bluuebunny/crossref_metadata_2025 huggingface dataset:
Suprasensory phenomena in those with a bipolar disorder
Authors: Parker Gordon , Paterson Amelia , Romano Mia , Granville Smith Isabelle
Published: March 2018

Objectives:

To increase awareness of the sensory changes experienced during hypo/manic and depressive states by those with a bipolar disorder and determine if the prevalence of such features is similar across differing bipolar sub-types.

Methods:

We interviewed 66 patients who acknowledged sensory changes during hypo/manic states. They were allocated to bipolar I, bipolar II and soft bipolar diagnostic categories and the prevalence of 10 differing sensory changes was quantified during hypo/manic and depressive phases.

Results:

Bipolar I patients were just as likely, if not more likely, to report suprasensory changes which typically involved enhancement of senses during hypo/manic phases and muting or blunting during depressive phases. The high prevalence of changes in intuition, empathy, appreciation of danger and predictive capacities suggests that these are more part of the intrinsic bipolar mood domain states and not necessarily suprasensory, while changes in primary senses of smell, taste, vision, touch and hearing appear to more commonly define the suprasensory domain.

Conclusions:

It is important for clinicians and patients with a bipolar disorder to be aware of non-psychotic, suprasensory phenomena. Identification of such features may aid diagnosis and also explain the recognised increased creativity in those with a bipolar condition.
Patients’ Interpersonal Communication Experiences in the Context of Type 2 Diabetes Care
Authors: Peltola Maija , Isotalus Pekka , Åstedt-Kurki Päivi
Published: March 2018

The aim of our study is to determine the relational communication characteristics of professional–patient communication situations that have either facilitated or impeded patients’ self-management. Conducted from the perspective of Finnish patients in the context of type 2 diabetes care, we used as our research methods an open e-survey and semistructured interviews. Data were analyzed using inductive qualitative content analysis. The critical incident technique was utilized throughout in all these methods. The results show that both positive and negative experiences described by patients were connected to four multidimensional relational communication characteristics: (a) building trust in the other party in the professional–patient relationship, (b) willingness to communicate, (c) emotional presence, and (d) appropriateness. Although the findings support the recommendations of earlier studies concerning individually tailored patient-centered care, acknowledging the characteristics in question can be used as a communication frame for constructing significant care relationships from the perspective of patients’ self-management.
Student’s Perceptions of School Safety
Authors: Williams Susan , Schneider Mallory , Wornell Cory , Langhinrichsen-Rohling Jennifer
Published: March 2018

This study examined the relationship of students’ perceptions of school safety and school avoidance related to feeling unsafe with predictor variables: bullying victimization, student/teacher/parent/administration relations, rule clarity and consistency, school physical environment (negative and positive), and student’s belongingness. In a public high school sample ( n = 585), 24.7% of students felt unsafe and 14.4% avoided school due to feeling unsafe during the past month. Being female and experiencing bullying was associated with feeling unsafe. However, after accounting for demographics and bullying victimization, perceptions of safety increased when students reported positive student and teacher relations, consistent rules, a clean school that is also crowded/noisy, and a sense of school belonging. Avoiding school because of safety concerns was related to decreased school belonging and teacher/student relationships, but not bullying. Focusing on enhancing the school climate/environment, facilitating student belongingness, and reducing bullying are ways school nurses can help promote safer schools.
Goldmann applanation tonometer versus ocular response analyzer for measuring intraocular pressure after congenital cataract surgery
Authors: Feizi Sepehr , Faramarzi Amir , Kheiri Bahareh
Published: March 2018

Purpose:

To compare intraocular pressure measured using the Goldmann applanation tonometer with that measured using the ocular response analyzer after congenital cataract surgery.

Methods:

This study included 113 eyes of 64 patients who underwent lensectomy and vitrectomy. In all, 36 eyes remained aphakic after surgery. Intraocular lens implantation was performed at the time of surgery in 47 eyes and secondarily in 30 eyes. Corneal hysteresis, corneal resistance factor, and cornea-compensated intraocular pressure were measured. The influences of independent factors on the difference between the cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer were investigated using linear regression analyses. Agreement between the two tonometers was investigated using the Bland and Altman and 95% limits of agreement analysis.

Results:

Central corneal thickness, corneal hysteresis, and corneal resistance factor were 591.2 ± 53.3 µm, 10.83 ± 2.27 mmHg, and 11.36 ± 2.14 mmHg, respectively. Cornea-compensated intraocular pressure (16.75 ± 4.82 mmHg) was significantly higher than intraocular pressure measured with Goldmann applanation tonometer (14.41 ± 2.27 mmHg, p < 0.001). Central corneal thickness (p = 0.02) and corneal hysteresis (p < 0.001) were identified as the main predictors of difference between cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer readings. A 95% limits of agreement for cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer was between −4.86 and 9.53 mmHg in the entire group. Cornea-compensated intraocular pressure showed the best agreement with intraocular pressure measured with Goldmann applanation tonometer in the primary pseudophakic subgroup as compared to the other subgroups.

Conclusion:

The Goldmann applanation tonometer and ocular response analyzer cannot be used interchangeably for measuring intraocular pressure after congenital cataract surgery. The difference between the cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer was primarily affected by central corneal thickness and corneal hysteresis. Among the subgroups, the primary pseudophakic subgroup had the thinnest cornea and the highest corneal hysteresis values and demonstrated the best agreement between the two tonometers.
Association of serum C1q tumour necrosis factor–related protein 9 with the severity of lower extremity peripheral arterial disease in type 2 diabetes patients
Authors: Jiang Wengao , Tang Qiang , Zhang Lei , Chao Yinxue , Hong Bing
Published: March 2018

Objective:

Recent studies have indicated the implication of C1q tumour necrosis factor–related protein 9 in vascular pathology of atherosclerosis. This study first investigated the association of C1q tumour necrosis factor–related protein 9 and the severity of lower extremity peripheral arterial disease in type 2 diabetes mellitus patients.

Methods:

A total of 200 patients with type 2 diabetes mellitus had ankle–brachial index examined in this cross-sectional study, 60 patients with ankle–brachial index of ⩽0.9 were diagnosed with peripheral arterial disease and further classified into mild, moderate and severe group with Vivid 7 diagnostic apparatus.

Results:

C1q tumour necrosis factor–related protein 9 and adiponectin were higher in diabetes mellitus with severe peripheral arterial disease than diabetes mellitus with mild and moderate peripheral arterial disease groups. After adjustment of conventional atherosclerosis risk factors, C1q tumour necrosis factor–related protein 9 ( r = −0.627, p < 0.001) and adiponectin ( r = −0.431, p = 0.003) were negatively correlated with the severity of peripheral arterial disease. Logistic regression analysis showed C1q tumour necrosis factor–related protein 9 was independently associated with the severity of peripheral arterial disease (odds ratio = 0.272, 95% confidence interval = 0.08–0.927, p = 0.037).

Conclusion:

Serum C1q tumour necrosis factor–related protein 9 is negatively and independently associated with the severity of peripheral arterial disease in type 2 diabetes mellitus patients, suggesting the protective potentials of C1q tumour necrosis factor–related protein 9 in the progression of peripheral arterial disease in human type 2 diabetes mellitus.
Poly(ε-caprolactone) electrospun nanofibers containing cinnamon essential oil nanocapsules: A promising technique for controlled release and high solubility
Authors: Amiri Sahar , Rahimi Azam
Published: March 2018

Nowadays, cinnamon essential oil is one of the most popular spices for food flavoring and also for medicinal uses such as anti-inflammation agent, but its low solubility, irritations, and allergic reactions limit its applications. To overcome these limitations, cinnamon essential oil-loaded nanocontainers were prepared via inclusion complexation between the cyclodextrins and cinnamon essential oil under two different conditions, i.e., at room temperature or under sonic energy. The resulting supramolecular nanocontainers were characterized by XRD, SEM, DSC, and FTIR. Successful insertion of cinnamon essential oil in the cyclodextrins’ cavity was confirmed by the significant differences between the FTIR, DSC, and XRD spectra of initial mixtures and those of the complexes. XRD results indicated that crystalline complexes adopted a mixture of head to head channel-type and cage conformation for cinnamon essential oil/cyclodextrins at various conditions. Solubility, bioavailability, and in vitro dissolution of obtained cinnamon essential oil nanocapsules were investigated, and results show that by encapsulation of cinnamon essential oil, solubility improved and its release is controllable. The solubility of cinnamon essential oil increased linearly as the concentration of cyclodextrins was increased, confirming the 1:1 stoichiometry of the complex. Electro-spun nanofibers of poly-ɛ-caprolactone containing cinnamon essential oil/cyclodextrins inclusion complex at various conditions indicated that these nanofibers did not show beading defect with controlled release of cinnamon essential oil.
Power Up for Health—Participants’ Perspectives on an Adaptation of the National Diabetes Prevention Program to Engage Men
Authors: Realmuto Lindsey , Kamler Alexandra , Weiss Linda , Gary-Webb Tiffany L. , Hodge Michael E. , Pagán José A. , Walker Elizabeth A.
Published: March 2018

The National Diabetes Prevention Program (NDPP) has been effectively translated to various community and clinical settings; however, regardless of setting, enrollment among men and lower-income populations is low. This study presents participant perspectives on Power Up for Health, a novel NDPP pilot adaption for men residing in low-income communities in New York City. We conducted nine interviews and one focus group with seven participants after the program ended. Interview and focus group participants had positive perceptions of the program and described the all-male aspect of the program and its reliance on male coaches as major strengths. Men felt the all-male adaptation allowed for more open, in-depth conversations on eating habits, weight loss, body image, and masculinity. Participants also reported increased knowledge and changes to their dietary and physical activity habits. Recommendations for improving the program included making the sessions more interactive by, for example, adding exercise or healthy cooking demonstrations. Overall, findings from the pilot suggest this NDPP adaptation was acceptable to men and facilitated behavior change and unique discussions that would likely not have occurred in a mixed-gender NDPP implementation.
Mechanical thrombectomy in MCA-mainstem occlusion in patients with low NIHSS scores
Authors: Kaschner Marius Georg , Caspers Julian , Rubbert Christian , Lande Raul , Kraus Bastian , Lee John-Ih , Gliem Michael , Jander Sebastian , Turowski Bernd
Published: March 2018

Introduction

While effectiveness of mechanical thrombectomy (MTE) in M1 segment occlusion is approved for patients with severe impairment, there is a lack of evidence for a potential benefit of MTE in patients with minor to moderate symptoms. The purpose of this study was to evaluate neurological outcome and occurrence of periprocedural complications after MTE in patients with low National Institutes of Health Stroke Scale (NIHSS) scores.

Materials and methods

A retrospective analysis of 1081 consecutive patients with anterior circulation ischemic stroke due to M1 occlusion detected by computed tomography angiography and treated with MTE at our hospital between February 2012 and November 2017 was performed. NIHSS, Barthel Index (BI) and modified Rankin Scale (mRS) scores between admission and discharge were compared with paired Mann–Whitney test, and recanalization rate and complications were assessed in patients with NIHSS ≤ 5 at admission.

Results

Thirty patients were included with a median NIHSS score of 4. NIHSS score (median: 4 vs. 1; p < 0.001), BI (median: 43 vs. 80; p < 0.001) and mRS (2 vs. 1; p < 0.001) showed significant improvement from admission to discharge after MTE. Recanalization rate was Thrombolysis in Cerebral Infarction (TICI) 2b to 3 in 29 of 30 patients (96.7%). One case of an intracerebral reperfusion hematoma (ECASS: PH2) required surgical treatment.

Conclusion

MTE might lead to a significantly improved clinical outcome also for patients with low NIHSS score due to M1 segment occlusion. Periprocedural complications appeared infrequently. These results encourage further evaluation of the benefit-risk profile of MTE compared to standard treatment in patients with low NIHSS scores in future randomized trials.
The road not taken: The EU as strategic American partner and a balancer to a rising China
Authors: Shepura Nathan
Published: March 2018

In the context of an increasingly competitive US–China rivalry, the intensity of which is unlikely to diminish in the foreseeable future, the EU finds itself with a unique challenge and a unique opportunity. It must reaffirm and assert its commitment to a strategic partnership with the US, foremost through increasing its cooperation with NATO and through a recommitment to forging ever-closer economic ties. The EU must also continue to offer bold, creative alternatives to a new bipolar global framework. In particular, these should emphasise the EU’s multilateral ties with partners around the world, as an important balance to potential conflict between the US and China.
Preparation and physical properties of functional barium carbonate nanostructures by a facile composite-hydroxide-mediated route
Authors: Shahid Tauseef , Arfan Muhammad , Zeb Aurang , BiBi Tayyaba , Khan Taj Muhammad
Published: March 2018

Recently, barium carbonate nanomaterial has been shown to be a proven versatile candidate for the catalysis and sensor applications. The catalytic and sensing efficiency can be improved by making barium carbonate composite with a suitable transition element. In this regard, the preparation of barium carbonate and its composite with nickel during the synthesis process is presented with the composite-hydroxide-mediated method, an effective, feasible, and low-temperature synthesis route. The nanomaterial produced is monitored for the structural and optical properties with various diagnostic methods. The X-ray diffraction results show the presence of orthorhombic structure of barium carbonate in both pure and 5% nickel samples. A mixed structure is formed with the phases of barium carbonate, Ba(NO3)2, and Ni(NO3)2 for the sample with 15% nickel. The average crystallite size estimated is in the range of 14–22 nm. The scanning electron microscope pictures captured on silicon (Si) covered with the product material reveal interesting rods, needle, and flower-type morphological features. The bandgap energy obtained by diffused reflectance spectroscopy is in the expected range of 5.48–5.71 eV. The proposed method seems effective to provide a feasible route for the synthesis of a broad range of nanomaterials for research purposes.
Foreign body ingestion and food impaction in adults: better to scope than to wait
Authors: Libânio Diogo , Garrido Mónica , Jácome Filipa , Dinis-Ribeiro Mário , Pedroto Isabel , Marcos-Pinto Ricardo
Published: March 2018

Background and objective

To assess clinical outcomes after foreign body ingestion and food impaction; to identify predictors of foreign body presence at the time of endoscopy.

Methods

A prospective study including consecutive adult patients with foreign body ingestion or suspected food impaction between May 2014 and August 2016.

Results

In total, 521 patients were included, 320 with foreign body ingestion and 201 with suspected food impaction. Food impaction patients were significantly older and more frequently had a history of oesophageal disease. The foreign body was encountered in the upper digestive tract in 43% of the patients with foreign body ingestion, and food impaction was confirmed in 87%. Older age (odds ratio (OR)year 1.04, 95% confidence interval (CI) 1.02–1.06) and early presentation (ORfirst six hours 4.41, 95% CI 2.24–8.66) were independent predictors of foreign body presence, while a history of psychiatric disease was an independent predictor of food impaction (OR 6.69, 95% CI 1.66–26.9). Successful endoscopic treatment was achieved in more than 90% of the cases, with adverse events occurring in fewer than 5%. Foreign body forceps was the preferred device in foreign body ingestion, while retrieval basket and mobilisation were preferred in food impaction. The need to use more than one instrument was significantly higher in food impaction.

Conclusion

Foreign bodies are encountered at endoscopy in almost half of the cases. Older age and earlier presentation are independent predictors of its presence. Given the high proportion of patients with foreign body at endoscopy and the low risk of complications, endoscopic evaluation is probably justified in the majority of cases.
Treatment Changes in General Practice Patients With Chronic Mental Disorders Following a Psychiatric–Psychosomatic Consultation
Authors: Linden Michael , Muschalla Beate , Noack Nils , Heintze Christoph , Doepfmer Susanne
Published: March 2018

Objective:

To determine whether a psychiatric–psychosomatic consultation can identify unmet treatment needs and improve treatment of patients with mental disorders in general practice.

Methods:

In 40 primary care practices, 307 consecutive primary patients who met criteria for chronic mental disorders were assessed by a psychiatric–psychosomatic consultant. After random assignment, general practitioners (GPs) were informed for half of the patients about the results of the assessment and received recommendations on how to improve treatment. Changes in treatment and patient status were reevaluated after 6 months.

Results:

Patients were mostly having depression, adjustment, or anxiety disorders, with 28.8% on sick leave. Contact with their respective GPs was longer than a year in 77.2% of cases. Patients had already received pharmacotherapy (60.9%), psychotherapeutic counseling by GPs themselves (27.7%), psychotherapy by specialists (73.9%), psychiatric outpatient care (57%), inpatient psychiatric treatment (12.1%), inpatient psychosomatic rehabilitation (ie, specialized behavioral medicine facilities for patients with work problems; 41.4%), and a broad spectrum of other diagnostic and therapeutic measures. Newly recommended interventions included leisure activities (42%), a new specialist psychotherapy (37.5%), or inpatient psychosomatic treatment (15.3%). Most recommendations were agreed upon by the GP. Nevertheless, there was only a limited increase in therapeutic actions 6 months later, and no statistically significant improvement in the status of patients.

Conclusion:

General practitioners undertake a broad spectrum of therapeutic interventions in patients with chronic mental disorders. According to our results, additional psychiatric–psychosomatic consultations can intensify treatment but does not significantly change the general course of chronic mental disorders.
Successful passive sentence comprehension among Danish adolescents with autism spectrum disorders
Authors: Jensen de López Kristine , Schroeder Kristen , Gavarró Anna
Published: March 2018

Background and aims

Language abilities vary greatly across children with autism spectrum disorders (ASD). In the present study, we investigate passive sentence comprehension, which has been underexplored among individuals with autism spectrum disorders and found to be delayed among other clinical populations. This study is the first to assess grammatical comprehension among Danish-speaking adolescents with autism spectrum disorders.

Methods

Fifteen Danish-speaking adolescents with autism (mean age: 14.9 years; age range: 13–18 years) participated in a picture selection task assessing comprehension of passive sentences relative to active sentences. We compared our findings for adolescents with autism spectrum disorders to those of 15 typically developing Danish-speaking adolescents matched for age and nonverbal reasoning as measured by the Matrix subtest of the WISC-IV/WAIS-IV. We also analyzed associations between passive comprehension and nonverbal reasoning.

Results

The results showed ceiling effects for both groups on all sentence types indicating that Danish adolescents with autism spectrum disorders do not face problems comprehending passive sentences. However, when considering variation within the autism spectrum disorder group, correct passive comprehension was highly significantly associated with nonverbal reasoning for the autism spectrum disorder group ( r = .75), while this was not the case for the typically developing adolescents. Analyses of the few errors produced showed a preference for Theta-role reversal errors in the autism spectrum disorder and the typically developing groups.

Conclusions

Danish-speaking adolescents with high-functioning autism spectrum disorders do not show impairment in passive sentence comprehension. Correlation analyses however show that for adolescents with autism spectrum disorders, passive sentence comprehension is associated with nonverbal reasoning. We discuss how these results can be viewed as consistent with the few previous studies on passive comprehension in individuals with autism spectrum disorders.

Implications

Our study provides additional cross-linguistic evidence that passive comprehension is not problematic for individuals with high-functioning autism spectrum disorders. The finding of the relationship between nonverbal reasoning and passive sentence comprehension may inform clinical best practices as children with autism spectrum disorders who underperform in measures of nonverbal reasoning may benefit from additional receptive language screening.
Guided Imagery Improves Mood, Fatigue, and Quality of Life in Individuals With Multiple Sclerosis: An Exploratory Efficacy Trial of Healing Light Guided Imagery
Authors: Case Laura K. , Jackson Paula , Kinkel Revere , Mills Paul J.
Published: March 2018

Multiple sclerosis is a disabling and progressive neurological disease that has significant negative effects on health-related quality of life. This exploratory efficacy study examined the effects of Healing Light Guided Imagery (HLGI), a novel variant of guided imagery, compared with a wait-list control in patients with relapsing-remitting multiple sclerosis. Changes in the Beck Depression Inventory, Fatigue Severity Scale, and Multiple Sclerosis Quality of Life instrument (physical and mental components) were compared between groups. Patients who completed HLGI (N = 9) showed significant reductions in depressed mood ( P < .05) and fatigue ( P < .01) and showed significant gains in physical ( P = .01) and mental ( P < .01) quality of life compared with journaling (N = 8). Our results suggest that HLGI can improve self-reported physical and mental well-being in patients with relapsing-remitting multiple sclerosis. Further research is needed to study the effectiveness of this therapy, as well as its mind-body mechanisms of action.
Enhancing functional platelet release in vivo from in vitro–grown megakaryocytes using small molecule inhibitors
Authors: Jarocha Danuta , Vo Karen K. , Lyde Randolph B. , Hayes Vincent , Camire Rodney M. , Poncz Mortimer
Published: March 2018

Key Points

Drugs shown to enhance megakaryocyte ploidy and size variably effect terminal injury and apoptosis of in vitro–grown megakaryocytes. The number of functional platelets released in vivo from infused megakaryocytes can be enhanced by these drug treatments.
Mental health reforms in the Czech Republic
Authors: Pec Ondrej
Published: March 2018

This paper describes the history and current provision of mental healthcare in the Czech Republic. After the political changes in 1989, there was an expansion of out-patient care and several non-governmental organisations began to provide social rehabilitation services, but the main focus of care still rested on mental hospitals. In recent years, mental health reform has been in progress, which has involved expanding community-based services and psychiatric wards of general hospitals, simultaneously with educational and destigmatisation programmes.
Modeling Diffuse Seismicity in Probabilistic Seismic Hazard Analysis: Treatment of Virtual Faults
Authors: Campbell Kenneth W. , Gupta Nitin
Published: March 2018

There is no scientific consensus on how finite virtual faults should be modeled in the probabilistic seismic hazard analysis of diffuse seismicity. Often pragmatic implementation decisions are made as a matter of convenience or computational efficiency. To better understand how differences in modeling virtual faults impact seismic hazard, we evaluated several methods of modeling such faults. For our preferred model, we test the sensitivity of the hazard to differences in fault discretization density, number of random azimuths, and cutoff distance. We propose a new computationally efficient method of modeling the random orientation of virtual faults by holding the fault plane fixed in space and rotating a virtual site around the source grid point. We show that there can be relatively large differences in seismic hazard, depending on how virtual faults are modeled, and provide guidance on how virtual-fault parameters should be selected in order to achieve a specified degree of accuracy.
Adjustment Factors to Account for the Effect of Bridge Deck Horizontal Curvature on the Seismic Response of Concrete Box-Girder Bridges in California
Authors: Mangalathu Sujith , Jeon Jong-Su
Published: March 2018

This research suggests adjustment factors to account for the effect of bridge deck horizontal curvature on the probabilistic seismic demand model (PSDMs) and fragility curves of concrete box-girder bridges in California. For this purpose, typical configurations of horizontally curved bridges in California are selected to create detailed three-dimensional (3-D) probabilistic bridge models with different levels of bridge deck horizontal curvature. Simulation results from the nonlinear time history analysis (NLTHA) of bridges are used to compare the PSDM of individual bridge components using a statistical technique called analysis of covariance (ANCOVA). Comparison results are used to group bridge classes and to suggest adjustment factors. Grouping results indicate that the PSDMs of unseating and bearing displacement are statistically significant for bridges with different levels of deck horizontal curvature. The effect of deck curvature and the use of the modification factors are demonstrated in this paper through the generation of fragility curves.
Factors Associated With Delays in Obtaining Cancer Care in Botswana
Authors: Bhatia Rohini , Rayne Sarah , Rate William , Bakwenabatsile Lame , Monare Barati , Narasimhamurthy Mohan , Dryden-Peterson Scott , Grover Surbhi
Published: March 2018

Abstract 61

Purpose

As life expectancy increases with widespread access to HIV treatment, cancer has become a leading cause of death in Botswana. Delays in the diagnosis and treatment of cancer can lead to the development of late-stage disease with poor survival. These delays represent a multifaceted problem that is attributable to patient, provider, and systemic factors. We aimed to quantify the delay intervals from symptom onset to treatment start among patients with cancer in Botswana as well as to understand knowledge, attitudes, and fears associated with these intervals.

Methods

From December 2015 to January 2017, we surveyed patients who were seen in an oncology clinic in Gaborone, Botswana. We calculated the proportions of patients who experienced delays in appraisal (between detecting symptoms and perceiving a reason to discuss with a provider, defined as > 1 month), getting help (between deciding to discuss and the first consultation with a provider, defined as > 1 month), diagnosis (between first consultation and receiving a diagnosis, defined as > 3 months), and treatment (between diagnosis and starting treatment, defined as > 2 months). We looked at the association of covariates, including beliefs and stigmas about cancer, with these delays.

Results

Among 214 patients with cancer who completed the survey, median age at diagnosis was 46 years, and the most common cancer was cervical (42.2%). Of patients, 81.3% were female, 60.7% were HIV infected, and 57.1% presented with advanced cancer (stage III and IV). Of patients, 25.7% experienced a delay in appraisal, 35.5% in getting help, 63.1% in diagnosis, and 76.85% in treatment. Patient income, education, and age were not associated with delays; however, patients who lived with larger families presented faster (odds ratio [OR], 0.89; P = .023). In multivariable analysis, males were more likely to experience an appraisal delay (OR, 2.31; P = .02). Patients with Kaposi’s sarcoma were more likely to have an appraisal delay (OR, 9.77; P < .001), whereas patients with breast cancer were more likely to have a treatment delay (OR, 9.12; P < .001). Patients who felt their symptoms were less serious were more likely to experience an appraisal delay (OR, 2.49; P = .02).

Conclusion

Nearly all patients who were surveyed experienced a delay in obtaining cancer care in Botswana. In a setting in which care is provided to patients without charge, cancer type and male sex were more important predictors of delays than socioeconomic factors. Improving cancer awareness by families, patients, and primary providers could reduce delays in cancer care.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Bilateral Adrenalectomy in Congenital Adrenal Hyperplasia: A Systematic Review and Meta-Analysis
Authors: MacKay Diana , Nordenström Anna , Falhammar Henrik
Published: March 2018

Context

Management of congenital adrenal hyperplasia (CAH) involves suppression of the hypothalamic–pituitary–adrenal axis using supraphysiological doses of exogenous glucocorticoids. This can pose a challenge, with Cushing syndrome a frequent complication of adequate suppression. Bilateral adrenalectomy, with subsequent replacement of glucocorticoids and mineralocorticoids at physiological doses, has been proposed as an alternative therapeutic strategy.

Objective

To review the outcomes after bilateral adrenalectomy for CAH.

Data Sources

A systematic search of PubMed/MEDLINE and Web of Science, identifying relevant reports published up to 10 January 2018.

Study Selection

Case reports or case series were included if they reported individual patient data from patients with CAH who had undergone bilateral adrenalectomy.

Data Extraction

Information regarding the following was extracted: first author, country, sex, age at adrenalectomy, year of adrenalectomy, diagnosis, molecular abnormality, pre- and postoperative biochemistry, pre- and postoperative medications, pre- and postoperative body mass index, indication for adrenalectomy, surgical technique, gross and microscopic adrenal characteristics, follow-up duration, and short- and long-term postoperative outcomes.

Data Synthesis

We identified 48 cases of bilateral adrenalectomy for CAH, with patients aged from 4 months to 56 years at surgery. The most common indication for surgery was the inability to control hyperandrogenism/virilization and/or Cushing syndrome (n = 30; 62%). Most patients (n = 34; 71%) reported symptomatic improvement postoperatively, with some cases of short-term (n = 5; 10%) and long-term (n = 13; 27%) adverse outcomes.

Conclusions

Bilateral adrenalectomy for CAH appears to be a reasonable therapeutic option for carefully selected patients who have had unsatisfactory outcomes with conventional medical management.
Percutaneous Dilatational Tracheostomy Using Tube Exchanger
Authors: Ronen Ohad , Gurevich Alexander , Ivry Shimon , Altman Edward , Kukuev Evgeni
Published: March 2018

We describe a modified technique for percutaneous dilatational tracheostomy using a 15F tube exchanger or Eschmann catheter. A retrospective review of 1180 procedures using this modified technique demonstrated it to be effective with a failure rate of only 0.25% (3 patients). Moreover, it provides an additional safeguard with the ability to rapidly reintroduce the endotracheal tube into the trachea guided by the exchange catheter in the event of accidental extubation during the procedure. This technique needs no additional special devices or equipment (eg, a bronchoscope). However, a prospective study is needed to better define its complication rate.
Thrombophlebitis und Varikothrombose: Wann wie therapieren?
Authors: Woitalla-Bruning J.
Published: March 2018

Im Allgemeinen wird die Thrombophlebitis als eine Thrombose und Entzündung der oberflächlichen Venen und ihrer Umgebung definiert. Da sie pathophysiologische und histologische Gemeinsamkeiten mit der tiefen Venenthrombose aufweist, wird sie neuerdings auch als oberflächliche Venenthrombose (OVT) bezeichnet. Man unterscheidet die OVT in primär gesunden Venen (Thrombophlebitis) von einer Varikothrombose, bei der es sich um eine Thrombose in varikös veränderten Venen handelt. Die OVT ist mit einer Prävalenz von 5,3% eine häufige Erkrankung. Sie tritt in 90 % der Fälle an den unteren Extremitäten auf und ist in bis zu 30% der Fälle mit einer tiefen Venenthrombose assoziiert, seltener mit einer Lungenembolie. In einigen Fällen sind auch tiefe Beinvenenthrombosen an mehreren Lokalisationen gleichzeitig beschrieben. Zur initialen Diagnostik sollte aus diesem Grund immer eine Duplexsonographie durchgeführt werden, um Lokalisation und Ausmaß der Thrombose exakt lokalisieren zu können. Die Therapie richtet sich nach Lokalisation und Ausdehnung der OVT. Die Therapiemöglichkeiten umfassen konservative sowie operative Maßnahmen. Einzig zugelassenes Medikament zur Therapie der OVT ist Fondaparinux. Niedermolekulare Heparine sind wirksam. Da die OVT Folge einer ernsthaften Grunderkrankung sein kann, sollte insbesondere bei Verdacht auf eine Thrombophlebitis oder bei rezidivierender Varikothrombose an eine Tumorsuche gedacht und bei jüngeren Patienten eventuell ein Thrombophilie Screening durchgeführt werden.
Evaluating disparities in the U.S. technology transfer ecosystem to improve bench to business translation
Authors: Weis James , Bashyam Ashvin , Ekchian Gregory J. , Paisner Kathryn , Vanderford Nathan L.
Published: March 2018

Background: A large number of highly impactful technologies originated from academic research, and the transfer of inventions from academic institutions to private industry is a major driver of economic growth, and a catalyst for further discovery. However, there are significant inefficiencies in academic technology transfer. In this work, we conducted a data-driven assessment of translational activity across United States (U.S.) institutions to better understand how effective universities are in facilitating the transfer of new technologies into the marketplace. From this analysis, we provide recommendations to guide technology transfer policy making at both the university and national level.

Methods: Using data from the Association of University Technology Managers U.S. Licensing Activity Survey, we defined a commercialization pipeline that reflects the typical path intellectual property takes; from initial research funding to startup formation and gross income. We use this pipeline to quantify the performance of academic institutions at each step of the process, as well as overall, and identify the top performing institutions via mean reciprocal rank. The corresponding distributions were visualized and disparities quantified using the Gini coefficient.

Results: We found significant discrepancies in commercialization activity between institutions; a small number of institutions contribute to the vast majority of total commercialization activity. By examining select top performing institutions, we suggest improvements universities and technology transfer offices could implement to emulate the environment at these high-performing institutions.

Conclusion: Significant disparities in technology transfer performance exist in which a select set of institutions produce a majority share of the total technology transfer activity. This disparity points to missed commercialization opportunities, and thus, further investigation into the distribution of technology transfer effectiveness across institutions and studies of policy changes that would improve the effectiveness of the commercialization pipeline is warranted.
Skin health: eczema and inflammatory dermatoses
Authors: Peters Jill
Published: March 2018

Jill Peters discusses skin health and integrity in the care home setting: she outlines the most common forms of eczema and other inflammatory conditions seen in older people and advises on prevention and treatment
Assessing and managing venous leg ulcers
Authors: Anderson Irene
Published: March 2018

Lower limb problems are relatively common in older people and are made worse when there is reduced mobility and one or more comorbidities. This article aims to revise the aetiology of venous ulceration and review the principles of treatment
A workforce competency framework for enhanced health
Authors: Thompson Juliana , Tiplady Sue , McNall Anne , Murray Jane , Cook Glenda , Hodgson Phil , Bainbridge Lesley
Published: March 2018

Due to the complex needs in the older care home population, it is essential to develop the right workforce. Juliana Thompson et al explore the development of a workforce competency framework that cuts across professional, organisational and sector boundaries.
Informed consent; legal and ethical considerations
Authors: Smith Angela , Parkhouse Julia
Published: March 2018

Angela Smith and Julia Parkhouse examine the principle of informed consent being given by residents in care homes in respect of their care and treatment and advise staff on how to comply with the rules
Understanding the latest CQC Assessment Framework
Authors: Hannah Laura
Published: March 2018

What are the new Care Quality Commission (CQC) assessment frameworks and how can a home prepare for them? Solicitor Laura Hannah, an expert in health and social care regulation and the CQC inspection regime, looks at how they could affect care homes
Issues with the financial model of care homes
Authors: Frankova Helena
Published: March 2018

The current financial model of the care home market is not sustainable, argues Helena Frankova. She addresses the problems faced by the sector and how both government and care home operators can do more to fill the funding gap
Completing the NMC revalidation process
Authors: Ashurst Adrian
Published: March 2018

Adrian Ashurst discusses the importance of registered nurses completing the Nursing and Midwifery Council (NMC) revalidation, explains the process and advises on how to adhere to the guidelines
Active learning in your lessons
Authors: Burnage Steve
Published: March 2018

Active learning focuses on how students learn, not just on what they learn. Continuing his regular series, Steve Burnage talks us through CPD ideas that can be adapted for your school. He will offer a template for a 45-minute workshop, with free handouts and slides available on our website. This instalment looks at active learning
Rising incidence of thyroid cancer in Singapore not solely due to micropapillary subtype
Authors: Shulin JH , Aizhen J , Kuo SM , Tan WB , Ngiam KY , Parameswaran R
Published: March 2018

Introduction

The annual incidence of thyroid cancer is known to vary with geographic area, age and gender. The increasing incidence of thyroid cancer has been attributed to increase in detection of micropapillary subtype, among other factors. The aim of the study was to investigate time trends in the incidence of thyroid cancer in Singapore, an iodine-sufficient area.

Materials and methods

Data retrieved from the Singapore National Cancer Registry on all thyroid cancers that were diagnosed from 1974 to 2013 were reviewed. We studied the time trends of thyroid cancer based on gender, race, pathology and treatment modalities where available.

Results

The age-standardised incidence rate of thyroid cancer increased to 5.6/100,000 in 2013 from 2.5/100,000 in 1974. Thyroid cancer appeared to be more common in women, with a higher incidence in Chinese and Malays compared with Indians. Papillary carcinoma is the most common subtype. The percentage of papillary microcarcinoma has remained relatively stable at around 38% of all papillary cancers between 2007 and 2013. Although the incidence of thyroid cancer has increased since 1974, the mortality rate has remained stable.

Conclusion

This trend of increase in incidence of thyroid cancer in Singapore compares with other published series; however, the rise seen was not solely due to micropapillary type. Thyroid cancer was also more common in Chinese and Malays compared with Indians for reasons that needs to be studied further.
Contributory factors in surgical incidents as delineated by a confidential reporting system
Authors: Mushtaq F , O’Driscoll C , Smith FCT , Wilkins D , Kapur N , Lawton R
Published: March 2018

Background

Confidential reporting systems play a key role in capturing information about adverse surgical events. However, the value of these systems is limited if the reports that are generated are not subjected to systematic analysis. The aim of this study was to provide the first systematic analysis of data from a novel surgical confidential reporting system to delineate contributory factors in surgical incidents and document lessons that can be learned.

Methods

One-hundred and forty-five patient safety incidents submitted to the UK Confidential Reporting System for Surgery over a 10-year period were analysed using an adapted version of the empirically-grounded Yorkshire Contributory Factors Framework.

Results

The most common factors identified as contributing to reported surgical incidents were cognitive limitations (30.09%), communication failures (16.11%) and a lack of adherence to established policies and procedures (8.81%). The analysis also revealed that adverse events were only rarely related to an isolated, single factor (20.71%) – with the majority of cases involving multiple contributory factors (79.29% of all cases had more than one contributory factor). Examination of active failures – those closest in time and space to the adverse event – pointed to frequent coupling with latent, systems-related contributory factors.

Conclusions

Specific patterns of errors often underlie surgical adverse events and may therefore be amenable to targeted intervention, including particular forms of training. The findings in this paper confirm the view that surgical errors tend to be multi-factorial in nature, which also necessitates a multi-disciplinary and system-wide approach to bringing about improvements.
Successful endoscopic management of a persistent bronchobiliary fistula with Histoacryl®/Lipiodol® mixture
Authors: Pinsker N , Papoulas M , Sodergren M , Harrison P , Heaton N , Menon K
Published: March 2018

Introduction

A bronchobiliary fistula (BBF) following liver directed therapy (resection/ablation) is a rare complication in which an abnormal communication between the biliary tract and bronchial tree is formed. This case report describes the successful management of a persistent BBF following multiple liver wedge resections and microwave ablation in a patient with a metastatic neuroendocrine tumour of the terminal ileum.

Case history

A 69-year-old man presented with unexplained weight loss and was subsequently diagnosed with a neuroendocrine tumour of the terminal ileum and liver metastasis. Following elective right hemicolectomy and multiple bilobar liver wedge resections combined with liver microwave ablation, he developed an early bile leak. A month later, a right subphrenic collection was identified and four months following surgery, biloptysis was noted. Numerous attempts with endoscopic retrograde biliary drainage (ERBD) failed to achieve sufficient drainage. The patient was treated successfully with endoscopic injection of a mixture of Histoacryl® glue (B Braun, Sheffield, UK) and Lipiodol® (Guerbet, Solihull, UK). There was no evidence of the BBF one year following intervention.

Conclusions

This novel approach for persistent BBF management using endoscopic Histoacryl® glue embolisation of the fistula tract should be considered either as an adjunct to ERBD or when biliary tract decompression by drainage and/or sphincterotomy fails, prior to proceeding with surgical interventions.
The changing practice of transurethral resection of the prostate
Authors: Young MJ , Elmussareh M , Morrison T , Wilson JR
Published: March 2018

Introduction

Transurethral resection of the prostate (TURP) is considered the gold standard surgical treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The number of TURPs performed has declined significantly over the last three decades owing to pharmaceutical therapy. TURP data from a single institution for the years 1990, 2000 and 2010 were compared to assess the difference in performance.

Methods

A retrospective analysis was undertaken of all patients who underwent TURP between January and December 2010. These findings were compared with historical data for the years 1990 and 2000: 100 sets of case notes were selected randomly from each of these years.

Results

The number of TURPs performed fell from 326 in 1990 to 113 in 2010. The mean age of patients increased from 70.6 years to 74.0 years. There was also a significant increase in the mean ASA grade from 1.9 to 2.3. The most common indication for TURP shifted from LUTS to acute urinary retention. No significant change in operating time was observed. The mean resection weight remained constant (22.95g in 1990, 22.55g in 2000, 20.76g in 2010). A reduction in transfusion rates was observed but there were higher rates of secondary haematuria and bladder neck stenosis. There was an increase from 2% to 11.5% of patients with long-term failure to void following TURP.

Conclusions

The number of TURPs performed continues to decline, which could lead to potential training issues. Urinary retention is still by far the most common indication. However, there has been a significant rise in the percentage of men presenting for TURP with high pressure chronic retention. The number of patients with bladder dysfunction who either have persistent storage LUTS or eventually require long-term catheterisation or intermittent self-catheterisation has increased markedly, which raises the question of what the long-term real life impact of medical therapy is on men with LUTS secondary to benign prostatic hyperplasia who eventually require surgery.