bluuebunny/crossref_metadata_2025_split huggingface dataset:
Slipped Capital Femoral Epiphysis, Food Deserts, Poverty, and Urban/Rural Residence: Is There a Link?
Authors: Luster Taylor , Gunderson Zachary J. , Sun Seungyup , Loder Randall T. 
Published: February 2023

Background:
Childhood obesity is increased in food deserts, a community with little to no access to healthy food. As obesity is associated with slipped capital femoral epiphysis (SCFE), it was the purpose of this study to analyze the prevalence of SCFE patients by food desert location and its interaction with rural/urban location.

Methods:
A retrospective review of all consecutive patients with idiopathic SCFE treated at our institution over 11 years was performed. From the patient’s address, the US Census Bureau tract in which the patient resided was determined. Using the census tract code, it was ascertained if the patient lived in a food desert and urban or rural location. Standard statistical analyses were performed; a P<0.05 was considered statistically significant.

Results:
There were 177 SCFE patients: 79 girls, 98 boys, 106, White, and 69 nonWhite. The average age at diagnosis was 12.1±1.7 years, the average symptom duration 4.1±5.1 months, and the average weight percentile 94±10. Of these 177 patients, 26.5% lived in a food desert, which was higher than the expected 17.5% (P=0.023). Those living in a food desert were more commonly nonWhite (60% vs. 32%, P=0.0014). There were 25% from rural areas and 75% from urban areas. No rural SCFE patients lived in food deserts whereas 34% of urban patients lived in food deserts. The average poverty rate of the SCFE patient census tracts was 19%, no greater than the expected 15% (P=0.32). SCFE patients living in rural census tracts had a lower poverty rate (P<10-6).

Conclusions:
There is a correlation with the prevalence of SCFE patients by residence in a “food desert”, but not with rural/urban locale or poverty status in Indiana. Further research will be needed to see if these findings apply to other states within the United States and other parts of the world.

Level of Evidence:
III.
Higher Grit Scores Are Associated With Earlier Increases in Knee Flexion Following Anterior Cruciate Ligament Reconstruction With Meniscus Repair in Pediatric Patients
Authors: Pascual-Leone Nicolas , Mackie Alexandra T. , Gross Preston W. , Kelly Anne M. , Green Daniel W. , Fabricant Peter D. 
Published: February 2023

Background:
The Grit Scale is used to measure grit, defined by Duckworth and colleagues as the disposition to show perseverance and passion for long-term goals. It has been shown that psychological factors like motivation, coachability, and coping with adversity are correlated with faster readiness for return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction (ACLR). This study investigates the association between pediatric patients’ baseline grit scores and; preoperative Patient-reported Outcomes Measurement Information System (PROMIS) Pain scores and the recovery of range of motion (ROM) after ACLR. The investigators hypothesized that higher preoperative grit scores would predict lower preoperative pain scores and earlier return of knee ROM in patients undergoing ACLR.

Methods:
This is a retrospective cohort study. Pediatric patients who underwent primary ACLR were assigned the pediatric Grit Scale. Patients were subdivided by meniscal procedures due to differences in postoperative protocols. ACLR alone or with meniscectomy (ACLR ± meniscectomy) were grouped together and ACLR with meniscal repair (ACLR + meniscus repair) represented the other cohort. Patients above the 50th grit percentile were considered “high grit”. Patients below the 50th percentile were considered “low grit”. Baseline PROMIS pain intensity and interference were collected. ROM was compared by grit cohort using the Mann-Whitney U test with a significance threshold of P ≤ 0.05.

Results:
A total of 58 patients undergoing ACLR were analyzed: 20 ACLR ± meniscectomy and 38 ACLR + meniscus repair. The mean age was 15.0 ± 2.1 years with 41.4% of participants identifying as females. No significant difference was noted between baseline PROMIS pain intensity and interference and grit score (P = 0.82, P = 0.91, respectively). Three months postoperatively, for those in the ACLR + meniscus repair cohort, low grit ROM was 130 degrees (interquartile range = 10 degrees), whereas high grit ROM was 135 degrees (interquartile range = 8 degrees) (P = 0.006).

Conclusions:
This study found no differences in pain scores at presentation between grit cohorts but found that patients with grit scores below the 50th percentile undergoing ACLR + meniscus repair have 5 degrees less total ROM at 3 months compared with those with high grit scores. Quicker ROM recovery in patients with high grit may be a leading indicator of these patients’ likelihood to achieve other postoperative milestones and meet criteria for RTS more quickly; the relationship between grit and readiness for RTS should be further investigated.

Level of Evidence:
Level IV; retrospective cohort study.
Deterioration After Surgery for Degenerative Cervical Myelopathy: An Observational Study From the Canadian Spine Outcomes and Research Network
Authors: Evaniew Nathan , Burger Lukas D. , Dea Nicolas , Cadotte David W. , Bailey Christopher S. , Christie Sean D. , Fisher Charles G. , Rampersaud Y Raja , Paquet Jérôme , Singh Supriya , Weber Michael H. , Attabib Najmedden , Johnson Michael G. , Manson Neil , Phan Philippe , Nataraj Andrew , Wilson Jefferson R. , Hall Hamilton , McIntosh Greg , Jacobs W. Bradley ,   On behalf of the Canadian Spine Outcomes and Research Network (CSORN)
Published: February 2023

Study Design.
A Prospective cohort study.

Objective.
To investigate the incidence, etiology, and outcomes of patients who experience neurological deterioration after surgery for Degenerative Cervical Myelopathy (DCM).

Summary of Background Data.
Postoperative neurological deterioration is one of the most undesirable complications that can occur after surgery for DCM.

Methods.
We analyzed data from the Canadian Spine Outcomes and Research Network DCM prospective cohort study. We defined postoperative neurological deterioration as any decrease in modified Japanese Orthopaedic Association (mJOA) score by at least one point from baseline to three months after surgery. Adverse events were collected using the Spinal Adverse Events Severity protocol. Secondary outcomes included patient-reported pain, disability, and health-related quality of life.

Results.
Among a study cohort of 428 patients, 50 (12%) deteriorated by at least one mJOA point after surgery for DCM (21 by one point, 15 by two points, and 14 by three points or more). Significant risk factors included older age, female sex, and milder disease. Among those who deteriorated, 13 experienced contributing intraoperative or postoperative adverse events, six had alternative non-DCM diagnoses, and 31 did not have an identifiable reason for deterioration. Patients who deteriorated had significantly lower mJOA scores at one year after surgery [13.5 (SD 2.7) vs. 15.2 (SD 2.2), P<0.01 and those with larger deteriorations were less likely to recover their mJOA to at least their preoperative baseline, but most secondary measures of pain, disability, and health-related quality of life were unaffected.

Conclusions.
The incidence of deterioration of mJOA scores after surgery for DCM was approximately one in 10, but some deteriorations were unrelated to actual spinal cord impairment and most secondary outcomes were unaffected. These findings can inform patient and surgeon expectations during shared decision-making, and they demonstrate that the interpretation of mJOA scores without clinical context can sometimes be misleading.
Medical Malpractice Litigation Due to Off-Label Use of Bone Morphogenetic Protein
Authors: Weldon Edward , Razzouk Jacob , Bohen Daniel , Ramos Omar , Danisa Olumide , Cheng Wayne 
Published: February 2023

Study Design.
Retrospective cohort study.

Objective.
To analyze the incidence and characteristics of malpractice lawsuits pertaining to the off-label use of Bone morphogenetic protein (BMP).

Summary of Background Data.
BMP continues to be a popular alternative to the use of autologous bone graft during spinal fusion procedures. However, ~85% of BMP is used in an off-label manner, which may expose surgeons to claims of malpractice.

Methods.
Westlaw and VerdictSearch were queried for malpractice claims filed between 2000 and 2022 using the keywords “bone graft” and “spine.” Case inclusion criteria were defined as a plaintiff’s basis of litigation resting on a claim of medical malpractice due to off-label use of BMP. Additional collected data included the date of the case hearing, plaintiff's sex and age, defendants named in the lawsuit, verdict ruling, location of the filed claim, payment or settlement amount, sustained injuries, and additional allegations.

Results.
Of 971 claims reviewed, 89 cases were due to off-label BMP use. The posterior approach was identified as the most common approach among the 89 cases. Of the 30 cases naming a surgeon defendant, 50% included allegations of insufficient informed consent. The most frequent adverse events were ectopic bone growth resulting in chronic pain or nerve damage. Zero cases involved heterotopic ossification, wound dehiscence, graft subsidence, hematoma, bladder retention, or retrograde ejaculation.

Conclusion.
A clear understanding that on-label BMP use is specific to single-level, anterior or anterolateral approaches between L2-S1 with vendor-specific cages is crucial for mitigating malpractice disputes. Though off-label use of BMP may incite litigation, the findings suggest court rulings are favorable for defendants as zero cases, resulting in plaintiff verdicts. Nevertheless, surgeons should balance the potential benefits of off-label use of BMP with the increased risk of litigation, and it may be advisable to disclose the use of BMP, whether on-label or off-label, in the informed consent.
Thoracolumbar Injury Classification Systems
Authors: Lightsey IV Harry M. , Giberson-Chen Carew C. , Crawford Alexander M. , Striano Brendan M. , Harris Mitchel B. , Bono Christopher M. , Simpson Andrew K. , Schoenfeld Andrew J. 
Published: February 2023

Study Design.
Narrative review.

Objective.
To describe the evolution of acute traumatic thoracolumbar (TL) injury classification systems; to promote standardization of concepts and vocabulary with respect to TL injuries.

Summary of Background Data.
Over the past century, numerous TL classification systems have been proposed and implemented, each influenced by the thought, imaging modalities, and surgical techniques available at the time. While much progress has been made in our understanding and management of these injuries, concepts, and terms are often intermixed, leading to potential confusion and miscommunication.

Methods.
We present a narrative review of the current state of the literature regarding classification systems for TL trauma.

Results.
The evolution of TL classification systems has broadly been characterized by a transition away from descriptive categorizations of fracture patterns to schema incorporating morphology, stability, and neurological function. In addition to these features, more recent systems have demonstrated the importance of predictive/prognostic capability, reliability, validity, and generalizability. The Arbeitsgemeinschaft fur Osteosynthesenfragen Spine Thoracolumbar Injury Classification System/Thoracolumbar Arbeitsgemeinschaft fur Osteosynthesenfragen Spine Injury Score represents the most modern and recently updated system, retiring past concepts and terminology in favor of clear, internationally agreed upon descriptors.

Conclusions.
Advancements in our understanding of blunt TL trauma injuries have led to changes in management. Such advances are reflected in modern, dedicated classification systems. Over time, various key factors have been acknowledged and incorporated. In an effort to promote standardization of thought and language, past ideas and terminology should be retired.
LSS-VGG16
Authors: Altun Sinan , Alkan Ahmet , Altun İdiris 
Published: February 2023

Study Design:
This was a retrospective study.

Objection:
Lumbar Spinal Stenosis (LSS) is a disease that causes chronic low back pain and can often be confused with herniated disk. In this study, a deep learning-based classification model is proposed to make LSS diagnosis quickly and automatically with an objective tool.

Summary of Background Data:
LSS is a disease that causes negative consequences such as low back pain, foot numbness, and pain. Diagnosis of this disease is difficult because it is confused with herniated disk and requires serious expertise. The shape and amount of this stenosis are very important in deciding the surgery and the surgical technique to be applied in these patients. When the spinal canal narrows, as a result of compression on these nerves and/or pressure on the vessels feeding the nerves, poor nutrition of the nerves causes loss of function and structure. Image processing techniques are applied in biomedical images such as MR and CT and high classification success is achieved. In this way, computer-aided diagnosis systems can be realized to help the specialist in the diagnosis of different diseases.

Methods:
To demonstrate the success of the proposed model, different deep learning methods and traditional machine learning techniques have been studied.

Results:
The highest classification success was obtained in the VGG16 method, with 87.70%.

Conclusions:
The proposed LSS-VGG16 model reveals that a computer-aided diagnosis system can be created for the diagnosis of spinal canal stenosis. In addition, it was observed that higher classification success was achieved compared with similar studies in the literature. This shows that the proposed LSS-VGG16 model will be an important resource for scientists who will work in this field.
Bilateral Lesser Tuberosity Fractures: Technique and a Case Report with Literature Review
Authors: Zuchelli Daniel M. , Penny Gregory S. , Aibinder William R. 
Published: February 2023

Isolated lesser tuberosity fractures are a rare subset of proximal humerus fractures and are often associated with seizures. Displaced fractures can lead to chronic pain, reduced shoulder function, and posterior instability. Operative treatment is frequently recommended with the displacement of more than 5 mm or angulation of more than 45 degrees. We report on a 31-year-old man with bilateral lesser tuberosity fractures who underwent operative fixation for 1 fracture and nonoperative fixation for the other.
Cardiovascular Subphenotypes in Acute Respiratory Distress Syndrome*
Authors: Chotalia Minesh , Ali Muzzammil , Alderman Joseph E. , Bansal Sukh , Patel Jaimin M. , Bangash Mansoor N. , Parekh Dhruv 
Published: February 2023

OBJECTIVES:
To use clustering methods on transthoracic echocardiography (TTE) findings and hemodynamic parameters to characterize circulatory failure subphenotypes and potentially elucidate underlying mechanisms in patients with acute respiratory distress syndrome (ARDS) and to describe their association with mortality compared with current definitions of right ventricular dysfunction (RVD).

DESIGN:
Retrospective, single-center cohort study.

SETTING:
University Hospital ICU, Birmingham, United Kingdom.

PATIENTS:
ICU patients that received TTE within 7 days of ARDS onset between April 2016 and December 2021.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Latent class analysis (LCA) of TTE/hemodynamic parameters was performed in 801 patients, 62 years old (interquartile range, 50–72 yr old), 63% male, and 40% 90-day mortality rate. Four cardiovascular subphenotypes were identified: class 1 (43%; mostly normal left and right ventricular [LV/RV] function), class 2 (24%; mostly dilated RV with preserved systolic function), class 3 (13%, mostly dilated RV with impaired systolic function), and class 4 (21%; mostly high cardiac output, with hyperdynamic LV function). The four subphenotypes differed in their characteristics and outcomes, with 90-day mortality rates of 19%, 40%, 78%, and 59% in classes 1–4, respectively (p < 0.0001). Following multivariable logistic regression analysis, class 3 had the highest odds ratio (OR) for mortality (OR, 6.9; 95% CI, 4.0–11.8) compared with other RVD definitions. Different three-variable models had high diagnostic accuracy in identifying each of these latent subphenotypes.

CONCLUSIONS:
LCA of TTE parameters identified four cardiovascular subphenotypes in ARDS that more closely aligned with circulatory failure mechanisms and mortality than current RVD definitions.
Effect of Admission and Discharge Times on Hospital Mortality in Patients With Sepsis
Authors: Zhou Xiaoming , Weng Jie , Xu Zhe , Yang Jinweng , Lin Jiaying , Hou Ruonan , Zhou Zhiliang , Wang Liang , Wang Zhiyi , Chen Chan 
Published: February 2023

Objectives:
To assess whether the time of admission/discharge time from the ICU and weekend admission are independently associated with hospital mortality in critically ill patients with sepsis.

Design:
Retrospective study. Each 24-hour period (08:00 to 07:59 hr) was split into three time periods, defined as “day” (08:00 to 16:59 hr), “evening” (17:00 to 23:59 hr), and “night” (00:00 to 07:59 hr). Weekends were defined as 17:00 hours on Friday to 07:59 hours on Monday. Multivariate logistic regression models were conducted to assess the association between the ICU admission/discharge time, weekend admission, and hospital mortality.

Setting:
Single-center ICUs in China.

Patients:
Characteristics and clinical outcomes of 1,341 consecutive septic patients admitted to the emergency ICU, general ICU, or cardiovascular ICU in a tertiary teaching hospital were collected.

Interventions:
None.

Measurements and Main Results:
ICU mortality rates were 5.8%, 11.9%, and 10.6%, and hospital mortality rates were 7.3%, 15.6%, and 17.1% during the day, evening, and night time, respectively. Hospital mortality was adjusted for patient to nurse (P/N) ratio, disease severity, Charlson index, age, gender, mechanical ventilation, and shock. Notably, ICU admission time and weekend admission were not predictors of mortality after adjustment. The P/N ratio at admission was significantly associated with mortality (p < 0.05). The P/N ratio and compliance with the Surviving Sepsis Campaign (SSC) were significantly correlated. After risk adjustment for illness severity at time of ICU discharge and Charlson index, the time of discharge was no longer a significant predictor of mortality.

Conclusions:
ICU admission/discharge time and weekend admission were not independent risk factors of hospital mortality in critically ill patients with sepsis. The P/N ratio at admission, which can affect the compliance rate with SSC, was a predictor of hospital survival. Unstable state on transfer from the ICU was the main risk factor for in-hospital death. These findings may have implications for the management of septic patients.
The Fate of Entrustable Professional Activities After Graduation: A Survey Study Among Graduated Physician Assistants
Authors: de Raad Timo , Wiersma Fraukje , Kuilman Luppo , ten Cate Olle 
Published: February 2023

Introduction:
Entrustable professional activities (EPAs) are used during training but may also have significance after graduation. This domain has not yet been much explored. We investigated the use of EPAs among alumni of Master Physician Assistant programs in the Netherlands, where EPAs have been used since 2010. We aim to describe if and how EPAs have a role after graduation. Are EPAs used for continuous entrustment decisions or when shifting work settings?

Methods:
In September 2020, all registered Dutch physician assistants (PAs) (n = 1441) were invited to participate in a voluntary, anonymous survey focusing on the use of EPAs after graduation. Survey items included questions regarding the use and usefulness of EPAs, views on continuous entrustment decisions, and how PAs document their competence.

Results:
A total of 421 PAs (response rate 29%) yielded information about the significance of EPAs after training. Among the respondents, 60% (n = 252) reported adding new competencies and skills after graduation. One-third (n = 120) of the respondents were trained in EPA-based programs. Almost all EPA-trained PAs (96%; n = 103) considered the EPA structure suitable to maintain and renew entrustment. Furthermore, PAs reported continued use of the EPA framework to seek formal qualifications through entrustment decisions.

Discussion:
This study shows that EPAs can play an ongoing role for PAs after graduation. EPA-trained PAs overwhelmingly support the continuous use of the EPA framework for entrustment decisions from graduation until retirement.
Advancing Research in Health Professions Education Through an Innovative Accelerator Panel
Authors: Kawczak Steven , Stoller James K. 
Published: February 2023

Introduction:
Research and scholarship are critical to advance the effective design, implementation, and evaluation of health professions education activities as well as to study outcomes and disseminate observations to the community. Yet, many educators are neither involved in nor equipped to conduct quality education research. This gap underscores the continuing education need to guide and train health professions educators to rigorously investigate, prepare, and report their educational research.

Methods:
A novel session called the Education Research Accelerator was designed to increase knowledge about education research methods and resources and to improve participants' competence and performance in implementing studies. A panel helped prospective researchers develop ideas or advance projects toward completion by offering real-time feedback to pitched ideas; a live audience of learners participated virtually, expanding the impact of the session, facilitating connections, and potentially inspiring other research ideas. The outcomes of the Education Research Accelerator were evaluated immediately after the session and 18 months later.

Results:
The Education Research Accelerator conferred favorable outcomes for participants' competence in designing education research studies and awareness of using available resources. Long-term follow-up confirmed actual benefits to use effective methodology to advance education research projects and to use resources and connections established in the Education Research Accelerator.

Conclusions:
Although further study is needed, the Education Research Accelerator model is a novel intervention to enhance learning, forge needed connections, and increase the sophistication of conducting education research. We propose that the model can be replicated and applied in other settings.