bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variation in 60-day Readmission for Surgical-site Infections (SSIs) and Reoperation Following Spinal Fusion Operations for Neuromuscular Scoliosis
Authors: McLeod Lisa , Flynn John , Erickson Mark , Miller Nancy , Keren Ron , Dormans John 
Published: May 2015

Background:
Readmission for surgical-site infection (SSIs) following spinal fusion for NMS impacts costs, patient risk, and family burden; however, it may be preventable. The purpose of this study was to examine variation in hospital performance based on risk-standardized 60-day readmission rates for SSI and reoperation across 39 US Children’s Hospitals.

Methods:
Retrospective cohort study using the Pediatric Health Information Systems (PHIS) database involving children aged 10 to 18 years with ICD9 codes indicating spinal fusion, scoliosis, and neuromuscular disease discharged from 39 US children’s hospitals between January 1, 2007 and September 1, 2012. Readmissions within 60 days for SSI were identified based on the presence of ICD9 codes for (1) infectious complication of device or procedure, or (2) sepsis or specific bacterial infection with an accompanying reoperation. Logistic regression models accounting for patient-level risk factors for SSI were used to estimate expected (patient-level risk across all hospitals) and predicted (weighted average of hospital-specific and all-hospital estimates) outcomes. Relative performance was determined using the hospital-specific predicted versus expected (pe) ratios.

Results:
Average volume across hospitals ranged from 2 to 23 fusions/quarter and was not associated with readmissions. Of the 7560 children in the cohort, 534 (7%) were readmitted for reoperation and 451 (6%) were readmitted for SSI within 60 days of discharge. Reoperations were associated with an SSI in 70% of cases. Across hospitals, SSI and reoperation rates ranged from 1% to 11% and 1% to 12%, respectively. After adjusting for age, sex, insurance, presence of a gastric tube, ventriculoperitoneal shunt, tracheostomy, prior admissions, number of chronic conditions, procedure type (anterior/posterior), and level (>9 or <9 vertebrae), pe ratios indicating hospital performance varied by 2-fold for each outcome.

Conclusions:
After standardizing outcomes using patient-level factors and relative case mix, several hospitals in this cohort were more successful at preventing readmissions for SSIs and reoperations. Closer examination of the organization and implementation of strategies for SSI prevention at high-performing centers may offer valuable clues for improving care at lower performing institutions.

Level of Evidence:
Level III.
Correction of Brachymetatarsia and Medial Angulation of the Great Toe of Apert Foot By Distraction Osteogenesis: A Review of 7 Years of Experience
Authors: Calis Mert , Oznur Ali , Ekin Omer , Vargel Ibrahim 
Published: May 2015

Background:
Apert foot anomalies may cause severe problems such as pain and development of callus formation related to weight redistribution, problems with footwear, and gait disturbances that may limit their daily activities. The main purpose of this study was to review our experience with distraction osteogenesis for the correction of brachymetatarsia and the great toe angulation of the patients with Apert syndrome.

Methods:
This study retrospectively reviewed 7 patients (14 extremities) followed up for Apert syndrome who underwent distraction for the correction of bilateral congenital brachymetatarsia and angulation of the great toe between 2004 and 2008. Correction of the metatarsal inclination angle, the medial angulation of the great toe, the percentage of lengthening, and lengthening rates of distracted bones were evaluated.

Results:
Patients ranged in age from 4 to 8 years at the distraction operation, with a mean age of 5.4±1.3 years, and the average length of follow-up was 86.6±21.0 months. The length of the first metatarsal bone increased significantly from the average length of 32.6±5.7 mm to an average of 46.7±6.5 mm (P<0.001). The mean lengthening rate and lengthening percentages of distracted bones were 0.4%±0.1%/month and 30.2%±6.4%/month, respectively. Preoperative and postoperative metatarsal inclination angles were at a mean of 43.8±5.12 and 32.6±3.8, respectively, and the correction of metatarsal inclination was considered as statistically significant (P<0.001). The mean angulation of the great toe reduced significantly from 49.8±11.76 to 13.2±8.5 degrees after distraction (P<0.001). Minor complications such as pin loosening, pin-tract infection, and early union that required reoperation were observed in 5 extremities (35.7%).

Conclusions:
Anatomic features of Apert foot may lead to complaints that may limit patients’ daily activities and require as much attention as associated hand and craniofacial anomalies. Distraction appears to be an effective and safe approach for the simultaneous correction of the shortness of the first ray and medial angulation of the great toe.

Level of Evidence:
Level IV.
Traumatic, Posterior Pediatric Hip Dislocations With Associated Posterior Labrum Osteochondral Avulsion: Recognizing the Acetabular “Fleck” Sign
Authors: Blanchard Christopher , Kushare Indranil , Boyles Aaron , Mundy Andrew , Beebe Allan C. , Klingele Kevin E. 
Published: May 2015

Background:
Traumatic dislocation of the hip is uncommon in the pediatric population. Concentric reduction is usually achieved by closed means. Open reduction may be needed if there is femoral head fracture, incarcerated fragment, or incomplete reduction due to soft tissue entrapment. We present a series of 10 patients who sustained a posterior hip dislocation or subluxation with associated osteochondral avulsion of the posterior labrum. During surgery they were noted to have a labral injury pattern not previously recognized. Such treatment was dictated by postreduction advanced imaging, which revealed a consistent acetabular “fleck” sign indicative of this labral injury, which has not been previously described in literature.

Methods:
We performed a retrospective case review of patients with traumatic posterior hip dislocation/subluxation, treated operatively for a suspected associated labral tear and fractures.

Results:
Ten patients (2 girls and 8 boys) were identified. Average age was 12.7 years. Eight patients had postreduction computed tomography scans, which revealed a posterior acetabular wall “fleck” sign, suggestive of osteochondral injury. The small bony fragment was consistently displaced at least 2 to 3 mm in all patients with majority of the posterior wall remaining intact. Closed reduction was felt to be congruent in 7 of the 10 patients. All patients were treated operatively for exploration and stabilization of the suspected posterior labrum pathology and associated injuries using a surgical hip dislocation. A consistent pattern of labral pathology was seen in all patients, with disruption of the posterior labrum from the superior 12 o’clock attachment to detachment at the inferior 6 o’clock location. Reattachment of the osteochondral labral avulsion was performed with suture anchors along the posterior rim, and the associated femoral head fractures were also addressed with internal fixation. Two patients had inadequate follow-up and were excluded, the average follow-up for the remaining 8 patients was 9.8 months (range, 6 to 26 mo). There were no findings of avascular necrosis in any of the 8 patients.

Conclusions:
Posterior hip dislocation in children may produce an acetabular “fleck” sign on advanced imaging, which in a stable, concentrically reduced hip has been treated without surgery in the past. Acetabular fleck sign may represent a near-complete avulsion of the posterior labrum as seen in our series. We recommend a high suspicion for this type of labral pathology and surgical repair when acetabular “fleck” sign is identified with hip subluxation or dislocation. Traumatic, posterior hip dislocations in young patients may be associated with significant labral pathology. Acetabular “fleck” sign on advanced imaging may predict such pathology.

Level of Evidence:
IV, retrospective study.
Bent Telescopic Rods in Patients With Osteogenesis Imperfecta
Authors: Lee R. Jay , Paloski Michael D. , Sponseller Paul D. , Leet Arabella I. 
Published: May 2015

Background:
Telescopic rods require alignment of 2 rods to enable lengthening. A telescopic rod converts functionally into a solid rod if either rod bends, preventing proper engagement. Our goal was to characterize implant bending as a mode of failure of telescopic rods used in the treatment of osteogenesis imperfecta in children.

Methods:
We conducted a retrospective review of our osteogenesis imperfecta database for patients treated with intramedullary telescopic rods at our institution from 1992 through 2010 and identified 12 patients with bent rods. The 6 boys and 6 girls had an average age at the time of initial surgery of 3.1 years (range, 1.8 to 8.3 y) and a total of 51 telescoping rods. Clinic notes, operative reports, and radiographs were reviewed. The rods were analyzed for amount of lengthening, characteristics of bending, presence of cut out, or disengagement from an anchor point. Bends in the rods were characterized by their location on the implant component. The bent and straight rods were compared. Data were analyzed with the Mann-Whitney test (statistical significance set at P≤0.05).

Results:
Of the 51 telescoping rods, 17 constructs (33%) bent. The average interval between surgery and rod bending was 4.0 years (range, 0.9 to 8.2 y). Before bending, 11 of 17 telescoping rods had routine follow-up radiographs for review. In 10 of the rods, bending was present when early signs of rod failure were first detected. Rod bending did not seem to be related to rod size. There was no area on the rod itself that seemed more susceptible to bending.

Conclusions:
Rod bending can be an early sign of impending rod failure. When rod bending is first noted, it may predispose the rod to other subsequent failures such as loss of proximal and distal fixation and cut out. Rod bending should be viewed as an indicator for closer monitoring of the patient and discussions regarding future need for rod exchange.

Level of Evidence:
Level III—retrospective review.
The Effectiveness of Medication Adherence Interventions Among Patients With Coronary Artery Disease
Authors: Chase Jo-Ana D. , Bogener Jennifer L. , Ruppar Todd M. , Conn Vicki S. 
Published: May 2015

Background:
Despite the known benefits of medication therapy for secondary prevention of coronary artery disease (CAD), many patients do not adhere to prescribed medication regimens. Medication nonadherence is associated with poor health outcomes and higher healthcare cost.

Objective:
The purpose of this meta-analysis was to determine the overall effectiveness of interventions designed to improve medication adherence (MA) among adults with CAD. In addition, sample, study design, and intervention characteristics were explored as potential moderators to intervention effectiveness.

Methods:
Comprehensive search strategies helped in facilitating the identification of 2-group, treatment-versus-control–design studies testing MA interventions among patients with CAD. Data were independently extracted by 2 trained research specialists. Standardized mean difference effect sizes were calculated for eligible primary studies, adjusted for bias, and then synthesized under a random-effects model. Homogeneity of variance was explored using a conventional heterogeneity statistic. Exploratory moderator analyses were conducted using meta-analytic analogs for analysis of variance and regression for dichotomous and continuous moderators, respectively.

Results:
Twenty-four primary studies were included in this meta-analysis. The overall effect size of MA interventions, calculated from 18,839 participants, was 0.229 (P < .001). The most effective interventions used nurses as interventionists, initiated interventions in the inpatient setting, and informed providers of patients’ MA behaviors. Medication adherence interventions tested among older patients were more effective than those among younger patients. The interventions were equally effective regardless of number of intervention sessions, targeting MA behavior alone or with other behaviors, and the use of written instructions only.

Conclusions:
Interventions to increase MA among patients with CAD were modestly effective. Nurses can be instrumental in improving MA among these patients. Future research is needed to investigate nurse-delivered MA interventions across varied clinical settings. In addition, more research testing MA interventions among younger populations and more racially diverse groups is needed.
Anger Traits Associated With Cardiovascular Risk Biomarkers in the Metabolic Syndrome
Authors: Lemche Alexandra V. , Chaban Oleg S. , Lemche Erwin 
Published: May 2015

Background:
Recent studies have shown that different personality traits contribute to mortality in different subtypes of cardiovascular disease (CVD). Anger traits have been shown to promote the constellation of the metabolic syndrome (MetS), which in turn increases CVD risks.

Objective:
To determine covariation of anger traits with CVD biomarkers, we examined patients (N = 101; 34 men and 67 women; age, 45.6 ± 13.96 years) in a nationally sampled treatment cohort for MetS in the Ukrainian governmental healthcare system.

Methods:
Data collection was conducted in 2007. Laboratory data of single components of the MetS according to International Diabetes Federation Consensus were dependent measures in regression models with self-reported overt aggressivity and covert hostility in the Buss-Durkee Hostility Inventory and sociodemographic data. Structural equation models (SEMs) were tested.

Results:
The SEM results are in favor of a sex-adjusted 2-factor solution R
2 = 0.723), as indicated by equation-level Bentler-Raykov goodness-of-fit coefficients of 0.81 to 0.97 for paths to biological variables. Two latent components, 1 relating to aggressivity and the other to hostility, combine lipid/obesity-related measures and cholesterol-related measures, respectively.

Conclusions:
The SEM results suggest that CVD-risk biomarker variables in this MetS sample (a) associate into 2 distinct profiles and (b) that 1 profile associates with overt anger, whereas the other associates with covert hostility. These results could contribute to more personalized prevention and care in CVD patients.
Cardiovascular Risk in Midlife African American Women Participating in a Lifestyle Physical Activity Program
Authors: Braun Lynne T. , Wilbur JoEllen , Buchholz Susan W. , Schoeny Michael E. , Miller Arlene M. , Fogg Louis , Volgman Annabelle S. , McDevitt Judith 
Published: May 2015

Background:
Cardiovascular disease (CVD) is the largest contributor to disparate morbidity and mortality in African American women.

Objective:
The aims of this article are to describe in a cohort of sedentary, urban community-based midlife African American women eligible for a physical activity program their (1) CVD risk factors and (2) awareness, treatment, and control of hypertension and hypercholesterolemia.

Methods:
Cross-sectional baseline findings on 297 women were examined at baseline of a controlled physical activity clinical trial. Cardiovascular disease risks included hypertension, hypercholesterolemia, smoking, diabetes, and obesity. Among women with hypertension and hypercholesterolemia, rates of awareness, treatment, and control were calculated.

Results:
Our sample had significantly more hypertension and obesity than reported in other national samples of African American women. The women mirrored national samples of African American women: fewer than 60% had adequate control of hypertension. Versus national samples of African Americans (men/women combined), our study groups both showed significantly lower low-density-lipoprotein cholesterol level: treatment, 33% versus 63.8%, and control, 24.8% versus 45.3%.

Conclusions:
Because national samples are more heterogeneous, our sample provides important information about CVD risks in inactive, urban community-dwelling, midlife African American women. Given the opportunity, many such women at elevated risk for CVD are willing to participate in a physical activity intervention. They must be identified and offered pharmacological and lifestyle interventions.
GO-PCA: An Unsupervised Method to Explore Biological Heterogeneity Based on Gene Expression and Prior Knowledge
Authors: Wagner Florian 
Published: May 2015

AbstractGenome-wide expression profiling is a cost-efficient and widely used method to characterize heterogeneous populations of cells, tissues, biopsies, or other biological specimen. The exploratory analysis of such datasets typically relies on generic unsupervised methods, e.g. principal component analysis or hierarchical clustering. However, generic methods fail to exploit the significant amount of knowledge that exists about the molecular functions of genes. Here, I introduce GO-PCA, an unsupervised method that incorporates prior knowledge about gene functions in the form of gene ontology (GO) annotations. GO-PCA aims to discover and represent biological heterogeneity along all major axes of variation in a given dataset, while suppressing heterogeneity due to technical biases. To this end, GO-PCA combines principal component analysis (PCA) with nonparametric GO enrichment analysis, and uses the results to generate expression signatures based on small sets of functionally related genes. I first applied GO-PCA to expression data from diverse lineages of the human hematopoietic system, and obtained a small set of signatures that captured known cell characteristics for most lineages. I then applied the method to expression profiles of glioblastoma (GBM) tumor biopsies, and obtained signatures that were strongly associated with multiple previously described GBM subtypes. Surprisingly, GO-PCA discovered a cell cycle-related signature that exhibited significant differences between the Proneural and the prognostically favorable GBM CpG Island Methylator (G-CIMP) subtypes, suggesting that the G-CIMP subtype is characterized in part by lower mitotic activity. Previous expression-based classifications have failed to separate these subtypes, demonstrating that GO-PCA can detect heterogeneity that is missed by other methods. My results show that GO-PCA is a powerful and versatile expression-based method that facilitates exploration of large-scale expression data, without requiring additional types of experimental data. The low-dimensional representation generated by GO-PCA lends itself to interpretation, hypothesis generation, and further analysis.
Mass spectrometry-based quantitation of Her2 in gastroesophageal tumor tissue: Comparison to IHC and FISH
Authors: Catenacci Daniel V.T. , Liao Wei-Li , Zhao Lei , Whitcomb Emma , Henderson Les , O’Day Emily , Xu Peng , Thyparambil Sheeno , Krisman David , Bengali Kathleen , Uzzell Jamar , Darflur Marlene , Cecchi Fabiola , Blackler Adele , Bang Yung-Jue , Hart John , Xiao Shu-Yuan , Lee Sang Mee , Burrows Jon , Hembrough Todd 
Published: May 2015

AbstractBackgroundTrastuzumab showed survival benefit for Her2-positive gastroesophageal cancers (GEC). Immunohistochemistry (IHC) and fluorescencein situhybridization (FISH) currently determine eligibility for trastuzumab-based therapy. However, both assays are low throughput with various limitations.MethodsWe developed a selected reaction monitoring mass spectrometric (SRM-MS) assay and quantified levels (amol/ug) of Her2-SRM in cell lines (n=27) and GEC tissues (n=139). We compared Her2-SRM expression with IHC/FISH, seeking to determine optimal SRM expression cut-offs to identifyHER2amplification.ResultsAfter demonstrating assay development, precision, and stability, Her2-SRM measurement was observed to be highly concordant withHER2/CEP17ratio, particularly in a multivariate regression model adjusted for SRM-expression of Met, Egfr, Her3, and HER2-heterogeneity covariates, and their interactions (cell lines r2=0.9842; FFPE r2=0.7643). In GEC tissues, Her2-SRM was detected in 71.2% of cases, and 12.3% were identified as ‘HER2+’. ROC curves demonstrated HER2-SRM levels to have high specificity (100%) at an upper-level cut-off of>750 amol/μg and sensitivity (75%) at lower-level cut-off of <450 amol/ug. We observed an ‘equivocal-zone’ between 450-750 amol/ug, analogous to ‘IHC2+’, but less frequent (9-16% of cases versus 36-41%).SignificanceCompared to IHC, SRM-MS provided more objective and quantitative Her2 expression with excellentHER2/CEP17FISH correlation and fewer ‘equivocal’ cases. Along with the multiplex capability for other relevant oncoproteins, these results demonstrated a refined HER2 expression assay for clinical application.
The complex admixture history and recent southern origins of Siberian populations
Authors: Pugach Irina , Matveev Rostislav , Spitsyn Viktor , Makarov Sergey , Novgorodov Innokentiy , Osakovsky Vladimir , Stoneking Mark , Pakendorf Brigitte 
Published: May 2015

AbstractAlthough Siberia was inhabited by modern humans at an early stage, there is still debate over whether this area remained habitable during the extremely cold period of the Last Glacial Maximum or whether it was subsequently repopulated by peoples with a recent shared ancestry. Previous studies of the genetic history of Siberian populations were hampered by the extensive admixture that appears to have taken place among these populations, since commonly used methods assume a tree-like population history and at most single admixture events. We therefore developed a new method based on the covariance of ancestry components, which we validated with simulated data, in order to investigate this potentially complex admixture history and to distinguish the effects of shared ancestry from prehistoric migrations and contact. We furthermore adapted a previously devised method of admixture dating for use with multiple events of gene flow, and applied these methods to whole-genome genotype data from over 500 individuals belonging to 20 different Siberian ethnolinguistic groups. The results of these analyses indicate that there have indeed been multiple layers of admixture detectable in most of the Siberian populations, with considerable differences in the admixture histories of individual populations, and with the earliest events dated to not more than 4500 years ago. Furthermore, most of the populations of Siberia included here, even those settled far to the north, can be shown to have a southern origin. These results provide support for a recent population replacement in this region, with the northward expansions of different populations possibly being driven partly by the advent of pastoralism, especially reindeer domestication. These newly developed methods to analyse multiple admixture events should aid in the investigation of similarly complex population histories elsewhere.Author SummaryWe developed a new method that lets us disentangle complex admixture events and date the individual episodes of gene flow. We applied this method to a large dataset of genome-wide SNP genotypes from a linguistically diverse sample of populations covering the extent of Siberia. Our results demonstrate that these populations have been in intense contact with each other, with most of them carrying more than two, and up to six different ancestries. Nevertheless, as shown by the dates we estimate, these various admixture events have taken place over a relatively short time, with the oldest dating to not more than 4500 years ago. Our results emphasize the enormous impact that contact has had on the genetic history of these Siberian populations, and the methods developed here will be of use in the investigation of admixture events in populations around the world.