bluuebunny/crossref_metadata_2025 huggingface dataset:
Courting Legitimacy: Enregistering Legal Reasoning among US Criminal Trial Jurors
Authors: Culver Katherine
Published: May 2017

This article discusses how law is produced semiotically as a category of social action through a study of jury decision making and the production of jury verdicts. In the US criminal justice system, citizens called for jury duty are interpellated as jurors and instructed in legal reasoning through encounters with a variety of texts. Jurors respond to the state’s hailing by producing themselves as competent jurors who can reason according to specifically legal forms of objectivity that may diverge from their everyday assessments of facts in reaching verdicts: for example, they can find a defendant legally “not guilty” while maintaining a belief in the defendant’s guilt. In ethnographic data discussed in this article, jurors affirm their competence as legal reasoners via the “enregisterment” of a style of reasoning that they link indexically to the constitutionally enshrined ideal of “impartiality.” In so doing, jurors recontextualize a style of reasoning, grounded in a logic of a “moralized objectivity of self-restraint” (Daston and Galison 1992), entextualized in the texts used to instruct them in legal reasoning during the trial process. Tracing these processes of enregisterment illustrates how legitimacy of law is semiotically mediated.
Silence Propaganda: A Semiotic Inquiry into the Ideologies of Taciturnity
Authors: Leone Massimo
Published: May 2017

Societies should be analyzed not only from the point of view of what they talk about but also from the point of view of what they are quiet about. Areas of silence in the semiosphere vary across cultures and history and stem from a complex interaction of historical circumstances and social agencies. Implicit norms of taciturnity are often codified into explicit legal frameworks, whose enforcement, though, substantially relies on state and government propaganda. Citizens must interiorize as a second nature the ideology of taciturnity that leads them not to share any content about certain topics. This mechanism of hegemonic silencing is macroscopically visible in times of war, when national interests solidify into specific rhetorics of taciturnity. This article is a comparative analysis of World War II silence propaganda. However, in times of relative peace both autocratic regimes and democratic states also need areas of silence and secrecy to pattern public discourse. Understanding how the creation of collective silence takes place is essential in an increasingly interconnected and global society in which limits to free disclosure and communication often give rise to tensions and conflicts.
Posting as a Form of Storytelling: The Sociolinguistic Analysis of a Sample of Pregnancy Narratives on Facebook
Authors: Massa Eleonora , Simeoni Valentina
Published: May 2017

Based on the cultural and linguistic analysis of a sample of posts written on Facebook by twenty Italian mothers-to-be, this article discusses the practice of online posting as a form of storytelling, this being considered one of the privileged human ways of processing and assigning a meaning to experiences by weaving them into plots and formulas. Facebook is defined as a narrative device that promotes not only the production of user-generated content but also its framing according to typical narrative patterns. Pregnancy is a beloved theme on Facebook because it lends itself to a reiterated formulation in the form of a personal story. Developed against the specific background of the Italian sociocultural context, a narratological consideration of the sample identifies the most recurrent plots through which pregnant women shape and share the phases of their experience, stressing both their similarities to, and differences from, offline stories of pregnancy. A closer look at the semiotic and rhetorical dimension of the posts finally allows us to explore the continuous interplay between verbal and visual codes and the semantic fields exploited to tell about pregnancy on Facebook. The combination of these two analytical perspectives in the study of online pregnancy narratives constitutes the theoretical and methodological purpose of this article.
Languages in Contact, Cultures in Contact: Verbal and Iconic Visual Signs in Mother Tongue and Culture as Mediators in Teaching English as a Foreign Language
Authors: Zafiri Makrina , Kourdis Evangelos
Published: May 2017

Interlingual translation, intersemiotic translation, and mediation seem to be the main means by which students who are learning English as a foreign language in Greece connect the learning of English as a foreign language and Greek as a mother tongue. This research probes into the teaching of English in Greek state schools and more specifically the teaching of English, as a foreign language, in the first year of junior high school. The research attempts to evaluate the authors’ choices of visual iconic messages that promote the Greek culture and language, the students’ mother tongue, as a means of mediation—mostly through interlingual translation—to familiarize them with the target language and culture, namely, the English language and culture. The fact that the visual iconic and verbal signs under scrutiny are all derived from a textbook published by the Greek Ministry of Education, Research and Religious Affairs gives more significance to the specific signs (thus legitimizing them).
A non-PI minimal system is Li-Yorke sensitive
Authors: Shao Song , Ye Xiangdong
Published: May 2017

It is shown that any non-PI minimal system is Li-Yorke sensitive. Consequently, any minimal system with non-trivial weakly mixing factor (such a system is non-PI) is Li-Yorke sensitive, which answers affirmatively an open question by Akin and Kolyada in [Nonlinearity, 16 (2003) pp. 1421–1433].
Groups with locally modular homogeneous pregeometries are commutative
Authors: Haykazyan Levon
Published: May 2017

It is well known that strongly minimal groups are commutative. Whether this is true for various generalisations of strong minimality has been asked in several different settings. In this note we show that the answer is positive for groups with locally modular homogeneous pregeometries.
A calculus proof of the Cramér–Wold theorem
Authors: Lyons Russell , Zumbrun Kevin
Published: May 2017

We present a short, elementary proof not involving Fourier transforms of the theorem of Cramér and Wold that a Borel probability measure is determined by its values on half-spaces.
Harmonic mappings of bounded boundary rotation
Authors: Bshouty D. , Lyzzaik A. , Sakar F.
Published: May 2017

The purpose of this paper is to investigate the valency of planar harmonic mappings of bounded boundary rotation of the open unit disc

D

.

\mathbb {D}.

The paper is motivated by the earlier work of the first two authors [Complex Analysis Oper. Theory 5 (2011), 767–774] and the recent work of T. Hayami [Complex Var. Elliptic Equ. 59 (2014), 1214–1222].

First, the authors give a counterexample showing that both the main result of Hayami, Theorem 2.1, and the related conjecture, Conjecture 4.1, are false. Second, the authors give a valency criterion for planar harmonic mappings of bounded boundary rotation of

D

\mathbb {D}

, proving an ameliorated statement of Theorem 2.1 and settling a modified version of Conjecture 4.1.
A new look at Bernoulli’s inequality
Authors: Ferreira Rui
Published: May 2017

In this work, a generalization of the well-known Bernoulli inequality is obtained by using the theory of discrete fractional calculus. As far as we know our approach is novel.
ℤ₂ⁿ-graded quasialgebras and the Hurwitz problem on compositions of quadratic forms
Authors: Hu Ya-Qing , Huang Hua-Lin , Zhang Chi
Published: May 2017

We introduce a series of

Z

2
n

\mathbb {Z}_2^n

-graded quasialgebras

P

n

(
m
)

\mathbb {P}_n(m)

which generalizes Clifford algebras, higher octonions, and higher Cayley algebras. The constructed series of algebras and their minor perturbations are applied to contribute explicit solutions to the Hurwitz problem on compositions of quadratic forms. In particular, we provide explicit expressions of the well-known Hurwitz-Radon square identities in a uniform way, recover the Yuzvinsky-Lam-Smith formulas, confirm the third family of admissible triples proposed by Yuzvinsky in 1984, improve the two infinite families of solutions obtained recently by Lenzhen, Morier-Genoud and Ovsienko, and construct several new infinite families of solutions.
Mechanical regulation of cardiac fibroblast profibrotic phenotypes
Authors: Herum Kate M. , Choppe Jonas , Kumar Aditya , Engler Adam J. , McCulloch Andrew D.
Published: May 2017

Cardiac fibrosis is a serious condition currently lacking effective treatments. It occurs as a result of cardiac fibroblast (CFB) activation and differentiation into myofibroblasts, characterized by proliferation, extracellular matrix (ECM) production and stiffening, and contraction due to the expression of smooth muscle α-actin. The mechanical properties of myocardium change regionally and over time after myocardial infarction (MI). Although mechanical cues are known to activate CFBs, it is unclear which specific mechanical stimuli regulate which specific phenotypic trait; thus we investigated these relationships using three in vitro models of CFB mechanical activation and found that 1) paracrine signaling from stretched cardiomyocytes induces CFB proliferation under mechanical conditions similar to those of the infarct border region; 2) direct stretch of CFBs mimicking the mechanical environment of the infarct region induces a synthetic phenotype with elevated ECM production; and 3) progressive matrix stiffening, modeling the mechanical effects of infarct scar maturation, causes smooth muscle α-actin fiber formation, up-regulation of collagen I, and down-regulation of collagen III. These findings suggest that myocyte stretch, fibroblast stretch, and matrix stiffening following MI may separately regulate different profibrotic traits of activated CFBs.
Antihypertensive Adherence Trajectories Among Older Adults in the First Year After Initiation of Therapy
Authors: Hargrove Jennifer L , Pate Virginia , Casteel Carri H , Golightly Yvonne M , Loehr Laura R , Marshall Stephen W , Stürmer Til
Published: May 2017

BACKGROUND

Adherence to antihypertensives is suboptimal, but previous methods of quantifying adherence fail to account for varying patterns of use over time. We sought to improve classification of antihypertensive adherence using group-based trajectory models, and to determine whether individual factors predict adherence trajectories.

METHODS

We identified older adults initiating antihypertensive therapy during 2008–2011 using a 20% sample of Medicare (federal health insurance available to US residents over the age of 65) beneficiaries enrolled in parts A (inpatient services), B (outpatient services), and D (prescription medication). We developed monthly adherence indicators using prescription fill dates and days supply data in the 12 months following initiation. Adherence was defined as having at least 80% of days covered. Logistic models were used to identify trajectory groups. Bayesian information criterion and trajectory group size were used to select the optimal trajectory model. We compared the distribution of covariates across trajectory groups using multivariable logistic regression.

RESULTS

During 2008–2011, 282,520 Medicare beneficiaries initiated antihypertensive therapy (mean age 75 years, 60% women, 84% White). Six trajectories were identified ranging from perfect adherence (12-month adherence of 0.97, 40% of beneficiaries) to immediate stopping (12-month adherence of 0.10, 18% of beneficiaries). The strongest predictors of nonadherence were initiation with a single antihypertensive class (adjusted odds ratio = 2.08 (95% confidence interval: 2.00–2.13)), Hispanic (2.93 (2.75–3.11)) or Black race/ethnicity (2.04 (1.95–2.13)), and no prior history of hypertension (2.04 (2.00–2.08)) (Area under the receiving operating characteristic curve: 0.53).

CONCLUSIONS

There is substantial variation in antihypertensive adherence among older adults. Certain patient characteristics are likely determinants of antihypertensive adherence trajectories.
Exploring spatially adjacent TFBS-clustered regions with Hi-C data
Authors: Chen Hebing , Jiang Shuai , Zhang Zhuo , Li Hao , Lu Yiming , Bo Xiaochen
Published: May 2017

Motivation

Transcription factor binding sites (TFBSs) are clustered in the human genome, forming the TFBS-clustered regions that regulate gene transcription, which requires dynamic chromatin configurations between promoters and distal regulatory elements. Here, we propose a regulatory model called spatially adjacent TFBS-clustered regions (SATs), in which TFBS-clustered regions are connected by spatial proximity as identified by high-resolution Hi-C data.

Results

TFBS-clustered regions forming SATs appeared less frequently in gene promoters than did isolated TFBS-clustered regions, whereas SATs as a whole appeared more frequently. These observations indicate that multiple distal TFBS-clustered regions combined to form SATs to regulate genes. Further examination confirmed that a substantial portion of genes regulated by SATs were located between the paired TFBS-clustered regions instead of the downstream. We reconstructed the chromosomal conformation of the H1 human embryonic stem cell line using the ShRec3D algorithm and proposed the SAT regulatory model.

Supplementary information

Supplementary data are available at Bioinformatics online.
modlAMP: Python for antimicrobial peptides
Authors: Müller Alex T , Gabernet Gisela , Hiss Jan A , Schneider Gisbert
Published: May 2017

We have implemented the molecular design laboratory’s antimicrobial peptides package (modlAMP), a Python-based software package for the design, classification and visual representation of peptide data. modlAMP offers functions for molecular descriptor calculation and the retrieval of amino acid sequences from public or local sequence databases, and provides instant access to precompiled datasets for machine learning. The package also contains methods for the analysis and representation of circular dichroism spectra.

Availability and Implementation

The modlAMP Python package is available under the BSD license from URL http://doi.org/10.5905/ethz-1007-72 or via pip from the Python Package Index (PyPI).

Supplementary information

Supplementary data are available at Bioinformatics online.
KMC 3: counting and manipulating k-mer statistics
Authors: Kokot Marek , Długosz Maciej , Deorowicz Sebastian
Published: May 2017

Counting all k-mers in a given dataset is a standard procedure in many bioinformatics applications. We introduce KMC3, a significant improvement of the former KMC2 algorithm together with KMC tools for manipulating k-mer databases. Usefulness of the tools is shown on a few real problems.

Availability and implementation

Program is freely available at http://sun.aei.polsl.pl/REFRESH/kmc.

Supplementary information

Supplementary data are available at Bioinformatics online.
Neuropsychology Outcomes Following Trephine Epilepsy Surgery: The Inferior Temporal Gyrus Approach for Amygdalohippocampectomy in Medically Refractory Mesial Temporal Lobe Epilepsy
Authors: Schoenberg Mike R , Clifton William E , Sever Ryan W , Vale Fernando L
Published: May 2017

BACKGROUND

Surgery is indicated in cases of mesial temporal lobe epilepsy(MTLE) that are refractory to medical management. The inferior temporal gyrus (ITG) approach provides access to the mesial temporal lobe (MTL) structures with minimal tissue disruption. Reported neuropsychology outcomes following this approach are limited.

OBJECTIVE

To report neuropsychological outcomes using an ITG approach to amygdalohippocampectomy (AH) in patients with medically refractory MTLE based on a prospective design.

METHODS

Fifty-four participants had Engel class I/II outcome following resection of MTL using the ITG approach. All participants had localization-related epilepsy confirmed by long-term surface video-electroencephalography and completed pre/postsurgical evaluations that included magnetic resonance imaging (MRI), Wada test or functional MRI, and neuropsychology assessment.

RESULTS

Clinical semiology/video-electroencephalography indicated that of the 54 patients, 28 (52%) had left MTLE and 26 (48%) had right MTLE. Dominant hemisphere resections were performed on 23 patients (43%), nondominant on 31(57%). Twenty-nine (29) had pathology-confirmed mesial temporal sclerosis (MTS). Group level analyses found declines in verbal memory for patients with language-dominant resections (P < .05). No significant decline in neuropsychological measures occurred for patients with MTS. Participants without MTS who underwent a language-dominant lobe resection exhibited a significant decline in verbal and visual memory (P < .05). Nondominant resection participants did not exhibit significant change in neuropsychology scores (P > .05).

CONCLUSION

Neuropsychology outcomes of an ITG approach for selective mesial temporal resection are comparable to other selective AH techniques showing minimal adverse cognitive effects. These data lend support to the ITG approach for selective AH as an option for MTLE.
Ophthalmic Complications Following Acoustic Neuroma Resection
Authors: Gange William S , Kirchner Ian D , Thompson John A , Hill Jacquelyn , Grahnke Kurt , Ibrahim Tarik , Leonetti John P , Anderson Douglas E , Bouchard Charles S
Published: May 2017

BACKGROUND

Past studies have shown high rates of ocular complications with the need for ophthalmic surgery following acoustic neuroma resection (ANR).

OBJECTIVE

To determine the rates of ophthalmic complications, referrals, and surgery following ANR, and the factors associated with poor outcomes.

METHODS

A retrospective study of ophthalmic outcomes in patients who underwent ANR was conducted, following institutional review board approval. Surgical approach, tumor size, tumor characteristics, completeness of resection, postoperative House-Brackmann grades, ocular complications, referrals to ophthalmology, and ophthalmic treatments were recorded.

RESULTS

Between 2007 and 2012, 174 patients underwent ANR. There were 3 surgical groups: retrosigmoid (n = 97), translabyrinthine (n = 59), and combined retrosigmoid and translabyrinthine (n = 18). Median tumor size was 2.2 cm. Postoperatively, 30% of patients had facial nerve dysfunction (House-Brackmann ≥3), which recovered to 19% by 1 mo and 8.6% by 1 yr following ANR. Fifty-six (32.9%) patients experienced ocular complications postoperatively, with lagophthalmos, dry eye, and blurry vision as the most common complications. Thirty-six (67.9%) of the patients who required ophthalmic treatment were managed nonsurgically, with just 13 (7.6%) patients requiring referral to an ophthalmologist. In total, only 9 (5.3%) patients received an ophthalmic procedure. Patients with tumors >2 cm, those undergoing combined retrosigmoid and translabyrinthine resection, and those with severe facial nerve dysfunction which did not improve in the first month following surgery were more likely to have poor ophthalmic outcomes.

CONCLUSION

We present lower rates of ophthalmic complications following ANR than previously reported. Improved surgical technique, better postoperative eye care, and facial nerve monitoring most likely accounted for the improved ocular outcomes.
Landmarks for Identifying the Suprascapular Foramen Anteriorly: Application to Anterior Neurotization and Decompressive Procedures
Authors: Manouvakhova Olga V , Macchi Veronica , Fries Fabian N , Loukas Marios , De Caro Raffaele , Oskouian Rod J , Spinner Robert J , Tubbs R Shane
Published: May 2017

BACKGROUND

Additional landmarks for identifying the suprascapular nerve at its entrance into the suprascapular foramen from an anterior approach would be useful to the surgeon.

OBJECTIVE

To identify landmarks for the identification of this hidden site within an anterior approach.

METHODS

In 8 adult cadavers (16 sides), lines were used to connect the superior angle of the scapula, the acromion, and the coracoid process tip thus creating an anatomic triangle. The suprascapular nerve's entrance into the suprascapular foramen was documented regarding its position within this anatomical triangle. Depths from the skin surface and specifically from the medial-most point of the clavicular attachment of the trapezius to the suprascapular nerve's entrance into the suprascapular foramen were measured using calipers and a ruler. The clavicle was then fractured and retracted superiorly to verify the position of the nerve's entrance into the suprascapular foramen.

RESULTS

From the trapezius, the nerve's entrance into the foramen was 3 to 4.2 cm deep (mean, 3.5 cm). The mean distance from the tip of the corocoid process to the suprascapular foramen was 3.8 cm. The angle best used to approach the suprascapular foramen from the surface was 15° to 20°.

CONCLUSION

Based on our study, an anterior suprascapular approach to the suprascapular nerve as it enters the suprascapular foramen can identify the most medial fibers of the trapezius attachment onto the clavicle and insert a finger at an angle of 15° to 20° laterally and advanced to an average depth of 3.5 cm.
A gapA PCR-sequencing Assay for Identifying the Dickeya and Pectobacterium Potato Pathogens
Authors: Cigna Jérémy , Dewaegeneire Pauline , Beury Amélie , Gobert Virginie , Faure Denis
Published: May 2017

Several pectinolytic Pectobacterium and Dickeya species and subspecies are causative agents of blackleg and soft rot diseases on potato plants and tubers. Rapid and accurate identification of these taxa is a crucial issue for the production and international trade of potato seed-tubers. Here, we developed a PCR-sequencing tool to easily characterize the different Pectobacterium and Dickeya taxa. The gapA gene sequences from 53 published genomes were aligned and a phylogeny tree was constructed. A set of 35 signature nucleotides was discovered to distinguish the Pectobacterium and Dickeya genera, species, and subspecies. Then, a PCR-primer couple was designed for amplifying the gapA gene in pectinolytic enterobacteria. The primers were tested on 22 isolates recovered from blackleg symptoms in several potato fields. Amplicons were sequenced and signature-nucleotides were analyzed. A phylogeny that includes gapA sequence specimens confirmed the taxonomical identification of these environmental isolates.
Creating an “Education Shark Tank” to Encourage and Support Educational Scholarship and Innovation
Authors: Cofrancesco Joseph , Wright Scott M. , Vohr Eric , Ziegelstein Roy C.
Published: May 2017

Problem

Creating and supporting opportunities for innovation that showcase and reward creativity in medical and biomedical education is critically important for academic institutions, learners, and faculty.

Approach

In 2014, the Institute for Excellence in Education at Johns Hopkins University School of Medicine created a small grant program called Education Shark Tank, in which two to five finalist teams present their proposals on innovative initiatives to improve education to four or five senior educator “sharks” at an educational conference, with an audience. The sharks then “grill” the presenters, considering which if any to fund, focusing on the rationale, feasibility, appropriateness of the outcome measures, evaluation and assessment plan, and proposed method of dissemination. They also make suggestions that challenge the presenters to assess and improve their designs.

Outcomes

In the program’s first year (2014), funds were divided equally between two projects, both of which were successfully completed and one of which led to a journal publication; this led to increased funding for the program in 2015. Participants have called Education Shark Tank a “challenging and rewarding experience.”

Next Steps

Education Shark Tank can facilitate educational innovation and scholarship via engaging and challenging interactions between grant applicants and reviewers in a public venue. The authors plan to conduct a five-year survey (after 2018) of all Education Shark Tank finalists to determine the success and challenges the funded projects have had, what scholarly dissemination has occurred, whether nonfunded projects were able to move forward, and the value of the feedback and mentoring received.
Well-Being in Graduate Medical Education: A Call for Action
Authors: Ripp Jonathan A. , Privitera Michael R. , West Colin P. , Leiter Richard , Logio Lia , Shapiro Jo , Bazari Hasan
Published: May 2017

Job burnout is highly prevalent in graduate medical trainees. Numerous demands and stressors drive the development of burnout in this population, leading to significant and potentially tragic consequences, not only for trainees but also for the patients and communities they serve. The literature on interventions to reduce resident burnout is limited but suggests that both individual- and system-level approaches are effective. Work hours limitations and mindfulness training are each likely to have modest benefit. Despite concerns that physician trainee wellness programs might be costly, attention to physician wellness may lead to important benefits such as greater patient satisfaction, long-term physician satisfaction, and increased physician productivity. A collaborative of medical educators, academic leaders, and researchers recently formed with the goal of improving trainee well-being and mitigating burnout. Its first task is outlining this framework of initial recommendations in a call to action. These recommendations are made at the national, hospital, program, and nonwork levels and are meant to inform stakeholders who have taken up the charge to address trainee well-being. Regulatory bodies and health care systems need to be accountable for the well-being of trainees under their supervision and drive an enforceable mandate to programs under their charge. Programs and individuals should develop and engage in a “menu” of wellness options to reach a variety of learners and standardize the effort to ameliorate burnout. The impact of these multilevel changes will promote a culture where trainees can learn in settings that will sustain them over the course of their careers.
Vertically Oriented Femoral Neck Fractures: A Biomechanical Comparison of 3 Fixation Constructs
Authors: Johnson Joey P. , Borenstein Todd R. , Waryasz Gregory R. , Klinge Stephen A. , McClure Philip K. , Chambers Alison B. , Hayda Roman A. , Born Christopher T.
Published: May 2017

Objectives:

To compare the static and dynamic mechanical properties of a modified crossed cannulated screw (CS) configuration, the inverted triangle (IT) cannulated screw configuration, and a compression hip screw (CHS) with derotation screw in Pauwels type III femoral neck fractures.

Methods:

Thirty synthetic femora were divided into 3 groups, and vertical femoral neck osteotomies were made. Ten osteotomized femora were fixed with a CS configuration, 10 were fixed with 3 parallel screws in an IT configuration, and the remaining 10 osteotomized femora were fixed with a CHS construct. All groups were tested using a cyclic (up to 15,000 load cycles) axial loading protocol, and survivors were statically loaded to failure. Cycles to failure, load to failure, and stiffness were calculated. The Kaplan–Meier method was used to estimate survival functions and were compared among fixation methods. The relationship between construct structural properties (maximum load and stiffness) and treatment were assessed using general linear modeling.

Results:

All CHS fixation constructs survived the 15,000 cycle loading protocol. They endured longer (P = 0.034) than the CS fixation constructs (mean failure 13,332 cycles), but were not different from IT fixation constructs (mean failure 13,592 cycles). Maximum loads to failure for CS (3870 N) and IT (3756 N) fixation constructs were not different, but were less (P < 0.0001) than the maximum loads to failure for the CHS fixation constructs (5654 N). These findings parallel the results of the axial stiffness measurements: CS fixation constructs (663.01 N/mm) were not stiffer than IT fixation constructs (620.0 N/mm), but were less (P = 0.0005) than the axial stiffness of the CHS fixation constructs (1241.86 N/mm).

Conclusions:

The biomechanical performance of the CHS fixation method was superior to both the CS fixation method and the IT fixation method using a synthetic femoral model and this test protocol. Biomechanical performance of the latter 2 groups was indistinguishable. We recommend the use of CHS with the derotational screw construct for Pauwels III femoral neck fractures whenever possible.
Does Provisional Plating of Closed Tibia Fractures Have Higher Complication Rates?
Authors: Haller Justin M. , Githens Michael , Scolaro John , Firoozabadi Reza
Published: May 2017

Objectives:

To compare infection and nonunion rates after provisional plating (PP) with standard reduction (SR) techniques for closed tibia fractures treated with an intramedullary nail.

Design:

Retrospective comparative study.

Setting:

Level 1 academic trauma center.

Patients/Participants:

Of the 348 closed tibia fractures (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen 42) treated using an intramedullary nail from January 2007 through June 2015, 231 (40 PP and 191 SR) patients met inclusion/exclusion criteria.

Intervention:

The patients received either a provisional plate or an SR before intramedullary nail placement.

Main Outcome Measurement:

Infection and nonunion.

Results:

The PP cohort had a significantly higher proportion of high-energy injury mechanism and a significantly higher proportion of diabetes than the SR cohort. We were unable to demonstrate a difference in rates of infection [PP cohort (1/40, 2.5%) vs. SR cohort (6/191, 3.1%), P = 1.0], nonunion [PP cohort (3/40, 7.5%) vs. SR cohort (9/191, 4.7%), P = 0.44], or malunion [PP cohort (0/40, 0%) vs. SR cohort (8/191, 4.2%), P = 0.36]. Symptomatic implant removal was similar between the 2 groups [PP cohort (4/40, 10%) vs. SR cohort (27/191, 14%), P = 0.61].

Conclusion:

PP can be used for complex, closed tibia fractures without an increased risk of infection, nonunion, and malunion compared with standard closed reduction techniques.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Medial Clamp Tine Positioning Affects Ankle Syndesmosis Malreduction
Authors: Cosgrove Christopher T. , Putnam Sara M. , Cherney Steven M. , Ricci William M. , Spraggs-Hughes Amanda , McAndrew Christopher M. , Gardner Michael J.
Published: May 2017

Objectives:

To determine whether the position of the medial clamp tine during syndesmotic reduction affected reduction accuracy.

Design:

Prospective cohort.

Setting:

Urban Level 1 trauma center.

Patients:

Seventy-two patients with operatively treated syndesmotic injuries.

Intervention:

Patients underwent operative fixation of their ankle syndesmotic injuries using reduction forceps. The position of the medial clamp tine was then recorded with intraoperative fluoroscopy. Malreduction rates were then assessed with bilateral ankle computerized tomography.

Main Outcome Measurement:

Fibular position within the incisura was measured with respect to the uninjured side to determine whether a malreduction had occurred. Malreductions were then analyzed for associations with injury pattern, patient demographics, and the location of the medial clamp tine.

Results:

A statistically significant association was found between medial clamp position and sagittal plane syndesmosis malreduction. In reference to anterior fibular translation, there was a 0% malreduction rate in the 18 patients where the clamp tine was placed in the anterior third, a 19.4% malreduction rate in the middle third, and 60% malreduction rate in the posterior third (P = 0.006). In reference to posterior fibular translation, there was a 11.1% malreduction when clamp placement was in the anterior third, a 16.1% malreduction rate in the middle third, and 60% malreduction rate in the posterior third (P = 0.062). There were no significant associations between medial clamp position and coronal plane malreductions (overcompression or undercompression) (P = 1).

Conclusions:

When using reduction forceps for syndesmotic reduction, the position of the medial clamp tine can be highly variable. The angle created with off-axis syndesmotic clamping is likely a major culprit in iatrogenic malreduction. Sagittal plane malreduction appears to be highly sensitive to clamp obliquity, which is directly related to the medial clamp tine placement. Based on these data, we recommend placing the medial clamp tine in the anterior third of the tibial line on the lateral view to minimize malreduction risk.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Spectrum of Diagnosis and Disposition of Patients Referred to a Pediatric Orthopaedic Center for a Diagnosis of Intoeing
Authors: Faulks Shawne , Brown Kaitlyn , Birch John G.
Published: May 2017

Background:

Orthopaedic surgeons frequently evaluate otherwise healthy children for concern of intoed gait. Intoeing in otherwise healthy young children due to metatarsus adductus, internal tibial torsion, and increased femoral anteversion do not typically require orthopaedic treatment. This study reviewed the actual diagnosis, management, and disposition of patients referred to a pediatric orthopaedic specialty hospital for a diagnosis of intoeing; the efficacy of an Advanced Practice Provider (APP) assessment program to screen and triage patients with a primary complaint of intoeing; and parental satisfaction with that program.

Methods:

We established an “Intoeing Clinic” conducted by APPs to conduct initial evaluations of patients referred for a diagnosis of intoeing meeting-specific criteria, including (1) a referring provider’s diagnosis of “intoeing”; (2) the patient was under the age of 9 years; and (3) there was no suggestion of comorbidity in the information provided by the referring provider to imply a diagnosis other than “benign” intoeing. Under pediatric orthopaedic surgeon “on-call” supervision, APPs were authorized to perform clinical assessments supplemented by radiographs and laboratory investigations as deemed necessary. We performed an Institutional Review Board-approved, retrospective medical record review of all patients appointed to our Intoeing Clinic over a 30-month period (March 2010 to September 2013).

Results:

About 95% of 926 patients appointed to APP Intoeing Clinic were confirmed to have a diagnosis of “benign” intoeing or a similar “benign” diagnosis; 5% of these patients requested a reevaluation for the same concern. Approximately 5% were determined to have a nonbenign diagnosis, either known to the family/provider, but not conveyed at the time of referral (4%), or identified at our institution (1%). Two patients (0.2%) were determined at follow-up examination to have a neurological abnormality at the subsequent examination.

Conclusions:

An “Intoeing Clinic” staffed by experienced Advanced Pediatric Practitioners or equivalent, with appropriate orthopaedic surgeon availability for consultation can be an effective and efficient method of evaluating patients referred for a diagnosis of “intoeing.”

Level of Evidence:

Level IV—case series.
Recommendations for Methicillin-Resistant Staphylococcus aureus Prevention in Adult ICUs: A Cost-Effectiveness Analysis*
Authors: Whittington Melanie D. , Atherly Adam J. , Curtis Donna J. , Lindrooth Richard C. , Bradley Cathy J. , Campbell Jonathan D.
Published: May 2017

Objective:

Patients in the ICU are at the greatest risk of contracting healthcare-associated infections like methicillin-resistant Staphylococcus aureus. This study calculates the cost-effectiveness of methicillin-resistant S aureus prevention strategies and recommends specific strategies based on screening test implementation.

Design:

A cost-effectiveness analysis using a Markov model from the hospital perspective was conducted to determine if the implementation costs of methicillin-resistant S aureus prevention strategies are justified by associated reductions in methicillin-resistant S aureus infections and improvements in quality-adjusted life years. Univariate and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness.

Setting:

ICU.

Patients:

Hypothetical cohort of adults admitted to the ICU.

Interventions:

Three prevention strategies were evaluated, including universal decolonization, targeted decolonization, and screening and isolation. Because prevention strategies have a screening component, the screening test in the model was varied to reflect commonly used screening test categories, including conventional culture, chromogenic agar, and polymerase chain reaction.

Measurements and Main Results:

Universal and targeted decolonization are less costly and more effective than screening and isolation. This is consistent for all screening tests. When compared with targeted decolonization, universal decolonization is cost-saving to cost-effective, with maximum cost savings occurring when a hospital uses more expensive screening tests like polymerase chain reaction. Results were robust to sensitivity analyses.

Conclusions:

As compared with screening and isolation, the current standard practice in ICUs, targeted decolonization, and universal decolonization are less costly and more effective. This supports updating the standard practice to a decolonization approach.
Development of a Smartphone Application to Monitor Pediatric Patient-Reported Outcomes
Authors: Wang Jingting , Yao Nengliang (Aaron) , Liu Yanyan , Geng Zhaohui , Wang Yuanyuan , Shen Nanping , Zhang Xiaoyan , Shen Min , Yuan Changrong
Published: May 2017

Patient-reported outcomes are increasingly emphasized in clinical trials and population health studies. Our research team developed a smartphone app to track patient-reported outcomes of children with chronic diseases. The purpose of this study is to develop a patient-reported outcome reporting app and evaluate its usability. A multidisciplinary research team including health services researchers, pediatric nurses, and software engineers worked collaboratively in developing the patient-reported outcome app and administration portal. Group discussions and several rounds of feedback and modification were used. Ten pediatric patients with cancer, five parents, and two nurses participated in the usability study. We conducted content analyses in app development and usability evaluation. The app collected demographic information and patient-reported outcomes. Patient-reported outcomes were collected by Chinese versions of pediatric Patient-Reported Outcomes Measurement Information System Short Forms and Patient-Reported Outcomes Measurement Information System Parent Proxy Report Scales for Children. Pediatric patients aged 8 to 17 years and parents with a 5- to 7-year-old pediatric child used different age-appropriate questionnaires. The Web-based administration portal helped to manage demographic information, questionnaires, administrators, and survey-conducting organizations. The users liked the app. All participants felt that this app was easy to use and the interfaces were friendly to children. Nurses thought the administration portal interfaces were simple and the data were convenient to download for further analysis. We conclude that the app and its administration portal meet researchers and clinical nurses’ demand and have potential to promote patient-reported outcomes in assessing quality of life and symptoms of pediatric patients.
Hemophagocytic lymphohistiocytosis in patients with metastatic malignant melanoma
Authors: Stabler Sarah , Becquart Coralie , Dumezy Florent , Terriou Louis , Mortier Laurent
Published: May 2017

Hemophagocytic lymphohistiocytosis (HLH) is an autoinflammatory disease that classically occurs because of infections, autoinflammatory, or autoimmune diseases, hematologic cancers, and rarely because of solid tumor. We report a rare case of HLH attributed to metastatic malignant melanoma treated without corticosteroid and with a nonfatal outcome thanks to specific therapies: etoposide for HLH and a selective inhibitor of mutated forms of BRAF kinase associated with a MEK inhibitor for melanoma.
BIOMARKERS OF NEOVASCULAR ACTIVITY IN AGE-RELATED MACULAR DEGENERATION USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Al-Sheikh Mayss , Iafe Nicholas A. , Phasukkijwatana Nopasak , Sadda SriniVas R. , Sarraf David
Published: May 2017

Purpose:

To study the qualitative and quantitative features of choroidal neovascular (NV) membranes in age-related macular degeneration using optical coherence tomography angiography in patients with active and quiescent NV lesions before and after treatment with anti–vascular endothelial growth factor.

Methods:

Macular optical coherence tomography angiography images were obtained using RTVue XR Avanti with AngioVue. Morphologic features and quantitative measurements of the NV lesion were analyzed using en face projection images. The NV lesion was subdivided into inner segment and outer fringe for further fractal dimension analysis.

Results:

In a series of 31 eyes, 11 eyes with active NV lesions at baseline and after consecutive follow-up after treatment with anti–vascular endothelial growth factor therapy and 20 eyes with quiescent NV lesions were included in this study. Morphologically, all the quiescent NV lesions versus 63.6% of the active NV lesions demonstrated a prominent central vessel and active leasions demonstrated a greater rate of small vessels branching (82%) and peripheral arcades (82%) than quiescent lesions (30% and 40% respectively) and this was statistically significant. The lesion area and vessel density was not statistically significantly different after treatment or versus quiescent lesions although the latter lesions were reduced in area. Lesion pattern complexity measured by the fractal dimension was statistically significantly lower in the inner part of the lesion after treatment and statistically significantly lower in the total lesion of the quiescent NV compared with the active NV.

Conclusion:

Optical coherence tomography angiography is a new, noninvasive imaging modality that can be used to perform qualitative and quantitative analyses of NV lesions. In the future, OCT angiography may provide biomarkers of activity and guide the evaluation and treatment and monitoring of neovascularization in age-related macular degeneration.
MACULAR EDEMA AFTER CATARACT SURGERY IN EYES WITH PREOPERATIVE RETINAL VEIN OCCLUSION
Authors: Cho Han Joo , Hwang Hyun Ji , Kim Hyoung Seok , Lee Dong Won , Kim Chul Gu , Kim Byoung Yeop , Kim Jong Woo
Published: May 2017

Purpose:

To evaluate the incidence of pseudophakic macular edema (PME) in eyes with a history of retinal vein occlusion before cataract surgery and to identify any associated risk factors.

Methods:

The records of 21,332 eyes that underwent cataract surgery were retrospectively reviewed. Eyes that had retinal vein occlusion preoperatively with no evidence of macular pathology on optical coherence tomography at the time of surgery and no macular edema treatment at least 6 months before surgery were included. Eyes with diabetes or diabetic retinopathy, those with a history of previous intraocular surgery or with intraoperative complications, and those administered glaucoma and nonsteroidal antiinflammatory eye drops were excluded.

Results:

Pseudophakic macular edema developed in 31 (27.4%) of 113 eyes within 3 months of cataract surgery. Mean visual acuity for eyes with PME (0.48 logarithm of the minimum angle of resolution [logMAR; 20/60 Snellen equivalent]) at 3 months after surgery was significantly worse than that for eyes without PME (0.28 logMAR; 20/38, P = 0.020). However, there was no significant difference in the visual acuity between the 2 groups 6 months after the surgery. Taking into consideration various baseline factors, a history of previous treatment of macular edema was significantly associated with an increased risk of PME (odds ratio, 11.022; 95% confidence interval, 7.258–17.712; P = 0.009). A higher number of intravitreal injections used to treat macular edema also significantly increased the risk of PME (odds ratio, 1.902; 95% confidence interval, 1.032–4.227; P = 0.031).

Conclusion:

Pseudophakic macular edema frequently developed after phacoemulsification cataract surgery in patients with a history of retinal vein occlusion. The risk of PME further increased when the patient had undergone macular edema treatment and had a higher prevalence of intravitreal injection treatment.
Concomitant Bacterial Meningitis in Infants With Urinary Tract Infection
Authors: Thomson Joanna , Cruz Andrea T. , Nigrovic Lise E. , Freedman Stephen B. , Garro Aris C. , Ishimine Paul T. , Kulik Dina M. , Uspal Neil G. , Grether-Jones Kendra L. , Miller Aaron S. , Schnadower David , Shah Samir S.
Published: May 2017

To determine age-stratified prevalence of concomitant bacterial meningitis in infants ≤60 days with a urinary tract infection, we performed a 23-center, retrospective study of 1737 infants with urinary tract infection. Concomitant bacterial meningitis was rare, but more common in infants 0–28 days of age [0.9%; 95% confidence interval (CI): 0.4%–1.9%) compared with infants 29–60 days of age (0.2%; 95% CI: 0%–0.8%).
Differences in Wait Times for Cosmetic Blepharoplasty by ASOPRS Members
Authors: Knezevic Alexander , Yoon Michael K.
Published: May 2017

Purpose:

Adequate access to subspecialty care is of concern to patients and physicians alike. One measure of availability is the wait time for cosmetic procedures. The authors investigated geographical differences in wait times for cosmetic upper eyelid blepharoplasty of American Society of Ophthalmic Plastic and Reconstructive Surgery members across the country.

Methods:

This study surveyed all 533 American Society of Ophthalmic Plastic and Reconstructive Surgery members’ practices in the United States based on the publically available contact information (www.asoprs.org). Scripted telephone calls were made requesting self-referred cosmetic upper eyelid blepharoplasty. Wait times until the first available appointment and time until the first available surgery date were collected.

Results:

Of the membership, 387 (72.6% response rate) respondents offered appointments for cosmetic upper eyelid blepharoplasty. Overall, 84.2% of respondents were male. Practice breakdown was 83.4% in private practice and 16.5% in academic practice. Median wait time until the next available appointment was 14 days (mean 21.2 days, 0–205 days; p = 0.145). Private practice wait time was shorter than academic (median 14 vs. 18 days, mean 19.7 vs. 28.9 days; p =0.004). However, there was wide variability based on region.

Conclusions:

Patients seeking cosmetic upper eyelid blepharoplasty have good access to care by American Society of Ophthalmic Plastic and Reconstructive Surgery members. There are variabilities based on academic versus private practice. Further study can evaluate whether similar findings exist for medically necessary functional procedures. This information may help assess the need for additional practitioners.
Multifocal Ocular Surface Squamous Neoplasia
Authors: Singh Swati , Mittal Ruchi , Rath Suryasnata
Published: May 2017

A 64-year-old healthy female presented with a papillomatous limbal lesion involving 6 clock hours of superior limbus and diffuse involvement of upper tarsal conjunctiva of left eye of 6 months duration. Excision of superior limbal lesion on histopathology showed carcinoma in situ with focal breach in basement membrane and moderate degree of differentiation. The surgical base and margins were uninvolved. The tarsal lesion was initially treated with subconjunctival interferon alpha 2b (IFN alpha 2b) (3 cycles of IFN alpha 2b) with poor response. Subsequently treatment with topical mitomycin C 0.04% showed a dramatic response in the upper eyelid tarsal lesion. A small residual lesion needed excision. One year after treatment, she was completely tumor-free. In multifocal ocular surface squamous neoplasia, multimodal treatment with excision and topical mitomycin C may be effective in cases refractory to immunotherapy.