bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transvitreal Endoresection of Refractory Retinal Capillary Hemangioblastoma After Feeder Vessel Ligation
Authors: Khurshid Gibran S. 
Published: May 2013

BACKGROUND AND OBJECTIVE:
Retinal capillary hemangioma (RCH) is a developmental vascular tumor occurring sporadically or associated with Von Hippel-Lindau syndrome. Treatment for large solitary RCH is challenging. Laser, cryotherapy, radiotherapy, photodynamic therapy, and en bloc resection for advanced cases have been described in the literature without consensus on standard management.

MATERIALS AND METHODS:
A novel technique of 20-gauge transvitreal endoresection of solitary peripheral RCH after ligating the feeder vessels is described.

RESULTS:
Tumors were successfully resected after ligating the feeder vessels bimanually in a closed and more controlled ocular environment. Feeder vessel ligation is intended to compensate for the involution time of the caliber of feeder vessels, when postoperative hemorrhage is more likely to occur. Another advantage of ligating the blood vessels is to secure hemostasis without using heavy endocautery. Postoperatively, proliferative vitreoretinopathy remains a concern.

CONCLUSION:
Pending a larger randomized trial, performing endoresection in RCH that is large and unresponsive to conventional treatment is an acceptable option.

[
Ophthalmic Surg Lasers Imaging Retina.
2013;44:278–280.]
Exergaming and Static Postural Control in Individuals With a History of Lower Limb Injury
Authors: Sims Jennifer , Cosby Nicole , Saliba Ethan N. , Hertel Jay , Saliba Susan A. 
Published: May 2013

Context:
Therapeutic exercise programs that incorporate real-time feedback have been reported to enhance outcomes in patients with lower extremity joint injuries. The Wii Fit has been purported to improve balance, strength, flexibility, and fitness.

Objective:
To determine the effects of Wii Fit rehabilitation on postural control and self-reported function in patients with a history of lower limb injury.

Design:
Single-blinded, randomized controlled trial.

Setting:
Laboratory.

Patients or Other Participants:
Twenty-eight physically active participants with a history of lower limb injuries were randomly assigned to 1 of 3 groups (9 Wii Fit, 10 traditional, 9 control).

Intervention(s):
Intervention groups performed supervised rehabilitation 3 d/wk for a total of 12 sessions.

Main Outcome Measure(s):
Time to boundary (TTB) and the Star Excursion Balance Test (SEBT) were conducted at baseline, 2 weeks, and 4 weeks. Self-reported function was measured at baseline and 4-week follow-up. Between-groups differences were compared using repeated-measures multivariate analysis of variance.

Results:
With the eyes open, both intervention groups improved (P &lt; .05) in the mean and the SD of the TTB anterior-posterior minima. In the eyes-closed condition, a time main effect (P &lt; .05) for absolute TTB medial-lateral minima was observed. A time main effect was also noted in the posteromedial and posterolateral reach directions of the SEBT. When the scores for each group were pooled, improvement (P &lt; .05) in self-reported function was demonstrated at 4-week follow-up.

Conclusions:
Rehabilitation using the Wii Fit and traditional exercises improved static postural control in patients with a history of lower extremity injury.
Perceptions of Wellness and Burnout Among Certified Athletic Trainers: Sex Differences
Authors: Naugle Keith E. , Behar-Horenstein Linda S. , Dodd Virginia J. , Tillman Mark D. , Borsa Paul A. 
Published: May 2013

Context:
Athletic trainers are exposed to various stressors, increasing the potential for burnout and decreasing perceived wellness. Burnout and decreased perceived wellness can result from many factors: years of experience, hours per week worked, or decreased levels of physical activity. Another factor that accounts for a portion of the variance is sex differences.

Objective:
To determine the differences in burnout, physical activity, and perceived wellness scores relating to sex in District 9 of the National Athletic Trainers' Association (NATA).

Design:
Cross-sectional study.

Setting:
Web-based questionnaire.

Patients or Other Participants:
Athletic trainers who were included in the e-mail directory of NATA District 9 (men = 232, women = 158).

Intervention(s):
A 19-item questionnaire for burnout, a 36-item questionnaire for perceived wellness, and a 16-item activity questionnaire for physical activity and demographics.

Main Outcome Measure(s):
The variables included demographics (hours per week worked, years of experience, sex), Copenhagen Burnout Inventory (CBI; scores range from 0–100, and higher scores represent a higher level of burnout), Perceived Wellness Survey (PWS; scores range from 1–36, and scores close to 29 are considered healthy), and Baecke Physical Activity Questionnaire (BPAQ; scores range from 1–15, and higher scores represent more physical activity).

Results:
Of the 1560 members contacted, 390 responded (response rate = 25%), and 59.5% (n = 232) were male. The mean scores were 38.73 ± 16.9 for men and 46.2 ± 17.1 for women for the CBI, 16.68 ± 2.76 for men and 16.41 ± 2.81 for women for the PWS, and 8.42 ± 1.32 for men and 8.77 ± 1.36 for women for the BPAQ. Men and women worked an average of 55.60 ± 26.03 and 47.86 ± 20.57 hours per week, respectively, and had a mean experience of 14.79 ± 9.86 and 8.92 ± 6.51 years, respectively. Women reported a higher level of burnout (t388 = −4.255, P = .001) and greater levels of physical activity (t388 = −2.52, P = .01) than men. Men reported working more hours (t388 = 3.131, P = .002) and having more years of experience (t388 = 6.568, P = .001) than women. Perceived wellness was not different between sexes (t388 = 0.958, P = .34).

Conclusions:
Our results suggest that women experienced moderate to high burnout and men experienced moderate burnout. Interestingly, men reported lower levels of burnout but worked more hours than women. Future researchers should focus on why women experience higher levels of burnout but work fewer hours. These findings may lead to educational interventions that might reduce burnout and increase professional longevity and quality of work.
Foot Structure and Muscle Reaction Time to a Simulated Ankle Sprain
Authors: Denyer Joanna R. , Hewitt Naomi L. A. , Mitchell Andrew C. S. 
Published: May 2013

Context:Foot structure has been shown to affect aspects of neuromuscular control, including postural stability and proprioception. However, despite an association between pronated and supinated foot structures and the incidence of lateral ankle sprains, no one to our knowledge has measured muscle reaction time to a simulated ankle-sprain mechanism in participants with different foot structures.Objective:To determine whether pronated or supinated foot structures contribute to neuromuscular deficits as measured by muscle reaction time to a simulated ankle-sprain mechanism.Design:Cross-sectional study.Setting:University biomechanics laboratory.Patients or Other Participants:Thirty volunteers were categorized into 3 groups according to navicular-drop–height measures. Ten participants (4 men, 6 women) had neutral feet (navicular-drop height = 5–9 mm), 10 participants (4 men, 6 women) had pronated feet (navicular-drop height ≥ 10 mm), and 10 participants (4 men, 6 women) had supinated feet (navicular-drop height ≤ 4 mm).Intervention(s):Three perturbations on a standing tilt platform simulating the mechanics of an inversion and plantar-flexion ankle sprain.Main Outcome Measure(s):Muscle reaction time in milliseconds of the peroneus longus, tibialis anterior, and gluteus medius to the tilt-platform perturbation.Results:Participants with pronated or supinated foot structures had slower peroneus longus reaction times than participants with neutral feet (P = .01 and P = .04, respectively). We found no differences for the tibialis anterior or gluteus medius.Conclusions:Foot structure influenced peroneus longus reaction time. Further research is required to establish the consequences of slower peroneal reaction times in pronated and supinated foot structures. Researchers investigating lower limb muscle reaction time should control for foot structure because it may influence results.
Use of Evidence-Based Practice Among Athletic Training Educators, Clinicians, and Students, Part 1: Perceived Importance, Knowledge, and Confidence
Authors: Hankemeier Dorice A. , Walter Jessica M. , McCarty Cailee W. , Newton Eric J. , Walker Stacy E. , Pribesh Shana L. , Jamali Beth E. , Manspeaker Sarah A. , Van Lunen Bonnie L. 
Published: May 2013

Context:
Although evidence-based practice (EBP) has become more prevalent, athletic trainers' perceptions of importance and knowledge of these concepts and their confidence in EBP are largely unknown.

Objective:
To assess perceived importance and knowledge of and confidence in EBP concepts in athletic trainers in various roles and with different degree levels.

Design:
Cross-sectional study.

Setting:
Online survey instrument.

Patients or Other Participants:
The survey was sent to 6702 athletic training educators, clinicians, and postprofessional students. A total of 1209 completed the survey, for a response rate of 18.04%.

Main Outcome Measure(s):
Demographic information and perceived importance and knowledge of and confidence in the steps of EBP were obtained. One-way analysis of variance, a Kruskal-Wallis test, and an independent-samples t test were used to determine differences in scores among the demographic variables.

Results:
Athletic trainers demonstrated low knowledge scores (64.2% ± 1.29%) and mild to moderate confidence (2.71 ± 0.55 out of 4.0). They valued EBP as moderately to extremely important (3.49 ± 0.41 out of 4.0). Perceived importance scores differed among roles (clinicians unaffiliated with an education program scored lower than postprofessional educators, P = .001) and highest educational degree attained (athletic trainers with terminal degrees scored higher than those with bachelor's or master's degrees, P &lt; .001). Postprofessional athletic training students demonstrated the highest total EBP knowledge scores (4.65 ± 0.91), whereas clinicians demonstrated the lowest scores (3.62 ± 1.35). Individuals with terminal degrees had higher (P &lt; .001) total knowledge scores (4.31 ± 1.24) than those with bachelor's (3.78 ± 1.2) or master's degrees (3.76 ± 1.35). Postprofessional educators demonstrated greater confidence in knowledge scores (3.36 ± 0.40 out of 4.0) than did those in all other athletic training roles (P &lt; .001).

Conclusions:
Overall knowledge of the basic EBP steps remained low across the various athletic trainers' roles. The higher level of importance indicated that athletic trainers valued EBP, but this value was not reflected in the knowledge of EBP concepts. Individuals with a terminal degree possessed higher knowledge scores than those with other educational preparations; however, EBP knowledge needs to increase across all demographics of the profession.
A Learner-Centered Technique and Clinical Reasoning, Reflection, and Case Presentation Attributes in Athletic Training Students
Authors: Heinerichs Scott , Vela Luzita I. , Drouin Joshua M. 
Published: May 2013

Context:Providing opportunities to develop clinical decision-making skills, including clinical reasoning, is an important aspect of clinical education. The learner-centered technique of summarizing the history and findings, narrowing the differential, analyzing the differential, probing the instructor about uncertainties, plan management, and selecting an issue for self-directed study (SNAPPS) is used in medicine to express clinical reasoning.Objective:To investigate the effects of SNAPPS on the clinical reasoning, reflection, and 4 case presentation attributes (length, conciseness, case summary, and expression of clinical reasoning) in athletic training students.Design:Randomized controlled clinical trial.Setting:Three undergraduate programs accredited by the Commission on Accreditation of Athletic Training Education.Patients or Other Participants:We randomly assigned 38 athletic training students (17 men, 21 women; age = 21.53 ± 1.18 years, grade point average = 3.25 ± 0.31) who had completed at least 1 year of clinical education and all orthopaedic evaluation coursework to the SNAPPS group or the usual and customary group using a stratification scheme.Intervention(s):The SNAPPS group completed four 45-minute clinical reasoning and case presentation learning modules led by an investigator to learn the SNAPPS technique, whereas the usual and customary group received no formal instruction. Both groups audio recorded all injury evaluations performed over a 2-week period.Main Outcome Measures:Participants completed the Diagnostic Thinking Inventory and Reflection in Learning Scale twice. Case presentations were analyzed for 4 attributes: length, conciseness, case summary, and expression of clinical reasoning.Results:Case presentations were longer (t18.806 = −5.862, P &lt; .001) but were more concise (t32 = 11.297, P &lt; .001) for the SNAPPS group than for the usual and customary group. The SNAPPS group performed better on both the case summary subscale (t32 = 2.857, P = .007) and the clinical reasoning subscale (t25.773 = −14.162, P &lt; .001) than the other group. We found a time effect for Diagnostic Thinking Inventory scores (F1,34 = 6.230, P = .02) but observed no group effects (F1,34 = 0.698, P = .41) or time-by-group interaction (F1,34 = 1.050, P = .31). The Reflection in Learning Scale scores analysis revealed no group-by-time interaction (F1,34 = 1.470, P = .23) and no group (F1,34 = 3.751, P = .06) or time (F1,34 = 0.835, P = .37) effects.Conclusions:The SNAPPS is an effective and feasible clinical education technique for case presentations. This learner-centered technique provides the opportunity for the expression of clinical reasoning skills.
Use of Evidence-Based Practice Among Athletic Training Educators, Clinicians, and Students, Part 2: Attitudes, Beliefs, Accessibility, and Barriers
Authors: W. McCarty Cailee , Hankemeier Dorice A. , Walter Jessica M. , Newton Eric J. , Van Lunen Bonnie L. 
Published: May 2013

Context:Successful implementation of evidence-based practice (EBP) within athletic training is contingent upon understanding the attitudes and beliefs and perceived barriers toward EBP as well as the accessibility to EBP resources of athletic training educators, clinicians, and students.Objective:To assess the attitudes, beliefs, and perceived barriers toward EBP and accessibility to EBP resources among athletic training educators, clinicians, and students.Design:Cross-sectional study.Setting:Online survey instrument.Patients or Other Participants:A total of 1209 athletic trainers participated: professional athletic training education program directors (n = 132), clinical preceptors (n = 266), clinicians (n = 716), postprofessional athletic training educators (n = 24) and postprofessional students (n = 71).Main Outcome Measure(s):Likert-scale items (1 = strongly disagree, 4 = strongly agree) assessed attitudes and beliefs and perceived barriers, whereas multipart questions assessed accessibility to resources. Kruskal-Wallis H tests (P ≤ .05) and Mann-Whitney U tests with a Bonferroni adjustment (P ≤ .01) were used to determine differences among groups.Results:Athletic trainers agreed (3.27 ± 0.39 out of 4.0) that EBP has various benefits to clinical practice and disagreed (2.23 ± 0.42 out of 4.0) that negative perceptions are associated with EBP. Benefits to practice scores (P = .002) and negative perception scores (P &lt; .001) differed among groups. With respect to perceived barriers, athletic trainers disagreed that personal skills and attributes (2.29 ± 0.52 out of 4.0) as well as support and accessibility to resources (2.40 ± 0.40 out of 4.0) were barriers to EBP implementation. Differences were found among groups for personal skills and attributes scores (P &lt; .001) and support and accessibility to resources scores (P &lt; .001). Time (76.6%) and availability of EBP mentors (69.6%) were the 2 most prevalent barriers reported. Of the resources assessed, participants were most unfamiliar with clinical prediction rules (37.6%) and Cochrane databases (52.5%); direct access to these 2 resources varied among participants.Conclusions:Athletic trainers had positive attitudes toward the implementation of EBP within didactic education and clinical practice. However, accessibility and resource use remained low for some EBP-related resources. Although the perceived barriers to implementation are minimal, effective integration of EBP within athletic training will present challenges until these barriers dissolve.
Intramuscular Heating Through Fluidotherapy and Heat Shock Protein Response
Authors: Vardiman John P. , Jefferies Laura , Touchberry Chad , Gallagher Phillip 
Published: May 2013

Context:Therapeutic modalities that can increase intramuscular temperature commonly are used to treat injuries in the clinical setting. Researchers recently have suggested that the physiologic changes occurring during an increase in temperature also could provide a cytoprotective effect for exercise-induced muscle damage.Objective(s):To determine if the Fluidotherapy treatment increases the inducible expression of heat shock protein (HSP), to identify the rate of heating that occurs in the lower extremity with Fluidotherapy treatment, and to evaluate the relationship between the inducible expression of HSP and temperature.Design:Controlled laboratory study.Setting:Laboratory.Patients or Other Participants:Six male (age = 21.67 ± 1.63 years, height = 180.09 ± 4.83 cm, mass = 87.60 ± 10.51 kg) and 6 female (age = 24.60 ± 4.59 years, height = 151.05 ± 35.76 cm, mass = 55.59 ± 14.58 kg) college-aged students.Intervention(s):One lower extremity was randomly selected to receive the heat treatment, and the other extremity received no treatment.Main Outcome Measure(s):We measured intramuscular temperature every 10 minutes, determining peak intramuscular temperature by 2 identical sequential measurements, and we analyzed the time to peak temperature. We analyzed the amount of HSP70 expression and HSP27P:T (ratio of HSP27 to the total HSP27 expression) in the gastrocnemius and soleus muscles and measured baseline skinfold thickness and estradiol levels.Results:Fluidotherapy increased intramuscular temperature by 5.66 ± 0.78°C (t11 = 25.67, P &lt; .001) compared with baseline temperature, with a peak temperature of 39.08°C ± 0.39°C occurring at 84.17 ± 6.69 minutes. We did not find a heat treatment effect for HSP70 or HSP27P:T in the gastrocnemius or soleus muscles (P &gt; .05). Peak temperature and the percentage change of HSP70 were positively correlated for the gastrocnemius and soleus muscles (P &lt; .05). We found no other correlations for skinfold thickness, sex, or estradiol levels (P &gt; .05). No effect of sex for skinfold thickness or estradiol levels at baseline was discovered (P &gt; .05).Conclusions:This Fluidotherapy protocol increased the intramuscular temperature to a therapeutic level; however, it did not stimulate inducible HSP70 or HSP27P:T in the soleus and gastrocnemius muscles regardless of sex or skinfold thickness. These data confirmed that Fluidotherapy is an effective heating modality but suggested it is not an effective method for stimulating an HSP response in the lower limb.
Serum PCT and CRP Levels in Upper Respiratory Tract Infections as a Marker of Infection
Authors: Sood Archana , Chauhan Preeti , Jain Manisha , Dabla Pradeep , Sood Sanjay 
Published: May 2013

ABSTRACT
Most of the upper respiratory tract infections are viral in origin and accounts for the most frequent cause of antibiotic misuse world over. Conventional test like microbiological culture for confirming bacterial etiology is not very sensitive. We evaluated the utility of biomarkers like procalcitonin (PCT), C-reactive protein (CRP) and total leukocyte count (TLC) to guide antibiotic treatment in such cases. Fifty patients were divided into two groups, those having acute suppurative tonsillitis (n = 40) and those having acute rhinosinusitis (n = 10) were included. Appropriate samples were processed for microbiological culture. Blood samples were taken for PCT, CRP and TLC estimation. Almost 34% of the patients were taking antibiotics at least 1 day prior to their consultation. Microbiological culture was positive only in 38% of cases. The levels of PCT were significantly higher in cases of acute suppurative tonsillitis as compared to rhinosinusitis. The PCT levels correlated well with CRP, TLC and degree of fever in tonsillitis cases. The levels of CRP correlated well with the TLC levels in rhinosinusitis cases. PCT and CRP levels were higher than the normal healthy population in our patients. They can be used as a marker for guiding antibiotic treatment in cases of upper respiratory tract infection of bacterial origin.

How to cite this article
Chauhan P, Sood A, Jain M, Dabla P, Sood S. Serum PCT and CRP Levels in Upper Respiratory Tract Infections as a Marker of Infection. Clin Rhinol An Int J 2013;6(1):1-4.
Reconstruction of Depressed Dorsum including Tip of Nose by Autogenous Materials: Our Experience
Authors: Majumder Aniruddha , Das Chiranjib , Hazra Tapan Kanti , Karmakar Minakshi , Paul Dipten 
Published: May 2013

ABSTRACT
Reconstruction of nose is a very challenging task. It has been practiced since ancient ages. Since, then various techniques have evolved. We have used forehead and nasolabial advancement flap for reconstruction of skin defect over iliac crest bone or conchal cartilage grafts. In small gap we used composite graft from pinna. In this article we share our experience with various grafts and flaps, their success and failures and methods to avoid or treat them.

How to cite this article
Hazra TK, Majumder A, Das C, Karmakar M, Paul D. Reconstruction of Depressed Dorsum including Tip of Nose by Autogenous Materials: Our Experience. Clin Rhinol An Int J 2013;6(1):22-27.
Fungal Rhinosinusitis in Delhi-National Capital Region
Authors: Agarwal Shilpi , Garg Sunil , Songara Prafulla , Sherwal BL , Rakshit Partha 
Published: May 2013

ABSTRACT

Background and objective
During past decades, fungal rhinosinusitis (FRS) has been diagnosed more frequently. Knowing the fungal flora and its prevalence in chronic rhinosinusitis (CRS) patients will allow a better understanding of this disease, diagnosis and treatment. We studied the prevalence of fungus in CRS patients in Delhi-NCR (National Capital Region) in a tertiary care hospital.

Materials and methods
In this prospective study, a total of 180 patients having CRS were enrolled in which functional endoscopic sinus surgery was done. In 173 (96.1%) patients, polyps/tissue/mass were collected during surgery. In seven (3.9%) cases, sinus secretions were obtained. All the collected samples were sent for microbiology and pathology examination. Diagnosis of FRS was confirmed by direct mycological (10% KOH) and/or culture and/or pathology analysis.

Results
Forty-eight cases were positive for fungus, out of these 180 patients of CRS. In patients of FRS, the most common presentation was nasal blockage followed by facial pain and facial fullness. The prevalence of FRS was found to be 26.6% in CRS and most common fungal pathogen isolated was Aspergillus flavus.

Conclusion
Delhi-NCR region falls under a moderate prevalence area for fungal infection in CRS patients as compared to other regions in India. Majority of cases were isolated in summer months, the dry and hot climate of the Delhi- NCR may be responsible for such prevalence.

How to cite this article
Garg S, Songara P, Sherwal BL, Agarwal S, Rakshit P, Kumar S. Fungal Rhinosinusitis in Delhi- National Capital Region. Clin Rhinol An Int J 2013;6(1): 28-31.