bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exercise Only, Exercise With Mechanical Traction, or Exercise With Over-Door Traction for Patients With Cervical Radiculopathy, With or Without Consideration of Status on a Previously Described Subgrouping Rule: A Randomized Clinical Trial
Authors: Fritz Julie M. , Thackeray Anne , Brennan Gerard P. , Childs John D. 
Published: January 2014

Study Design Randomized clinical trial. Objectives To examine the effectiveness of cervical traction in addition to exercise for specific subgroups of patients with neck pain. Background Cervical traction is frequently used, but its effectiveness has not been adequately examined. Existing studies have failed to target patients most likely to respond. Traction is typically recommended for patients with cervical radiculopathy. A prediction rule has been described to identify a narrower subgroup of patients likely to respond to cervical traction. Methods Patients with neck pain and signs of radiculopathy were randomized to 4 weeks of treatment with exercise, exercise with mechanical traction, or exercise with over-door traction. Baseline assessment included subgrouping-rule status. The primary outcome measure (Neck Disability Index, scored 0–100) and secondary outcome measure (neck and arm pain intensity) were assessed at 4 weeks, 6 months, and 12 months after enrollment. The primary analyses examined 2-way treatment-by-time interactions. Secondary analyses examined validity of the subgrouping rule by adding 3-way interactions. Results Eighty-six patients (53.5% female; mean age, 46.9 years) were enrolled in the study. Intention-to-treat analysis found lower Neck Disability Index scores at 6 months in the mechanical traction group compared to the exercise group (mean difference between groups, 13.3; 95% confidence interval: 5.6, 21.0) and over-door traction group (mean difference between groups, 8.1; 95% confidence interval: 0.8, 15.3), and at 12 months in the mechanical traction group compared to the exercise group (mean difference between groups, 9.8; 95% confidence interval: 0.2, 19.4). Secondary outcomes favored mechanical traction at several time points. The validity of the subgrouping rule was supported on the Neck Disability Index at the 6-month time point only. Conclusion Adding mechanical traction to exercise for patients with cervical radiculopathy resulted in lower disability and pain, particularly at long-term follow-ups. The study protocol was registered at http://clinicaltrials.gov (NCT00979108). Level of Evidence Therapy, level 2b-. J Orthop Sports Phys Ther 2014;44(2):45–57. Epub 9 January 2014. doi:10.2519/jospt.2014.5065
Does prey density limit Amur tiger Panthera tigris altaica recovery in northeastern China?
Authors: Zhang Changzhi , Zhang Minghai , Stott Philip 
Published: January 2014

A residual population of Amur tigers Panthera tigris altaica probably survives in the eastern Wanda Mountains (EWM) in China, where the main prey species are red deer Cervus elaphus, eastern roe deer Capreolus pygargus and wild boar Sus scrofa ussuricus. We used 53 snow sample plots each containing about 29 km of transects to detect ungulate presence and determined their total density in EWM in 2002 to be 87.9 ± 8.9 kg km−2. We then applied these data to three published models that predict the relationship between tiger density and prey biomass density to obtain three estimates of tiger carrying capacity in EWM. Existing estimates of tiger density suggest that tigers were below carrying capacity estimates. Relationships between prey density and tiger density from 15 studies indicate a threshold prey biomass of 195 kg km−2 (CI: 33‐433), below which a tiger population cannot be sustained. We therefore concluded that the EWM population of tigers is in peril. We compared densities between the years 2002 and 2008 using comparable data and found that the EWM populations of the three ungulate prey species all experienced decreases of 40‐45%, apparently due to intense poaching. This rapid decline in prey density and pervasive threats to tigers and their prey in the EWM demands immediate and effective protection of ungulate and tiger populations from poaching if tigers are to persist and recover.
Resource availability and use by Eurasian otters Lutra lutra in a heavily modified river‐canal system
Authors: Kloskowski Janusz , Rechulicz Jacek , Jarzynowa Barbara 
Published: January 2014

The freshwater habitats of semi‐aquatic carnivores in Europe have undergone substantial alterations due to regulation and construction of artificial watercourses. We compared seasonal estimates of otter Lutra lutra food composition with concomitantly collected data on fish availability and otter holt location in a strongly human‐modified ecosystem comprising the upper stretches of the Wieprz‐Krzna Canal, the longest artificial waterway in Poland, and an associated regulated river. Concrete lining of the canal, extreme water level variation and regular vegetation clearance to enhance water flow substantially limited otter food and shelter resources, yet the canal offered attractive habitats for some fish and hibernating amphibians, while otter resting sites were available at the closely adjacent river. The taxonomic composition of fish in the otter diet, reconstructed based on faecal analysis, was largely reflected in electrofishing catches. Fish communities in our study area were numerically dominated by small‐sized species and otters fed on very small fish (median seasonal total lengths: 46‐54 mm). Either the smaller fish in the population were taken or prey sizes did not differ from those available. The significant contribution of amphibians and waterbirds to otter diet (seasonally 41‐75% in terms of biomass) indicated poor fish supplies for otters in the canal‐river system. High trophic diversity, compared to other otter studies in temperate climatic conditions, indicates that otters facing unstable food conditions exhibit great flexibility in their diet, which may facilitate colonisation of anthropogenic, depauperate environments. Otter occurrence provides little opportunity for conflict with human economic interests in ecosystems that are highly managed for purposes other than fish production. Since anthropogenic habitats are typically poor in some resources, such as shelter structures, their suitability for otters can be enhanced by ensuring good connectivity with nearby less‐disturbed habitats, where the necessary resources can be supplemented.
Regional integration and free movement in Central Africa Integración regional y libre circulación en África Central L'intégration régionale et la libre circulation en Afrique centrale
Authors: Nono Guy Marcel 
Published: January 2014

A pillar of African emergence and an important issue of political debate that is central to regional integration, free movement is however not yet acquired in Central Africa. Yet a glance at the pre colonial history invites us to believe that Central Africa has been an area of free movement. The recognition of a right that cannot be realized only by an agreement leads to the Central African states pledging to work together in the context of regional integration by recognizing their citizens' right to full mobility. This contribution highlights the efforts, challenges and prospects of free movement in Central Africa by reference to the African Union framework, and asks if the legal and institutional framework of free movement in Central Africa has led to the emergence of a social policy supportive of free movement at the sub regional level. Spanish
La libre circulación de personas es un pilar del África emergente, un tema importante en el debate político, un punto central de la integración regional, y sin embargo todavía intangible en África Central. No obstante, una mirada a la historia precolonial nos invita a pensar que África Central ha sido un espacio de libre circulación. El reconocimiento de un derecho que no puede realizarse sólo por un acuerdo, conduce a que los Estados de África Central se comprometan a trabajar juntos en el marco de la integración regional para reconocer el derecho de sus ciudadanos a la movilidad total. Esta contribución destaca los esfuerzos, desafíos y perspectivas de la libre circulación en África Central en referencia con el marco de la Unión Africana, y se pregunta si el marco legal e institucional de la libre circulación en África Central ha llevado a la aparición de una política social que apoye la libre circulación a nivel subregional. French
Pilier de l'émergence de l'Afrique, enjeu des débats politiques et de l'intégration, la libre circulation n'est pas encore un acquis en Afrique Centrale. Pourtant, un regard porté sur l'histoire précoloniale nous invite à croire que l'Afrique centrale a été un espace de libre circulation. La reconnaissance d'un droit ne pouvant se faire que par l'objet d'un accord, les États d'Afrique Centrale se sont engagés dans le choix d'une histoire à réaliser ensemble dans le cadre de l'intégration, en consacrant dans des pactes communautaires la pleine mobilité de leurs ressortissants. Cette contribution met en évidence les efforts, défis et perspectives de la libre circulation en Afrique centrale par référence au cadre de l'Union africaine, et pose la question de savoir si le cadre juridique et institutionnel de la libre circulation en Afrique centrale a conduit à l'émergence d'une politique sociale en faveur de la libre circulation au niveau sous régional.
Predictive value of intraoperative 5-aminolevulinic acid–induced fluorescence for detecting bone invasion in meningioma surgery
Authors: Della Puppa Alessandro , Rustemi Oriela , Gioffrè Giorgio , Troncon Irene , Lombardi Giuseppe , Rolma Giuseppe , Sergi Massimo , Munari Marina , Cecchin Diego , Gardiman Marina Paola , Scienza Renato 
Published: January 2014

Object
Bone invasion is a major concern in meningioma surgery, since it is predictive of the recurrence of cranial involvement, morbidity, and mortality. Bone invasion has been reported in 20%–68% of studies with histopathologically confirmed data. Unfortunately, radical resection of bone invasion remains challenging. The aim of this study was to assess the role of 5-aminolevulinic acid (5-ALA) fluorescence in guiding the resection of bone-invading meningiomas. To this purpose, the sensitivity, specificity, and positive and negative predictive values of 5-ALA in detecting meningioma bone invasion were evaluated.

Methods
Data from 12 patients affected by bone-invading meningiomas (7 with skull base and 5 with convexity meningiomas) who had undergone surgery with the assistance of 5-ALA fluorescence and neuronavigation between July 2012 and March 2013 at the Department of Neurosurgery of Padua were retrospectively analyzed. To evaluate the sensitivity and specificity of 5-ALA fluorescence in detecting meningioma tissue, a pathologist analyzed 98 surgical bone samples under blue light, according to different fluorescence patterns. Magnetic resonance images and CT scans were obtained pre- and postoperatively to determine the extent of bone invasion resection.

Results
The rate of 5-ALA–induced fluorescence of both tumor and bone invasion was 100%. Based on the pathological examination of bone specimens, 5-ALA presented a sensitivity of 89.06% (95% CI 81.41%–96.71%) and a specificity of 100% in detecting meningioma bone invasion, while the positive and negative predictive values were 100% and 82.93% (95% CI 71.41%–94.45%), respectively. At the postoperative stage, MRI did not detect cases of meningioma bone invasion, whereas CT scans revealed residual hyperostosis in 2 cases.

Conclusions
In summary, 5-ALA fluorescence represents a suitable and reliable technique for identifying and removing bone infiltration by meningiomas. However, further studies are needed to prove the clinical consequences of this promising technique in a larger population.
Computed tomography characteristics in pediatric versus adult traumatic brain injury
Authors: Sarkar Korak , Keachie Krista , Nguyen UyenThao , Muizelaar J. Paul , Zwienenberg-Lee Marike , Shahlaie Kiarash 
Published: January 2014

Object
Traumatic brain injury (TBI) is a leading cause of injury, hospitalization, and death among pediatric patients. Admission CT scans play an important role in classifying TBI and directing clinical care, but little is known about the differences in CT findings between pediatric and adult patients. The aim of this study was to determine if radiographic differences exist between adult and pediatric TBI.

Methods
The authors retrospectively analyzed TBI registry data from 1206 consecutive patients with nonpenetrating TBI treated at a Level 1 adult and pediatric trauma center over a 30-month period.

Results
The distribution of sex, race, and Glasgow Coma Scale (GCS) score was not significantly different between the adult and pediatric populations; however, the distribution of CT findings was significantly different. Pediatric patients with TBI were more likely to have skull fractures (OR 3.21, p < 0.01) and epidural hematomas (OR 1.96, p < 0.01). Pediatric TBI was less likely to be associated with contusion, subdural hematoma, subarachnoid hemorrhage, or compression of the basal cisterns (p < 0.05). Rotterdam CT scores were significantly lower in the pediatric population (2.3 vs 2.6, p < 0.001).

Conclusions
There are significant differences in the CT findings in pediatric versus adult TBI, despite statistical similarities with regard to clinical severity of injury as measured by the GCS. These differences may be due to anatomical characteristics, the biomechanics of injury, and/or differences in injury mechanisms between pediatric and adult patients. The unique characteristics of pediatric TBI warrant consideration when formulating a clinical trial design or predicting functional outcome using prognostic models developed from adult TBI data.
A comparison of costs associated with endoscope-assisted craniectomy versus open cranial vault repair for infants with sagittal synostosis
Authors: Vogel Timothy W. , Woo Albert S. , Kane Alex A. , Patel Kamlesh B. , Naidoo Sybill D. , Smyth Matthew D. 
Published: January 2014

Object
The surgical management of infants with sagittal synostosis has traditionally relied on open cranial vault remodeling (CVR) techniques; however, minimally invasive technologies, including endoscope-assisted craniectomy (EAC) repair followed by helmet therapy (HT, EAC+HT), is increasingly used to treat various forms of craniosynostosis during the 1st year of life. In this study the authors determined the costs associated with EAC+HT in comparison with those for CVR.

Methods
The authors performed a retrospective case-control analysis of 21 children who had undergone CVR and 21 who had undergone EAC+HT. Eligibility criteria included an age less than 1 year and at least 1 year of clinical follow-up data. Financial and clinical records were reviewed for data related to length of hospital stay and transfusion rates as well as costs associated with physician, hospital, and outpatient clinic visits.

Results
The average age of patients who underwent CVR was 6.8 months compared with 3.1 months for those who underwent EAC+HT. Patients who underwent EAC+HT most often required the use of 2 helmets (76.5%), infrequently required a third helmet (13.3%), and averaged 1.8 clinic visits in the first 90 days after surgery. Endoscope-assisted craniectomy plus HT was associated with shorter hospital stays (mean 1.10 vs 4.67 days for CVR, p < 0.0001), a decreased rate of blood transfusions (9.5% vs 100% for CVR, p < 0.0001), and a decreased operative time (81.1 vs 165.8 minutes for CVR, p < 0.0001). The overall cost of EAC+HT, accounting for hospital charges, professional and helmet fees, and clinic visits, was also lower than that of CVR ($37,255.99 vs $56,990.46, respectively, p < 0.0001).

Conclusions
Endoscope-assisted craniectomy plus HT is a less costly surgical option for patients than CVR. In addition, EAC+HT was associated with a lower utilization of perioperative resources. Theses findings suggest that EAC+HT for infants with sagittal synostosis may be a cost-effective first-line surgical option.
Evaluation of complication rates of pediatric spinal procedures in which a polyethylene glycol sealant was used
Authors: Goodwin C. Rory , Recinos Pablo F. , Zhou Xin , Yang Jesse X. , Jallo George I. 
Published: January 2014

Object
Cerebrospinal fluid leakage following durotomy in spinal surgery can lead to significant patient morbidity and mortality, including meningitis and even death. Usage of a polyethylene glycol (PEG) sealant in combination with standard closure techniques has been shown to be effective in preventing CSF leaks in animal models and adult patients, but the results of its use have not been reported in the pediatric population.

Methods
A retrospective analysis was performed of pediatric neurosurgery patients (0–18 years of age) treated at The Johns Hopkins Hospital from 2003 to 2010. There were 93 spinal surgery patients identified in whom PEG was applied. The incidence of CSF leakage, meningitis, and neurological injury was recorded. There were 54 males and 39 females in this study with an average age of 8.7 years. Of the identified patients, 16.1%, 28%, and 55.9% underwent surgery in the cervical region, thoracic region, and lumbar region, respectively.

Results
At 90-day follow-up, 5 patients (5.4%) had a CSF leak, 4 patients (4.3%) required a reoperation, and 1 patient (1.1%) had meningitis within this time period. No deaths or associated neurological deficits were observed.

Conclusions
The use of a PEG sealant to augment dural closure in pediatric spine surgery appears to be a safe adjunct to standard dural closure in pediatric spine patients.
L'engagement algérien et humaniste du cardinal Léon-Étienne Duval (1903-1996)
Authors: Gonzales Denis 
Published: January 2014

« Certains hommes transcendent les limites de leur époque. Léon-Etienne Duval est largement de ceux-là. Le Cardinal, qui a si hautement incarné les vertus de la fraternité, a porté et délivré toute sa vie un message de raison dans un monde presque toujours déraisonnable ». 2
Using an Innovative Curriculum Evaluation Tool to Inform Program Improvement: The Clinical Skills Fair
Authors: Narayan Aditee P. , Whicker Shari A. , Staples Betty B. , Bookman Jack , Bartlett Kathleen W. , McGann Kathleen A. 
Published: January 2014

Abstract

Background
Program evaluation is important for assessing the effectiveness of the residency curriculum. Limited resources are available, however, and curriculum evaluation processes must be sustainable and well integrated into program improvement efforts.

Intervention
We describe the pediatric Clinical Skills Fair, an innovative method for evaluating the effectiveness of residency curriculum through assessment of trainees in 2 domains: medical knowledge/patient care and procedure. Each year from 2008 to 2011, interns completed the Clinical Skills Fair as rising interns in postgraduate year (PGY)-1 (R1s) and again at the end of the year, as rising residents in PGY-2 (R2s). Trainees completed the Clinical Skills Fair at the beginning and end of the intern year for each cohort to assess how well the curriculum prepared them to meet the intern goals and objectives.

Results
Participants were 48 R1s and 47 R2s. In the medical knowledge/patient care domain, intern scores improved from 48% to 65% correct (P &lt; .001). Significant improvement was demonstrated in the following subdomains: jaundice (41% to 65% correct; P &lt; .001), fever (67% to 94% correct; P &lt; .001), and asthma (43% to 62% correct; P  =  .002). No significant change was noted within the arrhythmia subdomain. There was significant improvement in the procedure domain for all interns (χ2  =  32.82, P &lt; .001).

Conclusions
The Clinical Skills Fair is a readily implemented and sustainable method for our residency program curriculum assessment. Its feasibility may allow other programs to assess their curriculum and track the impact of programmatic changes; it may be particularly useful for program evaluation committees.
High prevalence of low bone mass and associated factors in Korean HIV‐positive male patients undergoing antiretroviral therapy
Authors: Choe Pyoeng Gyun , Choi Hyung Jin , Kim Nak‐Hyun , Park Wan Beom , Song Kyoung‐Ho , Bang Ji Hwan , Kim Eu Suk , Park Sang Won , Kim Hong Bin , Oh Myoung‐don , Kim Nam Joong 
Published: January 2014

IntroductionLow bone mass is prevalent in HIV‐positive patients. However, compared to Western countries, less is known about HIV‐associated osteopenia in Asian populations.MethodsWe performed a cross‐sectional survey in Seoul National University Hospital from December 2011 to May 2012. We measured bone mineral density using central dual energy X‐ray absorptiometry, with consent, in male HIV‐positive patients, aged 40 years and older. Diagnosis of low bone mass was made using International Society for Clinical Densitometry Z‐score criteria in the 40–49 years age group and World Health Organization T‐score criteria in the >50‐year age group. The data were compared with those of a community‐based cohort in Korea.ResultsEighty‐four HIV‐positive male patients were included in this study. Median age was 49 (interquartile range [IQR], 45–56) years, and median body mass index (BMI) was 22.6 (IQR, 20.9–24.4). Viral suppression was achieved in 75 (89.3%) patients and median duration of antiretroviral therapy was 71 (IQR, 36–120) months. The overall prevalence of low bone mass was 16.7% in the 40–49 years age group and 54.8% in the>50 years age group. Our cohort had significantly lower bone mass at the femur neck and total hip than HIV‐negative Koreans in the 40–49 years age group. Low bone mass was significantly associated with low BMI, and a high level of serum carboxy‐terminal collagen crosslinks, but was not associated with antiretroviral regimen or duration of antiretroviral therapy.ConclusionsLow bone mass is prevalent in Korean HIV‐positive males undergoing antiretroviral therapy, and may be associated with increased bone resorption.