bluuebunny/crossref_metadata_2025 huggingface dataset:
The history of the biopsychosocial approach in medicine
Authors: Shorter Edward
Published: October 2017

This chapter presents a history of the biopsychosocial approach in medicine, including its origins, the work of George Engel, and the development of the biopsychosocial model after Engel.
The theoretical basis of the biopsychosocial model
Authors: Malmgren Helge
Published: October 2017

This chapter addresses the philosophy behind the biopsychosocial model. It summarizes five aetiological problems that the biopsychosocial model must address (nature versus nurture; single-factor versus multifactor causality; somatic versus mental causes; reasons versus causes; conscious versus non-conscious influences) with a particular focus on the mind-body problem, and uses an analogy between computer hardware and software to describe the relationship between the mind and body.
Remediable or preventable social factors in the aetiology and prognosis of medical disorders
Authors: Marmot Michael
Published: October 2017

This chapter reviews the role of social factors in disease incidence. It outlines data suggesting that social gradients affect differences in morbidity and mortality and that these change with time. Although consequent health risk behaviours, such as smoking, help to mediate this effect, work-related stressors have an independent effect. Non-human primate studies suggest that the relationship between social position and health may be causal in different ways in both sexes.
Fear and depression as remediable causes of disability in common medical conditions in primary care
Authors: Von Korff Michael
Published: October 2017

This chapter argues that psychological states, in particular fear and depression, are potentially remediable causes of social role disability among primary care patients. Using chronic low back pain as an example, it considers how recognising and treating depression can improve disability and quality of life for primary care patients with this and many other chronic conditions.
Theoretical perspectives and approaches
Authors: Albery Ian P. , Sharma Dinkar , Niazi Asli , Moss Antony C.
Published: October 2017

This chapter explores the role of cognition and cognitive biases in the understanding of concepts related to addiction, such as craving, from a number of theoretical stances. These include the dual-affect model, incentive sensitization theory, social learning and expectancy approaches, and finally the cognitive model of drug urges and drug-use behaviour. It also explores methodologies and research methods that have been used to test these various cognitive accounts of addictive behaviour.
An implicit cognition, associative memory framework for addiction
Authors: Stacy Alan W. , Wiers Reinout W.
Published: October 2017

This chapter outlines a framework that applies basic research on implicit cognition and associative memory to addictive behaviours. The framework helps provide a basis for continued development of cognitive theories of addiction, and suggests how the approach can foster prevention and cessation efforts. Findings and theories from neural systems, memory, implicit processes and addiction research are considered in an attempt to derive basic principles for the framework. Measurement domains are briefly summarized. Concepts from this framework are compared with related ideas, from expectancy and cue-reactivity research areas. This framework calls for a greater focus on the specific principles derived from basic cognitive research in multiple disciplines and encourages more attempts at integration across these areas.
Treatments for Pediatric Bipolar Disorder
Authors: Goldberg Pablo H. , Martin Prerna , Biernacki Carolina , Rynn Moira A.
Published: October 2017

The past two decades have seen significant advances in the development of evidence-based treatments for pediatric bipolar disorder. Practice guidelines recommend pharmacotherapy with mood stabilizers or second-generation antipsychotics (SGAs) as the first-line treatment. Lithium, risperidone, aripiprazole, quetiapine, and olanzapine are approved by the U.S. Food & Drug Administration for treating bipolar disorder in children and adolescents. The pharmacological literature suggests that SGAs are faster and more effective than mood stabilizers in treating acute manic or mixed episodes, but they have significant side effects and require careful monitoring. While mild to moderate bipolar disorder can be treated with monotherapy, combination pharmacotherapy with an SGA and a mood stabilizer is recommended for youth with severe bipolar disorder. A growing body of literature also suggests the efficacy of psychosocial interventions, with family psychoeducation and skills building as adjunct treatments to pharmacotherapy. More type 1 studies of pharmacotherapy and psychosocial treatments are needed.
Psychosocial Treatments for Bipolar Disorder
Authors: Muralidharan Anjana , Miklowitz David J. , Craighead W. Edward
Published: October 2017

Pharmacological interventions remain the primary treatment for bipolar disorder. However, adjunctive psychosocial interventions have the potential to increase adherence to medication regimens, decrease hospitalizations and relapses, decrease severity of symptoms, improve quality of life, and enhance mechanisms for coping with stress. Group psychoeducation, designed to provide information to bipolar patients about the disorder and its treatment, leads to lower rates of recurrence and greater adherence to medication among remitted bipolar patients at both short- and long-term follow-up. Cognitive-behavioral therapy as an ancillary treatment has found mixed results but generally supportive evidence indicating that it is useful in preventing relapse to depression in remitted patients. Family-based intervention, such as Family-Focused Therapy (FFT), may be combined with pharmacotherapy to reduce recurrences and hospitalization rates in adult patients.
Pharmacological Treatment of Posttraumatic Stress Disorder
Authors: Golier Julia A. , Michaelides Andreas C. , Genovesi Maya , Chapman Emily , Yehuda Rachel
Published: October 2017

Although psychotherapy is considered first-line treatment for posttraumatic stress disorder (PTSD), advances have been made in pharmacological treatment. Based on controlled clinical trials, antidepressants remain the first-line pharmacological treatment. Studies suggest that selective serotonin reuptake inhibitors reduce PTSD-specific symptoms and improve global outcome. Emerging evidence suggests efficacy for venlafaxine. Other individual agents found to be efficacious include imipramine and phenelzine. Prazosin is emerging as a beneficial adjunct for PTSD-related sleep disturbances and nightmares. Some evidence suggests that atypical antipsychotics may be efficacious against a broad range of symptoms, although the risk of metabolic side effects may limit widespread use. Trials are needed to assess whether anticonvulsants, cortisol-based treatments, sympatholytics, or other novel approaches are efficacious, and how pharmacotherapy can enhance psychotherapy outcomes. These studies should consider the goals of pharmacotherapy in PTSD and the subgroups of patients or clinical presentations most likely to benefit from pharmacological interventions.
Pharmacotherapy and Psychotherapy for Sexual Dysfunctions
Authors: Segraves R. Taylor
Published: October 2017

Well-controlled, double-blind, multisite investigations have demonstrated the efficacy of phosphodiesterase type 5 inhibitors for the treatment of erectile problems of mixed etiologies. A large number of studies affirm that serotonergic antidepressants delay ejaculation in men with premature ejaculation. Similarly, studies have demonstrated the efficacy of transdermal testosterone therapy in restoring sexual function in women after oophorectomy. There is suggestive evidence of the efficacy of cognitive-behavioral therapy in the treatment of sexual dysfunction in both sexes. However, the number and methodological rigor of such studies are limited and the effect sizes tend to be smaller than studies of pharmacological therapies.
Ideas from Psychology and Behavioral Science Leading to Dynamic Forms of Vitality
Authors: Stern Daniel N.
Published: October 2017

Chapter 3 explores ideas from psychology and behavioral science that are leading to dynamic forms of vitality, beginning with the ideas and influences of psychoanalysis and phenomenology, and reviews of the attempts of psychological and behavioral science to deal with dynamic forms of vitality.
Vitality Forms in Music, Dance, Theater, and Cinema
Authors: Stern Daniel N.
Published: October 2017

Chapter 5 examines how vitality forms have been dealt with in the arts of music, dance, theater, and cinema, and forms the basis of collaborations. It also discusses the problem of coding for the experience of vitality forms in music, dance, theater, and cinema, along with tools that are available to cinema in creating vitality forms.
Structured clinical management: general treatment strategies
Authors: Bateman Anthony W. , Krawitz Roy
Published: October 2017

Chapter 3 focuses on structured clinical management (SCM) as a treatment for borderline personality disorder (BPD). It describes the structure, pathway to assessment, process of assessment and diagnosis, crisis planning (including risk assessment, legal aspects, clinician and patient responsibilities, therapeutic alliance, substance abuse, stabilizing medication), and the treatment approach.
Emotional processing
Authors: MacPherson Sarah E. , Sala Sergio Della , Cox Simon R. , Girardi Alessandra , Iveson Matthew H.
Published: October 2017

Tests assessing emotional processing are described and evidence for localization of emotional processes within frontal subregions is discussed. The evidence comes from studies of patients with frontal lobe lesions and neuroimaging data. The influence of healthy adult aging on emotional processing is also considered.
Comparing galaxy formation in semi-analytic models and hydrodynamical simulations
Authors: Mitchell Peter D. , Lacey Cedric G. , Lagos Claudia D. P. , Frenk Carlos S. , Bower Richard G. , Cole Shaun , Helly John C. , Schaller Matthieu , Gonzalez-Perez Violeta , Theuns Tom
Published: October 2017

It is now possible for hydrodynamical simulations to reproduce a representative galaxy population. Accordingly, it is timely to assess critically some of the assumptions of traditional semi-analytic galaxy formation models. We use the eagle simulations to assess assumptions built into the galform semi-analytic model, focusing on those relating to baryon cycling, angular momentum and feedback. We show that the assumption in galform that newly formed stars have the same specific angular momentum as the total disc leads to a significant overestimate of the total stellar specific angular momentum of disc galaxies. In eagle, stars form preferentially out of low-specific angular momentum gas in the interstellar medium due to the assumed gas density threshold for stars to form, leading to more realistic galaxy sizes. We find that stellar mass assembly is similar between galform and eagle but that the evolution of gas properties is different, with various indications that the rate of baryon cycling in eagle is slower than is assumed in galform. Finally, by matching individual galaxies between eagle and galform, we find that an artificial dependence of active galactic nucleus feedback and gas infall rates on halo mass-doubling events in galform drives most of the scatter in stellar mass between individual objects. Put together our results suggest that the galform semi-analytic model can be significantly improved in light of recent advances.
Systemic Colonization and Expression of Disease Symptoms on Bittersweet Nightshade (Solanum dulcamara) Infected with a GFP-Tagged Dickeya solani IPO2222 (IPO2254)
Authors: Fikowicz-Krosko Jakub , Czajkowski Robert
Published: October 2017

Colonization of Solanum dulcamara (bittersweet nightshade) plants by a GFP-tagged Dickeya solani type strain IPO2222 (IPO2254) was investigated by selective plating and epifluorescence stereomicroscopy (ESM), using in vitro plants and plants grown in compost soil. Replicated experiments were carried out in a growth chamber and the progress of infection and disease symptoms on tissue of the cultured plants, following leaf- and stem-base inoculations with bacteria, was evaluated. Microscopy observations were confirmed by spread-plating dilutions of plant extracts onto agar medium directly after the harvest. In experiments where the stem base of in vitro plants inoculated with a range of inocula of D. solani (104 to 108 colony forming units [cfu] ml−1) was examined at 14 days post infection (dpi), blackleg-like symptoms developed in more than 80% plants together with a reduction of the plant fitness (disease symptoms, weight, height, and appearance). In leaf-inoculated plants at 14 dpi, 15% of the plants exhibited severe blackleg-like symptoms. In detached S. dulcamara leaf assays, IPO2254 survived on the adaxial surface for 14 days at populations of 106 cfu per leaf. Thirty days after stem inoculation of plants grown in compost soil in pots, up to 104 cfu g−1 of GFP-tagged D. solani were found inside the stems. D. solani were detected inside the vascular tissue (xylem vessels) of stems, in the pith tissue in roots, and on the internal surface of the stem hollow. The implications of S. dulcamara infection by D. solani for the long-distance dispersal of the bacterial inoculum are discussed.
Single Nucleotide Polymorphisms in B-Genome Specific UDP-Glucosyl Transferases Associated with Fusarium Head Blight Resistance and Reduced Deoxynivalenol Accumulation in Wheat Grain
Authors: Sharma Pallavi , Gangola Manu P. , Huang Chen , Kutcher H. Randy , Ganeshan Seedhabadee , Chibbar Ravindra N.
Published: October 2017

An in vitro spike culture method was optimized to evaluate Fusarium head blight (FHB) resistance in wheat (Triticum aestivum) and used to screen a population of ethyl methane sulfonate treated spike culture-derived variants (SCDV). Of the 134 SCDV evaluated, the disease severity score of 47 of the variants was ≤30%. Single nucleotide polymorphisms (SNP) in the UDP-glucosyltransferase (UGT) genes, TaUGT-2B, TaUGT-3B, and TaUGT-EST, differed between AC Nanda (an FHB-susceptible wheat variety) and Sumai-3 (an FHB-resistant wheat cultivar). SNP at 450 and 1,558 bp from the translation initiation site in TaUGT-2B and TaUGT-3B, respectively were negatively correlated with FHB severity in the SCDV population, whereas the SNP in TaUGT-EST was not associated with FHB severity. Fusarium graminearum strain M7-07-1 induced early expression of TaUGT-2B and TaUGT-3B in FHB-resistant SCDV lines, which were associated with deoxynivalenol accumulation and reduced FHB disease progression. At 8 days after inoculation, deoxynivalenol concentration varied from 767 ppm in FHB-resistant variants to 2,576 ppm in FHB-susceptible variants. The FHB-resistant SCDV identified can be used as new sources of FHB resistance in wheat improvement programs.
F240 of β2-Tubulin Explains why Fusarium graminearum is Less Sensitive to Carbendazim than Botrytis cinerea
Authors: Zhu Yuanye , Liang Xiaoyu , Li Yanjun , Duan Yabing , Zheng Zhitian , Wang Jianxin , Zhou Mingguo
Published: October 2017

β-Tubulin is the target of benzimidazole fungicides, the most widely used of which is carbendazim (methyl benzimidazol-2-ylcarbamate [MBC]). MBC sensitivity is determined by the differential affinity of MBC for β-tubulins. However, the mechanism of less sensitivity of Fusarium graminearum to MBC compared with other fungi, including Botrytis cinerea, Colletotrichum gloeosporioides, and Sclerotinia sclerotiorum, remains exclusive. Alignment of β-tubulin amino acid sequences showed that position 240 of β-tubulins is leucine (L) in most pathogenic fungi but is phenylalanine (F) in the Fgβ2-tubulin of the F. graminearum wild type. The effective concentration resulting in 50% inhibition (EC50) value of MBC against the Fgβ2F240L mutant of F. graminearum is 0.047 μg/ml, which was 10-fold lower than that of wild-type strain 2021. Moreover, The EC50 value of MBC against the BcβL“240”F (actually position 232) mutant of Botrytis cinerea was 0.44 μg/ml, which was ninefold higher than that of B. cinerea wild-type strain Bt4-1. In response to MBC treatment (0.15 μg/ml), microtubules were clearly visible in Fgβ2-enhanced green fluorescent protein (EGFP) but not in Fgβ2F240L-EGFP. Moreover, a molecular docking assay indicated that F240L mutation created a pi-pi interaction between Fgβ2-tubulin and MBC and increased the binding affinity of Fgβ2-tubulin to MBC. Our results suggest that F240 is responsible for the naturally less MBC sensitivity in F. graminearum compared with B. cinerea, C. gloeosporioides, and S. sclerotiorum by decreasing the binding affinity between Fgβ2-tubulin and MBC.
Opioid Addiction in Pregnancy: Does Depression Negatively Impact Adherence With Prenatal Care?
Authors: Hensley Lauren , Sulo Suela , Kozmic Sarah , Parilla Barbara V.
Published: October 2017

Objective:

We aimed to evaluate whether depression in pregnancy in women with opioid dependency negatively impacts adherence with prenatal care.

Methods:

This was a retrospective chart analysis of opioid-dependent pregnant women over a 6-year period at 2 large referral and tertiary care centers. The primary outcome was adherence with prenatal care based on the concurrent diagnosis of depression. Adherence was assessed by looking at the number of observed versus expected prenatal visits. Secondary outcomes included neonatal intensive care unit (NICU) stay, and incidence and severity of neonatal abstinence syndrome (NAS).

Results:

A total of 74 patient charts were reviewed. 45/74 (60.8%) of the opioid-dependent pregnant patients were either diagnosed with depression (n = 41), anxiety (n = 2), or scored >10 on the Edinburgh Prenatal Depression Scale (n = 1). Patients with a diagnosis of depression were significantly less adherent with prenatal care; 80% adherent (73% vs 93%; P = 0.03), 90% adherent (62% vs 93%; P = 0.003). A higher number of patients in the depression group had an infant treated for withdrawal (62% vs 38%; P = 0.041), and had longer NICU stays (27% vs 21%; P = 0.018). Analysis of the whole cohort of opioid dependent gravidas revealed Buprenorphine maintenance therapy had the lowest mean NAS score 6.5 ± 4.4, compared with methadone maintenance 10.6 ± 3.6, and no maintenance therapy 9.4 ± 4.0 (P = 0.008).

Conclusion:

Depression negatively impacts adherence with prenatal care and was significantly associated with a higher incidence of neonatal withdrawal and longer NICU stays. Buprenorphine therapy had the lowest incidence and severity of NAS when compared with methadone and no maintenance therapy.
Propofol-induced Changes in α-β Sensorimotor Cortical Connectivity
Authors: Malekmohammadi Mahsa , AuYong Nicholas , Price Collin M. , Tsolaki Evangelia , Hudson Andrew E. , Pouratian Nader
Published: October 2017

Background

Anesthetics are believed to alter functional connectivity across brain regions. However, network-level analyses of anesthesia, particularly in humans, are sparse. The authors hypothesized that propofol-induced loss of consciousness results in functional disconnection of human sensorimotor cortices underlying the loss of volitional motor responses.

Methods

The authors recorded local field potentials from sensorimotor cortices in patients with Parkinson disease (N = 12) and essential tremor (N = 7) undergoing deep brain stimulation surgery, before and after propofol-induced loss of consciousness. Local spectral power and interregional connectivity (coherence and imaginary coherence) were evaluated separately across conditions for the two populations.

Results

Propofol anesthesia caused power increases for frequencies between 2 and 100 Hz across the sensorimotor cortices and a shift of the dominant spectral peak in α and β frequencies toward lower frequencies (median ± SD peak frequency: 24.5 ± 2.6 Hz to 12.8 ± 2.3 Hz in Parkinson disease; 13.8 ± 2.1 Hz to 12.1 ± 1.0 Hz in essential tremor). Despite local increases in power, sensorimotor cortical coherence was suppressed with propofol in both cohorts, specifically in β frequencies (18 to 29 Hz) for Parkinson disease and α and β (10 to 48 Hz) in essential tremor.

Conclusions

The decrease in functional connectivity between sensory and motor cortices, despite an increase in local spectral power, suggests that propofol causes a functional disconnection of cortices with increases in autonomous activity within cortical regions. This pattern occurs across diseases evaluated, suggesting that these may be generalizable effects of propofol in patients with movement disorders and beyond. Sensorimotor network disruption may underlie anesthetic-induced loss of volitional control.
Prevalence of and Risk Factors for Tinnitus and Tinnitus-Related Handicap in a College-Aged Population
Authors: Bhatt Ishan Sunilkumar
Published: October 2017

Objective:

Tinnitus is a common otological condition that affects almost 10% of US adults. Research suggests that college students are vulnerable to tinnitus and hearing loss as they are exposed to traumatic levels of noise on a regular basis. Tinnitus and its influence in daily living continue to be underappreciated in the college-aged population. Therefore, the objective for the present study was to analyze prevalence and associated risk factors of tinnitus and tinnitus-related handicap in a sample of college-aged students.

Design:

A survey was administered to 678 students aged 18–30 years in a cross-section of randomly selected university classes. The survey was adopted from the National Health and Nutrition Examination Survey (2010). It inquired about demographic details, medical and audiological history, routine noise exposure, smoking, sound level tolerance, tinnitus, and tinnitus-related handicap in daily living. Tinnitus-related handicap was assessed by the Tinnitus Handicap Inventory (THI). Participants were divided into four groups: chronic tinnitus (bothersome tinnitus for >1 year), acute tinnitus (bothersome tinnitus for ≤1 year), subacute tinnitus (at least one experience of tinnitus in a lifetime), and no tinnitus (no experience of tinnitus in a lifetime).

Results:

The prevalence of chronic, acute, subacute, and no tinnitus was 8.4%, 13.0%, 37.9%, and 40.7% respectively. Almost 9% of subjects with any form of tinnitus reported more than a slight tinnitus-related handicap (i.e., THI score ≥18). A multinomial regression analysis revealed that individuals with high noise exposure, high sound level tolerance score, recurring ear infections, and self-reported hearing loss had high odds of chronic tinnitus. Females showed higher prevalence of acute tinnitus than males. Individuals with European American ethnicity and smoking history showed high odds of reporting subacute tinnitus. Almost 10% of the subjects reported that they were music students. The prevalence of chronic, acute, and subacute tinnitus was 11.3%, 22.5%, and 32.4%, respectively, for musicians, which was significantly higher than that for nonmusicians. Music exposure, firearm noise exposure, and occupational noise exposure were significantly correlated with tinnitus. Temporal characteristics of tinnitus, self-reported tinnitus loudness, and sound level tolerance were identified as major predictors for the overall THI score.

Conclusions:

Despite the reluctance to complain about tinnitus, a substantial portion of college-aged individuals reported tinnitus experience and its adverse influence in daily living. It was concluded that environmental and health-related factors can trigger tinnitus perception, while self-reported psychoacoustic descriptors of tinnitus may explain perceived tinnitus-related handicap in daily living by college-aged individuals. Future research is required to explore effects of tinnitus on educational achievements, social interaction, and vocational aspects of college students.
The Effect of Soft Tissue Injuries on Clinical Outcomes After Tibial Plateau Fracture Fixation
Authors: Warner Stephen J. , Garner Matthew R. , Schottel Patrick C. , Fabricant Peter D. , Thacher Ryan R. , Loftus Michael L. , Helfet David L. , Lorich Dean G.
Published: October 2017

Objective:

To determine if ligamentous and meniscal injuries as determined by initial magnetic resonance imaging altered clinical outcomes after the fixation of tibial plateau fractures.

Design:

Comparative cohort study.

Setting:

Academic level I trauma center.

Patients/Participants:

Eighty-two patients from a prospective database of operatively treated tibial plateau fractures met the inclusion criteria, which consisted of injury radiographs, preoperative knee magnetic resonance imaging (MRI), and a minimum of 12 months of clinical outcomes.

Intervention:

In addition to radiographs and computed tomography scans for fracture assessment, an MRI was performed to detect tears in the medial and lateral menisci and complete ruptures of the cruciate ligaments (anterior cruciate ligament and posterior cruciate ligament) and collateral ligaments [lateral collateral ligament and medial collateral ligament (MCL)]. Surgical fixation of tibial plateau fractures was performed by a single surgeon based on injury patterns.

Main Outcome Measurements:

Clinical outcomes included the Knee Outcome Survey Activities of Daily Living Scale, the Lower Extremity Functional Scale, the Short-Form 36, and knee range of motion. Secondary soft tissue surgeries and conversion to arthroplasty were also noted.

Results:

On injury MRI, 60 patients (73%) had injuries to at least one soft tissue structure. At final follow-up, 2 patients (2%) had a secondary soft tissue surgery and 1 patient (1%) underwent total knee arthroplasty. Patient-reported outcomes and range of motion assessments were not significantly different in patients with and without medial meniscal tears, lateral meniscal tears, and complete MCL ruptures.

Conclusions:

In this cohort of patients with operative tibial plateau fractures, sutured lateral meniscal tears, untreated medial meniscus tears, and complete MCL ruptures did not significantly affect clinical outcomes. In addition, these data suggest that obtaining a preoperative MRI in patients with tibial plateau fractures to diagnose soft tissue injuries may not alter the surgical treatment or alter patient prognosis for midterm outcomes.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Is It Safe to Prep the External Fixator In Situ During Second-Stage Pilon Surgical Treatment?
Authors: Nielsen Paul J. , Grossman Leonid S. , Siebler Justin C. , Lyden Elizabeth R. , Reed Lori K. , Mormino Matthew A.
Published: October 2017

Objective:

To evaluate the infection rate of our protocol of prepping the external fixator in situ during definitive second-stage pilon fracture open reduction internal fixation.

Design:

Retrospective clinical investigation.

Setting:

Academic Level 1 Trauma Center.

Patients/Participants:

Out of 229 patients with distal tibia fractures presenting to our institution from 1999 to 2014, 100 were treated in a 2-stage fashion utilizing this protocol.

Intervention:

Prepping the external fixator into the surgical field during the second-stage/definitive open reduction internal fixation procedure.

Main Outcome Measurement:

The rates of deep and superficial infections after definitive fixation.

Results:

The deep infection rate was 13%, and the superficial infection rate was 11%.

Conclusions:

Infection rates using this protocol are comparable to previously reported infection rates for two-stage surgical treatment of pilon fractures. This protocol provides the treating surgeon information about an alternative method to streamline definitive fixation.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Outcomes of Preoperative Versus Postoperative Radiation for Heterotopic Ossification Prevention in Children With Neuromuscular Hip Dysplasia Undergoing Proximal Femoral Resection
Authors: Hess Clayton B. , Stein-Wexler Rebecca , Qi LiHong , Davids Jon R. , Fragoso Ruben C.
Published: October 2017

Background:

Few studies exist to inform the extrapolated practice of irradiating children for heterotopic ossification (HO) prevention. We report the incidence of HO formation following prophylactic preoperative compared with postoperative radiation therapy (RT) in children with neuromuscular hip dysplasia (NHD) following proximal femoral resection (PFR).

Methods:

A retrospective, 2-institution chart review was performed. Eligibility was limited to patients with at least 1 year of follow-up. Evaluation included radiographic HO grading by a combined severity scale, assessment of synchronous symptoms of pain or decreased range of motion, and stratification by preoperative versus postoperative reception of RT. A control cohort included 4 nonirradiated hips with NHD after PFR.

Results:

Twenty-five hips in 20 children met eligibility criteria. Eleven hips were irradiated preoperatively and 14 postoperatively. Radiographic evidence of post-RT development of radiographic evidence of heterotopic ossification (rHO) was found in all 25 hips and earlier in patients irradiated preoperatively (median time to rHO was 4.0 vs. 15.7 mo, P=0.03, 95% confidence interval, 0.24-21.5). There was no statistically significant difference in the development of symptomatic HO (P=0.62) between the preoperative (45.5%) and postoperative (35.7%) groups, nor in HO grade (P=0.34). Seven (28%) of the 25 hips (5 preoperative and 2 postoperative) had documentation of rHO-free intervals after surgery, with an average duration of 5.6 months, while the remaining presented with rHO at first follow-up visit. All eligible control hips (100%) developed rHO and symptomatic heterotopic ossification.

Conclusions:

Perioperative RT did not prevent the formation of HO in any child with NHD after PFR. Extrapolation of evidence of the efficacy of RT for HO prevention in ambulatory adults after traumatic hip injury to a population of children with central nervous system injury and NHD may be premature. Additional studies are needed to clarify optimal prevention of HO in this population.

Level of Evidence:

Level III—therapeutic retrospective comparative study.
Racial and Geographic Disparities in Interhospital ICU Transfers*
Authors: Tyler Patrick D. , Stone David J. , Geisler Benjamin P. , McLennan Stuart , Celi Leo Anthony , Rush Barret
Published: October 2017

Objectives:

Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred.

Design:

Retrospective cohort study.

Setting:

Nationwide Inpatient Sample, 2006–2012.

Patients:

Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation.

Interventions:

None.

Measurements and Main Results:

We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser comorbidities. The outcome used was interhospital transfer from a small- or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (odds ratio, 0.98; 95% CI, 0.978–0.982), black race (odds ratio, 0.79; 95% CI, 0.70–0.89), Hispanic race (odds ratio, 0.79; 95% CI, 0.69–0.90), South region hospital (odds ratio, 0.79; 95% CI, 0.72–0.88), teaching hospital (odds ratio, 0.31; 95% CI, 0.28–0.33), and do not resuscitate status (odds ratio, 0.19; 95% CI, 0.15–0.25).

Conclusions:

In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.
Lasers and Energy-Based Devices in Men
Authors: Crispin Milène K. , Hruza George J. , Kilmer Suzanne L.
Published: October 2017

BACKGROUND

The demand for cosmetic treatments with lasers and energy-based devices has increased among men, but there is a dearth of literature that addresses the approach and treatment of cosmetic male patients.

OBJECTIVE

To summarize common cosmetic concerns for which male patients seek cosmetic treatments and to provide sex-specific recommendations for the lasers and energy-based devices that can be used for treatment.

MATERIALS AND METHODS

The authors conducted a literature search using the PubMed/MEDLINE and Google Scholar databases using the search terms male, men, gender, and cosmetic dermatology.

RESULTS

The authors review sex-specific treatment recommendations regarding the use of lasers and energy-based devices for the conditions for which men most commonly seek cosmetic treatment, which include photo-/actinic damage, acne scarring, rhinophyma, hair removal, axillary hyperhidrosis, and loose neck/submental skin. Cosmetic issues the authors will touch on, but whose approaches or considerations vary less in men compared with women, are hyperpigmentation, vascular lesions, and facial rejuvenation.

CONCLUSION

Sex-specific treatment approaches with lasers and energy-based devices should be used to best serve male cosmetic patients.
Touchscreen technology in the study of cognition-related behavior
Authors: Kangas Brian D. , Bergman Jack
Published: October 2017

There is a growing need for new translational animal models designed to capture complex behavioral phenotypes implicated in addiction and other neuropsychiatric conditions. For example, a complete understanding of the effects of commonly abused drugs, as well as candidate medications, requires assessments of their effects on learning, memory, attention, and other cognition-related behavior. Modern touch-sensitive technology provides an extremely flexible means to expose an experimental subject to a variety of complex behavioral tasks designed to assay dimensions of cognitive function before, during, and after drug administration. In addition to tailored variants of gold-standard cognitive assessments, touchscreen chambers offer the ability to develop novel tasks based upon the researcher’s needs. This methods perspective presents (i) a brief review of previous touchscreen-based animal studies, (ii) a primer on the construction of a touch-sensitive experimental chamber, and (iii) data from a proof-of-concept study examining cross-species continuity in performance across a diverse assortment of animal subjects (rats, marmosets, squirrel monkeys, and rhesus macaques) using the repeated acquisition task – a modern variant of a traditional animal model of learning. Taken together, the procedures and data discussed in this review illustrate the point that contemporary touchscreen methodology can be tailored to desired experimental goals and adapted to provide formal similarity in cognition-related tasks across experimental species. Moreover, touchscreen methodology allows for the development of new translational models that emerge through laboratory and clinical discovery to capture important dimensions of complex behavior and cognitive function.
Combined Tongue Flap and Deepithelialized Advancement Flap for Thick Lower Lip Reconstruction
Authors: Kakudo Natsuko , Kuro Atsuyuki , Morimoto Naoki , Hihara Masakatsu , Kusumoto Kenji
Published: October 2017

We repaired a long horizontal defect in the lower lip caused by the resection of squamous cell carcinoma by reconstructing the white lip with a V-Y advancement flap and vermilion with a tongue flap. During this procedure, we deepithelialized the V-Y flap, lifted the upper margin of the flap and sutured it to the remaining upper margin of the lip, and then covered it with the tongue flap, resulting in the successful reconstruction of a thick lip. There were no postoperative complications in articulation or swallowing. This novel procedure is a simple method to aesthetically and functionally reconstruct a thick lower lip.
COMPLIANCE AND ADHERENCE OF PATIENTS WITH DIABETIC MACULAR EDEMA TO INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN DAILY PRACTICE
Authors: Weiss Maximilian , Sim Dawn A. , Herold Tina , Schumann Ricarda G. , Liegl Raffael , Kern Christoph , Kreutzer Thomas , Schiefelbein Johannes , Rottmann Miriam , Priglinger Siegfried , KortUEm Karsten Ulrich
Published: October 2017

Purpose:

We assessed differences in compliance and adherence (lateness of patients, visual acuity, reasons for abstaining) between patients with diabetic macular edema (DME) and patients with age-related macular degeneration (AMD), both under anti–vascular endothelial growth factor therapy.

Methods:

We included 136 patients with DME (36% women, 65 years, 22 visits, 13.9 injections, and 29.9 months of follow-up) and 109 patients with AMD (59% women, 76 years, 20 visits, 14.7 injections, and 22.3 months of follow-up) (minimum follow-up of 12 months and at least 5 injections). We assessed missed appointments (lateness >14 days) and therapy break-offs (lateness >100 days). All delayed patients were called and interviewed for abstaining reasons.

Results:

Forty-six percent of patients with DME and 22% of patients with AMD had at least one break-off. Thirty-five percent of patients with DME and 50% of patients with AMD were always on schedule. In patients with DME, there was significant correlation (P = 0.017) between the number of break-offs and change of visual acuity. In 60% DME and 38% AMD of break-off cases, visual acuity was worse than the before break-off. The most common reason for abstaining was comorbidities (33% AMD and 20% DME).

Conclusion:

There are significant differences between patients with AMD and DME regarding compliance and adherence, which also affects outcome. Strategies to tie patients with DME to costly intravitreal therapy need to be developed to improve outcomes and efficacy.
INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR TREATMENT OF MACULAR HOLE RETINAL DETACHMENT IN HIGHLY MYOPIC EYES
Authors: Takahashi Hiroyuki , Inoue Makoto , Koto Takashi , Itoh Yuji , Hirota Kazunari , Hirakata Akito
Published: October 2017

Purpose:

To compare the efficacy of vitrectomy with inverted internal limiting membrane (ILM) flap to complete removal of the ILM for the treatment of macular hole (MH) retinal detachment in highly myopic eyes.

Methods:

Pars plana vitrectomy with inverted ILM flap technique (16 eyes; inverted group) or with the complete removal of the ILM (16 eyes; removed group) was performed in patients with high myopia with MH retinal detachment. The rate of retinal reattachment and MH closure, the best-corrected visual acuities, and the integrity of the foveal microstructures in the optical coherence tomographic images were compared.

Results:

Thirteen eyes (81%) in the inverted group and 15 eyes (93%) in the removed group had retinal reattachment after the initial surgery (P = 0.30). The MH was closed significantly more often in the inverted group (75%) than in the removed group (25%; P = 0.006). The postoperative best-corrected visual acuity was significantly better in the inverted group (P = 0.04). The number of eyes with outer nuclear layer, external limiting membrane, and ellipsoid zone lines at the closed MH was not significantly different in the two groups.

Conclusion:

The inverted ILM flap technique with the presence of bridging tissue over the MH is effective in closing the MH and improving the postoperative best-corrected visual acuity in eyes with MH retinal detachment by bridging tissue over the MH.
Study of the Effectiveness of Multipurpose Solutions on the Bacterial Disinfection of Silicone Hydrogel Contact Lenses In Vitro
Authors: Correa Priscila C. , Lui Aline C. F. , Silva Cely B. , Gracitelli Carolina P. B. , Mimica Lycia M. , Sasagawa Suzethe M. , Netto Adamo L.
Published: October 2017

Objectives:

To assess the antimicrobial effectiveness of multipurpose solutions in regard to the disinfection of silicone hydrogel contact lenses (CL) using a study of clinical bacterial isolates from ocular material.

Methods:

Three multipurpose solutions (solution A: polyhexamethylene biguanide 0.00025 g/100 mL; solution B: polyquaternary-1 0.001% and myristamidopropyl dimethylamine 0.0006%; and solution C: polyaminopropyl biguanide 0.00013% and polyquaternary 0.0001%) were used as a 3-phase disinfection on silicone hydrogel CL contaminated with bacteria from clinical isolates that were divided into five groups (group 1: Pseudomonas aeruginosa; group 2: Staphylococcus aureus; group 3: Staphylococcus epidermidis; group 4: Streptococcus spp; and group 5: enterobacteria).

Results:

No differences were observed between the 24- and 48-hr measurements in any of the samples, and the positivity of microorganisms in T0 was 100% for all solutions; it was 0% in T3. Therefore, only steps T1 (rubbing followed by rinsing) and T2 (rubbing followed by rinsing and immersion of CL into solution) were considered for analysis at the 24-hr measurement time. Throughout the phases, a decrease in the number of bacteria was observed, culminating in the elimination (no recovery) of all microorganisms in the three solutions.

Conclusions:

At the end of the proposed process, the tested solutions were effective.
Individualized neuropathic pain therapy based on phenotyping: are we there yet?
Authors: Forstenpointner Julia , Otto Jan , Baron Ralf
Published: October 2017

Patients with the same neuropathic pain disorder may have completely different sensory signs and symptoms yet receive the same medicinal treatment. New concepts suggest that patient stratification according to their pain mechanisms, reflected in their sensory phenotype, could be promising to implement an individualized therapy in neuropathic pain. Retrospective classification of patients according to their sensory phenotype showed predictive validity and reliability for treatment response in certain subgroups of patients. Recent prospective studies using stratification based on sensory phenotypes confirm this concept. In this article, we review the recent accomplishments towards an individualized pharmacological treatment of neuropathic pain.
Dopaminergic tone does not influence pain levels during placebo interventions in patients with chronic neuropathic pain
Authors: Skyt Ina , Moslemi Kurosh , Baastrup Cathrine , Grosen Kasper , Benedetti Fabrizio , Petersen Gitte L. , Price Donald D. , Hall Kathryn T. , Kaptchuk Ted J. , Svensson Peter , Jensen Troels S. , Vase Lene
Published: October 2017

Placebo effects have been reported in patients with chronic neuropathic pain. Expected pain levels and positive emotions are involved in the observed pain relief, but the underlying neurobiology is largely unknown. Patients with neuropathic pain are highly motivated for pain relief, and as motivational factors such as expectations of reward, as well as pain processing in itself, are related to the dopaminergic system, it can be speculated that dopamine release contributes to placebo effects in neuropathic pain. Nineteen patients with neuropathic pain after thoracic surgery were tested during a placebo intervention consisting of open and hidden applications of the pain-relieving agent lidocaine (2 mL) and no treatment. The dopamine antagonist haloperidol (2 mg) and the agonist levodopa/carbidopa (100/25 mg) were administered to test the involvement of dopamine. Expected pain levels, desire for pain relief, and ongoing and evoked pain were assessed on mechanical visual analog scales (0-10). Significant placebo effects on ongoing (P ≤ 0.003) and evoked (P ≤ 0.002) pain were observed. Expectancy and desire accounted for up to 41.2% and 71.5% of the variance in ongoing and evoked pain, respectively, after the open application of lidocaine. We found no evidence for an effect of haloperidol and levodopa/carbidopa on neuropathic pain levels (P = 0.071-0.963). Dopamine seemed to influence the levels of expectancy and desire, yet there was no evidence for indirect or interaction effects on the placebo effect. This is the first study to suggest that dopamine does not contribute to placebo effects in chronic neuropathic pain.
Discrete Patches of Hair Loss on the Scalp
Authors: Perez Caroline , Boghosian Gayle , Jacob Sharon E.
Published: October 2017

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of acute onset hair loss in ovoid patches on the scalp.
Annular Erythematous Plaque on Chest
Authors: Wahjudi Ingrid , Jacob Sharon E.
Published: October 2017

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of an annular erythematous plaque on the chest.
A Private Case of Allergic Contact Dermatitis
Authors: Nyhoff Heidi
Published: October 2017

Patch testing is considered the gold standard in the diagnosis of allergic contact dermatitis. A patient presenting with a pruritic rash and previous failed treatments should be considered as a candidate for patch testing. In this case study, a patient with pruritus, dermatitis, and pain to her vaginal area and buttocks is patch tested and tests positive to two common contact allergens, fragrance mix and tixocortol-21-pivalate, both of which are clinically relevant in this patient’s particular case. A follow-up of appropriate resources and education, as well as avoidance of the offending allergens, resulted in resolution of the patient’s contact dermatitis.
Perinatal Nurses Reported to Boards of Nursing
Authors: Cypher Rebecca L. , Kosycarz Kara
Published: October 2017

Today's healthcare system is in a state of transformation, as changes in technology, diagnostic approaches, treatments, and levels of professional practice occur on a regular basis. Nurses continue to be the most trusted profession. What has not changed in clinical practice is the amount of responsibility and level of accountability. Therefore, nurses are morally, legally, and ethically responsible for nursing judgment and clinical-based actions covered under each state's Nurse Practice Act, the American Nurses Association's core principles, and position statements as well as standard setting documents from professional organizations. Unfortunately, mistakes happen in an enormous system where human error cannot be entirely avoided, which is why being named in a board of nursing complaint can be so devastating. Stress and accusations of not providing reasonable or prudent care can be overwhelming, which may impact a perinatal clinician's health. This article's purpose is to provide information about the process of a board of nursing complaint, potential sequelae of an investigation, as well as best practices to decrease risk, focusing exclusively on perinatal nurses and advanced practice providers.