bluuebunny/crossref_metadata_2025 huggingface dataset:
Monthly vitamin D supplementation, pain, and pattern of analgesic prescription: secondary analysis from the randomized, double-blind, placebo-controlled Vitamin D Assessment study
Authors: Wu Zhenqiang , Camargo Carlos A. , Malihi Zarintaj , Bartley Jim , Waayer Debbie , Lawes Carlene M.M. , Toop Les , Khaw Kay-Tee , Scragg Robert
Published: February 2018

Observational studies suggest that vitamin D deficiency is associated with higher risk of pain. However, evidence on the effect of vitamin D supplementation on pain is limited and contradictory. The aim of this study was to compare the effect of monthly high-dose vitamin D supplementation on a pain impact questionnaire (PIQ-6) score and prescription of analgesics in the general population. We performed a randomized, double-blind, placebo-controlled trial of 5108 community-dwelling participants, aged 50 to 84 years, who were randomly assigned to receive monthly 100,000-IU capsules of vitamin D3 (n = 2558) or placebo (n = 2550) for a median of 3.3 years. The PIQ-6 was administered at baseline, year 1, and final follow-up. Analgesic prescription data were collected from Ministry of Health. There was no difference in mean PIQ-6 score at the end of follow-up (adjusted mean difference: 0.06; P = 0.82) between the vitamin D (n = 2041) and placebo (n = 2014) participants. The proportion of participants dispensed one or more opioids was similar in the vitamin D group (n = 559, 21.9%) compared with placebo (n = 593, 23.3%); the relative risk (RR) adjusted for age, sex, and ethnicity was 0.94 (P = 0.24). Similar results were observed for dispensing of nonsteroidal anti-inflammatory drugs (RR = 0.94; P = 0.24) and other nonopioids (RR = 0.98; P = 0.34). Focusing on vitamin D deficient participants (<50 nmol/L, 24.9%), there was a lower risk of dispensing nonsteroidal anti-inflammatory drugs in the vitamin D group compared with placebo (RR = 0.87; P = 0.009); all other subgroup analyses were not significant. Long-term monthly high-dose vitamin D supplementation did not improve mean PIQ-6 score or reduce analgesic dispensing in the general population.
Comparison of Video Head Impulse Test in the Posterior Semicircular Canal Plane and Cervical Vestibular Evoked Myogenic Potential in Patients With Vestibular Neuritis
Authors: Park Jin Su , Kim Chang-Hee , Kim Min-Beom
Published: February 2018

Objective:

The purpose of this study was to evaluate and compare the results of cervical vestibular evoked myogenic potential (cVEMP) and video head impulse test (p-vHIT) of posterior semicircular canal considered tools of inferior vestibular nerve function in vestibular neuritis.

Study Design:

Prospective cohort study.

Setting:

Tertiary otology clinic.

Patients and Interventions:

Seventy-nine patients with vestibular neuritis participated in this study. We analyzed the interaural amplitude difference in cVEMP with a positive rate of p-vHIT according to gain and corrective saccade in the study population.

Main Outcome Measure:

To evaluate the concordance rate of both tests, we analyzed Fleiss’ Kappa value inter-test agreement of cVEMP with p-vHIT. Finally, we performed detailed analysis of the bilaterally absent response on cVEMP according to the p-vHIT results.

Results:

The inter-test agreement between cVEMP and p-vHIT was 69.8% as we also considered the lesion side. This result indicated a statistically fair to good agreement in both tests. In mostly elderly patients with a bilaterally absent response (11 patients) on cVEMP, as a result of vHIT, nine patients with a bilaterally negative response on p-vHIT showed only canal paresis. Two patients showed canal paresis and a unilaterally positive response on p-vHIT.

Conclusions:

Inter-test agreement between cVEMP and p-vHIT assessed in vestibular neuritis was relatively lower than we had predicted. Probably, p-vHIT can provide additional information on the differential diagnosis of dysfunction of the inferior vestibular nerve which is composed of the saccular nerve and the posterior ampullary nerve.
Changes in liver stiffness and steatosis among patients with hepatitis C virus infection who received direct-acting antiviral therapy and achieved sustained virological response
Authors: Kobayashi Natsuko , Iijima Hiroko , Tada Toshifumi , Kumada Takashi , Yoshida Masahiro , Aoki Tomoko , Nishimura Takashi , Nakano Chikage , Takata Ryo , Yoh Kazunori , Ishii Akio , Takashima Tomoyuki , Sakai Yoshiyuki , Aizawa Nobuhiro , Nishikawa Hiroki , Ikeda Naoto , Iwata Yoshinori , Enomoto Hirayuki , Hirota Seiichi , Fujimoto Jiro , Nishiguchi Shuhei
Published: February 2018

Aim

Whether direct-acting antiviral (DAA) therapy can reduce liver fibrosis and steatosis in patients with chronic hepatitis C virus (HCV) infection remains unclear. We evaluated sequential changes in liver stiffness and steatosis using transient elastography (TE) and the TE-based controlled attenuation parameter (CAP) in patients with HCV who received DAA therapy.

Patients and methods

A total of 57 patients with HCV who received DAA therapy and achieved sustained virological response (SVR) were analyzed. Liver stiffness as evaluated with TE, steatosis as evaluated with CAP, and laboratory data were assessed before treatment (baseline), at end of treatment (EOT), 24 weeks after EOT (SVR24), and 48 weeks after EOT (SVR48).

Results

Alanine aminotransferase levels, corresponding to the presence of necroinflammatory activity, significantly decreased overall, with significant differences between baseline and EOT, EOT, and SVR24, and baseline and SVR48. However, alanine aminotransferase levels showed no significant changes between SVR24 and SVR48. Median (interquartile range) liver stiffness values at baseline, EOT, SVR24, and SVR48 were 8.3 (5.0–14.8), 7.4 (4.6–14.7), 5.3 (4.1–11.8), and 5.4 (4.0–13.4) kPa, respectively (baseline vs. EOT, P=0.044; EOT vs. SVR24, P=0.011; and SVR24 vs. SVR48, P=0.054). In patients with fatty liver (CAP≥236 dB/m, n=14), CAP values at baseline and SVR48 were 253 (245–278) and 229 (209–249) dB/m, respectively (P=0.020).

Conclusion

Liver stiffness at SVR24 might reflect liver fibrosis in the patients who received DAA therapy and achieved SVR. In addition, liver steatosis reduces in the same cohort with fatty liver.
Factors Contributing to Phlebitis Among Adult Patients Admitted in the Medical-Surgical Units of a Central Hospital in Harare, Zimbabwe
Authors: Nyika Munashe Livion , Mukona Doreen , Zvinavashe Mathilda
Published: February 2018

This descriptive survey identified factors contributing to phlebitis among 46 adult inpatients using a systematic random sample. The visual infusion phlebitis score was used for assessment. All participants had phlebitis, with stage 4 being most frequent. Factors identified were gender (males—91.7%); immunosuppression (human immunodeficiency virus—63.0%; diabetes—100%; immunosuppressive drugs—100%; absolute leucocyte count <1000 μL—100%); number of catheters inserted (>1—90.9%); site of catheterization (dorsum of wrist—100%); catheter dwell time (2-4 days—100%); catheter gauge (18-gauge—75%); catheter securement (unsecured/contaminated dressing—90%); regularity of catheter flushing (catheter never flushed—72.7%); and continuous infusion (94.2%).
Optimizing Drug Delivery of Small-Volume Infusions
Authors: Thoele Kelli , Piddoubny Maria , Ednalino Ryan , Terry Colin L.
Published: February 2018

When administering intermittent secondary intravenous infusions, commonly referred to as intravenous piggyback (IVPB) infusions, residual medication remains in the administration set and bag. No previous studies exist examining the optimal technique to infuse the residual medication. The aims of this study were to identify various IVPB ancillary techniques used to administer medication residing in the secondary administration set and bag following an infusion, evaluate the potential drug loss associated with each technique, and recommend a standard ancillary technique for administration of select small-volume IVPB infusions. Qualitative and quantitative tests were performed, leading to a recommendation for a standard ancillary technique for select small-volume IVPB infusions.
Understanding Functional Communication in Head and Neck Cancer Survivors Using a Mixed Methods Design
Authors: Fletcher Barbara Swore , Schumacher Karen , Cohen Marlene Z. , Kupzyk Kevin , Lydiatt William
Published: February 2018

Background

Functional communication, defined as everyday communication with family and friends, at work, and in the community, is an important but understudied concept in the head and neck cancer (HNC) survivor population.

Objective

The aim of this study was to better understand functional communication by using a mixed methods approach.

Methods

Head and neck cancer survivors participated in semistructured interviews and completed self-report questionnaires assessing multiple aspects of well-being and health-related quality of life (HRQOL). These qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated.

Results

Survivors' perceptions of functional communication ranged from “Communication is good” to “Communication has changed” to “Communication is difficult.” Using these qualitative results, survivors were categorized into 3 mutually exclusive groups. Clinically meaningful cut points were exceeded on measures of depressive symptoms (18%), state (40%) and trait (54%) anxiety, and pain (18%). Health-related quality of life scores were moderate to high for the sample as a whole. Statistically significant group differences were found only on the HNC-specific measure of HRQOL. A surprising finding was that the lowest mean score on social function was in the “Communication has changed” group. This group perceived changes in speech and voice that bothered them when communicating in social situations, although their speech was clear to a listener.

Conclusion

An underrecognized subpopulation of HNC survivors may exist, whose day-to-day functional communication has changed in ways that impact their relationships and sense of self.

Implications for Practice

Clinical identification of this subpopulation and provision of appropriate interventions are essential to facilitate optimal HRQOL after HNC treatment.
Integrating Palliative Care at the Point of Care
Authors: Thirlwell Sarah , Mason Tina M. , Davis Donna , Machowski Tamara P.
Published: February 2018

Integration of palliative care (PC) in oncology requires changes in delivery and processes of care, such as implementation of comprehensive, evidence-based interdisciplinary plans of care (IPOCs). A multidisciplinary design team partnered with an electronic health record company and an information analytics company that specializes in online clinical practice guidelines. The team sought to develop electronic IPOCs that address the unique needs of oncology inpatients, attend to PC needs, and reflect the interdisciplinary team’s contribution to quality patient outcomes. Our cancer center had paper-based care plans that were not well integrated into workflow, did not represent comprehensive PC, did not reflect interdisciplinary care, and did not guide evidence-based practice at point of care. The team designed IPOCs to be incorporated into each discipline’s workflow and unique documentation and established clinical decision support tools to suggest appropriate IPOCs. Thirty-five IPOCs were developed and included all domains of quality PC. Evaluation of IPOC use indicated incomplete, but improving, adoption of PC-specific IPOCs with engagement in collaborative care planning by a variety of disciplines and across oncology nursing subspecialties.
Development of Nurse Practitioner Competencies for Advance Care Planning
Authors: Heale Roberta , Rietze Lori , Hill Laura , Roles Stacey
Published: February 2018

This article describes the development of nurse practitioner (NP) competencies for advance care planning. Nurse practitioners are well positioned to implement advance care planning with their patients; however, very few patients have an advance care plan. A modified Delphi method was used to engage NPs in achieving consensus for advance care planning competencies. In round 1, draft competencies were developed from the findings of a survey of NP beliefs, knowledge, and level of implementation of advance care planning. In round 2, 29 NPs participated in the evaluation of the draft competencies and their components. Revisions were made, and a final round was conducted where 15 of the original NP participants confirmed their consensus with the final document. The final document includes 4 competencies, each with several elements: (1) Clinical Practice, (2) Consultation and Communication, (3) Advocacy, and (4) Therapeutic Management. Advance care planning competencies will provide NPs with a guide that can be used to ensure that they are able to clearly identify their distinct role in advance care planning. These competencies may inform the integration of advance care planning in a variety of health care settings and with other health care providers.
The Coping and Support Needs of Incurable Cancer Patients
Authors: Viitala Anu , Saukkonen Marita , Lehto Juho T. , Palonen Mira , Åstedt-Kurki Päivi
Published: February 2018

The purposes of this study were to describe the coping processes and support needs of patients with incurable cancer. The study was conducted as a qualitative study. The research data were gathered by conducting thematic interviews with outpatients with incurable cancer (n = 16) and analyzed by means of inductive content analysis. The results of the study indicate that the lives of patients were temporarily interrupted by the incurable illness. A sympathetic family was perceived as strength, and after the initial shock, the patients began to rebuild their lives. They had conflicting thoughts about cancer treatment. The patients felt that they were courageous, but fragile, in the face of their illness. They prepared for the approaching death by discussing the issue with their family members and friends and planning their own palliative care. The patients expected to be approached holistically. The results of this study are applicable in circumstances in which health care professionals are preparing to approach an incurable cancer patient as an individual, instead of simply as a medical case. The results can also be utilized to develop evidence-based, family-oriented palliative nursing for cancer patients and to better identify the expectations and needs of the patients while receiving treatment.
Facial Behavior During an Attachment Interview in Patients With Complicated Grief
Authors: Gander Manuela , Schiestl Cathrin , Dahlbender Rainer , Ronel Joram , Buchheim Anna
Published: February 2018

The present study investigated differences in various aspects of facial behavior among female patients with complicated grief (CG; n = 18) and healthy controls (n = 18) during the assessment of their attachment representation using the Adult Attachment Projective Picture System. All patients were classified with an unresolved attachment status. On a behavioral level, they demonstrated longer gazing behavior away from the interviewer and the picture stimuli, more speech pauses, less smiling toward the interviewer, and more crying, especially in response to stimuli portraying the theme of loss. Focusing on the in-depth analysis of death-related stimuli using the Facial Action Coding System, patients demonstrated less facial affective behavior, less disgust, and less smiling in response to these stimuli compared with the healthy controls. The impaired capacity of patients with CG responding in an affective appropriate manner regarding bereavement might be interpreted as a specific emotion dysregulation when their attachment and mourning system is activated.
Preventive Antibiotics for Poststroke Infection in Patients With Acute Stroke
Authors: Han Xiaonian , Huang Jing , Jia Xiaotao , Peng Lirong , Yan Kangkang , Zan Xin , Ma Li
Published: February 2018

Aims:

To determine if preventive antibiotics is effective in poststroke infection in patients with acute stroke in comparison with no prophylaxis.

Materials and Methods:

MEDLINE (1950 to January 2017), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2017) and EMBASE (1974 to January 2017) databases were used to search for randomized controlled trials with intervening measures related to the preventive antibiotics in patients with acute stroke. Besides, the reference lists of the retrieved publications were manually searched to explore other relevant studies.

Results:

We included 6 randomized controlled trials involving 4110 stroke patients. The study population, study design, intervening measures, and definition of infection were different. Preventive antibiotics significantly reduced the incidence of algorithm-defined infection in patients with acute stroke from 11.14% (220/1975) to 7.43% (149/2006); odds ratio (OR)=0.41; 95% confidence interval (CI), 0.20-0.87; P=0.02. There was no difference in mortality between 2 groups, the mortality in preventive antibiotics group was 17.03% (347/2037) and control group was 16.10% (328/2037); OR=1.07; 95% CI, 0.90-1.27; P=0.44. And preventive antibiotics did not improve the proportion of good outcome, the proportion of good outcome in preventive antibiotics group was 45.47% (909/1999) and control group was 45.76% (913/1995); OR=0.89; 95% CI, 0.62-1.28; P=0.53. None of the studies reported severe adverse relevant to the study antibiotics.

Conclusions:

Preventive antibiotics significantly reduced the incidence of algorithm-defined infection in patients with acute stroke, but did not decrease the mortality or improve the proportion of good outcome. Future research should aim to identify the group of stroke patients who will benefit most from antibiotic prophylaxis.
Acute Basilar Artery Occlusion
Authors: Chiang Chia-Chun , Dumitrascu Oana M. , Wingerchuk Dean M. , O’Carroll Cumara B.
Published: February 2018

Background:

Acute basilar artery occlusion (BAO) is a devastating, life-threatening condition that accounts for approximately 1% of all strokes. Currently, there is no consensus on the best treatment strategy for patients with BAO. Whereas endovascular reperfusion therapy is proven to improve outcomes in anterior circulation stroke, its benefit in acute BAO has not been confirmed in randomized controlled trials.

Objective:

To critically assess the current evidence regarding recanalization in acute BAO, and to discuss the outcomes of different treatment strategies in the management of acute BAO.

Materials and Methods:

The objective was addressed through the development of a critically appraised topic that included a clinical scenario, structured question, literature search strategy, critical appraisal, assessment of results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, and content experts in the field of vascular and hospital neurology.

Results:

A recent meta-analysis was selected for critical appraisal to assess the recanalization hypothesis in acute BAO. The authors performed a systematic literature search through August 2013 and pooled in the analysis of 45 studies and 2056 patients. The overall recanalization rate was 75% in this meta-analysis. The authors concluded that recanalization was associated with a 1.5-fold reduction in the risk of death or dependency, and a 2-fold reduction in the risk of mortality. Subgroup analysis comparing different modes of intervention revealed data that favor endovascular intervention over intravenous thrombolysis (IVT). However, the authors were not able to obtain a statistically valid direct comparison of the 2 therapies as their meta-analysis included observational studies. Subgroup analysis on the treatment window revealed that onset-to-treatment time of <12 hours was associated with a higher recanalization rate (81%) and a lower intracranial hemorrhage rate (10%) compared with onset-to-treatment time >12 hours.

Conclusions:

IVT is the standard of care for BAO patients presenting within 4.5 hours of symptom onset, whereas recanalization is associated with better outcomes regardless of how recanalization is achieved. Randomized controlled trials comparing IVT plus endovascular treatment versus IVT in the treatment of acute BAO are needed to provide evidence-based management guidance.
Quantification of Iodine Concentration Using Single-Source Dual-Energy Computed Tomography in a Calf Liver
Authors: Agostini Andrea , Mahmood Usman , Erdi Yusuf , Borgheresi Alessandra , Ragucci Monica , Sawan Peter , Ryan Davinia , Laino Maria Elena , Corrias Giuseppe , Mannelli Lorenzo
Published: February 2018

Objective

To evaluate the accuracy of single-source dual-energy computed tomography (ssDECT) in iodine quantification using various segmentation methods in an ex vivo model.

Methods

Ten sausages, injected with variable quantities of iodinated contrast, were inserted into 2 livers and scanned with ssDECT. Material density iodine images were reconstructed. Three radiologists segmented each sausage. Iodine concentration, volume, and absolute quantity were measured. Agreement between the measured and injected iodine was assessed with the concordance correlation coefficient (CCC). Intrareader agreement was assessed using the intraclass correlation coefficient (ICC).

Results

Air bubbles were observed in sausage (IX). Sausage (X) was within the same view as hyper-attenuating markers used for localization. With IX and X excluded, CCC and ICC were greater than 0.98 and greater than 0.88. When included, CCC and ICC were greater than 0.94 and greater than 0.79.

Conclusions

Iodine quantification was reproducible and precise. However, accuracy reduced in sausages consisting of air filled cavities and within the same view as hyperattenuating markers.
The Ability of Dual-Energy Computed Tomography to Distinguish Normal Bone Marrow From Metastases Using Bone Marrow Color Maps
Authors: Issa Ghada , Davis Derik , Mulligan Michael E.
Published: February 2018

Objective

The objective of this study was to determine if dual-energy computed-tomography bone marrow color maps can improve sensitivity, specificity, accuracy, and confidence of detection of bone metastases.

Methods

Institutional review board approved this retrospective review of a consecutive series of cancer patients. Two radiologists first evaluated the fused 120 kV computed tomography images and recorded a number of suspicious lesions, confidence level, and Hounsfield units for each lesion. After a time gap, the studies were randomized for a second review with dual-energy computed-tomography bone marrow color maps.

Results

Eighteen patients and 1105 bones were reviewed. A total of 227 true metastatic lesions were present. With bone marrow color map review, sensitivity increased from 76.2% to 86.8%, for reader 1, and from 80.2% to 92.8%, for reader 2. Specificity and accuracy also increased. Confidence level increased for 12 lesions.

Conclusions

Dual-energy computed-tomography bone marrow color map analysis of patients with metastatic cancers can improve the sensitivity, specificity, accuracy, and confidence level for the detection of bone metastases.
Demystifying the “Triple Point:” Technical Nuances of the Fronto-Orbital Advancement
Authors: Lopez Christopher D. , Kumar Anand , Lin Alexander Y. , Bonfield Christopher M. , Weinzweig Jeffrey , Naidich Thomas , Smith Christopher M. , Taub Peter J.
Published: February 2018

Removal of the fronto-orbital bandeau is one of the most critical components for procedures designed to correct anomalies of the craniofacial skeleton and remodel the anterior calvarial vault. It is also used to improve exposure of the anterior cranial fossa. It is arguably one of the more difficult portions of some craniofacial procedures. While the technique for fronto-orbito-sphenoid osteotomy has been frequently described, it has only been minimally detailed. Separation of bone in this region remains challenging due to the bone thickness, adjacent vital structures, and limited direct visibility. The present paper describes the anatomy of this particular region, which the authors have termed the “triple point”, to facilitate successful osteotomy and avoid potential injury.
Adult Cranioplasty Reconstruction With Customized Cranial Implants: Preferred Technique, Timing, and Biomaterials
Authors: Wolff Amir , Santiago Gabriel F. , Belzberg Micah , Huggins Charity , Lim Michael , Weingart Jon , Anderson William , Coon Alex , Huang Judy , Brem Henry , Gordon Chad
Published: February 2018

Introduction:

Complex cranial defects requiring delayed reconstruction present numerous challenges. Delayed cranioplasties accompany frequent complications approaching an incidence of 35 to 40%. Therefore, the authors sought to collate their experience in hopes of sharing their perspective on several topics including technique, timing, and preferred biomaterials.

Methods:

The authors’ 5-year consecutive experience over 430 customized cranial implants is described herein. Since its inception in 2012, the authors’ team has employed the pericranial-onlay cranioplasty technique instead of the standard epidural approach. Optimal timing for cranioplasty is determined using objective criteria such as scalp healing and parenchymal edema, close collaboration with neuroplastic surgery, conversion from autologous bone to sterile implant in instances of questionable viability/storage, and the first-line use of solid poly(methylmethacrylate) implants for uncomplicated, delayed cases, first-line porous polyethylene (MEDPOR) implants for single-stage cranioplasty, and first-line polyether-ether-ketone implants for cases with short notice. Furthermore, the use of the pterional design algorithm with temporal bulking for all customized implants has helped to correct and/or prevent temporal hollowing deformities.

Results:

The authors’ team has observed a three-fold reduction in reported complications as compared with the existing literature, with a major complication rate of 11%. The multidisciplinary center has provided an optimal stage for synergy and improved outcomes versus standard cranioplasty techniques.

Conclusion:

Secondary cranial reconstruction, or cranioplasty, can be challenging due to numerous reasons. These best practices, developed in collaboration with neuroplastic surgery and neurosurgery, appear to encompass the largest published experience to date. The authors find this approach to be both safe and reliable.
Pain Management for Nonsyndromic Craniosynostosis: Adequate Analgesia in a Pediatric Cohort?
Authors: Kattail Deepa , Macmillan Alexandra , Musavi Leila , Pedreira Rachel , Faateh Muhammad , Cho Regina , Lopez Joseph , Dorafshar Amir H.
Published: February 2018

Background:

Postoperative pain following open craniosynostosis repair has not been studied extensively and is sometimes thought to be inconsequential. The purpose of this study was to assess postoperative pain in this pediatric population.

Methods:

We performed a retrospective chart review of patients (n = 54) undergoing primary open craniosynostosis repair from 2010 to 2016. Demographics, length of stay (LOS), pain scores, emesis events, and perioperative analgesics were reviewed. Multivariable regression models were designed to assess for independent predictors of LOS and emesis.

Results:

A high proportion had moderate to severe pain on postoperative day 0 (56.5%) and day 1 (60.9%). Opioid administered in postoperative period was 1.40 mg/kg/d in morphine milligram equivalent (MME) (±1.07 mg/kg/d MME). Majority of patients transitioned to enteral opioids on postoperative day 1 (24.5%) or day 2 (49.1%). Ketorolac was administered to 11.1% (n = 6). Emesis was documented in 50% of patients. LOS revealed a positive association with age (P = 0.006), weight (P = 0.009), and day of transition to enteral opioids (P < 0.001); association with emesis was trending toward significance (P = 0.054). There was no association between overall LOS and amount of opioids administered postoperatively (P = 0.68). Postoperative emesis did not have any significant association with age, sex, weight, total amount of postoperative opioid administered, use of ketorolac, or intraoperative steroid use.

Conclusion:

Open craniosynostosis repair is associated with high levels of pain and low utilization of nonopioid analgesics. Strategies to improve pain, decrease emesis and LOS include implementation of multimodal analgesia period and avoidance of enteral medications in the first 24 hours after surgery.
Frontal Mucocele Extended Orbita and Endoscopic Marsupialization Technique
Authors: Erdogan Banu Atalay , Unlu Nazmiye , Aydin Sedat , Avci Hakan
Published: February 2018

Mucocele is benign, slow-growing, mucous-filled cystic lesions that arise in the paranasal sinuses. It causes progressive distension of the bony walls and induces compressive symptoms. Surgical treatment of paranasal sinus mucoceles includes endoscopic approach or external approach. The authors report a patient of frontal mucocele who presented with a history of progressive unilateral protrusion. Computed tomography scan revealed a large mucocele of the frontal sinus with orbital extension on the same side. He was successfully treated with endoscopic marsupialization without any serious complications.
Research in Nursing and Nutrition
Authors: Baldi Ileana , Soriani Nicola , Lorenzoni Giulia , Azzolina Danila , Dal Lago Elisa , De Bardi Sara , Verduci Elvira , Zanotti Renzo , Gregori Dario
Published: February 2018

The aim of this study was to assess the quality of reporting of nurse-driven randomized controlled trials involving a direct nutritional intervention. A bibliometric search for randomized controlled trials involving a direct nutritional intervention from 1991 to 2011 in nursing research was conducted. Both quality of the study and design aspects were evaluated. The prevalent randomized controlled trial design used is 2-arm parallel, individual, and randomized with a continuous primary endpoint. Global numbers of randomized controlled trials and the proportion of good-quality randomized controlled trials began a steady and marked rise, more than doubling, from the 1990s to about 2001 and increased slowly thereafter. Studies are overall sufficiently well designed, although there is still room for quality improvement. Additionally, implementation of new randomized controlled trial designs exists and should be advocated.
Hospital Variations in Clinical Complications and Patient-reported Outcomes at 2 Years After Immediate Breast Reconstruction
Authors: Berlin Nicholas L. , Tandon Vickram J. , Qi Ji , Kim Hyungjin M. , Hamill Jennifer B. , Momoh Adeyiza O. , Pusic Andrea L. , Wilkins Edwin G.
Published: February 2018

Objective:

Our objectives were to investigate case-mix adjusted hospital variations in 2-year clinical and patient-reported outcomes following immediate breast reconstruction.

Background:

Over the past few decades, variations in medical practice have been viewed as opportunities to promote best practices and high-value care.

Methods:

The Mastectomy Reconstruction Outcomes Consortium Study is an National Cancer Institute-funded longitudinal, prospective cohort study assessing clinical and patient-reported outcomes of immediate breast reconstruction after mastectomy at 11 leading medical centers. Case-mix adjusted comparisons were performed using generalized linear mixed-effects models to assess variation across the centers in any complication, major complications, satisfaction with outcome, and satisfaction with breast.

Results:

Among 2252 women in the analytic cohort, 1605 (71.3%) underwent implant-based and 647 (28.7%) underwent autologous breast reconstruction. There were significant differences in the sociodemographic and clinical characteristics, and distribution of procedure types at the different Mastectomy Reconstruction Outcomes Consortium Study centers. After case-mix adjustments, hospital variations in the rates of any and major postoperative complications were observed. Medical center odds ratios for major complication ranged from 0.58 to 2.13, compared with the average major complication rate across centers. There were also meaningful differences in satisfaction with outcome (from the lowest to highest of −2.79–2.62) and in satisfaction with breast (−2.82–2.07) compared with the average values.

Conclusions:

Two-year postoperative complications varied widely between hospitals following post-mastectomy breast reconstruction. These variations represent an important opportunity to improve care through dissemination of best practices and highlight the limitations of extrapolating single-institution level data and the ongoing challenges of studying hospital-based outcomes for this patient population.
Predictors of Opioid Administration in the Acute Postoperative Period
Authors: Willis-Gray Marcella G. , Husk Katherine E. , Brueseke Taylor J. , Wu Jennifer M. , Dieter Alexis A.
Published: February 2018

Objectives

Our primary objective was to evaluate age as a predictor of postanesthesia care unit (PACU) opioid administration in women undergoing reconstructive pelvic surgery. Our secondary objective was to identify additional predictors of PACU opioid administration.

Methods

We conducted a retrospective cohort study of women undergoing outpatient urogynecologic surgery for pelvic organ prolapse and/or stress urinary incontinence between September 2015 to October 2016 at 1 academic medical center. We compared 2 cohorts (1) women older than 65 years and (2) women older than 65 years. Our primary outcome was any opioid medication administered during the PACU admission.

Results

A total of 183 women were included in the study; 124 (68%) were younger than 65 years, and 59 (32%) were 65 years or older. For our primary outcome, women younger than 65 years were more likely to be given any opioids in PACU than women 65 years (70% vs 54%, P = 0.04, respectively). Women younger than 65 years were also given higher total amounts of opioid narcotics postoperatively (9.0 ± 8.3 vs 5.1 ± 6.0 mg, P < 0.05). For our secondary outcome, we found that PACU opioid administration was associated with midurethral sling (MUS) surgery (70% MUS vs 30% no MUS, P = 0.04) and high maximum PACU pain score (97% high vs 3% low, P < 0.01).

Conclusions

In women undergoing urogynecologic surgery, age younger than 65 years is a predictor of high PACU pain score and resultant PACU opioid dispensation. This population should be targeted in future studies addressing the use of nonopioid multimodal therapies in the treatment of postoperative pain.
Physico-chemical characteristics of evaporating respiratory fluid droplets
Authors: Vejerano Eric P. , Marr Linsey C.
Published: February 2018

The detailed physico-chemical characteristics of respiratory droplets in ambient air, where they are subject to evaporation, are poorly understood. Changes in the concentration and phase of major components in a droplet—salt (NaCl), protein (mucin) and surfactant (dipalmitoylphosphatidylcholine)—may affect the viability of any pathogens contained within it and thus may affect the efficiency of transmission of infectious disease by droplets and aerosols. The objective of this study is to investigate the effect of relative humidity (RH) on the physico-chemical characteristics of evaporating droplets of model respiratory fluids. We labelled these components in model respiratory fluids and observed evaporating droplets suspended on a superhydrophobic surface using optical and fluorescence microscopy. When exposed to continuously decreasing RH, droplets of different model respiratory fluids assumed different morphologies. Loss of water induced phase separation as well as indication of a decrease in pH. The presence of surfactant inhibited the rapid rehydration of the non-volatile components. An enveloped virus,
ϕ
6, that has been proposed as a surrogate for influenza virus appeared to be homogeneously distributed throughout the dried droplet. We hypothesize that the increasing acidity and salinity in evaporating respiratory droplets may affect the structure of the virus, although at low enough RH, crystallization of the droplet components may eliminate their harmful effects.
Gene expression differs in susceptible and resistant amphibians exposed to
Batrachochytrium dendrobatidis
Authors: Eskew Evan A. , Shock Barbara C. , LaDouceur Elise E. B. , Keel Kevin , Miller Michael R. , Foley Janet E. , Todd Brian D.
Published: February 2018

Chytridiomycosis, the disease caused by the fungal pathogen
Batrachochytrium dendrobatidis
(
Bd
), has devastated global amphibian biodiversity. Nevertheless, some hosts avoid disease after
Bd
exposure even as others experience near-complete extirpation. It remains unclear whether the amphibian adaptive immune system plays a role in
Bd
defence. Here, we describe gene expression in two host species—one susceptible to chytridiomycosis and one resistant—following exposure to two
Bd
isolates that differ in virulence. Susceptible wood frogs (
Rana sylvatica
) had high infection loads and mortality when exposed to the more virulent
Bd
isolate but lower infection loads and no fatal disease when exposed to the less virulent isolate. Resistant American bullfrogs (
R. catesbeiana
) had high survival across treatments and rapidly cleared
Bd
infection or avoided infection entirely. We found widespread upregulation of adaptive immune genes and downregulation of important metabolic and cellular maintenance components in wood frogs after
Bd
exposure, whereas American bullfrogs showed little gene expression change and no evidence of an adaptive immune response. Wood frog responses suggest that adaptive immune defences may be ineffective against virulent
Bd
isolates that can cause rapid physiological dysfunction. By contrast, American bullfrogs exhibited robust resistance to
Bd
that is likely attributable, at least in part, to their continued upkeep of metabolic and skin integrity pathways as well as greater antimicrobial peptide expression compared to wood frogs, regardless of exposure. Greater understanding of these defences will ultimately help conservationists manage chytridiomycosis.
Complexity of possibly gapped histogram and analysis of histogram
Authors: Fushing Hsieh , Roy Tania
Published: February 2018

We demonstrate that gaps and distributional patterns embedded within real-valued measurements are inseparable biological and mechanistic information contents of the system. Such patterns are discovered through data-driven possibly gapped histogram, which further leads to the geometry-based analysis of histogram (ANOHT). Constructing a possibly gapped histogram is a complex problem of statistical mechanics due to the ensemble of candidate histograms being captured by a two-layer Ising model. This construction is also a distinctive problem of Information Theory from the perspective of data compression via uniformity. By defining a Hamiltonian (or energy) as a sum of total coding lengths of boundaries and total decoding errors within bins, this issue of computing the minimum energy macroscopic states is surprisingly resolved by applying the hierarchical clustering algorithm. Thus, a possibly gapped histogram corresponds to a macro-state. And then the first phase of ANOHT is developed for simultaneous comparison of multiple treatments, while the second phase of ANOHT is developed based on classical empirical process theory for a tree-geometry that can check the authenticity of branches of the treatment tree. The well-knownIrisdata are used to illustrate our technical developments. Also, a large baseball pitching dataset and a heavily right-censored divorce data are analysed to showcase the existential gaps and utilities of ANOHT.
Fluorescent component and complexation mechanism of extracellular polymeric substances during dye wastewater biotreatment by anaerobic granular sludge
Authors: Li Na , Wei Dong , Sun Qunqun , Han Xiao , Du Bin , Wei Qin
Published: February 2018

In this study, methylene blue (MB) wastewater was biotreated by anaerobic granular sludge (AnGS), and the fluorescent components of extracellular polymeric substances (EPS) and complexation mechanism were evaluated. Based on the experimental data, the sorption of MB by both live and inactivated AnGS followed the pseudo-second-order model, and the adsorption isotherm conformed well to the Langmuir model. It was shown that the difference in the sorption of live and inactivated AnGS was not significant, indicating that the sorption is mainly a physical–chemical process and metabolically mediated diffusion is negligible. The interaction between EPS and MB was proved by three-dimensional excitation–emission matrix (3D-EEM) and synchronous fluorescence spectra. 3D-EEM indicated that protein (PN)-like substances were the main peaks of EPS, and gradually quenched with increase of MB concentrations. According to synchronous fluorescence spectra, the main fluorescence quenching was caused by PN-like and humic-like fractions, and belonged to the static type of quenching. FTIR spectra demonstrated that hydroxyl and amino groups played a major role in MB sorption.
Numerical simulation of the free surface and water inflow of a slope, considering the nonlinear flow properties of gravel layers: a case study
Authors: Yang Bin , Yang Tianhong , Xu Zenghe , Liu Honglei , Shi Wenhao , Yang Xin
Published: February 2018

Groundwater is an important factor of slope stability, and 90% of slope failures are related to the influence of groundwater. In the past, free surface calculations and the prediction of water inflow were based on Darcy's law. However, Darcy's law for steady fluid flow is a special case of non-Darcy flow, and many types of non-Darcy flows occur in practical engineering applications. In this paper, based on the experimental results of laboratory water seepage tests, the seepage state of each soil layer in the open-pit slope of the Yanshan Iron Mine, China, were determined, and the seepage parameters were obtained. The seepage behaviour in the silt layer, fine sand layer, silty clay layer and gravelly clay layer followed the traditional Darcy law, while the gravel layers showed clear nonlinear characteristics. The permeability increases exponentially and the non-Darcy coefficient decreases exponentially with an increase in porosity, and the relation among the permeability, the porosity and the non-Darcy coefficient is investigated. A coupled mathematical model is established for two flow fields, on the basis of Darcy flow in the low-permeability layers and Forchheimer flow in the high-permeability layers. In addition, the effect of the seepage in the slope on the transition from Darcy flow to Forchheimer flow was considered. Then, a numerical simulation was conducted by using finite-element software (FELAC 2.2). The results indicate that the free surface calculated by the Darcy–Forchheimer model is in good agreement with the
in situ
measurements; however, there is an evident deviation of the simulation results from the measured data when the Darcy model is used. Through a parameter sensitivity analysis of the gravel layers, it can be found that the height of the overflow point and the water inflow calculated by the Darcy–Forchheimer model are consistently less than those of the Darcy model, and the discrepancy between these two models increases as the permeability increases. The necessity of adopting the Darcy–Forchheimer model was explained. The Darcy–Forchheimer model would be applicable in slope engineering applications with highly permeable rock.
Repeatable aversion across threat types is linked with life-history traits but is dependent on how aversion is measured
Authors: Davidson Gabrielle L. , Reichert Michael S. , Crane Jodie M. S. , O'Shea William , Quinn John L.
Published: February 2018

Personality research suggests that individual differences in risk aversion may be explained by links with life-history variation. However, few empirical studies examine whether repeatable differences in risk avoidance behaviour covary with life-history traits among individuals in natural populations, or how these links vary depending on the context and the way risk aversion is measured. We measured two different risk avoidance behaviours (latency to enter the nest and inspection time) in wild great tits (Parus major) in two different contexts—response to a novel object and to a predator cue placed at the nest-box during incubation---and related these behaviours to female reproductive success and condition. Females responded equally strongly to both stimuli, and although both behaviours were repeatable, they did not correlate. Latency to enter was negatively related to body condition and the number of offspring fledged. By contrast, inspection time was directly explained by whether incubating females had been flushed from the nest before the trial began. Thus, our inferences on the relationship between risk aversion and fitness depend on how risk aversion was measured. Our results highlight the limitations of drawing conclusions about the relevance of single measures of a personality trait such as risk aversion.
A dislocation-based model for twin growth within and across grains
Authors: Lloyd J. T.
Published: February 2018

A computational method is presented for representing twins via two-dimensional dislocation statics in an isotropic elastic solid. The method is compared with analytical approximations of twin shape and is used to study how twins evolve within grains subjected to an arbitrary external shear stress. Twin transfer across grains is then studied using the same computational method. The dislocation-based model for twin growth gives the following dependencies: twin thickness increases linearly with grain size and external stress, and increases substantially as the grain is able to traverse multiple grain boundaries with low misorientation angles; the model also predicts that twin transfer becomes less prominent across grain boundaries with high misorientation angles. These predictions are consistent with experimentally measured extension twin growth in magnesium polycrystals. This study suggests that representing twins via discrete dislocations provides a physically reasonable approximation of twinning that can be naturally incorporated into existing dislocation statics and dynamics codes.
Meta-analysis reveals weak associations between intrinsic state and personality
Authors: Niemelä Petri T. , Dingemanse Niels J.
Published: February 2018

Individual differences in behaviour characterize humans and animals alike. A hot field in behavioural ecology asks why this variation in ‘personality’ evolved. Theory posits that selection favours the integration of ‘intrinsic state’ and behaviour. Metabolism, hormones, energetic reserves and structural size have particularly been proposed as states covarying with behaviour among-individuals, either genetically or through plasticity integration. We conducted a meta-analysis estimating the amount of among-individual variation in behaviour attributable to variation in state. Our literature search showed that only 22% of the studies claiming to estimate individual-level associations between state and behaviour actually did so. Our meta-analysis revealed that relatively aggressive, bold, explorative and/or active individuals had relatively high metabolic rates, hormone levels, body weights and/or body sizes. The proportion of among-individual variation common to state and behaviour was nevertheless small (approx. 5%). This means that (i) adaptive explanations involving intrinsic states fail to explain much individual variation in behaviour, (ii) empiricists should consider nonlinear, additive or interactive effects of (multiple) intrinsic states, (iii) explanations not involving intrinsic states might be important, or (iv) empirical tests of state-dependent personality theory were inappropriate. Our meta-analysis highlights the importance of feedback between empiricists and theoreticians in the study of adaptive behavioural variation.