bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrospective voting in Georgia: does the government’s past performance matter?
Authors: Babunashvili Giorgi
Published: September 2017

Voters are often assumed to be of tertiary importance in less than democratic contexts – the regime can manipulate, buy, or outright steal their votes goes the predominant logic. This article however shows that voters not only matter but engaged in retrospective voting in Georgia, a country with imperfect political competition, between 2008 and 2015. Analysis of two waves of nationally representative survey data from 2012 to 2015 supports the retrospective voting theory, with a positive relationship between voter support for the incumbent party and positive assessments of government policies related to socio-economic, democratization, and security issues. Citizens who assess government policies negatively are more prone to voting for opposition candidates or not voting at all compared to those who are more satisfied with the government’s performance in Georgia. Notably, these findings are very similar for two governments led by two very different parties in Georgia: the United National Movement (2008–2012) and Georgian Dream – Democratic Georgia (since 2012). Hence, I conclude that disregarding voters’ preferences has negative consequences for the legitimation and survival of the incumbent.
Elections and election fraud in Georgia and Armenia
Authors: Gilbreath Dustin , Balasanyan Sona
Published: September 2017

Elections on unfair playing fields are common. Yet election day fraud can result in authoritarians losing office. The freer the environment, the more an authoritarian must rely on means other than election day fraud to retain office, because they are less capable of coercing the population without facing repercussions. Among those other means is cooptation through public policy. A common theme in this special issue is that public policy has been of greater import in Georgia than Armenia. This article begins to explain this phenomenon using comparative case studies of election day fraud in Armenia and Georgia over time. To do so, the article uses methods from the field of election forensics to provide a quantitative comparison of the scale of election day fraud in each country’s elections since 2007 using precinct level election results for parliamentary and presidential elections. The test results suggest, as has been widely believed, that Georgia’s elections have had less election day fraud than Armenia’s during this period. This finding provides a theoretical basis to explain why public policy has been a greater concern in Georgia than Armenia.
Sustained propagation and control of topological excitations in polariton superfluid
Authors: Pigeon Simon , Bramati Alberto
Published: September 2017

We present a simple method to compensate for losses in a polariton superfluid. Based on a weak support field, it allows for the extended propagation of a resonantly driven polariton superfluid with minimal energetic cost. Moreover, this setup is based on optical bistability and leads to the significant release of the phase constraint imposed by resonant driving. This release, together with macroscopic polariton propagation, offers a unique opportunity to study the hydrodynamics of the topological excitations of polariton superfluids such as quantized vortices and dark solitons. We numerically study how the coherent field supporting the superfluid flow interacts with the vortices and how it can be used to control them. Interestingly, we show that standard hydrodynamics does not apply for this driven-dissipative fluid and new types of behaviour are identified.
Affine Deligne-Lusztig varieties and the action of 𝐽
Authors: Chen Miaofen , Viehmann Eva
Published: September 2017

We propose a new stratification of the reduced subschemes of Rapoport-Zink spaces and of affine Deligne-Lusztig varieties that highlights the relation between the geometry of these spaces and the action of the associated automorphism group. We show that this provides a joint group-theoretic interpretation of well-known stratifications which only exist for special cases such as the Bruhat-Tits stratification of Vollaard and Wedhorn, the semi-module stratification of de Jong and Oort, and the locus where theaa-invariant is equal to11.
Clinical Acupuncture and Ancient Chinese Medicine
Authors: Yang Jingduan , Monti Daniel A.
Published: September 2017

Clinical Acupuncture and Ancient Chinese Medicine provides health care professionals interested in learning or practicing acupuncture the essential theoretical foundation of Chinese medicine on which an effective acupuncture therapy must be based. It describes in detail the human energetic anatomy, physiology, pathophysiology, and etiology for both mental and physical functions of children, men, women, and the elderly. It offers a step-by-step algorithm for diagnosing physical or mental ailments with diagnostic techniques and formulation processes and treating them with effective strategies, plans, and acupuncture techniques. Clinical Acupuncture and Ancient Chinese Medicine also presents acupuncture as an energy medicine, in contrast to modern medicine, which is a more biochemically and structurally based medicine. Both are integral parts in the spectrum of human medicine, more complementary than alternative to each other. This book helps readers to study and practice acupuncture as part of their continued medical education (CME) and as a natural expansion of their practice to provide additional care for their patients at the energetic level at which a majority of ailments lay. The content is organized in a way that parallels modern medicine so readers can more easily relate and understand concepts that may be otherwise foreign to them. This book describes human health with the belief that a human being is essentially an energetic being and that the interaction of human energy with the energy of nature and the universe is critical to maintaining a healthy life. It provides useful contents for self-care and the ancient practice of life cultivation.
Summary of medically important bacteria
Authors: Matthews Philippa C.
Published: September 2017

This chapter provides a brief summary of a classification system for medically important bacteria, based on a traditional phenotypic approach. The primary focus is on organisms that are significant causes of disease in the tropics and subtropics.
Infections caused by Gram-positive bacteria
Authors: Matthews Philippa C.
Published: September 2017

This chapter consists of short notes, diagrams, and tables to summarize Gram-positive organisms that are significant causes of disease in the tropics and subtropics. This includes anthrax, tetanus, clostridial infections, diphtheria, and streptococci. For ease of reference, each topic is broken down into sections, including classification, epidemiology, microbiology, pathophysiology, clinical syndromes, diagnosis, treatment, and prevention.
Infections caused by RNA viruses
Authors: Matthews Philippa C.
Published: September 2017

This chapter consists of short notes, diagrams, maps, and tables to summarize RNA viruses that are significant causes of disease in the tropics and subtropics. This includes measles, polio, hepatitis A, C, and E viruses, rabies, arboviruses, and viral haemorrhagic fevers. The chapter also includes sections on important retroviruses, HIV, and human T-lymphotropic virus. For ease of reference, each topic is broken down into sections, including classification, epidemiology, microbiology, pathophysiology, clinical syndromes, diagnosis, treatment, and prevention.
Summary of fungal infections
Authors: Matthews Philippa C.
Published: September 2017

This chapter provides a brief summary of a classification system for medically important fungi, based on a traditional phenotypic approach that divides organisms into the categories of yeasts, moulds, dimorphic fungi, and dermatophytes, with diagrams to illustrate the distinctive features of each.
Fungal infections
Authors: Matthews Philippa C.
Published: September 2017

This chapter consists of short notes, diagrams, maps, and tables to summarize fungal infections that are significant causes of disease in the tropics and subtropics, with a primary focus on dimorphic fungi (Histoplasma, Blastomyces, Coccidioides, Paracoccidioides, and Penicillium species). The chapter also includes cryptococcal infection and Madura foot. For ease of reference, each topic is broken down into sections, including classification, epidemiology, microbiology, pathophysiology, clinical syndromes, diagnosis, treatment and prevention.
Nematodes (roundworms)
Authors: Matthews Philippa C.
Published: September 2017

This chapter consists of short notes, diagrams, maps, and tables to summarize human nematode (‘roundworm’) infections, starting with a classification of relevant organisms. The chapter then goes on to cover Ascaris, Trichinella, Enterobius (‘pin worm’), Trichuris (‘whip worm’), Necator and Ancylostoma (‘hook worms’), and Strongyloides (‘thread worm’). The chapter concludes with a section dedicated to filarial infection, including lymphatic filariasis, Loa Loa (‘eye worm’), Onchocerca volvulus (‘river blindness’), and Dracunculus (‘Guinea worm’). For ease of reference, each topic is broken down into sections, including classification, epidemiology, microbiology, pathophysiology, clinical syndromes, diagnosis, treatment and prevention.
Suicide risk management
Authors: Hughes Kerry C. , Metzner Jeffrey L.
Published: September 2017

There are many risks associated with incarceration, and a substantial one is suicide. Virtually every completed suicide generates litigation. Prevalence, demographics, trends, screening and assessment of suicide risk, and recognition of the key factors associated with increased risk and managing that risk safely and appropriately in jails is presented. The factors relating to increasing suicide risk in prisons are often quite distinct from other correctional settings. Issues such as restrictive housing, facility transfers, loss of community social supports, and chronic management all play potential roles. Proactive recognition of such concerns and active management is critical to effective risk reduction. This chapter discusses such factors in the context of changing prison dynamics and trends. Following completed suicides, a formal protocol is often followed to assist staff in understanding the events that led to the suicide and specifically intervening to address staff feelings that follow such a trauma. Such a process assists quality improvement initiatives, whether in the form of a root cause analysis or other format. Best practice approaches to post-mortem review and staff intervention/ support have been developed and are in use in many facilities. Working to eliminate or reduce the frequency of suicide attempts absolutely requires a staff culture committed to continued learning and improving of both knowledge and skills. This chapter presents a review of the current standards of suicide risk reduction training.
Contexts of Ill-Treatment
Authors: Haney Craig , Bakhshay Shirin
Published: September 2017

In contrast to most international definitions of cruel, inhuman, or degrading treatment (CIDT), and of torture per se, which focus primarily on individual acts or discrete forms of ill-treatment that are suffered at the hands of another (typically, a representative of the state), this chapter applies Bașoğlu’s “learning theory model of torture” to discuss the potential relationships between certain “contexts of ill-treatment”—especially, harsh conditions of prison confinement and other forms of involuntary detention—to CIDT and torture per se. It reviews the nature and adverse psychological effects of confinement and detention, including very severe conditions of the sort that exist in a number of international sites and are pervaded by unpredictable and uncontrollable traumas and stressors. This chapter also examines whether and how certain of these contexts of captivity may facilitate abuse, interact with and exacerbate other forms of ill-treatment and, at the extremes, themselves constitute CIDT and torture.
The Cumulative Effect
Authors: Stover Eric , Koenig K. Alexa , Fletcher Laurel E.
Published: September 2017

This chapter demonstrates how the US government selectively manipulated the medical and health literatures after the attacks of September 11, 2001 to justify the torture and cruel, inhuman, or degrading treatment of detainees held in US custody. The authors analyze the Department of Justice Office of Legal Counsel’s “Torture Memos” to illustrate the ways in which governments can attempt to circumvent the protections offered by existing definitions of torture, even while claiming to operate within legal limits. The authors offer a stark warning about the ways in which research findings can be perverted—and contradicting studies ignored—to justify governments’ policy aims when those aims conflict with legal constraints.
Powerlessness as a Defining Characteristic of Torture
Authors: Nowak Manfred
Published: September 2017

During the author’s six-year term as UN Special Rapporteur on Torture, he interviewed many hundreds of torture survivors in all world regions. This unique practical experience confirmed his legal analysis that intention and powerlessness, rather than the intensity of pain or suffering, are the decisive criteria that distinguish torture from other forms of cruel and inhuman treatment or punishment. This legal conclusion fully corresponds to the psychological findings of Başoğlu’s analysis of the question of whether the “enhanced interrogation techniques” applied by the Bush administration in the so-called US war on terror meet the definition of torture under US law. Başoğlu shows that “learned helplessness is mental harm that is severe enough to qualify as torture even by US standards.” Our two contributions leading to identical scientific findings underline that this unique book is moving multilateral research on torture to genuine interdisciplinary and transdisciplinary research.
Thinking about medicine
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Goodhart Anna , Hall Catriona , O’Neill Harriet
Published: September 2017

This chapter explores the subject of medicine. It includes the Hippocratic oath, medical care, diagnosis, bedside manner, communication skills, prescribing drugs, life on the wards, dealing with death, medical ethics, psychiatry, the older person, the pregnant woman, epidemiology, randomized controlled trials, medical mathematics, evidence-based medicine, and medicalization.
Endocrinology
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Goodhart Anna , Hall Catriona , O’Neill Harriet
Published: September 2017

This chapter discusses endocrinology, including endocrine physiology, diabetes mellitus (DM) classification, treatment, and complications, diabetic neuropathy and foot care, hypoglycaemia, insulinoma, thyroid function tests (TFTS), thyrotoxicosis, hypothyroidism (myxoedema), parathyroid hormone and hyperparathyroidism, hypoparathyroidism, adrenal cortex and Cushing’s syndrome, Addison’s disease (adrenal insufficiency), hyperaldosteronism, phaeochromocytoma, hirsutism, virilism, gynaecomastia, impotence, hypopituitarism, pituitary tumours, hyperprolactinaemia, acromegaly, and diabetes insipidus (DI).
Gastroenterology
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Goodhart Anna , Hall Catriona , O’Neill Harriet
Published: September 2017

This chapter explores gastroenterology, including healthy, enjoyable eating, mouth observations, endoscopy and biopsy, dysphagia, nausea and vomiting, dyspepsia and peptic ulcer disease, gastro-oesophageal reflux disease (GORD), upper gastrointestinal bleeding, diarrhoea, constipation, ulcerative colitis (UC), Crohn’s disease, gastrointestinal malabsorption, Coeliac disease, irritable bowel syndrome (IBS), nutritional disorders, chronic pancreatitis, carcinoma of the pancreas, carcinoid tumours, jaundice, liver failure, cirrhosis, viral hepatitis, alcoholism, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), non-alcoholic fatty liver disease (NAFLD), Wilson’s disease/hepatolenticular degeneration, liver tumours, hereditary haemochromatosis (HH), and α1-antitrypsin (A1AT) deficiency.
Haematology
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Goodhart Anna , Hall Catriona , O’Neill Harriet
Published: September 2017

This chapter presents all aspects of haematology, including the history of haematology, iron-deficiency anaemia, anaemia of chronic disease, sideroblastic anaemia, peripheral blood film, differential white cell count, macrocytic anaemia, B12 deficiency and pernicious anaemia, haemolytic anaemia, sickle-cell anaemia, thalassaemia, bleeding disorders, coagulations pathways, blood transfusion and blood products, anticoagulants, leukaemia and the on-call junior doctor, acute lymphoblastic leukaemia, acute myeloid leukaemia, chronic myeloid leukaemia, chronic lymphocytic leukaemia, Hodgkin’s lymphoma, Non-Hodgkin’s lymphoma, pancytopenia and bone marrow failure, myeloproliferative disorders, myeloma, paraproteinaemia, amyloidosis, erythrocyte sedimentation rate (ESR), plasma viscosity (PV), hyperviscosity syndrome, spleen and splenectomy, thrombophilia, and immunosuppressive drugs.
Infectious diseases
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Goodhart Anna , Hall Catriona , O’Neill Harriet
Published: September 2017

This chapter discusses infectious diseases, and includes bacterial infection, antibiotics, gram-positive bacteria, gram-negative bacteria, tuberculosis (TB), influenza, human immunodeficiency virus (HIV) diagnosis, complications, and HIV antiretroviral therapy (ART), herpes, immunization, fungi, healthcare-associated (nosocomial) infection, sexually transmitted infection, fever in the returning traveller, enteric fever, malaria, mosquito-borne disease, vector-borne disease, zoonoses, viral haemorrhagic fever (VHF), gastroenteritis, gastrointestinal parasites, schistosomiasis and liver disease, neurological disease, eye disease, skin disease, and pyrexia of unknown origin.
Oncology and palliative care
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Goodhart Anna , Hall Catriona , O’Neill Harriet
Published: September 2017

This chapter discusses oncology and palliative care, including looking after people with cancer, cancer genetics, diagnosis, medicine, surgery, and radiotherapy, interventional oncology, oncology emergencies, paraneoplastic syndromes, tumour markers, and palliative care principles, pain, and care in the last days of life.
Rheumatology
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Goodhart Anna , Hall Catriona , O’Neill Harriet
Published: September 2017

This chapter explores rheumatology, including rheumatological history, assessing the locomotor system, rheumatological investigations, back pain, osteoarthritis (OA), septic arthritis, rheumatoid arthritis (RA), gout, CPPD arthropathy, ankylosing spondylitis (AS), enteropathic, psoriatic, and reactive arthritis, systemic sclerosis, mixed connective tissue disease, relapsing polychondritis, polymyositis and dermatomyositis, systemic lupus erythematosus (SLE), giant cell arteritis, polyarteritis nodosa, microscopic polyangiitis, polymyalgia rheumatica, fibromyalgia, ocular manifestations, dermatological manifestations, acute SLE, acute systemic vasculitis, acute cord compression, GCA, methotrexate-induced pneumonitis, neutropenic sepsis, scleroderma: pulmonary hypertensive or renal crisis, and septic arthritis
Surgery
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Goodhart Anna , Hall Catriona , O’Neill Harriet
Published: September 2017

This chapter discusses surgery, including the language of surgery, pre-operative care, consent, prophylactic antibiotics in surgery, sutures, anaesthesia, control of pain, post-op complications, deep vein thrombosis (DVT), swollen legs, stoma care, nutritional support in hospital, parenteral (intravenous) nutrition, diabetic patients, jaundiced patients, patients on anticoagulants, patients on steroids, minimally invasive and day case surgery, lumps in head, neck and skin, breast carcinoma, abdominal masses, acute abdomen, acute appendicitis, obstruction of the bowel, hernias, colorectal carcinoma, gastro-oesophageal carcinomas, bowel ischaemia, gastric surgery and its aftermath, fundoplication for GORD, oesophageal rupture, surgical management of obesity, diverticular disease, perianal problems, haemorrhoids, hepatobiliary surgery, renal stones, urinary tract obstruction, benign prostatic hyperplasia, retroperitoneal fibrosis, urinary tract malignancies, bladder tumours, urinary incontinence, lumps in the groin and scrotum, testes, aneurysms of arteries, thoracic aortic dissection, peripheral arterial disease, varicose veins (VVS), gangrene and necrotizing fasciitis, and skin ulcers.
Clinical chemistry
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Goodhart Anna , Hall Catriona , O’Neill Harriet
Published: September 2017

This chapter explores clinical chemistry, including the normal range, laboratory medicine, major disease patterns in biochemistry, lab results indicating emergencies, fluid balance, IV fluid therapy, electrolyte physiology and the kidney, acid–base balance, hypernatraemia, hyponatraemia, syndrome of inappropriate ADH secretion (SIADH), hyperkalaemia, hypokalaemia, calcium and phosphate physiology, hypercalcaemia, hypocalcaemia, phosphate, magnesium, zinc, selenium, urate and the kidney, osteoporosis, osteomalacia, Paget’s disease of bone, plasma proteins, urinary proteins, plasma enzymes, hyperlipidaemia, and the porphyrias.
Radiology
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Goodhart Anna , Hall Catriona , O’Neill Harriet
Published: September 2017

This chapter explores radiology, including typical effective doses, justifying exposure to ionizing radiation, the art of the request, interpreting an image, presenting an image, chest X-ray (CXR), plain abdominal X-ray, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), nuclear medicine, thoracic imaging, cardiovascular imaging, gastrointestinal imaging, genitourinary imaging, neuroimaging, contrast media in imaging, and imaging the acutely unwell patient.
The Pain Disability Questionnaire (PDQ): evaluating the efficacy of the psychosocial and functional subscales for 12-month post-treatment outcomes after total knee arthroplasty
Authors: Gray Avia , Ramos Stephen , Howard Krista , Bryson Brooke , Ellis Henry B.
Published: September 2017

Background:

The Patient Disability Questionnaire (PDQ) has been shown to have good predictive validity for outcomes after total hip arthroplasty (TKA). However, the PDQ subscales (psychosocial and functional disability) have not been assessed independently. This study assesses 1-year surgical outcomes based on the PDQ’s psychosocial and functional disability subscale scores.

Methods:

The sample included 130 participants undergoing TKA. Physical and psychosocial measures included the PDQ, Knee Society Score (KSS), Western Ontario McMaster Arthritic Index (WOMAC), and the Short Form-36 Health Inventory (SF-36). Univariate correlations were used to cross-validate all subscales. Multivariate gamma and linear regressions were used to associate PDQ functional and psychosocial disability subscale scores with WOMAC and SF-36, 1 yr after TKA.

Results:

Poorer PDQ psychosocial scores were associated with being younger, black or Hispanic, and using Medicaid. Poorer functional disability scores were associated with being younger, female, black or Hispanic, and using Medicaid or without insurance. Multivariate regressions revealed that baseline PDQ psychosocial and functional disability were both significantly associated with 1-year WOMAC total scores and 1-year SF-36 Mental Composite Scores.

Conclusions:

The PDQ is useful in predicting 1-year outcomes for patients undergoing TKA. Worse baseline PDQ subscale scores indicated worse quality of life, more pain and stiffness of the joints, as determined by comparative WOMAC and SF-36 scores. Clinical implications from this study suggest screening patients before surgery to identify factors that could hinder recovery time or cause pain or function remission in adults undergoing TKA.
Intraoperative Arthrographic Assessment of Ambiguous Neck of Femur Fractures in Patients With Chronic Kidney Disease
Authors: Chan Gareth , Freeman Richard
Published: September 2017

The loss of bone mineral density caused by Chronic Kidney Disease can make the delineation of a patient’s bony anatomy impossible during intra-operative fluoroscopy. This has the potential to increase the failure rate of implants used in the surgical treatment of neck of femur fractures due to sub-optimal placements. Intra-operative arthrograms add to the techniques available to a surgeon to achieve optimal implant placement without compromising the patient’s renal function nor increasing the radiation dose exposure to the surgical team.
“Channel Lines”: A Simple Surgical Technique to Aid in Achieving Patient-specific Ante-version During Implantation of Uncemented Acetabular Cups
Authors: Raghavan Roshan , Plakogiannis Christos
Published: September 2017

Accurate acetabular cup placement is a crucial step for a successful total hip replacement. Transverse acetabular ligament is an important and reliable landmark that helps in determining the version during the placement of acetabular cups. However, the visualization of transverse acetabular ligament may not be easy as the view may be blocked by the implants and the instruments. We have devised a simple technique to aid in achieving patient-specific ante-version during implantation of uncemented acetabular cups by using “channel lines.”
Homeless No More
Authors: Caldwell Robin , Meraz Rebecca , Sweeney Reverend Robert
Published: September 2017

Caring for vulnerable and marginalized populations is a central tenet of professional nursing, and of Christian service. Due to the scope and complexities of problems associated with homelessness, nurses may feel overwhelmed and ill-equipped to serve homeless individuals. Strategies for ending homelessness largely include resource-intensive, publicly supported housing and comprehensive physical and mental health services. The role of spirituality in recovery from homelessness has not been widely examined. This article describes one homeless shelter's successful Christ-centered, comprehensive approach to helping individuals recover from homelessness. The integral role of the nurse in the multidisciplinary team and practical nursing interventions are described.
Thyroid Radiation Dose to Patients from Diagnostic Radiology Procedures over Eight Decades
Authors: Chang Lienard A. , Miller Donald L. , Lee Choonsik , Melo Dunstana R. , Villoing Daphnée , Drozdovitch Vladimir , Thierry-Chef Isabelle , Winters Sarah J. , Labrake Michael , Myers Charles F. , Lim Hyeyeun , Kitahara Cari M. , Linet Martha S. , Simon Steven L.
Published: September 2017

This study summarizes and compares estimates of radiation absorbed dose to the thyroid gland for typical patients who underwent diagnostic radiology examinations in the years from 1930 to 2010. The authors estimated the thyroid dose for common examinations, including radiography, mammography, dental radiography, fluoroscopy, nuclear medicine, and computed tomography (CT). For the most part, a clear downward trend in thyroid dose over time for each procedure was observed. Historically, the highest thyroid doses came from the nuclear medicine thyroid scans in the 1960s (630 mGy), full-mouth series dental radiography (390 mGy) in the early years of the use of x rays in dentistry (1930s), and the barium swallow (esophagram) fluoroscopic exam also in the 1930s (140 mGy). Thyroid uptake nuclear medicine examinations and pancreatic scans also gave relatively high doses to the thyroid (64 mGy and 21 mGy, respectively, in the 1960s). In the 21st century, the highest thyroid doses still result from nuclear medicine thyroid scans (130 mGy), but high thyroid doses are also associated with chest/abdomen/pelvis CT scans (18 and 19 mGy for males and females, respectively). Thyroid doses from CT scans did not exhibit the same downward trend as observed for other examinations. The largest thyroid doses from conventional radiography came from cervical spine and skull examinations. Thyroid doses from mammography (which began in the 1960s) were generally a fraction of 1 mGy. The highest average doses to the thyroid from mammography were about 0.42 mGy, with modestly larger doses associated with imaging of breasts with large compressed thicknesses. Thyroid doses from dental radiographic procedures have decreased markedly throughout the decades, from an average of 390 mGy for a full-mouth series in the 1930s to an average of 0.31 mGy today. Upper GI series fluoroscopy examinations resulted in up to two orders of magnitude lower thyroid doses than the barium swallow. There are considerable uncertainties associated with the presented doses, particularly for characterizing exposures of individual identified patients. Nonetheless, the tabulations provide the only comprehensive report on the estimation of typical radiation doses to the thyroid gland from medical diagnostic procedures over eight decades (1930–2010). These data can serve as a resource for epidemiologic studies that evaluate the late health effects of radiation exposure associated with diagnostic radiologic examinations.
UNILATERAL NEURORETINITIS AS A LATE-ONSET MANIFESTATION OF THE CHIKUNGUNYA FEVER: A CASE SERIES
Authors: Dávila Pedro J. , Toledo Allison , Ulloa-Padilla Jan P. , Izquierdo Natalio J. , Emanuelli Andrés
Published: September 2017

Purpose:

To report 3 cases of unilateral neuroretinitis associated with the chikungunya fever (CHIKV).

Methods:

Retrospective noncomparative case series.

Results:

Three female patients with similar complains of blurry vision and decreased visual acuity that started several weeks after experiencing symptoms of the CHIKV. All patients had decreased best-corrected visual acuity and distortion on the Amsler grid in the affected eye. Evidence of unilateral optic nerve swelling and macular exudates was noted in all patients. No pharmacologic therapy was given. At 2-month follow-up evaluation, all patients had regained at least 3 lines in the Snellen chart, and subretinal fluid and optic nerve swelling had resolved.

Conclusion:

Unilateral neuroretinitis can present as a late-onset manifestation of CHIKV. Three patients with diagnosis of CHIKV developed unilateral neuroretinitis weeks after the acute viral syndrome, suggesting a possible immunological etiology for this manifestation. To our knowledge, this is the first case series of CHIKV leading to neuroretinitis in the Western World.
CAPNOCYTOPHAGA CANIMORSUS ENDOPHTHALMITIS AFTER CATARACT SURGERY LINKED TO SALIVARY DOG-TO-HUMAN TRANSMISSION
Authors: Thommen François , Opota Onya , Greub Gilbert , Jaton Katia , Guex-Crosier Yan , Wolfensberger Thomas J. , Matet Alexandre
Published: September 2017

Purpose:

To describe a case of acute postoperative bacterial endophthalmitis because of Capnocytophaga canimorsus after cataract surgery, with probable contamination through salivary droplets of dog two days after the procedure.

Methods:

An 83-year-old woman who underwent uncomplicated cataract extraction with intraocular lens implantation, presented 12 days later with acute pain, redness, and vision loss in her left eye. Visual acuity was hand motion and clinical findings suggested the diagnosis of acute postoperative endophthalmitis. The patient underwent diagnostic vitrectomy, intravitreal ceftazidime/vancomycin injection and received oral moxifloxacin (400 mg/day). Two days later, she underwent complete pars-plana vitrectomy because of the absence of clinical improvement. Vitreous samples showed gram-negative bacterium on direct examination but cultures remained sterile, which prompted the realization of a broad-range bacterial polymerase chain reaction analysis.

Results:

Polymerase chain reaction on the vitreous sample detected C. canimorsus, a fastidious gram-negative bacterium of the oral canine flora. When asked for recent contact with dogs, the patient reported having proceeded to an intensive tooth care session for her dog at postoperative Day 2. Intravenous ceftriaxone (2 g/day) was added to the treatment. Anterior and posterior segment inflammation slowly resolved, and final visual acuity was 20/160.

Conclusion:

Although very rare, this complication suggests that patients undergoing ocular surgery should avoid contact with salivary secretions of pets during the early postoperative period. Diagnostic broad-range bacterial polymerase chain reaction is useful to detect unconventional or slow-growing agents in vitreous samples.
Discontinuation of Biological Treatments in Inflammatory Bowel Disease
Authors: Ben-Horin Shomron , Mao Ren , Qiu Yun , Chen Minhu
Published: September 2017

Despite the proven efficacy of biological drugs for inflammatory bowel disease, these therapies are costly and do carry some risks, providing incentive for exploring strategies to discontinue therapy in patients with prolonged remission. We presently review multiple cohort studies indicating the overall risk of relapse after stopping an anti-tumor necrosis factor (TNF) in inflammatory bowel disease patients is roughly 40% at 12 months after therapy cessation. Despite methodological differences across studies, it appears that patients without deep remission (ie, patients with endoscopic or biomarker evidence of inflammation) are at increased risk of relapse after stopping anti-TNF, as are those with high-adequate levels of anti-TNF before stopping. In patients who relapse after anti-TNF cessation, retreatment with the same biological seems to reinduce clinical response in most patients. Immunological reasons responsible for this high success rate for retreatment are elucidated, but resorting to retreatment also implies a small but finite risk of a severe flare leading to surgery, which should be borne in mind. Thus, stopping attempts should probably be reserved for patients with low risk for severe outcome should a relapse occur. Proactive endoscopic monitoring after drug cessation is imperative to reduce these risks. The recently introduced concept of treatment-cycles is discussed, along with a pragmatic algorithm of decision tree for therapy discontinuation in the selected appropriate patients.
Chymotrypsinogen C Genetic Variants, Including c.180TT, Are Strongly Associated With Chronic Pancreatitis in Pediatric Patients
Authors: Grabarczyk Alicja Monika , Oracz Grzegorz , Wertheim-Tysarowska Katarzyna , Anna Kujko Aleksandra , Wejnarska Karolina , Kolodziejczyk Elwira , Bal Jerzy , Koziel Dorota , Kowalik Artur , Gluszek Stanislaw , Rygiel Agnieszka Magdalena
Published: September 2017

Objectives:

Genetic studies in adults/adolescent patients with chronic pancreatitis (CP) identified chymotrypsinogen C (CTRC) genetic variants but their association with CP risk has been difficult to replicate. To evaluate the risk of CP associated with CTRC variants in CP pediatric patients-control study.

Methods:

The distribution of CTRC variants in CP pediatric cohort (n = 136, median age at CP onset 8 years) with no history of alcohol/smoking abuse was compared with controls (n = 401, median age 45).

Results:

We showed that p.Arg254Trp (4.6%) and p.Lys247_Arg254del (5.3%) heterozygous mutations are frequent and significantly associated with CP risk in pediatric patients (odds ratio [OR] = 19.1; 95% CI 2.8–160; P = 0.001 and OR = 5.5; 95% CI 1.6–19.4; P = 0.001, respectively). For the first time, we demonstrated that the c.180TT genotype of common p.Gly60Gly variant is strong, an independent CP risk factor (OR = 23; 95% CI 7.7–70; P < 0.001) with effect size comparable to p.Arg254Trp mutation. The other novel observation is that common c.493+51C>A variant, both CA and AA genotype, is significantly underrepresented in CP compared with controls (15% vs 35%; OR = 0.33; 95% CI 0.19–0.59; P < 0.001 and 2.8% vs 11%; OR = 0.24; 95% CI 0.06–0.85; P = 0.027, respectively).

Conclusions:

Our study provides evidence that CTRC variants, including c.180TT (p.Gly60Gly) are strong CP risk factors. The c.493+51C>A variant may play a protective role against CP development.
Impact of High-Reliability Education on Adverse Event Reporting by Registered Nurses
Authors: McFarland Diane M. , Doucette Jeffrey N.
Published: September 2017

Adverse event reporting is one strategy to identify risks and improve patient safety, but, historically, adverse events are underreported by registered nurses (RNs) because of fear of retribution and blame. A program was provided on high reliability to examine whether education would impact RNs' willingness to report adverse events. Although the findings were not statistically significant, they demonstrated a positive impact on adverse event reporting and support the need to create a culture of high reliability.
Loss of Magnet® Designation and Changes in RN Work Engagement
Authors: Wonder Amy Hagedorn , York Jacki , Jackson Kathryn L. , Sluys Teresa D.
Published: September 2017

OBJECTIVE

The aim of this study was to examine the loss of Magnet® designation and how RNs' work engagement changed at 1 community hospital.

BACKGROUND

The importance of RN work engagement to promote quality and safety is widely recognized in healthcare. Ongoing consistent research is critical to determine what organizational structures are needed to support RN work engagement.

METHODS

This was a comparative, descriptive, correlational study of RN cohorts at 2 time points: time 1 (T1), in 2011 during Magnet designation (n = 119), and time 2 (T2), in 2016, approximately 2 years after the loss of Magnet designation (n = 140).

RESULTS

The cohort of RNs at T2 reported significantly lower work engagement in the time period after the loss of Magnet designation when compared with the RN cohort at T1 during Magnet designation (P ≤ .0002).

CONCLUSION

These results provide insights for clinical leaders striving to support a culture of RN work engagement and quality care.
Newly Licensed RN Retention
Authors: Blegen Mary A. , Spector Nancy , Lynn Mary R. , Barnsteiner Jane , Ulrich Beth T.
Published: September 2017

OBJECTIVES

The aims of this study were to examine the relationship between 1-year retention of newly licensed RNs (NLRNs) employed in hospitals and personal and hospital characteristics, and determine which characteristics had the most influence.

METHODS

A secondary analysis of data collected in a study of transition to practice was used to describe the retention of 1464 NLRNs employed by 97 hospitals in 3 states. Hospitals varied in size, location (urban and rural), Magnet® designation, and university affiliation. The NLRNs also varied in education, age, race, gender, and experience.

RESULTS

The overall retention rate at 1 year was 83%. Retention of NLRNs was higher in urban areas and in Magnet hospitals. The only personal characteristic that affected retention was age, with younger nurses more likely to stay.

CONCLUSION

Hospital characteristics had a larger effect on NLRN retention than personal characteristics. Hospitals in rural areas have a particular challenge in retaining NLRNs.
Immunohistochemical Characterization of Cancer-associated Fibroblasts in Oral Squamous Cell Carcinoma
Authors: Dourado Raísa C. , Porto Lia P.A. , Leitão Águida C.G.H. , Cerqueira Paloma S.G. , dos Santos Jean N. , Ramalho Luciana M.P. , Xavier Flávia C.A.
Published: September 2017

Myofibroblasts are differentiated contractile cells that can secrete extracellular matrix components, cytokines, proteases, and proangiogenic factors. In neoplastic processes such as oral squamous cell carcinoma (OSCC), myofibroblasts are recognized as cancer-associated fibroblasts (CAFs) and actively participate in tumor progression. As the presence of myofibroblasts in the stroma may be an important parameter of invasion and proliferation, the aim of this study was to evaluate the presence of CAFs in OSCC by immunophenotyping and their association with histologic classification and clinicopathologic parameters. A total of 34 formalin-fixed, paraffin-embedded samples of OSCC were analyzed for CAF histology and immunophenotype established on the basis of the simultaneous immunohistochemical expression of α-SMA, fibronectin, FSP1, HHF35, and vimentin. According to the histologic classification of CAFs, 16 (47%) cases were classified as the mature subtype and 18 (53%) as the immature subtype. CAF immunophenotype was detected in 19 (56%) cases, and the immunophenotype was variable in 15 (44%) cases. The CAFs immunophenotype was significantly associated with the immature histologic subtype. Immunohistochemical expression of α-SMA, fibronectin, FSP1, HHF35, and vimentin represents a suitable CAF immunophenotype in OSCC. The CAF immunophenotype is associated with the immature histologic subtype. The characterization of CAFs may identify tumors with a distinct biological profile in OSCC. Studies extending the investigation of CAFs to OSCC are needed to determine the actual role of this cell population as a possible prognostic marker.
Optical Biomarker-based Biosensors for Cancer/Infectious Disease Medical Diagnoses
Authors: Gharatape Alireza , Yari Khosroushahi Ahmad
Published: September 2017

Thousands of billions of dollars have been disbursed worldwide for the diagnosis and therapy of disease. Nanobioscience combined with sensing technology has facilitated the pathway to diagnosis by introducing a novel, highly sensitive and selective detection system known as the nanobiosensor to reduce the overall cost of treatment. Among the many types of biosensors, optical ones are more easily developed because of their low cost, rapid construction, small size, high performance, high sensitivity and selectivity, high signal-to-noise ratio, flexible geometry, and portability properties. This study reviews and discusses nanobiosensors and electrochemical biosensors with the main focus on colorimetric, fluorometric, luminometric, fiber optic, and surface plasmon resonance-based optical biosensors and an emphasis on their applications in medical diagnosis.
Solitary Fibrous Tumor of the Vulva: Report of 2 Cases, Including a De Novo Dedifferentiated Solitary Fibrous Tumor Diagnosed After Molecular Demonstration of NAB2-STAT6 Gene Fusion
Authors: Tardío Juan C. , Machado Isidro , Alemany Isabel , López-Soto M. Victoria , Nieto M. Gema , Llombart-Bosch Antonio
Published: September 2017

Solitary fibrous tumor (SFT) is a neoplasm of fibroblastic lineage that has been documented in almost every anatomic location. Vulval SFT is very rare with only 10 cases reported to date. We present 2 additional SFTs located in the vulva, in adult women of 59 and 25 yr of age. The first showed a classic morphology and immunophenotype with uniform and strong STAT6 nuclear expression. The other one was a spindle-cellde novodedifferentiated SFT with heterogeneous nuclear and cytoplasmic STAT6 staining, which could only be correctly diagnosed after molecular analysis with demonstration of aNAB2-STAT6gene fusion. This genetic aberration is considered to represent the major pathogenic driver in SFT and is highly specific for this neoplasm. The differential diagnosis of vulval SFT is wide and varies depending on the histologic SFT subtype. Molecular analysis is mandatory for a correct diagnosis in cases without the characteristic histopathologic and immunophenotypical features.
From Theory to Practice: A 2-Year Demonstration of the Community-Centered Health Home Model
Authors: Mor Kyla , Hobor George , Riccardo Jessica , Robinson Melody
Published: September 2017

The Community-Centered Health Home (CCHH) model, developed by Prevention Institute, calls on health care organizations to contribute to improvements in community conditions that influence health such as employment or housing. The Louisiana Public Health Institute designed the first demonstration of CCHH and worked with 5 community health centers in the Gulf South to implement the model over a 2-year period. With support of funding and technical assistance, health centers and their community partners pursued a range of data collection, analysis, and community prevention activities. This article discusses the opportunities and challenges for replicating CCHH as a framework for how health care can respond to upstream determinants of health that affect the entire community. Further implementation efforts that address some of the challenges during this demonstration are needed to learn more about successful implementation and impact on population health.
Embedding a Social Work–Led Behavioral Health Program in a Primary Care System: A 2012-2018 Case Study
Authors: Rehner Tim , Brazeal Michelle , Doty Stephanie T.
Published: September 2017

Introduction:

The focus of this case study was the implementation of a fully integrated system of care that brought mental health into a federally qualified health center's primary care activities.

Objective:

The Mississippi Integrated Health and Disaster Program aimed to increase the federally qualified health center's capacity for providing mental health services and in so doing increase patients' access to mental and behavioral health services in primary care. Included are the historical origins of the program and the context in which these clinics operate, as well as successful processes that reduced barriers between medical providers and social workers and ultimately resulted in improved patient outcomes.

Results:

Data indicated that the Mississippi Integrated Health and Disaster Program's integrated health model significantly improved depression, anxiety, and self-care among chronic care patients.

Conclusion:

This integrated health approach transformed the treatment culture of patient care in primary care clinics and improved patient outcomes. This study highlights the benefits possible when behavioral health provided by social workers is fully integrated into primary care. This case study illustrates the importance of developing a care model that meets the patient populations' specific and varied needs while concurrently establishing an integrated service delivery culture within local clinics and within the organization's administrative structures.
A Retrospective Cohort Study on Payor Type and the Effect on Revisions in Breast Reconstruction
Authors: Odom Elizabeth B. , Sharma Ketan , Grant David W. , Buck Donald W. , Myckatyn Terence M.
Published: September 2017

Background:

Patients who are insured by Medicare and Medicaid are less likely to undergo breast reconstruction than their privately insured counterparts. Whether insurance type also affects subsequent revisions remains unknown. This study explores the relationship among payor type, revision procedures, and the completion of breast reconstruction.

Methods:

A retrospective cohort study was created including patients who underwent breast reconstruction at the authors’ institution from 1996 to 2016. Data collected included age, cancer stage, race, laterality, initial breast reconstruction type, total number of procedures, number of trips to the operating room, and subsequent revisions. Analysis of covariance and logistic regression were used to estimate the controlled mean number of revisions and probability of completion of reconstruction as a function of insurance type.

Results:

A total of 3113 patients were included: 2271 (72.9 percent) with private insurance, 450 (14.5 percent) with Medicare, and 392 (12.6 percent) with Medicaid. On controlled analysis, there was no difference in total number of procedures, number of revisions, or number of trips to the operating room among the three insurance types. There was no difference in the proportion of patients undergoing symmetry procedures or nipple-areola reconstruction.

Conclusions:

To the authors’ knowledge, this is the first study to evaluate discrepancies in number of procedures, revisions, and the proportion of patients completing breast reconstruction among insurance types. When controlling for other factors, the authors report no differences in care based solely on payor type. Instead, patient and surgeon variables may be responsible for the differences observed, and should be targeted in future research to improve equity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.