bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Predicting the Need for Surgery of the Opposite Side After Unilateral Evacuation of Bilateral Chronic Subdural Hematomas
Authors: Motiei-Langroudi Rouzbeh , Thomas Ajith J , Ascanio Luis , Alturki Abdulrahman , Papavassiliou Efstathios , Kasper Ekkehard M , Arle Jeffrey , Alterman Ronnie L , Ogilvy Christopher S , Stippler Martina
Published: August 2018

BACKGROUND

Patients with bilateral chronic subdural hematoma (bCSDH) undergo unilateral evacuation for the large or symptomatic side because the contralateral hematoma is either small or asymptomatic. However, the contralateral hematoma may subsequently grow and require evacuation.

OBJECTIVE

To characterize factors that predict contralateral hematoma growth and need for evacuation.

METHODS

A retrospective study on 128 surgically treated bCSDHs.

RESULTS

Fifty-one and 77 were bilaterally and unilaterally evacuated, respectively. Glasgow Coma Scale was lower and midline shift was higher in those evacuated unilaterally compared to those evacuated bilaterally. Hematoma size was a significant determinant of decision for unilateral vs bilateral evacuation. The contralateral side needed evacuation at a later stage in 7 cases (9.1%). There was no significant difference in terms of reoperation rate between those evacuated unilaterally and bilaterally. Greater contralateral hematoma thickness on the first postoperative day computed tomography (CT) and more postoperative midline shift reversal had higher rates of operation in the opposite side. There was no difference between the daily pace of hematoma decrease in the operated and nonoperated sides (0.7% decrease per day vs 0.9% for the operated and nonoperated sides, respectively).

CONCLUSION

Results of this study show that most bCSDHs evacuated unilaterally do not experience growth in the nonoperated side and unilateral evacuation results in hematoma resolution for both sides in most cases. Hematoma thickness on the opposite side on the first postoperative day CT and amount of midline shift reversal after surgery are the most important factors predicting the need for surgery on the opposite side.
Bacteria Associated with Russian Wheat Aphid (Diuraphis noxia) Enhance Aphid Virulence to Wheat
Authors: Luna Emily , van Eck Leon , Campillo Tony , Weinroth Margaret , Metcalf Jessica , Perez-Quintero Alvaro L. , Botha Anna-Maria , Thannhauser Theodore W. , Pappin Darryl , Tisserat Ned A. , Lapitan Nora L. V. , Argueso Cristiana T. , Ode Paul J. , Heck Michelle L. , Leach Jan E.
Published: August 2018

Phenotypic responses to biotic stresses are often studied as the interactions between two species; however, in the phytobiome, these responses frequently result from complex interactions involving several organisms. Here, we show that variation in chlorosis caused by Russian wheat aphid (Diuraphis noxia) feeding is determined, in part, by aphid-associated bacteria. Proteomic analysis of fluids injected into a sterile medium by the aphid during feeding indicate that 99% of the proteins are of bacterial origin. Of these, the greatest proportion are produced by bacteria in the order Enterobacteriales. Bacteria from five genera in four families that have the capacity to produce these proteins were isolated directly from aphids as well as from wheat leaves only after D. noxia feeding. By themselves or in combination, these bacteria were not virulent to wheat, even at high inoculum levels. Metagenomic analysis showed that the same five D. noxia-associated genera dominated the non-Buchnera component of the aphid microbiome, and that representation of these genera was reduced in aphids from colonies established after isolation of newborn nymphs from their mothers prior to feeding (isolated aphids). Isolation or treatment with antibiotics reduced bacterial numbers, and these aphids caused less feeding damage on wheat than non-isolated or non-antibiotic-treated aphids. Our data show that bacterial proteins are a significant component of Russian wheat aphid saliva, that the bacteria producing these proteins are associated with aphids and plants fed upon by aphids, and that these aphid-associated bacteria facilitate aphid virulence to wheat.
Synthetic cementum protein 1–derived peptide regulates mineralization in vitro and promotes bone regeneration in vivo
Authors: Correa Rodrigo , Arenas Jesús , Montoya Gonzalo , Hoz Lía , López Sonia , Salgado Fabiola , Arroyo Rita , Salmeron Nahúm , Romo Enrique , Zeichner-David Margarita , Arzate Higinio
Published: August 2018

The use of recombinant proteins has revolutionized the development of biologic pharmaceuticals; however, they are not free of complications. Some have very high molecular weight, some demonstrate in vivo instability, and the high cost of producing them remains a major problem. On the other hand, it has been shown that peptides derived from active domains keep their biologic activity and can trigger events, such as osteogenesis and bone regeneration. Small peptides are advantageous because of their ease of synthesis and handling and their low immunogenic activity. The purpose of this study was to investigate the functions of a synthetic peptide, cementum protein 1‐peptidel (CEMP‐1‐p1), both in vitro and in vivo. Our results show that CEMP‐1‐p1 significantly enhanced the proliferation and differentiation of human periodontal ligament cells toward a mineralizing‐like phenotype, as evidenced by increasing alkaline phosphatase (ALP)–specific activity and osterix, runt‐related transcription factor (RUNX)‐2, integrin binding sialoprotein, bone morphogenetic protein‐2, osteocalcin, and cementum protein (CEMP)‐1 expression at mRNA and protein levels. In vivo assays performed through standardized critical‐size calvarial defects in rats treated with CEMP‐1‐p1 resulted in newly formed bone after 30 and 60 d. These data demonstrate that CEMP‐1‐p1 is an effective bioactive peptide for bone tissue regeneration. The application of this bioactive peptide may lead to implementing new strategies for the regeneration of bone and other mineralized tissues.—Correa, R., Arenas, J., Montoya, G., Hoz, L., López, S., Salgado, F., Arroyo, R., Salmeron, N., Romo, E., Zeichner‐David, M., Arzate, H. Synthetic cementum protein 1–derived peptide regulates mineralization in vitro and promotes bone regeneration in vivo. FASEB J. 33, 1167–1178 (2019). www.fasebj.org
AMH prevents primordial ovarian follicle loss and fertility alteration in cyclophosphamide‐treated mice
Authors: Sonigo Charlotte , Beau Isabelle , Grynberg Michael , Binart Nadine
Published: August 2018

The follicular ovarian reserve, constituted by primordial follicles (PMFs), is established early in life, then keeps declining regularly along reproductive life. The maintenance of a normal female reproductive function implies the presence of a vast amount of dormant PMFs. This process involves a continuous repression of PMF activation into early growing follicle through the balance between factors activating the initiation of follicular growth, mainly actors of the PI3K signaling pathway, and inhibiting factors such as anti‐Müllerian hormone (AMH). Any disruption of this balance may induce follicle depletion and subsequent infertility. It has been recently proposed that cyclophosphamide (Cy), an alkylating agent commonly used for treating breast cancer, triggers PMF activation, further leading to premature ovarian insufficiency. Preventing chemotherapy‐induced ovarian dysfunction might represent an interesting option for preserving optimal chances of natural or medically assisted conceptions after healing. The aim of the present study was to evaluate, in a model of Cy‐treated pubertal mice, whether AMH administration might restrain PMF depletion. The counting of the total PMF number within mouse ovaries showed that recombinant AMH prevented Cy‐induced PMF loss. Western blot analysis revealed activation of PI3K signaling pathway after Cy administration. After AMH injection, FOXO3A phosphorylation, a main actor of PMF activation, was significantly decreased. Taken together, these results support a protective role of AMH against Cy‐induced follicular loss. We also provide evidence for a possible role of autophagy in the preservation of follicular pool reserve. Therefore, concomitant recombinant AMH administration during chemotherapy might offer a new option for preserving young patients' fertility.—Sonigo, C., Beau, I., Grynberg, M., Binart, N. AMH prevents primordial ovarian follicle loss and fertility alteration in cyclophosphamide‐treated mice. FASEB J. 33, 1278–1287 (2019). www.fasebj.org
Global Health Education at Home: Canadian Medical Students’ Perspectives After Learning Alongside Haitian Peers
Authors: Liauw Samantha Siu Lian , Kuper Ayelet , Noël Geoffroy , Richardson Lisa
Published: August 2018

Purpose

To explore how host medical students learn from visiting foreign students, by reporting on a global health program that has invited two or three Haitian medical students each year since 2013 to a Canadian medical school for a summer anatomy program.

Method

In 2017, the authors conducted a qualitative descriptive study that collected data through one-on-one, semistructured interviews with 10 Canadian students, who participated in the Université Quisqueya–McGill University collaborative, a bidirectional global health education initiative, 2013–2016. The authors’ critical constructivist thematic analysis, while exploratory, was sensitized by their knowledge of contemporary frameworks of global health competencies, a postcolonial understanding of power relations, and three key concepts (agency, cultural humility, and reflexivity).

Results

The authors found two phenomena related to bidirectional exchange: the nature of the relationship between Canadian and Haitian students, and elements of the learning experience that facilitated transformation and growth. There were three important components to the nature of the relationship between Canadian and Haitian students—reflection on practices and privilege, negotiation of power dynamics, and perception of Haitian students as agents—and three components of the learning experience that facilitated transformation and growth—working in groups, common learning objectives, and informal social gatherings.

Conclusions

Bidirectional programs may have implications for Canadian students’ perception of the agency of international medical learners and may prompt self-reflection that manifests in a range of ways, including an experience of culture shock at home. These tensions seemed to create space to practice reflexivity and cultural humility.
Governance of Academic Health Centers and Systems: A Conceptual Framework for Analysis
Authors: Pellegrini Vincent D. , Guzick David S. , Wilson Donald E. , Evarts C. McCollister
Published: August 2018

Health care has evolved from a cottage industry to a very complex one constituting nearly one-fifth of the U.S. economy. Large aggregated health care systems have evolved primarily for the purpose of optimizing financial performance by capturing greater market share and taking advantage of economies of scale in care delivery. With the noble intent of providing a broader base of support for the academic mission, academic health centers (AHCs) have followed suit by partnering with community hospitals and organizations with variable prior experience in the education and research arenas. Such a strategy makes good business sense, but it creates challenges for the academic mission. Singular emphasis on physicians’ clinical productivity enhances financial margin but often reduces faculty time and effort dedicated to the academic mission. While individual AHC governance is varied, the leadership structure of large aggregated health systems built around an AHC is even more complex and heterogeneous. Yet, to ensure the prosperity of the academic mission, the governance structure of such health care systems is of critical importance. Preservation of academic oversight of the faculty practice plan, a unifying central focal point of organizational decision making, and genuine physician leadership are three overarching governance characteristics that strengthen the prosperity of the academic mission within large aggregated health systems. Despite the heterogeneous nature of academic health system governance, these critical components of organizational leadership structure facilitate support of a robust academic mission. Understanding these principles and objectives of governance is essential for critical faculty engagement in AHC leadership activities.
Choosing Our Own Pathway to Competency-Based Undergraduate Medical Education
Authors: Veale Pamela , Busche Kevin , Touchie Claire , Coderre Sylvain , McLaughlin Kevin
Published: August 2018

After many years in the making, an increasing number of postgraduate medical education (PGME) training programs in North America are now adopting a competency-based medical education (CBME) framework based on entrustable professional activities (EPAs) that, in turn, encompass a larger number of competencies and training milestones. Following the lead of PGME, CBME is now being incorporated into undergraduate medical education (UME) in an attempt to improve integration across the medical education continuum and to facilitate a smooth transition from clerkship to residency by ensuring that all graduates are ready for indirect supervision of required EPAs on day one of residency training. The Association of Faculties of Medicine of Canada recently finalized its list of 12 EPAs, which closely parallels the list of 13 EPAs published earlier by the Association of American Medical Colleges, and defines the “core” EPAs that are an expectation of all medical school graduates.

In this article, the authors focus on important, practical considerations for the transition to CBME that they feel have not been adequately addressed in the existing literature. They suggest that the transition to CBME should not threaten diversity in UME or require a major curricular upheaval. However, each UME program must make important decisions that will define its version of CBME, including which terminology to use when describing the construct being evaluated, which rating tools and raters to include in the assessment program, and how to make promotion decisions based on all of the available data on EPAs.
Professional Responsibilities and Personal Impacts: Residents’ Experiences as Participants in Education Research
Authors: Devine Luke A. , Ginsburg Shiphra , Stenfors Terese , Cil Tulin D. , McDonald-Blumer Heather , Walsh Catharine M. , Stroud Lynfa
Published: August 2018

Purpose

Although the field of medical education research is growing and residents are increasingly recruited to participate as subjects in research studies, little is known about their experiences. The goal of this study was to explore the experiences and perceptions of residents who are study participants in medical education research.

Method

A phenomenographic approach was chosen to examine the range of residents’ experiences as research participants. A maximum variation sampling strategy was used to identify residents with diverse experiences. Semistructured interviews that explored experiences as research participants were conducted with 19 residents in internal medicine, general surgery, and pediatrics at the University of Toronto in 2015–2016.

Results

The perceptions and experiences of participants fell into two categories. First, participation was seen as a professional responsibility to advance the profession, including a desire to improve future educational practices and a sense of responsibility to contribute to the academic cause. Second, the experience was noted for its personal impact, including benefits (e.g., receiving monetary incentives or novel educational experiences) and risks (e.g., coercion and breaches of confidentiality). The time required to participate in a study was identified as one of the most important factors affecting willingness to participate and the impact of participation.

Conclusions

Being a participant in medical education research can be perceived in different ways. Understanding the view of resident participants is important to optimize potential benefits and minimize risks and negative consequences for them, thus fostering ready participation and high-quality research.
Ethical Shades of Gray: International Frequency of Scientific Misconduct and Questionable Research Practices in Health Professions Education
Authors: Artino Anthony R. , Driessen Erik W. , Maggio Lauren A.
Published: August 2018

Purpose

To maintain scientific integrity and engender public confidence, research must be conducted responsibly. Whereas deliberate scientific misconduct such as data fabrication is clearly unethical, other behaviors—often referred to as questionable research practices (QRPs)—exploit the ethical shades of gray that color acceptable practice. This study aimed to measure the frequency of self-reported misconduct and QRPs in a diverse, international sample of health professions education (HPE) researchers.

Method

In 2017, the authors conducted an anonymous, cross-sectional survey study. The web-based survey contained 43 items that asked respondents to rate how often they had engaged in a variety of irresponsible research behaviors. The items were adapted from previously published surveys.

Results

In total, 590 HPE researchers took the survey. The mean age was 46 years (SD = 11.6), and the majority of participants were from the United States (26.4%), Europe (23.2%), and Canada (15.3%). The three most frequently reported irresponsible research behaviors were adding authors who did not qualify for authorship (60.6%), citing articles that were not read (49.5%), and selectively citing papers to please editors or reviewers (49.4%). Additionally, respondents reported misrepresenting a participant’s words (6.7%), plagiarizing (5.5%), inappropriately modifying results (5.3%), deleting data without disclosure (3.4%), and fabricating data (2.4%). Overall, 533 (90.3%) respondents reported at least one irresponsible behavior.

Conclusions

Notwithstanding the methodological limitations of survey research, these findings indicate that a substantial proportion of HPE researchers report a range of misconduct and QRPs. Consequently, reforms may be needed to improve the conduct of HPE research.
A minimally invasive (sinus tarsi) approach with percutaneous K-wires fixation for intra-articular calcaneal fractures in children
Authors: Tong Lei , Li Mingjing , Li Fan , Xu Jian , Hu Tao
Published: August 2018

The aim of this study was to analyze the management of displaced intra-articular calcaneal fractures in children at our pediatric orthopedic and to determine the results following open reduction via minimally invasive sinus tarsi approach and fixation with Kirschner wires (K-wires). Overall, 25 available cases of calcaneal fractures in children with mean age of 9.8 years were treated by open reduction from January 2010 to December 2015. All patients were followed up from 12 to 30 months (mean: 19 months). Clinical functional outcomes were graded using the American Orthopedic Foot and Ankle Society hindfoot scores. Radiographic evaluation included measurement of the Bohler’s angle and Gissane’s angle of the calcaneus on the lateral view. All fractures healed within 3 months. According to the American Orthopedic Foot and Ankle Society foot scoring system, the mean scores of type II fractures were 92.7±2.1, type III 90.2±1.8, and type IV 89.7±2.7 at the latest follow-up. The preoperative and postoperative Bohler’s angles were 17.1°±10.7° and 35.9°±6.7° in Sanders type II fractures, 14.4°±11.5° and 34.7°±8.5° in type III, 9.3°±9.7° and 35.1°±4.9° in type IV, respectively. The preoperative and postoperative Gissane’s angles were 102.6°±11.5° and 125.7°±7.8° in Sanders type II fractures, 101.7°±9.1° and 117.5°±10.8° (P<0.05) in type III, and 104.7°±5.1° and 122.8°±9.1° (P<0.05) in type IV, respectively. No secondary arthrosis has been observed so far. No deep infection and wound necrosis occurred. One patient had superficial infection around K-wires that was managed using dressings. Treatment of calcaneal fractures in children by open reduction by sinus tarsi approach and K-wires fixation is a safe and effective method with low incidence of complications.
Extracellular Mitochondrial DNA and N-Formyl Peptides in Trauma and Critical Illness: A Systematic Review
Authors: Lubkin David T. , Bishawi Muath , Barbas Andrew S. , Brennan Todd V. , Kirk Allan D.
Published: August 2018

Objectives:

Extracellular mitochondrial DNA and N-formyl peptides released following tissue damage may contribute to systemic inflammation through stimulation of the innate immune system. In this review, we evaluate existing in vivo human data regarding a role for mitochondrial DNA and N-formyl peptides in producing systemic inflammation in trauma and critical illness, investigate the utility of these molecules in risk prediction and clinical decision support, and provide suggestions for standardization of future research.

Data Sources:

PubMed, Embase (1971–2017).

Study Selection:

Studies measuring extracellular mitochondrial DNA and/or N-formyl peptides in acutely ill patients.

Data Extraction:

Fifty-four studies were analyzed. Data extracted included article characteristics, methods, results, and performance in clinical prediction.

Data Synthesis:

The most common patient types investigated were trauma (19 studies) and sepsis (eight). In studies comparing patient mitochondrial DNA or N-formyl peptide levels to healthy controls, 38 (90.5%) reported significantly elevated mitochondrial DNA levels in patients at first reported time point, as did the one study making this comparison for N-formyl peptides. Nine studies (81.8%) reported significantly elevated plasma/serum mitochondrial DNA levels in at least one time point in patients who developed inflammatory complications of their primary pathology compared with patients without inflammatory complications. For the ability of mitochondrial DNA to predict complications or outcomes, the area under the curve was 0.7 or greater in 84.6% of receiver operating characteristic curves, and 92.9% of odds, adjusted odds, risk, and hazard ratios were statistically significant.

Conclusions:

Extracellular mitochondrial DNA levels are elevated early in patients’ hospital courses in many acute illnesses and are higher in patients who develop inflammatory complications. Elevated mitochondrial DNA levels may be clinically useful in risk prediction and clinical decision support systems. Further research is needed to determine the role of extracellular N-formyl peptides in systemic inflammation and their possible clinical utility.
Radiologic Evaluation of Clinically Benign Rectal Neoplasms May Not Be Necessary Before Local Excision
Authors: Lee Lawrence , Arbel Leor , Albert Matthew R. , Atallah Sam B. , Hill James , Monson John R.T.
Published: August 2018

BACKGROUND:

Local excision may be curative for benign and malignant rectal neoplasms. Because many early rectal cancers are discovered incidentally after local excision of clinically benign lesions, it is unclear whether preoperative imaging with transrectal ultrasound or MRI affects management.

OBJECTIVE:

The purpose of this study was to determine the diagnostic characteristics and effect of preoperative imaging on the incidence of malignancy in benign rectal lesions undergoing local excision.

DESIGN:

Prospective data from 2 institutions were included. Coarsened exact matching created a balanced cohort comparing imaging and no-imaging groups.

SETTING:

The study was conducted at high-volume specialist referral hospitals.

PATIENTS:

Adult patients undergoing local excision via transanal endoscopic surgery between 1997 and 2016 for clinically benign rectal neoplasms were included.

INTERVENTION:

The study intervention included preoperative imaging with transrectal ultrasound and/or MRI.

MAIN OUTCOME MEASURES:

We measured the incidence of malignancy and diagnostic accuracy of preoperative imaging.

RESULTS:

A total of 620 patients were included (272 with preoperative imaging and 348 without). There were 250 patients undergoing transrectal ultrasound, and 24 patients undergoing MRI (2 patients underwent both). Transrectal ultrasound and MRI correctly identified malignant polyps in 50% (11/22) and 44% (8/18). Overall agreement for benign versus malignant polyps between preoperative imaging and final pathology was κ = 0.30 (95% CI, 0.18–0.41) for transrectal ultrasound and 0.29 (95% CI, 0.01–0.57) for MRI. In both the overall and unmatched cohorts, the incidence of malignancy, margin involvement, and proportion of patients requiring salvage surgery was similar.

LIMITATIONS:

Data were obtained from 2 institutions with different equipment over a long time period.

CONCLUSIONS:

Preoperative imaging did not accurately identify malignancy in clinically benign rectal lesions and did not affect the incidence of malignancy, margin involvement, or proportion of patients requiring salvage surgery. Therefore, preoperative imaging may not be necessary for clinically benign lesions undergoing local excision. See Video Abstract at http://links.lww.com/DCR/A695.
The Comfort Theory as a Theoretical Framework Applied to a Clinical Case of Hospital at Home
Authors: Puchi Carolina , Paravic-Klijn Tatiana , Salazar Alide
Published: August 2018

The comfort theory was applied in the development of a nursing process for the clinical case of an older adult with pneumonia treated under hospital at home. It was observed that the theory is easy to apply in the domiciliary context and that it allows the implementation of a holistic care plan.
Do-Not-Resuscitate in Iranian Muslim Families
Authors: Bahramnezhad Fatemeh , Cheraghi Mohammad Ali , Mehrdad Neda
Published: August 2018

Families of patients who are dying have a key role in decisions regarding do-not-resuscitate orders. The objective of this study was to explore the aspects and characteristics of this decision by the families of Muslim patients with cancer. This study is a conventional content analysis. Eighteen families who met the inclusion criteria participated in this study and were selected by purposive sampling. Data collection was done by a semistructured interview (each interview was 60-110 minutes). The data analysis was performed using content analysis. The data analysis introduced 4 main categories and 8 subcategories: (a) feeling duality (“sacrifice against selfishness,” and “logic against emotion”), (b) religious beliefs (“guilt” and “miracle”), (c) stigmatized (“purgatory talk” and “family rejection”) and (d) decision-making mediators (“religious clergymen” and “the application of the deceased”). Maybe, since the effect of religion in Iran is more significant than other elements such as ethnicity and law, it is possible to receive help from clergymen. It seems necessary for Iran's Ministry of Health and Medical Education to plan clinical guidelines in this context.
A Rare Case of Malbranchea Species Pulmonary Infection in the Setting of Suspected Selective Immunoglobulin M Deficiency
Authors: Espinosa Ronald F. , Pyun John , Modena Brian D. , Crum-Cianflone Nancy
Published: August 2018

Humoral immunodeficiencies are traditionally associated with prolonged and recurrent respiratory tract infections, including unusual pathogens. We describe a case of a 63-year-old man with a history of chronic obstructive pulmonary disease and recurrent pneumonias (including Pseudomonas) who presented with cough, dyspnea, and respiratory failure with computed tomography imaging showing bilateral consolidations and cavitary lesions. The bronchoalveolar lavage fungal culture grew Malbranchea species, whereas viral, bacterial, and mycobacterial cultures were negative. Because of multiple hospitalizations for pneumonia and the presence of this unusual pathogen, quantitative immunoglobulin levels were obtained, revealing an undetectable total immunoglobulin M (IgM) level (<5 mg/dL) with normal levels of IgG (1270 mg/dL) and IgA (108 mg/dL). Complete blood count with differential and lymphocyte subsets (ie, CD4, CD8) showed no deficiency in immune cell counts, and human immunodeficiency virus antibody/antigen testing was negative. The patient improved clinically after antifungal therapy with posaconazole, and he additionally received prophylactic inhaled tobramycin given his history of recurrent pulmonary infections and suspected selective IgM deficiency.
Population Pharmacokinetic-Pharmacodynamic Modeling of a Novel Methylphenidate Extended-Release Orally Disintegrating Tablet in Pediatric Patients With Attention-Deficit/Hyperactivity Disorder
Authors: Teuscher Nathan S. , Sikes Carolyn R. , McMahen Russ , Engelking Dorothy
Published: August 2018

Purpose/Background

A methylphenidate (MPH) extended-release orally disintegrating tablet (MPH XR-ODT) formulation was recently approved for attention-deficit/hyperactivity disorder treatment in children 6 to 17 years of age. This analysis sought to develop a population pharmacokinetic (PK)/pharmacodynamic (PD) model to describe MPH XR-ODT PD-response data in a classroom study and use the model to simulate PD responses for a range of body weights and doses.

Methods/Procedures

The MPH XR-ODT PK/PD model was developed with pediatric and adult PK data from prior studies and efficacy data from a laboratory classroom study in children with attention-deficit/hyperactivity disorder. In these studies, the safety profile of MPH XR-ODT was consistent with other extended-release MPH formulations. The PK/PD model efficacy end point was the Swanson, Kotkin, Agler, M-Flynn, and Pelham Scale Combined score. Body weight effects on MPH clearance and volume of distribution were included in the resulting model. Simulations using the PK/PD model were performed for patients with body weights between 7 and 100 kg and MPH XR-ODT doses of 10 to 60 mg MPH hydrochloride equivalents.

Findings/Results

In the PK/PD model, the maximal reduction in the Swanson, Kotkin, Agler, M-Flynn, and Pelham Scale Combined score was approximately 38 units, and the MPH concentration required to achieve 50% of the maximal reduction was 14.24 ng/mL, suggesting favorable efficacy for MPH XR-ODT. Simulations showed a direct correlation between the effective MPH XR-ODT dose and body weight, with heavier participants requiring higher doses for symptom control.

Implications/Conclusion

This model may help facilitate the dose-titration process by identifying an effective MPH XR-ODT target dose.
Quality-of-Life in Achilles Tendinopathy: An Exploratory Study
Authors: Ceravolo Michael L. , Gaida James E. , Keegan Richard J.
Published: August 2018

Objective:

This research aimed to explore the quality-of-life and experiences of people with Achilles tendinopathy.

Design:

This mixed-methods research used the 8-dimension Assessment of Quality-of-Life (AQoL-8D), focus groups and grounded theory analysis. AQoL-8D scores were compared with population normative scores. In focus groups, participants discussed their experiences with Achilles tendinopathy.

Setting:

An online survey was completed, followed by focus groups and interviews held at the University of Canberra.

Participants:

Adults with Achilles tendon pain were eligible to participate in the online survey, which was distributed through email and social media.

Results:

Complete survey responses were obtained from 92 individuals, and 11 individuals participated in focus groups and interviews. AQoL-8D scores were significantly lower in those with Achilles tendinopathy (79 ± 11 vs 81 ± 13). AQoL-8Ds of mental health, pain, senses, and the physical “super dimension” were also significantly lower. The difference exceeded the AQoL-8D minimum clinically important difference of 6% only for the pain dimension. Themes identified included adapting lifestyles, living with the condition, changes in mental and social well-being, conflict with identity, frustration, and individual experiences.

Conclusions:

Achilles tendinopathy is associated with a lower quality-of-life score, but on average, the difference does not exceed the minimum clinically important difference. In focus groups, some individuals described profound impacts on their life. This discrepancy likely reflects the variability of the impact across individuals. For some people, the effect is minimal, yet for those who tie their identity and social activities to fitness and physical activity, the effect can be profound.
Health care providers' perceptions regarding fundamental issues to consider prior to launching nurse practitioner training in Tanzania
Authors: Mboineki Joanes Faustine , Changying Chen , Zhang Weihong
Published: August 2018

Background and purpose:

Although the demand for competent health care professionals and better services is high, studies concerning nursing education are not a priority in sub-Saharan African countries, as revealed in limited available records. Strengthening nursing education by establishing proper training models for newly developed advanced practice roles such as “nurse practitioner” (NP) will increase competency in nurses and reduce the shortage of skilled staff within the health care system, thereby enhancing the proper provision of health care services. The main purpose of this research was to investigate fundamental issues that should be considered in the launching of NP training.

Methods:

A descriptive qualitative design was used in this study. A nonprobability sampling approach and significantly purposeful sampling were also used to recruit 20 health care providers into the study. Individual face-to-face interviews were conducted on scheduled timings, which required an average of 30 minutes for each interview. Finally, a content analysis was used to identify the themes.

Conclusion:

The current working environment at the rural primary health care facilities is not convenient for the practices of NPs trained at the master's level. Therefore, before the training of NPs, the government and all stakeholders should strive to improve the environment of the facilities including adequate diagnostic equipment and on-time supply of drugs from the store. Institutions aiming to introduce programs for NPs must develop their curriculum based on currently available local and international guidelines.

Implications for practice:

Adequate preparation before launching an NP training program will be needed to help build a strong training and hence produce competent professionals.
The SLC26A4 c.706C>G (p.Leu236Val) Variant is a Frequent Cause of Hearing Impairment in Filipino Cochlear Implantees
Authors: Chiong Charlotte M. , Reyes-Quintos Ma. Rina T. , Yarza Talitha Karisse L. , Tobias-Grasso Celina Ann M. , Acharya Anushree , Leal Suzanne M. , Mohlke Karen L. , Mayol Nanette L. , Cutiongco-de la Paz Eva Maria , Santos-Cortez Regie Lyn P.
Published: August 2018

Hypothesis:

Variants in SLC26A4 are an important cause of congenital hearing impairment in the Philippines.

Background:

Cochlear implantation is a standard rehabilitation option for congenital hearing impairment worldwide, but places a huge cost burden in lower-income countries. The study of risk factors such as genetic variants that may help determine genetic etiology of hearing loss and also predict cochlear implant outcomes is therefore beneficial.

Methods:

DNA samples from 29 GJB2-negative Filipino cochlear implantees were Sanger-sequenced for the coding exons of SLC26A4. Exome sequencing was performed to confirm results.

Results:

Four cochlear implantees with bilaterally enlarged vestibular aqueducts (EVA) were homozygous for the pathogenic SLC26A4 c.706C>G (p.Leu236Val) variant, which has a minor allele frequency of 0.0015 in Filipino controls. In patients with the SLC26A4 variant there was no association between cochlear implant outcome and age at implantation or duration of implant. There was also no association between the occurrence of the SLC26A4 variant and postsurgical audiometric thresholds and parents’ evaluation of aural/oral performance of children (PEACH) scores. On the other hand, the SLC26A4 variant increased presurgical median audiometric thresholds (p = 0.01), particularly at 500 to 2000 Hz.

Conclusion:

The SLC26A4 c.706C>G (p.Leu236Val) variant is a frequent cause of congenital hearing impairment in Filipinos and is associated with bilateral EVA and increased presurgical audiometric thresholds, but does not adversely affect post-implant outcomes.
Hearing Loss Asymmetry due to Chronic Occupational Noise Exposure
Authors: Sturman Cara Jane , Frampton Chris Miles , Ten Cate Wouter J. F.
Published: August 2018

Objective:

To determine whether occupational noise exposure causes symmetrical or asymmetrical hearing loss.

Study Design:

Retrospective Case Series.

Setting:

Otorhinolaryngology Specialist Centre.

Patients:

Seven hundred forty-four reports for occupational noise-induced hearing loss (NIHL) compensation were analyzed. Subjects with at least 40% of their total hearing loss due to occupational NIHL were included. Claimants with any confounding factor that could cause asymmetric hearing loss such as history of shooting, head, or ear trauma were excluded. With the strict inclusion criteria, 83 subjects were included in the study. Claimants with ≥40%, ≥60%, and ≥80% occupational NIHL of their total hearing loss were compared.

Intervention(s):

None.

Main Outcome Measure(s):

The left ear hearing threshold compared with the right ear hearing threshold (dB) at the frequencies 0.5 to 8 kHz.

Results:

In the total group, the left ear hearing threshold was statistically significantly higher compared with the right ear at 3 kHz (2.41 dB). In the subgroups ≥60% and ≥80% occupational NIHL of total hearing loss, the left ear hearing threshold was statistically significant higher compared with the right ear at 3 kHz, respectively, 3.81 dB and 5.53 dB and 4 kHz, respectively, 2.86 dB and 5.53 dB. An asymmetry of more than 10 dB at 3 and 4 kHz was observed in 39% and 30% of the subjects respectively. In these cases, the vast majority had more pronounced hearing loss in the left ear.

Conclusion:

Findings of this study further indicate that the left ear is more susceptible to noise exposure compared with the right ear.
Proposal of a Treatment Strategy for Eosinophilic Otitis Media Based on Middle Ear Condition
Authors: Esu Yoshihiko , Iino Yukiko , Masuda Maria , Kanazawa Hiromi , Yoshida Naohiro
Published: August 2018

Objective:

We classified eosinophilic otitis media (EOM) into three grades (G1–G3) based on the middle ear mucosal thickness and aimed to establish a treatment strategy for EOM based on these pathological categories.

Study Design:

Retrospective cohort study.

Setting:

Tertiary referral center.

Patients:

We evaluated 136 ears of 68 patients (38 women, 30 men; average age, 56.1 yr; range, 32–80 yr) with bilateral EOM, including 14 surgically treated ears.

Interventions:

Diagnostics and treatment.

Main Outcome Measures:

Treatment responses to intratympanic instillation of triamcinolone acetonide (TA) and surgery.

Results:

G1 (mild) cases of EOM responded well to intratympanic TA. G2 (moderate) cases required both TA and systemic glucocorticoids. G3 (severe) cases with granulation were unresponsive to but tolerated the treatment. In 14 ears, granulation tissue was surgically removed and the area was covered with a gelatin sponge containing TA. After the surgery, the severity level of EOM decreased from G3 to G2 in 12 ears, and hearing improved in 4 ears. Three ears showed normalization of the tympanic membrane, and seven ears had less otorrhea. Risk factors for granulation (G3) were the presence of bacterial infection (p = 0.017) and diabetes mellitus (HbA1c of ≥6.5%) (P = 0.039) (odds ratios of 4.55 and 3.95, respectively).

Conclusions:

This study showed that G3 EOM was unresponsive to conservative glucocorticoid treatment and required granulation tissue removal. Classification based on the middle ear pathology is useful for determining the most appropriate and successful treatment for EOM.
Preliminary Study on Antinuclear Antibodies in Patients With Chronic Dilatory Eustachian Tube Dysfunction
Authors: Fuchs Anna , Witte Torsten , Lenarz Thomas , Teschner Magnus
Published: August 2018

Background and Hypothesis:

There are some known reasons for chronic dilatory Eustachian tube dysfunction (chronic D-ETD, also known as chronic obstructive tube dysfunction), for example infections, hyperplastic adenoids, or tumors. In many cases though, none of these reasons apply. The question arises whether there might be an autoimmune pathogenesis in patients with idiopathic chronic D-ETD.

Methods:

The study includes 31 consecutive patients with chronic D-ETD and 92 consecutive blood donors (BD, comparative cohort). The production of antinuclear antibodies (ANA), as an indicator for autoimmune pathologies, was measured in the serum of patients and BD.

Results:

ANA titers were significantly higher in patients with chronic D-ETD, compared with BD (p = 0.0027). The results weighted clearly toward higher ANA titers in younger patients. A comparison of ANA titers in patients and BD aged less than 40 years showed a significant difference (p = 0.0062), whereas it was not significant between patients and BD aged ≥ 40 years (p = 0.19).

Conclusion:

The significant results of elevated ANA titers in chronic D-ETD make an autoimmune pathogenesis highly probable, at least in some of the patients concerned. Further research with higher numbers of patients is needed to confirm the hypothesis of an autoimmune chronic D-ETD. A better understanding of etiology and pathogenesis of chronic D-ETD might open up new and perhaps even causal therapeutic strategies.
Pancreatic Cancer–Induced Cachexia and Relevant Mouse Models
Authors: Henderson Sally E. , Makhijani Neil , Mace Thomas A.
Published: August 2018

Pancreatic cancer is the third leading cause of cancer death in the United States, with projections that it will become the second leading cause by the year 2030. It carries a dismal prognosis with a 5-year overall survival rate of less than 9% and is associated with numerous comorbidities, the most notable being cachexia. Defined as the loss of muscle mass not reversible by conventional nutritional support, cachexia is seen in over 85% of pancreatic cancer patients and contributes significantly to mortality, where nearly 30% of pancreatic cancer deaths are due to cachexia rather than tumor burden. Therefore, there is an urgent need to identify the mechanisms behind the development of muscle wasting in pancreatic cancer patients and design novel therapeutics targeting cachexia. This review highlights the current understanding surrounding the mechanisms underpinning the development of cachexia in pancreatic cancer, as well as the current mouse models of pancreatic cancer–induced muscle wasting described in the literature.
Contribution of Oral Hygiene and Cosmetics on Contamination of Gluten‐free Diet
Authors: Verma Anil K. , Lionetti Elena , Gatti Simona , Franceschini Elisa , Catassi Giulia Naspi , Catassi Carlo
Published: August 2018

Objectives:

The only available treatment for celiac disease (CD) is the gluten‐free diet. It is unclear whether the presence of gluten in oral hygiene products and cosmetics that are applied on the mouth is a reason of concern for CD patients. The aim of this study was to test the level of gluten contamination in oral hygiene and cosmetic products available in the Italian market.

Methods:

A total of 66 products (toothpastes = 37; dental tablets = 2; mouthwashes = 5; lip‐balms = 10; lipsticks = 12) labelled gluten‐free or with unknown gluten content were randomly collected from different supermarkets and pharmacies. The gluten quantification was determined by the R5 ELISA method approved by EU regulations.

Results:

Out of 66 oral hygiene and cosmetics, 62 products (94%) were found to be gluten‐free (gluten level <20 ppm), while 4 (6%) (toothpastes = 3; lipsticks = 1) showed a gluten level >20 ppm (toothpastes: 20.7, 31.4, and 35 ppm; lipstick: 27.4 ppm). None of the selected products had ingredient derived from wheat, barley, or rye.

Conclusions:

Gluten contamination is currently not an issue in a wide array of cosmetic and oral hygiene products that are commonly in the market.
Effectiveness of robot-assisted gait training on motor impairments in people with Parkinson’s disease: a systematic review and meta-analysis
Authors: Alwardat Mohammad , Etoom Mohammad , Al Dajah Salameh , Schirinzi Tommaso , Di Lazzaro Giulia , Sinibaldi Salimei Paola , Biagio Mercuri Nicola , Pisani Antonio
Published: August 2018

The aim of this systematic review and meta-analysis was to evaluate the effectiveness of robot-assisted gait training (RAGT) on motor impairments in people with Parkinson’s disease (PD). A computer-based systematic literature search was performed in six databases according to PRISMA guidelines. Randomized controlled trials (RCTs) that assessed the effects of RAGT on motor impairments in people with PD were included. GRADE approach and PEDro scale were used to determine the studies’ quality of evidence. Meta-analyses were performed by calculating the weighted mean difference (WMD) at 95% confidence interval. Seven RCTs (PEDro: 5–8) met the inclusion criteria for systematic review and meta-analyses. The meta-analysis showed significant improvement on Unified Parkinson Disease Rating Scale Part III after intervention [WMD=3.292; 95% confidence interval (CI)=1.378–5.207; P=0.000], and after 1-month follow-up (WMD=5.512; 95% CI=2.396–8.629; P=0.001). Stride length (WMD=9.283; 95% CI=7.153–11.414; P=0.00) and gait speed (WMD=0.166; 95% CI=−0.090 to 0.243; P=0.000) showed significant improvements after RAGT. Balance as measured by Berg Balance Scale was improved significantly after intervention (WMD=3.87; 95% CI=0.374–6.735; P=0.029) and at 1-month follow-up (WMD=3.87; 95% CI=1.324–6.413; P=0.002). The pooled analysis did not detect any significant changes regarding stride time, cadence and functional balance scales. GRADE level of evidence ranged between high and low. The RAGT showed better outcomes than conventional interventions on some motor aspects in PD. However, RAGT did not seem superior to control interventions. Further RCTs that examine the effect of RAGT on more specific outcomes and at different medication statuses are required.
The Smart Nutrition and Conditioning for Kids (SNACK) Program
Authors: Jakubowski Tami L. , Perron Tracy , Farrell Anne , Kenner Carole , Hullings Christy
Published: August 2018

Background:

The Smart Nutrition and Conditioning for Kids (SNACK) program was developed in response to the 2010 Childhood Obesity Study (Rutgers Center for State Health Policy, 2010) recognizing a 49% childhood obesity rate in Trenton New Jersey. Lifestyle influences contributing to childhood obesity and Type 2 diabetes mellitus include poor food choices, inadequate access to healthy foods, decrease in physical activity, and insufficient access to safe play environments.

Methods:

Second-grade students were selected by teachers to be in the SNACK intervention group or a control group based on their classroom assignment. The SNACK program integrated nutrition lessons to students in an urban and urban rim elementary school during regularly scheduled physical education class. Nutrition lesson plans were developed to educate the children on healthy eating in a fun, interactive manner. The SNACK intervention was performed twice a week for 8 weeks. Pre- and poststudy CATCH (CATCH [Coordinated Approach to Child Health] Global Foundation, 2017) Nutritional Knowledge surveys were completed by all of the participating children.

Results:

Students who were offered the nutrition-based lessons (SNACK intervention group) performed better on their Healthy Choices survey (p < 0.05), but not the Nutritional Knowledge survey (p = 0.87), when compared with control group students.

Conclusion:

Results suggest that the SNACK program was a partial success and is one example of an interdisciplinary approach to early intervention that can teach young children how to choose healthy foods.