bluuebunny/crossref_metadata_2025 huggingface dataset:
Clustering of extremely red objects in the AKARI NEP-deep field
Authors: Seo Hyunjong , Jeong Woong-Seob , Shim Hyunjin , Kim Minjin , Ko Jongwan , Pyo Jeonghyun , Oi Nagisa , Goto Tomotsugu , Pearson Chris
Published: June 2019

We study the clustering property of extremely red objects (EROs) using Canada–France–Hawaii Telescope (CFHT) surveys with 0.55 deg2 in the AKARI north ecliptic pole (NEP) deep field. EROs are selected by the color criterion of r′ − Ks > 3.66, which is equivalent to (R − Ks)Vega > 5. We conducted the clustering analysis for two magnitude-limited cases, Ks < 20.3 (N = 363) and Ks < 20.9 (N = 727), using two-point angular correlation represented by a single power-law function. By fixing a power-law (with 0.8), the correlation lengths of EROs with Ks < 20.3 and Ks < 20.9 are 9.10 ± 1.86 and 7.81 ± 1.21 h−1 Mpc, respectively. We find that bias factors of EROs with Ks < 20.3 and Ks < 20.9 are 3.19 ± 0.59 and 2.83 ± 0.40, respectively, revealing that EROs reside in dark matter halos heavier than $\sim 10^{13}\, M_{\odot }$. To investigate possible descendants of EROs with Ks < 20.9, we calculate how the bias for dark matter halos that host EROs evolves by accounting for mass growth of halos along the redshift. We find that halos hosting EROs evolve into halos hosting local massive galaxies with 2–$7\, L^{*}$. It suggests that passive EROs with Ks < 20.9 are likely to be progenitors of massive galaxies in the present universe. The comparison between passive EROs (pEROs) and star-forming EROs (sEROs) classified by near-infrared colors shows that pEROs seem to be connected with more massive local galaxies. By fitting spectral energy distributions (SEDs), we estimate active galactic nucleus (AGN) contribution for 68 sEROs which are selected in mid-IR bands. AGN contributions to the IR luminosity are less than $10\%$ except for six sEROs. At least in the IR-selected sEROs, the contribution of AGN seems to be not significant.
Nanomedicine: an emerging era of theranostics and therapeutics for rheumatoid arthritis
Authors: Qamar Naila , Arif Ammara , Bhatti Attya , John Peter
Published: June 2019

RA is a multifactorial autoimmune inflammatory disease characterized by synovitis, bone destruction and joint dysfunction that leads to shortening of lifespan and increased mortality rates. Currently available treatments of RA, by controlling various symptoms, only delay disease progression and have their own side effects. Consequently, there is the need for a novel therapeutic strategy that offers a more sustainable and biocompatible solution. Nanomedicine is a modern branch of nanobiotechnology that provides targeted therapy to inflamed rheumatic joints and thus prevents unwanted off-target side effects. This review highlights various nanotheranostic and nanotherapeutic strategies that are currently being used for the treatment of RA.
RECENT TRITIUM CONCENTRATION OF MONTHLY PRECIPITATION IN JAPAN
Authors: Nakasone S , Ishimine A , Ishizu Y , Shiroma Y , Tanaka M , Akata N , Kakiuchi H , Sanada T , Furukawa M
Published: June 2019

To obtain a better understanding of recent tritium concentration and its seasonal cycle in Japan, monthly precipitation samples were collected in Hokkaido, Gifu and Okinawa prefectures from June 2014 to December 2017. The arithmetic mean ( ± standard deviation) of tritium concentrations in precipitation samples from Hokkaido, Gifu and Okinawa were estimated to be 0.62 ± 0.27 Bq L−1, 0.32 ± 0.12 Bq L−1 and 0.13 ± 0.05 Bq L−1, respectively. These results indicate that the concentrations increase with latitude. In addition, the highest and the lowest concentrations appeared in spring and summer, respectively. To clarify the origins and sources of these cycles, further analyses of chemical compositions of precipitation and meteorological conditions are needed.
Forever Homes and Temporary Stops: Housing Search Logics and Residential Selection
Authors: Harvey Hope , Fong Kelley , Edin Kathryn , DeLuca Stefanie
Published: June 2019

Residential selection is central in determining children’s housing, neighborhood, and school contexts, and an extensive literature considers the social processes that shape residential searches and attainment. While this literature typically frames the residential search as a uniform process oriented around finding residential options with desired characteristics, we examine whether individuals may differentially conceive of these searches in ways that sustain inequality in residential attainment. Drawing on repeated, in-depth interviews with a stratified random sample of 156 households with young children in two metropolitan counties, we find that parents exhibit distinct residential search logics, informed by the constraints they face. Higher-income families usually engage in purposive searches oriented around their residential preferences. They search for “forever homes” that will meet their families’ needs for years to come. In contrast, low-income parents typically draw on a logic of deferral. While they hope to eventually search for a home with the unit, neighborhood, and school characteristics they desire, aspirations for homeownership lead them to conceive of their moves (which are often between rental units) as “temporary stops,” which justifies accepting homes that are inconsistent with their long-term preferences. In addition, because they are often “pushed” to move by negative circumstances, they focus on their immediate housing needs and, in the most extreme cases, adopt an “anywhere but here” approach. These logics constitute an unexamined mechanism through which economic resources shape residential searches and ultimate attainment.
Parental Financial Transfers: Do They Vary by Children’s Sexual Orientation?
Authors: Perales Francisco , Huang Yangtao
Published: June 2019

Parents often play complex and highly variable roles in the lives of grown-up lesbian, gay and bisexual (LGB) people. Some act as support sources, helping their offspring buffer societal discrimination. Others are unaccepting of—or ambivalent about—their children’s sexual orientation, becoming further stressors. In practice, little research has examined whether parents treat adult LGB children differently than heterosexual children. This study tests this premise in relation to parental financial transfers using two waves of panel data from an Australian national sample (Household, Income and Labour Dynamics in Australia Survey, n = 18,448 observations) and random-effect panel regression models. We find that parents send money more often to LGB than heterosexual children, a pattern that persists over the adult life course. This association could not be explained by adult children’s socio-economic disadvantage, fertility intentions, parent-child contact, or parent-child distance. These findings suggest that, all else being equal, parental financial investments contribute to narrowing the social disadvantage experienced by Australian LGB people.
Better research by efficient sharing: evaluation of free management platforms for synthetic biology designs
Authors: Urquiza-García Uriel , Zieliński Tomasz , Millar Andrew J
Published: June 2019

Synthetic biology aims to introduce engineering principles into biology, for example, the construction of biological devices by assembling previously-characterized, functional parts. This approach demands new resources for cataloging and sharing biological components and designs, in order to accelerate the design-build-test-learn cycle. We evaluated two free, open source software platforms for managing synthetic biology data: Joint Bioenergy Institute-Inventory of Composable Elements (JBEI-ICE) and SynBioHub. We analyzed the systems from the perspective of experimental biology research groups in academia, which seek to incorporate the repositories into their synthetic biology workflow. Here, we define the minimal requirements for a repository in this context and develop three usage scenarios, where we then examine the two platforms: (i) supporting the synthetic biology design-build-test-learn cycle, (ii) batch deposit of existing designs into the repository and (iii) discovery and reuse of designs from the repository. Our evaluation of JBEI-ICE and SynBioHub provides an insight into the current state of synthetic biology resources, might encourage their wider adoption and should guide future development to better meet the needs of this user group.
Impact of Low-Dose Ionizing Radiation on the Composition of the Gut Microbiota of Mice
Authors: Liu Xiaodan , Zhou Yao , Wang Shaozheng , Guan Hua , Hu Sai , Huang Ruixue , Zhou Pingkun
Published: June 2019

Although the importance of the gut microbiota in the maintenance of human health has been well established, little is known about the impact of low-dose ionizing radiation ([LDR]; exposure to a dose of less than 0.5 Gy of low linear energy transfer radiation such as γ- or X-rays) on the composition and functional role of the gut microbiota. The aim of the present study was to investigate and compare the composition of the gut microbiota in mice exposed to LDR. Male BALB/c mice were exposed to low-dose Co60 radiation. Fecal samples taken prior to and after irradiation were used for high-throughput sequencing of 16S rRNA gene sequence amplicons. We observed substantial changes in the composition of the gut microbiota, including alpha diversity and beta diversity, in mice exposed to LDR compared with the nonradiated control group. Moreover, at the genus level, the abundance of Clostridium, Helicobacter, and Oscilibacter increased, and those of Bacteroides and Barnesiella decreased, in a time-dependent manner in the radiated groups compared with the nonradiated control group. The functional metabolic pathway analysis indicated that Bacteroides spp. and members of the other genera that were found are predicted to play roles in bacterial toxin production, DNA repair, and Type II diabetes. Furthermore, these alterations in the gut microbiota were accompanied by changes in the abundance of multiple metabolites, which were predicted to be involved in multiple signaling pathways, including glucagon, central carbon metabolism, and type II diabetes. The possibility of microbiota-mediated pathophysiology resulting from LDR may be an as yet unrecognized hazard that merits further experimental examination. This study provides a conceptual and analytical foundation for further research into the chronic effects of LDR on human health, and points to potential novel targets for intervention to prevent the adverse effects of radiation.
Computer Modeling of Prophylactic Dressings: An Indispensable Guide for Healthcare Professionals
Authors: Gefen Amit , Alves Paulo , Creehan Sue , Call Evan , Santamaria Nick
Published: June 2019

This article is a review of the work conducted and published to date in employing computer finite element (FE) modeling for efficacy research of prophylactic dressings in the context of preventing pressure injuries. The authors strive to explain why FE modeling is essential in establishing the efficacy of prophylactic dressings, as it is in the development and evaluation of any other preventive intervention. In particular, FE modeling provides insights into the interactions between dressing structures and weight-bearing body tissues (including susceptible anatomical locations such as the sacrum and heels of supine patients). Modeling further facilitates reliable visualization and quantification of the mechanical loads that develop in superficial and deep tissues as a result of body weight or external forces based on known physical principles. The modeling then helps to determine how these tissue loads are mitigated using prophylactic dressings of different designs, structures, and material compositions and rate performances of existing or new products.

All of the work published so far on modeling the modes of action of prophylactic dressings has focused on the Mepilex Border dressing (Mölnlycke Health Care AB, Gothenburg, Sweden). Published work has revealed several key design features that are pivotal for obtaining successful clinical outcomes, namely, (1) a multilayered alternating-stiffness structure with embedded anisotropy; (2) a minimal friction coefficient at the external surface of the dressing; and (3) low impact of fluid retention on the mechanical behavior of the dressing. These features, their importance, and the methods of identifying their roles in the modes of action of effective prophylactic dressings are detailed here.

Computer models clearly inform the process of engineering prophylactic dressings, but they may also provide guidance in clinical use, contribute to assessing technologies and products, support purchasing, and describe product endurance. As the methods of FE modeling of dressings improve, simulations may soon incorporate the simultaneous complex interactions among tissue distortion, heat transfer in tissue, and prophylactic dressings to inform patient care.
Are genetics/genomics competencies essential for all clinical nurses?
Authors: Newcomb Patricia , Behan Deborah , Sleutel Martha , Walsh Judith , Baldwin Kathleen , Lockwood Suzy
Published: June 2019

In 2006, the American Nurses Association created a set of essential genetics and genomics (G/G) competencies for all RNs, regardless of academic preparation, practice setting, or specialty. However, more than half of the RNs practicing today received no prelicensure education on these G/G competencies. This study describes the current use of G/G nursing competencies in acute care hospitals and how nurses perceive them.
Applicant Reactions to the AAMC Standardized Video Interview During the 2018 Application Cycle
Authors: Deiorio Nicole M. , Jarou Zachary J. , Alker Ashely , Bird Steven B. , Druck Jeffrey , Gallahue Fiona E. , Hiller Katherine M. , Karl Erin , Pierce Ava E. , Fletcher Laura , Dunleavy Dana
Published: June 2019

Purpose

This study examined applicant reactions to the Association of American Medical Colleges Standardized Video Interview (SVI) during its first year of operational use in emergency medicine (EM) residency program selection to identify strategies to improve applicants’ SVI experience and attitudes.

Method

Individuals who self-classified as EM applicants applying in the Electronic Residency Application Service 2018 cycle and who completed the SVI in summer 2017 were invited to participate in 2 surveys. Survey 1, which focused on procedural issues, was administered immediately after SVI completion. Survey 2, which focused on applicants’ SVI experience, was administered in fall 2017, after SVI scores were released.

Results

The response rates for surveys 1 and 2 were 82.3% (2,906/3,532) and 58.7% (2,074/3,532), respectively. Applicant reactions varied by aspect of the SVI studied and their SVI total scores. Most applicants were satisfied with most procedural aspects of the SVI, but most applicants were not satisfied with the SVI overall or with their total SVI scores. About 20% to 30% of applicants had neutral opinions about most aspects of the SVI. Negative reactions to the SVI were stronger for applicants who scored lower on the SVI.

Conclusions

Applicants had generally negative reactions to the SVI. Most were skeptical of its ability to assess the target competencies and its potential to add value to the selection process. Applicant acceptance and appreciation of the SVI will be critical to the SVI’s acceptance by the graduate medical education community.
Late-Career Expectations: A Survey of Full-Time Faculty Members Who Are 55 or Older at 14 U.S. Medical Schools
Authors: Skarupski Kimberly A. , Welch Cheryl , Dandar Valerie , Mylona Elza , Chatterjee Archana , Singh Meenakshi
Published: June 2019

Purpose

The average age of full-time faculty members at U.S. medical schools accredited by the Liaison Committee on Medical Education was 49.5 in 2017, yet the academic medicine community knows little about late-career faculty. The authors sought to characterize full-time faculty members 55 or older and assess their work–life expectations.

Method

The authors conducted a survey (May–September 2017) of faculty 55+ at 14 U.S. medical schools.

Results

Of the 5,204 faculty members invited, 2,126 (40.8%) responded. The average age of respondents was 62.3, and among those responding to the relevant questions, most identified as male (1,425; 67.2%), white (1,841; 88.3%), and married/partnered (1,803; 85.5%). Fewer than half (915; 45.2%) indicated they had begun thinking about full-time retirement, estimating that they would do so at a mean age of 67.8 (standard deviation = 4.3). Half the respondents (1,004; 50.0%) would consider moving to part-time status. The top 3 personal factors likely to affect retirement decisions were health, postretirement plans, and spouse’s/partner’s plans. The top 3 professional factors were phased retirement or part-time options, changes in institutional leadership, and presence of a successor. Faculty indicated that they would, post retirement, be interested in ongoing work in teaching/education and research/scholarship and that they wanted health insurance, email, and part-time teaching opportunities.

Conclusions

U.S. medical schools employ a rapidly aging workforce. These data indicate that neither faculty members nor institutions are prepared. Faculty affairs and develop ment leaders should champion efforts to engage with late-career faculty to prepare for this changing landscape.
Does Strategic Planning Matter?
Authors: Mallon William T.
Published: June 2019

In this Invited Commentary, the author examines the history, use, and effectiveness of strategic planning in higher education, academic medicine, and nonprofit settings. Strategic planning is a process by which an organization differentiates itself from its direct or emergent competition to achieve its mission. This form of planning is distinct from operational planning, in which an organization identifies the ways in which it will continuously improve. Many organizations employ a combination of strategic planning and operational planning but use the former term to describe their planning process without a clear definition or conceptual framework.

The empirical literature across disciplines has not demonstrated that strategic planning leads to positive organizational outcomes. Over the modern history of academic medicine in the United States, strategic planning may have had limited impact on organizational outcomes because of favorable environmental circumstances that catalyzed growth and innovation regardless of planning efforts. In the current environment, organizational and departmental leaders need to define trade-offs between the various opportunities that they confront; allow for both planned and emergent strategy formulation; avoid platitudes and fluff; and focus on operational excellence.

Theories from anthropology suggest that strategic plans may be more important for what they express than what they produce. Repetition of the themes and language of strategy in formal and informal discourse can have a decisive effect on the culture of the organization. Strategic planning, therefore, matters for its effect on organizational values, rituals, and ability to move the organization in new directions.
Patient-specific ICP Epidemiologic Thresholds in Adult Traumatic Brain Injury: A CENTER-TBI Validation Study
Authors: Zeiler Frederick A. , Ercole Ari , Cabeleira Manuel , Beqiri Erta , Zoerle Tommaso , Carbonara Marco , Stocchetti Nino , Menon David K. , Lazaridis Christos , Smielewski Peter , Czosnyka Marek
Published: June 2019

Background:

Patient-specific epidemiologic intracranial pressure (ICP) thresholds in adult traumatic brain injury (TBI) have emerged, using the relationship between pressure reactivity index (PRx) and ICP, displaying stronger association with outcome over existing guideline thresholds. The goal of this study was to explore this relationship in a multi-center cohort in order to confirm the previous finding.

Methods:

Using the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit cohort, we derived individualized epidemiologic ICP thresholds for each patient using the relationship between PRx and ICP. Mean hourly dose of ICP was calculated for every patient for the following thresholds: 20, 22 mm Hg and the patient’s individual ICP threshold. Univariate logistic regression models were created comparing mean hourly dose of ICP above thresholds to dichotomized outcome at 6 to 12 months, based on Glasgow Outcome Score—Extended (GOSE) (alive/dead—GOSE≥2/GOSE=1; favorable/unfavorable—GOSE 5 to 8/GOSE 1 to 4, respectively).

Results:

Individual thresholds were identified in 65.3% of patients (n=128), in keeping with previous results (23.0±11.8 mm Hg [interquartile range: 14.9 to 29.8 mm Hg]). Mean hourly dose of ICP above individual threshold provides superior discrimination (area under the receiver operating curve [AUC]=0.678, P=0.029) over mean hourly dose above 20 mm Hg (AUC=0.509, P=0.03) or above 22 mm Hg (AUC=0.492, P=0.035) on univariate analysis for alive/dead outcome at 6 to 12 months. The AUC for mean hourly dose above individual threshold trends to higher values for favorable/unfavorable outcome, but fails to reach statistical significance (AUC=0.610, P=0.060). This was maintained when controlling for baseline admission characteristics.

Conclusions:

Mean hourly dose of ICP above individual epidemiologic ICP threshold has stronger associations with mortality compared with the dose above Brain Trauma Foundation defined thresholds of 20 or 22 mm Hg, confirming prior findings. Further studies on patient-specific epidemiologic ICP thresholds are required.
Intramedullary Fixation of Both Bone Forearm Fractures in Children and Adolescents: Healing Correlates With Development of the Olecranon Apophysis
Authors: Morrison Martin J. , Speirs Joshua N. , Chicorelli Anne M. , Garner Matthew , Flynn John (Jack) M. , Herman Martin J.
Published: June 2019

Background:

The purpose of this study was to determine whether healing of both bone forearm (BBFA) fractures in children and adolescents is associated with the stage of the olecranon apophysis development as described by the Diméglio modification of the Sauvegrain method.

Methods:

Records were reviewed from 2 children’s hospitals from 1997 to 2008 to identify all patients younger than 18 years of age who had BBFA fractures treated with intramedullary nail fixation. Sixty-three patients were identified meeting inclusion and exclusion criteria. The stage of the olecranon apophysis was noted on the lateral radiograph at the time of the injury. Data were statistically analyzed to assess the olecranon stage at which the increased rate of delayed union becomes more prevalent using the receiver operating characteristic curve. Time to union, complications, and need for reoperation were recorded for each group.

Results:

One thousand three hundred ninety-eight patient records were reviewed with 63 patients meeting the inclusion criteria. Using a receiver operating characteristic curve, a cutoff of olecranon stage > 3 (stages 4 to 7) was a significant predictor of the increased rate of delayed union time compared with olecranon stages 0 to 3 (P=0.004). Non–healing-related complication rates for each group were 2/28 (7.1%) for olecranon stages and 0 to 3 and 6/35 (17.1%) for olecranon stages 4 to 7.

Conclusions:

The rate of delayed union for BBFA fractures that have been treated with intramedullary nail fixation is increased in children with more mature olecranon apophyses as compared with those with younger olecranon stages. We propose the use of the stage of olecranon apophysis development when choosing the surgical approach and implant for when treating operative BBFA fractures in children.

Level of Evidence:

Level III—retrospective comparative study.
Checkpoint Blockade in Combination With Doxorubicin Augments Tumor Cell Apoptosis in Osteosarcoma
Authors: Wang Jizhuang , Hu Chuanzhen , Wang Jun , Shen Yuhui , Bao Qiyuan , He Fangzhou , Wang Hongyi , Gong Liangzhi , Liu Zhuochao , Hu Fangqiong , Liang Jing , Zhou Qi , Wei Li , Wen Junxiang , Zhang Weibin
Published: June 2019

The aim of this study was to provide a basis for the theory that the combination of conventional chemotherapy and immunotherapy would be an effective treatment for osteosarcoma. Here, the expression of programmed death ligand 1 (PD-L1) in 26 clinical osteosarcoma tissue samples collected before and after chemotherapy was analyzed. The effects of osteosarcoma cells treated with doxorubicin, a conventional chemotherapeutic agent, on the proliferation and apoptosis of CD8+ T lymphocytes were investigated in vitro. Thereafter, the effectiveness of doxorubicin combined with an anti-PD-L1 antibody as an osteosarcoma therapy was tested in 24 subcutaneous tumor mouse models. The results showed that the expression of PD-L1 was upregulated by chemotherapy in both the clinical osteosarcoma tissue samples and the osteosarcoma cell lines. The proliferation of CD8+ T lymphocytes was inhibited, and apoptosis in CD8+ T lymphocytes was enhanced by the doxorubicin-pretreated osteosarcoma cells, whereas this effect was reversed by the anti-PD-L1 antibody. A more effective result was observed when doxorubicin was combined with the anti-PD-L1 antibody in vivo. In short, the combination of conventional chemotherapy and an anti-PD-L1 antibody might be an effective option for osteosarcoma treatment, as anti-PD-L1 antibody can reverse the immunosuppression induced by chemotherapy.
Frontiers in Oncologic Reconstruction
Authors: Samra Fares , Sobti Nikhil , Nelson Jonas A. , Allen Robert J. , Mehrara Babak , Dayan Joseph H.
Published: June 2019

Objectives:

The authors seek to highlight some of the ongoing challenges related to complex oncologic reconstruction and the current solutions to these problems.

The standard of care in reconstruction following oncologic resection is continually evolving. Current frontiers in breast reconstruction include addressing animation deformity through prepectoral reconstruction, offering autologous reconstruction to patients with limited donor sites, and improving postoperative sensation with innervation of free tissue transfer. Facial nerve reconstruction and contour defects pose an ongoing challenge in patients undergoing parotidectomy requiring complex nerve transfers and autologous reconstruction. Lymphedema is not a monolithic disease, and as our understanding of the pathophysiology improves, our surgical algorithms continue to evolve.
Effect of Native Type I Collagen with Polyhexamethylene Biguanide Antimicrobial on Wounds: Interim Registry Results
Authors: Bain Michael A. , Thibodeaux Kerry T. , Speyrer Marcus S. , Carlson Emily , Koullias George John
Published: June 2019

Background:

Biofilm can impair wound healing by maintaining an elevated, but ineffective, inflammatory state. This article describes interim results from the prospective RESPOND postmarketing registry evaluating the use of a native type 1, porcine collagen matrix with the embedded antimicrobial polyhexamethylene biguanide (PCMP) in the management of chronic wounds.

Methods:

Adults ≥18 years of age with ≥1 appropriate wound were eligible for inclusion. Data that were final on January 26, 2018 were included in this analysis. At week 0, wounds were cleaned, debrided, and prepared as necessary and PCMP was applied, with a dressing to fix it in place. Patients received standard wound care plus PCMP weekly, up to 24 weeks, at the investigator’s discretion. At each visit, wounds were assessed for area and quality of granulation tissue.

Results:

Most common wound types (N = 63) were venous ulcers (28.6%), trauma and lacerations (22.2%), postsurgical open wounds (15.9%), pressure injuries (12.7%), and diabetic ulcers (9.5%). Median baseline wound area was 6.5 cm2; mean wound duration at baseline was 4 months. Of the 63 wounds, 43 (68.3%) achieved complete wound closure, 41 of 43 (95.3%) closed after PCMP treatment, and 2 of 43 (4.7%) after bridging to other modalities and surgical closure. Twelve out of 63 wounds were bridged to other modalities after PCMP treatment. Mean time to closure for PCMP wounds was 5.0 weeks.

Conclusions:

PCMP appears to be a useful adjunct for treating various wound types. PCMP use should be considered when managing chronic or acute wounds.
Anagrelide Modulates Proplatelet Formation Resulting in Decreased Number and Increased Size of Platelets
Authors: Miyashita Naohiro , Onozawa Masahiro , Yokoyama Shota , Hidaka Daisuke , Hayasaka Koji , Kunishima Shinji , Teshima Takanori
Published: June 2019

Supplemental Digital Content is available in the text
Corneal Endotheliitis as a Presentation of Acanthamoeba Keratitis
Authors: Hsu Chih-Wei , Liu Chun-Hsiu , Hsiao Ching-Hsi
Published: June 2019

Objective:

To report 2 cases of Acanthamoeba keratitis (AK) presenting with corneal endotheliitis.

Methods:

Case report.

Results:

Two contact lens wearers, who had been diagnosed with herpes simplex virus (HSV) keratitis, predominantly manifested corneal endotheliitis composed of corneal edema, keratic precipitates, and anterior chamber reaction at referral. AK was confirmed using cultures or through polymerase chain reaction testing. The patients were started on polyhexamethylene biguanide and responded favorably to regain satisfactory visual acuity.

Conclusions:

Corneal endotheliitis, although uncommon, may be a manifestation of AK. We must have high-index suspicion for AK in all contact lens users, particularly before making a diagnosis of HSV keratitis. Accurate diagnosis and prompt treatment can result in a favorable prognosis for AK.
Epidemiology of Serious Bacterial Infections in Infants Less Than 90 Days in a Military Health System Cohort
Authors: Ramchandar Nanda , Gierhart Sarah , Creppage Kathleen E , Chukwuma Uzo , Gerber Jeffrey S. , Arnold John , Milder Edmund
Published: June 2019

Background:

Management of suspected serious bacterial infections (SBIs) in infants less than 3 months old is challenging. Understanding the epidemiology of SBI is necessary to inform management decisions. Recent publications have challenged the previously accepted distribution of infections by specimen source and pathogen. We sought to describe the burden of SBIs in previously healthy infants less than 90 days old.

Methods:

We conducted a retrospective analysis of the Military Health System database to identify SBI cases among term infants less than 90 days of age from 2005 to 2015. We defined an SBI case as any previously healthy infant with positive cultures for a likely pathogen from blood, urine or cerebrospinal fluid.

Results:

Of 467,462 live births between January 2005 and September 2015, 3421 infants had positive cultures. After excluding 1781 episodes with isolates considered nonpathogenic or ICD-9 codes for chronic conditions, the overall incidence of SBI was 3.1 cases/1000 live births. The SBI rate dropped from 5.0 cases/1000 live births in 2005 to 2.0 cases/1000 live births in 2015 (P < 0.001 for trend). The most common pathogen was Escherichia coli (51.3%).

Conclusions:

In this retrospective review of 467,462 live births, the incidence of SBI decreased from 5.0/1000 to 2.0/1000 live births over time. We identified no cases of Listeria monocytogenes. These data can help inform decisions related to treatment and management of infants with suspected bacterial infections.
Recurrent Pneumococcal Meningitis in Children
Authors: Darmaun Laura , Levy Corinne , Lagrée Marion , Béchet Stéphane , Varon Emmanuelle , Dessein Rodrigue , Cohen Robert , Martinot Alain , Dubos François
Published: June 2019

Background:

Pneumococcal meningitis (PM) is a serious disease that can rarely recur at a later time after the initial episode.

Methods:

A retrospective multicenter case–control study was conducted with data for children 18 years of age or younger obtained from the National Observatory of Bacterial Meningitis in Children between January 2001 and September 2015. Cases were all patients with RPM. Each case was matched with 2 randomized controls with a single PM episode in the year of the first episode of PM in the case and born the same year. Case and control data were compared.

Results:

Among the 1634 PM episodes in children 18 years of age or younger, 24 (1.5%) children had RPM. RPM cases were significantly less frequent than single PM cases in winter (27% vs. 48%; P=0.03) and showed significantly less concomitant ear, nose and throat infections when considering the first episode (30% vs. 56%, P = 0.04) and all episodes (28% vs. 56%, P < 0.01). Cerebrospinal fluid leakage was frequent in RPM cases versus controls (83% vs. 10%, P < 0.01), including 25% discovered after the third PM episode. Immune deficiency was absent in cases and present in 15% of controls. Cases and controls did not differ in death rate or neurologic outcome.

Conclusions:

RPM is rare in children. Cerebrospinal fluid leakage must be considered.
Repositioning a Prolapsed Tube After Bicanalicular Intubation of the Lacrimal System
Authors: Chu Zhaodong , Lu Guohua , Tan Ying , Deng Yuan
Published: June 2019

A new technique, the suture-probe with thread interlocking the silicone tube ring can reposition the prolapsed silicone tube in lacrimal sac.

Objective:

Prolapse of silicone tubes is one of the most common complications after bicanalicular intubation of the lacrimal system. This study describes a new method of repositioning prolapsed silicone tubes by using a suture-probe.

Methods:

This study was a retrospective chart review of 12 patients who experienced complete silicone tube prolapse after bicanalicular intubation. The silicone tube was repositioned by using a suture-probe; a double-stranded suture was placed in the lacrimal duct with a lacrimal probe with a hole in the front blunt tip, then interlocked with the prolapsed silicone tube. Subsequently, the suture loop was slowly stretched from the nasal cavity, and the silicone tube was repositioned. The silicone tube at the medial canthus was cut and loosened, then pulled out of the nasal cavity.

Results:

In all 12 cases, the silicone tube was restored with 100% success by using the suture-probe. Three patients were extubated immediately after the repositioning. For another 9 patients with an indwelling tube, extubation was performed after 3–4 months, and no patients experienced further tube dislocation during that time.

Conclusions:

The suture-probe technique is a simple, low cost, and minimally traumatic method for repositioning a prolapsed silicone tube after bicanalicular intubation of the lacrimal system.
Quantification Methodology of Health Technology in Senegalese Healthcare Facilities via New Indicator—“TechSan”
Authors: Ndione Fatou Bara , Langevin François , Diop Codou Mar , Leye Mamadou Maktar Mbacké , Kane Cheikhou
Published: June 2019

For more than 30 years, the management of medical equipment has largely focused on maintenance aspects. Many inventory-based indicators have been developed to ensure optimal follow-up of devices. However, certain qualitative aspects of medical devices are not taken into account by these usual indicators. This motivated the development of a quantifying indicator of “health technology” specific to each medical device and called “TechSan.” Based on the work of Fennigkoh and Smith in 1989 (Clinical equipment management. Joint Commission on Accreditation of Healthcare Organizations Plant Technology and Safety Management Series, 2:5–14), TechSan quantitatively characterizes “health technology” content of each medical device through the sum of the weighted criteria relating to “equipment cost,” importance of contribution to care missions, “and “level of maintenance required.”
Collaborative Partnership Among Hospital Healthcare Technology Management Community, Medical Device Manufacturers, and the FDA’s MedSun Program
Authors: Brown Cedric W. , Morabito Julie
Published: June 2019

The collaboration of hospitals, medical device manufacturers, and the US Food and Drug Administration serves to promote patient safety and device performance in the clinical setting. Each entity brings its own set of expertise, perspective, and resources that can be used to perform in-depth investigations into medical device–related safety concerns with the common goal of patient safety and device performance. This article describes the ways in which healthcare technology management professionals, medical device manufacturers, and Food and Drug Administration’s MedSun program work together to resolve medical device–related safety concerns, with a focus on case reports of exemplary communication and resolution of such concerns.
What Is the Impact of Physical Effort on the Diagnosis of Concussion?
Authors: Dechambre Xavier , Carling Christopher , Mrozek Ségolène , Pillard Fabien , Decq Philippe , Piscione Julien , Yrondi Antoine , Brauge David
Published: June 2019

Objective:

Sport-related concussion commonly occurs in contact sports such as rugby. To date, diagnosis is based on the realization of clinical tests conducted pitch-side. Yet, the potential effect of prior physical effort on the results of these tests remains poorly understood. The purpose of this study was to determine whether preceding physical effort can influence the outcome of concussion assessments.

Design:

Prospective observational study.

Setting:

University Medicine Center.

Patients:

A cohort of 40 subjects (20 rugby players and 20 athletes from a range of sports).

Intervention:

A concussion assessment was performed immediately after physical activity. After a period of 6 months and under the same experimental conditions, the same cohort performed the same tests in resting conditions.

Main outcome Measures:

Results of concussion tests.

Results:

In both cohorts, the comparison for postexercise and rest assessments demonstrated a most likely moderate-to-very large increase in the number of symptoms, severity of symptoms, and balance error scoring system score. In the rugby cohort, scores for concentration, delayed memory and standardized assessment of concussion (SAC), likely-to-most likely decreased following completion of physical activity compared with baseline values. The between-cohort comparison reported a most likely greater impact after exercise in the rugby players for delayed recall (0.73 ± 0.61) and SAC score (0.75 ± 0.41).

Conclusions:

Physical activity altered the results of concussion diagnostic tests in athletes from a range of sports and notably in rugby players. Therefore, physical efforts before the concussion incident should be accounted for during pitch-side assessments and particularly during rugby competition and training.
Abnormal Tectorial Membranes in Sensorineural Hearing Loss: A Human Temporal Bone Study
Authors: Ishai Reuven , Kamakura Takefumi , Nadol Joseph B.
Published: June 2019

Hypothesis:

This study evaluates the morphological changes of the tectorial membrane (TM) in conjunction with degeneration of hair cells, interdental cells, and presence of endolymphatic hydrops (EH) in sensorineural hearing loss (HL) in the human using histopathology techniques.

Background:

The TM plays an important role in mechanical transduction of acoustic energy, and pathology of the TM may result in HL.

Methods:

All temporal bone (TB) specimens from the Massachusetts Eye and Ear Otopathology Laboratory from patients with various causes of sensorineural HL and morphological abnormalities of the TM were evaluated. Cases with a history of cochlear trauma (other than acoustic trauma) and/or severe postmortem artifacts were excluded. The TBs were processed histologically, and the status of hair cells, supporting cells, interdental cells, presence of EH, and postmortem time were tabulated.

Results:

Two thousand two hundred ninety TBs from 1340 individuals were evaluated, and 164 of 748 TBs from the otological disorders in which the TM were abnormal, met the inclusion criteria. The most common disorders were idiopathic sudden deafness (57.1%), genetic etiology (53.7%), and ototoxicity (40.0%), as compared with cases with presbycusis (2.9%). EH was found in 33.3% of all cases with an identified abnormality of the TM.

Abnormalities of the TM were 1) deformed, 2) shrunken, 3) detached from the limbus, 4) encapsulated, or 5) missing. Encapsulated, shrunken and missing patterns (36, 35, 31%, respectively) were the most common.

Conclusion:

A relative high prevalence of EH among disorders with TM abnormalities suggests a possible common pathophysiology in both. In addition, anatomic abnormalities of the TM may play a role in the pathophysiology of HL in these disorders.
New insights on the genetics of type 1 diabetes
Authors: Oram Richard A. , Redondo Maria J.
Published: June 2019

Purpose of review

The genetic risk for type 1 diabetes has been studied for over half a century, with the strong genetic associations of type 1 diabetes forming critical evidence for the role of the immune system in pathogenesis. In this review, we discuss some of the original research leading to recent developments in type 1 diabetes genetics.

Recent findings

We examine the translation of polygenic scores for type 1 diabetes into tools for prediction and diagnosis of type 1 diabetes, in particular, when used in combination with other biomarkers and clinical features, such as age and islet-specific autoantibodies. Furthermore, we review the description of age associations with type 1 diabetes genetic risk, and the investigation of loci linked to type 2 diabetes in progression of type 1 diabetes. Finally, we consider current limitations, including the scarcity of data from racial and ethnic minorities, and future directions.

The development of polygenic risk scores has allowed the integration of type 1 diabetes genetics into diagnosis and prediction. Emerging information on the role of specific genes in subgroups of individuals with the disease, for example, early-onset, mild autoimmunity, and so forth, is facilitating our understanding of the heterogeneity of type 1 diabetes, with the ultimate goal of using genetic information in research and clinical practice.
Malignant maxillofacial bone tumors
Authors: Lopez Joseph , Tufaro Anthony P.
Published: June 2019

Purpose of review

Malignant bone tumors of the head and neck region are rare. Due to the paucity of studies on these tumors, patients with these maxillofacial malignancies can suffer from high morbidity and mortality.

Recent findings

Currently, mainstay management of these tumors includes wide surgical resection with margins followed by radiotherapy and/or adjuvant chemotherapy. Although much progress has been made over the last few decades regarding the prognosis of many of these tumors, large multicenter trials are needed to better determine their optimal management.

The current review will provide a broad review of the most current epidemiology, pathogenesis, prognosis, and management of the most common bone malignancies of the maxillofacial skeleton.
An interdisciplinary approach to the older transplant patient: strategies for improving clinical outcomes
Authors: Schaenman Joanna , Goldwater Deena , Malinis Maricar
Published: June 2019

Purpose of review

To describe the latest investigations into the role of frailty and assessment of other aging-related issues in the solid organ transplant candidate and recipient. This information is relevant for all involved in the care of transplant patients, but is especially relevant in infectious diseases, given the increased burden of infection seen in older and frailer patients.

Recent findings

The Fried Frailty Phenotype (FFP) and Short Performance Physical Battery (SPPB) are well validated tools for measuring frailty in older adults. Recently, these frailty tools have also been used to predict a range of clinical outcomes in adults with endstage organ disease undergoing advanced therapies including mechanical circulatory device (MCSD) or transplantation including death on the waiting list, length of hospital stay, need for readmission, infection, and death. Frailty may also be estimated by chart review and comorbidity assessment. Other aging-related evaluations of interest are cognitive function, sarcopenia, and nutritional status. The strength of association for each tool varies by the type of end organ disease, although there are many findings in common across organ types.

As trends in the aging of the population continue to impact transplant and MCSD candidates and recipients, it is increasingly important for providers to be cognizant of the methods for assessment of aging-associated dysfunction including frailty and sarcopenia.
To Transplant or Not to Transplant? Late-Onset Primary HLH in a Patient: A Case Report and Review of Literature
Authors: Ashok Vivek , Kent Paul , Tamulonis Karen , Vavra Kimberly
Published: June 2019

Primary, or familial, hemophagocytic lymphohistiocytosis (P-HLH) is a rare inherited autosomal-recessive immune deficiency which generally manifests during infancy or early childhood. Recent literature suggests an increased number of reports of late-onset P-HLH, especially in association with infection and underlying malignancy. The authors describe a case of subcutaneous T-cell lymphoma in a 8-year-old child that was complicated by primary, perforin-deficient HLH. In contrast, we examined retrospective data for 19 cases of late-onset P-HLH with available treatment data and compared the results of conservative medical therapy with hematopoietic stem cell transplant (HSCT) postremission therapy. Our patient displayed compound heterozygous mutations in PRF1 that have not been described in the literature previously: allele 1 [c.786_801del(p.Gln263fs)] and allele 2 [c.886T>C(p.Tyr296His)]. Of the 19 cases analyzed, 14 achieved remission. Postremission, 7 of 14 (50%) received HSCT and were reported alive at a median time of 24 months, 5 of 14 (36%) received medical therapy and were reported alive at a median time of 24 months, and 2 of 14 (14%) received medical therapy and died at a median of 73 months postremission. Our retrospective literature review suggests that some patients can survive late-onset, perforin-deficient, P-HLH without the potential lifelong risks of HSCT when in the first remission.
Preventing Catheter-Associated Urinary Tract Infection
Authors: Mundle William , Howell-Belle Carnett , Jeffs Lianne
Published: June 2019

Background:

Research has shown that catheter-associated urinary tract infections (CAUTIs) are highly preventable and have significant impact on patient morbidity and mortality as well as financial consequences for the health care system.

Local:

CAUTI rates were documented to be higher in the general internal medicine units when compared with the overall hospital rates.

Methods:

A comparative analysis was undertaken.

Intervention:

An interprofessional working group developed and implemented a quality improvement initiative bundled approach to reducing CAUTIs.

Results:

There was a 79% reduction in average CAUTI rates following the bundle implementation along with reduced variability in rates.

Conclusions:

Implementation of a standardized bundle of practices aimed at reducing CAUTIs resulted in decreased CAUTI rates. Organizations can use the design and implementation approach to reduce and minimize CAUTI rates, which can positively impact cost, care experience, and outcomes.
Development of Prelicensure Nursing Competencies in Caring for People With Disabilities Through Delphi Methodology
Authors: Kronk Rebecca , Colbert Alison M. , Smeltzer Suzanne C. , Blunt Elizabeth
Published: June 2019

Background

People with disabilities (PWDs) experience significant health disparities. The complex experience of disability requires that nurses are adequately and deliberately prepared to care for PWDs. However, there are no recognized nursing competencies to direct education and care.

Purpose

The purpose of this study was to develop a set of nursing competencies to better prepare prelincensure nursing students to provide competent care to PWDs.

Methods

A 2-round Delphi survey was administered to experts in the field of disabilities (n = 47, n = 35). Quantitative and qualitative methods were used to analyze data.

Results

Three major themes emerged: unique knowledge, volume and repetition, and distinct disability culture. Competencies were reduced with a focus on 4 dimensions: environment and care, communication, culture, and referral.

Conclusions

The 12 new competencies can serve as the foundation for the inclusion of disability content in nursing curricula.