bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonverbal predication in Movima
Authors: Haude Katharina
Published: July 2018

Movima (isolate, lowland Bolivia) is a language with predicate-initial constituent order in the core clause. There is no copula in affirmative clauses. Unpossessed common nouns can function as main-clause predicates just as well as verbs. The difference between verbal and nonverbal predicates only becomes apparent in embedded (i.e. adverbial and complement) clauses: the predicate of an embedded clause is overtly morphologically marked, and the type of marking distinguishes verbal from nonverbal predicates. The same pattern occurs in negated clauses, which consist of embedded predicates preceded by a negative copula. The morphological marking of embedded predicates shows that not only verbs and nouns, but also demonstratives, locative adverbs, and even personal pronouns can function as predicates. Therefore, it is argued that there is no “preverbal” or “topic position” to express the syntactically privileged argument: in principle, any word that has the potential to function as a predicate has predicate status when forming the first constituent of the clause.
Locative, existential and possessive predication in the Chaco
Authors: Payne Doris L. , Vidal Alejandra , Otero Manuel A.
Published: July 2018

Nivaĉle (Mataguayan) and Pilagá (Guaykuruan) languages, which geographically overlap in the Argentinian Chaco region of South America, present evidence challenging the often repeated claim that locative predications universally underlie possession predications (Lyons 1967; Jackendoff 1983; DeLancey 2000; Freeze 2001; Langacker 2009, among others). In both languages copular elements can link two Determined Phrases (DPs) to predicate location, possession or existence, i.e. the primary predicative element in such constructions is not a lexical verb. However, Nivaĉle and Pilagá each use a single copular form for both non-verbal existential and possessive predication constructions, and a different copular form for non-verbal locative predication constructions. Subtypes of the various constructions, including negative forms, can be related to Heine’s cognitive possession schemas. In Pilagá, all three negative constructions share the same copular elements, but there are arguably still more similarities between the negative possessive and negative existential constructions compared to the negative locative construction. If these shared features across the two languages are due to areal contact, the influence would have had to have happened at the Proto-Mataguayan and Proto-Guaykuruan languages stage.
Constructions with has(a) in Wampis
Authors: Peña Jaime
Published: July 2018

This paper analyzes the development of a copular element has(a) ‘become’ in Wampis. Has(a) can occur as a fully inflected verb or as an invariant copula particle. Based on comparative evidence, it is argued that this morpheme has arisen from the phonetic reduction of a posture verb stem meaning ‘stand’, likely through the use of this verb in locative and existential predicates. The form and semantics of has(a), as well as its use in different constructions associated with it are further analyzed taking into account both structural and functional characteristics. Has(a) is used for expressing the functions of proper inclusion and attribution, as well as for temporal and locative predicates. Has(a) can also serve to express translation and change in physical location, drawing on syntactic structures typically associated with verbs of movement in the language. The latter is an interesting development given the stative historical source of has(a).
Ni–B/SiC nanocomposite coating obtained by pulse plating and evaluation of its electrochemistry and mechanical properties
Authors: Ahmadiyeh Somayeh , Rasooli Ali , Hosseini Mir Ghasem
Published: July 2018

One of the important techniques for developing coatings with proper electrochemical and mechanical properties is electrodeposition method. The goal of the current work is to optimise contents of SiC particles in the bath to achieve Ni–B/SiC composite coatings with high corrosion resistance and wear properties. Pulse plating method was used to prepare Ni–B/SiC composite deposits of Watts bath including trimethylamine borane (TMAB) and SiC nanopowder addition. The effects of SiC concentration in the bath, which is the principal factor, on the main properties of the coatings were studied. Field Emission Scanning Electron Microscopy (FE-SEM), Energy-dispersive Spectroscopy (EDS) and X-ray diffraction (XRD) were used to analyse the characterisations of the coatings. In order to evaluate the corrosion behaviour of the coatings, the open circuit potential (OCP), electrochemical impedance (EIS) and potentiodynamic polarisation (Tafel) tests were applied in 3.5% NaCl solution. Moreover, the pin-on-disc procedure was designed to assess the wear behaviour of coatings. Increasing the SiC nanoparticles up to 12 g l−1 in the bath leads to produce a coating including 11 wt-% SiC particles which have a positive effect on the coating microstructure. Corrosion resistance improves by raising 4–12 g l−1 SiC incorporation in the coatings; so that corrosion resistance of the Ni–B/SiC12 g l−1 coating reaches to nearly 62 kΩ. The presence of SiC phase in the coating can result in decrease electrochemical active regions; therefore, this phenomenon can promote corrosion resistance of the composite coatings. Ni–B/SiC 12 g l−1 composite coating illustrates the best wear resistance in comparison with the others after which it shows the lowest weight losses (0.98 mg cm−2) and the friction coefficient of 0.57 due to the formation of the packed structures with less porosity and high content of SiC particles in the deposit.
Mixed‐methods pre‐match cooling improves simulated soccer performance in the heat
Authors: Aldous Jeffrey William Frederick , Chrismas Bryna Catherine Rose , Akubat Ibrahim , Stringer Charlotte Anne , Abt Grant , Taylor Lee
Published: July 2018

This investigation examined the effects of three pre‐match and half‐time cooling manoeuvres on physical performance and associated physiological and perceptual responses in eight University soccer players during a non‐motorised treadmill based individualised soccer‐specific simulation [intermittent soccer performance test (iSPT)] at 30°C. Four randomised experimental trials were completed; following 30‐min (pre‐match) and 15‐min (half‐time) cooling manoeuvres via (1) ice slurry ingestion (SLURRY); (2) ice‐packs placed on the quadriceps and hamstrings (PACKS); (3) mixed‐methods (MM; PACKS and SLURRY concurrently); or no‐cooling (CON). In iSPT first half, a moderate increase in total (Mean ± Standard Deviation: 108 ± 57 m, qualitative inference: most likely, Cohen's d: 0.87, 90%CL: ±0.31), high‐speed (56 ± 46 m, very likely, 0.68 ± 0.38) and variable run (15 ± 5 m, very likely, 0.81 ± 0.47) distance covered was reported in MM compared with CON. Additionally, pre‐match reductions in thermal sensation (–1.0 ± 0.5, most likely, –0.91 ± 0.36), rectal (–0.6 ± 0.1°C, very likely, –0.86 ± 0.35) and skin temperature (–1.1 ± 0.3°C, very likely, –0.88 ± 0.42) continued throughout iSPT first half. Physical performance during iSPT first half was unaltered in SLURRY and PACKS compared to CON. Rectal temperature was moderately increased in SLURRY at 45‐min (0.2 ± 0.1°C, very likely, 0.67 ± 0.36). Condition did not influence any measure in iSPT second half compared to CON. Only MM pre‐match cooling augmented physical performance during iSPT first half, likely due to peripheral and central thermoregulatory factors favourably influencing first half iSPT performance. Further practical half‐time cooling manoeuvres which enhance second half performance are still required.
Comfort assessment of running footwear: Does assessment type affect inter‐session reliability?
Authors: Lindorfer Julia , Kröll Josef , Schwameder Hermann
Published: July 2018

Assessing comfort of running footwear reliably is challenging. The purpose of this study was to compare the intra‐rater reliability between different assessment types, to calculate intra‐individual reliability scores and to evaluate the effect of rater selection based on individual reliability scores on group level reliability. Three assessment types: ranking, Visual Analogue Scale (VAS), and Likert Scale (LS) were provided twice in six separate sessions among 30 participants, who assessed comfort of five shoes after treadmill running. Spearman's rho provided an evaluation of inter‐session relative reliability and typical error as a measure of absolute reliability for each assessment type. Ranking (r = 0.70, 95% confidence interval [CI] 0.61–0.78) yielded the highest relative reliability for overall comfort, followed by VAS (r = 0.67, 95% CI 0.56–0.75) and LS (r = 0.63, 95% CI 0.52–0.72), with large‐scale overlaps of CIs between assessment types. The same order of assessment types was found for the percentage of reliable raters (r ≥ 0.7) with 60% in ranking scale, 47% in VAS and 37% in LS. Forming subgroups corresponding to the intra‐individual reliability substantially increased group level reliabilities. Based on measures of relative reliability, an extreme reduction in resolution as provided by the ranking from pairwise comparisons seems to be a valuable tool in footwear comfort assessments if assessment time is of minor importance. No preference can be provided for the two investigated rating scales. Besides the assessment type, a selection of the best raters in additional reliability checks seems to be a prerequisite for further comfort‐related studies.
Direct membrane binding and self-interaction contribute to Mmr1 function in mitochondrial inheritance
Authors: Chen WeiTing , Ping Holly A. , Lackner Laura L.
Published: July 2018

Mitochondrial transport and anchoring mechanisms work in concert to position mitochondria to meet cellular needs. In yeast, Mmr1 functions as a mitochondrial adaptor for Myo2 to facilitate actin-based transport of mitochondria to the bud. Posttransport, Mmr1 is proposed to anchor mitochondria at the bud tip. Although both functions require an interaction between Mmr1 and mitochondria, the molecular basis of the Mmr1–mitochondria interaction is poorly understood. Our in vitro phospholipid binding assays indicate Mmr1 can directly interact with phospholipid membranes. Through structure–function studies we identified an unpredicted membrane-binding domain composed of amino acids 76–195 that is both necessary and sufficient for Mmr1 to interact with mitochondria in vivo and liposomes in vitro. In addition, our structure–function analyses indicate that the coiled-coil domain of Mmr1 is necessary and sufficient for Mmr1 self-interaction and facilitates the polarized localization of the protein. Disrupting either the Mmr1–membrane interaction or Mmr1 self-interaction leads to defects in mitochondrial inheritance. Therefore, direct membrane binding and self-interaction are necessary for Mmr1 function in mitochondrial inheritance and are utilized as a means to spatially and temporally regulate mitochondrial positioning.
Botulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review of Efficacy, Safety, and Injection Technique
Authors: Sugrue Conor M , Kelly Jack L , McInerney Niall
Published: July 2018

Background

Platysma bands are characteristic of an aging neck. Resection and plication of the platysma muscle is the basis of treatment. However, unfavorable surgical outcomes and improved understanding of platysma band etiology have shifted treatment towards nonsurgical rejuvenation.

Objectives

The aim of this paper was to assess the efficacy, injection techniques, and complications associated with botulinum toxin injection for the treatment of platysma bands.

Methods

A systematic literature search was performed to identify articles reporting botulinum toxin injections for platysma bands in neck rejuvenation. The search included published articles in three electronic databases—Ovid MEDLINE, EMBASE, and the Cochrane Library—between January 1985 and December 2017.

Results

Three studies met the inclusion criteria, with a total of 78 patients undergoing botulinum toxin injection for platysma bands. Incobotulinumtoxin A was used in 62.3% (n = 45/78) of patients, with 38.4% (n = 30/78) receiving abobotulinumtoxin A. Efficacy was assessed using the Merz platysma score scale. A mean score improvement of 2.0 points, with a response rate of 93.7%, was observed after 14 ± 2 days. At 3 months, the mean score improvement was 1.2 points with a response rate of 86%. Patient-reported metrics demonstrated an improvement in 91% (n = 71/78) of subjects. The three studies used a standard injection technique, with a maximum 20 IU of incobotulinumtoxin A and 5 U abobotulinumtoxin A administered per band. Complications were reported in 15.4% (n = 12/78) of patients, with none requiring further intervention.

Conclusions

Botulinum toxin is a highly effective treatment for isolated platysma bands. A safe injection technique is described and recommended for clinical practice.

Level of Evidence: 4
Self reliant groups from India to Scotland: lessons from south to north
Authors: O’Connor Clementine Hill , Mazzei Micaela , Baker Rachel
Published: July 2018

There is a move towards partnership working across the global north and south but there remain questions about how to do it most effectively. This paper reports on the findings from a project that built a partnership between women in Scotland and India in order to transfer knowledge about Indian Self Help Groups. By creating peer to peer relationships that challenged traditional roles of ‘teacher’ and ‘learner’, the project was effective in transferring learning from south to north and generating meaningful outcomes for those involved. Despite the contextual differences, the successful transfer of key components of the model, savings, and loans, has led to a sense of empowerment in the Scottish women that is comparable to their Indian counterparts. As the project continues, it will be important that the dialogue between the partners continues, so there is ongoing learning as the Scottish groups expand and develop.
Screening for Tuberculosis With Xpert MTB/RIF Assay Versus Fluorescent Microscopy Among Adults Newly Diagnosed With Human Immunodeficiency Virus in Rural Malawi: A Cluster Randomized Trial (Chepetsa)
Authors: Ngwira Lucky G , Corbett Elizabeth L , Khundi McEwen , Barnes Grace L , Nkhoma Austin , Murowa Michael , Cohn Silvia , Moulton Lawrence H , Chaisson Richard E , Dowdy David W
Published: July 2018

Background

Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV)–infected individuals globally. Screening for TB at the point of HIV diagnosis with a high-sensitivity assay presents an opportunity to reduce mortality.

Methods

We performed a cluster randomized trial of TB screening among adults newly diagnosed with HIV in 12 primary health clinics in rural Thyolo, Malawi. Clinics were allocated in a 1:1 ratio to perform either point-of-care Xpert MTB/RIF assay (Xpert) or point-of-care light-emitting diode fluorescence microscopy (LED-FM) for individuals screening positive for TB symptoms. Asymptomatic participants were offered isoniazid preventive therapy in both arms. Investigators, but not clinic staff or participants, were masked to allocation. Our primary outcome was the incidence rate ratio (RR) of all-cause mortality within 12 months of HIV diagnosis.

Results

Prevalent TB was diagnosed in 24 of 1001 (2.4%) individuals enrolled in clinics randomized to Xpert, compared with 10 of 841 (1.2%) in clinics randomized to LED-FM. All-cause mortality was 22% lower in the Xpert arm than in the LED-FM arm (6.7 vs 8.6 per 100 person-years; RR, 0.78 [95% confidence interval {CI}, .58–1.06]). A planned subgroup analysis suggested that participants with more advanced HIV (World Health Organization clinical stage 3 or 4) disease had lower mortality in clinics randomized to Xpert than to LED-FM (RR, 0.43 [95% CI, .22–.87]).

Conclusions

In rural Malawi, using point-of-care Xpert MTB/RIF to test symptomatic patients for TB at the time of HIV diagnosis reduced all-cause 12-month mortality among individuals with advanced HIV.

Clinical Trials Registration

NCT01450085.
Ironic Consumption
Authors: Warren Caleb , Mohr Gina S
Published: July 2018

Ironic consumption refers to using a product (brand, style, behavior, etc.) with the intent of signaling a meaning (identity, message, belief, etc.) that reverses the conventional meaning of the product. We report five studies showing that people are more likely to think that a consumer is using a product ironically when the product is incongruent with the consumer’s known identity or beliefs. The impression that ironic consumers make on an observer depends on the observer’s relationship with the consumed product. When a consumer uses a product associated with the observer’s in-group (e.g., wearing a “Powered by Kale” shirt in front of a vegan), observers have a less favorable impression if they believe the consumer is using the product ironically. Conversely, when a consumer uses a product that is not associated with the observer’s in-group (e.g., wearing a “Powered by Kale” shirt in front of a meat-eater), observers have a more favorable impression if they believe the consumer is using the product ironically. Collectively, our studies suggest that consumers can use products ironically to selectively signal one meaning to an in-group (who is likely to detect irony), and another to out-groups (who are unlikely to detect irony).
Testing the Effectiveness of “Managing for Results”: Evidence from an Education Policy Innovation in New York City
Authors: Wang Weijie , Yeung Ryan
Published: July 2018

“Managing for results” (MFR) is a performance management system that decentralizes authority to managers in exchange for greater accountability in performance. Although MFR makes much theoretical sense, the evidence of the effectiveness of MFR has not been as conclusive. In this study, we use panel data methods to examine the impact of a particular MFR reform in New York City, the Empowerment Zone (EZ), which focused on providing city public school principals greater autonomy to improve school outcomes. In addition, we use objective measures of both performance management and organizational performance. Our differences-in-differences estimates suggest that the EZ had a significant and positive effect on school performance as measured by proficiency rates in standardized mathematics exams, overall performance, and Regents diploma graduation rates, though the effects were not immediately apparent.
Cytokine Microdialysis for Real-Time Immune Monitoring in Glioblastoma Patients Undergoing Checkpoint Blockade
Authors: Lynes John , Jackson Sadhana , Sanchez Victoria , Dominah Gifty , Wang Xiang , Kuek Averie , Hayes Christina Piper , Benzo Sarah , Scott Gretchen C , Chittiboina Prashant , Zaghloul Kareem A , Park Deric M , Wu Jing , Hourigan Christopher S , Giles Amber J , Wu Tianxia , Maric Dragan , Chen Jinguo , Quezado Martha , Heiss John D , Gilbert Mark R , Nduom Edjah K
Published: July 2018

BACKGROUND

Glioblastoma is the most common primary malignancy of the brain, with a dismal prognosis. Immunomodulation via checkpoint inhibition has provided encouraging results in non-CNS malignancies, but prediction of responders has proven to be challenging in glioblastoma patients.

OBJECTIVE

To determine the proportion of patients who have a measurable increase of interferon gamma levels in brain tumor tissue after their first dose of nivolumab, and to evaluate the safety of using brain tumor microdialysis to monitor for immune response while evaluating the safety of the combination of anti-programmed death 1 (PD-1) and anti-lymphocyte activation gene 3 (LAG-3) checkpoint inhibition.

METHODS

The study design is a single-center, nonrandomized phase 1 clinical trial. Up to 15 adult patients with recurrent glioblastoma will be enrolled with the goal of 10 patients completing the trial over an anticipated 18 mo. Patients will undergo biopsy; placement of microdialysis catheters and lumbar drains; treatment with anti-PD-1 checkpoint inhibition; comprehensive immune biomarker collection; tumor resection; and then treatment with anti-PD-1 and anti-LAG-3 checkpoint inhibition until progression.

EXPECTED OUTCOMES

We expect interferon gamma levels to increase in the brain as measured via microdialysis in treated patients. Based on published reports, microdialysis in this patient population is expected to be safe, and anti-LAG-3 and anti-PD-1 combined will likely have a similar side effect profile to other checkpoint inhibitor combinations.

DISCUSSION

The failure of recent trials of immune therapies in glioblastoma underscores the need to appropriately measure response in the treated tissue. This trial may provide insight on indicators of which patients will respond to immune therapy.
Caretaker attitudes toward swine euthanasia1
Authors: Campler Magnus R , Pairis-Garcia Monique D , Rault Jean-Loup , Coleman Grahame , Arruda Andreia G
Published: July 2018

Timely euthanasia is a fundamental part of safeguarding swine welfare by reducing suffering when compromised pigs are unable to recover. The quality and appropriateness of timely euthanasia rely mainly on the knowledge and experience of the individual caretaker but may also be affected by caretaker attitudes toward euthanasia. However, literature on caretaker attitudes toward swine euthanasia is lacking. This study investigated caretaker attitudes, perceived knowledge, and confidence in performing on-farm timely euthanasia. A total of 84 caretakers from eight swine farms (ranging in size from 1,300 to 7,000 sows) participated in a survey designed to investigate attitudes toward swine and swine euthanasia. Caretaker’s ages ranged from 18 to 59 yr with an average work experience of 8.5 yr. The majority of participants worked in either farrowing or breeding units. Survey questions were designed to assess caretakers’ attitudes and attributes (empathy affect, empathy attribution, attitudes toward pigs, feeling bad about euthanizing pigs, and assumptions about pigs’ emotional capabilities), decision-making skills (confidence in identifying compromised pigs or relying on coworkers to make decisions), and euthanasia skillset (confidence in performing euthanasia, training, and perceived level of knowledge). Using cluster analysis to analyze survey answers, three distinct groups of caretakers were identified: 1) confident and empathetic; 2) Confident, knowledgeable, and detached; and 3) unconfident and lacking knowledge. The survey results showed that empathy attribution was strongly correlated with empathy affect (r = 0.571, P < 0.01) and that empathy affect and empathy attribution were higher in female caretakers compared with male caretakers (P < 0.05). A risk analysis that included previously identified clusters showed that females were more likely to be grouped among caretakers that were confident and empathetic (P = 0.04), and caretakers with more than 2 yr of swine experience were more likely to be grouped as confident and skilled (P = 0.01), while the unconfident and empathetic were more likely to have had less than 2 yr of experience (P = 0.04). This study provides important information about variability in caretaker experience as well as their attitudes toward pigs and timely euthanasia. Increased knowledge about swine caretaker attitudes may be used to implement training and euthanasia protocols to increase both human and pig welfare on farm.
Compassionate Care in the Age of Evidence-Based Practice: A Critical Discourse Analysis in the Context of Chronic Pain Care
Authors: Baker Lindsay R. , Martimianakis Maria Athina (Tina) , Nasirzadeh Yasmin , Northup Elizabeth , Gold Karen , Friesen Farah , Bhatia Anuj , Ng Stella L.
Published: July 2018

Purpose

Health professions education and practice have seen renewed calls to restore compassion to care. However, because of the ways evidence-based practice (EBP) has been implemented in health care, wherein research-based knowledge is privileged, the dominance of EBP may silence clinician and patient experience-based knowledge needed for compassionate care. This study explored what happens when the discourses of compassionate care and EBP interact in practice.

Method

Chronic pain management in Canada was selected as the context for the study. Data collection involved compiling an archive of 458 chronic pain texts, including gray literature from 2009–2015 (non-peer-reviewed sources, e.g., guidelines), patient blog posts from 2013–2015, and transcripts of study interviews with 9 clinicians and postgraduate trainees from local pain clinics from 2015–2016. The archive was analyzed using an interpretive qualitative approach informed by critical discourse analysis.

Results

Four manifestations of the discourse of compassionate care were identified: curing the pain itself, returning to function, alleviating suffering, and validating the patient experience. These discourses produced particular subject positions, activities, practices, and privileged forms of knowledge. They operated in response, partnership, apology, and resistance, respectively, to the dominant discourse of EBP. These relationships were mediated by other prevalent discourses in the system: patient safety, patient-centered care, professional liability, interprofessional collaboration, and efficiency.

Conclusions

Medical education efforts to foster compassion in health professionals and systems need to acknowledge the complex web of discourses—which carry with them their own expectations, material effects, and roles—and support people in navigating this web.
New Evidence Supporting the Role of FBN1 in the Development of Adolescent Idiopathic Scoliosis
Authors: Sheng Fei , Xia Chao , Xu Leilei , Qin Xiaodong , Tang Nelson Leung-Sang , Qiu Yong , Cheng Jack Chun-Yiu , Zhu Zezhang
Published: July 2018

Study Design.

A genetic association study.

Objective.

To determine whether common variants of fibrillin-1 (FBN1) and fibrillin-2 (FBN2) are associated with adolescent idiopathic scoliosis (AIS), and to further investigate to further investigate the functional role of FBN1 in the onset and progression of AIS.

Summary of Background Data.

Previous studies have identified several rare variants in FBN1 and FBN2 that were associated with AIS. There is, however, a lack of knowledge concerning the association between common variants of FBN1 and FBN2 and AIS.

Methods.

Common variants covering FBN1 and FBN2 were genotyped in 952 patients with AIS and 1499 controls. Paraspinal muscles were collected from 66 patients with AIS and 18 patients with lumbar disc herniation (LDH) during surgical interventions. The differences of genotype and allele distributions between patients and controls were calculated using Chi-square test. The Student t test was used to compare the expression of FBN1 and FBN2 between patients with AIS and LDH. One-way analysis of variance test was used to compare the gene expression among different genotypes of the significantly associated variant. The Pearson correlation analysis was used to determine the relationship between FBN1 expression and the curve severity.

Results.

The common variant rs12916536 of FBN1 was significantly associated with AIS. Patients were found to have significantly lower frequency of allele A than the controls (0.397 vs. 0.450, P = 1.10 × 10−4) with an odds ratio of 0.81. Moreover, patients with AIS were found to have significantly lower FBN1 expression than patients with LDH (0.00033 ± 0.00015 vs. 0.00054 ± 0.00031, P = 1.70 × 10−4). The expression level of FBN1 was remarkably correlated with the curve severity (r = −0.352, P = 0.02). There was no significant difference of FBN1 expression among different genotypes of rs12916536.

Conclusion.

Common variant of FBN1 is significantly associated with the susceptibility of AIS. Moreover, the decreased expression of FBN1 is significantly correlated with the curve severity of AIS. The functional role of FBN in AIS is worthy of further investigation.

Level of Evidence: 3
Survival Outcome and Prognostic Factors After Pulmonary Metastasectomy in Sarcoma Patients
Authors: Cariboni Umberto , De Sanctis Rita , Giaretta Marta , Voulaz Emanuele , Morenghi Emanuela , Colombo Piergiuseppe , Novellis Pierluigi , Bottoni Edoardo , Errico Valentina , Crepaldi Alessandro , Marrari Andrea , Navarria Pierina , Ascolese Anna M. , Testori Alberto , Scorsetti Marta , Quagliuolo Vittorio , Santoro Armando , Alloisio Marco
Published: July 2018

Background:

Metastatic sarcoma patients have a poor prognosis with 3-year survival rate of 25%. About 30% of them present isolated lung metastases. We aimed to analyze the clinical outcome of sarcoma patients undergoing pulmonary metastasectomy (PM) and prognostic factors associated with local control, disease-free, and overall survival (OS).

Patients and Methods:

All sarcoma patients undergoing PM at Humanitas Cancer Center were retrospectively reviewed. Analyzed variables included clinicopathologic, surgical, and survival data. Exclusion criterion comprised a follow-up period inferior to 1 year. A univariable and multivariable Cox regression analysis was performed (P<0.05).

Results:

In total, 154 patients underwent PM from 1997 to 2015. Total complication rate was 7.1%. The median follow-up was 24 months. The median OS was 35.4 months from initial metastasectomy. In univariable analysis, we identified as significant negative prognostic factors a disease-free interval of <18 months, male sex, grading G3, and bilateral metastases. Three histology risk groups were defined according to OS: high risk (myxofibrosarcoma, malignant peripheral nerve sheath tumor, and Ewing sarcoma), intermediate risk (leiomyosarcoma, liposarcoma, and undifferentiated pleomorphic sarcoma), and low risk (synovial and chondrosarcoma) with a 3-year OS of 21.4%, 45.7%, and 74.1%, respectively. In multivariable analysis, male sex (P=0.042), bilateral metastases (P=0.004), and histology (intermediate vs. low-risk group, P=0.021; high vs. low-risk group, P<0.001) were identified as independent predictors of survival.

Conclusions:

PM for sarcoma is a valid therapeutic option. High-risk histologies and bilaterality of lung metastases are independent negative prognostic factors. A prognostic score to improve patient selection is proposed.
Traumatic Brain Injury Following Military Deployment: Evaluation of Diagnosis and Cause of Injury
Authors: Regasa Lemma Ebssa , Agimi Yll , Stout Katharine C.
Published: July 2018

Objective:

To evaluate the prevalence of delayed traumatic brain injury (TBI) diagnosis and cause of injury that resulted in a TBI diagnosis after military deployment.

Design:

Medical record notes were reviewed in 2016 from a random sample of 1150 US military service members who had their first-time deployment in 2011 and likely sustained a TBI. Location and cause of the injury were extracted from the progress note for analysis.

Participants and Setting:

Active-duty US military service members who received an International Classification of Diseases, Ninth Revision code for a TBI diagnosis in a military facility.

Main Outcome Measures:

Presence of TBI, location of injury, cause of injury, and time of diagnosis with respect to deployment.

Results:

The odds of being diagnosed with a deployment-related TBI were 8 times higher during the first 4 weeks upon return from deployment than the subsequent 32 weeks. The likelihood of diagnosing a deployment-sustained TBI during weeks 5 to 32 was 2 times higher than during 33 to 76 weeks following return from deployment. The proportion of deployment-related TBI diagnoses decreased with time following return from deployment but remained above 40% during weeks 33 to 76. Service branch, gender, race, occupation, and time between TBI diagnosis and return from deployment were significant predictors of deployment-related TBIs. Moving motor vehicle, sports, parachute, and being struck by objects were the top causes of injury in garrison (nondeployed setting), whereas blast produced the majority (66%) of all causes of injuries that resulted in a TBI in the deployed setting.

Conclusion:

The increased incidence rate of a TBI diagnosis following deployment can be attributed to delayed diagnosis of TBI sustained from injuries during deployment. TBIs sustained during deployment can be diagnosed beyond the initial 4 weeks after return from deployment and may continue up to 76 weeks following return from deployment.
CHALLENGES IN THE MANAGEMENT OF PRESUMED FUNGAL ENDOPHTHALMITIS IN PREGNANCY
Authors: Zhang Alice Y. , Brady Christopher J. , Reddy Ashvini K.
Published: July 2018

Purpose:

To report a rare case of endogenous endophthalmitis in pregnancy and the challenges of managing culture-negative fungal infection.

Methods:

Retrospective case report. A 30-year-old woman presented with a subfoveal chorioretinal lesion with vitritis and anterior chamber inflammation in the context of intravenous drug use. Spectral domain optical coherence tomography and fluorescein angiography were used for documentation and monitoring.

Results:

After 2 months of systemic and intravitreal injections of amphotericin, the patient had clinical improvement in visual acuity, degree of inflammation, and in the size and activity of the chorioretinal lesion, which was presumed to be fungal in origin.

Conclusion:

Among limited cases of endophthalmitis in pregnancy, we report a challenging case of presumed fungal endogenous endophthalmitis. The patient responded favorably to intravitreal and systemic antifungal medications.
Characterization of Corneal Donor Tissue Lesions by Anterior Segment Optical Coherence Tomography Compared With Eye Bank Technician Slit-Lamp Examination
Authors: Hsu S. Tammy , Perry Isaac , Botsay Sara , Ko Narae , Stinnett Sandra S. , Kuo Anthony N. , Shieh Christine
Published: July 2018

Purpose:

To compare anterior segment spectral-domain optical coherence tomography (OCT) with eye bank technician slit-lamp examination (SLE) in characterizing lesions in donor corneas.

Methods:

Twenty-nine donor corneas identified by eye bank technicians to have opacities or lesions potentially representing pathologic findings affecting the stroma were evaluated through the use of technician SLE, SLE photography, and OCT. Technicians were tasked with describing the lesion, estimating the lesion depth, and photographing their SLE findings. A masked grader evaluated the OCT images and measured the lesion depth using customized software. The lesions identified on OCT were then compared with those identified on SLE.

Results:

A total of 37 lesions were detected on SLE; 25 of the 37 lesions identified on SLE were matched to a lesion on OCT. SLE and OCT depth measurements were statistically significantly different (P = 0.0042, mean difference 4.8% ± 6.5%), and OCT graded lesions as slightly deeper. Of the 12 out of the 37 lesions that were noted on SLE (but not identified on OCT), these included 2 central and paracentral anterior stromal lesions (OCT showed loose epithelium), 5 peripheral anterior stromal lesions, and 5 corneas with LASIK.

Conclusions:

Our study highlights both advantages and limitations of OCT compared with technician SLE in the evaluation of donor corneal tissue. Although OCT may miss some peripheral lesions and LASIK scars that are identifiable on SLE, OCT's depth resolution is helpful in differentiating whether shallow anterior opacities actually extend deeper into the stroma or are confined superficially to the epithelium.
Comparison of Pharmacy Claims and Electronic Pill Bottles for Measurement of Medication Adherence Among Myocardial Infarction Patients
Authors: Mehta Shivan J. , Asch David A. , Troxel Andrea B. , Lim Raymond , Lewey Jennifer , Wang Wenli , Zhu Jingsan , Norton Laurie , Marcus Noora , Volpp Kevin G.
Published: July 2018

Background:

Medication adherence after myocardial infarction remains low. Pharmacy claims have typically been used to measure medication adherence, but electronic pill bottles may offer additional information.

Objective:

The main objectives of this study were to compare the association of adherence measured by prescription claims and remote monitoring technologies with cardiovascular events.

Research Design:

This study was a secondary analysis of a remote monitoring intervention to increase medication adherence in myocardial infarction patients.

Subjects:

In total, 682 myocardial infarction patients were randomized to the intervention group with both medical and pharmacy benefits.

Measures:

Pharmacy claims adherence was measured using proportion of days covered (PDC) and GlowCap adherence (GC) was measured as the proportion of days the pill bottle was opened. We compared the association of PDC and GC adherence for statins with time to first vascular readmission or death and assessed model fit using Akaike information criterion and Bayesian information criterion and the likelihood ratio test.

Results:

Higher PDC was significantly associated with a lower hazard rate for vascular readmissions or death (hazard ratio=0.435; P=0.009). There was also an association between GC adherence and vascular readmissions or death (hazard ratio=0.313; P≤0.001). Adding the GC adherence variable to the model using only PDC improved the model fit (likelihood ratio test, P=0.001), as well as vice versa (P=0.050).

Conclusions:

Pharmacy claims data provide useful but not complete data for medication adherence monitoring. New wireless technologies have the potential to provide additional data about clinical outcomes.
Significance of Molecular Monitoring of T Cells for the Decision of Treatment Strategy for Epstein-Barr Virus–associated Hemophagocytic Lymphohistiocytosis
Authors: Saito Takamasa , Tanaka Miyuki , Matsuda Kazuyuki , Honma Hitoshi , Komori Kazutoshi , Morita Daisuke , Nakazawa Hideyuki , Yanagisawa Ryu , Nakazawa Yozo
Published: July 2018

A 17-year-old patient with Epstein-Barr virus (EBV)-associated hemophagocytic lymphohistiocytosis achieved first remission after immunochemotherapy (ICT). However, he had fever with an increase in soluble interleukin-2 receptor, but not in ferritin. Molecular analysis revealed augmented plasma and T-cell EBV loads and reappearance of clonal T cells. Despite achieving second remission, the T-cell EBV load at week 8 after second ICT was almost similar to that at week 8 after first ICT. Hence, cyclosporine was decreased over a 9-month period, with molecular monitoring of plasma and T cells. In this article, we describe how useful molecular monitoring was for detecting relapse and resuming ICT.
Visual Motor Integration in Children With Sickle Cell Disease
Authors: Newby Robert F. , Epping Amanda , Geiger Jennifer A. , Miller Meghan S. , Scott John Paul
Published: July 2018

Background:

Children with sickle cell disease (SCD) demonstrate deficits in cognitive and academic functioning. This study compared the visual motor integration (VMI) skills of children with SCD to non-SCD sibling controls.

Procedure:

In total, 105 participants (67 patients with SCD, 38 controls) were recruited during a routine clinic visit. Each participant was administered the Grooved Pegboard Test, a test of manual dexterity and the Beery-Buktenica Developmental Test of VMI, a measure of graphomotor skills.

Results:

Children with SCD demonstrated average (M=89.61, SE=3.08) fine manual dexterity and speed, but more complex fine motor functioning (graphomotor skills) (M=77.61, SE=1.65) was impaired. Relative to healthy siblings, children with SCD were not found to have different fine manual dexterity and speed (P=0.617). Patients with SCD were found to have significantly worse graphomotor skills (P=0.04).

Conclusions:

Children with SCD were found to have average basic fine motor dexterity and speed, but impaired VMI, a more complex fine motor skill. This finding is significant given the functional importance of complex fine motor skills in early academic activities.
Patient-Centered Care in Primary Care Scale
Authors: Radwin Laurel E. , Cabral Howard J. , Seibert Marjorie Nealon , Stolzmann Kelly , Meterko Mark , Evans Leigh , Barker Anna , Bokhour Barbara
Published: July 2018

Background:

Nurse contributions to patient-centered care in primary care clinics are all but ignored in standard patient experience surveys.

Purpose:

The purpose was to conduct a pilot study to develop and psychometrically assess a scale measuring nurses' and other providers' patient-centered care in Veteran Affairs primary care clinics.

Method:

We developed a patient experience survey composed of original items and previous studies' items and scales. The survey was field tested online with patients who had a recent clinic appointment. The nonrandom analytic sample comprised 221 patients.

Results:

Exploratory factor analyses yielded a 36-item, 4-factor solution explaining 76% of the variance. The factors were: (1) Provider Knowing the Person/Individualizing Care (18 items; α = 0.98); (2) Nurse Knowing the Person (8; 0.95); (3) Nurse Individualizing Care (7; 0.94); and (4) Continuity of Care (3; not calculated). A short form with 23 items was created using stepwise regression. It had the same 4 factors as the long form with 76% of the variance explained.

Conclusions:

Patients reported distinctive nurse contributions that have not been routinely measured.
The Impact of Budget Cuts on Sexually Transmitted Disease Programmatic Activities in State and Local Health Departments With Staffing Reductions in Fiscal Year 2012
Authors: Gift Thomas L. , Cuffe Kendra M. , Leichliter Jami S.
Published: July 2018

Staffing reductions in state and local health departments in fiscal year 2012 were concentrated in disease investigation specialists and clinicians (local) and disease investigation specialists and administrative staff (state). Local health departments with budget cuts were significantly more likely to report reduced partner services if they had staffing reductions.
Treatment Effects Can Mimic Recurrent Extramammary Paget Disease in Perianal Skin
Authors: Pittman Meredith E. , Milsom Jeffrey , Yantiss Rhonda K.
Published: July 2018

The histologic differential diagnosis of perianal Paget disease includes malignant melanoma, pagetoid spread of squamous cell carcinoma, and secondary involvement by colorectal carcinoma. While consideration of these entities is useful when establishing a diagnosis, it does not apply when patients with Paget disease undergo surveillance for recurrent disease. Treatment of perianal Paget disease consists of a combination of surgical excision with skin grafts and topical chemotherapeutic agents that induce cytologic alterations in benign cells and simulate recurrent malignancy. To evaluate the therapy-related changes and possible diagnostic pitfalls in patients with Paget disease, we reviewed 412 posttreatment tissue samples from 3 women with primary perianal Paget disease who underwent wide excision, skin grafting, and topical 5-fluorouracil therapy. Biopsy samples from engrafted skin often displayed single and clustered cells with hyperchromatic nuclei dispersed in the deep epidermis. Similar cells were scattered throughout all levels of the epidermis in biopsy samples following topical chemotherapy. The abnormal cells were negative for cytokeratin 7 (CK7) and mucicarmine in both situations. Disease ultimately recurred in all patients; some Paget cells showed classic features with eosinophilic or mucinous cytoplasm and eccentric nuclei, whereas others were smaller with less conspicuous atypia. All Paget cells showed strong, membranous CK7 staining. In short, treatment of perianal Paget disease can elicit cytologic abnormalities in benign epithelial cells that simulate the cytologic features of recurrent disease, and can diminish the atypia of Paget cells. Immunohistochemical stains for CK7 can be helpful when evaluating surveillance samples from these patients.
Molecular Profiling of Salivary Gland Intraductal Carcinoma Revealed a Subset of Tumors Harboring NCOA4-RET and Novel TRIM27-RET Fusions
Authors: Skálová Alena , Vanecek Tomas , Uro-Coste Emmanuelle , Bishop Justin A. , Weinreb Ilan , Thompson Lester D.R. , de Sanctis Stefano , Schiavo-Lena Marco , Laco Jan , Badoual Cécile , Santana Conceiçao Thalita , Ptáková Nikola , Baněčkova Martina , Miesbauerová Marketa , Michal Michal
Published: July 2018

Intraductal carcinoma (IC) is the new World Health Organization designation for tumors previously called “low-grade cribriform cystadenocarcinoma” and “low-grade salivary duct carcinoma.” The relationship of IC to salivary duct carcinoma is controversial, but they now are considered to be distinct entities. IC is a rare low-grade malignant salivary gland neoplasm with features similar to mammary atypical ductal hyperplasia or ductal carcinoma in situ, that shows diffuse S100 protein and mammaglobin positivity and is only partially defined genetically. (Mammary analogue) secretory carcinoma harboring ETV6-NTRK3, and in rare cases ETV6-RET fusion, shares histomorphologic and immunophenotypical features with IC. Recently, RET rearrangements and NCOA4-RET have been described in IC, suggesting a partial genetic overlap with mammary analogue secretory carcinoma. Here, we genetically characterize the largest cohort of IC to date to further explore this relationship. Seventeen cases of IC were analyzed by next-generation sequencing using the FusionPlex Solid Tumor kit (ArcherDX). Identified fusions were confirmed using fluorescence in situ hybridization break apart and, in some cases, fusion probes, and a reverse transcription polymerase chain reaction designed specifically to the detected breakpoints. All analyzed cases were known to be negative for ETV6 rearrangement by fluorescence in situ hybridization and for ETV6-NTRK3 fusion by reverse transcription polymerase chain reaction. Next-generation sequencing analysis detected a NCOA4-RET fusion transcript joining exon 7 or 8 of NCOA4 gene and exon 12 of RET gene in 6 cases of intercalated duct type IC; and a novel TRIM27-RET fusion transcript between exons 3 and 12 in 2 cases of salivary gland tumors displaying histologic and immunohistochemical features typical of apocrine IC. A total of 47% of IC harbored a fusion involving RET. In conclusion, we have confirmed the presence of NCOA4-RET as the dominant fusion in intercalated duct type IC. A novel finding in our study has been a discovery of a subset of IC patients with apocrine variant IC harboring a novel TRIM27-RET.