bluuebunny/crossref_metadata_2025 huggingface dataset:
Factor Structure of the Quality of Life Scale for Mental Disorders in Patients With Schizophrenia
Authors: CHIU En-Chi , LEE Shu-Chun
Published: November 2017

Background:

The Quality of Life for Mental Disorders (QOLMD) scale was designed to measure health-related quality of life (HRQOL) in patients with mental illness, especially schizophrenia. The QOLMD contains 45 items, which are divided into eight domains. However, the factor structure of the QOLMD has not been evaluated, which restricts the interpretations of the results of this scale.

Purpose:

The purpose of this study was to evaluate the factor structures (i.e., unidimensionality, eight-factor structure, and second-order model) of the QOLMD in patients with schizophrenia.

Methods:

Two hundred thirty-eight outpatients with schizophrenia participated. We first conducted confirmatory factor analysis to evaluate the unidimensionality of each domain. After the unidimensionality of the eight individual domains was supported, we examined the eight-factor structure and second-order model.

Results:

The results of unidimensionality showed sufficient model fit in all of the domains with the exception of the autonomy domain. A good model fit was confirmed for the autonomy domain after deleting two of the original items. The eight-factor structure for the 43-item QOLMD showed an acceptable model fit, although the second-order model showed poor model fit.

Conclusions/Implications for Practice:

Our results supported the unidimensionality and eight-factor structure of the 43-item QOLMD. The sum score for each of the domains may be used to reflect its domain-specific function. We recommend using the 43-item QOLMD to capture the multiple domains of HRQOL. However, the second-order model showed an unsatisfactory model fit. Furthermore, caution is advised when interpreting overall HRQOL using the total score for the eight domains.
Mechanical Surface Area of Prosthetic Heart Valve: Adverse Clinical Impact of Large Mechanical Valve in Mitral Position
Authors: Cho Yang Hyun , Sung Kiick , Kim Wook Sung , Kim Jae-Hun , Kim Sung Mok , Park Pyo Won
Published: November 2017

Although thromboembolic accidents are serious adverse events associated with mechanical mitral valves, there have been no studies on the clinical impact of the large mechanical surface areas (MSAs) of mechanical mitral prostheses. Between 1995 and 2010, 488 consecutive adult patients underwent isolated mechanical mitral valve replacement. We measured the MSA via three-dimensional computed tomography for each prosthesis. Mean patient age was 50.6 ± 11.1 years. The mean body surface area (BSA) and MSA index (MSAI, MSA/BSA) were 1.6 ± 0.17 m2 and 12.9 ± 1.7 cm2/m2, respectively. The patients were divided into two groups according to the median MSAI. Patients in the high MSAI group had higher indexed left ventricular end-diastolic dimensions and smaller BSAs. The multivariate analysis demonstrated that old age, New York Heart Association class III or IV, and high MSAI were independent predictors of death. With respect to thromboembolic complications, New York Heart Association class III or IV and high MSAI were identified as independent risk factors. There were 11 patients (3%) with mean pressure gradients across the mitral valve greater than 6 mm Hg 1 year after operation. A large MSA relative to patient size was identified as a predictor of poor clinical outcome after mechanical mitral valve replacement.
Using a Theory-Driven Approach to Manage the Relocation of an Intensive Care Unit
Authors: Lin Frances , Marshall Andrea , Hervey Lucy , Foster Michelle , Hancock Jane , Chaboyer Wendy
Published: November 2017

Proactive planning and managing moving from old to newly built hospitals, and the relocation process of patients for complex specialized units such as intensive care units, are necessary for both patient safety and staff well-being. This article provides an exemplar for how theory can be used to facilitate a positive relocation experience. Using change management theory, a systematic approach to cocreate implementation strategy among researchers and clinicians was critical to the success of this project.
Improving Oral Hygiene for Veterans With Dementia in Residential Long-term Care
Authors: McConnell Eleanor S. , Lee Kyung Hee , Galkowski Lorraine , Downey Christine , Spainhour Mary Victoria , Horwitz Reginaldo
Published: November 2017

Oral hygiene care is neglected in long-term care (LTC) due to patient-, staff-, and systems-level barriers. A dementia-specific oral hygiene program, implemented and evaluated in a Department of Veterans Affairs LTC unit, addressed barriers to oral care at multiple levels. Improved staff competency, access to oral care supplies, and standardized documentation systems were accompanied by reduced oral plaque and gingivitis, demonstrating the feasibility and benefits of direct care staff providing improved oral hygiene in LTC.
Graduate Medical Education Funding and Curriculum in Physical Medicine and Rehabilitation
Authors: Perret Danielle , Knowlton Tiffany , Worsowicz Gregory
Published: November 2017

This national survey highlights graduate medical education funding sources for physical medicine and rehabilitation (PM&R) residency programs as well as perceived funding stability, alignment of the current funding and educational model, the need of further education in postacute care settings, and the practice of contemporary PM&R graduates as perceived by PM&R department/division chairs. Approximately half of the reported PM&R residency positions seem to be funded by Centers of Medicare and Medicaid Services; more than 40% of PM&R chairs believe that their residency program is undersized and nearly a quarter feel at risk for losing positions. A total of 30% of respondents report PM&R resident experiences in home health, 15% in long-term acute care, and 52.5% in a skilled nursing facility/subacute rehabilitation facility. In programs that do not offer these experiences, most chairs feel that this training should be included. In addition, study results suggest that most PM&R graduates work in an outpatient setting. Based on the results that chairs strongly feel the need for resident education in postacute care settings and that most graduates go on to practice in outpatient settings, there is a potential discordance for our current Centers of Medicare and Medicaid Services graduate medical education funding model being linked to the acute care setting.
Brief Report: Frequency of Monitoring Kidney Function in HIV-Uninfected Persons Using Daily Oral Tenofovir Disoproxil Fumarate Pre-exposure Prophylaxis
Authors: Mugwanya Kenneth K. , Baeten Jared M. , Wyatt Christina , Mugo Nelly R. , Celum Connie L. , Ronald Allan , Kiarie John , Katabira Elly , Heffron Renee ,   for the Partners PrEP Study and Partners Demonstration Project Teams
Published: November 2017

Background:

Wide-scale implementation of oral tenofovir-based pre-exposure prophylaxis (PrEP) for HIV prevention is now policy in many settings. However, the optimal frequency for monitoring kidney function remains uncertain. We investigated the impact of 6-monthly compared with 3-monthly creatinine clearance (CrCl) monitoring on the identification of moderate kidney dysfunction, defined as CrCl <60 mL/min.

Methods:

Data were from 2 prospective daily oral PrEP studies in Kenya and Uganda: the Partners PrEP Study, a randomized safety, and efficacy trial of PrEP that conducted 3-monthly CrCl monitoring (n = 4404) and the Partners Demonstration Project (n = 954), an open-label delivery study of PrEP that used 6-monthly monitoring. CrCl ≥60 mL/min was required for enrollment in both studies. Abnormal results were followed with confirmatory testing within approximately 1 week. Follow-up was for up to 24 months.

Results:

Of 5358 participants included in the analysis, 87% were younger than 45 years, a third were female, and 21% had a baseline CrCl between 60 and 90 mL/min. Confirmed CrCl <60 mL/min events were rare, occurring in 52 individuals (<1%) in 24 months. The 12-month cumulative proportion of persons with CrCl <60 mL/min was 0.2% with 3-monthly screening and 0.5% with 6-monthly screening. Older age (>45 years), lower weight (<55 kg), elevated blood pressure (>140 mm Hg), and baseline CrCl between 60 and 90 mL/min were independently associated with CrCl decline <60 mL/min during follow-up.

Conclusions:

In these 2 PrEP studies, with generally young participants, the occurrence and pattern of clinically relevant decline in CrCl were not qualitatively different based on 3- or 6-monthly CrCl monitoring schedule. These data suggest that for most persons receiving PrEP for up to 24 months, less frequent CrCl monitoring would be safe and reduce required expenditures for repeat confirmatory testing.
Firm Elevation of Reconstructed Auricle Using Polydactyly Digit in Microtia
Authors: Jang Suk Yoon , Kim Woo Seob , Kim Han Koo , Bae Tae Hui
Published: November 2017

Total ear reconstruction for microtia is usually accomplished in 2 stages which is known as Nagata technique. After framework fabrication and implantation, the elevation procedure is required as a second step surgery. The authors are introducing a novel material for augmenting projection of rib cartilage framework in microtia treatment.
ICTV Virus Taxonomy Profile: Pleolipoviridae
Authors: Bamford Dennis H. , Pietilä Maija K. , Roine Elina , Atanasova Nina S. , Dienstbier Ana , Oksanen Hanna M. ,   ICTV Report Consortium
Published: November 2017

Members of the family Pleolipoviridae (termed pleolipoviruses) are pseudo-spherical and pleomorphic archaeal viruses. The enveloped virion is a simple membrane vesicle, which encloses different types of DNA genomes of approximately 7–16 kbp (or kilonucleotides). Typically, virions contain a single type of transmembrane (spike) protein at the envelope and a single type of membrane protein, which is embedded in the envelope and located in the internal side of the membrane. All viruses infect extremely halophilic archaea in the class Halobacteria (phylum Euryarchaeota). Pleolipoviruses have a narrow host range and a persistent, non-lytic life cycle. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the taxonomy of the Pleolipoviridae which is available at www.ictv.global/report/pleolipoviridae.
The march of progress: structures of the adducts of potassium dicyanidoaurate(I) with 2,2′-bipyridyl (redetermination) and 1,10-phenanthroline
Authors: Döring Cindy , Strey Mark , Jones Peter G.
Published: November 2017

The structure of the 2,2′-bipyridyl adduct poly[(μ2-2,2′-bipyridyl-κ3
N,N′:N)di-μ3-cyanido-κ6
C:N:N-gold(I)potassium(I)], [AuK(CN)2(C10H8N2)]
n
, (1) (space group P21), has been redetermined [previous determination: Jones et al. (1980). Acta Cryst. B36, 160–162]. The bipyridyl ligands coordinate only the potassium ion, which has a coordination sphere consisting of seven N-atom donors; gold(I) remains in the form of linear dicyanidoaurate(I) ions. The extended structure consists of layers in which the AuI atoms form chains parallel to the short a axis, with Au...Au contacts of 3.7286 (1) Å, whereas the chains of potassium ions, which are also parallel to a, are bridged by bipyridyl and dicyanidoaurate residues. The analogous 1,10-phenanthroline adduct, namely poly[di-μ3-cyanido-κ6
C:N:N-(μ2-1,10-phenanthroline-κ3
N,N′:N)gold(I)potassium(I)], [AuK(CN)2(C12H8N2)]
n
, (2), crystallizes as nonmerohedral twins in the space group C2/c. The packing is closely related to that of (1), but the chains are now parallel to the short b axis and the layers are parallel to (10\overline{1}). The two independent AuI atoms occupy special positions on inversion centres and twofold axes; the Au...Au contacts are 3.6771 (2) Å.
Institutional complexity and sustainable supply chain management practices
Authors: Sayed Maysara , Hendry Linda C. , Zorzini Bell Marta
Published: November 2017

Purpose

The purpose of this study is to empirically investigate the impact of institutional pressures, institutional logics and institutional complexity on Sustainable Supply Chain Management (SSCM) practices across mixed public and private sector supply chains.

Design/methodology/approach

Multi-case study data were collected from three tiers of food and catering supply chains: the customer/consumer tier; focal public sector UK Universities; and private sector suppliers/contractors.

Findings

The findings indicate that: normative and mimetic pressures are more prevalent in focal Universities, compared to suppliers; there is typically no single dominant logic across these supply chains; and the multiplicity of institutional logics (e.g. sustainability logic versus financial logic) increases institutional complexity. Therefore, in the typical case of homogeneity in terms of institutional pressures and logics, e.g. with a dominant sustainability logic throughout the supply chain, radical change in SSCM practices is facilitated. In contrast, in the more typical case when there is heterogeneity, with competing logics at different supply chain tiers, this limits SSCM to more incremental changes in practices.

Research limitations/implications

This study is limited to three tiers of the food and catering supply chains of UK Universities.

Practical implications

To aid in the successful implementation of SSCM, this study suggests a need for managers to develop an initial understanding of the prevailing institutional logics and pressures at different tiers of the supply chain.

Social implications

A number of the SSCM practices studied address social sustainability.

Originality/value

No previous studies have empirically investigated the impact of institutional complexity in the context of SSCM practices across supply chains, involving both mixed public and private sector organisations.
Exposure to predicted precipitation patterns decreases population size and alters community structure of cyanobacteria in biological soil crusts from the Chihuahuan Desert
Authors: Fernandes Vanessa M.C. , Machado de Lima Náthali Maria , Roush Daniel , Rudgers Jennifer , Collins Scott L. , Garcia‐Pichel Ferran
Published: November 2017

Cyanobacteria typically colonize the surface of arid soils, building biological soil crust (biocrusts) that provide a variety of ecosystem benefits, ranging from fertilization to stabilization against erosion. We investigated how future scenarios in precipitation anticipated for the Northern Chihuahuan Desert affected abundance and composition of biocrust cyanobacteria in two grassland ecosystems. Scenarios included a decrease in precipitation and a delay of monsoon rainfall. After three years, both treatments negatively affected cyanobacteria, although the effects of monsoon delay were milder than those of decreased precipitation. Mature biocrusts in black grama grassland suffered severe losses in cyanobacterial biomass and diversity, but compositionally simpler biocrusts in blue grama‐dominated grassland maintained biomass, only suffering diversity losses. This could be partially explained by the differential sensitivity of cyanobacterial taxa: nitrogen‐fixing Scytonema spp. were the most sensitive, followed by phylotypes in the Microcoleus steenstrupii complex. Microcoleus vaginatus was the least affected in all cases, but is known to be very sensitive to warming. We predict that altered precipitation will tend to prevent biocrusts from reaching successional maturity, selecting for M. vaginatus over competing M. steenstrupii, among pioneer biocrust‐formers. A shift towards heat‐sensitive M. vaginatus could ultimately destabilize biocrusts when precipitation changes are combined with global warming.
Thermoacclimation and genome adaptation of the membrane lipidome in marine Synechococcus
Authors: Pittera Justine , Jouhet Juliette , Breton Solène , Garczarek Laurence , Partensky Frédéric , Maréchal Éric , Nguyen Ngoc A. , Doré Hugo , Ratin Morgane , Pitt Frances D. , Scanlan David J. , Six Christophe
Published: November 2017

The marine cyanobacteria of the genus Synechococcus are important primary producers, displaying a wide latitudinal distribution that is underpinned by diversification into temperature ecotypes. The physiological basis underlying these ecotypes is poorly known. In many organisms, regulation of membrane fluidity is crucial for acclimating to variations in temperature. Here, we reveal the detailed composition of the membrane lipidome of the model strain Synechococcus sp. WH7803 and its response to temperature variation. Unlike freshwater strains, membranes are almost devoid of C18, mainly containing C14 and C16 chains with no more than two unsaturations. In response to cold, we observed a rarely observed process of acyl chain shortening that likely induces membrane thinning, along with specific desaturation activities. Both of these mechanisms likely regulate membrane fluidity, facilitating the maintenance of efficient photosynthetic activity. A comprehensive examination of 53 Synechococcus genomes revealed clade‐specific gene sets regulating membrane lipids. In particular, the genes encoding desaturase enzymes, which is a key to the temperature stress response, appeared to be temperature ecotype‐specific, with some of them originating from lateral transfers. Our study suggests that regulation of membrane fluidity has been among the important adaptation processes for the colonization of different thermal niches by marine Synechococcus.
Regulation of cysteine residues in LsrB proteins from Sinorhizobium meliloti under free‐living and symbiotic oxidative stress
Authors: Tang Guirong , Xing Shenghui , Wang Sunjun , Yu Liangliang , Li Xuan , Staehelin Christian , Yang Menghua , Luo Li
Published: November 2017

The development of legume nitrogen‐fixing nodules is regulated by reactive oxygen species (ROS) produced by symbionts. Several regulators from Rhizobium are involved in ROS sensing. In a previous study, we found that Sinorhizobium meliloti LsrB regulates lipopolysaccharide production and is associated with H2O2 accumulation in alfalfa (Medicago sativa) nodules. However, its underlying regulatory mechanism remains unclear. Here, we report that the cysteine residues in LsrB are required for adaptation to oxidative stress, gene expression, alfalfa nodulation and nitrogen fixation. Moreover, LsrB directly activated the transcription of lrp3 and gshA (encoding γ‐glutamylcysteine synthetase, responsible for glutathione synthesis) and this regulation required the cysteine (Cys) residues in the LsrB substrate‐binding domain. The Cys residues could sense oxidative stress via the formation of intermolecular disulfide bonds, generating LsrB dimers and LsrB‐DNA complexes. Among the Cys residues, C238 is a positive regulatory site for the induction of downstream genes, whereas C146 and C275 play negative roles in the process. The lsrB mutants with Cys‐to‐Ser substitutions displayed altered phenotypes in respect to their adaptation to oxidative stress, nodulation and nitrogen fixation‐related plant growth. Our findings demonstrate that S. meliloti LsrB modulates alfalfa nodule development by directly regulating downstream gene expression via a post‐translational strategy.
Catabolic task division between two near‐isogenic subpopulations co‐existing in a herbicide‐degrading bacterial consortium: consequences for the interspecies consortium metabolic model
Authors: Albers Pieter , Lood Cédric , Özturk Basak , Horemans Benjamin , Lavigne Rob , van Noort Vera , De Mot René , Marchal Kathleen , Sanchez‐Rodriguez Aminael , Springael Dirk
Published: November 2017

Variovorax sp. WDL1 mediates hydrolysis of the herbicide linuron into 3,4‐dichloroaniline (DCA) and N,O‐dimethylhydroxylamine in a tripartite bacterial consortium with Comamonas testosteroni WDL7 and Hyphomicrobium sulfonivorans WDL6. Although strain WDL1 contains the dcaQTA1A2B operon for DCA oxidation, this conversion is mainly performed by WDL7. Phenotypic diversification observed in WDL1 cultures and scrutiny of the WDL1 genome suggest that WDL1 cultures consist of two dedicated subpopulations, i.e., a linuron‐hydrolysing subpopulation (Lin + DCA‐) and a DCA‐oxidizing subpopulation (Lin‐DCA+). Whole genome analysis of strains representing the respective subpopulations revealed that they are identical, aside from the presence of hylA (in Lin + DCA‐ cells) and the dcaQTA1A2B gene cluster (in Lin‐DCA+ cells), and that these catabolic gene modules replace each other at exactly the same locus on a 1380 kb extra‐chromosomal element that shows plasmid gene functions including genes for transferability by conjugation. Both subpopulations proliferate in consortium biofilms fed with linuron, but Lin + DCA‐ cells compose the main WDL1 subpopulation. Our observations instigated revisiting the interactions within the consortium and suggest that the physical separation of two essential linuron catabolic gene clusters in WDL1 by mutually exclusive integration in the same mobile genetic element is key to the existence of WDL1 in a consortium mode.
Integration of Non‐market and Market Activities in Cross‐border Mergers and Acquisitions
Authors: Ahammad Mohammad F. , Tarba Shlomo Y. , Frynas Jedrzej George , Scola Andrew
Published: November 2017

Drawing on resource dependence theory and the resource‐based view, we investigate the interactions between market and non‐market activities of firms in the context of the post‐merger integration phase in cross‐border mergers and acquisitions (M&As). Based on a cross‐country survey of 111 M&A practitioners who were personally involved in cross‐border M&As around the world, we test seven hypotheses on various market and non‐market aspects of post‐merger integration. We find a positive correlation between buffering strategies and adaptive capabilities in the non‐market environment and between bridging and adaptive capabilities in the market environment. However, we could not find any significant correlation between buffering and adaptive capabilities in the market environment and bridging and adaptive capabilities in the non‐market environment. We also find that adaptability in the non‐market environment is positively correlated with adaptability in the market environment, and in turn adaptability in the market environment leads to positive organizational performance of a cross‐border M&A. These results provide further support for the value of the alignment between market and non‐market activities and help to fill a gap in the literature on the market−non‐market interactions in post‐merger integration.
Integrating Social and Political Strategies as Forms of Reciprocal Exchange into the Analysis of Corporate Governance Modes
Authors: Boddewyn Jean J. , Buckley Peter J.
Published: November 2017

The concept and theory of reciprocity provide fruitful ways of integrating social and political strategies because both involve donating valuable resources to non‐market recipients – mainly non‐governmental organizations, politicians and regulators – who are not contractually bound to reciprocate although a return is normally expected. Besides, we interpret the use of non‐contractual reciprocity through relational‐models theory and transaction‐cost economics. The former offers a model of ‘equality‐matching’ that corresponds to reciprocity while transaction‐cost economics’ criteria of uncertainty, frequency and asset specificity can be applied to non‐contractual relationships in order to determine their efficiency. We also differentiate reciprocity from bribery and offer research implications of the fact that goods can be obtained from others without using transactions.
Home‐institutional Imprinting and Lobbying Expenditure of Foreign Firms: Moderating Effects of Experience and Technological Intensity
Authors: Shirodkar Vikrant , Konara Palitha , McGuire Steven
Published: November 2017

The issue of whether a firm's ‘home’ environment influences its non‐market activities in a ‘host’ country is being increasingly discussed in the international business literature. In this paper, we use institutional and organizational imprinting theories to argue that multinational enterprises (MNEs) founded in countries with stronger regulatory institutions are likely to spend more on lobbying in a host country compared to MNEs founded in countries with weaker regulatory institutions. We also argue that this effect is moderated by the MNE's overall experience, its experience within the host country and its technological intensity. We test our hypotheses using a sample of 378 foreign MNEs (among the largest 500) operating in the USA, spanning the eight year period 2006−2013, and representing 29 home countries. Our results support our hypothesis on the relationship between home‐institutional imprinting and overseas lobbying expenditure, as described above. Our results also support our arguments that MNEs’ overall experience and technological intensity reduce the imprinting effect of home institutions on lobbying expenditure; however, our moderating effect of host‐country experience on this relationship is not supported.
Bridging the “Expectation Gap” Using Student Preceptors
Authors: Koerner Michael
Published: November 2017

An “Expectation Gap” can exist between what teachers expect of their students and what effort students expect to and are willing to expend. In order to get students and teachers on the same learning page, this Gap needs remedied. One successful means of bridging the Gap is the use of Student Preceptors.
Chemical, Physiochemical, and Microstructural Properties, and Probiotic Survivability of Fermented Goat Milk Using Polymerized Whey Protein and Starter Culture Kefir Mild 01
Authors: Wang Hao , Wang Cuina , Wang Mu , Guo Mingruo
Published: November 2017

A set‐type fermented goat milk (FGM) using polymerized whey protein (PWP) as main thickening agent and Kefir Mild 01 as starter culture was developed. The FGM with PWP (0.3%, w/v) and pectin (0.2%, w/v) had low syneresis (5.44 ± 0.92%), desirable viscosity (952.86 ± 61.52 mPa⋅s), and hardness (112.57 ± 3.23 g), which were comparable to a fermented cow milk. Sensory evaluation data showed that the FGM with PWP and pectin had higher scores of both flavor (4.41 ± 0.39) and taste (3.72 ± 0.34) than the sample without PWP. Chemical composition of both fermented goat and cow milk were analyzed. The protein content of goat and cow milk samples were 3.50% ± 0.12% and 3.28% ± 0.09% (w/w), respectively. Lactobacillus acidophilus population in both FGM samples remained above 106 CFU/g during the 1st 4‐wk storage. There was a slight but no significant (P > 0.05) decrease in pH and TA during storage. Scanning electron microscopy micrographs displayed a compact and homogeneous protein network of the FGM with PWP and pectin. Polymerized whey protein may be a novel protein‐based thickening agent for formulation of a set‐type FGM with starter culture Kefir Mild 01.

Practical Application

Fermented goat milk is an increasingly popular dairy product in the world. However, it is difficult to make set type fermented goat milk due to the smaller size and lower content of casein micelles in goat milk. A fermented goat milk with PWP (0.3%, w/v) and pectin (0.2%, w/v) was successfully developed in this study. The product fermented by Kefir Mild 01 starter culture had a similar taste with Kefir but no yeast or alcoholic exists. The new product would be a promising food in the market.
Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial
Authors: Zahed Reza , Mousavi Jazayeri Mohammad Hossain , Naderi Asieh , Naderpour Zeinab , Saeedi Morteza
Published: November 2017

Objective

We evaluated the efficacy of topical application of the injectable form of tranexamic acid (TXA) compared with anterior nasal packing (ANP) for the treatment of epistaxis in patients taking antiplatelet drugs (aspirin, clopidogrel, or both) who presented to the emergency department (ED).

Methods

A randomized, parallel‐group clinical trial was conducted at two EDs. A total of 124 participants were randomized to receive topical TXA (500 mg in 5 mL) or ANP, 62 patients per group. The primary outcome was the proportion of patients in each group whose bleeding had stopped at 10 minutes. Secondary outcomes were the rebleeding rate at 24 hours and 1 week, ED length of stay (LOS), and patient satisfaction.

Results

Within 10 minutes of treatment, bleeding was stopped in 73% of the patients in the TXA group, compared with 29% in the ANP group (difference = 44%, 95% confidence interval, 26% to 57%; p < 0.001). Additionally, rebleeding was reported in 5 and 10% of patients during the first 24 hours in the TXA and the ANP groups, respectively. At 1 week, 5% of patients in the TXA group and 21% of patients in the ANP group had experienced recurrent bleeding (p = 0.007). Patients in the TXA group reported higher satisfaction scores (median [interquartile range {IQR}], 9 [8–9.25]) compared with the ANP group (median [IQR] = 4 [3–5]; p < 0.001). Discharge from the ED in <2 hours was achieved in 97% of patients in the TXA group versus 13% in the ANP group (p < 0.001). There were no adverse events reported in either group.

Conclusions

In our study population, epistaxis treatment with topical application of TXA resulted in faster bleeding cessation, less rebleeding at 1 week, shorter ED LOS, and higher patient satisfaction compared with ANP.
Low Inherent Sensitivity to the Intoxicating Effects of Ethanol in Rhesus Monkeys with Low CSF Concentrations of the Serotonin Metabolite 5‐Hydroxyindoleacetic Acid
Authors: Wood Elizabeth K. , Kruger Ryno , Bennion Angus , Cooke Bradley M. , Lindell Stephen , Schwandt Melanie , Goldman David , Barr Christina S. , Suomi Stephen J. , Higley James Dee
Published: November 2017

Background

Type 2 alcoholism is characterized by low serotonin system functioning and has a high degree of heritability, with offspring of alcoholics often showing a reduced response to the intoxicating effects of ethanol (EtOH), which is thought to be marker for future alcohol use disorders (AUDs). As such, an important aim of studies investigating the origins of AUDs is to understand the relationship between serotonin system functioning and level of intoxication. A nonhuman primate model was used to evaluate observational ratings of sensitivity to EtOH and to further investigate the relationship between central serotonin activity and behavioral response to EtOH.

Methods

Cerebrospinal fluid (CSF) concentrations of 5‐hydroxyindoleacetic acid (5‐HIAA) were obtained from 4 cohorts of alcohol‐naïve, adolescent rhesus macaques (N = 82, 45 females, 37 males). One to 3 months after the CSF sample, subjects were administered a standardized intravenous EtOH bolus (males: 2.1 g/kg body weight, females: 2.0 g/kg body weight), placed into an open‐top, clear plexiglass chamber suspended from the ceiling, and their latency to escape was recorded as a measure of the degree of intoxication. Thereafter, subjects were rated using a Likert scale for the degree of intoxication during a 30‐minute observation period.

Results

Our results indicate that latency to escape from the chamber was associated with intoxication ratings (p = 0.0009) following the standardized intravenous administration of EtOH. Low CSF 5‐HIAA concentrations predicted short escape latency (p = 0.007) and were associated with low intoxication ratings (p = 0.02), indicating that low central nervous system (CNS) serotonin functioning is related to relative insensitivity to the intoxicating effects of alcohol.

Conclusions

Our study shows that, in monkeys exposed to alcohol for the first time, objective measures of intoxication are associated with subjective ratings for intoxication, and both were associated with CSF 5‐HIAA concentrations. Our data confirm and extend the finding that low CNS serotonin functioning is predictive of intrinsic low sensitivity to the intoxicating effects of EtOH.
Reconstructive options for large back free flap donor sites
Authors: Azizeddin Arshia , Choong Peter F. M. , Grinsell Damien
Published: November 2017

Background

Reconstruction of posterior thoracic and trunk defects can prove challenging even to the most seasoned surgeons. Many commonly used techniques for closing back defects include primary closure and split skin grafts. Often times, however, other techniques are needed in order to give the patient the best aesthetic and functional outcome. In this study, we focus on and evaluate donor site closure techniques for defects in the back created by harvesting scapular and parascapular flaps.

Methods

Twenty patients were operated on to remove pathologically diagnosed sarcomas using a wide local excision. The defects, ranging from 5 to 22 cm in width, were closed using donor flaps from the scapular/parascapular region. Nine donor sites were then closed primarily with wide undermining, while 11 donor sites were closed using multiple techniques, such as large transposition flaps, large rotation advancement flaps, keystone neurovascular island flaps, latissimus dorsi advancement flap and large Y‐V advancement flaps.

Results

All recipient and donor flaps survived with good aesthetic and functional outcome. Patient satisfaction was high and only two of 20 donor site flaps required further surgery due to wound dehiscence. No other complications were seen during the follow‐up period.

Conclusion

The proposed advanced techniques for donor site closure in back defects have shown that primary wound healing can be achieved with the use of a variety of different techniques and the avoidance of the complications of a skin graft.
Safety of single‐incision laparoscopic cholecystectomy for acute cholecystitis
Authors: Byun Geon Young , Lee Sung Ryul , Koo Bum Hwan
Published: November 2017

Background

Single‐incision laparoscopic cholecystectomy (SILC) is a common procedure performed worldwide. In this study, we evaluated the safety and efficacy of SILC for acute cholecystitis.

Methods

Patients who underwent SILC between September 2012 and December 2016 were retrospectively enrolled and divided into acute and chronic groups. Demographic, operative and outcome data were obtained by reviewing medical records, physical examination and telephone follow‐up.

Results

In total, 1435 patients were included in this study: 220 (15.3%) in the acute group and 1215 (84.7%) in the chronic group. The mean operative time was longer in the acute group than in the chronic group (44.7 ± 21.6 versus 32.8 ± 9.8 min; P < 0.001). Insertion of additional ports was performed in 17 patients: six in the acute group and 11 in the chronic group. Conversion to abdominal laparotomy was performed in eight patients: one in the acute group and seven in the chronic group. The mean post‐operative hospital stay was 31.7 ± 20.4 h in the acute group and 27.7 ± 13.7 h in the chronic group. The complication rate was similar between the acute (n = 8, 3.6%) and chronic (n = 33, 2.7%) groups.

Conclusion

SILC does not increase the complication rate and is a safe and feasible technique for both chronic and acute cholecystitis.
LAPAROSCOPIC TREATMENT OF ENDOMETRIOSIS
Authors: Canis M. , Mage G. , Manhes H. , Pouly J.L. , Wattiez A. , Bruhat M.A.
Published: November 2017

Adequate management of endometriosis by laparoscopy included 3 steps: a laparoscopic diagnosis with peritoneal fluid sampling for cytologic examination and biopsies of implants and of peritoneum to assure a correct diagnosis, a laparoscopic evaluation of extension with the American Fertility Society (AFS) 85 scoring system in order to classify the severity of the disease, and a laparoscopic treatment with the following strategy: drainage of the ovarian endometrioma and careful peritoneal washing, treatment of peritoneal implants, ovariolysis, treatment of the ovarian cysts, hemostasis and peritoneal lavage. Treatment of peritoneal implants is very easily performed by CO2 laser vaporization using a suprapubic puncture. Ovarian endometriomas are treated by laparoscopic cystectomy using a transparietal cystectomy or an intraperitoneal cystectomy. Laser vaporization is used only in case of small ovarian cysts or after an incomplete resection of a large cyst.

Results of laparoscopic treatment of endometriosis compare favorably with those obtained with surgical procedures performed by laparotomy with the well known advantage of a laparoscopic approach.
THE MEDICAL TREATMENT OF MILD ENDOMETRIOSIS
Authors: Cooke I.D. , Thomas E.J.
Published: November 2017

Minor degrees of endometriosis have often been regarded as being of no import and hence remain untreated, but a study of the natural history of endometriosis has demonstrated that 47% (95% confidence limits, 23–71%) of patients (n=35) given placebo in a double‐blind, randomized controlled trial showed progression of the disease when assessed before and after treatment by laparoscopy. The active agent, the progestogen gestrinone, was given at a dose of 2.5 mg twice weekly and resulted in an improvement of the disease (p <0.004). Furthermore, follow‐up over 12 months showed no significant difference between those patients treated with active agent or placebo, and none between those with persistent disease and those in whom it had been obliterated. These data suggest that a diagnosis of mild endometriosis should be followed by treatment to prevent progressive disease, but that the treatment does not influence subsequent fertility. They indicate that expectant treatment has no place and that even if fertility is not an immediate requirement, active treatment should be instituted, and that the new gestogen, gestrinone is efficacious. Other treatments, such as danazol or luteinizing hormone releasing hormone (LHRH) agonists, or the older contraceptive or pseudopregnancy regimens, must be set against spontaneous improvement (in 5 of 17 patients i.e. 29%) or elimination (in 4 of 17 patients i.e. 24%) in the placebo group. Infertile patients with mild endometriosis have disorders of follicular and luteal function, and in vitro fertilization suggests a reduced fertilization rate. Nevertheless, these patients require active treatment if these problems are not to be compounded by adhesions, possibly leading to ovarian enclosure, that would further reduce the untreated cumulative conception rate.
First North American validation and head‐to‐head comparison of four preoperative nomograms for prediction of lymph node invasion before radical prostatectomy
Authors: Bandini Marco , Marchioni Michele , Pompe Raisa S. , Tian Zhe , Gandaglia Giorgio , Fossati Nicola , Abdollah Firas , Graefen Markus , Montorsi Francesco , Saad Fred , Shariat Shahrokh F. , Briganti Alberto , Karakiewicz Pierre I.
Published: November 2017

Objectives

To perform a head‐to‐head comparison of four nomograms; namely, the Cagiannos, the 2012‐Briganti, the Godoy and the online‐Memorial Sloan Kettering Cancer Center (MSKCC), for prediction of lymph node invasion (LNI) in a North American population.

Patients and Methods

A total of 19 775 patients with clinically localized prostate cancer (PCa) who had undergone radical prostatectomy and pelvic lymph node dissection (PLND) were identified within the Surveillance Epidemiology and End Results (SEER) database. All four nomograms were tested using Heagerty's concordance index (C‐index), calibration plots and decision curve analysis (DCA). In addition, we examined specific nomogram‐derived thresholds to compare the number of avoided PLNDs and missed LNI‐positive cases.

Results

All nomograms were found to have highly comparable C‐index values: the Cagiannos, 78.6%; the Godoy, 78.2%; the 2012‐Briganti, 79.8%; and the MSKCC, 79.9%. The Cagiannos nomogram showed the best calibration, followed by the 2012‐Briganti, the Godoy and the online‐MSKCC. In DCA, the 2012‐Briganti and the Cagiannos, in that order, provided the best results, followed by the Godoy and the online‐MSKCC models. For each nomogram, the threshold associated with ≤10% missed LNI cases avoided 8 693 (46.6%), 8 652 (46.4%), 8 461 (45.4%) and 8 590 (46.1%) PLNDs, respectively, with the use of the Cagiannos (2.6% threshold), the online‐MSKCC (4.3% threshold), the Godoy (3.6% threshold) and the 2012‐Briganti (4.6% threshold) nomograms.

Conclusion

The Cagiannos and the 2012‐Briganti nomograms exhibited the best calibrations and DCA results. Conversely, C‐index values and ability to avoid unnecessary PLNDs were virtually the same for all four nomograms examined.
The implications of baseline bone‐health assessment at initiation of androgen‐deprivation therapy for prostate cancer
Authors: Kirk Peter S. , Borza Tudor , Shahinian Vahakn B. , Caram Megan E.V. , Makarov Danil V. , Shelton Jeremy B. , Leppert John T. , Blake Ryan M. , Davis Jennifer A. , Hollenbeck Brent K. , Sales Anne , Skolarus Ted A.
Published: November 2017

Objectives

To assess bone‐density testing (BDT) use amongst prostate cancer survivors receiving androgen‐deprivation therapy (ADT), and downstream implications for osteoporosis and fracture diagnoses, as well as pharmacological osteoporosis treatment in a national integrated delivery system.

Patients and methods

We identified 17 017 men with prostate cancer who received any ADT between 2005 and 2014 using the Veterans Health Administration cancer registry and administrative data. We identified claims for BDT within a 3‐year period of ADT initiation. We then used multivariable regression to examine the association between BDT use and incident osteoporosis, fracture, and use of pharmacological treatment.

Results

We found that a minority of patients received BDT (n = 2 502, 15%); however, the rate of testing increased to >20% by the end of the study period. Men receiving BDT were older at diagnosis and had higher‐risk prostate cancer (both P < 0.001). Osteoporosis and fracture diagnoses, use of vitamin D ± calcium, and bisphosphonates were all more common in men who received BDT. After adjustment, BDT, and to a lesser degree ≥2 years of ADT, were both independently associated with incident osteoporosis, fracture, and osteoporosis treatment.

Conclusions

BDT is rare amongst patients with prostate cancer treated with ADT in this integrated delivery system. However, BDT was associated with substantially increased treatment of osteoporosis indicating an underappreciated burden of osteoporosis amongst prostate cancer survivors initiating ADT. Optimising BDT use and osteoporosis management in this at‐risk population appears warranted.
Defining a glycated haemoglobin (HbA1c) level that predicts increased risk of penile implant infection
Authors: Habous Mohamad , Tal Raanan , Tealab Alaa , Soliman Tarek , Nassar Mohammed , Mekawi Zenhom , Mahmoud Saad , Abdelwahab Osama , Elkhouly Mohamed , Kamr Hatem , Remeah Abdallah , Binsaleh Saleh , Ralph David , Mulhall John
Published: November 2017

Objectives

To re‐evaluate the role of diabetes mellitus (DM) as a risk factor for penile implant infection by exploring the association between glycated haemoglobin (HbA1c) levels and penile implant infection rates and to define a threshold value that predicts implant infection.

Patients and Methods

We conducted a multicentre prospective study including all patients undergoing penile implant surgery between 2009 and 2015. Preoperative, perioperative and postoperative management were identical for the entire cohort. Univariate analysis was performed to define predictors of implant infection. The HbA1c levels were analysed as continuous variables and sequential analysis was conducted using 0.5% increments to define a threshold level predicting implant infection. Multivariable analysis was performed with the following factors entered in the model: DM, HbA1C level, patient age, implant type, number of vascular risk factors (VRFs), presence of Peyronie's disease (PD), body mass index (BMI), and surgeon volume. A receiver operating characteristic (ROC) curve was generated to define the optimal HbA1C threshold for infection prediction.

Results

In all, 902 implant procedures were performed over the study period. The mean patient age was 56.6 years. The mean HbA1c level was 8.0%, with 81% of men having a HbA1c level of >6%. In all, 685 (76%) implants were malleable and 217 (24%) were inflatable devices; 302 (33.5%) patients also had a diagnosis of PD. The overall infection rate was 8.9% (80/902). Patients who had implant infection had significantly higher mean HbA1c levels, 9.5% vs 7.8% (P < 0.001). Grouping the cases by HbA1c level, we found infection rates were: 1.3% with HbA1c level of <6.5%, 1.5% for 6.5–7.5%, 6.5% for 7.6–8.5%, 14.7% for 8.6–9.5%, 22.4% for >9.5% (P < 0.001). Patient age, implant type, and number of VRFs were not predictive. Predictors defined on multivariable analysis were: PD, high BMI, and high HbA1c level, whilst a high‐volume surgeon had a protective effect and was associated with a reduced infection risk. Using ROC analysis, we determined that a HbA1c threshold level of 8.5% predicted infection with a sensitivity of 80% and a specificity of 65%.

Conclusion

Uncontrolled DM is associated with increased risk of infection after penile implant surgery. The risk is directly related to the HbA1c level. A threshold HbA1c level of 8.5% is suggested for clinical use to identify patients at increased infection risk.
The presentation of depression symptoms in attention‐deficit/hyperactivity disorder: comparing child and parent reports
Authors: Fraser Annie , Cooper Miriam , Agha Sharifah Shameem , Collishaw Stephan , Rice Frances , Thapar Anita , Eyre Olga
Published: November 2017

Background

Attention‐deficit/hyperactivity disorder (ADHD) frequently co‐occurs with depression, and outcomes are poor when both are present. Little is known about whether depression symptoms present differently in ADHD compared to the general population, or how reliable young people with ADHD are at reporting these symptoms. This study aimed to describe depression symptoms in a clinical ADHD sample compared to a population sample, and compare self‐reports of depression symptoms with parent‐reports.

Methods

Two hundred and forty‐nine children with ADHD and their parents completed follow‐up questionnaires around 5 years after taking part in a Cardiff University ADHD study. Child depression symptoms were measured using parent‐ and child‐reported Mood and Feelings Questionnaires (MFQ) and compared to a population sample with MFQ data (n = 1460). Within both samples, child‐ and parent‐reported depression symptoms were compared.

Results

Although the profile of depression symptoms was similar between young people with ADHD and those in the general population, depression symptoms were much more common in the ADHD sample (parent‐rated MFQ score = 24.52 vs. 9.39; child‐rated = 21.02 vs. 11.86). The most common symptoms in both samples included irritability, restlessness and concentration difficulties, with core depression symptoms such as feeling miserable/unhappy also prominent. Within the ADHD sample, but not the population sample, children reported depression symptoms less frequently than their parents.

Conclusions

Young people with ADHD are at high risk of experiencing symptoms of depression but may under‐report the severity of their symptoms. Obtaining parent reports of depression symptoms in this group may be important to avoid missing key indicators of risk.