bluuebunny/crossref_metadata_2025 huggingface dataset:
Synbiotics impact on dominant faecal microbiota and short-chain fatty acids production in sows
Authors: Śliżewska Katarzyna , Chlebicz Agnieszka
Published: July 2019

The aim of this study was to estimate the influence of synbiotics on intestinal microbiota and its metabolism in sows. Three different synbiotics were administered with feed to animals from three experimental groups. Two groups of sows were given commercially available probiotics (BioPlus 2B®, Cylactin® LBC) as forage additives for comparison. The control group of sows was given unmodified fodder. The study was conducted for 48 days (10 days before farrowing, and continued 38 days after) and faeces samples were collected four times. The scope of this work was to designate the dominant microbiota in sows’ faeces. Therefore, the total number of anaerobic bacteria, Bifidobacterium sp., Lactobacillus sp., Bacteroides sp., Clostridium sp., Enterococcus sp., Enterobacteriaceae, Escherichia coli and yeast was determined, using the plate method. Changes in the concentration of lactic acid, short-chain fatty acids (SCFAs) and branched-chain fatty acids (BCFAs) were also determined in correlation with the feed additives administered to the sows using high-performance liquid chromatography analysis (HPLC). Our results allowed us to conclude that synbiotics have a beneficial effect on intestinal microbiota of sows and its metabolism. We observed that the impact of the synbiotics on the microbiota was more significant than the one induced by probiotics.
Survivors of Ebola Virus Disease Develop Polyfunctional Antibody Responses
Authors: Gunn Bronwyn M , Roy Vicky , Karim Marcus M , Hartnett Jessica N , Suscovich Todd J , Goba Augustine , Momoh Mambu , Sandi John Demby , Kanneh Lansana , Andersen Kristian G , Shaffer Jeffrey G , Schieffelin John S , Garry Robert F , Grant Donald S , Alter Galit
Published: July 2019

Monoclonal antibodies can mediate protection against Ebola virus (EBOV) infection through direct neutralization as well as through the recruitment of innate immune effector functions. However, the antibody functional response following survival of acute EBOV disease has not been well characterized. In this study, serum antibodies from Ebola virus disease (EVD) survivors from Sierra Leone were profiled to capture variation in overall subclass/isotype abundance, neutralizing activity, and innate immune effector functions. Antibodies from EVD survivors exhibited robust innate immune effector functions, mediated primarily by IgG1 and IgA1. In conclusion, development of functional antibodies follows survival of acute EVD.
Development of a Humanized Murine Model for the Study of Oxalobacter formigenes Intestinal Colonization
Authors: Pebenito Amanda M , Liu Menghan , Nazzal Lama , Blaser Martin J
Published: July 2019

Background

Oxalobacter formigenes are bacteria that colonize the human gut and degrade oxalate, a component of most kidney stones. Findings of clinical and epidemiological studies suggest that O. formigenes colonization reduces the risk for kidney stones. We sought to develop murine models to allow investigating O. formigenes in the context of its native human microbiome.

Methods

For humanization, we transplanted pooled feces from healthy, noncolonized human donors supplemented with a human O. formigenes strain into recipient mice. We transplanted microbiota into mice that were treated with broad-spectrum antibiotics to suppress their native microbiome, were germ free, or received humanization without pretreatment or received sham gavage (controls).

Results

All humanized mice were stably colonized with O. formigenes through 8 weeks after gavage, whereas mice receiving sham gavage remained uncolonized (P < .001). Humanization significantly changed the murine intestinal microbial community structure (P < .001), with humanized germ-free and antibiotic-treated groups overlapping in β-diversity. Both germ-free and antibiotic-treated mice had significantly increased numbers of human species compared with sham-gavaged mice (P < .001).

Conclusions

Transplanting mice with human feces and O. formigenes introduced new microbial populations resembling the human microbiome, with stable O. formigenes colonization; such models can define optimal O. formigenes strains to facilitate clinical trials.
How Government Agencies React to Termination Threats
Authors: Askim Jostein , Blom-Hansen Jens , Houlberg Kurt , Serritzlew Søren
Published: July 2019

Much research following Kaufman’s classic study Are Government Organizations Immortal? has investigated the claim that government agencies enjoy great security and long life. Less attention has been paid to Kaufman’s thesis that government agencies facing a termination threat have strong incentives to react. In a study of the on-going Norwegian local government amalgamation reform, we demonstrate that this type of government agency reacts by hoarding (i.e., a last-minute flurry of spending) when faced with a termination threat. This finding shows that agencies facing termination threats are active players in the termination game. We discuss implications for research on agency termination and design implications for reformers of the public sector.
Alvesian Theopoetics, the Academy, and What May Come
Authors: Keefe-Perry L Callid
Published: July 2019

This article explores a significant stream of theopoetics largely informed by Rubem Alves and the work of ARC: Arts | Religion | Culture. It considers some of the features that differentiate theopoetic engagement from the scholarship of ‘Theology and The Arts’ and reflects on the relationship between theopoetics and the academy more broadly. It also grapples with the impact of coloniality on theopoetics and the ways in which this may have influenced the aversion to ideas like ‘rationalism’ and ‘objectivity’ in the Alvesian stream.
The migration decision process among returnees: Assessing the risks and benefits in contemporary Mexico–US migration
Authors: Chávez Sergio , Altman Claire E. , Gorman Bridget K.
Published: July 2019

This article investigates how return migrants assess the risks and benefits of migrating internationally by drawing on their previous migration experiences. We draw on data collected in a small city in Guanajuato, Mexico that contains in-depth interviews with 49 participants and 480 surveys on migration and health outcomes for return migrants and nonmigrants. This manuscript contributes to the literature by focusing on how return migrants, who previously worked in the USA without legal authorization, assess the risks and benefits in the migration decision process. Our article contributes to the substantive and theoretical migration literature by taking into consideration how the accumulation of migration and labor market experience may shape intentions and behaviors among returnees. Our findings highlight the broad array of factors that migrants consider including the dangers of crossing the border, hazardous working conditions, and prolonged family separation. Though the risks associated with unauthorized migration to the USA have escalated in recent years, some return migrants in our sample plan to migrate again to the USA. Respondents report wanting to return to the USA because of the perceived availability of jobs through social networks that provide access to higher wages and improvements to lifestyle and work experiences when compared to their current socioeconomic situation. Therefore, we argue that prior US experience provides migrants with a new frame of reference which they use to compare their lives upon returning to Mexico—and which likely informs their future desires to remigrate to the USA.
Risk factors for childhood and adult primary brain tumors
Authors: Ostrom Quinn T , Fahmideh Maral Adel , Cote David J , Muskens Ivo S , Schraw Jeremy M , Scheurer Michael E , Bondy Melissa L
Published: July 2019

Primary brain tumors account for ~1% of new cancer cases and ~2% of cancer deaths in the United States; however, they are the most commonly occurring solid tumors in children. These tumors are very heterogeneous and can be broadly classified into malignant and benign (or non-malignant), and specific histologies vary in frequency by age, sex, and race/ethnicity. Epidemiological studies have explored numerous potential risk factors, and thus far the only validated associations for brain tumors are ionizing radiation (which increases risk in both adults and children) and history of allergies (which decreases risk in adults). Studies of genetic risk factors have identified 32 germline variants associated with increased risk for these tumors in adults (25 in glioma, 2 in meningioma, 3 in pituitary adenoma, and 2 in primary CNS lymphoma), and further studies are currently under way for other histologic subtypes, as well as for various childhood brain tumors. While identifying risk factors for these tumors is difficult due to their rarity, many existing datasets can be leveraged for future discoveries in multi-institutional collaborations. Many institutions are continuing to develop large clinical databases including pre-diagnostic risk factor data, and developments in molecular characterization of tumor subtypes continue to allow for investigation of more refined phenotypes.

Key Point

1. Brain tumors are a heterogeneous group of tumors that vary significantly in incidence by age, sex, and race/ethnicity.2. The only well-validated risk factors for brain tumors are ionizing radiation (which increases risk in adults and children) and history of allergies (which decreases risk).3. Genome-wide association studies have identified 32 histology-specific inherited genetic variants associated with increased risk of these tumors.
CDKN2A homozygous deletion is a strong adverse prognosis factor in diffuse malignant IDH-mutant gliomas
Authors: Appay Romain , Dehais Caroline , Maurage Claude-Alain , Alentorn Agusti , Carpentier Catherine , Colin Carole , Ducray François , Escande Fabienne , Idbaih Ahmed , Kamoun Aurélie , Marie Yannick , Mokhtari Karima , Tabouret Emeline , Trabelsi Nesrine , Uro-Coste Emmanuelle , Delattre Jean-Yves , Figarella-Branger Dominique ,   POLA Network
Published: July 2019

Background

The 2016 WHO classification of the central nervous system tumors stratifies IDH-mutant gliomas into two major groups depending on the presence or absence of 1p/19q-codeletion. However, the grading system remains unchanged and it is now controversial whether it can be still applied to this updated molecular classification.

Methods

In a large cohort of 911 high grade IDH-mutant gliomas from the French national POLA network (including 428 IDH-mutant gliomas without 1p/19q-codeletion and 483 anaplastic oligodendrogliomas, IDH-mutant and 1p/19q-codeleted), we investigated the prognostic value of CDKN2A gene homozygous deletion as well as WHO grading criteria (mitoses, microvascular proliferation and necrosis). In addition, we also searched for other retinoblastoma pathway gene alterations (CDK4 amplification and RB1 homozygous deletion) in a subset of patients. CDKN2A homozygous deletion was also searched in an independent series of 40 grade II IDH-mutant gliomas.

Results

CDKN2A homozygous deletion was associated with dismal outcome among IDH-mutant gliomas lacking 1p/19q-codeletion (p<0.0001 for progression-free survival and p=0.004 for overall survival) as well as among anaplastic oligodendrogliomas, IDH-mutant and 1p/19q-codeleted (p=0.002 for progression-free survival and p<0.0001 for overall survival) in univariate and multivariate analysis including age, extend of surgery, adjuvant treatment, MVP and necrosis. In both groups, the presence of microvascular proliferation (MVP) and/or necrosis remained of prognostic value only in cases lacking CDKN2A homozygous deletion. CDKN2A homozygous deletion was not recorded in grade II gliomas.

Conclusions

Our study pointed out the utmost relevance of CDKN2A homozygous deletion as an adverse prognostic factor in the two broad categories of IDH-mutant gliomas stratified on 1p/19q-codeletion and suggest to refine the grading of these tumors.
Pattern recognition is a sequential process—accurate diagnosis and treatment 20 years after presentation
Authors: Merinopoulos Dimos , Saada Janak , Jones Colin , Mukhtyar Chetan
Published: July 2019

A 25-year-old woman presented with ophthalmic and neurological manifestations. Her ocular manifestations included bilateral uveitis, multifocal retinal phlebitis, vitreitis and multiple retinal haemorrhages. Her neurological manifestations included migrainous headaches with visual aura, transient sensory symptoms and posterior circulation Transient Ischemic Attack (TIA). Magnetic resonance imaging of the brain demonstrated lesions that involved the deep white matter lesions initially and progressed to also involve the juxta cortical white and deep grey matter and brain stem, but without further neurological manifestations. She was sequentially treated with intravenous and oral glucocorticoid, cyclophosphamide and mycophenolate mofetil, but she continued to suffer with persistent episodes of retinal haemorrhages. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), Susac syndrome and Behcet’s disease were considered in the differential diagnosis. Genetic workup and clinical picture were not suggestive of the former two. Further history of oro-genital ulceration in younger age emerged, which pointed strongly towards a diagnosis of Behcet’s disease with neurological involvement. She was treated with infliximab and methotrexate with complete resolution of her symptoms and withdrawal of corticosteroids for the first time in over two decades.
Clinical Characteristics and Therapeutic Results in a Series of 68 Patients with Occipital Neuralgia
Authors: Martínez-Pías Enrique , Trigo-López Javier , García-Azorín David , McGreal Aisling , Peral Ángel Luis Guerrero
Published: July 2019

Objective

Cranial pain is a condition that has a negative impact on human lives, and occipital neuralgia is among its causes. This study aims to evaluate the clinical characteristics and therapeutic results of a series of patients with occipital neuralgia.

Design

Prospective registry (observational study).

Settings

Headache outpatient clinic in a tertiary hospital.

Subjects

Sixty-eight cases.

Methods

Demographic and nosological characteristics have been analyzed, as well as treatment response of occipital neuralgia. All patients were recruited between January 2008 and January 2018, and the diagnosis of occipital neuralgia was made according to the International Headache Society (International Classification of Headache Disorders) criteria being utilized at the time of diagnosis.

Results

Sixty-eight patients were diagnosed with occipital neuralgia, which corresponded to 1.2% of the total number of patients (5,515) who visited our Headache Unit during the aforementioned period. Fifty-four (79.4%) of them were female. Baseline pain was present in 62 (91.1%) patients, and exacerbations in 42 (61.8%). Latency from onset (range) was 27.7 ± 56.1 (1–360) months.

Conclusions

Occipital neuralgia is an uncommon disorder in the sample explored. The prolonged latency between the onset of symptoms and diagnosis suggests that there should be an increased awareness of this disorder.
Firm-Level Political Risk: Measurement and Effects*
Authors: Hassan Tarek A , Hollander Stephan , van Lent Laurence , Tahoun Ahmed
Published: July 2019

We adapt simple tools from computational linguistics to construct a new measure of political risk faced by individual U.S. firms: the share of their quarterly earnings conference calls that they devote to political risks. We validate our measure by showing that it correctly identifies calls containing extensive conversations on risks that are political in nature, that it varies intuitively over time and across sectors, and that it correlates with the firm’s actions and stock market volatility in a manner that is highly indicative of political risk. Firms exposed to political risk retrench hiring and investment and actively lobby and donate to politicians. These results continue to hold after controlling for news about the mean (as opposed to the variance) of political shocks. Interestingly, the vast majority of the variation in our measure is at the firm level rather than at the aggregate or sector level, in the sense that it is captured neither by the interaction of sector and time fixed effects nor by heterogeneous exposure of individual firms to aggregate political risk. The dispersion of this firm-level political risk increases significantly at times with high aggregate political risk. Decomposing our measure of political risk by topic, we find that firms that devote more time to discussing risks associated with a given political topic tend to increase lobbying on that topic, but not on other topics, in the following quarter.
DETERMINING THE DOSE RATE DEPENDENCE OF DIFFERENT ACTIVE PERSONAL DOSEMETERS IN STANDARDIZED PULSED AND CONTINUOUS RADIATION FIELDS
Authors: Hupe Oliver , Friedrich Sabrina , Vanhavere Filip , Brodecki Marcin
Published: July 2019

In 2016, the EURADOS working group 12 started a project to gather reliable data concerning the behavior of active personal dosemeters (APDs) used by European hospitals in standardized pulsed and hospital fields. This paper concentrates on the tests that deal with the dose rate dependence of APDs in laboratory tests. The dependence on the dose rate was determined for 10 dosemeter types with continuous radiation of a 60Co source and pulsed radiation of the reference radiation facility of Physikalisch-Technische Bundesanstalt. Furthermore, irradiations were done with continuous radiation of a 137Cs source of the Karlsruher Institute of Technology and with continuous X-rays of the two radiation qualites in radiation beams emerging from the X-ray source assembly, RQR5 and RQR8, of Nofer Institute of Occupational Medicine. For the first time, APDs have been systematically investigated under laboratory conditions in a pulsed reference fields according to ISO/TS 18090-1 and the experience gained by these test procedures will be included in the new IEC/TS 63050.
Addressing Exclusion in Organizations: Social Desire Paths and Undocumented Students Attending College
Authors: Nichols Laura
Published: July 2019

With data from a national study of a network of 28 private, non-profit colleges in the United States, I show how the individual actions of high school and college staff became collective “social desire paths” to introduce new organizational practices to enroll students who were undocumented. In interviews with staff, four factors emerged as important in enrolling students: (1) the way social desire paths started as ad hoc processes and then were entrenched through the collective and similar responses of staff; (2) identification of financial, administrative, structural, and cultural barriers to inclusion that formed the basis for the development of social desire paths; (3) the way staff innovated paths by reforming current procedures as well as developing new practices; and (4) the role of organizational values in supporting social desire paths. Along with uncovering the processes and practices, I also argue that using a social desire path approach helps researchers and managers detect organizational structures that exclude desired populations, and provides a means by which the actions of “street-level bureaucrats” that become collective can address social problems at the organization level.
As Goes the City? Older Americans’ Home Upkeep in the Aftermath of the Great Recession
Authors: Schafer Markus H , Settels Jason , Upenieks Laura
Published: July 2019

The private home is a crucial site in the aging process, yet the upkeep of this physical space often poses a challenge for community-dwelling older adults. Previous efforts to explain variation in disorderly household conditions have relied on individual-level characteristics, but ecological perspectives propose that home environments are inescapably nested within the dynamic socioeconomic circumstances of surrounding spatial contexts, such as the metro area. We address this ecological embeddedness in the context of the Great Recession, an event in which some U.S. cities saw pronounced and persistent declines across multiple economic indicators while other areas rebounded more rapidly. Panel data (2005–6 and 2010–11) from a national survey of older adults were linked to interviewer home evaluations and city-level economic data. Results from fixed-effects regression support the hypothesis that older adults dwelling in struggling cities experienced an uptick in disorderly household conditions. Findings emphasize the importance of city-specificity when probing effects of a downturn. Observing changes in home upkeep also underscores the myriad ways in which a city’s most vulnerable residents— older adults, in particular—are affected by its economic fortunes.
The Varying Effects of Incarceration, Conviction, and Arrest on Wealth Outcomes among Young Adults
Authors: Maroto Michelle , Sykes Bryan L
Published: July 2019

Previous research indicates that incarceration leads to declines in rates of homeownership and net worth, especially among baby boomers, but questions remain as to how other types of criminal justice system contact affect wealth outcomes during the transition to adulthood. Using data from the 1997 National Longitudinal Survey of Youth, we investigate how arrests, convictions, and incarceration influence net worth, financial assets, and debt among young adults. We find that most contact with the criminal justice system limited the ability of young adults to accumulate wealth between the ages of 25 and 30, an especially important time for building life-cycle wealth. Arrests were associated with asset and debt declines of 52–53 percent, and incarceration led to net worth and asset declines of 34 and 76 percent, respectively. These direct effects were also bolstered by the indirect effects of these variables through their relationship with marriage and earnings, especially in the case of incarceration. This study draws attention to how criminal justice system contact affects early adult wealth, thereby setting the stage to influence a host of life course dynamics for individuals and their families.
What Explains Uneven Female Labor Force Participation Levels and Trends in Developing Countries?
Authors: Klasen Stephan
Published: July 2019

Rapid fertility decline, a strong expansion of female education, and favorable economic conditions should have promoted female labor force participation in developing countries. Yet trends in female labor force participation rates (FLFP) have been quite heterogeneous, rising strongly in Latin America and stagnating in many other regions, while improvements were modest in the Middle East and female participation even fell in South Asia. These trends are inconsistent with secular theories such as the feminization U hypothesis but point to an interplay of initial conditions, economic structure, structural change, and persistent gender norms and values. We find that differences in levels are heavily affected by historical differences in economic structure that circumscribe women's economic opportunities still today. Shocks can bring about drastic changes, with the experience of socialism being the most important shock to women's labor force participation. Trends are heavily affected by how much women's labor force participation depends on their household's economic conditions, how jobs deemed appropriate for more educated women are growing relative to the supply of more educated women, whether growth strategies are promoting female employment, and to what extent women are able to break down occupational barriers within the sectors where women predominantly work.
Validating the Italian Version of the International Skin Tear Advisory Panel Classification System
Authors: Bassola Barbara , Ceci Paolo , Lolli Angela , LeBlanc Kimberly , Lusignani Maura
Published: July 2019

OBJECTIVE

To validate the International Skin Tear Advisory Panel (ISTAP) Classification System in Italian.

METHODS

In collaboration with the ISTAP, the classification system was translated into Italian using a forward-back translation process. To validate the translated system, a convenience sample of 212 health professionals classified 30 photographs of skin tears originally used by ISTAP. The wound images were labeled type 1, 2, or 3 as described by the classification system. The resulting scores were compared with the ISTAP classification, and the reliability of agreement was calculated with Fleiss κ.

RESULTS

Complete data were obtained from 209 healthcare professionals. When the image classifications were compared with the original ISTAP indications, 72.5% of all classifications were correct. Data indicated a moderate level of agreement (Fleiss κ = 0.466, range = 0.41-0.60). Data analysis showed similar agreement levels between nurses (n = 197, Fleiss κ = 0.466) and nonnurses (n = 12, Fleiss κ = 0.46).

CONCLUSIONS

The study validates the Italian version of the ISTAP skin tear classification system. Further studies are necessary to confirm the system’s usability in Italian research and clinical settings.
Clinical Information Needs
Authors: Schlegel Cara S. , Yoder Linda H. , Jones Terry L.
Published: July 2019

Health care organizations have invested resources to implement and upgrade information systems capable of collecting large quantities of data. Recent technology developments have created a renewed interest in studying clinician information needs. However, a common definition and analysis of the concept clinical information needs have not been provided. Walker and Avant's method was used to perform a concept analysis. Following a review of relevant literature, a clinical information need was defined as a conscious expression, which can be verbal or nonverbal, of a desire for knowledge to answer clinical questions in the course of decision making to deliver patient care.
Analysis and Evaluation of Conceptual Model for Health-Related Quality of Life Employing Fawcett and DeSanto-Madeya's Critique Framework
Authors: Jang Min Kyeong , Vincent Catherine
Published: July 2019

Health-related quality of life is increasingly used as a predictor in nursing research and practice because its multidimensional constructs encompass the holistic spectrum of care. This article comprehensively analyzes and evaluates the conceptual model of health-related quality of life of Ferrans and colleagues using Fawcett and Desanto-Madeya's 2013 framework. The model encompasses all relevant concepts and propositions in its theoretical foundation while maintaining consistency with the nursing metaparadigm. Also, the model has comprehensive content, appropriate context, and social and theoretical significance. To maximize the model's empirical and pragmatic adequacy, researchers should carefully define the variables associated with each concept.
Factors That Influence Health-Promoting Self-care in Registered Nurses
Authors: Ross Alyson , Touchton-Leonard Katharine , Perez Avery , Wehrlen Leslie , Kazmi Narjis , Gibbons Susanne
Published: July 2019

Nurses are instrumental in the battle against lifestyle-related diseases, yet nurses may not be participating in their own health-promoting self-care. This study used qualitative content analysis of survey responses to explore nurses' perceptions regarding barriers and facilitators to health-promoting behaviors such as exercise, healthy eating, and participation in stress reduction activities. Seven themes emerged: lack of time/overwork, lack of resources/facilities, fatigue, outside commitments, “unhealthy” food culture, supportive versus unsupportive individuals, and positive versus negative role models. Institutional, interpersonal, and intrapersonal changes are needed to adequately address barriers to nurses' participation in health-promoting behaviors.
Toward a System Theory of Stress, Resilience, and Reintegration
Authors: Etchin Anna G. , Fonda Jennifer R. , McGlinchey Regina E. , Howard Elizabeth P.
Published: July 2019

Military to civilian reintegration is a complex, multidimensional phenomenon warranting holistic perspectives. Complex phenomena require theory to understand and interpret relationships among concepts. Despite the need for theory-driven research, recent nursing reports often lack a theoretical structure. We extracted relevant concepts from the Neuman's Systems Model (stressors, environment, and person) and the Transactional Model of Stress and Coping (primary and secondary appraisal, coping, and adaptation) to form a Conceptual-Theoretical-Empirical model. Exemplar empirical instruments are presented, along with their conceptual and theoretical dimensions. An integrated System Theory of Stress, Resilience, and Reintegration is presented with its utility demonstrated through a research application.
Estimated Effects of Early Diuretic Use in Critical Illness
Authors: McCoy Ian E. , Montez-Rath Maria E. , Chertow Glenn M. , Chang Tara I.
Published: July 2019

Objectives:

To estimate the effects of diuretic use during the first 24 hours of an ICU stay on in-hospital mortality and other clinical outcomes including acute kidney injury and duration of mechanical ventilation.

Design:

Retrospective cohort study.

Setting:

Urban, academic medical center.

Patients:

Adult patients admitted to medical or cardiac ICUs between 2001 and 2012, excluding those on maintenance dialysis or with ICU length of stay less than 24 hours.

Interventions:

None.

Measurements and Main Results:

We included 13,589 patients: 2,606 with and 10,983 without early diuretic use (loop diuretic exposure during the first 24 hr of an ICU stay). Propensity score matching generated 2,523 pairs with well-balanced baseline characteristics. Early diuretic use was unassociated with in-hospital mortality (risk ratio, 1.01; 99.5% CI, 0.83–1.22). We found no evidence of associations with ICU or hospital length of stay, or duration or provision of mechanical ventilation. Early diuretic use was associated with higher rates of subsequent acute kidney injury (risk ratio, 1.41; 99.5% CI, 1.25–1.59) and electrolyte abnormalities. Results were not materially different in subgroups of patients with heart failure, chronic kidney disease, or acute lung injury.

Conclusions:

Early diuretic use in critical illness was unassociated with in-hospital mortality, ICU or hospital length of stay, or duration of mechanical ventilation, but risks of acute kidney injury and electrolyte abnormalities were higher.
Validated Assessment Scales for Skin Laxity on the Posterior Thighs, Buttocks, Anterior Thighs, and Knees in Female Patients
Authors: Kaminer Michael S. , Casabona Gabriela , Peeters Wouter , Bartsch Rolf , Butterwick Kimberly , Yen-Yu Chao Yates , Costa Joana , Eviatar Joseph , Fabi Sabrina Guillen , Geister Thorin L. , Goldie Kate , Grice Jenny , Hexsel Doris , Lorenc Paul , Lupo Mary , Pooth Rainer , Sattler Gerhard , Waldorf Heidi A. , Yutskovskaya Yana , Kerscher Martina
Published: July 2019

BACKGROUND

The demand for noninvasive skin-tightening body procedures is increasing.

OBJECTIVE

To develop a set of grading scales for the objective assessment of skin laxity and assess their reliability and validity.

MATERIALS AND METHODS

Two photonumeric grading scales were created and validated for skin laxity in female patients: Skin Laxity—Posterior Thighs/Buttocks, and Anterior Thighs/Knees. Fifteen aesthetic experts rated photographs of 50 women in 2 validation sessions. Responses were analyzed to assess inter-rater and intra-rater reliability.

RESULTS

Overall inter-rater reliability according to intraclass correlation efficient (ICC) 2.1 and weighted kappa was at least “substantial” for both scales in both sessions, and “almost perfect” (≥0.81) for the Anterior Thighs and Knees scale in session 2. Intra-rater reliability was “almost perfect” for both scales (ICC 2.1) and “substantial” to “almost perfect” by weighted kappa. A correlation between the skin laxity scales and body mass index, age, weight, sun exposure, and cellulite severity was observed.

CONCLUSION

The skin laxity photonumeric grading scales are valid and reliable instruments for assessing laxity on the posterior thighs and buttocks, and anterior thighs and knees. The scales will be of value for standardizing clinical evaluations and quantifying outcome measurements in research and clinical practice.
A Validated Assessment Scale for Asian Chin Projection
Authors: Suwanchinda Atchima , Seo Kyle , Geister Thorin L. , Yu Chao Yates Yen , Chhabra Chiranjiv , Fabi Sabrina G. , Hornfeldt Carl S. , Kerscher Martina , Lam Stephanie , Pavicic Tatjana , Peng Peter H.L. , Rzany Berthold , Tseng Fang-Wen , Pooth Rainer , Corduff Niamh
Published: July 2019

BACKGROUND

As the number of different aesthetic treatments increase, numerous photonumeric assessment scales have been developed and validated to measure the effectiveness of these new treatments and techniques. Photonumeric rating scales have been developed to objectively assess improvements in anatomical areas; however, these have been based on the features of Caucasian patients.

OBJECTIVE

To develop and validate a Chin Projection Scale for use in the female Asian patient population.

METHODS AND MATERIALS

During 2 validation sessions, 13 raters assessed full frontal and lateral facial views of 50 Asian subjects and also estimated their age and the aesthetic treatment effort required for each subject. Chin projection was rated on a scale from 0 (optimal) to 4 (very severely receding).

RESULTS

Inter-rater reliability was 0.80 (substantial) for Validation Session 1 and 0.83 (almost perfect) for Validation Session 2. The results for Estimated Age and Estimated Treatment Effort were essentially the same.

CONCLUSION

This study demonstrated the validity of the first photonumeric assessment scale for assessing the appearance of the female Asian chin. This new scale will provide a standardized measure of chin projection for Asian patients in clinical practice and clinical research settings.
A Systematic Review of Social Contact Surveys to Inform Transmission Models of Close-contact Infections
Authors: Hoang Thang , Coletti Pietro , Melegaro Alessia , Wallinga Jacco , Grijalva Carlos G. , Edmunds John W. , Beutels Philippe , Hens Niel
Published: July 2019

Background:

Researchers increasingly use social contact data to inform models for infectious disease spread with the aim of guiding effective policies about disease prevention and control. In this article, we undertake a systematic review of the study design, statistical analyses, and outcomes of the many social contact surveys that have been published.

Methods:

We systematically searched PubMed and Web of Science for articles regarding social contact surveys. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines as closely as possible.

Results:

In total, we identified 64 social contact surveys, with more than 80% of the surveys conducted in high-income countries. Study settings included general population (58%), schools or universities (37%), and health care/conference/research institutes (5%). The largest number of studies did not focus on a specific age group (38%), whereas others focused on adults (32%) or children (19%). Retrospective (45%) and prospective (41%) designs were used most often with 6% using both for comparison purposes. The definition of a contact varied among surveys, e.g., a nonphysical contact may require conversation, close proximity, or both. We identified age, time schedule (e.g., weekday/weekend), and household size as relevant determinants of contact patterns across a large number of studies.

Conclusions:

We found that the overall features of the contact patterns were remarkably robust across several countries, and irrespective of the study details. By considering the most common approach in each aspect of design (e.g., sampling schemes, data collection, definition of contact), we could identify recommendations for future contact data surveys that may be used to facilitate comparison between studies.
CORRELATION OF SUBRETINAL HYPERREFLECTIVE MATERIAL MORPHOLOGY AND VISUAL ACUITY IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Kumar Jaya B. , Stinnett Sandra , Han Jung I. L. , Jaffe Glenn J.
Published: July 2019

Purpose:

To evaluate the association of subretinal hyperreflective material (SHRM) morphological features with visual acuity in eyes with neovascular age-related macular degeneration.

Methods:

Retrospective analysis of treatment-naïve patients with neovascular age-related macular degeneration enrolled in randomized anti–vascular endothelial growth factor (VEGF) and anti–platelet-derived growth factor clinical trials. Standardized spectral domain optical coherence tomography images were graded at baseline, 12-week, and 24-week follow-up visits. Masked readers evaluated the morphology of SHRM (reflectivity, shape, anterior, and posterior boundaries) and measured SHRM height, width, and area at the fovea, within the center 1 mm2, and outside the center 1 mm2.

Results:

Baseline SHRM characteristics that correlated with worse visual acuity at 12 and 24 weeks included layered appearance (P = 0.006, 0.001), hyperreflective spots in SHRM (P = 0.001, 0.011), and separation between SHRM and outer retina (P = 0.03, 0.019). The disappearance of SHRM correlated with better visual acuity at Weeks 12 and 24 (P < 0.001). Layered appearance of SHRM at baseline was significantly associated with increased reflectivity at Weeks 12 and 24 (P = 0.009, 0.003). Decreasing reflectivity of SHRM lesion at Weeks 12 and 24 correlated with better visual acuity (P < 0.01, 0.01). Increased width and area of baseline SHRM at the foveal center correlated with worse visual acuity at 12 (P < 0.001, <0.001) and 24 weeks (<0.001, <0.001).

Conclusion:

Several attributes of SHRM including, layered appearance, increased reflectivity, larger size, and hyperreflective spots correlated with worse visual acuity at 12- and 24-week follow-ups. Baseline SHRM characteristics can help practitioners predict visual and morphological prognosis and guide therapy.
REDUCTION OF POSTINTRAVITREAL INJECTION PAIN USING ICE
Authors: Yahalomi Tal , Hecht Idan , Lagstein Oded , Nemet Achia , Pe'er Liron , Hadad Fady , Keren-Yaar Ari , Kassem Rabea , Burgansky-Eliash Zvia , Bar Asaf , Achiron Asaf
Published: July 2019

Purpose:

Intravitreal injections of intraocular therapeutic agents are a common and effective treatment for various retinal pathologies. Patient discomfort related to injection is a potential barrier to treatment. Our aim in this study was to evaluate whether cooling the eye using topical ice compresses before intravitreal injection will reduce pain or bleeding.

Methods:

This randomized controlled open-label study included 42 patients. All patients received a standard topical anesthesia protocol and then were randomly assigned to either receive a placement of ice packs (intervention group) or a room-temperature pack (control group) on the eyelid, 2 minutes before the intravitreal injection. Patients' discomfort, itching, burning and pain (using visual analog scale), and bleeding size (using photographs) were measured 1 and 10 minutes after the injection. Tolerability was calculated by averaging patients' discomfort, itching, burning, and pain scores.

Results:

At 1 minute, pain (1.95 vs. 4.27, P = 0.01) and overall tolerability (1.66 vs. 2.98, P = 0.03) were significantly lower in patients receiving ice packs. At 10 minutes, pain (1.6 vs. 3.73, P = 0.02), burning (0.9 vs. 3.09, P = 0.007), discomfort (2.1 vs. 4.27, P = 0.008), and overall tolerability (1.23 vs. 2.87, P = 0.004) were all significantly lower in the ice group compared with the controls. Bleeding size (area or circumference) was not statistical different between groups.

Conclusion:

Topical ice patch administered before intravitreal injection significantly decreased pain and overall tolerability. This simple and inexpensive method may be used to ameliorated pain and improve tolerability.
ALTERATIONS OF MACULAR BLOOD FLOW IN SUPERFICIAL AND DEEP CAPILLARY PLEXUSES IN THE FELLOW AND AFFECTED EYES OF PATIENTS WITH UNILATERAL IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Coppe Andrea M. , Lapucci Giuliana , Gilardi Marta , Petruzzella Francesca , Ripandelli Guido
Published: July 2019

Purpose:

Previous research suggests that proliferation of the idiopathic epiretinal membrane (IERM) is related to microbreaks in the inner limiting membrane, which are caused by posterior vitreous detachment. In this study, we used optical coherence tomography angiography to determine whether a vascular defect in the inner retina is present before the mechanical damage caused by posterior vitreous detachment.

Methods:

For patients with unilateral IERM (N = 23), optical coherence tomography angiography with blood flow measurement was performed in both eyes at the superficial capillary plexuses (SCP) and deep capillary plexuses (DCP) with 6 mm × 6-mm scans and ETDRS grids centered on the fixation point. These values were then compared with 45 healthy control eyes (CEs).

Results:

The optical coherence tomography angiography data showed that blood flow was lower in the fellow eyes of IERM patients than in CEs when the whole enface macula (SCP: P = 0.031, DCP: P = 0.004) and extramacular area (SCP: P = 0.048, DCP: P = 0.026) were compared between groups. The blood flow was also lower in the affected eyes compared with CEs in both whole en face macula (SCP: P < 0.001, DCP: P < 0.001) and extramacular areas (SCP: P = 0.011, DCP: P < 0.001).

Conclusion:

Data from this study revealed that blood flow is significantly reduced in the fellow eyes of patients with unilateral IERM when compared with CEs. Overall, the data suggest that a vascular retinal defect could produce changes in the inner retina, preceding and influencing the formation of microbreaks occurring at the time of posterior vitreous detachment in the inner limiting membrane. Understanding the upstream mechanism of inner limiting membrane microbreaks may provide a therapeutic target aimed to ultimately prevent Müller cells, astrocyte, and fibroblast migration, which cause IERM proliferation.
CLOSTRIDIAL ENDOPHTHALMITIS: CLINICAL PRESENTATIONS, MANAGEMENT OUTCOMES, AND REVIEW OF LITERATURE
Authors: Dave Vivek P. , Joseph Joveeta , Pathengay Avinash , Pappuru Rajeev R. , Das Taraprasad
Published: July 2019

Purpose:

To describe the clinical presentations, diagnosis and management outcomes of clostridial endophthalmitis, and a review of the previous literature.

Design:

Retrospective, interventional case series from January 2005 to March 2018 and a literature review.

Methods:

The study included seven eyes of seven patients with culture-proven Clostridium sp. endophthalmitis. Identification of Clostridium sp. was confirmed by the VITEK 2 system using the ANC card. When VITEK failed to identify the organism, MALDI-TOF was used. Data regarding demography, clinical presentations, interventions received, and final visual and anatomical outcomes were noted.

Results:The

mean age of the patients was 28.28 ± 22.35 years (median 21 years). By the etiology of infection, 5 (75%) eyes were post–open-globe injury, 1 (12.5%) was post-trabeculectomy, and 1 (12.5%) was postintravitreal injection. The mean follow-up was 9.71 ± 12.03 months, median 6 months. Two samples were positive for Clostridium perfringens, one each for C. subterminale, C. difficile, and C. tertium, and two were unidentified clostridial species. Favorable anatomical outcome was seen in 3/7 eyes (42.85%). Favorable functional outcome was seen in 2/7 eyes (28.57%). These were comparable with the outcomes of the pooled pre-existing literature. There was a trend toward better functional and anatomical outcomes and lesser evisceration/enucleation rates with vitrectomy instead of a vitreous tap, although not statistically significant. All cases showed susceptibility to empirically used intravitreal antibiotic vancomycin.

Conclusion:

Commonest setting of clostridial endophthalmitis is post–open-globe injury. Despite treatment with appropriate antibiotics, the visual and anatomical outcome is unsatisfactory because of high organism virulence. Early vitrectomy may allow for globe salvage and potential vision.
Descemet Membrane Endothelial Keratoplasty Under Failed Penetrating Keratoplasty Without Host Descemetorhexis for the Management of Secondary Graft Failure
Authors: Alió del Barrio Jorge L. , Montesel Andrea , Ho Vivian , Bhogal Maninder
Published: July 2019

Purpose:

To evaluate the safety and efficacy of the treatment of secondary graft failure in penetrating keratoplasty (PK) by performing Descemet membrane endothelial keratoplasty (DMEK) without host descemetorhexis.

Methods:

This is a retrospective case series study of 8 eyes from 8 patients who underwent non host Descemet membrane stripping DMEK surgery under a previously failed PK. The DMEK graft diameter was either matched or 0.25 to 0.5 mm undersized in relation to the PK diameter. Six-month postoperative data are presented. Primary outcome measures were safety and anatomical success.

Results:

No intraoperative complications were registered. Postoperatively, 1 case developed a PK host–donor junction dehiscence in relation to a previous early suture removal, requiring PK resuturing and DMEK rebubbling. Only 1 additional case required DMEK rebubbling. No primary graft failure was detected, and all cases achieved full PK transparency within 2 weeks. Corrected distance visual acuity improved from a median of counting fingers (CF-0.2) to 0.57 (0.05–0.7). Median central corneal thickness improved from 650.5 (497–897) to 464 (372–597) μm. Median endothelial cell density was 1080 (581–2043) cells/mm2. Rebubbling rate (25%) was lower than that previously reported. All patients had extensive preoperative ocular comorbidity.

Conclusions:

DMEK under PK without host descemetorhexis is a feasible surgical alternative for the treatment of graft failure after PK. It is associated with equivalent levels of efficacy and safety compared with Descemet membrane stripping DMEK techniques but simplifies the surgical procedure and avoids potential intraoperative complications associated with Descemet stripping. Further studies with a larger sample and a longer follow-up are necessary to confirm our preliminary outcomes.
A Simple 60-Second Swelling Technique for More Consistent Ultrathin DSAEK Graft Preparation
Authors: Farbman Neil H. , Y. Li Jennifer , Ling Jennifer , Conwell Chris , Ramirez Tiffany
Published: July 2019

Purpose:

The purpose of this study is to describe a simple but novel 60-second swelling technique for ultrathin Descemet stripping automated endothelial keratoplasty (DSAEK) graft preparation. In addition, we aim to demonstrate the effectiveness of this technique in obtaining thinner DSAEK grafts more consistently without compromising graft quality.

Methods:

We performed a retrospective case–control study comparing standard DSAEK preparation using an ML7 Microkeratome Donor Cornea System (Med-Logics Inc, Athens, TX) with an additional 60 seconds of stromal swelling with a balanced salt solution after the removal of the epithelium but before the microkeratome pass. Thirty cases using this novel swelling technique were compared with controls matched by age, sex, and precut corneal thickness. Donor characteristics and both precut and postcut graft characteristics were analyzed.

Results:

DSAEK grafts prepared with our simple swelling method were approximately 13 μm thinner on average than those prepared with our conventional ultrathin DSAEK preparation technique (P = 0.001). The frequency of grafts less than 100 μm was much greater with swelling (93.3% vs. 63.3% with conventional technique, P = 0.0052). There were no significant differences in postcut cell counts or decrease in cell counts between the groups.

Conclusions:

A simple 60-second swelling technique can yield significantly thinner DSAEK tissue in a more consistent range without a significant impact on the endothelial cell count.