bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative fasting in the department of plastic surgery
Authors: Davies Andrew , Pang Wei Sheng , Fowler Timothy , Dewi Ffion , Wright Thomas
Published: November 2018

Preoperative fasting is necessary to reduce the risk of regurgitation of gastric contents and pulmonary aspiration in patients undergoing general anaesthetic and procedural sedation. Excessive fasting is associated with metabolic, cardiovascular and gastrointestinal complications and patient discomfort. We aimed to reduce the fasting time for patients on the plastic surgery trauma list. Adult inpatients awaiting surgery were asked to complete a preoperative assessment sheet. Questions included the length of preoperative fasting, clarity of instructions and wellness scores. Three cycles of data collection were performed over a 12-month period, patients who declined to participate or were unable to consent were excluded. The first cycle revealed the need for significant improvement. Interventions included staff education, patient information sheets, preoperative drinks, greater availability of ward snacks and improved communication between the ward staff and surgical team through our electronic trauma database. The initial audit of 15 patients revealed a mean fasting time of 16.3 hours for fluid (range 10–22) and a mean of 19.3 hours for solid food (range 10–24). The mean wellness score was 6/10 (10 being very well), 67% of patients felt they were given clear information. The final cycle demonstrated clear improvement in all domains. The mean fasting time declined to 5.1 hours for fluid (range 3–10 hours) and 13 hours for solid food (range 7.5–17 hours). The mean wellness score (10=very well) increased from 6 to 8, the mean thirst score declined from 6.1 to 5.1 and 100% patients felt they had been given clear information. Removal of the traditional ‘NBM from midnight’, patient education, a clear fasting routine with preoperative drinks and improved communication between the full multidisciplinary team has led to a reduction in the fasting times on our trauma list.
A team approach to the introduction of safe early mobilisation in an adult critical care unit
Authors: Chohan Sanjiv , Ash Sara , Senior Lorraine
Published: November 2018

Delirium and intensive care unit acquired weakness are common in patients requiring critical care and associated with higher mortality and poor long-term outcomes. Early mobilisation has been shown to reduce the duration of both conditions and is recommended as part of a strategy of rehabilitation of critically ill patients starting during their stay in intensive care. Our aim was to achieve 95% reliability with a standardised mobilisation process. Multidisciplinary involvement through the use of regular focus groups lead to the development of a standardised process of sitting a ventilated or non-ventilated patient at the side of the bed for a set period of time, which was called the daily dangle. Team learning from Plan, Do, Study, Act (PDSA)cycles, as well as feedback from both staff and patients, allowed us to develop the process and achieve a median 87% reliability. Delirium rates fell from 54.1% to 28.8%. There was no change in average length of stay, and no adverse events. Ownership by the staff, development of the process by staff, iterative testing and learning, and designs for reliability were the factors behind the successful adoption of a new and challenging process. Particular changes which drove reliability were standardisation of the criteria for a dangle, standardisation of the dangle itself and a reminder included on the daily goals checklist.
Interprofessional education model for geriatric falls risk assessment and prevention
Authors: Brown Diane K , Fosnight Sue , Whitford Maureen , Hazelett Susan , Mcquown Colleen , Drost Jenifer C , Kropp Denise J , Hovland Cynthia A , Niederriter Joan E , Patton Rikki , Morgan Abigail , Fleming Eileen , Steiner Richard P , Scott Edward Demond , Ortiz-Figueroa Fabiana
Published: November 2018

Background

One in three people over the age of 65 fall every year, with 1/3 sustaining at least moderate injury. Falls risk reduction requires an interprofessional health team approach. The literature is lacking in effective models to teach students how to work collaboratively in interprofessional teams for geriatric falls prevention. The purpose of this paper is to describe the development, administration and outcome measures of an education programme to teach principles of interprofessional care for older adults in the context of falls prevention.

Methods

Students from three academic institutions representing 12 health disciplines took part in the education programme over 18 months (n=237). A mixed method one-group pretest and post-test experimental design was implemented to measure the impact of a multistep education model on progression in interprofessional collaboration competencies and satisfaction.

Results

Pairedt-tests of pre-education to posteducation measures of Interprofessional Socialization and Valuing Scale scores (n=136) demonstrated statistically significant increase in subscales and total scores (p<0.001). Qualitative satisfaction results were strongly positive.

Discussion

Results of this study indicate that active interprofessional education can result in positive student attitude regarding interprofessional team-based care, and satisfaction with learning. Lessons learnt in a rapid cycle plan-do-study-act approach are shared to guide replication efforts for other educators.

Conclusion

Effective models to teach falls prevention interventions and interprofessional practice are not yet established. This education model is easily replicable and can be used to teach interprofessional teamwork competency skills in falls and other geriatric syndromes.
Impact of health behaviours and deprivation on well-being in a national sample of English young people
Authors: Gireesh Aswathikutty , Das Shikta , Viner Russell M
Published: November 2018

Objective

To determine the modifiable factors influencing well-being in boys and girls by accounting for deprivation, ethnicity and clustering within local authorities.

Methods

We used data from a very large nationally representative survey, the What About Youth study involving 120 115 adolescents aged 15 years. Our outcome measure of mental well-being was the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Potential explanatory factors included substance abuse, screen time, eating habits, reading, bullying, sleeping pattern, physical activity and area-level deprivation. We ran unadjusted and adjusted multilevel models for each explanatory factor, after adjusting for ethnicity, deprivation and including a random effect for the local authority.

Results

Boys had a higher overall mean WEMWBS score than girls (p<0.0001). In the adjusted model, each of multiple risk behaviours, eating habits, sleep, bullying, physical activity, screen-time and reading were independently associated with mental well-being in both boy and girls (p<0.0001 for both). Sleep and eating behaviours had a stronger association in both sexes than bullying, physical activity and screen time. Young people from black ethnic groups had significantly higher well-being in both sexes. Deprivation was not associated with well-being among boys but was among girls.

Conclusion

The largest contributors to adolescent well-being appear to be sleep, eating behaviours and bullying when considered in a multivariable framework. While adolescents from black ethnic groups had higher overall well-being scores, area deprivation did not affect male well-being but had a small effect on female well-being. Future longitudinal studies and health policies need to consider a range of behavioural factors to drive improvements in adolescent well-being.
Using laxatives and/or enemas to accelerate the diagnosis in children presenting with acute abdominal pain: a randomised controlled trial study protocol
Authors: Timmerman Marjolijn E W , Trzpis Monika , Broens Paul M A
Published: November 2018

Introduction

Many children with acute abdominal pain and suspicion of appendicitis are diagnosed with constipation. Nevertheless, it can be difficult to differentiate between acute constipation and acute appendicitis because of similar symptoms and lack of diagnostic criteria. Consequently, constipation is often missed despite repeated consultations at the emergency department. We hypothesise that the diagnostic process can be improved and adequate treatment accelerated by supporting faecal evacuation in children with acute abdominal pain.

Methods and analysis

An unblinded randomised controlled trial including children aged between 5 years and 18 years with acute abdominal pain and suspicion of acute appendicitis. Children who do not have a definitive diagnosis after the first consultation and who need to return for a second consultation will be randomised. The intervention group will receive laxatives and enemas, while the control group will receive no medication. If, after the second consultation, still no diagnosis is established, and a third consultation is needed, then the intervention group will receive only laxatives, and the control group will again not receive medication. The primary outcome will be the differences in abdominal pain scores obtained with FACES Pain Rating Scale and the visual analogue scale at first, second and possibly third consultation. The secondary outcome will be the number of consultations needed to reach final diagnosis.

Ethics and dissemination

Laxatives and enemas have proven to be safe and effective treatments for constipation in children. Adverse events are therefore not expected, however, should they occur, then the child concerned shall be properly followed and treated until the event is over. The local Medical Research Ethics Committee approved of this study and waived the otherwise mandatory insurance for human test subjects.

Trial registration numbers

Pre-results: CCMO NL44710.042.12 andEudraCT 2013-000498-56.
Aripiprazole augmentation in treating comorbid bipolar disorder and obsessive-compulsive disorder
Authors: Amerio Andrea , Odone Anna
Published: November 2018

Obsessive-compulsive disorder (OCD) is one of the most difficult additional diagnoses to manage in patients with bipolar disorder (BD) since the gold standard treatment for one disease (antidepressants for OCD) can worsen the other. This case report describes the efficacy of aripiprazole augmentation as maintenance therapy in a young patient with comorbid BD-OCD. Our patient presented complete remission of affective and obsessive-compulsive symptoms with remarkable improvement in social and occupational functioning for 24 months. Adverse drug reactions were not severe enough to result in drug discontinuation. In consideration of the important nosological, clinical and therapeutic implications, future research efforts may lead to more grounded guidelines, which are greatly needed in patients with comorbid BD-OCD.
CADASIL syndrome (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) presenting as psychosis
Authors: Mishra Dheerendra Kumar , Kishore Aman , Niranjan Vijay
Published: November 2018

Cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) is the most common monogenic form of cerebral small-vessel disease characterised by recurrent strokes. Behavioural disturbance also presents in a significant proportion of subjects as neurotic spectrum disorders and psychotic features are rarely reported. In this case report, we highlight a 32-year-old man with CADASIL syndrome, who had overt psychotic symptoms with neurological signs later on.
Changes in calcium channel proteins according to magnesium sulfate administration in placentas from pregnancies with pre-eclampsia or fetal growth restriction
Authors: Cha Hyun-Hwa , Hwang Jae-Ryoung , Sung Ji Hee , Choi Suk-Joo , Oh Soo-young , Roh Cheong-Rae
Published: November 2018

We aimed to evaluate the changes in plasma membrane Ca2+-ATPase (PMCA) and sarcoendoplasmic reticulum CA2+-ATPase (SERCA-2) according to the antepartal magnesium sulfate (MgSO4) administration in the placentas from pregnancies with pre-eclampsia (PE) or fetal growth restriction (FGR). Pregnant women were classified as follows: (group 1) pregnancies without PE or FGR (n=16), (group 2) pregnancies with PE or FGR but without MgSO4 administration (n=14), and (group 3) pregnancies with PE or FGR and with MgSO4 administration (n=28). We observed the localization of PMCA and SERCA-2 in placentas and compared its expression among 3 groups. And we observed its expression in BeWo cells following treatment with MgSO4 and CoCl2. PMCA staining was more observed in the basal membrane, whereas SERCA-2 staining was observed predominantly under the microvillous membrane. SERCA-2 expression was significantly increased in group 3 compared with that in group 1. Considering the gestational age at delivery, PMCA expression was increased in group 2 and group 3 compared with that in group 1 after 36 weeks of gestation. SERCA-2 was increased in group 3, but not in group 2 compared with that in group 1 after 36 weeks of gestation. In BeWo cells, MgSO4 treatment increased PMCA and SERCA-2 expression. PMCA expression was influenced by gestational age at delivery, and SERCA-2 expression was increased in the presence of PE and antepartal MgSO4 administration. This indicates that antepartal MgSO4 administration has a greater influence on SERCA-2 than PMCA.
Characterising the phenotype and mode of inheritance of patients with inherited peripheral neuropathies carrying MME mutations
Authors: Lupo Vincenzo , Frasquet Marina , Sánchez-Monteagudo Ana , Pelayo-Negro Ana Lara , García-Sobrino Tania , Sedano María José , Pardo Julio , Misiego Mercedes , García-García Jorge , Sobrido María Jesús , Martínez-Rubio María Dolores , Chumillas María José , Vílchez Juan Jesús , Vázquez-Costa Juan Francisco , Espinós Carmen , Sevilla Teresa
Published: November 2018

Background

Mutations in the metalloendopeptidase (MME) gene were initially identified as a cause of autosomal recessive Charcot-Marie-Tooth disease type 2 (CMT2). Subsequently, variants in MME were linked to other late-onset autosomal dominant polyneuropathies. Thus, our goal was to define the phenotype and mode of inheritance of patients carrying changes in MME.

Methods

We screened 197 index cases with a hereditary neuropathy of the CMT type or distal hereditary motor neuropathy (dHMN) and 10 probands with familial amyotrophic lateral sclerosis (fALS) using a custom panel of 119 genes. In addition to the index case subjects, we also studied other clinically and/or genetically affected and unaffected family members.

Results

We found 17 variants in MME in a total of 20 index cases, with biallelic MME mutations detected in 13 cases from nine families (three in homozygosis and six in compound heterozygosis) and heterozygous variants found in 11 families. All patients with biallelic variants had a similar phenotype, consistent with late-onset axonal neuropathy. Conversely, the phenotype of patients carrying heterozygous mutations was highly variable [CMT type 1 (CMT1), CMT2, dHMN and fALS] and mutations did not segregate with the disease.

Conclusion

MME mutations that segregate in an autosomal recessive pattern are associated with a late-onset CMT2 phenotype, yet we could not demonstrate that MME variants in heterozygosis cause neuropathy. Our data highlight the importance of establishing an accurate genetic diagnosis in patients carrying MME mutations, especially with a view to genetic counselling.
Peacekeepers suffered combat-related injuries in Mali: a retrospective, descriptive study
Authors: Yongqiang Zhao , Dousheng H , Yanning L , Xin M , Kunping W
Published: November 2018

Purpose

To describe the combat-related injuries cured by Chinese Level 2 medical treatment facility (CHN L2) in Mali from 1 March 2016 to 1 March 2018, including type of weapon, mortality, nature of injuries, degree and location of injuries and surgical procedures.

Methods 

A retrospective, descriptive study of 176 injured cases that met the terrorist attacks was conducted. The medical data were collected by an electronic database system. All collected data were entered into an Excel spreadsheet for calculation.

Results

We found that improvised explosive devices (114/176, 65%) were the most commonly used weapons of attack in Mali. 68.75% of the injuries (121/176) were classified as 'minor injuries according to Abbreviated Injury Scale score. As one patient may suffer multiple injuries, each location and nature of injuries was counted separately. Surface injuries were the top (116/197, 58.88%), followed by orthopaedic injuries (52/197, 26.39%) and internal injuries (29/197, 14.72%). The extremities were the most frequently injured body parts (144/197, 73.09%). We operated 175 surgeries to deal with the 176 combat-related injuries, which accounted for 40.05% of all 437 surgeries. The surgical debridement to remove fragments of explosive was the most frequently performed surgery. We also admitted 20 cases (18/176, 34%) into intensive care unit and transferred 40 cases to Level 3 medical facility.

Conclusion 

Peacekeepers taking protective measures for head and trunk frequently got surface injuries. And their unprotected extremities often got injured. The fragment removal was the top surgery and the damage control surgery was the highly technical nature surgery we performed. Chinese military should offer advanced surgical training course to military surgeons who carry out overseas operations.
Neuroergonomic and psychometric evaluation of full-face crew oxygen masks respiratory tolerance: a proof-of-concept study
Authors: Nierat Marie-Cécile , Raux M , Redolfi S , Gonzalez-Bermejo J , Biondi G , Straus C , Rivals I , Morélot-Panzini C , Similowski T
Published: November 2018

Introduction

Preventing in-flight hypoxia in pilots is typically achieved by wearing oxygen masks. These masks must be as comfortable as possible to allow prolonged and repeated use. The consequences of mask-induced facial contact pressure have been extensively studied, but little is known about mask-induced breathing discomfort. Because breathlessness is a strong distractor and engages cerebral resources, it could negatively impact flying performances.

Methods

Seventeen volunteers (age 20–32) rated respiratory discomfort while breathing with no mask and with two models of quick-donning full-face crew oxygen masks with regulators (mask A, mask B). Electroencephalographic recordings were performed to detect a putative respiratory-related cortical activation in response to inspiratory constraint (experiment 1, n=10). Oxygen consumption was measured using indirect calorimetry (experiment 2, n=10).

Results

With mask B, mild respiratory discomfort was reported significantly more frequently than with no mask or mask A (experiment 1: median respiratory discomfort on visual analogue scale 0.9 cm (0.5–1.4), experiment 1; experiment 2: 2 cm (1.7–2.9)). Respiratory-related cortical activation was present in 1/10 subjects with no mask, 1/10 with mask A and 6/10 with mask B (significantly more frequently with mask B). Breathing pattern, sigh frequency and oxygen consumption were not different.

Conclusions

In a laboratory setting, breathing through high-end aeronautical full-face crew oxygen masks can induce mild breathing discomfort and activate respiratory-related cortical networks. Whether or not this can occur in real-life conditions and have operational consequences remains to be investigated. Meanwhile, respiratory psychometric and neuroergonomic approaches could be worth integrating to masks development and evaluation processes.
History of military psychology
Authors: Hacker Hughes Jamie , McCauley M , Wilson L
Published: November 2018

Military psychology is a specialist discipline within applied psychology. It entails the application of psychological science to military operations, systems and personnel. The specialty was formally founded during World War I in the UK and the USA, and it was integral to many early concepts and interventions for psychological and neuropsychological trauma. It also established a fundamental basis for the psychological assessment and selection of military personnel. During and after World War II, military psychology continued to make significant contributions to aviation psychology, cognitive testing, rehabilitation psychology and many models of psychotherapy. Military psychology now consists of several subspecialties, including clinical, research and occupational psychology, with the latter often referred to in the USA as industrial/organisational psychology. This article will provide an overview of the origins, history and current composition of military psychology in the UK, with select international illustrations also being offered.
Neuropsychology and clinical health psychology in the UK Ministry of Defence
Authors: Sturgeon-Clegg Imogen , Hurn H , McCauley M
Published: November 2018

Neuropsychological testing has been used in a wide range of applications across military settings, including the selection of personnel to engage in covert operations, battlefield assessment and rehabilitation following blast exposure, traumatic brain injury, other neurological conditions and assessment of malingering. Over recent decades, military psychologists have helped to shape the advances in assessing and remediating the psychological sequela that is associated with operationally related neurological and other physical injuries. This paper will present an overview of some of the neuropsychological and related services within the UK Armed Forces, which are provided to service personnel with traumatic brain and other physical injuries.
Downstream vascular changes after flow-diverting device deployment in a rabbit model
Authors: Kolumam Parameswaran Praveen , Dai Daying , Ding Yong-Hong , Urban Matthew W , Manlove Logan , Sathish Venkatachalem , Cebral Juan R , Kallmes David F , Kadirvel Ramanathan
Published: November 2018

Background

Flow diverters (FDs) are increasingly used in the treatment of intracranial aneurysms, and carry the risk of thromboembolic complications, even in patients treated with dual antiplatelet therapy. The effect of FDs on the downstream vascular is unknown. The aim of the study was to investigate vascular wall pulse wave velocity (PWV) and contractility changes following FD treatment in a rabbit model.

Methods

FDs (Pipeline Embolic Device, Medtronic Inc., Irvine, California, USA) were implanted in the aorta of normal rabbits and sham-operated aorta were used as controls (n=6 per group). Pulse wave imaging with ultra-fast ultrasound at 1600 frames per second (Vantage, Verasonics, Inc., Kirkland, WA) was performed in the vessel wall distal to FD prior to device implantation and at 8- week follow-up to measure the PWV. Force contraction vascular reactivity studies were conducted in the aortic rings using an organ bath.

Results

The difference in mean PWV in the follow-up compared with pre-implantation was significantly higher in the distal vessels compared with sham controls (1.18 m/s [SD=0.54] vs. 0.37 m/s [SD=1.09], P=0.03). Conversely, the aortic segments distal to the FD exhibited a 55% increase in vascular contractility compared with proximal segments (P=0.002). We observed a significant positive correlation between mean PWV and mean vascular contractility.

Conclusion

Implantation of FD was associated with increased PWV and vascular contractility, suggesting that FD implantation causes changes to the vascular wall. Further studies are needed to understand the clinical implication of changes in vascular PWV and contractility.
Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature
Authors: Lakomkin Nikita , Dhamoon Mandip , Carroll Kirsten , Singh Inder Paul , Tuhrim Stanley , Lee Joyce , Fifi Johanna T , Mocco J
Published: November 2018

Background

Accurate assessment of the prevalence of large vessel occlusion (LVO) in patients presenting with acute ischemic stroke (AIS) is critical for optimal resource allocation in neurovascular intervention.

Objective

To perform a systematic review of the literature in order to identify the proportion of patients with AIS presenting with LVO on image analysis.

Methods

A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in order to identify studies reporting LVO rates for patients presenting with AIS. Studies that included patients younger than 18 years, were non-clinical, or did not report LVO rates in the context of a consecutive AIS series were excluded. Characteristics regarding presentation, diagnosis, and LVO classification were recorded for each paper.

Results

Sixteen studies, spanning a total of 11 763 patients assessed for stroke, were included in the qualitative synthesis. The majority (10/16) of articles reported LVO rates exceeding 30% in patients presenting with AIS. There was substantial variability in the LVO definitions used, with nine unique classification schemes among the 16 studies. The mean prevalence of LVO was 31.1% across all studies, and 29.3% when weighted by the number of patients included in each study.

Conclusions

Despite the wide variability in LVO classification, the majority of studies in the last 10 years report a high prevalence of LVO in patients presenting with AIS. These rates of LVO may have implications for the volume of patients with AIS who may benefit from endovascular therapy.
Influence of ASPECTS and endovascular thrombectomy in acute ischemic stroke: a meta-analysis
Authors: Phan Kevin , Saleh Serag , Dmytriw Adam A , Maingard Julian , Barras Christen , Hirsch Joshua A , Kok Hong Kuan , Brooks Mark , Chandra Ronil V , Asadi Hamed
Published: November 2018

Background

Prompt revascularization of the ischemic penumbra following an acute ischemic event (AIS) has established benefit within the literature. However, use of the semi-quantitative Alberta Stroke Program Early CT Score (ASPECTS) to evaluate patient suitability for revascularization has been inconsistent in patient risk stratification and selection.

Objective

To conduct a meta-analysis to evaluate the available evidence for a clinically valid ASPECTS threshold in assessment of suitability for revascularization following AIS.

Methods

Two independent reviewers searched Medline (Ovid) and Cochrane Central Register of Systematic Reviews databases for studies appraising outcomes of endovascular thrombectomy (EVT) in relation to a variably-defined preoperative ASPECTS.

Results

A total of 13 articles were included. The pooled good outcome proportion after EVT was 41.4% (95% CI 36.4% to 46.6%; p<0.001), with subjective study-specific definitions of favorable and unfavorable subgroup outcomes of 49.7% (95% CI 44.2% to 55.3%; I2=76.5%; p<0.001) and 33.2% (95% CI 28.5% to 38.3%; I2=33.16%), respectively. Objective trichotomization into low (0–4), intermediate (5–7), and high (8–10) subgroups yielded pooled good outcome proportions of 17.1% (95% CI 6.8% to 36.8%; I2=64.24%; p=0.039), 35.7% (95% CI 30.5% to 41.3%; I2=23.11%; p=0.245), and 49.7% (95% CI 44.2% to 55.3%; I2=76.5%; p<0.001) for low, intermediate, and high ASPECTS, respectively.

Conclusions

A subjectively favorable ASPECTS is associated with significantly better outcomes after EVT than an unfavorable ASPECTS, regardless of the cut-off used. EVT is unlikely to be useful in patients with an objectively low ASPECTS and is likely to be useful for those with high ASPECTS; findings in patients with intermediate ASPECTS were equivocal.
Percutaneous transluminal angioplasty using the novel drug-coated balloon catheter SeQuent Please NEO for the treatment of symptomatic intracranial severe stenosis: feasibility and safety study
Authors: Gruber Philipp , Braun Christina , Kahles Timo , Hlavica Martin , Anon Javier , Diepers Michael , Nedeltchev Krassen , Berberat Jatta , Remonda Luca
Published: November 2018

Objectives

Intracranial arteriosclerotic disease is a relevant cause of ischemic stroke worldwide with a high recurrence rate despite best medical treatment. Following the SAMMPRIS trial, endovascular treatment has remained a second-line therapy. Meanwhile, there has been significant advances in device technology. SeQuent Please NEO is a novel polymer-free, drug-coated (paclitaxel/iopromide) balloon (DCB) primarily designed for cardiology. Because of its high flexibility and pushability, it may also be suitable for intracranial use. The aim of this study was to assess the feasibility and safety of SeQuent Please NEO DCB in symptomatic intracranial severe stenosis.

Methods

A single-center retrospective cohort study of patients with symptomatic intracranial severe stenosis treated with SeQuent Please NEO DCB was performed at a tertiary stroke center.

Results

Ten patients (all men, median age 73 years (IQR 69–77)) were included. Median pre-treatment stenosis grade was 78% (IQR 75–80%) with four internal carotid artery, two mid-basilar artery, and four vertebral artery lesions. Median post-treatment stenosis grade was 50% (IQR 45–53%). Successful angioplasty was achieved in all cases without technical failure. There were no cases of peri-procedural reocclusion and no deaths at median follow-up of 3 months (IQR 2–3).

Conclusion

In this pilot study, SeQuent Please NEO DCB was feasible and safe in the treatment of symptomatic intracranial severe stenosis. It might represent a promising alternative to medical treatment in selected cases.
The occurrence of neointimal hyperplasia after flow-diverter implantation is associated with cardiovascular risks factors and the stent design
Authors: Caroff Jildaz , Iacobucci Marta , Rouchaud Aymeric , Mihalea Cristian , de Carvalho Fernando Mota , Jocson Victor Erwin D , Chalumeau Vanessa , Da Ros Valerio , King Robert M , Arslanian Rose , Ikka Léon , Ben Achour Nidhal , Moret Jacques , Spelle Laurent
Published: November 2018

Background

Neo-intimal hyperplasia (NIH) is frequently observed after flow-diverter stent (FDS) implantation. Although mostly asymptomatic, this vascular response can sometimes lead to delayed ischemic strokes. This study intended to evaluate the factors potentially influencing the rates of NIH following FDS treatment.

Material and Methods

All aneurysm treatments performed with a Pipeline embolization device (PED) or a SILK stent from May 2011 to May 2015 were collected in a prospectively maintained database. Patient demographics, clinical, and angiographic outcomes including both digital subtraction angiography and C-arm cone-beam CT were registered. Two blind reviewers rated the presence of NIH on a binary scale (present/absent).

Results

From 148 patients, 63 datasets were available for analysis. Inter-reader agreement was excellent (Kappa=0.88). NIH was positively correlated with smoking, dyslipidemia, and high blood pressure, but not with aneurysm characteristics. At early follow-up (<12 months), NIH was more frequently associated with the use of the SILK stent (68%) rather than the PED (38%): P<0.02. At long-term follow-up, the NIH rate in the total population dropped from 55% to 26% with no more significant difference between the two stents. The complete occlusion rate as seen in early follow-up was higher in the SILK group with 76% vs 65% but without statistical significance (P=0.4).

Conclusion

NIH is a dual-vessel reaction after FDS implant. When planning a treatment in locations at risk of ischemic complications if severe NIH would occur, then the stent design should be considered. However, minimal NIH might also be needed as it is involved in aneurysm healing. Before treatment patients should be recommended best medical management of their cardiovascular risks factors to prevent an excessive NIH reaction.
Early detection of lung cancer in a population at high risk due to occupation and smoking
Authors: Welch Laura S , Dement John M , Cranford Kim , Shorter Janet , Quinn Patricia S , Madtes David K , Ringen Knut
Published: November 2018

Objective

The US National Comprehensive Cancer Network (NCCN) recommends two pathways for eligibility for Early Lung Cancer Detection (ELCD) programmes. Option 2 includes individuals with occupational exposures to lung carcinogens, in combination with a lesser requirement on smoking. Our objective was to determine if this algorithm resulted in a similar prevalence of lung cancer as has been found using smoking risk alone, and if so to present an approach for lung cancer screening in high-risk worker populations.

Methods

We enrolled 1260 former workers meeting NCCN criteria, with modifications to account for occupational exposures in an ELCD programme.

Results

At baseline, 1.6% had a lung cancer diagnosed, a rate similar to the National Lung Cancer Screening Trial (NLST). Among NLST participants, 59% were current smokers at the time of baseline scan or had quit smoking fewer than 15 years prior to baseline; all had a minimum of 30 pack-years of smoking. Among our population, only 24.5% were current smokers and 40.1% of our participants had smoked fewer than 30 pack-years; only 43.5% would meet entry criteria for the NLST. The most likely explanation for the high prevalence of screen-detected lung cancers in the face of a reduced risk from smoking is the addition of occupational risk factors for lung cancer.

Conclusion

Occupational exposures to lung carcinogens should be incorporated into criteria used for ELCD programmes, using the algorithm developed by NCCN or with an individualised risk assessment; current risk assessment tools can be modified to incorporate occupational risk.
Patient and physician view on patient information and decision-making in congenital aortic and pulmonary valve surgery
Authors: Etnel Jonathan R G , Helbing Willem A , Roos-Hesselink Jolien W , The Regina , Bogers Ad J J C , Takkenberg Johanna J M
Published: November 2018

Background

To assess the current state of patient information and decision-making in congenital aortic and pulmonary valve disease, we conducted a survey among patients, parents and physicians.

Methods

A questionnaire was sent by ground mail to 157 adults and 32 parents of children who previously underwent surgery for congenital aortic or pulmonary valve disease at 0–40 years of age between January 2005 and February 2014 at the Erasmus University Medical Center and to all paediatric and adult congenital cardiologists and congenital cardiac surgeons in the Netherlands (n=88).

Results

73 patients/parents (39% response rate, 62 adult patients, 11 parents of paediatric patients) and 35 physicians (40% response rate) responded. Median patient age at the time of surgery was 25.7 years. Basic disease-specific knowledge was adequate in 42% of patients/parents and numeracy was sufficient in 47%. Patients/parents reported that they rely heavily on their physicians for information and often experience difficulty in finding reliable information elsewhere. They lack information on psychosocial aspects of disease (29% of respondents) and risks and benefits of treatment options (26%). They feel less involved in decision-making than they would prefer to be (p=0.014). Decisional conflict at the time of surgery was experienced by 31% of patients/parents. If they had to do it again, 72% of patients/parents would want the same treatment. Quality of life is often impaired due to various valve-related anxieties and lifestyle changes. Physicians reported that they are unable to fully inform and sufficiently involve patients, due to limited patient/parent knowledge and understanding (56%) and limited time during consultations (32%). Patients/parents (98%) and physicians (97%) agree that they should have shared roles in decision-making.

Conclusion

The substantial shortcomings in our current practice of patient information and decision-making underline the need for innovative solutions, such as careful implementation of patient information tools and shared decision-making in the care path.
Intermittent systemic hypoxic–hyperoxic training for myocardial protection in patients undergoing coronary artery bypass surgery: first results from a single-centre, randomised controlled trial
Authors: Tuter Denis S , Kopylov Philippe Y , Syrkin Abram L , Glazachev Oleg S , Komarov Roman N , Katkov Andrei I , Severova Ljudmila P , Ivanova Ekaterina V , Zhang Young , Saner Hugo
Published: November 2018

Background

Although remote ischaemic preconditioning (RIP) provides protection against myocardial ischaemia and reperfusion injury during cardiac surgery, it is not widely used. Systemic intermittent hypoxic–hyperoxic training (IHHT) may be a suitable alternative.

Methods

This is a prospective, single-centre, randomised controlled trial. 127 patients with ischaemic heart disease and indication for coronary artery bypass graft (CABG) surgery from the Cardiology Clinic IM Sechenov First Moscow State Medical University were randomly assigned to IHHT, IHHT-control or RIP. Primary endpoint was serum concentration of troponin I and lactate 2 and 24 hours after surgery.

Results

Median value for troponin I 24 hours after surgery was 1.068 (0.388–1.397) ng/mL in the IHHT group and was significantly lower compared with IHHT-controls with 1.980 (1.068–3.239) ng/mL (p=0.012) and to the RIP group with 1.762 (1.288–2.186) ng/mL (p=0.029), while there was no significant difference between RIP and the IHHT-control. Serum lactate after surgery was 1.74 (1.23–2.04) mmol/L in the IHHT group and was also significantly lower compared with IHHT-controls with 2.10 (1.80–2.29) mmol/L (p=0.045) and RIP with 2.12 (1.91–2.33) mmol/L (p=0.032). No significant complications or serious adverse events were observed during IHHT. Intraoperative and early postoperative complications did not differ significantly between groups.

Conclusions

The results of this first trial using IHHT for myocardial protection against perioperative ischaemic myocardial injury in patients undergoing CABG surgery are promising and further larger trials should be done with adequate power to detect clinical rather than surrogate marker benefits.
Migration diversity, spawning behavior, and habitat utilization of winter flounder
Authors: Ziegler Catherine M. , Zacharias Joshua P. , Frisk Michael G.
Published: November 2018

Winter flounder (Pseudopleuronectes americanus) have declined to less than 11% of their historical abundance in offshore areas and have experienced severe declines and inbreeding in coastal subpopulations. Understanding metapopulation structure and disparate migratory behavior is vital to understanding the species’ dynamics. We used acoustic telemetry to evaluate migratory types, homing behavior, and spawning behavior in adult winter flounder (n = 72) in Mattituck Creek, New York. Telemetry results showed that 17% of the tagged individuals displayed resident behavior and remained in the creek year-round despite mean summer temperatures reaching 28 °C. Alternatively, the migratory group (∼83%) started to leave the system when the mean water temperature reached 12 °C. A dominant driver of migration was not indicated; instead, migration out of or into the creek appeared complex and related to date, temperature, lunar cycle, photoperiod, and year. Approximate spawning was estimated to occur as early as November and continued through April based on aggregative behaviors of adults and back-calculations of dates using young-of-the-year otoliths. Our results support the emerging view that winter flounder’s dynamics reflect local life history and population diversity, which are currently unaccounted for in management.
Valuing changes in frequency of fish stock assessments
Authors: Hutniczak Barbara , Lipton Douglas , Wiedenmann John , Wilberg Michael
Published: November 2018

Updating stock assessments frequently and ensuring that the most recent fishery-dependent and -independent data are included is a costly endeavor. We use a management strategy evaluation for the mid-Atlantic summer flounder (Paralichthys dentatus) fishery to determine the economic returns to increasing update frequencies and decreasing the data management lag. We simulate the annual acceptable biological catch for the period 2015–2040 under a range of update frequencies and data lags. We calculate present value net economic benefits for the commercial and recreational fisheries for each scenario. Discounting, the timing of harvest quotas, species-specific price flexibilities, and fishing cost response to biomass and quota differences suggest that the benefits gained from frequent updating and reduction in data lags will vary by fishery. For summer flounder, we find the cost of more frequent updating (1 versus 5 years) and reducing the data management lag (1 versus 2 years) are more than compensated for by societal benefits generated by the fishery.
Ópio para Ovídio
Authors: Vale Alice do
Published: November 2018

Este artigo2 visa a expor as principais questões envolvidas no processo de tradução do alemão para o português do Brasil do livro Opium für Ovid: Ein Kopfkissenbuch von 22 Frauen (Ópio para Ovídio: um Livro do Travesseiro de 22 mulheres), de Yoko Tawada. Com vistas ao exercício de traduzir, este trabalho deve ser entendido como um estudo preliminar sobre a escritora e seu livro Ópio para Ovídio, escrito em uma língua estrangeira. Num contexto de constante migração e, ao mesmo tempo, de negação do Outro e de xenofobia, entende-se como necessária a busca por uma experiência de alteridade. Nesse sentido, este trabalho persegue o deslocamento do olhar para uma perspectiva e uma língua estrangeiras, de modo que o texto traduzido propicie uma experiência com o fremd.
Influências interlinguais e estratégias de comunicação por aprendizes de alemão como terceira língua
Authors: Tanaka Victor Almeida , Uphoff Dörthe
Published: November 2018

Neste artigo, trazemos algumas reflexões a respeito da influência exercida por línguas anteriormente aprendidas no processo de aprendizagem de alemão como L3 por aprendizes brasileiros. Essas influências podem operar tanto por meio de transferências linguísticas intencionais, controladas pelos próprios aprendizes, quanto por transferências não intencionais. Dependendo do referencial teórico adotado, essas transferências intencionais são consideradas estratégias de aprendizagem e/ou de comunicação. Com base em uma pesquisa empírica realizada em 2017 e em alguns debates na área acadêmica em torno do assunto (OXFORD 1990, 2011; BIMMEL e RAMPILLON 2000; SELINKER 1972, 2014; HUFEISEN 2010), este artigo tem como objetivo analisar as estratégias utilizadas por aprendizes de alemão como L3 em um chat online e refletir sobre as influências interlinguais exercidas sobre os aprendizes de forma não intencional. Os resultados obtidos apontam para contrastes (1) quanto ao tipo de estratégias utilizadas por aprendizes em diferentes níveis de aprendizagem e (2) quanto à língua da qual decorreram as influências não intencionais: aprendizes mais proficientes utilizaram estratégias que mobilizaram mais elementos da língua-alvo, como os circunlóquios, e não sofreram nenhuma influência exclusivamente da língua materna (apenas da L1 e da L2 concomitantemente ou apenas da L2), ao contrário de aprendizes menos proficientes.
Platz zum Denken!? – Praxis und Reflexion als entscheidende Impulse in der brasilianischen Deutschlehrerausbildung
Authors: Santos Ynaiara dos , Kleinbing Hudson , Scribelk Liane , Voerkel Paul
Published: November 2018

Unter Bezugnahme auf den Deutschstudiengang an einer Bundesuniversität im Südosten Brasiliens beschreibt der Artikel zunächst einige Grundlagen der Deutschlehrerausbildung des Landes. Dabei wird deutlich, wie wichtig die Verknüpfung von Theorie und Praxis für die Kompetenzentwicklung der Studierenden ist. Vor diesem Hintergrund wird ein Seminarangebot aus dem Deutschstudiengang der Universität vorgestellt, bei dem die Teilnehmenden im Rahmen der Aktionsforschung ihren eigenen Unterricht reflektieren und damit ihr professionelles Handeln als Lehrkräfte stärken können. Aus den Erfahrungen heraus werden schließlich einige Vorschläge für eine sinnvolle Integration reflexiver Elemente in die Lehrerausbildung formuliert.
Espectros da morte em duas narrativas de Thomas Bernhard
Authors: Santos José Lucas , Maas Wilma
Published: November 2018

Nos romances do escritor austríaco Thomas Bernhard, a morte de alguém próximo ao narrador serve de motivo para que este inicie o relato de suas memórias. Nossa proposta é verificar como o estatuto da morte configura o espaço literário de duas obras de Bernhard, a saber, O náufrago (1983) e Árvores abatidas – uma provocação (1984). Considerando que, nesses romances, a morte se dá pela via do suicídio, utilizaremos como fundamentação teórica o Seminário 10 – A angústia, livro em que Jacques Lacan aponta o suicídio (ou passagem ao ato) como uma forma encontrada pelo sujeito para sair de uma cena a qual ele não conseguiria mais sustentar pela palavra. Desse modo, abordaremos como o contato com a morte reverbera na subjetividade do narrador, já que a morte também é responsável por seu retorno à Áustria, país de onde ele sempre tentara se desvencilhar.
Fundamentos kantianos da filosofia da linguagem de Walter Benjamin
Authors: Silva Rafael Guimarães Tavares da
Published: November 2018

Partindo de considerações sobre os escritos precoces que Benjamin dedicou à questão da linguagem – sem descuidar de outros escritos do mesmo período –, pretendemos sugerir a importância que a reflexão de Kant teve para a formulação de seu pensamento linguístico. Nesse sentido, voltamo-nos principalmente para a Segunda Parte da Crítica da Faculdade de Juízo, na qual é desenvolvido e trabalhado o importante conceito de “Zweckmässigkeit” (“conformidade a fins”), sobretudo a partir de uma reflexão sobre a perfeição da natureza, em sua dimensão teleológica. Benjamin retoma esse conceito e – elaborando uma série de imagens sobre a dimensão natural da linguagem, na linha do que propunha um pensador como Humboldt – desenvolve uma filosofia da linguagem a um só tempo natural e teológica. Depois de demonstrar textualmente a existência dessa relação entre a Faculdade do Juízo Teleológica de Kant e a filosofia da linguagem do jovem Benjamin, pretendemos sugerir que este último cede àquilo que o filósofo de Königsberg considerava a ilusão natural da razão, pois, ao postular uma “afinidade meta-histórica entre as línguas”, fundamentada no conceito suprassensível de “die reine Sprache” (“a língua pura”), Benjamin aborda algo que escapa à possibilidade de experiência humana e propõe desdobramentos dogmáticos a partir daí.
O último banquete em Herculano: guia didático
Authors:   Universidade de São Paulo. Museu de Arqueologia e Etnologia, Gregori Alessandro Mortaio , Pina Amanda Daltro de Viveiros ,   Universidade de São Paulo. Museu de Arqueologia e Etnologia
Published: November 2018

O Último Banquete em Herculano: Guia Didático é um material adaptado à realidade pedagógica dos docentes, muitas vezes limitados por um pequeno número de aulas, programas apertados e exigências de avaliações externas. É oferecida a oportunidade de se explorar uma ferramenta de interatividade, a qual estimula a imersão do indivíduo em um contexto histórico específico, permitindo contato visual e emocional com o objeto de estudo. Ao utilizar um recurso como um videogame, salientamos que o educador não abandona seu papel central na aprendizagem, mas reafirma-se como mediador, explorando potencialidades e estimulando o contato entre educando e objeto de estudo. Ao proporcionar ao educador um trabalho seguro, contextualizado e amparado por especialistas na História e Arqueologia de Roma, espera-se que este Guia forneça subsídios para o uso de videogames em sala de aula.