bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utility of a Language Screening Measure for Predicting Risk for Language Impairment in Bilinguals
Authors: Lugo-Neris Mirza J. , Peña Elizabeth D. , Bedore Lisa M. , Gillam Ronald B. 
Published: April 2015

Purpose
This study evaluated the accuracy of an experimental version of the Bilingual English Spanish Oral Screener (BESOS; Peña, Bedore, Iglesias, Gutiérrez-Clellen, & Goldstein, 2008) for predicting the long-term risk for language impairment (LI) for a matched group of preschool-aged Spanish–English bilingual children with and without LI.

Method
A total of 1,029 Spanish–English bilingual children completed the BESOS before entering kindergarten. A subset of 167 participants completed a follow-up language evaluation in 1st grade. Twenty-one of these children were identified as having LI and were matched to a group of 21 typically developing peers from the larger sample. A series of discriminant analyses were used to determine the combination of scores on the BESOS that most accurately predicted 2 years later which children presented with and without LI.

Results
The linear combination of the semantics and morphosyntax scores in the best language resulted in predictive sensitivity of 95.2% and predictive specificity of 71.4%, with an overall accuracy of 81% for predicting risk for LI.

Conclusion
A bilingual language screener administered before kindergarten can be useful for predicting risk for LI in bilingual children in 1st grade.
Prevalence of pilus genes in pneumococci isolated from healthy preschool children in Iceland: association with vaccine serotypes and antibiotic resistance
Authors: Hjálmarsdóttir Martha Á. , Pétursdóttir Brynhildur , Erlendsdóttir Helga , Haraldsson Gunnsteinn , Kristinsson Karl G. 
Published: April 2015

Abstract

Objectives
The objective of this study was to investigate the prevalence of pilus islets [pilus islet 1 (PI-1) and pilus islet 2 (PI-2)] in pneumococcal isolates from healthy Icelandic preschool children attending day care centres, prior to the introduction of conjugated pneumococcal vaccine, and the association of the pilus islets with vaccine serotypes and antibiotic resistance.

Methods
Nasopharyngeal swabs were collected from 516 healthy children attending day care centres in Reykjavik in March and April 2009. Infant vaccination was started in 2011, thus the great majority of the children were unvaccinated. Pneumococci were cultured selectively, tested for antimicrobial susceptibility and serotyped. The presence of PI-1 and PI-2 was detected using PCR.

Results
A total of 398 viable isolates were obtained of which 134 (33.7%) showed the presence of PI-1. PI-1-positive isolates were most often seen in serotype 19F [30/31 (96.8%)] and were of clade I, and in 6B [48/58 (82.8%)] of clade II. PI-2-positive isolates were most common in serotype 19F [27/31 (87.1%)]; all of them were also PI-1 positive. Of the PI-1-positive and PI-2-positive isolates, 118 (88.1%) and 31 (81.6%), respectively, were of vaccine serotypes. Both PI-1 and PI-2 were more often present in penicillin-non-susceptible pneumococci (PNSP) than in penicillin-susceptible pneumococci [PI-1 in 41/58 (70.7%) and 93/340 (27.4%), respectively, and PI-2 in 28/58 (48.3%) and 10/340 (2.9%), respectively].

Conclusions
Genes for PI-1 and/or PI-2 in pneumococci isolated from healthy Icelandic children are mainly found in isolates of vaccine serotypes and in PNSP isolates belonging to multiresistant international clones that have been endemic in the country.
Leveraging health information technology to achieve the “triple aim” of healthcare reform
Authors: Sheikh Aziz , Sood Harpreet S , Bates David W 
Published: April 2015

Abstract
Objective To investigate experiences with leveraging health information technology (HIT) to improve patient care and population health, and reduce healthcare expenditures.
Materials and methods In-depth qualitative interviews with federal government employees, health policy, HIT and medico-legal experts, health providers, physicians, purchasers, payers, patient advocates, and vendors from across the United States.
Results The authors undertook 47 interviews. There was a widely shared belief that Health Information Technology for Economic and Clinical Health (HITECH) had catalyzed the creation of a digital infrastructure, which was being used in innovative ways to improve quality of care and curtail costs. There were however major concerns about the poor usability of electronic health records (EHRs), their limited ability to support multi-disciplinary care, and major difficulties with health information exchange, which undermined efforts to deliver integrated patient-centered care. Proposed strategies for enhancing the benefits of HIT included federal stimulation of competition by mandating vendors to open-up their application program interfaces, incenting development of low-cost consumer informatics tools, and promoting Congressional review of the The Health Insurance Portability and Accountability Act (HIPPA) to optimize the balance between data privacy and reuse. Many underscored the need to “kick the legs from underneath the fee-for-service model” and replace it with a data-driven reimbursement system that rewards high quality care.
Conclusions The HITECH Act has stimulated unprecedented, multi-stakeholder interest in HIT. Early experiences indicate that the resulting digital infrastructure is being used to improve quality of care and curtail costs. Reform efforts are however severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm—addressing these issues therefore needs to be the federal government’s main policy target.
Automated methods for the summarization of electronic health records
Authors: Pivovarov Rimma , Elhadad Noémie 
Published: April 2015

AbstractObjectives This review examines work on automated summarization of electronic health record (EHR) data and in particular, individual patient record summarization. We organize the published research and highlight methodological challenges in the area of EHR summarization implementation.Target audience The target audience for this review includes researchers, designers, and informaticians who are concerned about the problem of information overload in the clinical setting as well as both users and developers of clinical summarization systems.Scope Automated summarization has been a long-studied subject in the fields of natural language processing and human–computer interaction, but the translation of summarization and visualization methods to the complexity of the clinical workflow is slow moving. We assess work in aggregating and visualizing patient information with a particular focus on methods for detecting and removing redundancy, describing temporality, determining salience, accounting for missing data, and taking advantage of encoded clinical knowledge. We identify and discuss open challenges critical to the implementation and use of robust EHR summarization systems.
Preexisting Immunity, More Than Aging, Influences Influenza Vaccine Responses
Authors: Reber Adrian J. , Kim Jin Hyang , Biber Renata , Talbot H. Keipp , Coleman Laura A. , Chirkova Tatiana , Gross F. Liaini , Steward-Clark Evelene , Cao Weiping , Jefferson Stacie , Veguilla Vic , Gillis Eric , Meece Jennifer , Bai Yaohui , Tatum Heather , Hancock Kathy , Stevens James , Spencer Sarah , Chen Jufu , Gargiullo Paul , Braun Elise , Griffin Marie R. , Sundaram Maria , Belongia Edward A. , Shay David K. , Katz Jacqueline M. , Sambhara Suryaprakash 
Published: April 2015

Abstract
Background.  Influenza disproportionately impacts older adults while current vaccines have reduced effectiveness in the older population.
Methods.  We conducted a comprehensive evaluation of cellular and humoral immune responses of adults aged 50 years and older to the 2008–2009 seasonal trivalent inactivated influenza vaccine and assessed factors influencing vaccine response.
Results.  Vaccination increased hemagglutination inhibition and neutralizing antibody; however, 66.3% of subjects did not reach hemagglutination inhibition titers ≥ 40 for H1N1, compared with 22.5% for H3N2. Increasing age had a minor negative impact on antibody responses, whereas prevaccination titers were the best predictors of postvaccination antibody levels. Preexisting memory B cells declined with age, especially for H3N2. However, older adults still demonstrated a significant increase in antigen-specific IgG+ and IgA+ memory B cells postvaccination. Despite reduced frequency of preexisting memory B cells associated with advanced age, fold-rise in memory B cell frequency in subjects 60+ was comparable to subjects age 50–59.
Conclusions.  Older adults mounted statistically significant humoral and cell-mediated immune responses, but many failed to reach hemagglutination inhibition titers ≥40, especially for H1N1. Although age had a modest negative effect on vaccine responses, prevaccination titers were the best predictor of postvaccination antibody levels, irrespective of age.
Corynebacterium pseudotuberculosis Pneumonia in a Veterinary Student Infected During Laboratory Work
Authors: Heggelund Lars , Gaustad Peter , Håvelsrud Othilde Elise , Blom Jochen , Borgen Lars , Sundset Arve , Sørum Henning , Frøland Stig Sophus 
Published: April 2015

Abstract
We present a case of Corynebacterium pseudotuberculosis pneumonia in a veterinary student, with molecular genetic evidence of acquisition during laboratory work, an observation relevant for laboratory personnel working with C pseudotuberculosis isolates. The patient was clinically cured with 14 months trimethoprim/sulfamethoxazole and rifampicin combination treatment.
Dose-dependent Association between Intermediate-acting Neuromuscular-blocking Agents and Postoperative Respiratory Complications
Authors: McLean Duncan J. , Diaz-Gil Daniel , Farhan Hassan N. , Ladha Karim S. , Kurth Tobias , Eikermann Matthias 
Published: April 2015

AbstractAbstract
In a review of nearly 50,000 subjects, use of intermediate-acting neuromuscular blockers was associated with a dose-dependent increase in pulmonary complications. Neostigmine also was associated with a dose-dependent increase in pulmonary complications although exploratory analysis suggested that this reflected lack of neostigmine dose adjustment using neuromuscular transmission monitoring.

Background:
Duration of action increases with repeated administration of neuromuscular-blocking agents, and intraoperative use of high doses of neuromuscular-blocking agent may affect respiratory safety.

Methods:
In a hospital-based registry study on 48,499 patients who received intermediate-acting neuromuscular-blocking agents, the authors tested the primary hypothesis that neuromuscular-blocking agents are dose dependently associated with the risk of postoperative respiratory complications. In the secondary analysis, the authors evaluated the association between neostigmine dose given for reversal of neuromuscular-blocking agents and respiratory complications. Post hoc, the authors evaluated the effects of appropriate neostigmine reversal (neostigmine ≤60 μg/kg after recovery of train-of-four count of 2) on respiratory complications. The authors controlled for patient-, anesthesia-, and surgical complexity–related risk factors.

Results:
High doses of neuromuscular-blocking agents were associated with an increased risk of postoperative respiratory complications (n = 644) compared with low doses (n = 205) (odds ratio [OR], 1.28; 95% CI, 1.04 to 1.57). Neostigmine was associated with a dose-dependent increase in the risk of postoperative respiratory complications (OR, 1.51; 95% CI, 1.25 to 1.83). Post hoc analysis revealed that appropriate neostigmine reversal eliminated the dose-dependent association between neuromuscular-blocking agents and respiratory complications (for neuromuscular-blocking agent effects with appropriate reversal: OR, 0.98; 95% CI, 0.63 to 1.52).

Conclusions:
The use of neuromuscular-blocking agents was dose dependently associated with increased risk of postoperative respiratory complications. Neostigmine reversal was also associated with a dose-dependent increase in the risk of respiratory complications. However, the exploratory data analysis suggests that the proper use of neostigmine guided by neuromuscular transmission monitoring results can help eliminate postoperative respiratory complications associated with the use of neuromuscular-blocking agents.
Lower Extremity Deformity Management in MPS IVA, Morquio-Brailsford Syndrome: Preliminary Report of Hemiepiphysiodesis Correction of Genu Valgum
Authors: Cooper George A. , Southorn Thomas , Eastwood Deborah M. , Bache C. Edward 
Published: April 2015

Background:
Morquio-Brailsford syndrome or mucopolysaccharidosis type IV-A (MPS IV-A) is an inherited metabolic disease in which skeletal deformities can be extreme. An international registry has shown that 46% of patients are unable to walk 200 m and 30% use a wheelchair. Lower limb surgery is performed to restore alignment with the expectation of maintaining mobility. We are, however, not aware of reports correlating function with alignment. This study assesses the role of orthopaedic intervention with reference to anatomic and functional outcome in MPS IV-A: specifically hemiepiphysiodesis correction of genu valgum.

Methods:
Interrogation of the MPS patient database identified 63 patients. Patient demographic and radiographic data were collected along with information on deformity, correction, mobility, and genotype. Genu valgum was assessed by intermalleolar distance and mobility by a standardized 6-minute walk test. Sequential hip anatomy was assessed radiographically.

Results:
Twenty-six surgical hemiepiphysiodesis episodes were performed on 23 patients. There were no cases of implant failure, loosening, or infection. The average intermalleolar distance reduction was 6.12 cm (paired t test, P=0.0001) (95% confidence interval, 7.6-4.7 cm) and the mean change in 6-minute walk test was +69.5 m (P=0.0339). There was no correlation between hip subluxation/dislocation and mobility (Fisher exact test, P=1.000), although hip parameters deteriorated over time. Three patients required repeat 8-plate insertion and 1 a femoral osteotomy.

Conclusions:
Eight-plate hemiepiphysiodesis correction of genu valgum in MPS IV-A is an effective treatment with low complication rates. The insult of surgery is minimal compared with that of osteotomy which can reduce mobility further. Our outcomes suggest that mobility is maintained or improved even in severe genotypes where mobility typically worsens. We have found hip pathology to be less debilitating, but further studies are needed to assess the effect of genu valgum correction upon femoral head subluxation and collapse.
We suggest hemiepiphysiodesis should be considered as part of the treatment strategy for limb alignment in MPS IV-A patients, depending on remaining growth, mobility status, and genotype.

Level of Evidence:
Level IV—therapeutic case series.
Open Versus Arthroscopic Reduction for Tibial Eminence Fracture Fixation in Children
Authors: Watts Chad D. , Larson A. Noelle , Milbrandt Todd A. 
Published: April 2015

Background:
Stiffness is a common complication following surgically treated tibial eminence fractures. Fractures can be addressed with either open reduction and internal fixation (ORIF) or arthroscopic reduction and internal fixation (ARIF). We sought to evaluate the effects of surgical approach and other modifiable perioperative factors on postoperative arthrofibrosis. We hypothesized that ARIF would result in a lower risk of arthrofibrosis.

Methods:
We retrospectively reviewed the records of all patients aged 18 years and below treated for tibial eminence fractures at our institution from 1998 to 2014. All patients were treated by either pediatric or sports fellowship-trained orthopaedic surgeons and followed until radiographic union and return of range of motion or treatment for arthrofibrosis (minimum 3 mo).

Results:
Thirty-one patients were included in our analysis, 13 in the ORIF group and 18 in the ARIF group. The groups were similar in regards to sex, age, fracture type, fixation method, and length of postoperative immobilization. However, when compared with the ORIF group, patients in the ARIF group had significantly longer time from injury to surgery (4.2 vs. 6.3 d, P=0.03), operative time (98 vs. 141 min, P=0.02), and tourniquet time (76 vs. 100 min, P=0.006). In the ARIF group, 6 (33.3%) patients acquired arthrofibrosis compared with only 1 (7.7%) patient in the ORIF group. Delaying surgery ≥7 days from injury [hazard ratio (HR)=4.7, P=0.04] and operative time ≥120 minutes (HR=9.1, P=0.03) were risk factors for arthrofibrosis. ARIF was a risk factor in univariate (HR=4.0, P=0.04), but not in multivariate (1.4, P=0.77) analysis.

Conclusions:
Delayed surgery (≥7 d from injury) and prolonged operative times (≥120 min) were significant risk factors for arthrofibrosis. Although ARIF was not an independent risk factor, these patients were exposed to markedly longer wait times before surgery and operative times when compared with ORIF patients. ORIF is a reasonable option for treatment of displaced tibial eminence fractures. Surgeons should approach tibial eminence fractures with whichever mode they can accomplish with higher efficiency.

Level of Evidence:
Level III—therapeutic study.
Titanium Elastic Nailing for Pediatric Tibia Fractures: Do Older, Heavier Kids Do Worse?
Authors: Goodbody Christine M. , Lee Rushyuan J. , Flynn John M. , Sankar Wudbhav N. 
Published: April 2015

Background:
Elastic nailing is a common method of fixation for tibial shaft fractures in skeletally immature individuals. Poor outcomes of titanium elastic nails for femoral shaft fractures have been associated with increasing patient age and weight, especially patients weighing >50 kg. Our objective is to determine if there is an upper weight or age limit to the safe and effective use of titanium elastic nails for tibial shaft fractures in the pediatric population.

Methods:
This is a retrospective cohort study of patients who underwent stabilization of a tibial shaft fracture with titanium elastic nails at a large tertiary-care pediatric trauma center. Data collected included patient demographics, injury characteristics, and radiographic data. Weight groups were stratified as ≥ or <50 kg, and age groups as 14 years or older or less than 14 years old. Malunion was defined as 10 degrees of angulation in either the sagittal or coronal plane. Union was defined as bridging of ≥3 cortices on orthogonal radiographs. A significant difference in time to union was considered to be 3 weeks.

Results:
Ninety-five patients were included with a mean age of 12.1 years (range, 6 to 16 y) and a mean weight of 50.2 kg (range, 21 to 122 kg). Malunion rate was similar between weight cohorts: 13.3% (6/45) in the ≥50-kg group and 10% (5/50) in the <50-kg group (P=0.61). Malunion rate was similarly comparable between age groups: 17.6% (6/34) in the 14 years and older group and 8.2% (5/61) in the less than 14-year-old group (P=0.17). There was no statistically significant difference in time to union between weight or age cohorts. In sum, we did not find a significant difference in the rate of malunion or time to healing between younger and older patients or between lighter and heavier patients.

Conclusion:
The use of titanium elastic nails for tibial shaft fractures, unlike for other long bone fractures, seems not to be precluded in older and heavier patients.

Level of Evidence:
Level III.
Hip Instability in Down Syndrome: A Focus on Acetabular Retroversion
Authors: Abousamra Oussama , Bayhan Ilhan A. , Rogers Kenneth J. , Miller Freeman 
Published: April 2015

Background:
The aim of this study is to compare acetabular anteversion between children with Down syndrome with or without hip instability. The second aim is to report the surgical experience at our institution in treating unstable hips for this population.

Methods:
All children with Down syndrome who were seen at our institution between 2004 and 2014 were reviewed, and those who had pelvic axial computed tomographic or magnetic resonance imaging scans were identified. Acetabular anteversion was compared between 2 groups: those with hip instability as a single hip pathology and those without hip instability. For patients who had surgery for their unstable hips, demographic, clinical, and surgical data were recorded. Preoperative and last visit radiographs were reviewed. Extrusion index and Tonnis, Sharp, lateral center edge, and neck shaft angles were measured. Presence of Shenton’s line disruption, crossover, and posterior wall signs were recorded. Independent and paired t test, Wilcoxon signed-rank test, and χ2 test were used with a significance level at 0.05.

Results:
Out of 308 children with Down syndrome, there were 10 patients with 13 unstable hips and 13 patients with 26 stable hips who had computed tomographic or magnetic resonance imaging scans. Age and sex distributions were similar (P>0.3) with no difference in acetabular anteversion (P=0.926) between them. Twelve patients (6 boys and 6 girls) had reconstruction for 17 hips. The mean age was 9 years (3 to 15 y) and the mean follow-up was 7 years (1.2 to 17.6 y). Five hips were painful preoperatively and 1 hip was painful at last visit. Radiographic measurements improved significantly (P<0.05). Shenton’s line disruption was found in fewer hips (P=0.001) at last visit with no difference in the crossover and posterior wall signs (P=0.177).

Conclusions:
This report suggests that a wide range of acetabular anteversion measurements exist in children with Down syndrome. After detailed anatomic study of the hip, good results with a low complication rate can be expected over the intermediate term after hip reconstruction.

Level of Evidence:
Level IV—prognostic and therapeutic study.
Treatment of Snapping Scapula Syndrome in Children and Adolescents
Authors: Haus Brian , Nasreddine Adam Y. , Suppan Catherine , Kocher Mininder S. 
Published: April 2015

Purpose:
The purpose of this study was to review 2 separate cohorts of young patients treated for snapping scapula: those treated surgically and those managed nonoperatively.

Methods:
A retrospective IRB-approved review was conducted on 18 pediatric aged patients (19 shoulders): 12 patients (average age 13.3) were treated nonoperatively, 6 patients (average age 15.4) (7 shoulders) were treated operatively. Demographic and clinical data were collected from medical records and 2 questionnaires for level of activity, return to sport, subjective satisfaction from treatment, and preoperative/postoperative levels of pain. The American Shoulder and Elbow Society (ASES) score was measured for both groups.

Results:
Mean follow-up for nonoperative patients was 43.7 months (range, 20 to 116 mo). Pretreatment subjective pain levels were 5.2 (scale 1 to 10), posttreatment were 1.5. There was a 75% return to play rate, and an overall 75% satisfaction rate. Posttreatment ASES scores were 90.0. Mean follow-up for surgical patients was 129.5 months (range, 68 to 177 mo). Pretreatment subjective pain level was 8.6, posttreatment was 0.75. There was an 83% return to play rate, and an overall 100% satisfaction rate. There were no complications. Posttreatment ASES scores were 92.6.

Conclusions:
Outcomes for nonoperative treatment of snapping scapula are good for young patients. Surgical management of snapping scapula is a safe and viable treatment option for patients who fail nonoperative treatment.

Level of Evidence:
Level IV.