normal saline group on day 3 (p < 0.05). There was a significant increase in tactile allodynia in the MIA group compared to preoperative levels, as well as compared to the normal saline group at all time points (p < 0.05). In vivo NF-κB luminescence correlated with tactile allodynia (p < 0.0001) and with ex vivo imaging (p < 0.0001).

Conclusion
This study validates the use of IVIS imaging of NF-κB activity in a MIA rodent model of arthritis and provides evidence for the use of NF-κB luminescence imaging as an imaging biomarker of pain sensitivities. This can be utilized in the future to further elucidate NF-κB's role in inflammation and OA. In addition, it can help evaluate potential therapeutic agents that target NF-κB.
Mata BA, Bowles R, Mwangi TK, Setton LA. Impaired Function and in vivo Imaging of NF-κB Activation in a Mouse Model of Knee Joint Inflammation. The Duke Orthop J 2013;3(1):41-47.
MRI Determination of Knee Effusion Volume: A Cadaveric Study
Authors: Wittstein Jocelyn , Spritzer Charles , Garrett William E 
Published: July 2013

ABSTRACT

Background
There is currently limited literature on quantitative determination of knee effusion volume using magnetic resonance imaging (MRI).

Purpose
To describe a method of knee effusion volume determination using MRI generated models and to demonstrate accuracy of this technique.

Materials and methods
Using axial T2-weighted turbo spin echo and sagittal SPACE sequences, MRIs of three cadaver knees with multiple saline loads were obtained. Effusions models were created and effusion volumes were estimated using the Rhinoceros software. Estimated and known effusion volumes were compared using a bivariate correlation analysis.

Results
The SPACE sequence and T2WTSE estimates were highly correlated with the known volumes (R = 0.996 and 0.993 respectively, p < 0.001).

Conclusion
MRI-generated models of knee effusions provide accurate estimates of knee effusion volumes.

Clinical relevance
MRI determination of knee effusion volume may provide a useful clinical outcomes tool.
Wittstein J, Spritzer C, Garrett WE. MRI Determination of Knee Effusion Volume: A Cadaveric Study. The Duke Orthop J 2013;3(1):67-70.
Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers
Authors: Mangiapani Daniel S , Peterson Bret C , Kellogg Ryan , Leversedge Fraser J 
Published: July 2013

ABSTRACT

Purpose
The inconsistency of subspecialty emergency call services is a growing concern as declining reimbursements, increased legal risk, and challenging social and professional issues present a deterrent to call panel participation. This study assessed call availability of hand and microvascular replantation surgery at all level I and II trauma centers in the US.

Materials and methods
Between May and December 2010, all level I (n = 137) and level II (n = 153) trauma centers across the US were contacted by telephone. Phone contact was unannounced; responders were invited to participate in our IRBapproved anonymous survey regarding hand and microvascular replantation emergency coverage specific to their hospital.
Results: Level 1 centers: 117 of 137 (85%) participated, of which 64 (54.7%) had immediate access for hand surgery and microvascular replantation services. Six hospitals provided services 15 to 31 days per month and 3 hospitals supported 1 to 15 days per month. Ten hospitals indicated an inconsistent coverage which was difficult to estimate and 34 hospitals reported no coverage.

Level 2 centers
132 of 153 (86.3%) participated, of which 38 (29%) had immediate access for hand surgery and microvascular replantation services. Seven hospitals provided services 15 to 31 days per month and 3 hospitals for 1 to 15 days per month. 84 hospitals reported no specific coverage protocol.

Conclusion
Consistent on-call availability for emergency hand and microvascular replantation services remains a challenge across the US:
• 54.7% of level I trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage;
• 29% of level II trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage. Over 50% had no specific coverage protocol;
• Many hospitals indicated the presence of subspecialty hand surgery coverage, however microvascular replantation resources were not available consistently;
• While not confirmed, the current study findings suggest that a more clearly defined and coordinated system of hand surgery and microvascular replantation emergency call coverage will likely improve the efficiency of a limited resource and, ultimately, improve patient care.
Peterson BC, Mangiapani DS, Kellogg R, Leversedge FJ. Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers. The Duke Orthop J 2013;3(1):88-92.
Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients
Authors: Katolik Leonid I , Hanel Douglas P , Wartinbee Daniel A , Ruch David 
Published: July 2013

ABSTRACTPurposeTo evaluate the use of internal distraction plating for the management of comminuted, intra-articular distal radius fractures in patients over 60 years of age at two level one trauma centers. Our hypothesis was that distraction plating of comminuted distal radius fractures in the elderly would result in acceptable outcomes regarding range of motion, disabilities of the arm, shoulder and hand (DASH) score, and radiographic parameters and would thereby provide the upper extremity surgeon with another option for the treatment of these fractures.Materials and methodsA retrospective review was performed on 33 patients over 60 years of age with comminuted distal radius fractures treated by internal distraction plating at two level 1 trauma centers. Patients were treated with internal distraction plating across the radiocarpal joint. At the time of final follow-up, radiographs were evaluated for ulnar variance, radial inclination, and palmar tilt. Range of motion, complications and DASH scores were also obtained.ResultsThirty-three patients with a mean age of 70 years were treated with distraction plating for comminuted distal radius fractures. At final follow-up, all fractures had healed and radiographs demonstrated mean palmar tilt of 5° and mean positive ulnar variance of 0.6 mm. Mean radial inclination was 20°. Mean values for wrist flexion and extension were 46° and 50° respectively. Mean pronation and supination were 79° and 77° respectively. At the final follow-up, the mean DASH score was 32.ConclusionIn the elderly, distraction plating is an effective method of treatment for comminuted, osteoporotic distal radius fractures.Level of evidenceTherapeutic, Level IV (Retrospective case series).Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch D. Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients. The Duke Orthop J 2013;3(1):93-98.
Working With Wilmsen: Paleoindian End Scraper Design and use at Nobles Pond
Authors: Seeman Mark F. , Loebel Thomas J. , Comstock Aaron , Summers Garry L. 
Published: July 2013

AbstractThis study is an investigation of tool design and the organization of work. Here we further test Wilmsen’s (1970) conclusion that early Paleoindian tools—specifically, hafted end scrapers—were redesigned to facilitate the processing of a broader range of resources as colonizing populations moved into the forested environments of eastern North America from the west. We use a large sample from the Nobles Pond site, morphometic variables, and high-powered microwear to evaluate the effects of design and reduction as they bear on this generalization. Results do not support Wilmsen’s model, and, more generally, we conclude that an understanding of form and function in reductive technologies comes not only from an appreciation of the planned, stage-like change that is inherent in the design of reliable tools, but also from a consideration of the many contingencies and particular work situations that arise in the lives of mobile foragers.