bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Efficacy of Internet Gaming Disorder With Attention Deficit Hyperactivity Disorder and Emotional Dysregulaton
Authors: Chang Chuan-Hsin , Chang Yue-Cune , Cheng Helen , Tzang Ruu-Fen
Published: February 2020

Background

Recent youth with Attention Deficit Hyperactivity Disorder (ADHD) noticed emotional dysregulation if they had Internet Gaming Disorder (IGD). This study aims to understand the treatment efficacy of IGD with ADHD and emotional dysregulaton.

Method

A total of 101 ADHD youths were recruited. We used the Chen Internet Addiction Scale and IGD criteria of the diagnotsic statistical manual (DSM)-5 to confirm IGD. The Swanson, Nolan, and Pelham questionnaire Version IV was used for symptoms of ADHD and oppositional defiant disorder. Disruptive mood dysregulation disorder was assessed by psychiatrist.

Results

There is a new phenomenon that emotional dysregulation has been frequently noticed in severely gaming-addicted ADHD youth. Treatment efficacy of IGD is good when the underlying symptom of ADHD is controlled. Symptom scores of disruptive mood dysregulation (DMDD) were significantly reduced by 71.9%, 74.8%, and 84.4% at week 2, 3, and 4, respectively (P ≤ .001) after adjusting baseline symptom severity.

Conclusion

IGD may strongly arouse emotional dysregulation. Future DSM criteria could consider these gaming-addicted youth as a specific subclass of ADHD.
Determination of the Efficacy of Preservation of Non-Eye Area Water-Miscible Cosmetic and Toiletry Formulations: Collaborative Study
Authors: Machtigere Neal A , Fischler George E , Adams Margaret C , Spielmaker Ron , Graf Joyce F ,   Collaborators:, Anger C B , Beauchamp J , Borovian G , Conlin S , DeVito M A , English D J , Entrup M R , Flanagan J , Huntley M , Kaiserman J , Lenczewski M , Mikulan-Maxfield L , Mitchell K S , O’Hearn K , Palmieri P , Parker L , Schnittger S , Schultz S L , Scibienski E , Seehase C , Settineri F , Shaffer M J , Spiegelman S , Tran T T , Vitolo P , Young-Bandala L
Published: February 2020

A collaborative study was conducted to test a method developed to distinguish between adequately and inadequately preserved cosmetic formulations. Nineteen laboratories participated in the study. Samples tested included shampoos, hair conditioners, oil-in-water emulsions, and water-in-oil-emulsions. Triplicate samples of 4 adequately preserved and 4 inadequately preserved cosmetic products were tested by each collaborative laboratory. Results showed that all inadequately preserved shampoo and conditioner samples failed to meet the acceptance criteria for adequately preserved formulations. Of the 51 preserved samples, 49 shampoos and 48 conditioners met the criteria for adequate preservation. All samples of inadequately preserved water-in-oil emulsions and oil-in-water emulsions failed to meet the acceptance criteria, whereas all adequately preserved emulsion formulations met the acceptance criteria.
Combined Phenyl Silane and Immunoaffinity Column Cleanup with Liquid Chromatography for Determination of Ochratoxin A in Roasted Coffee: Collaborative Study
Authors: Entwisle A Catherine , Williams Alison C , Mann Peter J , Russell Joanne , Slack Philip T , Gilbert John ,   Collaborators:, Burdaspal P , Eklund E , Gardikis J , Hald B , Herry M-P , Jørgensen K , Kandler H , Patel S , Pittet A , Schuster M , Solfrizzo M , Strassmeier E , Tiebach R , Torgensen T , Van der Stegen A
Published: February 2020

A collaborative study was conducted to evaluate a liquid chromatography (LC) method for ochratoxin A using sequential phenyl silane and immunoaffinity column cleanup. The method was tested at 3 different levels of ochratoxin A in roasted coffee, which spanned the range of possible future European regulatory limits. The test portion was extracted with methanol and sodium bicarbonate by shaking for 30 min. The extract was filtered, centrifuged, and then cleaned up on a phenyl silane column before being eluted from the washed column with methanol–water. The eluate was diluted with phosphate-buffered saline (PBS) and applied to an ochratoxin A immunoaffinity column, which was washed with water. The ochratoxin A was eluted with methanol, the solvent was evaporated, and the residue was redissolved in injection solvent. After injection of this solution onto a reversed-phase LC apparatus, ochratoxin A was measured by fluorescence detection. Eight laboratory samples of low-level naturally contaminated roasted coffee and 2 laboratory samples of blank coffee (< 0.2 ng/g ochratoxin A at the signal-to-noise ratio of 3:1), along with ampules of ochratoxin A calibrant and spiking solutions, were sent to 15 laboratories in 13 different European countries. Test portions of the laboratory samples were spiked at levels of 4 ng/g ochratoxin A, and recoveries ranged from 65 to 97%. Based on results for spiked blank material (blind duplicates) and naturally contaminated material (blind duplicates at 3 levels), the relative standard deviation for repeatability (RSDr) ranged from 2 to 22% and the relative standard deviation for reproducibility (RSDR) ranged from 14 to 26%. The method showed acceptable within- and between-laboratory precision, as evidenced by HORRAT values, at the low level of determination for ochratoxin A in roasted coffee.
Computational analysis of bioconvective flow of nanofluid containing gyrotactic microorganisms over a nonlinear stretching sheet with variable viscosity using HAM
Authors: Mondal Surya Kanta , Pal Dulal
Published: February 2020

This paper is concerned with the investigation of variable viscosity bioconvection flow of nanofluid containing motile gyrotactic microorganisms over a nonlinear stretching sheet in the presence of nonlinear thermal radiation, chemical reaction, internal heat source, and suction/injection effects. The homotopy analysis method has been developed for solving the governing nonlinear differential equations of the boundary layer flow of nanofluid over a stretching sheet. The scaling group transformation (a special form of Lie group transformation) has been applied to find the similarity variable $\eta $. Figures are drawn by using Mathematica software to analyze the results that correspond to some important physical parameters and bioconvection parameters on velocity, temperature, nanoparticle concentration, and density of gyrotactic microorganisms. It is found that the influence of variable viscosity on velocity profiles showed that there is an increase in the velocity profiles of nanofluid and the reverse effect is observed on its temperature distribution. It is seen that the thermal radiation parameter increases the temperature distribution, whereas it decreases the nanoparticle concentration distribution. It is also found that the inverse Darcy number reduces the velocity profile, whereas it enhances the temperature distribution. This work may find applications in advanced nanomechanical bioconvection energy conversion devices, bio-nanocoolant systems, etc.
Understandings of Trauma: Contrasting Sudanese Refugees and Holocaust Survivors
Authors: White Jarrod , Manderson Lenore , Newman Louise , Melvin Glenn
Published: February 2020

Responses to deeply traumatic events vary according to cultural context, yet we have little insight into why these discrepancies occur. In order to explore cultural variation in models of trauma, we draw on data from semi-structured interviews with Sudanese refugees (n = 12) and with Holocaust survivors (n = 13) in Melbourne, Australia. Using descriptive phenomenological analysis, we examine the similarities and differences between the two groups. Group differences were found in the meaning of traumatic memory, the communication of somatoform symptoms in the Sudanese-refugee group only, conceptions of self after the traumatic event and the relationship change with the social world. Similarities included the persistence of traumatic memory, an impact on identity, a change in one’s relationship with the social world and the emergence of existential anxiety. The findings contribute to uncovering delineation points between cultural models for understanding trauma, while simultaneously presenting a potential cross-cultural language useful for understanding trauma.
Plica syndrome after medial patellofemoral ligament reconstruction: a case report
Authors: Iwaasa Tomoya , Tensho Keiji , Koyama Suguru , Shimodaira Hiroki , Horiuchi Hiroshi , Saito Naoto , Takahashi Jun
Published: February 2020

A 16-year-old female with a history of left recurrent patellar dislocation underwent medial patellofemoral ligament (MPFL) reconstruction surgery. Two months postoperatively, the patient presented with medial patellar pain. Left medial plica syndrome was suspected, and we performed a partial arthroscopic resection of the medial synovial plica. The symptom gradually improved after surgery. To the best of our knowledge, there are no reports that discuss the relationship between postoperative pain of MPFL reconstruction and synovial plica as found in this case report. Surgeons should be aware of the possibility that asymptomatic synovial plica could become symptomatic.
Stellar population properties of ETGs in compact groups of galaxies
Authors: Moura Tatiana C , de Carvalho Reinaldo R , Rembold Sandro B , Trevisan Marina , Ribeiro Andre L B , Pérez-Villegas Angeles , La Barbera Francesco , Stalder Diego H , Rosa Reinaldo R
Published: February 2020

We present results on the study of the stellar population in early-type galaxies (ETGs) belonging to 151 compact groups (CGs). We also selected a field sample composed of 846 ETGs to investigate environmental effects on galaxy evolution. We find that the dependences of mean stellar ages, [Z/H] and [α/Fe] on central stellar velocity dispersion are similar, regardless where the ETG resides, CGs or field. When compared to the sample of centrals and satellites from the literature, we find that ETGs in CGs behave similarly to centrals, especially those embedded in low-mass haloes ($M_{\mathrm{ h}} \lt 10^ {12.5}\, \mathrm{M}_{\odot }$). Except for the low-mass limit, where field galaxies present a star-forming signature, not seen in CGs, the ionization agent of the gas in CG and field galaxies seem to be similar due to hot, evolved low-mass stars. However, field ETGs present an excess of H α emission relative to ETGs in CGs. Additionally, we performed a dynamical analysis, which shows that CGs present a bimodality in the group velocity dispersion distribution – a high- and low-σ mode. Our results indicate that high-σ groups have a smaller fraction of spirals, shorter crossing times, and a more luminous population of galaxies than the low-σ groups. It is important to emphasize that our findings point to a small environmental impact on galaxies located in CGs. The only evidence we find is the change in gas content, suggesting environmentally driven gas loss.
NGC 7469 as seen by MEGARA: new results from high-resolution IFU spectroscopy
Authors: Cazzoli S , Gil de Paz A , Márquez I , Masegosa J , Iglesias J , Gallego J , Carrasco E , Cedazo R , García-Vargas M L , Castillo-Morales Á , Pascual S , Cardiel N , Pérez-Calpena A , Gómez-Alvarez P , Martínez-Delgado I , Hermosa-Muñoz L
Published: February 2020

We present our analysis of high-resolution (R ∼ 20 000) GTC/MEGARA integral-field unit spectroscopic observations, obtained during the commissioning run, in the inner region (12.5 arcsec × 11.3 arcsec) of the active galaxy NGC 7469, at spatial scales of 0.62 arcsec. We explore the kinematics, dynamics, ionization mechanisms, and oxygen abundances of the ionized gas, by modelling the H α-[N ii] emission lines at high signal-to-noise (> 15) with multiple Gaussian components. MEGARA observations reveal, for the first time for NGC 7469, the presence of a very thin (20 pc) ionized gas disc supported by rotation (V/σ = 4.3), embedded in a thicker (222 pc), dynamically hotter (V/σ  =  1.3) one. These discs nearly corotate with similar peak-to-peak velocities (163  versus  137 km s−1), but with different average velocity dispersion (38 ± 1 versus 108 ± 4 km s−1). The kinematics of both discs could be possibly perturbed by star-forming regions. We interpret the morphology and the kinematics of a third (broader) component (σ > 250 km s−1) as suggestive of the presence of non-rotational turbulent motions possibly associated either to an outflow or to the lense. For the narrow component, the [N ii]/H α ratios point to the star-formation as the dominant mechanism of ionization, being consistent with ionization from shocks in the case of the intermediate component. All components have roughly solar metallicity. In the nuclear region of NGC 7469, at r ≤ 1.85 arcsec, a very broad (FWHM  =  2590 km s−1) H α component is contributing (41 per cent) to the global H α-[N ii] profile, being originated in the (unresolved) broad line region of the Seyfert 1.5 nucleus of NGC 7469.
High-School Students Rarely Use E-Cigarettes Alone: A Sociodemographic Analysis of Polysubstance Use Among Adolescents in the United States
Authors: Gilbert Paul A , Kava Christine M , Afifi Rima
Published: February 2020

Introduction

Most adolescents reporting e-cigarette use have also used combustible tobacco; however, the extent to which they use other substances is less clear. This study assessed e-cigarette use with tobacco, alcohol, or cannabis and quantified the risk of polysubstance use among adolescents overall and by sociodemographic characteristics.

Aims and Methods

Using 2017 Youth Behavioral Risk Factor Surveillance System data from adolescents (grades 9–12) with complete substance use information (n = 11 244), we examined e-cigarette poly-use status (none [referent], e-cigarettes only, or e-cigarettes + other substances). We estimated the prevalence of substance use and modeled odds of e-cigarette use, alone or with other substances, by several sociodemographic characteristics. Analyses were completed in Stata version 15.1 using survey procedures to account for the complex survey design.

Results

Approximately 12% of adolescents reported past 30-day e-cigarette use. Almost all (93%) e-cigarette users also reported other substance use; alcohol appeared most frequently in combinations. Odds of e-cigarette single use and e-cigarette poly-use (vs. no use) were higher for males and adolescents with lower grades (odds ratios [ORs] = 1.44–2.31). Racial/ethnic minorities had lower odds of e-cigarette poly-use than White peers (ORs = 0.18–0.61), and bisexual (vs. straight) adolescents were more likely to be e-cigarette poly-users (OR = 1.62). E-cigarette use increased from 9th grade (7%) to 12th grade (16%).

Conclusions

Polysubstance use is highly prevalent among adolescents who use e-cigarettes. Therefore, e-cigarette screening should include the assessment of other substances, especially alcohol. Early and comprehensive prevention efforts to reduce e-cigarette and other substance use could have a substantial beneficial impact on population health over time.

Implications

This study extends knowledge about e-cigarette use among adolescents by exploring its use with alcohol, cannabis, and other tobacco products. We found that e-cigarettes were very rarely used alone, and our analysis identified several sociodemographic factors associated with greater odds of e-cigarette polysubstance use. In response, we recommend that prevention interventions address multiple substances concurrently, screen repeatedly to detect new initiation as age increases, focus on e-cigarette use as a less stigmatized entry point to discussions of substance use, and target priority population subgroups.
Miocene Olivine Leucitites in the Hoh Xil Basin, Northern Tibet: Implications for Intracontinental Lithosphere Melting and Surface Uplift of the Tibetan Plateau
Authors: Qi Yue , Wang Qiang , Zhu Ying-Tang , Shi Lian-Chang , Yang Ya-Nan
Published: February 2020

The generation of Miocene–Pliocene post-collisional magmatic rocks in northern Tibet was coeval with surface uplift, meaning that understanding the petrogenesis of these rocks should provide clues to the mechanism of uplift of the Tibetan Plateau. However, the nature of the source(s) of Miocene–Pliocene post-collisional rocks is unresolved, especially for potassic–ultrapotassic rocks. This study focuses on 16 Ma olivine leucitites in the Hoh Xil Basin of northern Tibet, which display the lowest SiO2 (43·4–48·8 wt%) contents of all Miocene–Pliocene magmatic rocks in northern Tibet and have high MgO (4·85–8·57 wt%) contents and high K2O/Na2O (>1) ratios. Whole-rock geochemical compositions suggest that the olivine leucitites did not undergo significant fractional crystallization or crustal assimilation. All samples are enriched in large ion lithophile elements relative to high field strength elements, and they exhibit uniform whole-rock Sr–Nd isotope [(87Sr/86Sr)i = 0·7071–0·7077 and εNd(t) = −3·1 to −3·9] and olivine O isotope (5·8–6·6 ‰, mean of 6·2 ± 0·2 ‰, n = 21) compositions. We propose that the olivine leucitites were derived by low-degree partial melting of phlogopite-lherzolite in garnet-facies lithospheric mantle. Given the tectonic evolution of the Hoh Xil Basin and adjacent areas, we suggest that southward subduction of Asian (Qaidam block) lithosphere after India–Asia collision transferred potassium and other incompatible elements into the lithospheric mantle, forming the K-enriched mantle source of the Miocene–Pliocene potassic–ultrapotassic rocks. Removal of lower lithospheric mantle subsequently induced voluminous Miocene–Pliocene magmatism and generated >1 km surface uplift in the Hoh Xil Basin.
GATE MODELING OF LATERAL SCATTERING OF PROTON PENCIL BEAMS
Authors: Zarifi Shiva , Ahangari Hadi Taleshi , Jia Sayyed Bijan , Tajik-Mansoury Mohammad Ali , Najafzadeh Milad
Published: February 2020

To validate the GATE Monte Carlo simulation code and to investigate the lateral scattering of proton pencil beams in the major body tissue elements in the therapeutic energy range. In this study, GATE Monte Carlo simulation code was used to compute absorbed dose and fluence of protons in a water cubic phantom for the clinical energy range. To apply the suitable physics model for simulation, different physics lists were investigated. The present research also investigated the optimal value of the water ionization potential as a simulation parameter. Thereafter, the lateral beam profile of proton pencil beams were simulated at different energies and depths in body tissue elements. The range results obtained using the QGSP_BIC_EMY physics showed the best compatibility with the NIST database data. Moreover, it was found that the 76 eV is the optimal value for the water ionization potential. In the next step, it was shown that the beam halo can be described by adding a supplementary Gaussian function to the standard single-Gaussian model, which currently is used by treatment planning systems (TPS).
Secondary Analysis of Pain Outcomes in a Large Pragmatic Randomized Trial of Buprenorphine/Naloxone Versus Methadone for Opioid Use Disorder
Authors: Shulman Matisyahu , Luo Sean X. , Campbell Aimee N. C. , Scodes Jennifer , Pavlicova Martina , Broffman Andi , Saxon Andrew J. , Nunes Edward V.
Published: February 2020

Objective:

Opioid use disorder (OUD) is associated with chronic pain. We investigated the association between medication treatments for OUD and pain in a post-hoc secondary analysis of a randomized trial of methadone versus buprenorphine/naloxone.

Methods:

1241 individuals with OUD participated in an open label, pragmatic randomized trial of methadone versus buprenorphine/naloxone in nine treatment programs licensed to dispense agonist medication for OUD between 2006 to 2009. In this post-hoc analysis, pain was dichotomized (present or not present) using responses from the Short Form-36. Logistic regression models were fit to test the effect of (1) having baseline pain on week 24 retention, (2) treatment assignment on improvement in pain among those reporting pain at baseline, and (3) pain improvement at week 4 on week 24 retention among those reporting pain at baseline.

Results:

Almost half (48.2%) of the sample reported pain at baseline. Participants with baseline pain did not significantly differ in week 24 retention compared to those without baseline pain. Among those reporting pain at baseline, there was no significant difference between treatment arms in improvement of pain at week 4, but improvement in pain at week 4 was associated with significantly greater odds of being retained at week 24 (OR [95% CI] = 1.76 [1.10, 2.82], P = 0.020).

Conclusion and Relevance:

In this large multisite randomized trial of medication treatments for OUD, nearly half of the participants reported pain at baseline, and improvement in pain early in treatment was associated with increased likelihood of retention in treatment.
A Nomogram and a Risk Classification System Predicting the Cancer-Specific Survival of Patients With Initially-Diagnosed Osseous Spinal and Pelvic Tumors
Authors: Zhou Qiang , Li A-bing , Lin Zhong-qin , Zhang Hong-zhen
Published: February 2020

Study Design.

Retrospective analysis.

Objective.

Our goal was to provide a predictive model and a risk classification system that predicts cancer-specific survival (CSS) from spinal and pelvic tumors.

Summary of Background Data.

Primary bone tumors of the spinal and pelvic are rare, thus limiting the understanding of the manifestations and survival from these tumors. Nomograms are the graphical representation of mathematical relationships or laws that accurately predict individual survival.

Methods.

A total of 1033 patients with spinal and pelvic bone tumors between 2004 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate Cox analysis was used on the training set to select significant predictors to build a nomogram that predicted 3- and 5-year CSS. We validate the precision of the nomogram by discrimination and calibration, and the clinical value of nomogram was assessed by making use of a decision curve analyses (DCA).

Results.

Data from 1033 patients with initially-diagnosed spinal and pelvic tumors were extracted from the SEER database. Multivariate analysis of the training cohort, predictors included in the nomogram were age, pathological type, tumor stage, and surgery. The value of C-index was 0.711 and 0.743 for the internal and external validation sets, respectively, indicating good agreement with actual CSS. The internal and external calibration curves revealed good correlation of CSS between the actual observation and the nomogram. Then, the DCA showed greater net benefits than that of treat-all or treat-none at all time points. A novel risk grouping system was established for CSS that can readily divide all patients into three distinct risk groups.

Conclusion.

The proposed nomogram obtained more precision prognostic prediction for patients with initially-diagnosed primary spinal and pelvic tumors.

Level of Evidence: 3
Outcomes and cost of lung cancer patients treated surgically or medically in Catalunya: cost–benefit implications for lung cancer screening programs
Authors: Guzman Rudith , Guirao Àngela , Vela Emili , Clèries Montserrat , García-Altés Anna , Sagarra Joan , Magem David , Espinas Josep A. , Grau Jaume , Nadal Cristina , Agusti Àlvar , Molins Laureano
Published: February 2020

Lung cancer screening programs with computed tomography of the chest reduce mortality by more than 20%. Yet, they have not been implemented widely because of logistic and cost implications. Here, we sought to: (1) use real-life data to compare the outcomes and cost of lung cancer patients with treated medically or surgically in our region and (2) from this data, estimate the cost–benefit ratio of a lung cancer screening program (CRIBAR) soon to be deployed in our region (Catalunya, Spain). We accessed the Catalan Health Surveillance System (CHSS) and analysed data of all patients with a first diagnosis of lung cancer between 1 January 2014 and 31 December 2016. Analysis was carried forward until 30 months (t = 30) after lung cancer diagnosis. Main results showed that: (1) surgically treated lung cancer patients have better survival and return earlier to regular home activities, use less healthcare related resources and cost less tax-payer money and (2) depending on incidence of lung cancer identified and treated in the program (1–2%), the return on investment for CRIBAR is expected to break even at 3–6 years, respectively, after its launch. Surgical treatment of lung cancer is cheaper and offers better outcomes. CRIBAR is estimated to be cost-effective soon after launch.
REAL-COLOR VERSUS PSEUDO-COLOR IMAGING OF FIBROTIC SCARS IN EXUDATIVE AGE-RELATED MACULAR DEGENERATION
Authors: De Rosa Irene , Ohayon Avi , Semoun Oudy , Miere Alexandra , Jung Camille , Capuano Vittorio , Cirafici Paola , Souied Eric H.
Published: February 2020

Purpose:

To compare the morphological characteristics of subretinal fibrosis in late age-related macular degeneration using multicolor (MC) imaging, color fundus photography (CFP), and ultra-widefield CFP (UWFCFP).

Methods:

Thirty-two eyes of 31 patients diagnosed with subretinal fibrosis complicating exudative age-related macular degeneration were included. Included eyes were imaged by MC, CFP, and UWFCFP. The overall ability to visualize fibrosis, its margins, and dissimilarity with surrounding atrophy was graded using a score (0: not visible, 1: barely visible, 2: mostly visible, and 3: fully visible) by two readers. Area of fibrosis was calculated. Scaling, lesion colocalization on all three imaging techniques, and area measurements were performed using ImageJ.

Results:

Ninety-six images of 32 eyes were graded. The average area of fibrosis was 14.59 ± 8.94 mm2 for MC, 13.84 ± 8.56 mm2 for CFP, and 13.76 ± 8.79 mm2 for UWFCFP. Fibrosis was fully visible in 87.5% of cases using MC and 50% using CFP and UWFCFP. Fibrosis' margins were sharply defined in 40.6% of eyes with MC, 15.6% and 9.4% with CFP and UWFCFP, respectively. Multicolor imaging provided superior distinction between fibrosis and atrophy (100% for MC vs. 13.4% for CFP and 33.3% for UWFCFP). The inter- and intra-reader agreement was high for all measurements (P < 0.0001).

Conclusion:

Multicolor technology allows for improved visualization and analysis of subretinal fibrosis when compared with CFP and UWFCFP, especially when surrounding atrophy is present.
Recovery from nerve injury induced behavioral hypersensitivity in rats parallels resolution of abnormal primary sensory afferent signaling
Authors: Boada M. Danilo , Martin Thomas J. , Parker Renee , Houle Timothy T. , Eisenach James C. , Ririe Douglas G.
Published: February 2020

Pain and hypersensitivity months after peripheral injury reflect abnormal input from peripheral afferents likely in conjunction with central sensitization. We hypothesize that peripheral changes occur in defined sensory afferents and resolve as behavioral response to injury resolves. Male Sprague–Dawley rats underwent sham or partial L5 spinal nerve ligation, and paw withdrawal threshold (PWT) was sequentially measured during recovery. At 2, 4, 8, and 12 weeks after injury, randomized animals underwent electrophysiologic assessment of L4 fast-conducting high- and low-threshold mechanoreceptors, and individual neuronal mechanical thresholds (MTs) were contrasted with PWTs in the same animals. Paw withdrawal thresholds decreased after injury and resolved over time (P < 0.001). Similarly, MTs of fast-conducting high-threshold mechanoreceptors decreased after injury and resolved over time (P < 0.001). By contrast, MTs of low-threshold mechanoreceptors increased after injury and resolved over time (P < 0.001). Distributions of recordings from each afferent subtype were perturbed after injury, and this too resolved over time. After resolution of behavioral changes, several electrical abnormalities persisted in both neuronal subtypes. These data extend previous findings that mechanically sensitive nociceptors are sensitized, whereas tactile, largely Aβ afferents are desensitized after nerve injury by showing that the time course of resolution of these changes mirrors that of behavioral hypersensitivity in a surgical injury including neural damage. These data support a role of abnormal peripheral input, from both nociceptor and tactile afferents, during recovery from peripheral injury and underscore the potential importance of both classes of afferents as potential targets for pain treatment.
Improving attitudes toward poverty among DNP students: Implementing a Community Action Poverty Simulation©
Authors: Ehmke Melissa , Sanner-Stiehr Ericka
Published: February 2020

Poverty has detrimental effects on health outcomes. Doctorally prepared nurse practitioners are in a position to promote health for patients and communities experiencing poverty. To do so, they must be aware of their own attitudes and to have empathy toward the condition of poverty. Specialized poverty simulations have been successfully used to improve attitudes toward poverty among prelicensure nursing students, but there is a paucity of evidence exploring the effects of poverty simulations among Students in a Doctor of Nurse Practice (DNP) program. The purpose of this study was to evaluate the impact of a poverty simulation for students enrolled in a DNP program on their attitudes toward poverty. A quasi-experimental, pre-test and post-test survey design was used in this curriculum improvement project. A total of 29 DNP students participated in a 1-time, 4-hour Community Action Poverty Simulation© (CAPS). The simulations presented various challenges faced during 1 month of living in poverty. The Attitudes toward Poverty Scale-Short Form (ATPS-SF) was used to measure attitudes toward poverty both before and after the CAPS© experience. Descriptive statistics and paired t-tests were used to describe the participant group and measure the impact of the simulation on attitudes toward poverty. Attitudes toward poverty improved overall on all dimensions of the ATPS-SF after the CAPS© experience as compared to the pre-test, with particular improvement regarding stigmas related to poverty. Statistically significant improvements were detected on four items, and the overall favorable shift in attitudes presents clinically significant results. This poverty simulation experience should be considered for adoption into DNP curricula.
Bundling Rapid Human Immunodeficiency Virus and Hepatitis C Virus Testing to Increase Receipt of Test Results
Authors: Frimpong Jemima A. , Shiu-Yee Karen , Tross Susan , D’Aunno Thomas , Perlman David C. , Strauss Shiela M. , Schackman Bruce R. , Feaster Daniel J. , Metsch Lisa R.
Published: February 2020

Background:

The overlapping human immunodeficiency virus (HIV) and hepatitis C virus (HCV) epidemics disproportionately affect people with substance use disorders. However, many people who use substances remain unaware of their infection(s).

Objective:

The objective of this study was to examine the efficacy of an on-site bundled rapid HIV and HCV testing strategy in increasing receipt of both HIV and HCV test results.

Research Design:

Two-armed randomized controlled trial in substance use disorder treatment programs (SUDTP) in New York City. Participants in the treatment arm were offered bundled rapid HIV and HCV tests with immediate results on-site. Participants in the control arm were offered the standard of care, that is, referrals to on-site or off-site laboratory-based HIV and HCV testing with delayed results.

Participants:

A total of 162 clients with unknown or negative HIV and HCV status.

Measures:

The primary outcome was the percentage of participants with self-reported receipt of HIV and HCV test results at 1-month postrandomization.

Results:

Over half of participants were Hispanic (51.2%), with 25.3% being non-Hispanic black and 17.9% non-Hispanic white. Two thirds were male, and 54.9% reported injection as method of drug use. One hundred thirty-four participants (82.7%) completed the 1-month assessment. Participants in the treatment arm were more likely to report having received both test results than those in the control arm (69% vs. 19%, P<0.001). Seven participants in the treatment arm received a preliminary new HCV diagnosis, versus 1 in the control arm (P=0.029).

Conclusion:

Offering bundled rapid HIV and HCV testing with immediate results on-site in SUDTPs may increase awareness of HIV and HCV infection among people with substance use disorders.
Collaborations and Connections
Authors: Caufield Courtnay , Marken-George Sandy , Mattioni Colleen , Hancock Beverly
Published: February 2020

In 2019, American Organization for Nursing Leadership (AONL) instructed its 1st cohort of Nurse Executive Fellowship participants in response to a need in the field to support nurses new to executive positions. This aligns with the AONL mission to shape healthcare through innovative and expert nursing leadership.
Black Feminist Thought
Authors: Armour-Burton Teri , Etland Caroline
Published: February 2020

Background

African American women (AAW) are diagnosed with more aggressive forms of breast cancer when compared to White women and are more likely to die before the age of 45 years. Researchers have suggested that psychological stress could be a precursor to breast cancer. AAW experience a unique form of stress that is a result of living at the intersection of socially constructed roles of race, gender, and class (intersectionality). No studies have used the paradigm of Black Feminist Thought to examine breast cancer disparities among AAW.

Objective

The purpose of this study was to examine how the intersection of race, gender, and class influences mental and physiological well-being among AAW with breast cancer.

Methods

A phenomenological design was used. Ten AAW ages 45–60 years were recruited from across the United States. Semistructured interviews were conducted and analyzed using a modified Husserlian approach of descriptive phenomenology. The interviews were audiotaped and transcribed verbatim, and themes were identified using Giorgi’s method.

Results

Four themes emerged: (a) altruism (selfless giving and caring for others), (b) silent strength (strength in silence while enduring life in the intersection), (c) existential invisibility (an essential, obscured presence in society), and (d) marginalization (living at the margins of society). Marginalization manifested in two forms: (a) passive marginalization (circumstances in which women removed themselves mentally or physically from societal adversity) and (b) active marginalization (circumstances in which women were overlooked, devalued, or ostracized by others).

Discussion

This study supports the use of Black Feminist Thought to garner knowledge that adds to the discussion of breast cancer disparities. The themes identified suggest other upstream psychosocial risk factors for the development of breast cancer in AAW that stem from life within the societal intersection.
The State of Burn Care Training During Plastic Surgery Residency
Authors: Vrouwe Sebastian Q. , Pham Christopher H. , Minasian Raquel A. , Yenikomshian Haig A. , Garner Warren L. , Gillenwater T. Justin
Published: February 2020

Introduction

There is an ongoing shortage of burn specialists, and workforce reports suggest possible hurdles attracting plastic surgeons into burn care. The purpose of this study was to (1) determine the state of burn care in plastic surgery residency and (2) identify what barriers might exist for plastic surgeons pursuing a practice that involves burn care.

Methods

Surveys were distributed to North American plastic surgery program directors and residents, respectively, during the 2018–2019 academic year.

Results

Fifty-eight program directors (response, 54%) and 320 plastic surgery residents (response, 30%) participated. Burn care was felt to be an important component in training by most program directors (USA, 88%; Canada, 100%) and residents (USA, 87%; Canada, 99%). The majority of program directors included a burn unit rotation (USA, 88%; Canada, 90%). Rotations for integrated residents averaged 2.5 months and most commonly occurred during second year; independent residents spent 1.2 months on rotation, usually in first year. Three-quarters of American residents were interested in a career that involves burn care in some capacity, primarily burn reconstruction (40%). Factors that would discourage a trainee from practicing burn care in the future included the nature of burn care (60%) and burn operations (45%), the on-call commitment (39%), and a narrow scope of practice (38%).

Discussion

This study challenges the belief that plastic surgery trainees are disinterested in burn care. Burn surgery remains an important component of training programs, and we propose several steps to encourage greater interest and participation in the burn surgery workforce.
Plastic Surgery Patient Expectations for Postoperative Opioid Prescriptions
Authors: Long Emily A. , Johnson Shepard P. , Valmadrid Al , Wormer Blair A. , Drolet Brian C. , Perdikis Galen
Published: February 2020

Background

The opioid epidemic is a healthcare crisis perpetuated by analgesic overprescribing. Despite public health attention on this issue, expectations for pain management and opioid use by plastic surgery patients are poorly understood. This study aimed to evaluate patient expectations of postoperative pain, concern for opioid dependence, and anticipated analgesic plan after plastic surgery.

Methods

New patients presenting to an academic plastic surgery clinic were prospectively enrolled from November 2017 to September 2018. These patients completed a preconsultation survey regarding their pain history and anticipated postoperative pain and analgesics regimens. Responses between cohorts expecting and not expecting postoperative opioids were compared using descriptive and univariate analyses.

Results

A total of 168 patients (63.9% female, 36.1% male; mean ± SD age 46 ± 17 years) completed the survey before breast (21.9%), cosmetic (5.3%), craniofacial (3.0%), general reconstruction (13.0%), hand (3.0%), and skin and soft tissue (49.1%) surgeries. Twenty-eight percent of patients expected opioid prescriptions. On a standard visual analog scale, patients who expected opioids anticipated greater postoperative pain (6.9 vs 4.6, P < 0.05). They were more concerned about experiencing pain (5.8 vs 4.9, P < 0.05), expected a longer duration of opioid use (63.0% vs 37.0%, P < 0.05), and were less interested in nonnarcotic analgesic alternatives (57.9% vs 19.8%, P < 0.05).

Conclusions

Less than one-third of plastic surgery patients in this study expect opioid pain medications after surgery. This supports broader use of nonopioid, multimodal pain regimens. Identification and management of patient pain expectations, especially among those anticipating a need for opioids, provide a critical opportunity for preoperative education on the benefits of nonopioid analgesics, thus minimizing opiate prescribing.
Immediate Latissimus Dorsi and Prosthetic Reconstruction in the Setting of Postmastectomy Radiation
Authors: Chiasson Katherine F. , Kumbla Pallavi A. , Restrepo Ryan D. , Soto Edgar , Cohn Alvin B.
Published: February 2020

Background

In immediate breast reconstruction, the plastic surgeon must strive to create an aesthetically pleasing result while minimizing complications. The latissimus dorsi (LD) myocutaneous flap has long been used a workhorse flap in breast reconstruction. Often times, it is used a salvage flap after other methods of breast reconstruction have failed. In this study, we review the use of this flap in conjunction with prosthetic devices, regardless of the need for adjuvant radiation, to determine the safety and efficacy of this approach as a primary method of reconstruction.

Methods

A single surgeon practice with a standardized reconstructive algorithm was reviewed. This compromises a 2-stage approach involving the use of LD myocutaneous flaps and tissue expanders for immediate reconstruction after mastectomy, followed by exchange for implants at a secondary surgery. A retrospective chart review was performed on 201 patients (376 breast reconstructions) who met inclusion criteria. Patient demographics and outcomes were compared based on radiation status. The primary outcome, reconstructive success, was defined as no need for further autologous reconstruction beyond the 2-stage approach utilized.

Results

Statistical analysis was performed on both patient demographics, complications, and reconstructive outcomes. Demographics were equivalent between the 2 groups. When analyzing complications and outcomes, there was no difference between nonradiated patients and radiated patients except when looking at reconstructive loss, which was 3.6% in the nonradiated group and 16.6% in the radiated group (P = 0.03). However, one third of the patients in the radiated group who had reconstructive losses were due to reasons not related to radiation therapy. Taking this into account, overall reconstructive success showed no statistical significance between the 2 groups.

Conclusions

The findings from this study show that immediate reconstruction with LD myocutaneous flaps in conjunction with prosthetic devices is a reliable and safe option, even in the setting of adjuvant radiation therapy, as the autologous tissue mitigates many sequelae of radiation therapy. Not only does this type of reconstruction provide an aesthetically pleasing result in 2 stages, but also has a favorable complication profile and success rate.
Shaping an Anatomical Breast Using Extended Latissimus Dorsi Flap and Lipofilling in Immediate Breast Reconstruction
Authors: Cha Han Gyu , Kwon Jin Geun , Kim Eun Key
Published: February 2020

Background

Although many attempts have been made to augment the volume of the latissimus dorsi (LD) myocutaneous flap in breast reconstruction, only a few studies on the shaping of the LD flap to achieve a natural native breast have been conducted. We introduce our novel method to reconstruct a naturally shaped breast by combining an extended LD myocutaneous flap with immediate lipofilling.

Methods

The patients who underwent an immediate unilateral breast reconstruction with an extended LD myocutaneous flap and lipofilling were retrospectively reviewed. The extended LD myocutaneous flap in 180-degree rotation was combined with an immediate lipofilling procedure followed by suturing to reproduce the constant dimensions of a neobreast.

Results

A total of 45 patients with a mean age of 46 years and an average body mass index of 23.1 kg/m2 were enrolled. The average weight of the mastectomy specimens was 299.0 g. An average 18.8 × 8.7-cm skin paddle within the flap was harvested, and 71.0 mL of fat was injected into the flap. Donor site seroma was found in 9 patients, and no flap or fat necrosis was found.

Conclusions

Our technique of extended LD muscle flap with lipofilling reproduced breasts with constant dimensions and appropriate width, height, and projection. Shaping the LD muscle flap is not difficult or unpredictable. This is a simple and easy technique to shape the LD flap and will provide surgeons with an additional autologous option for breast reconstruction.
Intracranial Pure Germinoma With Optic Nerve Infiltration
Authors: Cohen Devon A. , Bhatti M. Tariq , Giannini Caterina , Eckel Laurence J. , Garrity James A. , Chen John J.
Published: February 2020

A 19-year-old man presented with a 3-year history of episodic headaches, right hemiparesis, and progressive vision loss in both eyes. Initially, extensive laboratory testing was unrevealing. MRI later demonstrated progressive enlargement and enhancement of the left optic nerve poorly correlated with the timing of his clinical manifestations. There was no clinical or radiological response to treatment with corticosteroids, mycophenolate mofetil, or rituximab administered empirically for possible inflammatory processes. Later in the disease course, he developed diabetes insipidus (DI), worsening vision to light perception bilaterally, severe cognitive decline, and spastic quadriparesis. Cerebrospinal fluid (CSF) beta human chorionic gonadotropin (β-hCG) was elevated. Eventually, a left optic nerve biopsy was performed, which was consistent with an intracranial pure germinoma with infiltration of the optic nerve and disseminated leptomeningeal disease. Although rare, intracranial germ cell tumors can primarily involve the anterior visual pathways and should be considered in the setting of DI and elevated CSF β-hCG.
Deafferentation as a cause of hallucinations
Authors: Marschall Theresa M. , Brederoo Sanne G. , Ćurčić-Blake Branislava , Sommer Iris E.C.
Published: February 2020

Purpose of review

The association between hallucinations and sensory loss, especially vision- and hearing-impairment, has been firmly established over the past years. The deafferentation theory, a decrease of the threshold for activation in the brain and the consequential imbalance between excitatory and inhibitory brain networks, is hypothesized to underly this relationship. Here we review the studies investigating this theory with a focus on the most recent literature to better understand the contribution of sensory loss to hallucinations.

Recent findings

A large cross-sectional study has recently confirmed the relationship between auditory impairment and deafferentation. However, the underlying mechanisms of deafferentation are still under debate, with hyperexcitability and deviations in bottom-up and top-down processes being the most likely explanations. Social isolation following sensory impairment increases the risk for hallucinations. Better knowledge and awareness about the contribution of deafferentation and loneliness would benefit diagnosis and treatment of hallucinations.

Studies imply activity in higher order areas, corresponding to the functional mapping of sensory system, and a general state of higher excitability as neurobiological explanation. Auditory deafferentation, tinnitus and other auditory hallucinations, likely lie on a continuum. Social isolation mediates psychotic symptoms in sensory-impaired individuals. Currently, there is no standard treatment for deafferentation hallucinations.
A Case of Ischemic Stroke Incidental to the Postelectroconvulsive Therapy Period
Authors: Shahin Hazem , Livingston Robin
Published: February 2020

Electroconvulsive therapy (ECT) is a routine treatment for multiple psychiatric disorders including treatment-refractory mood and psychotic disorders. Although ECT is generally a safe and well-tolerated intervention, rare cerebrovascular and cardiovascular complications have been reported. The hemodynamic changes during the ECT seizure are well-recognized, with an initial parasympathetically mediated decrease in heart rate and blood pressure followed by a sympathetically mediated increase in these parameters. Despite intraoperative or postoperative blood pressure fluctuations, the risk of a hypertensive intracerebral bleed during ECT is very low and the risk of ischemic stroke after ECT appears to be even rarer. The authors present a case of a patient who developed an ischemic stroke after ECT treatment. Before stroke, the patient had been undergoing ECT routinely for over 2 years without alarming complications. Ischemic strokes are a rare but serious complication of ECT treatment.