bluuebunny/crossref_metadata_2025 huggingface dataset:
Access to Palliative Care for Cancer Patients Living in a Northern and Rural Environment in Ontario, Canada: The Effects of Geographic Region and Rurality on End-of-Life Care in a Population-Based Decedent Cancer Cohort
Authors: Conlon Michael SC , Caswell Joseph M , Santi Stacey A , Ballantyne Barbara , Meigs Margaret L , Knight Andrew , Earle Craig C , Hartman Mark
Published: February 2019

Background:

Access to palliative care has been associated with improving quality of life and reducing the use of potentially aggressive end-of-life care. However, many challenges and barriers exist in providing palliative care to residents in northern and rural settings in Ontario, Canada.

Aim:

The purpose of this study was to examine access to palliative care and associations with the use of end-of-life care in a decedent cohort of northern and southern, rural and urban, residents.

Design:

Using linked administrative databases, residents were classified into geographic and rural categories. Regression methods were used to define use and associations of palliative and end-of-life care and death in acute care hospital.

Setting/Participants:

A decedent cancer cohort of Ontario residents (2007-2012).

Results:

Northern rural residents were less likely to receive palliative care (adjusted odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.83-0.97). Those not receiving palliative care were more likely to receive potentially aggressive end-of-life care and die in an acute care hospital (adjusted OR = 1.20, 95% CI: 1.02-1.41).

Conclusions:

Palliative care was significantly associated with reduced use of aggressive end-of-life care; however, disparities exist in rural locations, especially those in the north. Higher usage of emergency department (ED) and hospital resources at end of life in rural locations also reflects differing roles of rural community hospitals compared with urban hospitals. Improving access to palliative care in rural and northern locations is an important care issue and may reduce use of potentially aggressive end-of-life care.
Deconstructive Hermeneutics of Nature and Culture: Thinking After Derrida
Authors: Jin Huimin
Published: February 2019

The question of how Derrida’s deconstruction may help in reading nature and culture has not aroused much concern from critics, nor even from Derrida himself. A dialogue between them remains to be constructed. Following after Derrida, this article takes “l’opposition nature/culture” as a linguistic supposition; namely, it takes “nature” and “culture” and their “opposition” as signifiers, the signified of which is, of course, nature itself. According to the theory of deconstruction, however, these signifiers can never reach their signified. The implication of this for the question of nature and culture is that nature in itself is unsayable. To say is always to obscure. What deconstruction did is to give prominence to the “insignifierability” of the signifier, and the effacement that culture does to nature; but without that “culture,” we cannot access nature. The significance of deconstruction is, therefore, to remind us that to return to nature, we have to reflect unceasingly on culture that (in)signifies it, which means a faith in nature—if so, we have arrived at a point of after-Derrida.
Refugee solidarity in Europe: Shifting the discourse
Authors: Siapera Eugenia
Published: February 2019

This article focuses on the discourses in support of refugees as developed in Greece by local grassroots groups. The article theorises the public debate of the refugee issue as taking place in a hybrid media system, in which elites and policy makers, mainstream media, large non-governmental organisations and smaller solidarity groups as well as everyday people participate in unequal ways in constructing this debate and its parameters. In focusing on the solidarity discourses emerging from the grassroots, this article hopes to show how these groups seek to re-politicise the question of refugees, directly countering the (post)humanitarian and charity discourses of non-governmental organisations as well as the racist and security frames found in the mass media and policy discourses. In focusing on Greece, this article shows how two crises, the refugee and austerity crises – both symptoms of an underlying deep structural crisis of capitalism – may be dealt with in ways that overcome dilemmas of belongingness and otherness. In empirically supporting such arguments, the article posits the issue of solidarity to refugees as a research question: what kinds of solidarity do refugee support groups in Greece mobilise? This is addressed through focusing on the Facebook pages of 12 local solidarity initiatives. The analysis concludes that their alternative discourse is not based on spectacle and pity, nor on irony, but on togetherness and solidarity. This solidarity takes three forms, human, social and class solidarity, all feeding into the creation of a political project revolving around ideas of autonomy and self-organisation, freedom, equality and justice.
Shear strength of reinforced concrete beams with recycled aggregates
Authors: Wardeh George , Ghorbel Elhem
Published: February 2019

This article presents an experimental program on the shear behavior of beams without transversal reinforcement manufactured with natural aggregate concrete and 100% recycled aggregate concrete. The beams were tested under four-point bending for a shear span-to-depth ratio ( a/ d) equal to 1.5 and 3.0. The mechanical properties of two mixes were characterized in terms of compressive strength, splitting tensile strength, and elastic modulus. Three-point bending tests were performed on plain pre-notched samples in order to determine the fracture properties by an inverse analysis of experimental force–crack mouth opening displacement curves using the analytical nonlinear hinge model and a power law strain-softening relationship. The strain-softening law is described by two parameters being, respectively, the power n and the critical crack opening displacement wc. The experimental results show that, for the same class of compressive strength, tensile strength, fracture energy, and the shear strength of recycled aggregate concrete are lower than natural aggregate concrete. The decrease in the fracture energy and the shear strength is consistent with the decrease in the splitting tensile strength of the recycled aggregate concrete mixes compared to the natural aggregate concrete. Critical shear crack theory was adopted to model the shear behavior of beams tested with a/ d = 3.0. For an accurate evaluation of the deformation capacity of tested beams, the nonlinear hinge model for recycled concrete members was extended to recycled concrete sections. For deep beams ( a/ d = 1.5), the strut-and-tie model was used. Finally, comparisons of prediction models to a wide range of experimental data are presented.
Isotope labeling and infrared multiple-photon photodissociation investigation of product ions generated by dissociation of [ZnNO3(CH3OH)2]+: Conversion of methanol to formaldehyde
Authors: Perez Evan , Corcovilos Theodore A , Gibson John K , Martens Jonathan , Berden Giel , Oomens Jos , Van Stipdonk Michael J
Published: February 2019

Electrospray ionization was used to generate species such as [ZnNO3(CH3OH)2]+ from Zn(NO3)2•XH2O dissolved in a mixture of CH3OH and H2O. Collision-induced dissociation of [ZnNO3(CH3OH)2]+ causes elimination of CH3OH to form [ZnNO3(CH3OH)]+. Subsequent collision-induced dissociation of [ZnNO3(CH3OH)]+ causes elimination of 47 mass units (u), consistent with ejection of HNO2. The neutral loss shifts to 48 u for collision-induced dissociation of [ZnNO3(CD3OH)]+, demonstrating the ejection of HNO2 involves intra-complex transfer of H from the methyl group methanol ligand. Subsequent collision-induced dissociation causes the elimination of 30 u (32 u for the complex with CD3OH), suggesting the elimination of formaldehyde (CH2 = O). The product ion is [ZnOH]+. Collision-induced dissociation of a precursor complex created using CH3-18OH shows the isotope label is retained in CH2 = O. Density functional theory calculations suggested that the “rearranged” product, ZnOH with bound HNO2 and formaldehyde is significantly lower in energy than ZnNO3 with bound methanol. We therefore used infrared multiple-photon photodissociation spectroscopy to determine the structures of both [ZnNO3(CH3OH)2]+ and [ZnNO3(CH3OH)]+. The infrared spectra clearly show that both ions contain intact nitrate and methanol ligands, which suggests that rearrangement occurs during collision-induced dissociation of [ZnNO3(CH3OH)]+. Based on the density functional theory calculations, we propose that transfer of H, from the methyl group of the CH3OH ligand to nitrate, occurs in concert with the formation of a Zn–C bond. After dissociation to release HNO2, the product rearranges with the insertion of the remaining O atom into the Zn–C bond. Subsequent C–O bond cleavage, with H transfer, produces an ion–molecule complex composed of [ZnOH]+ and O = CH2.
Investigation of electrospray for a capillary electrophoresis–mass spectrometry interface in reverse polarity and negative ion mode
Authors: Stickney Morgan , Xia Qiangwei , Amster I Jonathan
Published: February 2019

Capillary zone electrophoresis (CZE) paired with mass spectrometry (MS) is a powerful analytical technique for examining mixtures of ionic analytes such as glycosaminoglycans. This study examines the mechanics of the electrospray process for a sheath flow CZE-MS interface under reverse polarity negative ionization conditions. Liquid flow in a sheath flow nano-electrospray CZE-MS interface is driven by two mechanisms, electroosmotic flow and electrospray nebulization. The contribution of these two processes to the overall flow of solution to the electrospray tip is influenced by the surface coatings of the sheath flow emitter tip and by the solvent composition. We have investigated the application of this interface to the reverse polarity separation of glycosaminoglycans and find that the role of electroosmotic flow is far less than has been reported previously, and the electrospray process itself is the largest contributor to the flow of the sheath liquid.
Social Movement Learning and Social Innovation: Empathy, Agency, and the Design of Solutions to Unmet Social Needs
Authors: Bennett Elisabeth E. , McWhorter Rochell R.
Published: February 2019

The Problem

Social innovation (SI) is integral to productive outcomes that resolve unmet social needs in various social movements throughout history, and it has become a movement of its own. SI provides a powerful place for social movement learning (SML) where solutions are often discovered through partnership of cross-sector affiliates who engage in creative work that often challenges the status quo in society. This learning is little understood let alone leveraged in the field of Human Resource Development (HRD).

The Solution

The purpose of this article is to explore SI as a site of SML and illuminate design thinking as an underlying learning process for the SI movement with implications for HRD. SI is predicated on sincerely held social values and more specifically empathy for others, and these are embedded in design thinking, which is a technique that HRD professionals can add to the toolbox and use when partnering with affiliates in corporate social responsibility projects, designing innovation initiatives, and working for social organizations. This article argues that learning to empathize with people who are subjects of innovation is a fundamental learning outcome in the social movement, as is agency, or the belief that one can act to create change, such as developing feasible and workable solutions to unmet social needs.

The Stakeholders

Stakeholders include HRD professionals, leaders and employers, social organizations and centers, and social movements and students in higher education that engage in SI projects that prepare them for working with innovation and to meet the social needs in society, whether home or abroad.
Influenza-Related Communication and Community Mitigation Strategies: Results From the 2015 Pandemic Influenza Readiness Assessment
Authors: Naik Rupesh I. , Vagi Sara J. , Uzicanin Amra , Dopson Stephanie A.
Published: February 2019

Emergence of a novel infectious disease, such as pandemic influenza, is the one global crisis most likely to affect the greatest number of people worldwide. Because of the potentially severe and contagious nature of influenza, a rapid multifaceted pandemic response, which includes nonpharmaceutical interventions (NPIs) and effective strategies for communication with the public are essential for a timely response and mitigating the spread of disease. A web-based questionnaire was administered via email in July 2015 to 62 Public Health Emergency Preparedness (PHEP) directors across jurisdictions that receive funding through the Centers for Disease Control and Prevention PHEP cooperative agreement. This report focuses on two modules: Public Information and Communication and Community Mitigation. Consistent and targeted communication are critical for the acceptability and success of NPIs. All 62 jurisdictions have developed or are in the process of developing a communications plan. Community-level NPIs such as home isolation, school closures, and respiratory etiquette play a critical role in mitigating the spread of disease. Effective, ongoing communication with the public is essential to ensuring wide spread compliance of NPI’s, especially among non–English-speaking populations. Planning should also include reaching vulnerable populations and identifying the correct legal authorities for closing schools and canceling mass gatherings.
Merged block randomisation: A novel randomisation procedure for small clinical trials
Authors: van der Pas Stéphanie L
Published: February 2019

Background/Aims:

Randomisation in small clinical trials is a delicate matter, due to the tension between the conflicting aims of balanced groups and unpredictable allocations. The commonly used method of permuted block randomisation has been heavily criticised for its high predictability. This article introduces merged block randomisation, a novel and conceptually simple restricted randomisation design for small clinical trials (less than 100 patients per stratum). Merged block randomisation is a simple procedure that can be carried out without need for a computer. Merged block randomisation is not restricted to 1:1 randomisation, but is readily applied to unequal target allocations and to more than two treatment groups.

Methods:

The position of merged block randomisation on the spectrum of balance and predictability is investigated in a simulation study, in two common situations: a single-centre study and a multicentre study (with sampling stratified per centre). Methods included for comparison were permuted block randomisation, Efron’s biased coin design, the maximal procedure, the block urn design and the big stick design.

Results:

Compared to permuted block randomisation with blocks of size 4, merged block randomisation has the same maximum tolerated imbalance and is thus as impervious to chronological bias, with the added benefit of being less predictable. Each method in the study takes a different position on the balance/determinism spectrum, and none was uniformly best. Merged block randomisation was either less predictable or more balanced than the other methods, in all simulation settings.

Conclusion:

Merged block randomisation is a versatile restricted randomisation method that outperforms permuted block randomisation and is a good choice for small clinical trials where imbalance is a main concern, especially in multicentre trials where the number of patients per centre may be small.
Targets for improving dispatcher identification of acute stroke
Authors: Mattila Olli S , Puolakka Tuukka , Ritvonen Juhani , Pihlasviita Saana , Harve Heini , Alanen Ari , Sibolt Gerli , Curtze Sami , Strbian Daniel , Pystynen Mikko , Tatlisumak Turgut , Kuisma Markku , Lindsberg Perttu J
Published: February 2019

Background

Accurate identification of acute stroke by Emergency Medical Dispatchers (EMD) is essential for timely and purposeful deployment of Emergency Medical Services (EMS), and a prerequisite for operating mobile stroke units. However, precision of EMD stroke recognition is currently modest.

Aims

We sought to identify targets for improving dispatcher stroke identification.

Methods

Dispatch codes and EMS patient records were cross-linked to investigate factors associated with an incorrect dispatch code in a prospective observational cohort of 625 patients with a final diagnosis of acute stroke or transient ischemic attack (TIA), transported to our stroke center as candidates for recanalization therapies. Call recordings were analyzed in a subgroup that received an incorrect low-priority dispatch code indicating a fall or unknown acute illness ( n = 46).

Results

Out of 625 acute stroke/TIA patients, 450 received a high-priority stroke dispatch code (sensitivity 72.0%; 95% CI, 68.5–75.5). Independent predictors of dispatcher missed acute stroke included a bystander caller (aOR, 3.72; 1.48–9.34), confusion (aOR, 2.62; 1.59–4.31), fall at onset (aOR, 1.86; 1.24–2.78), and older age (aOR [per year], 1.02; 1.01–1.04). Of the analyzed call recordings, 71.7% revealed targets for improvement, including failure to recognize a Face Arm Speech Time (FAST) test symptom (21/46 cases, 18 with speech disturbance), or failure to thoroughly evaluate symptoms (12/46 cases).

Conclusions

Based on our findings, efforts to improve dispatcher stroke identification should primarily focus on improving recognition of acute speech disturbance, and implementing screening of FAST-symptoms in emergency phone calls revealing a fall or confusion.

Clinical Trial Registration

URL: http://www.clinicaltrials.gov . Unique identifier: NCT02145663.
The road to 21 seconds: A case report of a 2016 Olympic swimming sprinter
Authors: Barbosa Augusto Carvalho , Valadão Pedro Frederico , Wilke Carolina Franco , Martins Felipe de Souza , Silva Dellano Cézar Pinto , Volkers Scott Alexander , Lima Cláudio Olívio Vilela , Ribeiro José Ricardo Claudino , Bittencourt Natália Franco , Barroso Renato
Published: February 2019

This study aimed to describe training characteristics as well as physical, technical and morphological changes of an elite Olympic swimming sprinter throughout his road to 21 s in the 50 m freestyle. Over a ∼2.5-year period, the following assessments were obtained: external training load, competitive performance, instantaneous swimming speed, tethered force, dry-land maximal dynamic strength in bench press, pull-up and back squat and body composition. From 2014 to 2016, the athlete dropped 3.3% of his initial best time by reducing total swimming time (i.e. the total time minus 15-m start time – from 17.07 s to 16.21 s) and improving the stroke length (from 1.83 m to 2.00 m). Dry-land strength (bench press: 27.3%, pull-up: 9.1% and back squat: 37.5%) and tethered force (impulse: 30.5%) increased. Competitive performance was associated to average (r = −0.82, p = 0.001) and peak speeds (r = −0.71; p = 0.009) and to lean body mass (r = −0.55; p = 0.03), which increased in the first year and remained stable thereafter. External training load presented a polarized pattern in all training seasons. This swimmer reached the sub-22 s mark by reducing total swimming time, which was effected by a longer stroke length. He also considerably improved his dry-land strength and tethered force levels likely due to a combination of neural and morphological adaptations.
The Popularity of Outcome Measures Used in the Foot and Ankle Literature
Authors: Hijji Fady Y. , Schneider Andrew D. , Pyper Michael , Laughlin Richard T.
Published: February 2019

Background. Outcome measures are frequently employed in clinical studies to determine the efficacy of orthopaedic surgical procedures. However, substantial variability exists among the outcome instruments utilized in foot and ankle (F&A) literature. The purpose of this study is to determine the number of outcome measures reported in F&A literature recently published in major orthopaedic journals and the association between study characteristics and the use of particular outcome measurement categories. Methods. All manuscripts published in 6 major orthopaedic journals between 2013-2017 reporting at least one clinical outcome measure were collected. For each manuscript, the journal, title, authors, country/region of origin, level of evidence, topic, and anatomic location were recorded. Outcome measures were characterized as generic, F&A specific, and disease specific. Poisson regression with robust error variance was used to test for association between study characteristics and outcome measure categories. Results. A total of 541 F&A articles were included with fifty-two different outcome measures reported. The most popular tool was the American Orthopaedic Foot and Ankle Score (AOFAS) (56.9%). Generic outcome measures were used in 331 (61.1%) studies, while 440 (81.3%) studies used F&A specific measures and 64 (11.8%) used disease-specific measures. The use of generic and disease-specific outcome measures was associated with a higher level of evidence (p < 0.001). Conclusion. AA substantial variety of outcome measures are employed among recent published studies, with many studies utilizing non-validated measures. Reporting a combination of validated and focused outcome measures is necessary to improve the quality and generalizability of published studies in foot and ankle literature.

Levels of Evidence: Level II: Systematic review
Functionalising lignin in crude glycerol to prepare polyols and polyurethane
Authors: Muller Louis Christiaan , Marx Sanette , Vosloo Hermanus CM , Chiyanzu Idan
Published: February 2019

In this work, crude glycerol liquefaction of lignins produced in the pulp and paper industry, as well as an organosolv lignin (sugarcane bagasse), was studied with the ultimate aim of preparing bio-based polyols for polyurethane (PU) preparation. This is a proposed strategy to valorise the by-products of biodiesel and lignocellulose biorefineries. Size-exclusion chromatography revealed that the lignins behave differently during liquefaction based on a ranging product molecular weight (MW). The MW of the liquefaction products was concluded to be related to the phenolic and aliphatic hydroxyl group content of the respective lignins, as well as the removal of glycerol and monoacylglycerol during liquefaction. Lignin was modified to yield mostly a solid-phase product. Fourier transform infrared spectroscopy suggests that crude glycerol constituents like glycerol and fatty acid esters are bound to lignin during liquefaction through formation of ether and ester bonds. Liquefaction yield further also varied with lignin type. The liquefaction products were effectively employed as bio-based polyols to prepare PU.
Maximizing respondent-driven sampling field procedures in the recruitment of sexual minorities for health research
Authors: Hequembourg Amy L , Panagakis Christina
Published: February 2019

Objectives:

Research to address the significant health burden experienced by sexual minority populations remains hampered by a lack of appropriate sampling methods to support evidence-based studies. Respondent-driven sampling offers one viable strategy to recruit these hidden populations. Because few studies systematically report their experiences using respondent-driven sampling to recruit sexual minorities, this article aligns with recent recommendations for the standardization of reporting and transparency in studies utilizing respondent-driven sampling. We (1) provide detailed descriptions about the successful execution of respondent-driven sampling in two community-based studies of sexual minority individuals, (2) outline procedures to enhance the effectiveness of respondent-driven sampling referral processes, (3) present mixed-methods results regarding the effectiveness of respondent-driven sampling in our studies, and (4) offer recommendations for other researchers when using respondent-driven sampling.

Methods:

We successfully recruited 655 sexual minority men and women for two studies using respondent-driven sampling.

Results:

Resulting metrics indicate the successful achievement of equilibrium in each study. In addition, exit interviews elucidated strategies to effectively target referrals who meet the study criteria and procedures to promote the study that will maximize referral chains and ensure attainment of equilibrium.

Conclusion:

Mixed-methods results suggest that respondent-driven sampling can be an effective means of recruiting a community-based sample of sexual minorities in smaller urban regions. Limitations are presented and suggestions are offered to researchers utilizing respondent-driven sampling in future studies.
Physical education teachers’ and principals’ perspectives on the use of FitnessGram
Authors: Suminski Richard R , Blair Rachel I , Lessard Laura , Peterson Michael , Killingsworth Richard
Published: February 2019

Objectives:

FitnessGram is commonly used to measure physical fitness and improve physical activity and health in youth. However, little is known about its use for informing physical activity and health promotion policy within schools and school districts, especially from the perspective of key decision-makers like principals. Therefore, this study examined physical education teachers’ and principals’ perceptions of FitnessGram use and its relationship with school and district efforts to promote physical activity.

Methods:

Principal and physical education teacher surveys were developed, converted to an online format, and then emailed along with a project description and instructions to all Delaware public and charter school physical education teachers (N = 183) and principals (N = 193) with a valid email.

Results:

Completed surveys were received from 35.5% of the teachers and 21.2% of the principals. All teachers and 95.1% of the principals reported their school used FitnessGram the past academic year. FitnessGram was significantly more likely to be used if FitnessGram results better aligned with school/district policies (r = 0.39) and were considered important in the school’s decision-making process (r = 0.53). Significantly more principals than teachers said that FitnessGram results were important in their school’s decision-making process and that FitnessGram results were used to inform policy-/decision-making.

Conclusion:

Use of FitnessGram was correlated with how well it related to school/district policy. Unfortunately, most of the physical education teachers and principals did not think FitnessGram was adequately integrated into the policy-/decision-making process.
Suspected phenobarbital-induced fever in a cat
Authors: Djani Dylan M , Draper William E
Published: February 2019

Case summary

A 3-year-old spayed female domestic shorthair cat developed a fever 1 week after starting the anticonvulsant phenobarbital. A diagnostic work-up for seizures and subsequent onset of fever of unknown origin, consisting of MRI of the brain, cerebrospinal fluid analysis and infectious disease testing, was unremarkable. The cat was switched from phenobarbital onto pregabalin with complete resolution of the fever within 24 h, consistent with a drug-induced fever following phenobarbital administration.

Relevance and novel information

While anticonvulsant hypersensitivities have been reported and studied in veterinary medicine, phenobarbital-induced fever outside of the context of systemic clinical signs has not been documented in the veterinary scientific literature. Drug-induced fever secondary to anticonvulsants should be considered in patients that develop a fever after starting anticonvulsant therapy with an unrewarding diagnostic work-up for fever of unknown origin.
Dynamic Changes of Cauda Equina Motion Before and After Decompressive Laminectomy for Lumbar Spinal Stenosis With Redundant Nerve Roots: Cauda Equina Activation Sign
Authors: Kawasaki Yosuke , Seichi Atsushi , Zhang Liuzhe , Tani Shoichiro , Kimura Atsushi
Published: February 2019

Study Design:

Cross-sectional observational study (consecutive case series).

Objectives:

The aim of this study was to define a criterion for achieving successful decompression of lumbar spinal stenosis (LSS) using intraoperative ultrasonography (IOUS) and to investigate the pathogenesis of redundant nerve roots (RNRs) based on the ultrasonographic findings.

Methods:

A total of 100 LSS patients (71 males, 29 females, mean age, 71 ± 8 years) with RNRs were enrolled as subjects in this study. IOUS was performed to evaluate pulsatile motion of the cauda equina (PMCE) just before and after decompressive laminectomy. To determine the decompression status of the cauda equina, the ultrasonographic findings were classified into 3 types on the basis of the presence or absence of PMCE: type 1, predecompression PMCE (−) to postdecompression PMCE (+); type 2, pre- and postdecompression PMCE (+); and type 3, pre- and postdecompression PMCE (−). The pathogenesis of RNRs was also investigated based on the ultrasonographic findings.

Results:

Around the stenosis, PMCE was almost always absent before decompression and appeared after decompression (type 1 in 94 patients, type 2 in 6, type 3 in 0). IOUS showed that, before decompression, the cauda equina was held at the stenosis and could not pulsate beyond the stenotic site, and after decompression, PMCE recovered in the craniocaudal direction, leading to the resolution of RNRs.

Conclusions:

The emergence of PMCE can be a sign of successful decompression for LSS. Ultrasonographic findings support the notion that disturbance of PMCE around the stenosis is a basic component of the pathogenesis of RNRs.
Overlapping, Masquerading, and Causative Cervical Spine and Shoulder Pathology: A Systematic Review
Authors: Katsuura Yoshihiro , Bruce Jeremy , Taylor Samuel , Gullota Lawrence , Kim Han Jo
Published: February 2019

Study Design:

Systematic review.

Objective:

To assess the current literature regarding the relationship between the shoulder and the spine with regard to (1) overlapping pain pathways; (2) differentiating history, exam findings, and diagnostic findings; (3) concomitant pathology and optimal treatments; and (4) cervical spine-based etiology for shoulder problems.

Methods:

A systematic literature search was performed according to the guidelines set forth by the Cochrane Collaboration. Studies were included if they examined the clinical, anatomical, or physiological overlap between the shoulder and cervical spine. Two reviewers screened and selected full texts for inclusion according to the objectives of the study. Quality of evidence was graded using OCEBM (Oxford Center for Evidence Based Medicine) and MINORS (Methodological Index for Nonrandomized Studies) scores.

Results:

Out of 477 references screened, 76 articles were included for review and grouped into 4 main sections (overlapping pain pathways, differentiating exam findings, concomitant/masquerading pathology, and cervical spine-based etiology of shoulder pathology). There is evidence to suggest cervical spine pathology may cause shoulder pain and that shoulder pathology may cause neck pain. Specific examination tests used to differentiate shoulder and spine pathology are critical as imaging studies may be misleading. Diagnostic injections can be useful to confirm sources of pain as well as predicting the success of surgery in both the shoulder and the spine. There is limited evidence to suggest alterations in the relationship between the spine and the scapula may predispose to shoulder impingement or rotator cuff tears. Moreover, cervical neurological lesions may predispose patients to developing rotator cuff tears. The decision to proceed with shoulder or spine surgery first should be delineated with careful examination and the use of shoulder and spine diagnostic injections.

Conclusion:

Shoulder and spine pathology commonly overlap. Knowledge of anatomy, pain referral patterns, shoulder kinematics, and examination techniques are invaluable to the clinician in making an appropriate diagnosis and guiding treatment. In this review, we present an algorithm for the identification and treatment of shoulder and cervical spine pathology.
Evolution of a Stand-Alone Undergraduate Public Health Program and the Inclusion of a Peace Corps Prep Certificate Program
Authors: Cherry Sabrina T. , Cottrell Randall R. , Whipple Kerry
Published: February 2019

For over a decade there has been a growing interest in undergraduate public health degree programs and global health careers. To this end, colleges and universities across the United States are training undergraduate students to meet these demands. In 2014, the Council on Education for Public Health began to accredit stand-alone, undergraduate public health programs. This article highlights the steps followed by one university to obtain Council accreditation. Additionally, the authors describe how the university’s Peace Corps Prep Certificate Program has been intertwined with the Public Health Studies curriculum to offer public health students a unique opportunity to fulfill both degree and program requirements, while receiving specialized training in global health.
Artificial intelligence outperforms pulmonologists in the interpretation of pulmonary function tests
Authors: Topalovic Marko , Das Nilakash , Burgel Pierre-Régis , Daenen Marc , Derom Eric , Haenebalcke Christel , Janssen Rob , Kerstjens Huib A.M. , Liistro Giuseppe , Louis Renaud , Ninane Vincent , Pison Christophe , Schlesser Marc , Vercauter Piet , Vogelmeier Claus F. , Wouters Emiel , Wynants Jokke , Janssens Wim
Published: February 2019

The interpretation of pulmonary function tests (PFTs) to diagnose respiratory diseases is built on expert opinion that relies on the recognition of patterns and the clinical context for detection of specific diseases. In this study, we aimed to explore the accuracy and interrater variability of pulmonologists when interpreting PFTs compared with artificial intelligence (AI)-based software that was developed and validated in more than 1500 historical patient cases.

120 pulmonologists from 16 European hospitals evaluated 50 cases with PFT and clinical information, resulting in 6000 independent interpretations. The AI software examined the same data. American Thoracic Society/European Respiratory Society guidelines were used as the gold standard for PFT pattern interpretation. The gold standard for diagnosis was derived from clinical history, PFT and all additional tests.

The pattern recognition of PFTs by pulmonologists (senior 73%, junior 27%) matched the guidelines in 74.4±5.9% of the cases (range 56–88%). The interrater variability of κ=0.67 pointed to a common agreement. Pulmonologists made correct diagnoses in 44.6±8.7% of the cases (range 24–62%) with a large interrater variability (κ=0.35). The AI-based software perfectly matched the PFT pattern interpretations (100%) and assigned a correct diagnosis in 82% of all cases (p<0.0001 for both measures).

The interpretation of PFTs by pulmonologists leads to marked variations and errors. AI-based software provides more accurate interpretations and may serve as a powerful decision support tool to improve clinical practice.
Benefits of improved air quality on ageing lungs: impacts of genetics and obesity
Authors: Hüls Anke , Sugiri Dorothee , Abramson Michael J. , Hoffmann Barbara , Schwender Holger , Ickstadt Katja , Krämer Ursula , Schikowski Tamara
Published: February 2019

Introduction

The beneficial effect of improving air quality on lung function in the elderly remains unclear. We examined associations between decline in air pollutants and lung function, and effect modifications by genetics and body mass index (BMI), in elderly German women.

Methods

Data were analysed from the prospective SALIA (Study on the influence of Air pollution on Lung function, Inflammation and Aging) study (n=601). Spirometry was conducted at baseline (1985–1994; age 55 years), in 2007–2010 and in 2012–2013. Air pollution concentrations at home addresses were determined for each time-point using land-use regression models. Global Lung Initiative 2012 z-scores were calculated. Weighted genetic risk scores (GRSs) were determined from lung function-related risk alleles and used to investigate interactions with improved air quality. Multiple linear mixed models were fitted.

Results

Air pollution levels decreased substantially during the study period. Reduction of air pollution was associated with an increase in z-scores for forced expiratory volume in 1 s (FEV1) and the FEV1/forced vital capacity ratio. For a decrease of 10 µg·m−3in nitrogen dioxide (NO2), the z-score for FEV1increased by 0.14 (95% CI 0.01–0.26). However, with an increasing number of lung function-related risk alleles, the benefit from improved air quality decreased (GRS×NO2interaction: p=0.029). Interactions with BMI were not significant.

Conclusions

Reduction of air pollution is associated with a relative improvement of lung function in elderly women, but also depends on their genetic make-up.
The Electronic Asthma Management System (eAMS) improves primary care asthma management
Authors: Gupta Samir , Price Courtney , Agarwal Gina , Chan David , Goel Sanjeev , Boulet Louis-Philippe , Kaplan Alan G. , Lebovic Gerald , Mamdani Muhammad , Straus Sharon E.
Published: February 2019

A high prevalence of suboptimal asthma control is attributable to known evidence–practice gaps. We developed a computerised clinical decision support system (the Electronic Asthma Management System (eAMS)) to address major care gaps and sought to measure its impact on care in adults with asthma.

This was a 2-year interrupted time-series study of usual care (year 1)versuseAMS (year 2) at three Canadian primary care sites. We included asthma patients aged ≥16 years receiving an asthma medication within the last 12 months. The eAMS consisted of a touch tablet patient questionnaire completed in the waiting room, with real-time data processing producing electronic medical record-integrated clinician decision support.

Action plan delivery (primary outcome) improved from zero out of 412 (0%) to 79 out of 443 (17.8%) eligible patients (absolute increase 0.18 (95% CI 0.14–0.22)). Time-series analysis indicated a 30.5% increase in physician visits with action plan delivery with the intervention (p<0.0001). Assessment of asthma control level increased from 173 out of 3497 (4.9%) to 849 out of 3062 (27.7%) eligible visits (adjusted OR 8.62 (95% CI 5.14–12.45)). Clinicians escalated controller therapy in 108 out of 3422 (3.2%) baseline visitsversus126 out of 3240 (3.9%) intervention visits (p=0.12). At baseline, a short-acting β-agonist alone was added in 62 visits and a controller added in 54 visits; with the intervention, this occurred in 33 and 229 visits, respectively (p<0.001).

The eAMS improved asthma quality of care in real-world primary care settings. Strategies to further increase clinician uptake and a randomised controlled trial to assess impact on patient outcomes are now required.
Tiotropium discontinuation in patients with early-stage COPD: a prospective observational cohort study
Authors: Li Chenglong , Zhou Yumin , Liu Sha , Zheng Mengning , Zheng Jinzhen , Peng Huanhuan , Deng Zhishan , Zhong Nanshan , Ran Pixin
Published: February 2019

Background

Tiotropium improves lung function and ameliorates the annual decline in forced expiratory volume in 1 s (FEV1) after bronchodilator use in patients with mild to moderate chronic obstructive pulmonary disease (COPD). However, whether these benefits persist in patients with early-stage COPD after tiotropium discontinuation is unknown.

Methods

In this prospective cohort observational follow-up study, patients who had completed the Tiotropium in Early-Stage COPD (Tie-COPD) trial were followed for a maximum of 3 years, continuing or discontinuing treatment according to their willingness. The outcomes measured were spirometry parameters, COPD exacerbations, COPD Assessment Test (CAT) scores, Clinical COPD Questionnaire (CCQ) scores, modified Medical Research Council (mMRC) scores and the use of respiratory medications.

Results

Out of 376 patients, 262 (126 in the post-placebo group and 136 in the post-tiotropium group) completed the maximum 3-year follow-up after the study medication was withdrawn. After discontinuation, the decrease in FEV1and forced vital capacity (FVC) did not differ significantly between the two groups, and neither did their annual decline. In addition, the frequency of acute COPD exacerbations and the mMRC scores were similar between the two groups after medication withdrawal. Both the mean CAT and CCQ scores were significantly lower in the post-tiotropium group than in the post-placebo group (p<0.05 for all comparisons) at the 1-year follow-up after withdrawal, but they were not different at the next follow-up.

Conclusion

Withdrawal of tiotropium treatment in early-stage COPD resulted in difference reduction of both FEV1and FVC, indicating that treatment should be continued.
The frequency of high PD-L1 expression is low in lung adenocarcinoma patients from Northeast Brazil
Authors: Alves da Silva Antonio V. , Martins Neto Francisco , de Oliveira Ana Claudia da Silva M. , Carneiro Benedito A. , Alves Marclesson , Nogueira Cleto Dantas , Tavora Fabio
Published: February 2019

Background

As Immune checkpoint inhibitors (ICPIs) are changing the standard-care in lung cancer with good clinical activities and durable responses, its indication must be based on the appropriate patient selection once only a fraction of patients has a response to these costly drugs. In larger cohorts the expression of programmed cell death–ligand 1 (PD-L1) has been associated with good clinical response of ICPIs in lung adenocarcinoma where the rate of high PD-L1 expression (defined as PD-L1tumor proportion score ≥ 50%) is ~ 30%, but once rare studies are available addressing the frequency of PD-L1 in populations outside those cohorts, we aimed to report the prevalence of PD-L1 and the frequency of patients with high PD-L1 expression utilizing data from a major pathology laboratory in Northeastern Brazil.

Methods

We retrospectively evaluated the PD-L1 expression in 158 surgically resected primary lung adenocarcinoma including 158 with anaplastic lymphoma kinase (ALK) expression. PD-L1 and ALK expression were evaluated by immunohistochemical analysis with the SP263 and D5F3 assays, respectively.

Results

Of the 158 samples analyzed, 94 (59.5%) had a PD-L1 tumor proportion score (TPS) < 1%, 38 (24.0%) had a PD-L1 TPS of 1–49% and 26 (16.5%) had a PD-L1 TPS of ≥50%. ALK expression was detected in 21 (13.3%) of the 158 tumor samples and 5 (3.2%) of them had a PD-L1 TPS of ≥50%.

Conclusion

The frequency of strong PD-L1 expression was lower than that previously reported in the trials where PD-L1 expression was used as a biomarker for patient selection. Also, considering that a subset of patients with ALK positivity had a strong PD-L1 expression, further studies will be required to examine the efficacy of PD-1/PD-L1 inhibitors in such patients.
Failed Awake Intubation for Critical Airway Obstruction Rescued With the Ventrain Device and an Arndt Exchange Catheter: A Case Report
Authors: Morrison Stuart , Aerts Sophie , Van Rompaey Diane , Vanderveken Olivier
Published: February 2019

A 71-year-old man with advanced vocal cord carcinoma presented with severe airway obstruction. Therapeutic anticoagulation with enoxaparin complicated management. Failure of an oral awake bronchoscopic intubation was rescued by passing a guidewire through the working channel and threading an Arndt exchange catheter into the trachea under videoscopic vision. Ventilation with the Ventrain device lasting 40 minutes (15 L/min, inspiration/expiration 1:1, 15 breaths/min), during IV anesthesia with muscle paralysis, resulted in excellent blood gas values until placement of the tracheal cannula. This case report highlights the effectiveness of a novel ventilation technique that should be considered as back-up when bronchoscopic intubation fails.
E-cadherin expression pattern during zebrafish embryonic epidermis development
Authors: Sampedro María Florencia , Izaguirre María Fernanda , Sigot Valeria
Published: February 2019

Background: E-cadherin is the major adhesion receptor in epithelial adherens junctions (AJs). On established epidermis, E-cadherin performs fine-tuned cell-cell contact remodeling to maintain tissue integrity, which is characterized by modulation of cell shape, size and packing density. In zebrafish, the organization and distribution of E-cadherin in AJs during embryonic epidermis development remain scarcely described.

Methods:Combining classical immunofluorescence, deconvolution microscopy and 3D-segmentation of AJs in epithelial cells, a quantitative approach was implemented to assess the spatial and temporal distribution of E-cadherin across zebrafish epidermis between 24 and 72 hpf.

Results:increasing levels of E-cadh protein parallel higher cell density and the appearance of hexagonal cells in the enveloping layer (EVL) as well as the establishments of new cell-cell contacts in the epidermal basal layer (EBL), being significantly between 31 and 48 hpf.

Conclusions:Increasing levels of E-cadherin in AJs correlates with extensive changes in cell morphology towards hexagonal packing during the epidermis morphogenesis.
Recent advances in understanding and managing postoperative respiratory problems
Authors: Eikermann Matthias , Santer Peter , Ramachandran Satya-Krishna , Pandit Jaideep
Published: February 2019

Postoperative respiratory complications increase healthcare utilization (e.g. hospital length of stay, unplanned admission to intensive care or high-dependency units, and hospital readmission), mortality, and adverse discharge to a nursing home. Furthermore, they are associated with significant costs. Center-specific treatment guidelines may reduce risks and can be guided by a local champion with multidisciplinary involvement. Patients should be risk-stratified before surgery and offered anesthetic choices (such as regional anesthesia). It is established that laparoscopic surgery improves respiratory outcomes over open surgery but requires tailored anesthesia/ventilation strategies (positive end-expiratory pressure utilization and low inflation pressure). Interventions to optimize treatment include judicious use of intensive care, moderately restrictive fluid therapy, and appropriate neuromuscular blockade with adequate reversal. Patients’ ventilatory drive should be kept within a normal range wherever possible. High-dose opioids should be avoided, while volatile anesthetics appear to be lung protective. Tracheal extubation should occur in the reverse Trendelenburg position, and postoperative continuous positive airway pressure helps prevent airway collapse. In combination, all of these interventions facilitate early mobilization.