bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolated aortic insufficiency valve repair with external ring annuloplasty: a standardized approach
Authors: Zakkar Mustafa , Bruno Vito D , Zacek Pavel , Di Centa Isabelle , Acar Christophe , Khelil Nizar , Debauchez Mathieu , Lansac Emmanuel
Published: July 2019

OBJECTIVES

Aortic valve (AV) insufficiency with normal root and ascending aorta is most frequently treated by valve replacement with significant prosthetic-related complications and reduced life expectancy. We compared the outcomes of a new standardized isolated AV repair approach using an external aortic annuloplasty ring at the subvalvular level (single ring annuloplasty) and the role of an additional supravalvular ring at the sinotubular junction (double ring annuloplasty).

METHODS

Single centre data were collected from the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) between 2003 and 2017. A total of 93 patients (56 single ring and 37 double ring) underwent isolated AV repair.

RESULTS

The overall 30-day mortality rate and the need for a permanent pacemaker were 1% and 2%, respectively. The overall survival rate at 6 years was similar for sex- and age-matched members of the general population (89% vs 95%; P = 0.1) and did not differ between the double and single ring groups (82% vs 93%; P = 0.4) at 6 years. There were no thromboembolic or bleeding events in the entire cohort. However, at 6 years, the cumulative incidence of valve-related reintervention was 26% in the single ring annuloplasty group compared to 3% in the double ring annuloplasty (P = 0.02) group. Similarly, at 6 years, the cumulative incidence of moderate-to-severe (>2) aortic insufficiency was 30% in the single ring annuloplasty group compared to 0% in the double ring annuloplasty group (P = 0.007).

CONCLUSIONS

Standardized AV repair with external ring annuloplasty has a survival rate similar to that of the general population. The additional stabilization of the sinotubular junction with a second supravalvular ring (double ring annuloplasty) is associated with better outcomes compared to single subvalvular annuloplasty. It can be considered as a first line intervention for patients with isolated aortic insufficiency and pliable leaflets.
Mars or Mercury? The geopolitics of international currency choice*
Authors: Eichengreen Barry , Mehl Arnaud , Chiţu Livia
Published: July 2019

We assess the role of economic and security considerations in the currency composition of international reserves. We contrast the ‘Mercury hypothesis’ that currency choice is governed by pecuniary factors familiar to the literature, such as economic size and credibility of major reserve currency issuers, against the ‘Mars hypothesis’ that this depends on geopolitical factors. Using data on foreign reserves of 19 countries before World War I, for which the currency composition of reserves is known and security alliances proliferated, our results lend support to both hypotheses. We find that military alliances boost the share of a currency in the partner’s foreign reserve holdings by about 30 percentage points. These findings speak to the implications of possible US disengagement from global geopolitical affairs. In a hypothetical scenario where the United States withdraws from the world, our estimates suggest that long-term US interest rates could rise by as much as 80 basis points, assuming that the composition of global reserves changes but their level does not.
The contribution of drinking culture at comprehensive school to heavy episodic drinking from adolescence to midlife
Authors: Berg Noora , Virtanen Marianna , Lintonen Tomi , Hammarström Anne
Published: July 2019

Background

The school context is associated with adolescent alcohol use, but it is not clear whether this association continues into adulthood. This study examined whether exposure to drunkenness oriented drinking culture in 9th grade school class is associated with individuals’ heavy episodic drinking (HED) from adolescence to midlife.

Methods

Participants in the ‘Northern Swedish Cohort’ study aged 16 years in 1981 were followed-up when aged 18, 21, 30 and 43 (N = 1080). Individual-level factors were HED, positive attitudes towards drunkenness, early initiation of HED and peer-oriented spare-time. School class-level drinking culture was measured as classmate reported HED, positive attitudes, early initiation of HED and peer-oriented spare time. Multilevel log-binomial regression analyses were adjusted for gender, parental socioeconomic background, family structure and HED at age 16.

Results

After adjustment for sociodemographic factors several cross-sectional and longitudinal associations were found between class-level indicators of drinking culture and individual HED. After additional adjustment for age 16 HED, most associations attenuated. The risk ratio (95% confidence interval) for engaging in HED at age 43 was 1.58 (1.03–2.42) times higher for those who at age 16 had many classmates reporting positive attitude towards drunkenness.

Conclusions

These findings suggest that drinking culture in school may have a long-lasting impact on drinking habits in adulthood. The associations with HED at follow-ups are likely mediated by HED in adolescence. Studies on alcohol use would benefit from taking into account both individual and contextual factors in a life course perspective.
On the Group of Almost Periodic Diffeomorphisms and its Exponential Map
Authors: Sun Xu , Topalov Peter
Published: July 2019

We define the group of almost periodic diffeomorphisms on $\mathbb{R}^n$ and on an arbitrary Lie group. We then study the properties of its Riemannian and Lie group exponential maps and provide applications to fluid equations. In particular, we show that there exists a geodesic of a weak Riemannian metric on the group of almost periodic diffeomorphisms of the line that consists entirely of conjugate points.
The Hilbert Transform and Orthogonal Martingales in Banach Spaces
Authors: Osękowski Adam , Yaroslavtsev Ivan
Published: July 2019

Let $X$ be a given Banach space, and let $M$ and $N$ be two orthogonal $X$-valued local martingales such that $N$ is weakly differentially subordinate to $M$. The paper contains the proof of the estimate $\mathbb E \Psi (N_t) \leq C_{\Phi ,\Psi ,X} \mathbb E \Phi (M_t)$, $t\geq 0$, where $\Phi , \Psi :X \to \mathbb R_+$ are convex continuous functions and the least admissible constant $C_{\Phi ,\Psi ,X}$ coincides with the $\Phi ,\Psi $-norm of the periodic Hilbert transform. As a corollary, it is shown that the $\Phi ,\Psi $-norms of the periodic Hilbert transform, the Hilbert transform on the real line, and the discrete Hilbert transform are the same if $\Phi $ is symmetric. We also prove that under certain natural assumptions on $\Phi $ and $\Psi $, the condition $C_{\Phi ,\Psi ,X}<\infty $ yields the UMD property of the space $X$. As an application, we provide comparison of $L^p$-norms of the periodic Hilbert transform to Wiener and Paley–Walsh decoupling constants. We also study the norms of the periodic, nonperiodic, and discrete Hilbert transforms and present the corresponding estimates in the context of differentially subordinate harmonic functions and more general singular integral operators.
Zap it track it: the application of Lean Six Sigma methods to improve the screening system of low-grade mucinous neoplasms of the appendix in an acute hospital setting
Authors: McGrath kathleen , Casserly Mairéad , O’mara Freda , Mulsow Jurgen , Shields Conor , Staunton Oonagh , Teeling Seán Paul , Ward Marie
Published: July 2019

Objective

To improve the number of patients receiving annual computed tomography (CT) scan and tumour markers, who are diagnosed with low-grade mucinous neoplasms (LAMN).

Design

A pre-/post-intervention design was employed using Lean Six Sigma methods to identify gaps in the screening system and to develop and implement solutions for a more robust, auditable screening programme.

Setting

The patients diagnosed with LAMN of the appendix referred to the acute hospital and are enrolled in the screening service.

Participants

Consultant colorectal surgeons, cancer nurse specialist, colorectal medical team and quality improvement staff.

Interventions

Diagnostic tools identified gaps in the current process. A set of improvements were implemented to standardize the pathway for referral and surveillance of patients, provide information on the condition and treatment and standardize and track information received by patients and their referring hospital.

Main Outcome Measure(s)

Pre and post-intervention outcome measures were taken for the number of patients who receive an annual CT of thoracic, abdomen and peritoneum and tumour markers and number of patients who receive information and contact details.

Results

At baseline, of the 28 patients that met the inclusion criteria only 61% had a correct follow-up. Following the implementation of improvements, 78% of patients had correct follow-up and 90% had received information.

Conclusions

Gaps in the current cancer screening system were identified and improvements implemented a reduced number of patients having an incorrect follow-up. Findings are applicable across all precancerous screening systems irrespective of the type of malignancy. The methods used empowered patients and fostered an interdisciplinary team approach to care.
Aedes Vector Surveillance in the Southeastern United States Reveals Growing Threat of Aedes japonicus japonicus (Diptera: Culicidae) and Aedes albopictus
Authors: McKenzie Benjamin A , Stevens Kelly , McKenzie Ansley E , Bozic Jovana , Mathias Derrick , Zohdy Sarah
Published: July 2019

Mosquito-borne diseases are on the rise globally, and have the potential to thrive along the Gulf Coast of the United States, where subtropical conditions may facilitate the introduction or movement of mosquito vectors. Despite surveillance efforts, Aedes aegypti (L.) had not been detected in the Gulf state of Alabama for nearly three decades. The detection of Ae. aegypti in Alabama may suggest remnant or reemergent populations of this vector. We conducted adult sampling between May and August of 2018 to capture mosquitoes during a time frame when all species should be active. This was to ensure no species were missed due to overwintering and to identify the distributions of Aedes mosquitoes of medical importance. No Ae. aegypti were detected in Alabama over the period of this study. We detected Aedes albopictus (Skuse) in 65 counties and the recently invasive Aedes japonicus japonicus (Theobald) in 30 counties across the state. These results indicate that while Ae. aegypti was recently reported from parts of Alabama, the state is not experiencing a major resurgence of the species, whereas Ae. albopictus remains ubiquitous. Further, results indicate that a third wave of Aedes invasion may be occurring, that of Ae. japonicus japonicus. All three of these species are medically important vectors and may pose threats to the public health of the Gulf Coast of the United States.
My Way to Theopoetics Through Eriugena
Authors: Kearney Richard
Published: July 2019

This piece charts the author’s journey to theopoetics through the work of John Scotus Eriugena. Focusing on the key role played by Celtic mysticism in the development of a panentheist vision of things, the essay offers a poetical and ecological approach to our philosophical rethinking of divinity, nature and creation. It concludes with a tribute to the hilarious notion of a ‘running God’.
Spoken Word and Spirit’s Breath: A Theopoetics of Performance Poetry
Authors: Dodd Elizabeth S
Published: July 2019

Stanley Romaine Hopper defined theopoiesis as a performative form of thinking that ‘effect[s] disclosure through the crucial nexus of event’. Unlike theology which seeks an explanation of the revelatory through the tools of rational discourse, this poetic and participatory activity is ‘a breathing with the inhale and exhale of Being … that “the god” may breathe through us’. Following Hopper, this article addresses the performative ‘event’ of the spoken word as a window into a discussion of creative breath, exploring its implications for a theology that seeks to ‘breathe with’ the Spirit. The use of breath in the work of contemporary poets Tony Walsh and Kate Tempest demonstrates a perhaps largely unacknowledged form of poetic ‘difficulty’ (one of Geoffrey Hill’s criteria for good poetry) in the spoken word. Their intriguing practices of creative breath may contribute to a theopoetics of the Spirit that takes poetic performance seriously as a means of revelatory disclosure.
Mucormycosis due to Apophysomyces species complex- 25 years’ experience at a tertiary care hospital in southern India
Authors: Pamidimukkala Umabala , Sudhaharan Sukanya , Kancharla Anuradha , Vemu Lakshmi , Challa Sundaram , Karanam Sandhya Devi , Chavali Padmasri , Prakash Hariprasath , Ghosh Anup Kumar , Gupta Sunita , Rudramurthy Shivaprakash M , Chakrabarti Arunaloke
Published: July 2019

Apophysomyces elegans species complex is an important cause of cutaneous mucormycosis in India. However, majority of those cases are reported as case reports only. We desired to analyze our patients with Apophysomyces infection reported over 25 years (1992–2017) to understand the epidemiology, management, and outcome of the disease. During the study period 24 cases were reported, and the majority (95.8%) of them presented with necrotizing fasciitis following accidental/surgical/iatrogenic trauma. One patient presented with continuous ambulatory peritoneal dialysis (CAPD) related peritonitis. Healthcare related Apophysomyces infection was noted in 29.2% patients. In addition to trauma, comorbidities were noted in 37.5% patients (type 2diabetes mellitus-6, chronic alcoholism-2, and chronic kidney disease-1). Of the 24 isolates, 11 isolates starting from year 2014 were identified as Apophysomyces variabilis by molecular methods. Majority (95.8%) of the patients were managed surgically with or without amphotericin B deoxycholate therapy, while one patient was treated with amphotericin B deoxycholate alone. Among 24 patients, seven (29.1%) recovered, six (25%) patients could not afford antifungal management and left the hospital against medical advice, and 11 (45.9%) patients died.The present case series highlights that necrotizing fasciitis caused by A. variabilis is prevalent in India, and the disease may be healthcare related. Although diagnosis is not difficult, awareness among surgeons is still limited about the infection, leading to a delay in sending samples to the mycology laboratory. Apophysomyces infection must be considered in the differential diagnosis in apatient with progressive necrosis of a wound who is not responding to antibacterial therapy.
Five new real-time detections of fast radio bursts with UTMOST
Authors: Farah W , Flynn C , Bailes M , Jameson A , Bateman T , Campbell-Wilson D , Day C K , Deller A T , Green A J , Gupta V , Hunstead R , Lower M E , Osłowski S , Parthasarathy A , Price D C , Ravi V , Shannon R M , Sutherland A , Temby D , Krishnan V Venkatraman , Caleb M , Chang S-W , Cruces M , Roy J , Morello V , Onken C A , Stappers B W , Webb S , Wolf C
Published: July 2019

We detail a new fast radio burst (FRB) survey with the Molonglo Radio Telescope, in which six FRBs were detected between 2017 June and 2018 December. By using a real-time FRB detection system, we captured raw voltages for five of the six events, which allowed for coherent dedispersion and very high time resolution (10.24 $\mu$s) studies of the bursts. Five of the FRBs show temporal broadening consistent with interstellar and/or intergalactic scattering, with scattering time-scales ranging from 0.16 to 29.1 ms. One burst, FRB181017, shows remarkable temporal structure, with three peaks each separated by 1 ms. We searched for phase-coherence between the leading and trailing peaks and found none, ruling out lensing scenarios. Based on this survey, we calculate an all-sky rate at 843 MHz of $98^{+59}_{-39}$ events sky−1 d−1 to a fluence limit of 8 Jy ms: a factor of 7 below the rates estimated from the Parkes and ASKAP telescopes at 1.4 GHz assuming the ASKAP-derived spectral index α = −1.6 (Fν ∝ να). Our results suggest that FRB spectra may turn over below 1 GHz. Optical, radio, and X-ray follow-up has been made for most of the reported bursts, with no associated transients found. No repeat bursts were found in the survey.
The tidal disruption event AT2017eqx: spectroscopic evolution from hydrogen rich to poor suggests an atmosphere and outflow
Authors: Nicholl M , Blanchard P K , Berger E , Gomez S , Margutti R , Alexander K D , Guillochon J , Leja J , Chornock R , Snios B , Auchettl K , Bruce A G , Challis P , D’Orazio D J , Drout M R , Eftekhari T , Foley R J , Graur O , Kilpatrick C D , Lawrence A , Piro A L , Rojas-Bravo C , Ross N P , Short P , Smartt S J , Smith K W , Stalder B
Published: July 2019

We present and analyse a new tidal disruption event (TDE), AT2017eqx at redshift z = 0.1089, discovered by Pan-STARRS and ATLAS. The position of the transient is consistent with the nucleus of its host galaxy; the spectrum shows a persistent blackbody temperature T ≳ 20 000 K with broad H i and He ii emission; and it peaks at a blackbody luminosity of L ≈ 1044 erg s−1. The lines are initially centred at zero velocity, but by 100 d, the H i lines disappear while the He ii develops a blueshift of ≳ 5000 km s−1. Both the early- and late-time morphologies have been seen in other TDEs, but the complete transition between them is unprecedented. The evolution can be explained by combining an extended atmosphere, undergoing slow contraction, with a wind in the polar direction becoming visible at late times. Our observations confirm that a lack of hydrogen a TDE spectrum does not indicate a stripped star, while the proposed model implies that much of the diversity in TDEs may be due to the observer viewing angle. Modelling the light curve suggests AT2017eqx resulted from the complete disruption of a solar-mass star by a black hole of ∼106.3 M⊙. The host is another Balmer-strong absorption galaxy, though fainter and less centrally concentrated than most TDE hosts. Radio limits rule out a relativistic jet, while X-ray limits at 500 d are among the deepest for a TDE at this phase.
Optical follow-up study of 32 high-redshift galaxy cluster candidates from Planck with the William Herschel Telescope
Authors: Zohren Hannah , Schrabback Tim , van der Burg Remco F J , Arnaud Monique , Melin Jean-Baptiste , van den Busch Jan Luca , Hoekstra Henk , Klein Matthias
Published: July 2019

The Planck satellite has detected cluster candidates via the Sunyaev Zel’dovich (SZ) effect, but the optical follow-up required to confirm these candidates is still incomplete, especially at high redshifts and for SZ detections at low significance. In this work, we present our analysis of optical observations obtained for 32 Planck cluster candidates using ACAM on the 4.2-m William Herschel Telescope. These cluster candidates were pre-selected using SDSS, WISE, and Pan-STARRS images to likely represent distant clusters at redshifts z ≳ 0.7. We obtain photometric redshift and richness estimates for all of the cluster candidates from a red-sequence analysis of r-, i-, and z-band imaging data. In addition, long-slit observations allow us to measure the redshifts of a subset of the clusters spectroscopically. The optical richness is often lower than expected from the inferred SZ mass when compared to scaling relations previously calibrated at low redshifts. This likely indicates the impact of Eddington bias and projection effects or noise-induced detections, especially at low-SZ significance. Thus, optical follow-up not only provides redshift measurements, but also an important independent verification method. We find that 18 (7) of the candidates at redshifts z > 0.5 (z > 0.8) are at least half as rich as expected from scaling relations, thereby clearly confirming these candidates as massive clusters. While the complex selection function of our sample due to our pre-selection hampers its use for cosmological studies, we do provide a validation of massive high-redshift clusters particularly suitable for further astrophysical investigations.
Radiation hydrodynamics simulations of the evolution of the diffuse ionized gas in disc galaxies
Authors: Vandenbroucke Bert , Wood Kenneth
Published: July 2019

There is strong evidence that the diffuse ionized gas (DIG) in disc galaxies is photoionized by radiation from UV luminous O and B stars in the galactic disc, both from observations and detailed numerical models. However, it is still not clear what mechanism is responsible for providing the necessary pressure support for a diffuse gas layer at kpc-scale above the disc. In this work, we investigate if the pressure increase caused by photoionization can provide this support. We run self-consistent radiation hydrodynamics (RHD) models of a gaseous disc in an external potential. We find that photoionization feedback can drive low levels of turbulence in the dense galactic disc, and that it provides pressure support for an extended diffuse gas layer. Our results show that there is a natural fine-tuning between the total ionizing radiation budget of the sources in the galaxy and the amount of gas in the different ionization phases of the interstellar medium, and provide the first fully consistent RHD model of the DIG.
Evaluation of patient education materials for stereotactic radiosurgery from high-performing neurosurgery hospitals and professional societies
Authors: Rooney Michael K , Golden Daniel W , Byun John , Lukas Rimas V , Sonabend Adam M , Lesniak Maciej S , Sachdev Sean
Published: July 2019

Background

Little is known about the readability and utility of patient education materials for stereotactic radiosurgery (SRS). Therefore, the goal of this investigation was to evaluate such materials from high-performing neurosurgery hospitals and professional societies through an analysis of readability and educational content.

Methods

In this cross-cross sectional study, 61 websites associated with the top 50 neurosurgery and neurology hospitals according to U.S. News & World Report (USNWR) and 11 predetermined professional medical societies were queried. Identified SRS education materials were analyzed by 6 readability indices. Educational content was assessed by 10 criteria based on surveys of patients’ perspectives about SRS.

Results

Fifty-four materials were identified from the target population (45 from USNWR hospital websites and 9 from professional society websites). Mean readability of materials ranged from 11.7 to 15.3 grade level, far more difficult than national recommendations of sixth and eighth grade. Materials were found to have deficiencies in educational content. Compared with high-performing hospitals, materials from websites of professional societies were longer (P = .002), and more likely to discuss risks and benefits specific to SRS (P = .008), alternative treatment options (P = .05) and expected outcomes or postprocedure descriptions (P = .004). Hospital materials were also more likely to favor brand-specific terminology (eg, GammaKnife) over generic terminology (eg, radiosurgery; P = .019).

Conclusion

Publicly available online patient educational materials for SRS are written at reading levels above national recommendations. Furthermore, many lack information identified as important by patients. Reevaluation and improvement of online SRS educational materials on a national scale are warranted.
Mapping the nature of distress raised by patients with high-grade glioma and their family caregivers: a descriptive longitudinal study
Authors: Philip Jennifer , Collins Anna , Panozzo Stacey , Staker Jane , Murphy Michael
Published: July 2019

Background

Few supportive and palliative care interventions have been described for people with high-grade glioma (HGG) and their caregivers. A structured intervention, I-CoPE, which includes regular screening of patients’ and caregivers’ needs, was delivered as a pilot study in a tertiary neuro-oncological unit. This study prospectively described the severity and content of key concerns raised by patients and their caregivers in the 3 months following a diagnosis of HGG.

Methods

Consecutive patients and caregivers were screened for distress longitudinally using the Distress Thermometer at 3 time points. Exploration of the issues raised during screening was undertaken by the care coordinator and the issues documented. This documentation was subsequently audited to map patterns and nature of distress. The key reasons underlying distress and responses offered were grouped thematically and summarized using descriptive statistics.

Results

Thirty-two patients and 31 caregivers were recruited and underwent screening. At diagnosis, 87% of caregivers (n = 27) and 60% of patients (n = 19) reported distress scores meeting clinical significance. The predominant concerns reported by patients during screening related to existential issues such as fear of dying, whereas caregivers were more focused on practical caring responsibilities. Over time, the reasons for distress changed to include more physical health concerns for patients and more psychological concerns for caregivers.

Conclusions

This prospective longitudinal descriptive study revealed that following a new diagnosis of HGG, patients and caregivers had changing needs for support and fluctuating distress, mirroring the illness trajectory. Palliative care needs were apparent from diagnosis, and early integration of palliative care should be considered.
Technology transfer at the US National Institute of Standards and Technology
Authors: Link Albert N
Published: July 2019

This article analyzes the interrelationship among technology transfer mechanisms using data specific to the US National Institute of Standards and Technology (NIST). An overview of the history of NIST and US policies that emphasize the economic importance of technology transfer are discussed. The empirical analysis focuses on NIST investments in research and development (R&D) and the cascading impact of those investments on new inventions disclosed, new patent applications, new patents issued and new patent licenses; and accounting for the effects of R&D on these three investments, an overall estimate of the R&D elasticity of new patent licenses is calculated to be 0.7976. The article concludes with a policy-focused summary of the implications of the empirical findings, and a suggested road map for future research related to technology transfer from US federal laboratories.
An Integrative Computational Approach for a Prioritization of Key Transcription Regulators Associated With Nanomaterial-Induced Toxicity
Authors: Zhernovkov Vadim , Santra Tapesh , Cassidy Hilary , Rukhlenko Oleksii , Matallanas David , Krstic Aleksandar , Kolch Walter , Lobaskin Vladimir , Kholodenko Boris N
Published: July 2019

A rapid increase of new nanomaterial (NM) products poses new challenges for their risk assessment. Current traditional methods for estimating potential adverse health effect of NMs are complex, time consuming, and expensive. In order to develop new prediction tests for nanotoxicity evaluation, a systems biology approach, and data from high-throughput omics experiments can be used. We present a computational approach that combines reverse engineering techniques, network analysis and pathway enrichment analysis for inferring the transcriptional regulation landscape and its functional interpretation. To illustrate this approach, we used published transcriptomic data derived from mice lung tissue exposed to carbon nanotubes (NM-401 and NRCWE-26). Because fibrosis is the most common adverse effect of these NMs, we included in our analysis the data for bleomycin (BLM) treatment, which is a well-known fibrosis inducer. We inferred gene regulatory networks for each NM and BLM to capture functional hierarchical regulatory structures between genes and their regulators. Despite the different nature of the lung injury caused by nanoparticles and BLM, we identified several conserved core regulators for all agents. We reason that these regulators can be considered as early predictors of toxic responses after NMs exposure. This integrative approach, which refines traditional methods of transcriptomic analysis, can be useful for prioritization of potential core regulators and generation of new hypothesis about mechanisms of nanoparticles toxicity.
Hand hygiene compliance and environmental contamination with gram-negative bacilli in a rural hospital in Madarounfa, Niger
Authors: Tang Kevin , Berthé Fatou , Nackers Fabienne , Hanson Kerstin , Mambula Christopher , Langendorf Celine , Marquer Caroline , Isanaka Sheila
Published: July 2019

Background

Healthcare-associated infections pose a major, yet often preventable risk to patient safety. Poor hand hygiene among healthcare personnel and unsanitary hospital environments may contribute to this risk in low-income settings. We aimed to describe hand hygiene behaviour and environmental contamination by season in a rural, sub-Saharan African hospital setting.

Methods

We conducted a concurrent triangulation mixed-methods study combining three types of data at a hospital in Madarounfa, Niger. Hand hygiene observations among healthcare personnel during two seasons contributed quantitative data describing hand hygiene frequency and its variability in relation to seasonal changes in caseload. Semistructured interviews with healthcare personnel contributed qualitative data on knowledge, attitudes and barriers to hand hygiene. Biweekly environmental samples evaluated microbial contamination from October 2016 to December 2017. Triangulation identified convergences, complements and contradictions across results.

Results

Hand hygiene compliance, or the proportion of actions (handrubbing or handwashing) performed out of all actions required, was low (11% during non-peak and 36% during peak caseload seasons). Interviews with healthcare personnel suggesting good general knowledge of hand hygiene contradicted the low hand hygiene compliance. However, compliance by healthcare activity was convergent with poor knowledge of precise hand hygiene steps and the motivation to prevent personal acquisition of infection identified during interviews. Contamination of environmental samples with gram-negative bacilli was high (45%), with the highest rates of contamination observed during the peak caseload season.

Conclusion

Low hand hygiene compliance coupled with high contamination rates of hospital environments may increase the risk of hospital-acquired infections in sub-Saharan African settings.
Patient and Disease Characteristics Associate With Sensory Testing Results in Chronic Pancreatitis
Authors: Kuhlmann Louise , Olesen Søren S. , Grønlund Debbie , Olesen Anne E. , Phillips Anna E. , Faghih Mahya , Drewes Asbjørn M.
Published: July 2019

Background:

Abdominal pain is the most common symptom in chronic pancreatitis (CP) and has an extensive impact on patients’ lives. Quantitative sensory testing (QST) provides information on sensitivity to pain and mechanisms that can help quantify pain and guide treatment. The aims of this study were (1) to explore sensitivity to pain in patients with CP using QST and (2) to associate patient and disease characteristics with QST results.

Methods:

Ninety-one patients with painful CP and 28 healthy control participants completed a QST paradigm using static tests (muscle pressure stimulation and electrical skin stimulations) to unravel segmental and widespread hyperalgesia as a consequence of visceral pain. A dynamic conditioned pain modulation (CPM) paradigm was used as a proxy of pain modulation from the brainstem to inhibit incoming nociceptive barrage, and questionnaires were used to gather information on pain experience and quality of life.

Results:

Patients had impaired CPM compared with controls (18.0±29.3% vs. 30.9±29.3%,P=0.04) and were hypersensitive to pressure stimulation, specifically in the pancreatic (Th10) dermatome (P<0.001). The capacity of CPM was associated with clinical pain intensity (P=0.01) and (in the univariate analysis only) the use of opioids was associated with hyperalgesia to pressure stimulation (P<0.05).

Conclusions:

Sensitivity to pain in CP patients can be characterized by a simple bedside QST. Severe clinical pain in CP was associated with reduced CPM function and should be targeted in management.
Mandatory Pain Assessment in a Pediatric Emergency Department: Failure or Success?
Authors: Marzona Federico , Pedicini Sara , Passone Eva , Pusiol Anna , Cogo Paola
Published: July 2019

Objective:

Pain control is a priority in patient evaluation. Despite the proliferation of guidelines, pain is still underassessed and undertreated, especially in children. To improve efficiency and to adhere to best medical practice, our triage software was upgraded; it included mandatory pain scoring for the admission of a child to the pediatric emergency service, thereby limiting the chances of overlooking a child experiencing pain. We conducted this study to verify the effect of routine versus mandatory pain scoring on pain management under the hypothesis that mandatory pain assessment would improve reevaluation and pain treatment.

Methods:

This retrospective case-control study was conducted in our Pediatric Emergency Department (ED). We collected data with regard to pain assessment and reassessment at triage and during the entire stay in the ED, and also with regard to the drugs eventually administered. We reviewed the charts of 1274 patients admitted with the older triage software and those of 1262 patients admitted with the newer triage software (intervention group).

Results:

Pain was evaluated significantly more frequently in the intervention group at triage, during the medical evaluation, and at discharge. In the intervention group, a smaller percentage of patients were treated for pain at both triage and during their stay in the ED (P=0.078 and 0.048). Pain reassessment resulted lower in the intervention group (P<0.01).

Discussion:

Mandatory pain assessment improved the pain evaluation rate. This did not, however, translate into better treatment and management of pain in the pediatric emergency setting.
Acquired Elastotic Hemangioma: A Case Report and Review of 49 Previously Reported Cases
Authors: Jeunon Thiago , Carvalho Wagnes Stöfler Maria E. , Teixeira Rezende Patricia , Staccioli Castro Marcelo , Jeunon-Sousa Maria A.
Published: July 2019

In the past decades, there was a considerable advance in regard to recognition of morphologic findings and classification of several benign and malignant vascular proliferations. In 2002, attention was called by Requena et al to a new variant of cutaneous hemangioma named acquired elastotic hemangioma. In this article, a case of acquired elastotic hemangioma is reported with documentation of clinical, dermatoscopic, histopathological, and immunohistochemical findings. A systematic review of the previously 49 reported cases is provided. The criteria for clinical and histopathological diagnosis are highlighted.
Comparing Retail Clinics With Other Sites of Care
Authors: Hoff Timothy , Prout Kathryn
Published: July 2019

Background:

Retail clinics, also referred to as walk-in or convenient care clinics, share common features such as a limited menu of primary care services, on-demand patient appointments, greater use of nonphysician providers such as nurse practitioners, and more convenient hours and access points for patients.

Objectives:

Given their rising popularity as an alternative primary care delivery site, it is important to examine retail clinics’ impact on patient outcomes. This study’s aim was to systematically review the extant literature on retail clinics in the United States with respect to 3 outcomes of interest: quality, cost, and patient satisfaction.

Research Design:

A systematic search of 4 databases was done using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies needed to be empirical, measure care in retail, walk-in, or convenient care clinic, and present quality, cost, and/or satisfaction findings.

Measures:

The majority of studies used commercial, administrative claims databases to procure patient outcome data (n=9). Nine of the 15 studies examined costs, 6 examined quality, and only 1 examined patient satisfaction.

Results:

Overall, retail clinic care compares favorably with similar care in other settings in terms of lower costs, although the evidence on quality and patient satisfaction is minimal and less conclusive.

Conclusions:

Future research on retail clinic care requires more rigorous study designs, richer quality measures, inclusion of the patient experience in outcomes, less reliance on administrative claims data, and greater independence from industry stakeholders with interest in seeing the retail clinic model grow.
Gastric Emptying and Distal Gastrectomy Independently Enhance Postprandial Glucagon-Like Peptide-1 Release After a Mixed Meal and Improve Glycemic Control in Subjects Having Undergone Pancreaticoduodenectomy
Authors: Steiner Emanuel , Breuer Robert , Kazianka Lukas , Wewalka Marlene , Stimpfl Thomas , Reiter Birgit , Holst Jens Juul , Miholic Johannes
Published: July 2019

Objectives

New-onset diabetes frequently resolves after pancreaticoduodenectomy (PD). Glucagon-like peptide-1 (GLP-1) conceivably is involved as its release is enhanced by rapid gastric emptying and distal bowel exposure to nutrients. We aimed at studying factors associated with GLP-1 release after PD.

Methods

Fifteen PD subjects with distal gastrectomy (Whipple) and 15 with pylorus preservation were evaluated. A test meal containing 1 g paracetamol to measure gastric emptying was ingested. Blood for the measurement of paracetamol, glucose, insulin, and GLP-1 was drawn at baseline and 10, 20, 30, 60, 90, 120, 150, and 180 minutes thereafter. The Matsuda index of insulin sensitivity was calculated.

Results

In univariate analysis, gastric emptying correlated with GLP-1. Glucagon-like peptide-1 responses to the modes of operation did not differ. Multiple regression analysis confirmed gastric emptying and Whipple versus pylorus-preserving pancreaticoduodenectomy as independent predictors of GLP-1 release. The Matsuda index of insulin sensitivity correlated with GLP-1 concentrations and inversely with body mass index. Patients after Whipple procedure revealed lower glycated hemoglobin as compared with pylorus-preserving pancreaticoduodenectomy.

Conclusions

Following PD, the postprandial GLP-1 release seems to be enhanced by rapid gastric emptying and to improve insulin sensitivity. Partial gastrectomy versus pylorus preservation enhanced the release of GLP-1, conceivably because of greater distal bowel exposure to undigested nutrients.
Bleeding and Thrombosis With Pediatric Extracorporeal Life Support: A Roadmap for Management, Research, and the Future From the Pediatric Cardiac Intensive Care Society: Part 1*
Authors: Penk Jamie S. , Reddy Sushma , Polito Angelo , Cisco Michael J. , Allan Catherine K. , Bembea Melania M. , Giglia Therese M. , Cheng Henry H. , Thiagarajan Ravi R. , Dalton Heidi J.
Published: July 2019

Objectives:

To make practical and evidence-based recommendations on improving understanding of bleeding and thrombosis with pediatric extracorporeal life support and to make recommendations for research directions.

Data Sources:

Evaluation of literature and consensus conferences of pediatric critical care and extracorporeal life support experts.

Study Selection:

A team of 10 experts with pediatric cardiac and extracorporeal membrane oxygenation experience and expertise met through the Pediatric Cardiac Intensive Care Society to review current knowledge and make recommendations for future research to establish “best practice” for anticoagulation management related to extracorporeal life support.

Data Extraction/Synthesis:

The first of a two-part white article focuses on clinical understanding and limitations of medications in use for anticoagulation, including novel medications. For each medication, limitations of current knowledge are addressed and research recommendations are suggested to allow for more definitive clinical guidelines in the future.

Conclusions:

No consensus on best practice for anticoagulation exists. Structured scientific evaluation to answer questions regarding anticoagulant medication and bleeding and thrombotic events should occur in multicenter studies using standardized approaches and well-defined endpoints. Outcomes related to need for component change, blood product administration, healthcare outcome, and economic assessment should be incorporated into studies. All centers should report data on patients receiving extracorporeal life support to a registry. The Extracorporeal Life Support Organization registry, designed primarily for quality improvement purposes, remains the primary and most successful data repository to date.
Strengths and Difficulties Questionnaire Assessment of Long-Term Psychological Outcome in Children After Intensive Care Admission*
Authors: Kyösti Elina , Ala-Kokko Tero I. , Ohtonen Pasi , Peltoniemi Outi , Ebeling Hanna , Spalding Michael , Rautiainen Paula , Kataja Janne , Liisanantti Janne H.
Published: July 2019

Objectives:

We investigated the long-term psychologic symptoms of patients who survived pediatric intensive care admission.

Design:

Longitudinal follow-up study.

Setting:

Nationwide cohort study based on a national ICU register and a questionnaire survey.

Patients:

All pediatric patients (0–16 yr old) who were admitted to an ICU in Finland in 2009–2010.

Interventions:

None.

Measurements and Main Results:

Six years after ICU admission, all surviving patients were sent the Strengths and Difficulties Questionnaire, and questionnaires regarding chronic diseases and need for medication and therapy. At the end of the follow-up period, there were 3,674 surviving children who had been admitted to an ICU in 2009–2010. Of these children, 1,105 completed the Strengths and Difficulties Questionnaire 6 years after admission. Strengths and Difficulties Questionnaire scores were abnormal for 84 children (7.6%), borderline for 80 (7.2%), and normal for 941 (85.2%). Participants with abnormal scores were younger at admission to the ICU (3.06 vs 4.70 yr; p = 0.02), and more commonly had a chronic disease (79.5% vs 47.4%; p < 0.001), a need for continuous medication (49.4% vs 31.7%; p < 0.001), a need for therapy (58.5% vs 15.9%; p < 0.001), and a need for annual healthcare visits (91.4% vs 85.2%; p = 0.05). Abnormal Strengths and Difficulties Questionnaire scores were associated with higher rates of neurologic (32.1% vs 10.2%), gastrointestinal (7.1% vs 3.9%), psychiatric (3.6% vs 0.5%), and chromosomal disorders (9.5% vs 1.3%), as well as with long-term pain (1.2% vs 0.6%).

Conclusions:

Participants with abnormal Strengths and Difficulties Questionnaire scores (poor psychologic outcome) at 6 years after childhood ICU admission more commonly suffered neurologic, chromosomal, or psychiatric diagnoses or long-term pain, and generally required higher levels of healthcare services, therapies, and medication.
Incidence and Geographic Distribution of Injuries Due to Falls Among Pediatric Communities of Maryland
Authors: Husain Amyna , Sridharma Suganya , Baker Mark Douglas , Kharrazi Hadi
Published: July 2019

Objectives

Falls are the leading cause of pediatric injury and account for the majority of emergency department injury visits, costing US $5 billion in medical costs annually. Epidemiology of pediatric falls has primarily been studied at single hospital centers and has not been analyzed statewide. We assessed pediatric falls across Maryland and geographically mapped them by census tract and block group.

Methods

The study used Maryland Health Services Cost Review Commission discharge data to retrospectively analyze the demographics and cross-sectional incidence rates of fall injuries in Maryland from 2013 to 2015. Geographical clusters were calculated for pediatric falls in Maryland and Baltimore City.

Results

From 2013 to 2015, Maryland hospitals discharged 738,819 pediatric patients, of whom 77,113 had fall injuries. Falls were more prevalent among males (56%), white race (55%), and patients with public insurance (56%). Over this period, 2 children who presented with fall injuries died. The incidence of falls did not vary from 2013 (27,481 children) to 2014 (27,261) and 2015 (26,451). Mapping fall injuries across Maryland identified Baltimore City as the primary cluster and rural pockets as secondary clusters of high incidence rates. Baltimore City maps showed a stable high-incidence cluster in the southwest region across all 3 years.

Conclusions

Pediatric fall injuries comprise a large volume of emergency department visits yet have a low mortality. Geographic mapping shows that fall incidence varies across the state and persists over time. Statewide geographic information can be used to focus resource management and target prevention strategies.
Diagnostic Efficacy of T2 Dark Spot, T2 Dark Rim Signs, and T2 Shading on Magnetic Resonance Imaging in Differentiating Endometriomas From Hemorrhagic Cysts
Authors: Cansu Aysegul , Bulut Eser , Dinc Gulseren , Bekircavusoglu Suleyman , Eyuboglu Ilker , Guven Emine Seda , Ahmetoglu Ali
Published: July 2019

Objective

This study aimed to evaluate the diagnostic efficacy of T2 dark spot, T2 dark rim, and T2 shading signs on magnetic resonance imaging in the differentiation of endometriomas from hemorrhagic cysts.

Methods

Seventy-two hemorrhagic lesions were included in this retrospective study. The presence of T2 dark spot, T2 dark rim, and T2 shading signs in the lesions and the presence of complete or incomplete rim in lesions exhibiting T2 dark rim signs were evaluated.

Results

Of 72 lesions, 50 were diagnosed with endometrioma and 22 were diagnosed with hemorrhagic cyst. Twenty-six of 50 endometriomas and none of the hemorrhagic cysts showed T2 dark spot sign. T2 shading was observed in 90% of endometriomas and 18% of hemorrhagic cysts. Incomplete T2 dark rim was detected in 67% of endometriomas and 21% of hemorrhagic cysts.

Conclusions

T2 dark spot and T2 dark rim signs could be useful for distinguishing endometriomas from hemorrhagic cysts.
Generalization of the Zabolotskaya equation to all incompressible isotropic elastic solids
Authors: Destrade Michel , Pucci Edvige , Saccomandi Giuseppe
Published: July 2019

We study elastic shear waves of small but finite amplitude, composed of an anti-plane shear motion and a general in-plane motion. We use a multiple scales expansion to derive an asymptotic system of coupled nonlinear equations describing their propagation in all isotropic incompressible nonlinear elastic solids, generalizing the scalar Zabolotskaya equation of compressible nonlinear elasticity. We show that for a general isotropic incompressible solid, the coupling between anti-plane and in-plane motions cannot be undone and thus conclude that linear polarization is impossible for general nonlinear two-dimensional shear waves. We then use the equations to study the evolution of a nonlinear Gaussian beam in a soft solid: we show that a pure (linearly polarized) shear beam source generates only odd harmonics, but that introducing a slight in-plane noise in the source signal leads to a second harmonic, of the same magnitude as the fifth harmonic, a phenomenon recently observed experimentally. Finally, we present examples of some special shear motions with linear polarization.