bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyfrecation and Interference With Implantable Cardiac Devices
Authors: Amin Sima D. , Homan Katie B. , Assar Manish , Lee Mary , Housewright Chad D.
Published: October 2019

BACKGROUND

Mohs micrographic surgery, excisional surgery, and electrodessication and curettage (ED&C) are common dermatologic procedures that often use electrodessication through hyfrecators to achieve hemostasis. According to in vitro studies, electrodessication is considered safe in patients with implanted cardiac devices. To the authors' knowledge, there are no in vivo data to support this claim.

OBJECTIVE

In this study, the authors aim to describe the outcomes of hyfrecation during dermatologic procedures in patients with pacemakers and implantable cardiac devices.

METHODS

Retrospective chart review was completed from March 2014 to April 2018 at a single center. Forty-five patients met criteria of having a cardiac device and having undergone an electrosurgery procedure using the Conmed 2000 Hyfrecator (Utica, NY). Adverse perioperative and postoperative outcomes, as well as device malfunction, were evaluated.

RESULTS

No adverse perioperative effects were reported. Device reports were examined for inappropriate firing of the defibrillator, loss of capture, temporary inhibition of pacing, battery drainage, pacing at an elevated or erratic rate, failure to deliver antitachycardia, reversion to asynchronous pacing, induction of arrhythmias, or tissue damage at lead tissue, but no such issues were found.

CONCLUSION

The lack of complications associated with cardiac devices with hyfrecation is reassuring. However, prospective and larger retrospective studies are warranted.
Efficacy of Intralesional Cryosurgery in the Treatment of Multiple Extragenital Cutaneous Warts: A Randomized Controlled Study
Authors: Awad Sara M. , El-Badawy Omnia , Abou-Taleb Doaa A.E.
Published: October 2019

BACKGROUND

The efficacy of intralesional (IL) cryosurgery in the treatment of cutaneous warts has not been previously studied.

OBJECTIVE

To compare the efficacy and safety of IL cryosurgery versus electrosurgery in multiple extragenital warts and investigate their effect on serum interleukin (IL)-12 and interferon-gamma (IFN-γ).

MATERIALS AND METHODS

Thirty-one patients were included; 18 received IL cryosurgery, and 13 had electrosurgery. Treatment was performed for the largest or few (2–3) small warts (target) until cleared, leaving the remaining (distant) warts untreated. Clinical response of the target and distant warts and adverse effects were evaluated. Serum IL-12 and IFN-γ levels were assessed before and after treatment.

RESULTS

All patients had complete clearing of the treated wart in both groups. IL cryosurgery was well tolerated; infection, ulceration, and recurrence occurred only with electrosurgery. Complete/near-complete resolution of the distant untreated warts was seen in 33.3% versus none of patients in the IL cryosurgery and electrosurgery groups, respectively (p = .003). Furthermore, IL-12 and IFN-γ levels showed a tendency to increase after IL cryosurgery, and their increase correlated with distant wart response.

CONCLUSION

Intralesional cryosurgery is effective not only in clearing treated warts but also resolving untreated warts and possibly enhances human papillomavirus–directed immune response.
Family planning in adolescents
Authors: Ganti Amitha K. , Hillard Paula J.A.
Published: October 2019

Purpose of review

As politics continue to shape contraception and abortion care, providers have a responsibility to address the specific needs of the adolescent patient. Here we review the current literature on contraception and abortion in adolescents.

Recent findings

Shared decision-making among patients, parents, and providers is the cornerstone of successful adolescent family planning. Providers should be aware of local state regulations related to consent in minors. When provided directive and noncoercive contraception counseling at no cost, adolescents are motivated and effective decision-makers in their care. Long-acting reversible contraceptives should be offered as the first-line method of contraception in adolescents.

Family planning in adolescents presents unique challenges to obstetrician-gynecologists. Improved access to contraception and abortion services is significantly lowering unintended pregnancies rates in adolescents, but more data assessing the effectiveness of interventions in marginalized communities are needed.
Surgical-Site Infection Prevention After Hysterectomy: Use of a Consensus Bundle to Guide Improvement
Authors: Burgess Adriane , Fish Megan , Goldberg Seth , Summers Keziah , Cornwell Kim , Lowe Jason
Published: October 2019

Hysterectomy is one of the most commonly performed surgeries in women. Surgical-site infections (SSI) after hysterectomy can lead to increased morbidity and mortality as well as readmission, which is associated with increased costs for health systems. The aim of the project was to improve standardization of preoperative education on infection prevention and incorporate the use of preoperative chlorhexidine (CHG) bathing for patients undergoing hysterectomy to decrease rates of SSI. Data on SSI after hysterectomy were reviewed. Tracer methodology was used to identify gaps in the preoperative process by comparing the current process to the Council on Patient Safety in Women's Health Care Patient Safety Bundle “Prevention of Surgical Site Infection after Gynecologic Surgery.” After implementation, survey data were collected on adherence to the washing protocol, and SSI data were monitored. Survey results reflected high compliance with the CHG washing protocol, provision of patient education, and overall patient satisfaction with the process. Before implementation in 2016, we reported 8 deep or organ/space SSI to the National Healthcare Safety Network. After implementation in 2018, we reported 3 deep or organ/space SSI. Standardizing infection prevention processes to align with safety bundles improves the quality of care provided to patients.
PAEA End of Rotation™ Exams Accurately Identify Students at Risk of Physician Assistant National Certifying Exam Failure
Authors: Buchs Shalon R. , Baginski Robert , Coombs Jennifer M. , Duffy Diane , Garbas Breann , Honda Trenton , Moloney-Johns Amanda , Mazur Ziemowit , Murfin Melissa , Statler Michel , Thurnes Tracey
Published: October 2019

Purpose

Physician Assistant Education Association (PAEA) End of Rotation™ exams are used by programs across the country. However, little information exists on the predictive ability of the exams' scale scores and Physician Assistant National Certifying Exam (PANCE) performance. The purpose of this study was to evaluate End of Rotation exam scores and their relationship with poor PANCE performance (PPP).

Methods

In an IRB-approved, multi-center, multi-year study, associations between PAEA End of Rotation exam scale scores and PANCE scores were explored. A taxonomy of nested linear regression models with random intercepts was fit at the program level. Fully adjusted models controlled for year, timing of the exam, student age, and gender.

Results

Fully adjusted linear models found that 10-point increases in End of Rotation exam scores were associated with a 16.8-point (95% confidence interval [CI]: 14.1-19.6) to 23.5-point (95% CI: 20.6-26.5) increase in PANCE score for Women's Health and Emergency Medicine, respectively. Associations between exams did not significantly vary (P = .768). Logistic models found End of Rotation exam scores were strongly and consistently associated with lower odds of PPP, with higher exam scores (10-point increase) associated with decrements in odds of PPP, ranging between 37% and 48% across exams. The effect estimate for the Emergency Medicine exam was consistently stronger in all models.

Conclusions

PAEA End of Rotation exam scores were consistently predictive of PPP. While each End of Rotation exam measures a specialty content area, the association with the overall PANCE score varied only by a change in odds of low performance or failure by a small percentage. Low End of Rotation exam scores appear to be consistent predictors of PPP in our multi-center cohort of physician assistant students.
An obscure case of using apixaban anti-Xa levels in a morbidly obese patient who was nil per os with enterocutaneous fistula
Authors: Cole Jennifer L.
Published: October 2019

Apixaban anti-Xa levels have been introduced to monitor apixaban activity. Presented is a fundamental use of anti-Xa monitoring in questionable absorption in enterocutaneous fistula. A 57-year-old morbidly obese male (150 kg, BMI 42.5) presented to the emergency department with deep venous thromboses and pulmonary embolisms. He also had high-output enterocutaneous fistula managed with an abdominal collection device, total parental nutrition therapy, and nil per os status. He was able to take some oral (PO) medications; however, he reported finding whole capsules in his collection device. He refused enoxaparin injections for venous thromboembolism treatment. The decision was made to load with apixaban therapy with anti-Xa monitoring. After two 10-mg doses, peak apixaban anti-Xa level was 146 ng/ml which fell within on-therapy levels in the AMPLIFY study, prothrombin time 18 s, partial thromboplastin time 35.5 s, international normalized ration 1.5. Monitoring was an important factor in this patient with questionable absorption and further complicated by his morbid obesity which has not been adequately studied in clinical trials.
Acute pancreatitis in oldest old: a 10-year retrospective analysis of patients referred to the emergency department of a large tertiary hospital
Authors: Quero Giuseppe , Covino Marcello , Ojetti Veronica , Fiorillo Claudio , Rosa Fausto , Menghi Roberta , Laterza Vito , Candelli Marcello , Franceschi Francesco , Alfieri Sergio
Published: October 2019

Objective

Contrasting results are reported on the clinical course of acute pancreatitis (AP) in the geriatric population. The aim of this study is to compare the AP clinical outcomes between patients aged from 65 to 79 years and those over 80 years.

Methods

A total of 115 patients over 80 years (oldest old) were compared to a group of 236 patients aged 65–79 years (elderly). Clinicodemographic, biochemical, and radiological data were reviewed. The primary outcome was to compare the overall mortality. Secondary outcomes included intensive care unit (ICU) admission, in-hospital length of stay (LOS), and need for surgical procedures.

Results

Laboratory values at admission were similar between the two groups. Over 80 patients presented a lower rate of abdominal symptoms (68.7% vs. 81.4%; P = 0.008), a higher mortality (14.8% vs. 3.5%; P = 0.003), and ICU admission (13.9% vs. 3.8%; P = 0.001) rates. Median LOS was comparable between the two groups. Multivariate analysis identified age [odds ratio (OR): 3.56; 95% confidence interval (CI): 1.502–8.46; P = 0.004], a higher Ranson score (OR: 3.22; 95% CI: 1.24–8.39; P = 0.016), and the absence of abdominal pain (OR: 2.94; 95% CI: 1.25–6.87; P = 0.013) as independent predictors of mortality. Conversely, only age (OR: 3.83; 95% CI: 1.55–9.44; P = 0.003) and a more severe AP (OR: 3.56; 95% CI: 1.95–6.89; P = 0.041) were recognized as influencing ICU admission. Only the operative treatment (OR: 2.805; 95% CI: 1.166–5.443; P = 0.037) was evidenced as independent risk factor for LOS (OR: 3.74; 95% CI: 1.031–6.16; P = 0.003).

Conclusion

Oldest old patients have a higher mortality and ICU admission rate as compared to the other subgroups of elderly. Early diagnosis and prompt treatment are key elements to improve outcomes in this frailer population.
Lumen-apposing metal stents in interventional endoscopy: a state-of-the-art review with focus on technical and clinical successes and complications
Authors: Kadah Anas , Khoury Tawfik , Mari Amir , Mahamid Mahmud , Sbeit Wisam
Published: October 2019

Endoscopic transmural drainage is considered the initial treatment option for pancreatic fluid collections. Recently, lumen-apposing metal stents have been introduced for pancreatic fluid collections drainage under endoscopic ultrasound guidance, in addition to evolving data in bile duct and gallbladder drainage. We aimed to perform systematic review with reporting pooled data analysis on technical success, clinical success and complications rate of endoscopic ultrasound-guided lumen-apposing metal stents uses. A MEDLINE/PubMed and EMBASE search for all studies on lumen-apposing metal stents uses in pancreatic, biliary and other indications was conducted. Data regarding safety, complications and yield were extracted and included in the final pooled analysis. Overall, 19 articles dealing with pancreatic fluid collections drainage, 18 articles reporting on bile duct drainage and 19 articles relevant to gallbladder drainage were identified. Technical and clinical successes in all disease conditions were high and reached more than 95%. Complications rate in pancreatic fluid collections, bile duct and gallbladder drainages were 12%, 11.2% and 9.8%, respectively. Endoscopic ultrasound-guided lumen-apposing metal stents is technically feasible with very high success rate and acceptable complications rate.
Surgical versus endoscopic resection of large sessile duodenal and papillary lesions
Authors: Xu Mengque , Wu Jiaguo , Yu Liangliang , Liu Xing , Wang Xianfa , Dai Ning
Published: October 2019

Background

Data on the endoscopic resection of duodenal and papillary lesions less than 15 mm in size have been well supported by systematic studies. However, for large sessile lesions of the duodenum or papilla (LSL-D/P), surgery is often performed despite significant morbidity and mortality. This study aimed to compare the outcomes and costs between endoscopic and surgical resection of such lesions.

Methods

Patients who underwent endoscopic or surgical resection of LSL-D/P at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University from 2013 to 2017 were retrospectively analyzed. Endoscopic and surgical outcomes and costs were compared.

Results

A total of 68 lesions were evaluated (47.1% of patients were male; mean lesion size 25 mm); 46 were treated by endoscopic resection, and 22 were managed by surgical resection. At the initial procedure, complete resection was achieved in 93.4%. Major complications (perforation, delayed bleeding, pancreatitis, infections and admission to the ICU) occurred in 15.3% of the endoscopic group and 22.6% of the surgical group. For recurrence at the first surveillance endoscopic examination, there was a 12.1% recurrence rate in the endoscopic group and a 5.3% recurrence rate in the surgical group (P = 0.654). Compared with surgical resection, regardless of lesion location, endoscopic resection had a shorter procedural time and hospital stay, a lower morbidity rate and was less costly.

Conclusion

In centers specialized in complex endoscopic resection, patients with LSL-D/P would likely benefit from advanced endoscopic management, which offers a lower morbidity profile and reduced costs.
Predictors of Multiple Emergency Department Utilization Among Frequent Emergency Department Users in 3 States
Authors: Giannouchos Theodoros V. , Washburn David J. , Kum Hye-Chung , Sage William M. , Ohsfeldt Robert L.
Published: October 2019

Background:

Research on frequent emergency department (ED) use shows that a subgroup of patients visits multiple EDs. This study characterizes these individuals.

Objective:

The objective of this study was to determine how many frequent ED users seek care at multiple EDs and to identify sociodemographic, clinical, and contextual factors associated with such behavior.

Research Design:

We used the 2011–2014 Healthcare Cost and Utilization Project State Emergency Department Databases data on all outpatient ED visits in New York, Massachusetts, and Florida. We studied all adult ED users with ≥5 visits in a year and defined multisite use as visits to ≥3 different sites. We estimated predictors of multisite use with multivariate logistic regressions.

Results:

Across all 3 states, 1,033,626 frequent users accounted for 7,613,077 ED visits. Of frequent users, 25% were multisite users, accounting for 30% of the visits studied. Frequent users with at least 1 visit for mental health or substance use-related diagnosis were more likely to use multiple sites. Uninsured frequent users and those with public insurance were associated with less use of multiple EDs than those with private coverage while lacking consistent coverage by the same insurance within each year were associated with using multiple sites.

Conclusions:

Health policy interventions to reduce duplicative or unnecessary ED use should apply a population health perspective and engage multiple hospitals. Community-level preventive approaches and a stronger infrastructure for mental health and substance use are essential to mitigate multisite ED use.
An update on treatment of voice-gender incongruence by otolaryngologists and speech-language pathologists
Authors: Pasternak Kevin , Francis David O.
Published: October 2019

Purpose of review

The current review provides an update of literature published in the past 2 years related to treatment of voice-gender incongruence in the gender expansive population, commonly referred to as transgender voice modification.

Recent findings

Four main themes have emerged in research during the review period. These include comparison of surgical and behavioral techniques for raising pitch, with consistent findings of a greater increase in fundamental frequency (F0) following endoscopic glottoplasty compared with cricothyroid approximation. Voice therapy similarly can increase pitch (F0), often to degrees commensurate with surgical approaches. A second theme identifies the perceptual correlates of gender in voice and communication, highlighting recent findings that perception of gender relates primarily to nonpitch-related features of voice. A third theme is the importance of considering patient-reported outcomes in treatment and research. Finally, several recent studies challenge the assumption that transmasculine individuals taking HRT are satisfied with their voice and communication.

Speech-language pathologists and otolaryngologists should work collaboratively to treat voice-gender incongruence. Together, we should consider treatment evidence, individual patient goals, and validated patient-reported outcome measures when recommending treatment and evaluating outcomes. Understanding the nuance of how each individual defines benefit is critical to clinicians whose aim is to personalize and optimize treatment of voice-gender incongruence. This is particularly important as management broadens to include individuals across the gender spectrum.
Mammography Self-efficacy Scale and Breast Cancer Fear Scale
Authors: Alyami Mohsen , Al-Sharef Abdullah , Al-Aseri Mai , Henning Marcus
Published: October 2019

Background

Early screening for breast cancer (BC) is critical for improving health outcomes and reducing mortality. Research has shown that self-efficacy and fear of BC can influence patients’ screening behaviors. Validated measures to assess these constructs among Saudi women are lacking.

Objective

The aim of this study was to assess the psychometric properties of the Arabic versions of the Champion Mammography Self-efficacy Scale (CMSES) and Champion Breast Cancer Fear Scale (CBCFS) in a sample of Saudi women.

Methods

The CMSES and CBCFS were back-translated into Arabic using an established translation protocol. Reliability was assessed using Cronbach’s α coefficients. Construct validity was evaluated using exploratory and confirmatory factor analytical procedures.

Results

The findings from the factor analysis confirmed the unidimensional structure of both scales as reported by the original authors. Additionally, both scales exhibited high internal consistency (Cronbach’s α coefficients) of .91 for the modified CMSES-Arabic and .94 for the CBCFS-Arabic.

Conclusions

This article provided initial evidence of reliability and construct validity for the modified CMSES-Arabic and the CBCFS-Arabic.

Implications for Practice

Nurses and other allied health professionals can now use these measures to better understand how self-efficacy and fear of BC are related to compliance with cancer screening among Saudi women and in other Arabic-speaking contexts. The scales could also be useful for developing and testing the effectiveness of interventions aimed at improving mammography testing rates.
Impact of Behavior Management Training on Nurses' Confidence in Managing Patient Aggression
Authors: de la Fuente Margarita , Schoenfisch Ashley , Wadsworth Barbara , Foresman-Capuzzi Joyce
Published: October 2019

OBJECTIVE

The aim of this study was to evaluate the impact of behavior management training on nurses' confidence in managing aggressive patients.

BACKGROUND

Nurses are at a high risk of experiencing violence directed toward them by patients.

METHODS

This quality improvement project used a pre-and-post study design. A survey was administered within 1 month before behavior management training and 1 month after training, capturing participants' demographic and work characteristics, as well as their experiences with patient/visitor-perpetrated violence. Confidence was measured using the Confidence in Coping with Patient Aggression Instrument. Open-ended questions sought participants' thoughts on workplace violence prevention initiatives.

RESULTS

Thirty-eight confidence scores were assessed. Nurses' confidence in coping with patient aggression was significantly higher after behavior management training. Nurse participants described the training as “timely,” “helpful,” and “beneficial.”

CONCLUSION

With an increased understanding of violent behavior stages and warning signs, a nurse is better able to manage a potentially violent situation.
Preparing Nurse Managers for Authentic Leadership
Authors: Frasier Nora
Published: October 2019

OBJECTIVE:

This study examined the impact of a pilot leadership development program on nurse managers' (NMs') use of authentic leadership behaviors.

BACKGROUND:

Nurse managers often receive little or no formal training. Literature suggests formal leadership development programs can enhance their leadership competency. A leadership development program was designed and pilot tested to determine effectiveness in enhancing authentic leadership competency.

METHODS:

A cross-sectional study used a convenience sample of 16 NMs who participated in the pilot program.

RESULTS:

Measurable increases in authentic leadership behaviors were demonstrated in both the self-assessments (mean scores increased in 3 of 4 subscales) and RN direct report assessments (mean scores increased in all 4 subscales), with statistical significance achieved in 1 self-awareness behavior.

CONCLUSIONS:

The pilot program demonstrated merit as a tool to enhance NMs' authentic leadership behaviors. Managers perceived greater self-awareness, and direct reports perceived positive change in managers' use of authentic leadership behaviors.
Chief Nursing Officers' Perspectives on Hospital-Based Building or Remodeling Projects
Authors: Keys Yolanda
Published: October 2019

OBJECTIVE

This descriptive survey explores the experiences of chief nursing officers (CNOs) who have participated in hospital-based building or remodeling projects.

BACKGROUND

As a pivotal member of the leadership team for facility projects, CNOs are often charged with contributing to decisions regarding placement of technology connections, selection of design elements to prevent healthcare-associated infections, choice of location for supplies, and management of construction change orders.

METHODS

A descriptive survey approach guided telephone interviews with 12 CNOs from across the United States. Credibility was achieved through peer debriefing and member checking. Transferability was demonstrated through detailed description; dependability and confirmability were demonstrated through an audit trail of the data collection and analysis processes.

RESULTS

Three main themes were identified, and a list of practice implications was developed.

CONCLUSIONS

CNOs can use the recommendations from this study as a starting point for future building or remodeling projects.
First Responses to the Symptoms of Sexually Transmitted Infections and Treatment-Seeking Behavior Among Men Who Have Sex With Men in 13 Cities in China
Authors: Li Jing , Yue Xiaoli , Wang Yajie , Gong Xiangdong
Published: October 2019

Background

Data are scarce on sexually transmitted infection (STI) treatment-seeking behavior among men who have sex with men (MSM) in China. The purpose of the study was to characterize the first response to STI symptoms, treatment-seeking behavior, and its associated factors among MSM in China.

Methods

A cross-sectional study with convenience sampling design was conducted in 13 cities from April to July 2017. Face-to-face interviews were conducted to collect information on demographics, STI symptoms, and treatment-seeking behavior. Logistic regression analysis was conducted to evaluate variables associated with not seeking treatment.

Results

Among 3925 recruited participants, 628 (16.0%) reported STI symptoms in the past 12 months and were included in the analysis. Upon or after being notified of the symptoms, MSM sought help from various sources or self-tested using rapid testing kits. Only 322(51.3%) went to see a doctor in clinic. In multiple logistic regression analyses, younger age, lower income, less STI knowledge (adjusted odds ratio [AOR], 1.8; 95% confidence interval [CI], 1.2–2.5), not knowing own STI risk (AOR, 1.8; 95% CI, 1.2–2.7), no symptoms of anogenital ulcers (AOR, 2.3; 95% CI, 1.3–3.8) or anogenital warts (AOR, 2.4; 95% CI, 1.6–3.7), no syphilis testing in the past 12 months (AOR, 2.1; 95% CI, 1.5–3.0) were associated with higher probability of not seeking treatment in clinics.

Conclusions

We found a high prevalence of STI symptoms among MSM and only half sought treatment. Prevention efforts should promote STI education, testing, and adequate treatment-seeking behavior.
Unilateral Lateral Rectus Paralysis Showing Incomplete “V” Sign’ on 18F-FDG PET/CT
Authors: Parihar Ashwin Singh , Vadi Shelvin Kumar , Kumar Rajender , Singh Harmandeep , Takkar Aastha , Mittal Bhagwant Rai , Lal Vivek
Published: October 2019

Extraocular muscles show physiologic radiotracer uptake on 18F-FDG PET/CT as is encountered in most routine scans. Certain pathologies can cause palsy of one or more of the extraocular muscles, leading to hypometabolism on 18F-FDG PET/CT. We present a case with a classical finding of unilateral hypometabolism of the lateral rectus muscle, disrupting the “V” sign formed due to physiologic uptake. The patient had presented with the complaint of diplopia and was being evaluated further to rule out the possibility of inflammatory/granulomatous infectious etiopathogenesis leading to compression of the abducens nerve resulting in lateral rectus palsy.
Differential 18F-FDG and 18F-Fluciclovine Uptake Pattern in a Patient With Poorly Differentiated Adenocarcinoma of the Lung and Prostate Cancer Biochemical Recurrence
Authors: Nguyen Nghi C. , Muthukrishnan Ashok , Mountz James M.
Published: October 2019

A 72-year-old man with a history of T1cN0M0 prostate adenocarcinoma and rising prostate-specific antigen underwent a fluciclovine PET/CT scan that showed high uptake in several para-aortic nodes, suspicious for prostate cancer. A right upper lobe single pulmonary nodule (SPN), demonstrated only mild uptake, which raised the suspicion for a lung primary. Subsequent FDG PET/CT showed high uptake in the SPN, revealing poorly differentiated adenocarcinoma at biopsy, but with no abnormal uptake in the para-aortic nodes. This case highlights the complementary potential of fluciclovine and FDG PET in patients with a history of prostate cancer biochemical recurrence and SPN.
Complete Spontaneous Regression of Hepatosplenic T-Cell Lymphoma After Surgical Biopsy
Authors: Nakamoto Ryusuke , Okuyama Chio , Oka Satoshi
Published: October 2019

18F-FDG PET/CT for a 74-year-old man with elevated serum soluble interleukin 2 receptor showed multiple intense uptake in the liver, spleen, and bone. A surgical biopsy from 2 of liver tumors confirmed hepatosplenic αβ T-cell lymphoma. One and a half months after biopsy, FDG PET scan was performed again for staging before starting chemotherapy, and it showed the complete disappearance of all of the lesions. The excisional biopsy could be a possible trigger of his spontaneous regression.
Intranasal Bolsters: A Novel Technique for Nasal Bone Stabilization
Authors: Shokri Tom , Hilger Peter A. , Lighthall Jessyka G.
Published: October 2019

Nasal bone stabilization, in the setting of comminuted nasal fracture or surgical osteotomy, represents a challenging surgical experience. Postoperative shifting of osseous fragments may result in compromised outcomes in an otherwise well-performed procedure. Although prior studies have reported nasal bone fixation with implementation of wires, plates, or halos, these techniques are often difficult to employ routinely. Herein, the authors describe a novel and facile technique for the maintenance of unstable nasal bones using customized intranasal bolsters.
Center-related Bias in MELD Scores Within a Liver Transplant UNOS Region: A Call for Standardization
Authors: Verna Elizabeth C. , Connelly Charles , Dove Lorna M. , Adem Patricia , Babic Nikolina , Corsetti James , Faix James , Hayden Joshua A. , Lifshitz Mark , Stotler Brie , Jin Zhezhen , Mohan Sumit , Emond Jean C. , Hod Eldad A. , Kratz Alexander
Published: October 2019

Background.

Model for End-Stage Liver Disease (MELD) score–based liver transplant allocation was implemented as a fair and objective measure to prioritize patients based upon disease severity. Accuracy and reproducibility of MELD is an essential assumption to ensure fairness in organ access. We hypothesized that variability in laboratory methodology between centers could impact allocation scores for individuals on the transplant waiting list.

Methods.

Aliquots of 30 patient serum samples were analyzed for creatinine, bilirubin, and sodium in all transplant centers within United Network for Organ Sharing (UNOS) region 9. Descriptive statistics, intraclass correlation coefficients (ICCs), and linear mixed-effects regression were used to determine the relationship between center, bilirubin, and calculated MELD-sodium (MELD-Na) score.

Results.

The mean MELD-Na score per sample ranged from 14 to 38. The mean range in MELD-Na per sample was 3 points, but 30% of samples had a range of 4–6 points. Correlation plots and intraclass correlation coefficient analysis confirmed bilirubin interfered with creatinine, with worsening agreement in creatinine at high bilirubin levels. Center and bilirubin were independently associated with creatinine reported in mixed-effects models. Unbiased hierarchical clustering suggested that samples from specific centers have consistently higher creatinine and MELD-Na values.

Conclusions.

Despite implementation of creatinine standardization, centers within a single UNOS region report clinically significant differences in MELD-Na on an identical sample, with differences of up to 6 points in high MELD-Na patients. The bias in MELD-Na scores based upon center choice within a region should be addressed in the current efforts to eliminate disparities in liver transplant access.
Synthesis of low immunogenicity RNA with high-temperature in vitro transcription
Authors: Wu Monica Z. , Asahara Haruichi , Tzertzinis George , Roy Bijoyita
Published: October 2019

The use of synthetic RNA for therapeutics requires that the in vitro synthesis process be robust and efficient. The technology used for the synthesis of these in vitro-transcribed mRNAs, predominantly using phage RNA polymerases (RNAPs), is well established. However, transcripts synthesized with RNAPs are known to display an immune-stimulatory activity in vivo, that is often undesirable. Previous studies have identified double-stranded RNA (dsRNA), a major by-product of the in vitro transcription (IVT) process, as a trigger of cellular immune responses. Here we describe the characterization of a high-temperature IVT process using thermostable T7 RNAPs to synthesize functional mRNAs that demonstrate reduced immunogenicity without the need for a post-synthesis purification step. We identify features that drive the production of two kinds of dsRNA by-products—one arising from 3’ extension of the run-off product and one formed by the production of antisense RNAs—and demonstrate that at a high temperature, T7 RNAP has reduced 3’-self extension of the run-off product. We show that template-encoded poly-A tailing does not affect 3’-self extension but reduces the formation of the antisense RNA by-products and that combining high-temperature IVT with template-encoded poly-A tailing prevents formation of both kinds of by-products.
Trait evolution under multiple selection pressures: Prey responses to predictable and unpredictable variation
Authors: Sharma Manvi , Isvaran Kavita
Published: October 2019

When a strong selection pressure, such as predation risk, varies widely in space and time, how should prey respond? When risk varies predictably, prey are hypothesized to respond in a risk-sensitive manner. It is less clear how prey should respond when risk varies unpredictably.

Additionally, prey response may also depend on how predation risk interacts with other selection pressures. Our understanding of the complex action of multiple and variable selection pressures on prey traits is still comparatively poor. Here, we examine how predictable and unpredictable aspects of predation risk act together with another important selection pressure to influence prey behaviour in the rock pool breeding mosquito,Aedes vexans.Through the selection of sites for oviposition, female mosquitoes can influence the predation risk faced by their offspring. We tested how females select oviposition sites, when encountering pools that vary in larval predation risk and desiccation risk. We comprehensively quantified spatial and temporal variation in predation risk by measuring densities of predatory dragonfly nymphs in rock pools of different sizes, along the mosquito breeding season. We also measured hydroperiod length. We next conducted manipulative experiments in rock pools and measured female oviposition responses to variation in predation and desiccation risks. Predation risk varied widely in space and time. Desiccation risk only appeared important for the small pools. Ovipositing females appeared to respond to these multiple aspects of variation in selection pressures. Females seemed to respond to predictable variation by avoiding large pools that permanently harboured predators in natural settings. Female responses were more variable to medium-sized pools with naturally stochastic predator densities, highlighting the role of unpredictability in predation risk in shaping behaviour. Females did not clearly prefer small pools that were naturally devoid of predators but carried high desiccation risk, suggesting that they balance multiple risks – predation versus desiccation – when choosing oviposition sites. Our study suggests that wild populations may commonly experience multiple and variable selection pressures that can favour seemingly puzzling trait variation. We highlight the need to quantify variation in selection pressures and investigate how such variation, especially the unpredictable aspects, shapes prey traits.
Flexible Modulation of Neural Variance Facilitates Neuroprosthetic Skill Learning
Authors: You Albert K. , Liu Bing , Singhal Abhimanyu , Gowda Suraj , Moorman Helene , Orsborn Amy , Ganguly Karunesh , Carmena Jose M.
Published: October 2019

One hallmark of natural motor control is the brain’s ability to adapt to perturbations ranging from temporary visual-motor rotations to paresis caused by stroke. These adaptations require modifications of learned neural patterns that can span the time-course of minutes to months. Previous work with brain-machine interfaces (BMI) has shown that over learning, neurons consolidate firing activity onto low-dimensional neural subspaces, and additional studies have shown that neurons require longer timescales to adapt to task perturbations that require neural activity outside of these subspaces. However, it is unclear how the motor cortex adapts alongside task changes that do not require modifications of the existing neural subspace over learning. To answer this question, five nonhuman primates were used in three BMI experiments, which allowed us to track how specific populations of neurons changed firing patterns as task performance improved. In each experiment, neural activity was transformed into cursor kinematics using decoding algorithms that were periodically readapted based on natural arm movements or visual feedback. We found that decoder changes caused neurons to increase exploratory-like patterns on within-day timescales without hindering previously consolidated patterns regardless of task performance. The flexible modulation of these exploratory patterns in contrast to relatively stable consolidated activity suggests a simultaneous exploration-exploitation strategy that adapts existing neural patterns during learning.
Applying ANP to analyse sensory experience in restaurants
Authors: Chang Wei-Lun
Published: October 2019

Purpose

The purpose of this paper is to explore the relative importance of the five types of sensory experience in restaurants and the differences between experts and customers.

Design/methodology/approach

Analytic network process was used to select the critical factors for the five types of sensory experiences. Expert and consumer questionnaires were compared to examine the differences between expert opinions and customer awareness.

Findings

Restaurants consider taste and smell to be important senses, whereas hearing was considered to be the least important.

Originality/value

Experts paid more attention to criteria and sub-criteria that resonated with consumers’ memories and emotions. Consumers paid more attention to intuitively obtaining emotional experiences during each purchase.
Social and financial aid for disaster relief operations using CSR and crowdfunding
Authors: Behl Abhishek , Dutta Pankaj
Published: October 2019

Purpose

The purpose of this paper is to understand the interlinkages between corporate social responsibility (CSR) and crowdfunding in the context of disaster relief operations (DRO). It intends to explore how information quality moderates the relationship of CSR and crowdfunding to achieve financial and social stability. The study also controls variables such as type of disaster, size of the firm and sector to which the firms belong while drawing implications.

Design/methodology/approach

The study collects empirical data in an Indian context through a structured questionnaire. The respondents belong to organizations which made a financial contribution toward DRO during the past decade (2008–2018). The sample size for data analysis is 232 responses belonging to different industries like plastic, chemical, textile and apparel, automotive parts and electronics, and construction. The study employs partial least squares structural equation modeling for testing the hypothesis.

Findings

Results indicate a positive effect of CSR activities on donation-based crowdfunding to achieve financial and social normalcy in a DRO. CSR can thus be used as an alternate way to support DRO. Results also reveal that quality of information positively impacts the relationship between crowdfunding and social aid as well as financial aid offered to the victims of the disasters. It is further observed that the type of disaster accounts for the inflow and frequency of funds made by companies as a part of their CSR activities.

Research limitations/implications

The study restricts its analysis to CSR contributions made by Indian firms for DRO in an Indian context. While the study is centered in an Indian context, it holds strong implications by offering guidelines and framework for integrating funds of the government, CSR contributions of companies and donations made by citizens. The outcome also provokes thoughts on testing the results with multiple disasters across the globe in order to validate the findings and possibly extend them.

Originality/value

The approach of the study holds a unique slot in understanding concepts relating to CSR, crowdfunding and information science literature in the context of DRO. The study offers unique contribution in making the readers aware how CSR funds, when guided through a donation-based crowdfunding platform can help achieve social and financial aid for the victims of natural disaster.
Key leadership skills of great sales leaders
Authors: Longenecker Clinton Oliver , Mallin Michael L.
Published: October 2019

Purpose

The purpose of this research paper is to identify and describe the key leadership skills associated with great leaders in the sales discipline. Nine critically important sales leadership skills are identified and discussed in this manuscript with the purpose of getting sales leaders think about skill set development while providing those responsible for sales leadership development an opportunity to think through some critically important questions.

Design/methodology/approach

A sample of over 300 sales personnel were asked to individually describe the best sales leader with whom they had ever worked for during your career. Focus groups were then conducted to identify the most critical skills for sales leadership success. A content analysis of the focus group findings were then used to tabulate the key findings in this paper.

Findings

Key findings from this focus group study identified a wide range of critically important leadership skills and behaviors that included: emotional intelligence and 360° communication skills, possessing the ability to effectively coach and develop sales personnel, the ability to create clear performance expectations and accountability, problem-solving and conflict resolution skills, the ability to engage a sales workforce, strategic acumen, character and integrity, and data Mining and analytical skills, among others.

Research limitations/implications

The key findings from this research provide the reader with a host of potentially testable hypotheses as well as ideas and findings for future sales leadership research. 10;This study provides a clear roadmap for sales leaders to develop critically important skill sets needed for improving a sales force's performance and revenue generation capabilities. 10.

Practical implications

This study provides a clear roadmap for sales leaders to develop critically important skill sets needed for improving a sales force's performance and revenue generation capabilities.

Social implications

The social implications of the study make it clear that great sales leaders take great care of their workforces, develop their people, and demonstrate great character and integrity in the workplace.

Originality/value

This paper will identified nine specific leadership skills and practices required for high performance in this regard. Focus group findings will challenge the readers thinking on several key fronts while at the same time providing them with a punch list of critically important behaviors that can be targeted and developed. This information is important for both individual performers as well as those responsible for sales leadership development in their organizations.
Social performance of the company
Authors: Arfaoui Najla , Hofaidhllaoui Mahrane , Chawla Ginni
Published: October 2019

Purpose

The notion of social performance of the company (SPC) is a fundamental concept of the research on ethics of business and work on company-society relationships. The study raises several debates concerning SPC’s determinants. The purpose of this paper is to provide a framework of SPC along with its social and technological determinants. After identification of the determinants, the authors have searched through a managerial perspective to recognize the effects of these determinants on SPC.

Design/methodology/approach

Content analysis of 18 semi-structured interviews with the HR managers, and statistical analysis of data collected from Managers/HR Managers (n=250) working in private and public sector banks of Tunisia was undertaken. Structural equation modeling (SEM), has been used to test the hypotheses and statistically validate the proposed relationships. Data for the study were collected online.

Findings

Results indicate a strong interrelationship between SPC and its determinants. Such an interrelation aims to enrich the framework of analysis of the SPC by considering the action of social responsibility of the company, organizational commitment and managers’ characteristics on one hand, and human resources information system, the practices of knowledge management, and facilitating conditions for the use of the information and communication technologies on the other.

Originality/value

The study reconciles various perspectives in the SPC literature and presents a comprehensive model of SPC by identifying its determinants – social and technological, which could stimulate the SPC in Tunisian context.
The promise of andragogy, heutagogy and academagogy to enterprise and entrepreneurship education pedagogy
Authors: Jones Colin , Penaluna Kathryn , Penaluna Andy
Published: October 2019

Purpose

The purpose of this paper is to address the recent development of heutagogy in the domain of enterprise and entrepreneurship education (EE). Responding to recent thinking within our domain of education, this paper discusses the origins of heutagogy, its adoption within enterprise and EE and offers suggestions as to the further development of such thinking in this domain.

Design/methodology/approach

This conceptual paper revisits the original thinking that developed the process of heutagogy, or self-determined learning. Revisiting the conceptual foundations of heutagogy, comparing it to andragogy and to the idea of academagogy enables the process of academagogical process knowledge (APK) to be outlined. Through this process, the authors argue it is possible to envisage the real potential value of heutagogy to enterprise and EE.

Findings

In advocating for the development of APK, the authors highlight the importance of six specific knowledge bases; knowledge of self, knowledge of entrepreneurship theories, knowledge of transformational learning approaches, knowledge of authentic assessment processes, knowledge of student engagement and knowledge of how to scholarly lead. The authors argue that the development of scholarship of teaching and learning for enterprise and EE can be advanced through these six knowledge bases.

Practical implications

There are important implications that arise for all enterprise and entrepreneurship educators in the discussions presented here, especially if we consider entrepreneurial approaches within disciplines and interests that anchor the studies, as opposed to more generic approaches found in entrepreneurship courses. Most importantly, that heutagogy must be evaluated alongside the blended contributions of pedagogy, andragogy and academagogy.

Originality/value

This paper advances the readers’ understanding of the potential role of heutagogy in enterprise and EE. In doing so, differing opinions related to the use of heutagogy in the domain have been addressed, and a developmental pathway outlined.