bluuebunny/crossref_metadata_2025 huggingface dataset:
Phenomenological Psychopathology and Quantitative Research
Authors: Nordgaard Frederiksen Julie E. , Henriksen Mads Gram
Published: June 2018

This article explores how research in phenomenological psychopathology can be translated to quantitative data, using the “EASE: Examination of Anomalous Self-Experience” scale as an example. To appreciate the distinctiveness of phenomenological psychopathology, we first describe key features of the philosophical discipline of phenomenology, in which phenomenological psychopathology is rooted. We then outline central characteristics of phenomenological psychopathology itself, before examining the construction of EASE scale, its psychometric properties, and the results from this direction of empirical-quantitative research. Finally, we emphasize that even though the EASE scale is rooted by phenomenology, the EASE interviews themselves must also be conducted in a phenomenologically faithful way, and we offer some insights into how these interviews must be conducted, for example, in a semi-structured, conversational manner, by keeping focus on the patients’ lived experiences, and by identifying essential features of the patients’ anomalies of self-experience (i.e. self-disorders).
Rawls on Distributive Justice and the Difference Principle
Authors: Freeman Samuel
Published: June 2018

This chapter analyzes Rawls’s complex account of distributive justice. Rawls’s difference principle requires that economic systems be organized so that the least advantaged members of society are better off than they would be in any alternative economic arrangement. The following questions are addressed here: What constraints are imposed by equal basic liberties and fair equality of opportunity on inequalities allowed by the difference principle? What are the difference principle’s broad and narrow requirements? Is maximizing the least advantaged position mandatory regardless of the inequalities created, or is it optional so that a society can choose to limit inequalities permitted by the difference principle? In what respect is the difference principle a reciprocity principle and not prioritarian? What measures are required to realize the difference principle under ideal conditions of a well-ordered society versus non-ideal conditions of an unjust society? Why should property-owning democracy rather than welfare-state capitalism satisfy Rawls’s principles of justice?
Public Goods
Authors: Miller David , Taylor Isaac
Published: June 2018

Supplying public goods generates costs and benefits that can be allocated among individuals in different ways. Yet leading theories of justice within liberalism fail to offer concrete guidance on how these allocations should be assessed. This chapter critically examines a number of principles of distributive justice that might be used for this purpose. It argues that the appropriate principle will depend on whether the public goods in question are “essential public goods” (ones that are required by justice) or “discretionary public goods” (ones that are not). While a number of principles have previously been put forward for both categories, the chapter concludes that none of them are free from counter-intuitive implications. Further work is needed in order to arrive at a satisfactory way of assessing the distributive consequences of public good supply.
Race
Authors: Boxill Bernard
Published: June 2018

This article examines the tendency of racial differences to support violations of distributive justice. It is thus a discussion in non-ideal theory and avoids discussion of ideal theory. It begins by showing that races are social constructions. Social constructions are sets of mainly false beliefs, and racial differences support violations of distributive justice because of the nature of these beliefs. The races as social constructions are generated by ideologies that are developed for some political purpose such as a defense of black slavery or the forced deportation of black people from America. Affirmative action is defended on the basis of a backward looking appeal to compensatory justice. The argument is that it can be designed so as to expunge the false beliefs that constitute the social constructions of race, and educate the public about racism.
Retributive Justice
Authors: Alexander Larry
Published: June 2018

The topic of this chapter is the relationship between retributive justice and distributive justice. The author expounds his view that retributive justice should be noncomparative, and that the currency of retributive desert should be suffering. Some theories of distributive justice employ desert as a basis for distribution, whereas other theories of distributive justice do not. The author explains his belief that retributive justice relies on the notion of negative desert, but acknowledges that there are problems if not only negative desert is to be punished but positive desert is to be rewarded. The challenge is how to integrate retributive justice into the different theories of distributive justice.
Distributive Justice and Human Nature
Authors: Casal Paula
Published: June 2018

This chapter examines the relation between distributive doctrines and human nature. It reviews various responses to the conservative view that many progressive social reforms are doomed because of human nature. Some responses present a different view of human nature while others stress that human nature can be modified because it is the product of nurture or because it can be socially or biomedically altered. The chapter also offers an evolutionary approach to values like ‘liberté, égalité, fraternité’ and discusses whether human nature could have more than merely instrumental relevance to distributive justice. For example, our endorsement, and interpretation, of moral demands regarding human rights, human flourishing, and human capabilities, or even regarding the principles of sufficiency, equality and priority, may depend on assumptions about human nature.
The Capability Approach
Authors: Robeyns Ingrid
Published: June 2018

This chapter analyzes the contribution of the capability approach to the literature on distributive justice. The capability approach in itself does not provide a full theory of distributive justice, but rather argues that the metric of distributive justice should be functionings and/or capabilities. The chapter critically analyzes various issues that need addressing when we adopt this metric, such as the questions of which capabilities should be selected, and how they should be aggregated in order to make interpersonal comparisons of advantage. Comparisons with other metrics of justice are also discussed, such as Rawls’s social primary goods and welfarist metrics. The chapter concludes by arguing that we should think of the capability approach to justice as a family of theories, and describes which theoretical modules are needed for a full capabilitarian theory of justice.
Material Culture and Childhood in Harappan South Asia
Authors: Varma Supriya
Published: June 2018

The Harappan Civilization came up in the mid-third millennium bce over an area that extended over much of the northwestern part of the Indian subcontinent. This chapter will specifically focus on two major cities, Mohenjodaro and Harappa, to discuss material culture and childhood in Harappan South Asia, including the wide range of arguably child-related objects found at these sites which provide a lens through which we can get a glimpse of quotidian activities within these two cities. Many of the artefacts that have been categorized as toys represent household chores that took place around children as well as objects (such as wheeled vehicles), animals, and birds that they routinely encountered.
The Developing Forager
Authors: Harrington Lesley , Osipov Benjamin
Published: June 2018

Studies of regional and chronological variation in skeletal markers of physical activity in past hunter-gatherer populations typically focus on adults, however, patterns of bone strength develop predominantly during childhood and adolescence. Ethnographic studies suggest that differences in environment and subsistence strategy would have brought about variation in how children grew up to be productive foragers capable of procuring food for themselves and others. Different foraging activities require varying degrees of physical strength and skills development. These factors would have influenced the age at which individuals began to participate in different foraging activities and lead to regional and chronological differences in the ontogeny of limb robusticity. This process is culturally-mediated in terms of the degree to which children are ‘trained’ in subsistence activities. Consequently, this study compares ontogenetic patterns in the development of bone strength with the aim of reconstructing physical activity patterns among the children of two Holocene hunter-gatherer populations.
Feeding Infants from the Iron Age to the Early Medieval Period in Britain
Authors: Redfern Rebecca C.
Published: June 2018

The feeding and rearing of infants are sociocultural and developmental processes, each with their own timetables that can either unite or diverge, depending on the wellbeing and physiological growth of the infant, and the needs of the mother or carer and the society in which they live. They are highly emotive and complex topics, which go to the heart of human relationships and behaviours, because they are regarded as important steps to achieving personhood and a social identity. Furthermore, because these processes begin during pregnancy, they rely on the intimate connections between a mother and foetus, and carer and baby. This chapter will examine these processes from pregnancy through to childhood, providing a framework to understand the practices and choices made by the Iron Age, Roman and Saxon communities in Britain and Europe.
Children’s Burial Grounds (cillíní) in Ireland
Authors: Donnelly Colm J. , Murphy Eileen M.
Published: June 2018

Children’s burial grounds (cillíní) are a recognized class of Irish archaeological monument that were used as the designated burial places for unbaptized infants among the Roman Catholic population. The evidence from historical and archaeological studies indicates a proliferation in the use of cillíní following the 17th century and that the tradition continued in use until the mid 20th century. This can be linked with the rise of Counter-Reformation Catholicism and the role played in Ireland by the Franciscans of Louvain, who were strong Augustinianists. The chapter reviews the development of new burial legislation in the Victorian era and suggests that this led the Church to take greater responsibility for the burial of the unbaptized through the creation of unconsecrated burial plots in Catholic cemeteries. The end of the tradition can be ascribed to the reforms undertaken within the Church as a result of the Second Vatican Council in the 1960s.
Gazing on the Past (and Being Photobombed by Children)
Authors: Crawford Sally , Ulmschneider Katharina
Published: June 2018

Archaeologists often ignore the presence of children as a contributing factor in the archaeological record. However, recent analysis of a number of glass plate and film photographs taken by archaeologists at the end of the nineteenth century and the first half of the twentieth century shows that children were often incorporated into the photograph, either deliberately or inadvertently. These images provide not just a record of ancient sites and monuments, but also of the many local children who appear in the photographs. The children recorded by archaeologists offer an insight into children, their childhoods, their freedoms, and their place in society across a range of cultures in the late nineteenth century and early twentieth century, as well as raising questions about how archaeologists ‘saw’ the human subject in photographs where monuments and sites were the object.
Material Culture, Museums, Movies, and Make Believe
Authors: Hall Mark A.
Published: June 2018

This contribution explores the biographical life stage of childhood in medieval Europe through the contemporary (now) representations of such childhood, particularly in the cinema and the museum. Aspects to be explored include defining childhood, nested identities, gender and social contexts, narrative inclinations and independence of action (e.g. through play, education and apprenticeship, and training for adulthood). A range of films will be considered for their powerful and vital depictions of a constructed and variously authentic notion of medieval childhood, in particular Andrei Roublev, The Seventh Seal, Anchoress, Navigator: A Medieval Odyssey, Marketa Lazarová, and Brave. The various strands of exploration will be drawn together in an assessment of the images being put forward to represent children both in archaeology and museums (including temporary exhibitions and permanent museums of childhood) and in cinema.
Do Hospitals Performing Frequent Neuraxial Anesthesia for Hip and Knee Replacements Have Better Outcomes?
Authors: Memtsoudis Stavros G. , Poeran Jashvant , Zubizarreta Nicole , Olson Ashley , Cozowicz Crispiana , Mörwald Eva E. , Mariano Edward R. , Mazumdar Madhu
Published: June 2018

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Neuraxial anesthesia is increasingly recommended for hip/knee replacements as some studies show improved outcomes on the individual level. With hospital-level studies lacking, we assessed the relationship between hospital-level neuraxial anesthesia utilization and outcomes.

Methods

National data on 808,237 total knee and 371,607 hip replacements were included (Premier Healthcare 2006 to 2014; 550 hospitals). Multivariable associations were measured between hospital-level neuraxial anesthesia volume (subgrouped into quartiles) and outcomes (respiratory/cardiac complications, blood transfusion/intensive care unit need, opioid utilization, and length/cost of hospitalization). Odds ratios (or percent change) and 95% CI are reported. Volume-outcome relationships were additionally assessed by plotting hospital-level neuraxial anesthesia volume against predicted hospital-specific outcomes; trend tests were applied with trendlines’ R
2 statistics reported.

Results

Annual hospital-specific neuraxial anesthesia volume varied greatly: interquartile range, 3 to 78 for hips and 6 to 163 for knees. Increasing frequency of neuraxial anesthesia was not associated with reliable improvements in any of the study’s clinical outcomes. However, significant reductions of up to –14.1% (95% CI, –20.9% to –6.6%) and –15.6% (95% CI, –22.8% to –7.7%) were seen for hospitalization cost in knee and hip replacements, respectively, both in the third quartile of neuraxial volume. This coincided with significant volume effects for hospitalization cost; test for trend P < 0.001 for both procedures, R
2 0.13 and 0.41 for hip and knee replacements, respectively.

Conclusions

Increased hospital-level use of neuraxial anesthesia is associated with lower hospitalization cost for lower joint replacements. However, additional studies are needed to elucidate all drivers of differences found before considering hospital-level neuraxial anesthesia use as a potential marker of quality.
A novel method for determining sagittal pediatric patellar height with the Blumensaat-Epiphyseal Containment of the Knee Angle
Authors: Beck Jennifer J. , Boguszewski Daniel V. , Joshi Nirav B. , Cheung Edward C. , Bowen Richard E. , Oppenheim William L.
Published: June 2018

Defining normal pediatric patellar height is complicated. Current methods use ratios calculated from lateral radiographs, but often provide inconsistent results and are time-consuming. It has been observed that the angle formed by Blumensaat’s line and the distal femoral physis, when extended, form an area of patellar containment throughout a range of knee flexion. Deemed the Blumensaat-Epiphyseal Containment of the Knee (BECK) Angle, the objective of this study was to investigate this as a simple alternative to identify normal pediatric patellar height. Lateral radiographs were taken every 15° from 0° to 90° flexion on 10 fresh-frozen cadaveric knees. Patellar height was measured as the percentage of pole-to-pole patellar length contained within the BECK angle. The method was then applied to normal lateral radiographs of 105 pediatric knees, divided into age groups of 7–9, 10–12, and 13–16 years old. BECK angle patellar containment was compared with previously described methods. For cadaveric specimens, at least 50% patellar containment occurred between 0° and 71° flexion without quadriceps tension and between 21° and 81° flexion with 30 N of quadriceps tension. For pediatric radiographs, flexion ranged from 9° to 81°. At least 50% patellar containment occurred in 96% of knees in all three age groups. Knee flexion fell within a range of 15°–60° in 92 of the 105 pediatric knees. Limiting the analysis to this range, at least 50% patellar containment occurred in 99% of knees in all three age groups. On the basis of this study, normal pediatric knee lateral radiographs between 15° and 60° flexion should show at least 50% patellar containment within the BECK angle. Level of Evidence: Diagnostic Level II study.
Pediatric Forearm Deformity: Use of 3D Modeling to Guide Deformity Correction
Authors: Sibbel Sarah E.
Published: June 2018

Pediatric forearm deformity correction is one of many fundamental skills of practicing pediatric orthopedist. The etiology of forearm deformity can vary from congenital to traumatic. When residual posttraumatic forearm angulation exceeds 20 degrees, and rotational deformity is >30 degrees, an osteotomy may be indicated. Surgeons tasked with preoperative planning are limited by the 2-dimensional (2D) nature of radiographs. It becomes increasingly beneficial to have 3D information when surgical correction is mandated in multiple areas or critical locations such as the distal radioulnar joint or radial head. The purpose of this article is to provide a description of preoperative planning using 3D modeling to create patient-specific guides for intraoperative use to correct pediatric forearm deformity. Studies and cases utilizing 3D modeling have shown improvement in forearm rotation, distal radioulnar joint and/or radial head stability following correction of forearm deformity. The use of 3D modeling to create patient-specific guides for intraoperative use has been shown to provide good short-term efficacy but is considered off-label use by the Food and Drug Administration.
Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols
Authors: Ban Kristen A. , Berian Julia R. , Liu Jason B. , Ko Clifford Y. , Feldman Liane S. , Thacker Julie K. M.
Published: June 2018

BACKGROUND:

Implementation of enhanced recovery protocols in colectomy reduces length of stay and morbidity, but it remains unknown whether benefits vary by clinical diagnosis.

OBJECTIVE:

Outcomes after colectomy in the setting of enhanced recovery protocols were compared for 3 diagnoses: 1) neoplasm, 2) diverticulitis, and 3) IBD.

DESIGN:

This was a retrospective registry-based cohort study.

SETTINGS:

Novel enhanced recovery variables were released in the American College of Surgeons National Surgical Quality Improvement Program in 2014.

PATIENTS:

Patients with enhanced recovery variable data undergoing elective colectomy (July 2014 to December 2015) for neoplasm, diverticulitis, or IBD were included.

MAIN OUTCOME MEASURES:

The primary outcome of interest was prolonged length of stay. Additional outcomes included surgical site infection, death/serious morbidity, reoperation, readmission, and days to achieve per os pain control, tolerance of a diet, and return of bowel function.

RESULTS:

We identified 4620 patients with neoplasm, 1730 patients with diverticulitis, and 593 patients with IBD. Patients undergoing colectomy for IBD were more likely to have prolonged length of stay (OR, 1.98; 95% CI, 1.46–2.69), death/serious morbidity (OR, 1.62; 95% CI, 1.13–2.32), and readmission (OR, 1.54; 95% CI, 1.15–2.08) compared with patients with neoplasm. Patients with IBD took longer than patients with neoplasm or diverticulitis to achieve per os pain control (mean, 4.2 days vs 3.4 and 3.5 days, p < 0.001) and tolerate a diet (mean, 4.1 days vs 3.7 and 3.5 days, p < 0.001). No statistically significant differences in outcomes between patients with neoplasm and diverticulitis were seen.

LIMITATIONS:

There may be heterogeneity among implemented enhanced recovery protocols.

CONCLUSIONS:

Patients undergoing colectomy for neoplasm and diverticulitis have improved outcomes in comparison with patients undergoing colectomy for IBD. Knowledge of expected outcomes for patients with different diagnoses may inform clinician and patient expectations. See Video Abstract at http://links.lww.com/DCR/A623.
The role of appendectomy at the time of laparoscopic surgery for benign gynecologic conditions
Authors: Peters Ann , Mansuria Suketu M.
Published: June 2018

Purpose of review

The risk–benefit ratio of concurrent appendectomy at the time of gynecologic surgery has long been debated and remains controversial. However, emerging data on the appendix's role in chronic pain syndromes point to a previously unrecognized link between gynecologic disorders and appendicular pathology. In this article, we review the indications for appendectomy at the time of laparoscopic gynecologic surgery for the treatment of endometriosis and chronic pelvic pain.

Recent findings

The incidence of appendiceal endometriosis is highly variable depending on the patient population selected. Although rare in patients undergoing appendectomy for acute appendicitis, women with endometriosis may experience rates as high as 9.3–39.0%, especially when suffering from deep infiltrative endometriosis. Appendectomy may also significantly reduce pain in women with unexplained chronic pelvic pain.

Despite lack of prospective data, retrospective studies suggest that appendectomy during gynecologic procedures for chronic pelvic pain and severe endometriosis may be beneficial and necessary to fully address the treatment of these complex gynecologic conditions. In these clinical scenarios, the benefits of laparoscopic appendectomy at the time of the primary gynecologic procedure may outweigh the risks and cost, and should be discussed with patients preoperatively.
Golimumab effectiveness and safety in clinical practice for moderately active ulcerative colitis
Authors: O’Connell Jim , Rowan Cathy , Stack Roisin , Harkin Grace , Parihar Vikrant , Chan Grace , Breslin Niall , Cullen Garret , Dunne Cara , Egan Laurence , Harewood Gavin , Leyden Jan , MacCarthy Finbar , MacMathuna Padraic , Mahmud Nasir , McKiernan Susan , McNamara Deirdre , Mulcahy Hugh , Murray Frank , O’Connor Anthony , O’Toole Aoibhlinn , Patchett Stephen , Ryan Barbara , Sheridan Juliette , Slattery Eoin , Doherty Glen , Kevans David
Published: June 2018

Background and aims

Golimumab (GLB) is an antitumour necrosis factor-α (anti-TNF) therapy that has shown efficacy as induction and maintenance therapy for ulcerative colitis (UC). We aimed to describe the outcome of GLB therapy for UC in a real-world clinical practice.

Patients and methods

Consecutive patients receiving GLB for UC in six Irish Academic Medical Centres were identified. The primary study endpoint was the 6-month corticosteroid-free remission rate. The secondary endpoints included the 3-month clinical response, time free of GLB discontinuation and adverse events.

Results

Seventy-two patients were identified [57% men; median (range) age of 41.4 years (20.3–76.8); disease duration 6.6 years (0–29.9); follow-up 8.7 months (0.4–39.2)]. Sixty-four percent of patients were anti-TNF naive. The 3-month clinical response and the 6-month corticosteroid-free remission rates were 55 and 39%, respectively. Forty-four percent of patients discontinued GLB during the follow-up, median (95% confidence interval) time to GLB discontinuation 18.7 months (9.2–28.1). A C-reactive protein more than 5 mg/l at baseline was associated with failure to achieve 6-month corticosteroid-free remission and a shorter time to GLB discontinuation, odds ratio 0.2 (0.1–0.7),P=0.008, and hazard ratio (95% confidence interval) 2.8 (1.3–5.7),P=0.007, respectively. Adverse events occurred in 7% of patients (n=5), all of which were minor and self-limiting.

Conclusion

These real-world clinical data suggest that GLB is an effective and safe therapy for a UC cohort with significant previous anti-TNF exposure. An elevated baseline C-reactive protein, likely reflective of increased inflammatory burden, is associated with a reduced likelihood of a successful outcome of GLB therapy.
Acute kidney injury in patients presenting with chest pain to the emergency department, a descriptive study of the most common discharge diagnoses and mortality
Authors: Hertzberg Daniel , Holzmann Martin J. , Than Martin , Pickering John W.
Published: June 2018

Objective

To describe patients presenting with chest pain to the emergency department (ED) according to acute kidney injury (AKI) status at arrival, with a focus on the most common discharge diagnoses and on long-term mortality.

Methods

All adult patients visiting the Karolinska University Hospital ED between December 2010 and October 2014 with a principal complaint of chest pain were included. AKI at arrival was defined as an increase in presentation serum creatinine concentration of at least 26 µmol/l ( ≥ 0.3 mg/dl) or at least 50% above baseline. Risk ratios (RR) with 95% confidence intervals (CIs) between the AKI and no-AKI groups were calculated for the most common discharge diagnoses in the AKI group. Hazard ratios for long-term mortality were calculated using Cox regression models with adjustment for covariates.

Results

In total, 8480 patients were included, of whom 476 (5.6%) had AKI. AKI patients were older and had more comorbidities. It was more common in AKI patients compared to no AKI patients to be diagnosed with heart failure, RR 3.03 (CI: 2.15–4.26) and myocardial infarction RR 1.44 (CI: 1.01–2.04). During a median follow-up of 3.2 years (interquartile range: 2.1–4.3), 37% of the patients with AKI died compared with 16% of patients without AKI. The multivariable adjusted hazard ratio of death for AKI compared with no AKI was 1.30 (95% CI: 1.10–1.53).

Conclusion

When attending the ED, patients with chest pain and AKI were more likely to be diagnosed with heart failure and myocardial infarction and had an increased long-term mortality compared with patients with no AKI.
Pulmonary infectious complications after hematopoietic stem cell transplantation: a practical guide to clinicians
Authors: Gea-Banacloche Juan
Published: June 2018

Purpose of review

The current review highlights the most relevant articles on lung infections following hematopoietic stem cell transplantation (HCT) published over the last year. Between 30 and 50% of HCT recipients will develop pulmonary infiltrates. These pulmonary complications may be infectious (caused by virus, bacteria, fungi, or protozoa) or noninfectious (e.g., fluid overload, heart failure, transfusion reactions like transfusion associated lung injury and transfusion-associated circulatory overload, drug reactions, engraftment syndrome, idiopathic pneumonia syndrome, diffuse alveolar hemorrhage, cryptogenic organizing pneumonia, and bronchiolitis obliterans syndrome).

Recent findings

New data on the yield of bronchoscopy and bronchoalveolar lavage (BAL), the prevalence and clinical manifestations of respiratory viruses and the usefulness of molecular techniques for diagnosis have been published. In addition, guidelines or meta-analyses on the management of neutropenic fever, serological diagnosis of fungal infections and diagnosis and management of Pneumocystis and aspergillosis have been published.

Respiratory viruses are important pathogens after HCT. PCR in the BAL is becoming the diagnostic modality of choice for a variety of infections. The best approach for the empirical management of pulmonary infiltrates following HCT remains to be defined.
Shadow of the third pandemic: a review of the epidemiology, microbiology, ecology, clinical features, molecular diagnosis and treatment of plague
Authors: Amphlett Alexander
Published: June 2018

Yersinia pestis has caused three plague pandemics. The third pandemic created a legacy of disease in 16 countries with The Democratic Republic of Congo and Madagascar most affected. Phylogenetically, Y. pestis gained pathogenicity and the ability to spread via fleas due to the acquisition of plasmids Pst and Fra. Recently, contaminated soil has been implicated as an additional transmission route. In well resourced settings, plague diagnosis was transformed in the 2000s by PCR and ELISA. More recently, matrix assisted laser desorption/ionization time-of-flight has enabled species identification within 6 min. However, these innovations have had little impact on the rural, resource poor settings, in which plague is most prevalent. Here, the F1 dipstick has been a more effective method of field diagnosis. A new plasminogen activator protease dipstick is currently being validated. The emergence of two antibiotic resistant strains and potential for bioweaponization has stimulated vaccine development with the F1-LcrV vaccine most promising in animal models.
Tracheostomy Care Practices in a Simulated Setting
Authors: Bolsega Thomas J. , Sole Mary Lou
Published: June 2018

Purpose/Aims:

Many critically ill patients undergo a tracheostomy. Tracheostomy care is performed to maintain the airway and promote stoma skin integrity. Variation in practices may affect outcomes. The study purpose was to describe tracheostomy care practices of caregivers who perform tracheostomy care in critical care settings and compare practices with published recommendations.

Design:

This is a descriptive, exploratory study of tracheostomy care practices of nurses and respiratory therapists using a simulated setting.

Methods:

Staff working in critical care and step-down units were approached to participate in the study. Equipment used for tracheostomy care and the steps performed were observed and video recorded. Observations were compared with recommended practices. Data were analyzed with descriptive statistics.

Results:

Fifteen registered nurses (75%) and 5 respiratory therapists (25%) participated. Most participants (80%) were female and held a baccalaureate degree; median experience was 5 years. Equipment used and order of steps varied widely. Only 1 individual performed in the order recommended in a commonly used procedure manual. The most common sequence performed was hand hygiene, clean flange, clean stoma, change inner cannula, change ties, and apply dressing.

Conclusion:

Wide variability in equipment and practices emphasizes the need for establishing an evidence-based approach for performing tracheostomy care to prevent complications.
Location of the Internal Mammary Vessels for Microvascular Autologous Breast Reconstruction: The “1–2–3 Rule”
Authors: Lee Christina Dami , Butterworth James , Stephens Robert E. , Wright Barth , Surek Christopher
Published: June 2018

Background:

Postmastectomy breast reconstruction provides psychosocial benefits in self-esteem, sexuality, and quality of life. Autologous procedures yield the highest overall patient satisfaction compared with implant-based breast reconstruction as the gold standard. The internal mammary vessels are the preferred recipient vessels for free flap breast reconstruction. The purpose of this study is to provide surgeons with a reliable method for locating the vessels intraoperatively.

Methods:

The internal mammary vessels were dissected bilaterally on 30 cadaveric specimens. Distances from the lateral sternal borders and the costochondral junctions to the internal mammary vessels at the second, third, and fourth costal levels were recorded. Descriptive bifurcation patterns were recorded. Initial dissection practicums were performed using the proposed safer dissection zone according to quantitative data.

Results:

Sixty internal mammary arteries and 120 internal mammary veins were studied at three costal levels, resulting in 180 sets of measurements. Distances from the lateral sternal border to the medial internal mammary vein were 6.12, 9.04, and 10.45 mm at costal levels 2, 3, and 4, respectively. Mean distances between costochondral junctions and internal mammary arteries were 12.80, 24.78, and 33.28 mm at costal levels 2, 3, and 4, respectively. Most internal mammary vein bifurcated at the third costal level, and the left side bifurcated higher than the right. Dissection practicums revealed that the proposed dissection zone was consistently reliable in locating the vessels.

Conclusions:

This study provides mean measurements from common bony landmarks to the internal mammary vessels, equipping surgeons with a reliable zone of dissection for recipient vessel exposure. This may decrease morbidity and improve outcomes in autologous breast reconstructions.
Novel Approach for Risk-Reducing Mastectomy: First-Stage Implant Placement and Subsequent Second-Stage Mastectomy
Authors: Lim Geok Hoon , Baildam Andrew D.
Published: June 2018

Background:

Risk-reducing mastectomy with tissue expander and then implant-based breast reconstruction conventionally involved immediate submuscular placement of tissue expanders during mastectomy and then, after expansion, replacement of expanders for permanent implants in a second-stage operation. Use of acellular dermal matrix can achieve a single-stage operation; however, acellular dermal matrices are costly and may have potential complications. The authors aim to assess the feasibility of placement of implants as a first-stage procedure before risk-reducing mastectomy as a novel technique of reconstruction that avoids the need for serial outpatient expansion and acellular dermal matrix.

Methods:

Patients for whom risk-reducing mastectomy was planned were offered first-stage dual-plane placement of fixed volume silicone gel permanent implants by means of inframammary fold incisions. Risk-reducing mastectomy was undertaken several months later as the second operation, leaving the implants in place protected by the muscle and capsule pocket. Nipples were preserved or reconstructed according to the patient’s choice.

Results:

Eight patients with 15 operated breasts were recruited. Anatomically shaped implants were used in all patients, and complete coverage of each implant was achieved. Mean implant volume was 433 ml (range, 290 to 545 ml). There were no complications, and good aesthetic outcomes were achieved.

Conclusions:

This proof-of-principle study finds that placement of implants before risk-reducing mastectomy is a novel technique for women at high breast cancer risk that could reduce the use of tissue expanders and acellular dermal matrices and their associated problems. Two-stage risk-reducing mastectomy with first-stage implant placement and subsequent risk-reducing mastectomy leaving the implants in place is feasible, with no complications, and can produce a good cosmetic outcome.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Changes in Cutaneous Gene Expression after Microvascular Free Tissue Transfer in Parry-Romberg Syndrome
Authors: Chen Jenny Tzujane , Eisinger Brian , Esquibel Corinne , Poore Samuel O. , Eliceiri Kevin , Siebert John W.
Published: June 2018

Background:

Parry-Romberg syndrome is an enigmatic craniofacial disorder characterized by progressive facial atrophy. The pathogenesis and molecular mechanisms governing Parry-Romberg syndrome have never before been described. The purpose of the current study was twofold: (1) to begin to elucidate the pathophysiology of this disease using next-generation RNA sequencing and (2) to evaluate the effect of surgical treatment on gene expression.

Methods:

Patients with Parry-Romberg syndrome underwent microvascular free tissue transfer to the face to address contour deformity in both active and burned out disease. Tissue samples were collected for analysis at the time of initial microvascular free tissue transfer, and 6 months later at a scheduled revision operation. Patients presenting for rhytidectomy had tissue samples taken as control tissue. Samples from patients with disease were compared to control samples.

Results:

Twenty-two subjects were evaluated (six control and 16 Parry-Romberg syndrome patients). All patients with Parry-Romberg syndrome underwent microvascular free tissue transfer to the face. Thirteen patients underwent scheduled 6-month revision surgery. Disease samples were distinct from healthy controls, and postoperative patient samples were more similar to healthy control samples. Parry-Romberg syndrome patients had a unique proinflammatory gene expression profile, including up-regulation of IL24, ADAMTS4, and GFCSF3. Postoperatively, more than 3400 genes were changed (p < 0.005), and of the 460 genes dysregulated in disease, 118 were changed in a corrective fashion by microvascular free tissue transfer.

Conclusions:

The authors describe for the first time molecular signatures in Parry-Romberg syndrome. Molecular signatures in skin became more similar to those in healthy controls and were associated with clinical improvement after microvascular free tissue transfer in Parry-Romberg syndrome.
Cerebrovascular disorders
Authors: Fazekas Franz , Gattringer Thomas , Enzinger Christian
Published: June 2018

Purpose of review

Not unexpected from the variety of cerebrovascular disorders and their morphologic and clinical consequences the contributions of neuroimaging are also quite diverse and go with different approaches in different directions. By reviewing the recent advances in these various areas, we will attempt to highlight those contributions, which may be most meaningful both for the clinician and the researcher dealing with cerebrovascular disorders.

Recent findings

After long expectations of the utility of mismatch concepts, such patient selection has proven successful in extending the benefit of recanalization of acute ischaemic stroke by mechanical thrombectomy beyond 6 h and the importance of infarct size and collaterals has been documented. Insights into the association of bleeding markers such as cerebral microbleeds and cortical superficial siderosis with spontaneous, treatment-related, first or recurrent intracerebral haemorrhage have been consolidated and explored further. New data have been added to better understand the clinical and prognostic impact of the various features of small vessel disease including cortical microinfarcts.

Neuroimaging findings increasingly serve to guide treatment decisions in acute ischaemic stroke, to identify morphologic markers associated with the risk for intracerebral haemorrhage and to detect and understand the consequences of chronically accumulating cerebrovascular damage.
ICTV Virus Taxonomy Profile: Bicaudaviridae
Authors: Prangishvili David , Krupovic Mart ,   ICTV Report Consortium
Published: June 2018

The family Bicaudaviridae includes viruses that infect hyperthermophilic archaea in the genus Acidianus. The circular double-stranded DNA genome of Acidianus two-tailed virus consists of 62 730 bp, and replication can be either lytic or lysogenic. Virions undergo unique extracellular morphogenesis, being released from host cells as spindle-shaped particles that subsequently develop long tails, one at each of the two pointed ends. The spindle-shaped morphology represents a group of archaea-specific virion morphotypes. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the taxonomy of the Bicaudaviridae which is available at www.ictv.global/report/bicaudaviridae.
Nano-particles from Chaetomium against Rice Blast
Authors: Song JiaoJiao , Soytong Kasem
Published: June 2018

The effective isolate of Chaetomium sp actively against Magnaporthe sp causing rice blast were tested. Morphology and phylogenic identification was also confirmed Chaetomium.sp. Magnporthe sp proved to be virulent isolate to cause blast of rice. Bi-culture test proved that Chaetomium sp can be suppressed the growth of Magnaporthe sp. The fungal metabolites extracted from Chaetomium sp expressed antifungal Magnaporthe sp. Nano-particles derived from Chaetomium sp extracts exhibited significantly antifungal activity against Magnaporthe sp. Further investigation is to formulate the nanoparticles from active compounds of Chaetomium sp for plant immunity and to be applied in the rice fields.

IMPORTANCE

Rice blast is an economic important disease which caused by Magnaporthe. It causes yield loss and economic damage wherever rice is grown in Asia. It becomes the main disease due to wide distribution and most infection under favorable condition. The farmers have been applied several kinds of chemical fungicides that leading to the pathogen become resistant to those fungicides, and causes environmental pollution which the toxic chemicals residue in soil, water and surrounding environment. The significance of this research is to discover a new agricultural input as nanoparticles from Chaetomium to control the blast pathogen which will develop the nanoproduct to elicit immunity in rice, environmental protection and food safety.
Biophysical modeling of VIM to assess contributions of oscillatory activity to essential tremor
Authors: Lee Shane , Segar David J , Asaad Wael F , Jones Stephanie R
Published: June 2018

Essential tremor (ET) is the most common movement disorder, in which the primary symptom is a prominent, involuntary 4–10 Hz rhythmic movement. The presence of tremor frequency oscillations (TFOs) in the ventral intermediate nucleus of the thalamus (VIM) is well-established, but it is often assumed that it is driven by cerebellar tremor frequency activity, while the role of intrinsic oscillatory activity in VIM is not clear. An improved understanding of the mechanisms of tremor and non-tremor frequency activity in VIM is critical to the development of improved pharmacological and neuromodulatory therapies. Starting from a canonical model of thalamus, we developed a biophysically-principled computational model of tremor field activity in the VIM, coupled with the thalamic reticular nucleus (TRN). We simulated TFOs in the model generated either by extrinsic tremor-periodic drive or intrinsic VIM-TRN interaction to understand whether these networks exhibited distinct biophysical properties, which may impact the efficacy of pharmacological or stimulation treatment for TFOs. Extrinsic and intrinsic TFOs in the model depended on T-type Ca2+channels in different ways. Each also depended on GABA modulation in a site- and type-specific manner. These results suggested that efficacy of pharmacological manipulations may depend upon the mechanisms generating TFOs in VIM. Simulated non-tremor-related motor activity from cerebellum decreased extrinsic but increased intrinsic TFOs. Our results suggest that both mechanisms may be important to understand the emergence and cessation of TFOs in VIM and lead to experimentally testable predictions on how to modulate tremor frequency activity to improve treatment strategies for ET.

Significance Statement

Essential Tremor (ET) is a movement disorder in which the primary symptom is a prominent, involuntary, and rhythmic shaking, often of the hands. Electrical activity in many areas of the brain exhibit rhythmicity related to the patient’s tremor. One such area resides in a structure called the thalamus, but it is not fully known what gives rise to tremor-related activity. We created a computational model of this activity, which suggested how to differentiate tremor mechanisms and how these differences may contribute to other impairments in ET. Knowledge of the biophysical mechanisms contributing to tremor can ultimately lead to improvements in treatments to alleviate symptoms of ET.
Longitudinal changes in the prevalence and intensity of soil-transmitted helminth infection following expanded community-wide mass drug administration in the delta region of Myanmar
Authors: Dunn Julia C , Bettis Alison A , Wyine Nay Yee , Moe Moe Lwin Aye , Tun Aung , Maung Nay Soe , Anderson Roy M
Published: June 2018

Mass drug administration (MDA), targeted at school-aged children is the method recommended by the World Health Organization for the control of morbidity induced by soil-transmitted helminth (STH) infection in endemic countries. However, MDA does not prevent reinfection between treatment rounds. In countries with endemic infection, such as Myanmar, the MDA coverage, who is targeted, and rates of reinfection in given environmental and social settings will determine how effective mass drug treatment is in suppressing transmission in the long-term. In this paper, data from an epidemiology study on STH, conducted between June 2015 and June 2016 in the delta region of Myanmar, are analysed to determine the risks of STH infection in the whole community over a year which included two MDA rounds. Risk ratios (RRs) for the four-month reinfection period were below one, whereas RRs for the six-month reinfection period were above one, indicating that more people were infected after six months of exposure post-MDA. Evidence of predisposition, as measured by the Kendall Tau-b statistic, was found for all STH species and across all age groups. This study demonstrates that a six-month gap between MDA in these communities is enough time for STH infection to return to pre-MDA levels and that the same individuals are being consistently infected between MDA rounds.

Author summary

Mass drug administration (MDA), treating either whole communities or targeted groups without a prior diagnosis, is used as a control strategy for many neglected tropical diseases, including soil-transmitted helminth (STH) infection. MDA takes place at set intervals, aiming to reduce morbidity caused by the target disease and potentially interrupt transmission. In this study we measure STH infection in two villages in the delta region of Myanmar over the course of a year, both before and after MDA rounds, to quantify the effect of treatment on infection and to identify groups with persistent infections. We found that whilst overall prevalence of STH infection decreased over the year, intensity of infection, measured by eggs per gram of faeces, did not significantly decrease. We also found evidence to suggest that particular people are predisposed to STH infection. This is possibly due to non-compliance to MDA, or behavioural and social factors. The findings presented here will provide evidence to support continuing Myanmar’s MDA programme for STH control and using accurate diagnostics to identify and target “predisposed” people for sustained treatment.
Rapid adaptation of endocytosis, exocytosis and eisosomes after an acute increase in membrane tension in yeast cells
Authors: Lemière Joël , Ren Yuan , Berro Julien
Published: June 2018

During clathrin-mediated endocytosis in eukaryotes, actin assembly is required to overcome large membrane tension and turgor pressure. However, the molecular mechanisms by which the actin machinery adapts to varying membrane tension remain unknown. In addition, how cells reduce their membrane tension when they are challenged by hypotonic shocks remains unclear. We used quantitative microscopy to demonstrate that cells rapidly reduce their membrane tension using three parallel mechanisms. In addition to using their cell wall for mechanical protection, yeast cells disassemble eisosomes to buffer moderate changes in membrane tension on a minute time scale. Meanwhile, a temporary reduction of the rate of endocytosis for 2 to 6 minutes, and an increase in the rate of exocytosis for at least 5 minutes allow cells to add large pools of membrane to the plasma membrane. We built on these results to submit the cells to abrupt increases in membrane tension and determine that the endocytic actin machinery of fission yeast cells rapidly adapts to perform clathrin-mediated endocytosis. Our study sheds light on the tight connection between membrane tension regulation, endocytosis and exocytosis.