bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral Antihistamines Alone vs in Combination with Leukotriene Receptor Antagonists for Allergic Rhinitis: A Meta‐analysis
Authors: Liu Guo , Zhou Xu , Chen Jianrong , Liu Feng
Published: January 2018

Objective

To evaluate whether an adjuvant therapy of leukotriene receptor antagonists (LTRAs) based on oral H1‐antihistamines (H1) can increase efficacy of allergic rhinitis (AR) treatment.

Data Sources

The search involved databases of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, from inception up to September 23, 2017. Randomized controlled trials (RCTs) that compared efficacy of LTRAs + H1 vs H1 alone were eligible.

Review Methods

Pooled comparative effects were measured using weighted mean difference (WMD) and 95% confidence interval (CI). Subgroup analysis comparing seasonal vs perennial AR was prespecified to explore the source of heterogeneity. The evidence quality of each outcome was assessed by the GRADE approach.

Results

A total of 8 RCTs were included (n = 1886), and all measured outcomes used scaled scores. Compared with H1 alone, H1 + LTRAs were superior to improve overall daytime (WMD, –0.11; 95% CI, –0.19 to –0.03, high quality) and composite (WMD, –0.12; 95% CI, –0.23 to –0.01; low quality) nasal symptoms. Specifically, H1 + LTRAs had better efficacy against composite nasal rhinorrhea, sneezing, and daytime itching but not congestion. The effects were more pronounced in patients with perennial AR compared to those with seasonal AR. There were no significant differences in nighttime nasal symptoms and eye symptoms between the 2 groups.

Conclusion

The current evidence suggests that LTRAs + H1 can increase the therapeutic efficacy against daytime and composite nasal symptoms, including rhinorrhea, sneezing, and itching; however, it does not affect nighttime nasal symptoms and eye symptoms. The patients with perennial AR may benefit more from the combination therapy.
Defining the Learning Curve for Hip Arthroscopy: A Threshold Analysis of the Volume-Outcomes Relationship
Authors: Mehta Nabil , Chamberlin Peter , Marx Robert G. , Hidaka Chisa , Ge Yile , Nawabi Danyal H. , Lyman Stephen
Published: January 2018

Background:

Hip arthroscopy has emerged as a successful option for the treatment of femoroacetabular impingement and related hip disorders, but the procedure is technically challenging.

Purpose:

To define the learning curve through which surgeons become proficient at hip arthroscopy.

Study Design:

Cohort study; level of evidence, 3.

Methods:

The authors identified hip arthroscopy procedures performed by surgeons through a New York State database (Statewide Planning and Research Cooperative System) and followed those cases for additional hip surgery (total hip arthroplasty, hip resurfacing, or ipsilateral hip arthroscopy) within 5 years of the original procedure. Career volume for each case was calculated as the number of hip arthroscopy procedures that the surgeon had performed. Volume strata were identified via the stratum-specific likelihood ratio method. A Cox proportional hazards model was used to measure the effect of surgeon career volume on risk of additional hip surgery, adjusting for the following patient characteristics: age, sex, race/ethnicity, insurance type, and concurrent diagnosis of hip osteoarthritis.

Results:

Among 8041 hip arthroscopies performed by 251 surgeons, 989 (12.3%) cases underwent additional hip surgery within 5 years. Four strata of surgeon career volume associated with distinct frequencies of reoperation were identified: cases in the lowest stratum (0-97) had the highest frequency of additional surgery (15.4%). Frequencies declined for cases in the medium (98-388), high (389-518), and highest (≥519) strata (13.8%, 10.1%, and 2.6%, respectively). There was an increased risk of subsequent surgery in each stratum when compared with the highest stratum (hazard ratio [95% CI]: low volume, 3.22 [2.29-4.54]; medium, 3.40 [2.41-4.82]; high, 2.81 [1.86-4.25]; P < .0001 for all). Patients with a diagnosis of hip osteoarthritis had increased risk of subsequent hip arthroplasty or resurfacing (2.46 [2.09-2.89], P < .0001) . Risk also increased with age: 30 to 39 vs ≤29 years (5.12 [3.29-8.00], P < .0001), 40 to 49 vs ≤29 years (11.30 [7.43-17.190], P < .0001), ≥50 vs ≤29 years (18.39 [12.10-27.96], P < .0001). Increased age and osteoarthritis were not risk factors for revision hip arthroscopy.

Conclusion:

The learning curve for hip arthroscopy was unexpectedly demanding. Cases performed by surgeons with career volumes ≥519 had significantly lower risk of subsequent hip surgery than those performed by lower-volume surgeons.
Bench-scale test facility for evaluating the performance of thermal imagers for fire service applications
Authors: Kim Sung Chan , Hamins Anthony
Published: January 2018

A bench-scale facility was developed for the evaluation of thermal imaging cameras. Smoke obscuration conditions in the optical smoke cell were characterized by measuring laser light transmittance through the cell. Measurements showed that the laser transmittance along the axial direction of the optical smoke cell was relatively uniform in the upper and lower halves of the cell for various smoke obscuration conditions. The thermal sensitivity of thermal imagers was investigated using the Michelson Contrast as a performance metric for a bar target viewed through the smoke-filled cell for different background thermal conditions. The results of the study indicate that the optical smoke cell can be utilized as a well-controlled and effective bench-scale test apparatus to evaluate aspects of the performance of thermal imagers for fire service applications.
Developing the Computer Programming Self-Efficacy Scale for Computer Literacy Education
Authors: Tsai Meng-Jung , Wang Ching-Yeh , Hsu Po-Fen
Published: January 2018

Computer programming has been gradually emphasized in recent computer literacy education and regarded as a requirement for all middle school students in some countries. To understand young students’ perceptions about their own learning in computer programming, this study aimed to develop an instrument, Computer Programming Self-Efficacy Scale (CPSES), for all students above middle school levels. Based on Berland and Lee’s computational thinking framework, this study developed the CPSES items at a literacy level and finally the instrument included the five subscales: Logical Thinking, Algorithm, Debug, Control, and Cooperation. An exploratory factor analysis and reliability tests were conducted in this study. The reliability alpha was .96 for the overall scale, and ranged from .84 to .96 for the subscales. This study also confirmed the positive correlation between computer programming experience and computer programming self-efficacy. In addition, for low- and middle-experienced learners, significant gender differences were found in two subscales: Algorithm and Debug. The CPSES can be applied as an evaluation tool in computer education, robotics education, as well as integrated STEM or STEAM education in which computer programming was regarded as a part of computer literacy.
Association of Neutrophil/Lymphocyte Ratio With Intravenous Immunoglobulin Treatment in Children With Guillain-Barré Syndrome
Authors: Hüner Ezgi Altuntas , Dai Alper I. , Demiryürek Abdullah T.
Published: January 2018

Guillain-Barré syndrome (GBS) is an acute immune-mediated inflammatory polyneuropathy of the peripheral nervous system. The authors aimed to investigate whether the neutrophil/lymphocyte (N/L) and platelet/lymphocyte (P/L) ratios are the parameters that associated with the drug treatment or severity of GBS. Twenty-seven children with GBS were retrospectively analyzed from the medical records of patients who attended to the Pediatric Neurology Department of the Gaziantep University Hospital. Biochemical and hematologic parameters were measured. Leukocytes, neutrophils counts and N/L ratio were significantly higher before the intravenous immunoglobulin treatment ( P < .001). However, there were no marked differences in platelet count and P/L ratio. In addition, marked correlation was observed between the N/L ratio after treatment and duration of weakness. The results of the study showed that N/L ratio is significantly higher in GBS patients, and reduces following with intravenous immunoglobulin treatment.
What Are the Psychosocial Factors Associated With Migraine in the Child? Comorbid Psychiatric Disorders, Family Functioning, Parenting Style, or Mom’s Psychiatric Symptoms?
Authors: Kandemir Gozde , Hesapcioglu Selma Tural , Kurt Aysegül N. Citak
Published: January 2018

Objective:

Psychiatric diagnoses, parenting style, family functioning among children and adolescents with migraine, and psychiatric symptoms of their mothers were examined.

Methods:

The K-SADS and other measurements were used to assess psychiatric disorders in 50 children with migraine (aged 8-18) and matched 50 controls.

Results:

At least one psychiatric disorder was diagnosed in 56% of the migraine group. The presence of any psychiatric disorder in children (odds ratio [OR] = 2.765, P = .027) and somatization symptoms in their mothers (OR = 2.061, P = .025) were increasing the risk of migraine diagnosis. The parenting style scale assessments revealed that parents in the migraine group grant their children less autonomy.

Conclusion:

Psychiatric comorbidity, especially depression and anxiety disorders, is more common in children with migraine. The frequency of eating disorder is also higher. Evaluating comorbidity, family functioning, and particularly affective responsiveness in migraine families may guide the clinician to a targeted treatment plan.
The Association Between Premorbid Conditions in School-Aged Children With Prolonged Concussion Recovery
Authors: Guerriero Réjean M. , Kuemmerle Karameh , Pepin Michael J. , Taylor Alex M. , Wolff Robert , Meehan William P.
Published: January 2018

The association between preexisting anxiety, depression, and/or neurodevelopmental disorders and symptom duration among younger children who sustain concussions is not well known. The authors conducted a prospective cohort study of 569 patients presenting to a pediatric neurology clinic with the diagnosis of concussion. The authors measured associations between symptom duration and premorbid conditions, as well as gender, age, mechanism of injury, and other factors. Premorbid conditions were common in both age groups. On univariate modeling female gender, age >12 years, and premorbid conditions were associated with longer symptom duration. On multivariable modeling, females and patients ≤12 years old with a history of headaches, migraines, or a history of psychiatric conditions took significantly longer to recover than those without such conditions. Premorbid conditions are associated with a prolonged recovery from concussion among those patients ≤12 years old.
Pain Assessment Documentation After Opioid Administration at a Community Teaching Hospital
Authors: Phillips Megan E. , Gilmore Rod A. , Sheffield Melody C. , Phan Stephanie V.
Published: January 2018

Purpose:

To compare pain assessment documentation postopioid administration in hospitalized patients before and after implementing nurse education.

Methods:

Patients 18 years and older were randomly selected for inclusion if they received 1 opioid dose while admitted to the hospital. Through retrospective chart review, opioid data, including date and time, were collected for each opioid administered. Pain score data, including time and date of documentation, were recorded for analysis. The primary objective of this study was to determine whether a nursing education intervention would improve documentation of pain scores within an appropriate time frame postadministration of an opioid medication. The intervention was a training presentation uploaded to the institution’s intranet with an assessment. The primary outcome was measured by comparing the frequency by which nurses documented pain scores following opioid administration before and after education.

Results:

Three hundred twenty patients (160 patients per time period) were evaluated. The percentage of pain scores recorded within the appropriate assessment time following opioid administration increased from 32.9% to 37.8% ( P = .003). The proportion of appropriate pain score documentation increased 4.9% (95% confidence interval [CI]: 1.6%-8.2%).

Conclusion:

An increase in the documentation of efficacy assessments after opioid administration was demonstrated after nursing education. Further studies should be done to identify additional strategies to increase monitoring as well as to identify a benchmark for institutions with regard to pain management monitoring.
Rapid optimal design of a multimode power split hybrid electric vehicle transmission
Authors: Anselma Pier Giuseppe , Huo Yi , Roeleveld Joel , Emadi Ali , Belingardi Giovanni
Published: January 2018

This work aims at presenting a design methodology capable of modeling, generating, and testing a large number of multimode power split hybrid electric vehicle transmission designs in a relatively short period of time. Design parameters include the planetary gear ratios, the final drive ratio, the configuration of hookups to link the hybrid powertrain components to the planetary gear sets and the locations of clutch connections between different nodes of the planetary gear sets. The system modeling approach is first presented, including formulations for each component (the vehicle and road load, the engine, the motor/generators and the battery). A rapid and automated modeling procedure is proposed for hybrid electric vehicle transmissions including multiple planetary gear sets and clutch connections. Two algorithms are subsequently presented that enable fast evaluation of fuel economy and acceleration performance of hybrid electric vehicle transmission designs, namely the enhanced Power-Weighted Efficiency Analysis for Rapid Sizing and the Rapid Efficiency-based Launching Performance Analysis algorithms. The developed design methodology is tested by first modeling and evaluating three hybrid electric vehicle designs from the state-of-art. Later, an investigation for optimal designs that can ameliorate the examined benchmarks is performed. Several millions of design options are rapidly generated and tested using the proposed procedure. The methodology is proved effective by quickly coming up with two sub-optimal designs. Fuel economy and acceleration performance are improved by 5.56% and 40.56%, respectively, compared to the corresponding best benchmarks.
Evaluation of air quality at the Birmingham New Street Railway Station
Authors: Hickman AL , Baker CJ , Cai X , Delgado-Saborit JM , Thornes JE
Published: January 2018

Air pollution from diesel emissions is becoming an increased international concern, and whilst attention has been primarily focused on the automotive industry, concerns have also been raised about emissions from diesel rail vehicles. This paper reports an extensive series of measurements made at the Birmingham New Street station, a major rail interchange in the Midlands of England, with a mix of diesel and electric train movements, which is of particular concern because of the enclosed nature of the platforms. This study was undertaken in collaboration with Network Rail to better understand the environment in and around the station over a longer period to provide a more detailed analysis of the complex environment at the station. The station environment has been considered in terms of the European Union (EU) and Department of Environment, Food and Rural Affairs (DEFRA) limits as part of the monitoring methodology, but it should be noted that these limits do not apply in this environment as the Management of Health and Safety at Work Regulation 1999 and the Control of Substances Hazardous to Health Regulations 2002 are applicable. The monitoring campaign consisted of diffusion tube measurements to measure nitrogen dioxide at a large number of different locations throughout and around the station. These were followed by detailed measurements of oxides of nitrogen, particulate matter, carbon dioxide and black carbon (a diesel tracer) at a smaller number of sites at the platform level. The results are analysed to give concentrations over a wide variety of time scales, and long- and short-term averages. The effects of ambient wind conditions and individual train movements are also considered. Recommendations are made for possible remedial measures and for future work to more fully understand the physical mechanisms involved.
Flap–control mechanism for flapping-wing micro air vehicles
Authors: Zhou Chaoying , Zhang Rui , Wang Chao
Published: January 2018

Flapping-wing micro air vehicles controlled by tail are poor in stability and maneuverability. A crank-slider and double-pendulum control mechanism which integrates flap and control and provides a good maneuverability by breaking the symmetry between the flapping motions of two lateral wings is proposed for the design of flapping-wing micro air vehicles. The kinematics of this mechanism is analyzed and the effects of flapping angles, flapping amplitudes, and the differences between the flapping angles of two lateral wings on the maneuverability are discussed. The results indicate that flapping angle differences between two lateral wings generated by breaking the symmetry play the most important role in providing good maneuverability. The maneuverability of turning is obtained by moving the pivots of the flapping bars in the system and a servo-gear-rack device is used to realize the movement. The proposed novel flap–control mechanism is compact and easy to control.
A robust likelihood approach to inference about the kappa coefficient for correlated binary data
Authors: Tsou Tsung-Shan
Published: January 2018

We construct a legitimate likelihood function for the agreement kappa coefficient for correlated data without specifically modelling all levels of correlation. This makes available the likelihood ratio test, the score test and other tools without the knowledge of the underlying distributions. This parametric robust likelihood approach applies to general clustered data scenarios. We provide simulations and real data analysis to demonstrate the advantage of the robust procedure.
A mixed-effects, spatially varying coefficients model with application to multi-resolution functional magnetic resonance imaging data
Authors: Liu Zhuqing , Bartsch Andreas J , Berrocal Veronica J , Johnson Timothy D
Published: January 2018

Spatial resolution plays an important role in functional magnetic resonance imaging studies as the signal-to-noise ratio increases linearly with voxel volume. In scientific studies, where functional magnetic resonance imaging is widely used, the standard spatial resolution typically used is relatively low which ensures a relatively high signal-to-noise ratio. However, for pre-surgical functional magnetic resonance imaging analysis, where spatial accuracy is paramount, high-resolution functional magnetic resonance imaging may play an important role with its greater spatial resolution. High spatial resolution comes at the cost of a smaller signal-to-noise ratio. This begs the question as to whether we can leverage the higher signal-to-noise ratio of a standard functional magnetic resonance imaging study with the greater spatial accuracy of a high-resolution functional magnetic resonance imaging study in a pre-operative patient. To answer this question, we propose to regress the statistic image from a high resolution scan onto the statistic image obtained from a standard resolution scan using a mixed-effects model with spatially varying coefficients. We evaluate our model via simulation studies and we compare its performance with a recently proposed model that operates at a single spatial resolution. We apply and compare the two models on data from a patient awaiting tumor resection. Both simulation study results and the real data analysis demonstrate that our newly proposed model indeed leverages the larger signal-to-noise ratio of the standard spatial resolution scan while maintaining the advantages of the high spatial resolution scan.
Working Long Hours and Its Impact on Family Life: Experiences of Women Professionals and Managers in Sri Lanka
Authors: Kodagoda Thilakshi
Published: January 2018

Worldwide studies of professional and managerial dual-earner couples in specific professions have indicated that with the double burdens of work and family, working long hours limit women’s career aspirations. Based on in-depth, semi-structured interviews with 40 respondents, this article examines how long working hours in the banking and health sectors impact professional and managerial mothers’ family life and health, and how the latter perceive motherhood roles. Though there was evidence of negative effects of long hours especially on childcare and children’s cognitive development, while rationalising their decision on combining motherhood and paid work, mothers interviewed valued their full-time employment.
Book Review: Bhargavi V. Davar and T. K. Sundari Ravindran (Eds), Gendering Mental Health: Knowledges, Critiques and Institutions
Authors: Johri Rachana
Published: January 2018

Bhargavi V. Davar and T. K. Sundari Ravindran (Eds), Gendering Mental Health: Knowledges, Critiques and Institutions. New Delhi: Oxford University Press, 2015, 236 pages, ₹850. ISBN 978-0-19-945353-5.
The Shifting Shape of the Rape Discourse
Authors: Vishwanath Neetika
Published: January 2018

This article reports findings based on non-participant observation during eight weeks of rape trials in a Fast Track Court (FTC) in Lucknow, established exclusively to hold trials of cases involving ‘crimes against women’. Research methods included an in-depth study of 15 ‘disposed off’ case files, in-depth semi-structured interviews conducted with 12 lawyers and focus group discussions (FGDs) with police officials held at 15 police stations in Lucknow district. Around 50 per cent of the rape trials were found to be related to the offence of statutory rape in cases of runaway marriages of minors. Another distinct category of cases that came to trial as rape cases were those involving ‘breaking of or false promise of marriage’. This article problematises and contests the construction of these categories of cases as ‘rape’ and argues that it points to a shift and hijack of the rape discourse by patriarchal familial and legal forces.
Gender and Sustainable Development Goals (SDGs)
Authors: Dhar Suneeta
Published: January 2018

This paper briefly highlights key challenges faced in advancing women’s rights in the last two decades. It draws attention to ‘gains and gaps’ in the implementation of the UN Beijing Platform for Action (1995) and the UN Millennium Development Goals (2000). It marks the evolution of a new compact on women’s human rights and gender equality through the Sustainable Development Goals (SDGs) that has been universally endorsed by governments, donors, women’s movements, civil society and other stakeholders. Women’s groups have consistently been raising critical questions of how equality, inclusion and participation would be embedded in a world structured around grave inequalities and exclusions. While the framework of the paper is global, it throws light on two critical areas in India—the economic empowerment of women and ending violence against women—with pointers regarding how these commitments could be better realised in the implementation of the SDGs, especially SDG Goal 5. The paper concludes by sharing information on how some countries are developing mechanisms to advance SDG 5 and draws attention to the lack of data and monitoring measures for gender equality. It emphasises that for transformative changes, governments need to engage with women’s organisations for policy development and implementation.
Conceptualising Gender Studies: Curriculum and Pedagogy
Authors: Nagalia Shubhra
Published: January 2018

This article draws upon the experience of inhabiting the disciplinary space of Gender Studies (GS) as faculty in a newly founded social science and humanities university, Ambedkar University Delhi (AUD). It attempts to formulate the challenges in and potential for giving shape to this specialised discipline in a neo-liberal context. It grapples with some of the complexities of the originary moment and how they have affected the discipline. Issues and linkages with Women’s Studies also foreground some of the tensions that have characterised our brief disciplinary history. These themes are explored by drawing upon the experience of curricular review and design of the Master’s programme in GS and the pedagogical dilemmas that constantly crop up in this age of celebration of ‘difference’. The first section focuses on the larger context of higher education in which a university like AUD was set up along with a discussion of the specific context of the location of GS within AUD. The second section looks at the various transactions and negotiations needed to run the GS programme.
When Bad News Arrives: Project HOPE in a Post-Factual World
Authors: Cullen Francis T. , Pratt Travis C. , Turanovic Jillian J. , Butler Leah
Published: January 2018

On the basis of limited empirical evidence, advocates of Project HOPE (Hawaii’s Opportunity Probation with Enforcement) have succeeded in spreading the model to a reported 31 states and 160 locations. A recent randomized control experiment across four sites has revealed negative results: no overall effect on recidivism. In this context, we examine how prominent advocates of Project HOPE have coped with the arrival of this “bad news.” Despite null findings from a “gold standard” evaluation study, advocates continue to express confidence in the HOPE model and to support its further implementation. The risk thus exists that Project HOPE is entering a post-factual world in which diminishing its appeal—let alone its falsification—is not possible. It is the collective responsibility of corrections researchers to warn policy makers that the HOPE model is not a proven intervention and may not be effective in many agencies. It is also our responsibility to create a science of community supervision that can establish more definitively best practices in this area.
The Monetary Benefits and Costs of Community Supervision
Authors: Drake Elizabeth K.
Published: January 2018

In 2014, nearly 5 million people were supervised in the community on probation or parole; yet, little research evidence exists indicating whether supervision is a cost-effective strategy to reduce recidivism. Using a meta-analytic framework, this article presents findings from the Washington State Institute for Public Policy (WSIPP) on the cost-effectiveness of four community supervision strategies including intensive supervision programs both with and without a focus on treatment, supervision with risk–need–responsivity training for officers, and swift, certain, and fair supervision policies to address violation behavior. Results from the systematic review of the rigorous research evidence indicates that three of the four supervision strategies are effective at reducing recidivism and produce long-term financial benefits that outweigh the costs with a high degree of certainty. The implications of these findings are discussed as well as suggestions for future research.
Contingency Management Programs in Corrections: Another Panacea?
Authors: Gendreau Paul , Listwan Shelley J.
Published: January 2018

The mantra of best practices in corrections, while well intended, may lead to iatrogenic consequences. Community corrections and prisons are under increasing pressures to manage their caseloads; moreover, the current accountability and get-tough agenda in corrections demands offenders take on more responsibility for their behaviors. As a consequence, we predict more episodes of “panaceaphilia” or quick fix solutions because corrections jurisdictions in the United States are under tremendous pressure to handle their populations at this point in time. In this article, we focus on contingency management programs as the potential next panacea, not because they do not have a proven track record of success, but because they require highly skilled staff and make great demands upon correctional agencies’ decision-making practices. To help counteract panaceaphilia from happening with contingency management, we describe the theory and practice of contingency management, the demands they place on programmers, the type of research needed to evaluate their effectiveness, and how to prevent these programs from turning into punitive punishment regimes.
Through the Looking Glass: Taking Stock of Offender Reentry
Authors: Schlager Melinda D.
Published: January 2018

Offender reentry has been part of the fabric of the criminal justice system since the first prison opened its doors and people who went in the front door were, at some point, released. Traditionally, the research on offender reentry has either supported best practice by determining what specific individual-level programming “works” or “doesn’t work” or it has assessed the success of programs in terms of their ability to reduce recidivism. And while we may have moved the dial in the last 50 years with respect to what we know about individual-level offender reentry attributes, there is no effective overarching narrative to explain the offender reentry phenomenon. Overwhelmingly, practitioners and academics in the criminal justice system operate within a paradigm that assesses and evaluates everything using risk. Unfortunately, a risk- or deficit-focused approach to viewing offender reentry severely limits our ability to think differently about the problem. However, if we employ a paradigm for offender reentry that focuses less on problems and more on strengths, different outcomes are possible. Work done in social work that promotes “strengths-based, solution-focused, capacity building, asset creating, motivation enhancing” empowerment models that accentuate the positive serves as an exemplar for us to use in criminal justice when discussing offender reentry. The three strengths-based principles adapted to offender reentry and discussed here are as follows: Officer–offender relationships that emphasize collaboration will promote law-abiding, prosocial behavior; offenders who are empowered will be more likely to seek to change; and cooperation from the community is key to successful offender reentry. Fiscal, political, and common sense reasons for using a strengths-based approach to offender reentry are discussed.
The Four Cs of Parenting
Authors: Perron Nathan C. D.
Published: January 2018

Parenting is a challenge that faces every culture, creed, and nation. It carries a variety of assumptions, values, and perspectives that indicate how proper parenting should look. Much has been written with the hope of supporting positive parenting within the counseling and psychology literature, but putting these concepts into practice can prove challenging from the counseling office. This article explores common counseling concepts that promote healthy parenting through a careful review of the counseling literature regarding current practices and perspectives that exist internationally across countries, cultures, and families. Key findings in the literature highlight the significance of parenting styles, balanced agendas, autonomy, awareness, and cultural values. Understanding these concepts remains important for counselors to remain competent in supporting families, parents, and children on an international level. Out of these findings, counselors are presented with a simple, practical format for parents to enhance parenting experiences: the four Cs. Further detail about the four Cs outlines the significance of how parents can support children with a foundation of care, consistency, choices, and consequences and how they can be practiced in the counseling office. Suggestions for ongoing studies also provide future pathways for evaluating the four Cs in future practice.
Postradiation Synovial Sarcoma of the Common Bile Duct: A Previously Unreported Anatomic Site
Authors: Herrera-Goepfert Roberto
Published: January 2018

Synovial sarcoma is a ubiquitous neoplasm predominantly affecting soft tissues of young adults of any gender; few cases have been described in the digestive system, mostly in the stomach. The (X;18)(p11.2; q11.2) translocation yields unique SS18-SSX fusion genes. Synovial sarcoma has been related to radiotherapy, but no synovial sarcoma has been associated with the digestive system. This article describes the case of a synovial sarcoma arising along the extrahepatic biliary tree, 10 years after the application of an abdominal radiotherapy schedule due to a retroperitoneal metastatic seminoma in a male who developed progressive obstructive jaundice. Ninety percent of the analyzed cells carried the SS18 gene with separation of sequences, thus denoting a translocation. There are only 8 post-radiotherapy synovial sarcomas that have been reported previously, and this is the first report of a radiotherapy-related synovial sarcoma arising from the extrahepatic biliary tree, and the second case described in this anatomic region.
Outcomes of Bilateral vs Unilateral Ankle Arthrodesis
Authors: Maenohara Yuji , Taniguchi Akira , Tomiwa Kiyonori , Tsuboyama Daisuke , Kurokawa Hiroaki , Kumai Tsukasa , Tanaka Sakae , Tanaka Yasuhito
Published: January 2018

Background:

While ankle arthrodesis is a common treatment for severe ankle osteoarthritis, performing bilateral ankle arthrodesis is controversial because of associated problems, such as severe gait abnormality and bilateral loss of talocrural joint motion. Furthermore, few reports exist regarding the detailed outcomes of bilateral ankle arthrodesis. Therefore, we aimed to compare the outcomes of bilateral ankle arthrodesis with those of unilateral ankle arthrodesis, using both subjective and objective assessments.

Methods:

The data from 20 patients (10 each in the bilateral and unilateral groups), who underwent arthrodesis between 2005 and 2015, were retrospectively reviewed. The minimum follow-up duration was 2 years. Radiographic outcomes were assessed using radiographs and computed tomography. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) scale and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q).

Results:

With the numbers available, no significant group differences were observed for any of the patient characteristics or postoperative range of motion. Mean JSSF scale scores significantly improved in both groups ( P < .001); however, scores on the SAFE-Q subscale for “social functioning” were significantly lower in the bilateral group compared to the unilateral group ( P = .049).

Conclusions:

Within the limitations of the current study design, bilateral ankle arthrodesis did not appear to be inferior to unilateral ankle arthrodesis, with the possible exception of social functioning ability. Thus, bilateral ankle arthrodesis can be considered a viable treatment option.

Level of Evidence:

Level III, retrospective cohort study.
Stenting of Central Venous Stenoses and Occlusions to Maintain Hemodialysis Vascular Access
Authors: Hatzimpaloglou A. , Velissaris I. , Gourasas I. , Grekas D. , Kiskinis D. , Kaitzis D. , Louridas G.
Published: January 2018

Background/Aims: The aim of the study was to evaluate the efficacy of stenting for the treatment of central arm vein obstructions in hemodialysis patients in order to maintain hemodialysis from the affected side. Methods: Fifteen self-expanding (8) and balloon expandable (7) stainless steel stents were implanted in 10 hemodialysis patients for the treatment of symptomatic central arm vein obstructions. Thirteen lesions were treated: 6 subclavian, 4 innominate and 3 restenoses. Results: Stent deployment was successful in all cases leading to resolution of symptoms by correcting the underlying cause of venous hypertension. Follow-up from 3 months to 4 years revealed four deaths from unrelated causes, three restenoses at 1, 3, 4 months and one occlusion at 6 months respectively for a cumulative primary one-year and two-year patency rate of 70%. Conclusion: Stenting of subclavian and innominate venous stenoses and occlusions effectively corrected the underlying lesions responsible for disturbed hemodynamics and, in most cases, prolonged available hemodialysis access from the affected side.
Measuring Central Venous Structures in Humans: Implications for Central-Vein Catheter Dimensions
Authors: Twardowski Zbylut J. , Seger Richard M.
Published: January 2018

The tip of a central vein catheter for hemodialysis should be located in the upper right atrium for the best performance. Hemodialysis catheters do have internal diameter unadjusted to the catheter length; however, the longer the catheter the slower the flow at the same pressure difference. On the other hand, the catheter diameter cannot be so large as to fill the vein too tightly as it predisposes to the damage of the vein wall, thrombosis and stenosis. Therefore, the catheter length and diameter should be appropriate for the patient. For this purpose, the exact dimensions of the venous system in vivo should be known. In this study we correlated the anthropometric measurements and the dimensions of the large upper body veins in 31 adult volunteers.

After deep inspiration, magnetic resonance imaging of the chest was performed in three planes; the positions of specific points in the three-dimensional coordinate system were measured, and the distance to adjacent points was calculated according to the analytic geometry formula. The total length from the catheter entry point to the right atrium was the sum of distances between the adjacent points. The lengths of the veins were correlated with the body anthropometric measurements (height, weight, body surface area, biacromion span, and height plus biacromion span).

The best overall correlations of the lengths and diameters of the large upper body veins are with the body surface area. A table is included to guide the selection of the total catheter length and diameter in relation to the body surface area and insertion site.
Central Venous Catheter and the Hemodialysis Patient: A Difficult Symbiosis
Authors: Mandolfo S. , Piazza W. , Galli F.
Published: January 2018

In the last ten years, tunneled central venous catheters (pCVCs) have been increasingly utilized in chronic hemodialysis patients, sometimes in the place of fistulas. They have gained popularity for their unquestioned advantages, such as the possibility for immediate use. However, several problems have emerged following their diffusion. In this paper we review the main complications of pCVCs. Complications connected with insertion are generally due to an inaccurate approach to the vein. Ultrasonographic guidance has partially solved this problem and EC-ECG (endocavitary ECG) allows an accurate positioning of the tip. Infections, venous and/or pCVCs) thrombosis and dysfunctions are the most important catheter-related complications. Infections may occur with and without symptoms of systemic illness. Early diagnosis and appropriate antibiotic treatment are essential for saving the catheter. The pathogenesis of infections and strategies for prevention are discussed. Thrombosis and stenosis are well known complications of subclavian and jugular catheterization. In uremic patients, for temporary use, we suggest using the femoral position. Protocols for application of thrombolytic agents in pCVCs are considered. Dysfunction, defined as the failure to maintain a blood flow of at least 250 ml/min, remains the Achilles’ heel of the system. Adequate look therapy and tip position are only two basic aspects. In conclusion, a pessimistic outlook on the matter could lead us to consider that the advantages of catheter use are far outweighed by the disadvantages. However, we cannot avoid using central venous catheters in our dialysis units and a great challenge awaits both physicians and manufactures in the coming years.
The Role of the Staphylococcus Aureus Nasal Carriage and Type of Vascular Access in the Outcome of High-Risk Patients on Hemodialysis
Authors: Saxena A.K. , Panhotra B.R. , Uzzaman W. , Venkateshappa C.K.
Published: January 2018

Background

Populations of elderly and type-II diabetics are increasing worldwide. Therefore elderly diabetics on hemodialysis (HD), known to have higher nasal carriage rates, are also increasing. These patients are more often dialyzed through central venous catheters (CVCs). They represent the high-risk groups for Staphylococcus aureus linked vascular access-related septicemia (VRS) and ensuing mortality. The outcome of VRS in terms of mortality was studied in the three high-risk groups: elderly; type-II diabetics; elderly diabetics, following optimization of arteriovenous fistula (AVF) prevalence to at least 50%.

Methods

Persistent nasal carriage was defined by two or more positive standardized nasal swab cultures performed on 187 ESRD patients undergoing HD from July 1997 to July 2000. Peripheral blood samples were collected for culture and sensitivity on clinical suspicion of septicemia. Overall, AVF prevalence of over 50% was achieved through joint efforts of nephrology and vascular surgery departments.

Results

A nasal carriage rate of 47.6% was observed in this HD cohort. This included nasal carriage rates of 16.4% in <65 years non-diabetic (reference) group, 55.8% in elderly and 70.7% among type-II diabetics along with that of 75.5% in elderly-diabetic group. We achieved an overall AVF prevalence of 72.7% inclusive of 66.17% in elderly, 65.5% in type-II diabetics and 86.8% in reference group along with 37.7% in elderly-diabetic group. We recorded a mortality due to S. aureus nasal carriage-related VRS of 6.86% in elderly (RR-1.50, p-NS), 10.91% in type-II diabetics (RR-1.52, p<0.02) and 13.20% in the elderly-diabetic group (RR-2.87, p<0.0004) as compared to that of 4.4% per year in the reference group (assigned RR of one) with overall mortality of 7.3% per year.

Conclusions

AVF prevalence of over 50% is achievable in all the high-risk groups except among elderly-diabetics due to the predominance of peripheral vasculopathy. Optimizing AVF placement is a physiological and safer approach for achieving significant reductions in mortality associated with S. aureus nasal carriage-related VRS among high-risk groups.
Aneurysm of Arteriovenous Fistula in Uremic Patients: Is Endograft a Viable Therapeutic Approach?
Authors: Allaria P.M. , Costantini E. , Lucatello A. , Gandini E. , Caligara F. , Giangrande A.
Published: January 2018

One of the complications of arteriovenous fistulas in chronic hemodialyzed patients is the onset of an aneurysm which can be at risk of rupture.

Traditional surgical repair is not always feasible and may not be successful in these cases, leading therefore to the loss of a functioning vascular access and requiring in any case the temporary use of a central venous catheter to allow regular hemodialysis sessions.

We applied to this kind of aneurysm the same experience developed in the management of major arterial aneurysms and we considered endografting repair a good alternative in this case. In this paper we present the successful treatment of an arteriovenous fistula aneurysm using that technique.

A distal radio-cephalic arteriovenous fistula in one of our patients presented an aneurysm with high risk of rupture. The endografting repair with percutaneous insertion of a Wallgraft™ endoprosthesis was well tolerated and the vascular access could be used the day after, without the need for a central venous catheter insertion.
Surgery versus Interventional Radiology in the Management of Thrombosed Vascular Access for Hemodialysis
Authors: Morosetti M. , Meloni C. , Gandini R. , Galderisi C. , Pampana E. , Frattarelli D. , Simonetti G. , Casciani C.U.
Published: January 2018

Thrombosis is the most frequent complication occurring in vascular access (VA). The two widely used treatment strategies for thrombosed VA are surgical and endovascular. Which is the best and whether different approaches should be used on proximal versus distal VA, is still debated. This is a retrospective study. Over a three years period, we studied among a population of 475 dialysis patients, 54 VA thromboses in 46 patients. Surgical procedure was successful in 14/17 (82%) distal artero-venous fistulas (AVF) while, in 9 proximal AVF, it led to initial success in 6 patients (66%), with a six months primary patency respectively of 93% and 84%. Radiological procedure resolved 6/10 distal AVF (initial success 60%) with primary patency of 66%, and was successful in 16/18 proximal AVF (initial success 89%) with primary patency of 81%. Taking our data all together, no differences are found between two thrombolitic (surgical and endovascular) procedures. But results were different in thrombosed proximal VA (where endovascular treatment should be preferred) versus distal ones (where surgery seems better).
Haemodialysis Access: A Single Centre UK Experience
Authors: Fan S.L-S. , Naqvi R. , Ahmad R. , Thuraisingham R. , Raftery M.J. , Rudge C.J. , Sobeh M. , Yaqoob M.M.
Published: January 2018

Background

The aim of this study was to determine whether the US National Kidney Foundation Disease Outcome Quality Initiative (K/DOQI) guidelines on haemodialysis access could be achieved and to examine its relevance to patients on dialysis in the UK.

Method

A cross sectional study of chronic haemodialysis patients at our institution which involved case note review and measurements of biochemical parameters and dynamic venous pressure (dVP) was performed. Patients with polytetrafluoroethylene (PTFE) grafts were followed prospectively for 18 months.

Results

262 patients were studied - 12%, 43%, 30% and 15% underwent dialysis through dialysis catheters, radial-cephalic fistulae (rAVF), brachial-cephalic fistulae (bAVF) and PTFE grafts respectively. RAVFs, bAVFs and PTFE grafts were the primary access (i.e. the first access created for the patient) in 58%, 35% and 7% respectively. Compared with patients of Caucasian origin, patients of Afro-Caribbean race were 3.80 times (95% confidence limit: 1.51 – 9.53) more likely to have a PTFE graft. Patients with higher “dry weights” were more likely to have PTFE grafts (p<0.005 by ANOVA). Dialysis adequacy was similar irrespective of type and site of access. We found that 64% of PTFE grafts, 46% of bAVFs and 13% of rAVF had dVPs greater than 150 mmHg, (p<0.0001 by χ2). This threshold recommended by DOQI predicted 12 of 13 dysfunctional grafts, but had a positive predictive value of only 50%.

Conclusion

We have demonstrated that the K/DOQI guidelines are not only achievable, but that they can be exceeded by a considerable margin. Our data also suggest that the demographic details of patients within a unit will influence the achievable proportion of AVF: PTFE grafts (the proportion of PTFE grafts in Afro-Caribbeans being 3 times higher than in Whites). Although a dVP >150 mmHg proved sensitive in predicting future graft dysfunction, it had low specificity.