bluuebunny/crossref_metadata_2025 huggingface dataset:
Gibt es Veränderungen in der Qualität bzw. Komplikationshäufigkeit in der Knieendoprothetik durch die Etablierung eines Endoprothesenzetrums?
Authors: Düzgünoglu Muzaffer , Hönle Wolfgang , Scheller Alexander , Schuh Alexander
Published: May 2018

Einleitung Ziel dieser Arbeit ist es, Veränderungen der Qualität bzw. Komplikationshäufigkeit in der Knieendoprothetik durch die Etablierung eines Endoprothesenzentrums (EPZ) zu untersuchen.

Material und Methode Es handelt sich um eine retrospektive Studie, in der 100 Fälle in dem Jahr vor Einführung des EPZ an unserer Klinik (Gruppe I) mit 100 Fällen in dem Folgejahr nach Einführung des EPZ (Gruppe II) verglichen wurden. Die Daten wurden der elektronischen Patientenakte entnommen bzw. dem Entlassbrief der Rehaklinik. Es wurden die Parameter – die für die Etablierung eines EPZ gefordert sind – „Vorliegen Röntgenaufnahme“ vor der Operation und nach der Operation, „Vorliegen Ganzbeinstandaufnahme prä-OP oder Navigation“, „Vorliegen präoperative Prothesenplanung“, OP-Zeit primäre Knie-TEP im Zentrum < 100 min, periprothetische Infektionen, Auftreten periprothetischer Fissuren/Frakturen, Patientenzufriedenheit mit stationärer Versorgung, Thrombose, Embolie, Sterblichkeit und neurologische Komplikationen festgehalten und analysiert. Zusätzlich wurden der femorotibiale Winkel, der Femurwinkel, der Tibiawinkel und der Tibia-Slope gemessen. Die statistische Auswertung erfolgte mit dem Programm SPSS 22.0. Es wurde der Kolmogorow-Smirnow-Test, Chi-Quadrat-Test und der Mann-Whitney-U-Test verwendet.

Ergebnisse Bei den perioperativen Komplikationen fanden sich sowohl bei den lokalen als auch den systemischen Komplikationen keine statistisch signifikanten Unterschiede. Die OP-Dauer betrug in Gruppe I 82,9 min (Min.: 55, Max.: 141) und in Gruppe II 81,5 min (Min.: 57, Max.: 129; p > 0,05). In Gruppe I betrug bei 20/100 Fällen (20%) die OP-Dauer über 100 Minuten, in Gruppe II bei 13/100 (13%) (p < 0,001). Bei der Analyse des anatomischen femorotibialen Winkels, des Femurwinkels, des Tibiawinkels und des Tibia-Slopes ergaben sich keine statistisch signifikanten Unterschiede. Die Patientenzufriedenheit mit dem stationären Aufenthalt wurde in Gruppe I in 62% der Fälle dokumentiert, in Gruppe II in 98% der Fälle (p < 0,001).

Schlussfolgerung Durch die Einführung eines EPZ konnte in der aktuellen Studie nur bei dem Parameter „OP-Dauer über 100 Minuten“ und Vorliegen der Untersuchung der Patientenzufriedenheit eine signifikante Verbesserung erzielt werden, bei der Komplikationshäufigkeit jedoch nicht.
Classification and Microvascular Flap Selection for Anterior Cranial Fossa Reconstruction
Authors: Vargo James , Przylecki Wojciech , Camarata Paul , Andrews Brian
Published: May 2018

Background Microvascular reconstruction of the anterior cranial fossa (ACF) creates difficult challenges. Reconstructive goals and flap selection vary based on the defect location within the ACF. This study evaluates the feasibility and reliability of free tissue transfer for salvage reconstruction of low, middle, and high ACF defects.

Methods A retrospective review was performed. Reconstructions were anatomically classified as low (anterior skull base), middle (frontal bar/sinus), and high (frontal bone/soft tissue). Subjects were evaluated based on pathologic indication and goal, type of flap used, and complications observed.

Results Eleven flaps in 10 subjects were identified and anatomic sites included: low (n = 5), middle (n = 3), and high (n = 3). Eight of 11 reconstructions utilized osteocutaneous flaps including the osteocutaneous radial forearm free flap (OCRFFF) (n = 7) and fibula (n = 1). Other reconstructions included a split calvarial graft wrapped within a temporoparietal fascia free flap (n = 1), latissimus myocutaneous flap (n = 1), and rectus abdominis myofascial flap (n = 1). All 11 flaps were successful without microvascular compromise. No complications were observed in the high and middle ACF defect groups. Two of five flaps in the low defect group using OCRFFF flaps failed to achieve surgical goals despite demonstrating healthy flaps upon re-exploration. Complications included persistent cerebrospinal fluid leak (n = 1) and pneumocephalus (n = 1), requiring flap repositioning in one subject and a second microvascular flap in the second subject to achieve surgical goals.

Conclusion In our experience, osteocutaneous flaps (especially the OCRFFF) are preferred for complete autologous reconstruction of high and middle ACF defects. Low skull base defects are more difficult to reconstruct, and consideration of free muscle flaps (no bone) should be weighed as an option in this anatomic area.
Zeit gewinnen durch Delegation – Entwicklung braucht Freiraum
Authors: Freitag-Herse Barbara
Published: May 2018

In Ihrer Praxis sind Sie der Kapitän – Sie geben die Richtung vor, koordinieren die einzelnen Schritte, die zum Erreichen Ihrer Ziele notwendig sind, und bringen ihr Praxis-Schiff zum Schwimmen. Das heißt aber auch, dass Sie nicht jeden Handgriff selbst machen können. Um Zeit für die Weiterentwicklung Ihrer Praxis zu gewinnen, müssen Sie delegieren. Wir zeigen, wie das in nur sieben Schritten gelingen kann. Also: Lassen Sie Segel setzen und volle Fahrt voraus!
Governance Configurations for Inter-Organizational Coordination: A Study of Public Safety Networks
Authors: Fedorowicz Jane , Sawyer Steve , Tomasino Arthur
Published: May 2018

We focus on networked arrangements of digital resources that are shared among otherwise independent units to advance conceptual and empirical insights about their governance. We are motivated by the simple observation that, increasingly, independent organizations are engaging in shared activities, often relying on purpose-built digital infrastructures to support this move to inter-dependence. To advance current conceptualizations of networked governance, we draw on data from 42 public safety networks and use fuzzy-set qualitative comparative analysis. We do so because fsQCA allows us to account for the realities of inter-dependence among the concepts and variables we consider and to illuminate the multiple viable governance patterns that are possible. The results show the importance of network-level governance competencies to manage stakeholders and information infrastructure to achieve high effectiveness of PSN. Analysis makes clear that there exist five configurations of PSN governance practices that enable high levels of network governance effectiveness. Common to all these configurations are the network-level competence in managing both stakeholders and the digital infrastructure, suggesting these are necessary (but not sufficient) network-level governance competencies. Building from the analysis, we advance the role of specific network-level governance competencies, and the current conceptualization of network governance more broadly.
Hordeum vulgare and Hordeum maritimum respond to extended salinity stress displaying different temporal accumulation pattern of metabolites
Authors: Ferchichi Selma , Hessini Kamel , Dell'Aversana Emilia , D'Amelia Luisa , Woodrow Pasqualina , Ciarmiello Loredana F. , Fuggi Amodio , Carillo Petronia
Published: May 2018

Hordeum maritimum With. (= H. marinum Huds. subsp. marinum, 2n = 14) is a wild cereal present in the saline depressions of the Soliman and Kelbia Sebkhas, which contributes significantly to annual biomass production in Tunisia. This species is able to tolerate high NaCl concentrations at the seedling stage without showing symptoms of toxicity; however, the tolerance strategy mechanisms of this plant have not yet been unravelled. Our metabolite analysis, performed on leaves of H. maritimum during extended stress in comparison with Hordeum vulgare L. cv. Lamsi, has revealed an adaptive response of the wild species based on a different temporal accumulation pattern of ions and compatible metabolites. Further, wild and cultivated genotypes with contrasting salt-tolerant behaviour display different pattern of metabolites when salt stress is prolonged over 2 weeks. In particular, when exposed to up to 3 weeks of 200 mM NaCl salt stress, H. maritimum is able to maintain lower leaf concentrations of sodium and chloride, and higher concentrations of potassium compared with H. vulgare. This likely restricts sodium entry into plants at the root level, and uses the toxic ions, glycine betaine and low levels of proline for osmotic adjustment. Under prolonged stress, the accumulation of proline increases, reaching the highest levels in concomitance with the decrease of potassium to sodium ratio, the increase of hydrogen peroxide and decrease of chlorophylls. The modulation of proline accumulation over time can be interpreted as an adaptive response to long-term salinity. Moreover, once synthetised glycine betaine is transported but not metabolised, it can contribute together with proline to osmotically balance H. maritimum leaves and protect them from oxidative stress. The 2–3 week delay of H. maritimum in showing the symptoms of stress and damages compared with H. vulgare could be important in the survival of plants when soil salinity is not a permanent condition, but just a transient state of stress.
Effect of interfacial compounds on mechanical properties of titanium–steel vacuum roll-cladding plates
Authors: Yang De-han , Luo Zong-an , Xie Guang-ming , Misra R. D. K.
Published: May 2018

The titanium–steel clad plates were prepared by vacuum roll cladding. Ti–Fe compounds and TiC were observed at different cooling rates after rolling. Optical microscopy, electron microprobe analyser, X-ray diffraction and shear test studies were carried out to study the effect of Ti–Fe compounds and TiC on the ultimate microstructure and mechanical properties of titanium–steel clad plates. At a cooling rate of 6.2°C/min, TiC and Ti–Fe compounds seriously impacted the mechanical properties of the clad plate. At a cooling rate of 1.8°C/min, the thickness of the TiC layer was optimal much that the maximum shear strength of 296 MPa was obtained. At a cooling rate of 0.6°C/min, the thickness of the TiC layer was relatively thick, which affected the mechanical properties of clad plates.
SUPPLEMENTARY COMPARISON COOMET. M.P-S5 of hydraulic gauge pressure standards from 5 MPa to 34 MPa
Authors: Babayev E A , Klenovská Simona , Páviš Richard , Pražák Dominik
Published: May 2018

This report describes the results of bilateral inter laboratory comparison (BILC) denoted as COOMET.M.P-S5 (also known as supplementary comparison COOMET 723/AZ/17). The comparison measurements between the two participants, Czech Metrology Institute (CMI) (pilot laboratory) and Azerbaijan İnstitute of Metrology (AzMI), started in April 2017 and finished in June 2017. The transfer standards was a digital manometer, Crystal XP 2i with the gauge pressure range (0–34000) kPa.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
SimExTargId: a comprehensive package for real-time LC-MS data acquisition and analysis
Authors: Edmands William M B , Hayes Josie , Rappaport Stephen M
Published: May 2018

Liquid chromatography mass spectrometry (LC-MS) is the favored method for untargeted metabolomic analysis of small molecules in biofluids. Here we present SimExTargId, an open-source R package for autonomous analysis of metabolomic data and real-time observation of experimental runs. This simultaneous, fully automated and multi-threaded (optional) package is a wrapper for vendor-independent format conversion (ProteoWizard), xcms- and CAMERA- based peak-picking, MetMSLine-based pre-processing and covariate-based statistical analysis. Users are notified of detrimental instrument drift or errors by email. Also included are two shiny applications, targetId for real-time MS2 target identification, and peakMonitor to monitor targeted metabolites.

Availability and implementation

SimExTargId is publicly available under GNU LGPL v3.0 license at https://github.com/JosieLHayes/simExTargId, which includes a vignette with example data. SimExTargId should be installed on a dedicated data-processing workstation or server that is networked to the LC-MS platform to facilitate MS1 profiling of metabolomic data.

Supplementary information

Supplementary data are available at Bioinformatics online.
Drone Proliferation and the Challenge of Regulating Dual-Use Technologies
Authors: Schulzke Marcus
Published: May 2018

The controversy surrounding military drones has generated many proposals for restricting or prohibiting existing drones, additional autonomous variants that may be created in the future, and the sale of drones to certain markets. Moreover, there is broad interest in regulating military drones, with proposals coming not only from academics but also from NGOs and policymakers. I argue that these proposals generally fail to consider the dual-use character of drones and that they therefore provide inadequate regulatory guidance. Drones are not confined to the military but rather spread across international and domestic security roles, humanitarian relief efforts, and dozens of civilian applications. Drones, their component technologies, the control infrastructure, and the relevant technical expertise would continue to develop under a military-focused regulatory regime as civilian technologies that have the potential to be militarized. I evaluate the prospects of drone regulation with the help of research on other dual-use technologies, while also showing what the study of drones can contribute to that literature. Drones’ ubiquity in nonmilitary roles presents special regulatory challenges beyond those associated with WMDs and missiles, which indicates that strict regulatory controls or international governance frameworks are unlikely to succeed. With this in mind, I further argue that future research should acknowledge that drone proliferation across military and civilian spheres is unavoidable and shift focus to considering how drone warfare may be moderated by countermeasures and institutional pressures.
The Preventable Shunt Revision Rate: A Multicenter Evaluation
Authors: Dave Pooja , Venable Garrett T , Jones Tamekia L , Khan Nickalus R , Albert Gregory W , Chern Joshua J , Wheelus Jennifer L , Governale Lance S , Huntoon Kristin M , Maher Cormac O , Bruzek Amy K , Mangano Francesco T , Mehta Vivek , Beaudoin Wendy , Naftel Robert P , Basem Jade , Whitney Anna , Shimony Nir , Rodriguez Luis F , Vaughn Brandy N , Klimo Paul
Published: May 2018

BACKGROUND

The Preventable Shunt Revision Rate (PSRR) was recently introduced as a novel quality metric.

OBJECTIVE

To evaluate the PSRR across multiple centers and determine associated variables.

METHODS

Nine participating centers in North America provided at least 2 years of consecutive shunt operations. Index surgery was defined as new shunt implantation, or revision of an existing shunt. For any index surgery that resulted in a reoperation within 90-days, index surgery information (demographic, clinical, and procedural) was collected and a decision made whether the failure was potentially preventable. The 90-day shunt failure rate and PSRR were calculated per institution and combined. Bivariate analyses were performed to evaluate individual effects of each independent variable on preventable shunt failure followed by a final multivariable model using a backward model selection approach.

RESULTS

A total of 5092 shunt operations were performed; 861 failed within 90 days of index operation, resulting in a 16.9% combined 90-day shunt failure rate and 17.6% median failure rate (range, 8.7%-26.9%). Of the failures, 307 were potentially preventable (overall and median 90-day PSRR, 35.7% and 33.9%, respectively; range, 16.1%-55.4%). The most common etiologies of avoidable failure were infection (n = 134, 44%) and proximal catheter malposition (n = 83, 27%). Independent predictors of preventable failure (P < .05) were lack of endoscopy (odds ratio [OR] = 2.26), recent shunt infection (OR = 3.65), shunt type (OR = 2.06) and center.

CONCLUSION

PSRR is variable across institutions, but can be 50% or higher. While the PSRR may never reach zero, this study demonstrates that overall about a third of early failures are potentially preventable.
Importance of Fenestration Size for Definitive Treatment of a Quadrigeminal Arachnoid Cyst: Endoscopic Inspection of the Cyst and Surrounding Anatomy: 2-Dimensional Operative Video
Authors: Lechanoine François , Spennato Pietro , Ruggiero Claudio , Cinalli Giuseppe
Published: May 2018

Arachnoid cysts are fluid-filled sacs, located between the brain or spinal cord and the arachnoid membrane. Their prevalence in children is between 1% and 3%. Quadrigeminal arachnoid cysts represent 1% to 10% of them and are often associated with hydrocephalus, mostly by an obstructive mechanism, explained by compression of the tectum of the midbrain. When an indication for treatment is retained, 3 surgical options are available: microsurgical excision/fenestration, endoscopic fenestration, and shunt placement. Endoscopic treatment is considered the best compromise of definitive treatment with least surgical morbidity, especially because quadrigeminal cysts are located close to the midline, in intimate relationships with basal cisterns and ventricles. We here present the endoscopic treatment of a prenatally diagnosed quadrigeminal arachnoid cyst type III
1
with right lateral extension into the middle cerebral fossa, and associated hydrocephalus, treated at the age of 18 mo.

Step-by-step detail of surgical technique is presented in original anatomic conditions. Restoration of better cerebrospinal fluid pathways being the objective of this surgery, ventriculocystic, and cyst-cisternal fenestrations were made. Secondary obstruction of the cyst occurred a few months later, requiring further endoscopic treatment to obtain a larger fenestration that allowed good long-term clinical and radiological outcome. The key point of this video is to compare the 2 procedures, stressing the importance of the dimension of fenestrations, to ensure a long-term patency of both stomas.

The patient being a child, both parents gave their consent for publication and signed a form.
Microsurgical Resection of Spinal Cord Hemangioblastoma: 2-Dimensional Operative Video
Authors: Pojskić Mirza , Arnautović Kenan I
Published: May 2018

This video demonstrates microsurgical resection of spinal cord hemangioblastoma. Hemangioblastomas are rare, benign, highly vascularized tumors classified as grade I according to World Health Organization classification systems. About 3% of all intramedullary tumors are hemangioblastomas.
1,2
Spinal cord hemangioblastomas are either sporadic
3,4
or manifestations of von Hippel-Lindau (VHL) disease in 20% to 45% of patients.
5,6

 A 30-year-old male presented with sudden onset urinary incontinence. Magnetic resonance imaging showed contrast enhancing intramedullary tumor with adjacent cyst in T11, and syringomyelia extending to C1. Surgical resection followed rules that apply to resection of arteriovascular malformations: coagulation of arterial feeders precedes the coagulation of the draining vein, which is preserved until the end of surgery.
2,4,5,7,8

 First, posterior midline myelotomy was performed and the tumor cyst was drained in order to develop a dissection plane. Following this, we continuously separated dorsal nerve roots from the tumor nodule using microsurgical technique. The key step in tumor resection is devascularization of the tumor, achievable in 2 ways.
2,7,9-13
The circumferential detachment of the normal pia from the tumor pia is crucial in developing a plane of dissection. The coagulation and division of arterial feeders while preserving the drainage vein further devascularizes the tumor. Once the tumor mural nodule was detached from the spinal cord, the drainage vein was coagulated last and the tumor was removed. The patient fully recovered from his incontinence and was neurologically intact. Screening for VHL disease was negative.

 Written consent was obtained directly from the patient.
A Method for Cranial Nerve XI Silencing During Surgery of the Foramen Magnum Region: Technical Case Report
Authors: Southwell Derek G , Breshears Jonathan D , Lyon William R , McDermott Michael W
Published: May 2018

BACKGROUND AND IMPORTANCE

Skull base surgery involves the microdissection and intraoperative monitoring of cranial nerves, including cranial nerve XI (CN XI). Manipulation of CN XI can evoke brisk trapezius contraction, which in turn may disturb the surgical procedure and risk patient safety. Here we describe a method for temporarily silencing CN XI via direct intraoperative application of 1% lidocaine.

CLINICAL PRESENTATION

A 41-yr-old woman presented with symptoms of elevated intracranial pressure and obstructive hydrocephalus secondary to a hemangioblastoma of the right cerebellar tonsil. A far-lateral suboccipital craniotomy was performed for resection of the lesion. During the initial stages of microdissection, vigorous trapezius contraction compromised the course of the operation. Following exposure of the cranial and cervical portions of CN XI, lidocaine was applied to the course of the exposed nerve. Within 3 min, trapezius electromyography demonstrated neuromuscular silencing, and further manipulation of CN XI did not cause shoulder movements. Approximately 30 min after lidocaine application, trapezius contractions returned, and lidocaine was again applied to re-silence CN XI. Gross total resection of the hemangioblastoma was performed during periods of CN XI inactivation, when trapezius contractions were absent.

CONCLUSION

Direct application of lidocaine to CN XI temporarily silenced neuromuscular activity and prevented unwanted trapezius contraction during skull base microsurgery. This method improved operative safety and efficiency by significantly reducing patient movement due to the unavoidable manipulation of CN XI.
SHORT TERM NEONATAL OUTCOMES IN PREGNANCY INDUCED HYPERTENSION
Authors: Razak Abdul , Patel Waseemoddin , Durrani Naveed , McDonald Sarah , Shah Prakeshkumar , Mukerji Amit
Published: May 2018

BACKGROUND

Studies have demonstrated heterogeneity in association of pregnancy-induced hypertension (PIH) and respiratory outcomes or mortality in preterm infants, largely attributed to effect of gestation and antenatal steroids (survival bias).

OBJECTIVES

To comparatively evaluate mortality and short-term respiratory outcomes in preterm infants < 33 weeks GA born to mothers with and without PIH.

DESIGN/METHODS

This retrospective cohort study of preterm infants younger than 33 weeks’ gestation born between July 1, 2014 to June 30, 2016 was conducted at a tertiary academic hospital. Infants exposed to PIH (exposure) were matched to infants not exposed to PIH (control) in a 1:2 ratio, based on gestation, sex and antenatal steroid exposure status. The primary outcomes were respiratory index (RI), mortality and bronchopulmonary dysplasia (BPD). RI was defined as area under curve (AUC) for mean airway pressure and fraction inspired oxygen on invasive ventilation during first 72 hours.

RESULTS

Of 539 infants, 79 (exposure) were matched with 158 infants (control). Infants born to mothers with PIH had lower birth weight, more likely to delivered through caesarean section and less likely to exposed to chorioamnionitis compared to infants born to mothers without PIH. No differences in RI were noted in infants with (median 1854; IQR 186, 13901) or without PIH (median 1359; IQR 210, 11302) (P-value 0.63). On conditional regression analysis, PIH did not predict RI (adjusted risk 1.15; 95% C.I 0.69–1.90; P value 0.594). No association between PIH and death (OR 3.14; 95% C.I 0.76–13.0; P-value 0.11) was identified. PIH was significantly associated with BPD on univariate analysis (odds ratio (OR) 2.29; 95% C.I 1.02–5.17; P-value 0.046), but on regression analysis was not significant (adjusted OR 1.26; 95% C.I 0.38–4.19; P-value 0.7) (Table 1).

CONCLUSION

PIH was not associated with RI, mortality or BPD in this matched cohort. This contradicts from previous studies which may have been influenced with the survival bias. Further studies with larger samples are needed to confirm our results.
A RANDOMIZED CONTROLLED TRIAL: SUPRAPUBIC ASPIRATION VERSUS URINARY CATHETERIZATION IN THE NEONATAL INTENSIVE CARE UNIT
Authors: Moore Gregory , Momoli Franco , Agarwal Amisha , Agarushi Rula , Brophy Jason , Bariciak Erika
Published: May 2018

BACKGROUND

Urinary tract infection (UTI) is common in infants (10%). Urinary catheterization (UC) and supra-pubic aspiration (SPA) allow for sterile collection of urine. Some studies suggest SPA has a lower contamination rate than UC, however the optimal method of urine collection for culture remains unclear.

OBJECTIVES

To determine if there is: 1) a lower contamination rate in urine obtained by SPA assisted by bladder ultrasound versus UC in infants admitted to a neonatal intensive care unit (NICU); 2) a difference between procedures in: success rates for obtaining urine, short-term complication rates, and number of attempts required.

DESIGN/METHODS

A multicentre, unblinded, randomized controlled trial from 04/2013 to 05/2016. All gestational age (GA) infants greater than 72 hours of age investigated for UTI were eligible for randomization. Crossover to the other procedure could occur after 2 hours or 2 failed attempts. Target sample size was 165. Contamination was defined as growth of ≥2 microorganisms (SPA, UC) or growth <104 CFU/ml (UC). Primary analysis was by intention-to-treat.

RESULTS

Enrolment was stopped for futility. 906 families were approached with 151 providing consent. 50 infants were eligible for randomization with 47 randomized (SPA n=23, UC n=24). Table 1 shows participant demographics. UTI incidence was 13% for SPA, 8% for UC (p=0.67). Crossover rates were high: 56% for SPA; 21% for UC. No urine sample was obtained in 2 participants per group despite attempts. There was no statistically significant difference between the 2 groups in contamination rates (14% SPA, 18% UC, p=1.00). No short-term complications were reported in either group. Prior to crossover, there was no difference in the number of attempts (i.e. up to 2 attempts pre-crossover or to successfully obtain urine) per procedure (p=0.08); however, there was a difference in the success rates per procedure (44% SPA, 75% UC, p=0.04).

CONCLUSION

This trial found no difference in contamination rates between SPA and UC, while noting the low enrolment and high crossover rate. More procedural training (particularly for SPA) may ensure greater procedural confidence and success. Post-procedural consent could improve enrolment given that equipoise on the optimal urine collection method still exists.
EVALUATION OF THE USE OF SHARED DECISION MAKING DURING ANTENATAL COUNSELLING FOR ANTICIPATED EXTREMELY PRETERM BIRTH
Authors: Ding Sharon , Bijelic Vid , Daboval Thierry , Lemyre Brigitte , Dunn Sandra , Moore Gregory
Published: May 2018

BACKGROUND

Paediatric organizations advocate the use of shared decision making (SDM) during counselling with families facing the birth of an extremely preterm infant. A local guideline was implemented in 2015 to promote SDM.

OBJECTIVES

To determine the percentage of consultations where SDM was used.

DESIGN/METHODS

Single-center prospective cohort study from September 2015 to June 2017 with data collected on all women presenting to obstetrical triage at 22 + 0 to 25 + 6 wks GA. Decision coaching (determined from the written consultation) during consultations served as a surrogate marker for use of SDM. Fisher’s exact test was used to compare proportions; logistic regression was used to examine trend over time.

RESULTS

130 women presented. A neonatology consultation occurred in 92 cases. SDM was used at initial consultation in 85% (78/92) of cases: 84% (16/19) at 22 wks; 88% (22/25) at 23 wks; 96% (27/28) at 24 wks; 65% (13/20) at 25 wks. Secondary analyses indicate use of SDM declined over time (p=0.03) and parental ability to come to a decision was not significantly different between SDM and ‘non-SDM’ consults (89% in SDM vs 92% in non-SDM; p=0.7). At 22 wks, 89% (17/19) made a decision; at 23 wks, 80% (20/25); at 24 wks, 86% (24/28); at 25 wks, 85% (17/20) (p=0.84). Infant survival to NICU discharge, using denominator ‘infants who received resuscitation’, was 67% (2/3) at 22 wks; 33% (3/9) at 23 wks; 87% (13/15) at 24 wks; 89% (17/19) at 25 wks.

CONCLUSION

Implementation of an SDM framework is feasible with a resulting high percentage of consultations appearing to use SDM. The possible waning use of SDM and lower use at 25 wks GA requires further investigation. Recordings of consultations and parental perspectives to directly assess the use of SDM would provide greater insight into the applicability of SDM in this clinical setting.
Effect of Monitor Placement on Situational Awareness and Visual Attention in Simulated Neonatal Resuscitations
Authors: Yan Law Brenda Hiu , Cheung Po-Yin , van Os Sylvia , Fray Caroline , Schmölzer Georg
Published: May 2018

BACKGROUND

Decision-making in neonatal resuscitation depends on clinical evaluation, oxygen saturation and heart-rate. However, the position of vital signs monitors varies between institutions and might lead to obstructed or difficult to see displays, which might affect Health Care Provider (HCP) performance.

OBJECTIVES

To compare Situation Awareness (SA), Neonatal Resuscitation (NRP) checklist score, Visual Attention (VA) and participant satisfaction during simulated neonatal resuscitations using two vital signs monitors locations.

DESIGN/METHODS

NRP-trained HCPs were recruited from a tertiary Neonatal Intensive Care Unit and randomized to either central (eye-level on the radiant warmer) or peripheral (left of the warmer) monitor placement. Following an orientation scenario, each HCP lead a resuscitation requiring intubation and chest compressions with a high-fidelity manikin (Newborn HAL, Gaumard Scientific, Miami, FL) and a standardized assistant. Each scenario was paused at 3 predetermined points and the HCP was asked 5 SA questions at each pause, per the Situation Awareness Global Assessment Tool (SAGAT) format. Simulations were video-recorded to analyze SAGAT responses and performance rating using a modified NRP checklist. VA was recorded using eye-tracking glasses (Tobii Pro, Tobii Technology Inc., Falls Church, VA) worn by participants. Statistical analysis was performed using Mann-Whitney U test. A post-simulation survey examined user preference.

RESULTS

We randomized 30 HCPs; all were analyzed for SA and NRP checklist scores. Twenty-two eye-tracking recordings were of sufficient quality and analyzed. SAGAT scores (median 11/15 vs. 12/15, p=0.52) and NRP Checklist Scores (median 46/50, p=0.75) were similar between groups. Distribution of VA was also similar in both groups. In the post-simulation survey, all HCPs found central monitor placement convenient, compared with only 8/15 in peripheral placement.

CONCLUSION

During simulated neonatal resuscitation, HCPs found central monitor placement more convenient. However, no differences in accuracy of situation awareness responses, NRP checklist scores, or visual attention were found. Hi-fidelity simulation, SAGAT, and eye-tracking can be used to evaluate physical ergonomics of neonatal resuscitation.
DOES PRESENCE OF DOWN SYNDROME INCREASE RESPIRATORY SYNCYTIAL VIRUS (RSV) RELATED HOSPITALIZATION IN CHILDREN LESS THAN 2 YEARS OF AGE? A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Mitra Souvik , McCord Helen , El Azrak Mohamed , Paes Bosco
Published: May 2018

BACKGROUND

Down syndrome (DS) is associated with a number of immunologic abnormalities and congenital heart disease (CHD) which increase susceptibility to respiratory syncytial virus (RSV). However current position statements from the American Academy of Pediatrics and the Canadian Paediatric Society do not recommend routine RSV prophylaxis with Palivizumab to all infants with DS,

OBJECTIVES

To conduct a systematic reviewand meta-analysis of observational studies to compare RSV-related hospitalization (RSVH) rates, length of hospital stay(LOS), need for intensive care and assisted ventilation in DS children <2 years of age compared with children without DS.

DESIGN/METHODS

Data Sources:

The authors searched MEDLINE, Embase, CINAHL, reference lists of relevant articles, abstracts and conference proceedings, results of unpublished trials, and contacted the primary authors of relevant studies. Studies were included if data was provided on RSV-related hospitalization in children <2yr of age with and without DS.

Data extraction & Synthesis:

Two reviewers independently screened the search results, applied inclusion criteria and assessed methodological quality using the Newcastle-Ottawa Scale. Data was extracted and checked in duplicate.

Main outcomes & measures:

The primary outcome was RSV-related hospitalization. Secondary outcomes included length of hospital stay, need for intensive care and assisted ventilation. Sensitivity analysis was conducted for the primary outcome comparing DS infants without congenital heart disease (CHD) with non-DS infants.

RESULTS

19 cohort studies met the inclusion criteria. Ten studies involving 1,390,380 children were analyzed. DS-children had significantly higher RSVH compared to non-DS children (Relative Risk, 6.97; 95% CI, 6.01 to 8.08; I2=0%; Figure 1a). Among children hospitalized with RSV, need for assisted ventilation (RR, 5.82; 95% CI, 1.81 to 18.69; I2=84%; Figure 1b) and LOS (Mean difference, 2.28 days; 95% CI, 1.61 to 2.96 days; I2=0%; Figure 1c) were significantly higher in DS-children. The sensitivity analysis also confirmed that DS children without CHD had a significantly higher RSVH rate compared to non-DS children (RR, 6.31; 95% CI, 4.83 to 8.23;I2=0%; Figure 1d).

CONCLUSION

Compared to children without DS, RSV-related hospitalization, need for assisted ventilation and length of RSV-related hospital stay is significantly higher in children with DS in the first 2 years of life. The results of this systematic review should prompt a favorable recommendation for routine RSV prophylaxis in both healthy and medically compromised DS children aged <2years.
Exploiting metamerism to regulate the impact of a visual display on alertness and melatonin suppression independent of visual appearance
Authors: Allen Annette E , Hazelhoff Esther M , Martial Franck P , Cajochen Christian , Lucas Robert J
Published: May 2018

Objectives

Artificial light sources such as visual display units (VDUs) elicit a range of subconscious and reflex light responses, including increases in alertness and suppression of pineal melatonin. Such responses employ dedicated retinal circuits encompassing melanopsin photoreceptors. Here, we aimed to determine whether this arrangement can be exploited to modulate the impact of VDUs on melatonin onset and alertness without altering visual appearance.

Methods

We generated a five-primary VDU capable of presenting metameric movies (matched for color and luminance) but varying in melanopic-irradiance. Healthy human participants (n = 11) were exposed to the VDU from 18:00 to 23:00 hours at high- or low-melanopic setting in a randomized cross-over design and measured salivary melatonin and self-reported sleepiness at 30-minute intervals.

Results

Our VDU presented a 3× adjustment in melanopic-irradiance for images matched photometrically for color and luminance. Participants reported no significant difference in visual appearance (color and glare) between conditions. During the time in which the VDU was viewed, self-reported sleepiness and salivary melatonin levels increased significantly, as would be expected in this phase of the diurnal cycle. The magnitude of the increase in both parameters was significantly enhanced when melanopic-irradiance was reduced.

Conclusions

Our data demonstrate that melatonin onset and self-reported sleepiness can be modulated independent of photometric parameters (color and luminance) under a commonly encountered light exposure scenario (evening use of a VDU). They provide the first demonstration that the impact of light on alertness and melatonin production can be controlled independently of visual experience, and establish a VDU capable of achieving this objective.
The Political Incorporation of Undocumented Youth
Authors: Wong Tom K , García Angela S , Valdivia Carolina
Published: May 2018

This article develops and empirically tests a model of political incorporation for undocumented youth in the United States, focusing on nonvoting forms of political engagement. Using one of the ﬁrst nationwide surveys of undocumented millennials between the ages of 18 and 35 (n = 1,472), we show that (1) undocumented youth express much higher levels of political efficacy and participation than the literature on immigrant political incorporation leads us to expect, (2) membership in organizations that work on immigration-related issues is a main determinant of this sense of political efficacy, and (3) through mediation analysis, that organizational membership (the mediator) inﬂuences how political efficacy affects political participation, and not the other way around. The literature on immigrant political incorporation is vast, but precedent studies too often focus on formal acts of political participation, such as naturalization and voting, by those with lawful immigration status. With an analytical focus on youth without lawful immigration status, this article contributes to theoretical and empirical knowledge about how and to what extent undocumented youth become politically active and engaged despite the many obstacles that exist to their formal participation in politics.
What Is the Frequency of Early Dissociation of Bipolar Cups and What Factors Are Associated With Dissociation?
Authors: Lee Young-Kyun , Park Chan Ho , Ha Yong-Chan , Koo Kyung-Hoi
Published: May 2018

Background

Dissociation between a prosthetic cup and femoral head is a rare complication of bipolar hemiarthroplasty that usually occurs during closed reduction of a dislocated bipolar cup. The dissociation usually results in reoperation because closed reduction is challenging. To our knowledge, no study has reported on the frequency of bipolar cup-femoral head dissociation, and risk factors for dissociation are unknown.

Questions/purposes

The purposes of this study were (1) to evaluate the frequency of dissociation of prosthetic femoral heads from bipolar cups during manual reduction of a dislocated bipolar hemiarthroplasty; and (2) to explore in a preliminary fashion any prosthesis or patient factors that may be associated with dissociation.

Methods

From May 2003 to August 2016, 60 bipolar hemiarthroplasties were treated at three institutions as a result of early (within 3 years) dislocation after arthroplasty; of these, 55 could be identified and categorized in terms of the type of locking mechanism used, and these were the patients evaluated in this retrospective study. Because the index hemiarthroplasties were not performed exclusively at the three participating centers, we cannot comment on the indications for prosthesis selection in these patients (such as why some patients may have received components with single rather than double locking mechanisms). Manual reduction was attempted in all patients. Although 34 dislocations were manually reduced, 21 hips underwent surgical intervention because they could not be closed reduced (14 hips) or because of bipolar cup-femoral head dissociation (seven hips). We compared patients’ demographics and prosthetic factors between the dissociation group (n = 7) and the nondissociation group (n = 48).

Results

Bipolar cup-femoral head dissociation occurred in seven of 55 patients with dislocations (13%). Among the seven dissociated cups, six had a single polyethylene locking ring, whereas 20 of 48 nondissociation cups (42%) had the single locking ring (p = 0.044). We found no other patient or prosthesis factors associated with dissociation.

Conclusions

Bipolar cups with a single locking mechanism (rather than a double locking mechanism) may be associated with an increased risk of bipolar cup-femoral head dissociation. However, because we could not evaluate prosthesis indications in this study, and because our sample size was too small to control for potential confounding variables, future studies are needed to confirm this finding. All the same, because good alternatives are available, we do not recommend the use of this type of locking mechanism in bipolar hemiarthroplasty.

Level of Evidence

Level III, therapeutic study.
Involvement of Parents in the Care of Preterm Infants: A Pilot Study Evaluating a Family-Centered Care Intervention in a Chinese Neonatal ICU
Authors: Zhang Rong , Huang Rui-wena , Gao Xi-ronga , Peng Xiao-minga , Zhu Li-hui , Rangasamy Ramanathan , Latour Jos M.
Published: May 2018

Objectives:

To evaluate the effectiveness and safety of a family-centered care intervention in a Chinese neonatal ICU.

Design:

Pilot study using a randomized controlled trial design to inform a main randomized controlled trial study.

Setting:

Stand-alone tertiary children’s hospital in China with a 60-bed neonatal ICU serving as a regional neonatal ICU center.

Patients:

Premature infants (n = 61) and their parents (n = 110).

Interventions:

Parent education program followed by parents’ participation in care as primary caregiver until discharge for a minimum of 4 hours per day.

Measurements and Main Results:

Primary outcomes were infants’ weight gain at discharge, length of stay, and readmission. Parental outcomes were stress, anxiety, satisfaction, and clinical knowledge. Infants in family-centered care group (n = 31) had higher weight gain (886g vs 542g; p = 0.013), less neonatal ICU length of stay in days (43 vs 46; p = 0.937), and decreased readmission rate at 1 week (41.9 vs 70.0; p = 0.045) and at 1 month (6.5% vs 50%; p < 0.001) compared with the control group (n = 30). Total Mean Parental Stress and Anxiety scores were lower in the family-centered care group (42 vs 59; p ≤ 0.007), mean satisfaction rates in family-centered care group were higher compared with control group (96 vs 90; p < 0.001), and parents in the family-centered care group had better educational outcomes related to neonatal specialized care skills (p < 0.05).

Conclusions:

Involving parents in the care of their infant improved clinical outcomes of infants. Family-centered care also contributed to a better understanding of parent’s clinical education, decrease stress levels, and increased parental satisfaction. Our study suggests that involving parents in the daily care of their infants is feasible and should be promoted by neonatal ICU clinicians.
Structure and consistency of self-reported social contact networks in British secondary schools
Authors: Kucharski Adam J. , Wenham Clare , Brownlee Polly , Racon Lucie , Widmer Natasha , Eames Ken T. D. , Conlan Andrew J. K.
Published: May 2018

Self-reported social mixing patterns are commonly used in mathematical models of infectious diseases. It is particularly important to quantify patterns for school-age children given their disproportionate role in transmission, but it remains unclear how the structure of such social interactions changes over time. By integrating data collection into a public engagement programme, we examined self-reported contact networks in year 7 groups in four UK secondary schools. We collected data from 460 unique participants across four rounds of data collection conducted between January and June 2015, with 7,315 identifiable contacts reported in total. Although individual-level contacts varied over the study period, we were able to obtain out-of-sample accuracies of more than 90% and F-scores of 0.49-0.84 when predicting the presence or absence of social contacts between specific individuals across rounds of data collection. Network properties such as clustering and number of communities were broadly consistent within schools between survey rounds, but varied significantly between schools. Networks were assortative according to gender, and to a lesser extent school class, with the estimated clustering coefficient larger among males in all surveyed co-educational schools. Our results demonstrate that it is feasible to collect longitudinal self-reported social contact data from school children and that key properties of these data are consistent between rounds of data collection.
A dynamic power-law sexual network model of gonorrhoea outbreaks
Authors: Whittles Lilith K , White Peter J , Didelot Xavier
Published: May 2018

Human networks of sexual contacts are dynamic by nature, with partnerships forming and breaking continuously over time. Sexual behaviours are also highly heterogeneous, so that the number of partners reported by individuals over a given period of time is typically distributed as a power-law. Both the dynamism and heterogeneity of sexual partnerships are likely to have an effect in the patterns of spread of sexually transmitted diseases. To represent these two fundamental properties of sexual networks, we developed a stochastic process of dynamic partnership formation and dissolution, which results in power-law numbers of partners over time. Model parameters can be set to produce realistic conditions in terms of the exponent of the power-law distribution, of the number of individuals without relationships and of the average duration of relationships. Using an outbreak of antibiotic resistant gonorrhoea amongst men have sex with men as a case study, we show that our realistic dynamic network exhibits different properties compared to the frequently used static networks or homogeneous mixing models. We also consider an approximation to our dynamic network model in terms of a much simpler branching process. We estimate the parameters of the generation time distribution and offspring distribution which can be used for example in the context of outbreak reconstruction based on genomic data. Finally, we investigate the impact of a range of interventions against gonorrhoea, including increased condom use, more frequent screening and immunisation, concluding that the latter shows great promise to reduce the burden of gonorrhoea, even if the vaccine was only partially effective or applied to only a random subset of the population.
Detection of protein markers for autophagy, autolysis and apoptosis processes in aSaccharomyces cerevisiaewine flor yeast strain when forming biofilm
Authors: Moreno-García Jaime , Mauricio Juan Carlos , Moreno Juan , García-Martínez Teresa
Published: May 2018

Abstract

Yeast autophagy, autolysis and apoptosis are biological processes triggered by nutrient starvation conditions that usually take place in winemaking. Biological aging of Sherry wines constitutes an enological environment suitable for the induction of these mechanisms due to the scarcity of nutrients and formation of yeast social communities, i.e.; biofilm; however, few studies have been carried out in this regard. Here, we perform a proteomic analysis to detect any autolysis/autophagy/apoptosis protein markers and/or proteins potentially related to these processes under flor forming and fermentative conditions. The scarce presence of autophagy proteins in flor biofilm forming conditions, the existence of autophagy inhibitors (e.g. Pph21p), and high quantity of crucial proteins for autolysis and apoptosis, Pep4p and Mca1p, respectively; indicate that autophagy may be silenced while autolysis and apoptosis are activated when the yeasts are forming flor. This is the first time that autophagy, autolysis and apoptosis proteomes have been studied as a whole in flor yeast under film forming conditions to our knowledge.