bluuebunny/crossref_metadata_2025 huggingface dataset:
Skeletal Dysplasias
Authors: Clark Robin D. , Curry Cynthia J.
Published: February 2019

This chapter reviews the more common viable skeletal dysplasias. The disorders discussed here include the less severe type II collagenopathies, spondyloepiphyseal dysplasia and Kniest dysplasia. The many types of chondrodysplasia punctata, both the environmental and genetic types are reviewed. Syndromes and disorders with vertebral abnormalities are enumerated including spondylothoracic dysplasia. Important metaphyseal dysplasias with immune dysfunction such as Cartilage-hair hypoplasia are covered as well a few of the skeletal ciliopathies including Jeune syndrome and Ellis Van Creveld syndrome. Diastrophic dysplasia and the underdiagnosed Three M syndrome are discussed. The clinical approach and testing strategies are reviewed. The clinical case presentation features an infant, born to a mother with mixed connective tissue disease, with chondrodysplasia punctata caused by transplacental passage of maternal autoantibodies
Skeletal Dysplasias
Authors: Clark Robin D. , Curry Cynthia J.
Published: February 2019

This chapter reviews the incidence, genetics, and classification of osteogenesis imperfecta (OI) and other bone fragility syndromes that can present with fractures in the newborn. A few rare recessive disorders including Stuve Wiedemann syndrome are discussed briefly. Distinquishing clinical features are highlighted. The utility of gene panels in the differential diagnosis of these disorders is presented. Therapeutic advances including the use of bisphosphonates and asfotase alfa in disorders with increased fracture risk can be expected to increase. Non-accidental injury, is discussed briefly as is the differential diagnosis of rickets, including that associated with prematurity. The clinical case presentation features an infant with osteogenesis imperfecta type IV.
Skin
Authors: Clark Robin D. , Curry Cynthia J.
Published: February 2019

This chapter reviews miscellaneous congenital skin disorders, including albinism, pigmentary dysplasias, and cutis aplasia. Oculocutaneous albinism I is the form of albinism most likely to be diagnosed in the neonate. Other forms present later in infancy or childhood. Prader-Willi syndrome and Angelman syndrome children are frequently hypopigmented due to involvement of the OCA2 locus. Localized hypopigmentation is seen in several forms of Waardenburg syndrome. Cutis aplasia can have a myriad of causes, some benign and others associated with serious chromosomal disorders or syndromes. Pigmentary mosaicism for chromosomal abnormalities or single gene variantschanges cause streaky pigmentarytion changes previously termed hypomelanosis of Ito. Microarray, gene sequencing panels or single gene testing in a tissue other than blood may establish the diagnosis in those syndromes that are mosaic. A clinical case presentation features an infant with oculocutaneous albinism type I.
Open Resection versus Laser Interstitial Thermal Therapy for the Treatment of Pediatric Insular Epilepsy
Authors: Hale Andrew T , Sen Sonali , Haider Ali S , Perkins Freedom F , Clarke Dave F , Lee Mark R , Tomycz Luke D
Published: February 2019

BACKGROUND

Various studies suggest that the insular cortex may play an underappreciated role in pediatric frontotemporal/parietal epilepsy. Here, we report on the postsurgical outcomes in 26 pediatric patients with confirmed insular involvement by depth electrode monitoring.

OBJECTIVE

To describe one of the largest series of pediatric patients with medically refractory epilepsy undergoing laser interstitial thermal therapy (LITT) or surgical resection of at least some portion of the insular cortex.

METHODS

Pediatric patients in whom invasive insular sampling confirmed insular involvement and who subsequently underwent a second stage surgery (LITT or open resection) were included. Complications and Engel Class outcomes at least 1 yr postsurgery were compiled as well as pathology results in the open surgical cases.

RESULTS

The average age in our cohort was 10.3 yr, 58% were male, and the average length of follow-up was 2.43 ± 0.20 (SEM) yr. A total of 14 patients underwent LITT, whereas 12 patients underwent open resection. Complications in patients undergoing either LITT or open resection were mostly minimal and generally transient. Forty-three percent of patients who underwent LITT were Engel Class I, compared to 50% of patients who underwent open insular resection.

CONCLUSION

Both surgical resection and LITT are valid management options in the treatment of medically refractory insular/opercular epilepsy in children. Although LITT may be a less invasive alternative to craniotomy, further studies are needed to determine its noninferiority in terms of complication rates and seizure freedom, especially in cases of cortical dysplasia that may involve extensive regions of the brain.
Modern Japanese Buddhist Philosophy
Authors: Kopf Gereon
Published: February 2019

Recent years have seen an increased presence of Japanese Buddhist philosophy in the world of Anglophone scholarship. In 2013 the first issue of the Journal of Japanese Philosophy (SUNY Press) appeared, in 2015 the first issue of the Journal of Buddhist Philosophy (SUNY Press) was released, and in 2016 the first issue of the European Journal of Japanese Philosophy (Chisokudō Publications) was published. Japanese Buddhist philosophy emerges and exists at the intersection of Buddhist and Japanese philosophy. The history of the term “Buddhist philosophy” in Japan commences with the encounter between the Japanese and Euro-American intellectual traditions during the Meiji period (1868–1912). As is well known, Nishi Amane 西周 (b. 1829–d. 1897) coined the Japanese word for “philosophy”: tetsugaku哲学. He utilized this concept to refer to European and American philosophy and to distinguish these traditions from the works of the Japanese traditions, including Japanese Buddhism, which he classified as “thought” (shisō思想). Today’s understanding of “philosophy” has somewhat shifted. Rein Raud suggests that “[w]hat matters” for philosophers . . . is “interpretations, their quality, their productivity for further thought.” “Buddhist philosophy,” Dale Wright proposes, “is that form of reflection [the effort to ‘understand how things in the broadest possible sense of the term hang together’] as practiced by participants who are Buddhists”; that is, “philosophy practiced by those who regard themselves as Buddhist.” By the same token, Inoue Enryō 井上円了 (b. 1858–d. 1919) asserted with the very title of his 1893 work Buddhist Philosophy (Bukkyō tetsugaku仏教哲学) that there is Buddhist philosophy in Japan, premodern, modern, and contemporary. This bibliographic essay includes Anglophone texts in the Japanese Buddhist tradition published after the Meiji restoration (1868 ce). The titles are divided into four categories: (1) Translations, (2) Collections, (3) English-Language Works, and (4) Crossover Works. Unfortunately, a lot of brilliant philosophy produced in Japan is only accessible in the Japanese language. Recent years have seen exciting trends and stimulating ideas in the field of Japanese Buddhist philosophy. The disaster of 3/11, for example, has even given rise to the category of “post-Fukushima” philosophy. The purpose of this bibliographical essay is thus twofold. It is the hope of the editors that this bibliography will help raise the awareness of the wealth and significance of the Japanese Buddhist traditions. At the same time, this essay on modern and contemporary Japanese Buddhist philosophy is designed to encourage scholars to generate more translations in this field.
Social Identity
Authors: Mikkola Mari
Published: February 2019

Many political struggles for emancipation seemingly presuppose identity politics: a form of political mobilization based on social kind membership, where some shared experiences or traits delimit “belonging.” This is because social and political philosophers typically hold that contemporary injustices such as oppression and discrimination are structural, systematic, and social. In being structural, they have their causes in norms, habits, symbolic meanings, and assumptions unquestionably embedded in and underlying institutional and social arrangements. In being systematic, social injustices exist throughout a society and usually over a period of time, so that societal institutions come to form interlocking webs that maintain and reinforce injustices experienced. And in being social, contemporary injustices are grounded in socially salient self- and other-directed identifications, where such identifications typically fix social group membership. Social injustice is not incidental and individual but targets members of certain groups due to their group membership: typically, due to individuals’ gender/sex, sexuality, race, ethnicity, ability, and/or class. Elucidating the nature of social identities then appears to be necessary in order to understand contemporary social injustices. We may face oppression due to membership in a collective, where others impose such membership upon us; or we may personally and voluntarily identify with an oppressed collective for which we seek political recognition. Thus, the expression “social identity” can denote either a group-based or an individual phenomenon, which needs disambiguating. We can ask on what basis are, for example, all women as women bound together (what constitutes their collective kind identity)? Or is gender identity essential to a person qua that person (are certain social classifications part of our individual identity)? Additionally, there are different modes by which social identifications and identity formation can take place: this may be voluntary (we choose certain identifications), or ascriptive (certain identities are attributed to us by others). However, elucidating particular social identities is riddled with difficulties, and this has generated various so-called identity crises. Identity politics presumes the existence of social kinds founded on some category-wide common traits or experiences. But as many have argued, no such transcultural/transhistorical commonality exists because our axes of identity (gender, race, ability, class) are intertwined and inseparable. In an attempt to unlock this impasse, the past few decades have witnessed lively philosophical debates about the nature of social identity more generally, and about the character of particular social identities.
Drug Courts
Authors: Boldt Richard , Nolan James L.
Published: February 2019

Several thousand drug courts operate in jurisdictions throughout the United States. Similar courts have been established in Canada, Australia, the United Kingdom, and elsewhere. The first drug court appeared in Dade County, Florida, in 1989. This initial effort and other first-generation drug courts helped to establish a model for subsequent problem-solving courts focused on substance use disorders, mental illness, domestic violence, and other circumstances that frequently co-occur with criminal justice system involvement. A range of problem-solving courts—including mental health courts, DUI (driving under the influence) courts, veterans courts, prostitution courts, re-entry courts, and gambling courts—have been developed both in the United States and internationally based on the drug court model. The design of these specialty courts emphasizes collaboration rather than an adversarial due-process-based approach to decision-making, therapeutic interventions instead of the legal resolution of disputed cases, and informal, individualized engagement by judges and other court actors. Key features of the drug court model include the placement of defendants in treatment programs, the close judicial monitoring of defendants though periodic status hearings, and the use of criminal penalties as leverage to retain defendants in treatment. Some drug courts engage criminal defendants prior to the adjudication of their charges, but increasingly these courts operate post-plea with the imposition of program requirements as conditions of probation or a suspended sentence. Drug courts have been a politically popular response to the problems of over-incarceration and criminal system overload produced in part by the late-20th-century “war on drugs.” Outcome studies often report successes in reducing drug use and criminal recidivism. Significant critiques of the drug court model and of problem-solving courts more generally have been offered, however, raising questions about the reliability of the outcome studies and about other negative consequences of the model, including net-widening, debasement of the therapeutic intentions of the enterprise, and other distortions in both the behavioral health treatment system and the criminal justice system.
Open societies before market economies: Historical analysis
Authors: van Bavel Bas
Published: February 2019

It is often assumed that the market economy and the open society reinforce each other and have risen together. Even those who are more skeptical about their long-run compatibility will usually agree that the rise of the two was part of a process of modernization, starting in early modern England and unfolding in the modern West. This article builds on the latest historical research to reject this assumption. It shows that several market economies existed much earlier in history. These were all preceded by social movements generating a more open society. In each of these cases, the functioning of the market economy slowly eroded social and, next, political openness, and later shriveled itself again. This endogenous, cycle-like process, in which the interaction of the market economy and the open society developed from positive to negative, may also be seen in modern cases, including the present USA.
Is Predicted Data a Viable Alternative to Real Data?
Authors: Fujii Tomoki , van der Weide Roy
Published: February 2019

It is costly to collect the household- and individual-level data that underlie official estimates of poverty and health. For this reason, developing countries often do not have the budget to update estimates of poverty and health regularly, even though these estimates are most needed there. One way to reduce the financial burden is to substitute some of the real data with predicted data by means of double sampling, where the expensive outcome variable is collected for a subsample and its predictors for all. This study finds that double sampling yields only modest reductions in financial costs when imposing a statistical precision constraint in a wide range of realistic empirical settings. There are circumstances in which the gains can be more substantial, but these denote the exception rather than the rule. The recommendation is to rely on real data whenever there is a need for new data and to use prediction estimators to leverage existing data.
Virulence, Molecular Diversity, and Mating Type of Curvularia lunata in China
Authors: Zhang Dan , Wang Fen , Zhao Jiamei , Sun Jiaying , Fu Dandan , Liu Kexin , Chen Nan , Li Guofu , Xiao Shuqin , Xue Chunsheng
Published: February 2019

Curvularia leaf spot (CuLS), caused by Curvularia lunata, is a devasting foliar disease in the maize-growing regions of China. Resistant varieties were widely planted in these regions in response to CuLS. However, over time, C. lunata has gradually adapted to the selective pressure and, in recent years, the incidence of CuLS has increased. To assess the correlation between virulence and genetic diversity, a total of 111 isolates was collected from 15 maize-growing regions located in nine provinces in China. These isolates were evaluated for virulence on maize using nine differential hosts: Shen135, CN165, Mo17, Luyuan92, 78599, Ye478, B73, E28, and Huangzaosi. To evaluate the genetic diversity, 657 polymorphic amplified fragment length polymorphism markers were generated. Results showed that the isolates could be grouped into three pathotypes according to the phenotypic expression of the differential inbred lines. Isolates were clustered into two genetic diversity groups and further divided into subgroups. However, the correlation between virulence and genetic diversity grouping was low. Also, there was a low correlation observed between pathotype and geographic distribution. The ratio of mating type I to mating type II for all isolates was close to 3:4.
Reasonable Academic Accommodation Implementation in Clinical Nursing Education: A Scoping Review
Authors: Horkey Erin
Published: February 2019

AIM

A scoping review was conducted to answer the question: What is known from existing literature about how reasonable academic accommodations have been implemented within clinical nursing education for prelicensure nursing students with physical disabilities?

BACKGROUND

An increased number of students with disabilities are entering nursing education. Many students with disabilities require accommodations to be successful; however, most nursing programs lack a developed framework for accommodation, and many nurse faculty lack knowledge on how to accommodate. These barriers can hinder student success.

METHOD

Arskey and O’Malley’s 2005 framework was used to explore the nursing literature.

RESULTS

Four themes emerged from the literature: collaboration, evolving accommodation practices, previously used accommodations, and poorly understood implementation.

CONCLUSION

Current nursing research fails to adequately address clinical accommodations for nursing students with physical disabilities. Further research into how accommodations are used in nursing clinical education and how faculty can successfully accommodate students is needed.
Exploring Grit Among Black Prelicensure Nursing Students
Authors: Young-Brice Amber , Dreifuerst Kristina Thomas
Published: February 2019

Unequal representation of black nurses in the workforce continues to plague the nursing profession. Preconceptions and understandings of the discipline are underpinned by the dominant white racial makeup, which may challenge ethnically diverse nursing students’ perceptions of their ability for success. The need for a diverse nursing workforce includes the challenge of enticing minority students into and successfully through prelicensure programs. This study of attributes of grit in the lived experiences of black nursing students revealed evidence including consistent efforts and perseverance to reach goals in the participants’ stories.
The Relationship Between Board Certification and Disciplinary Actions Against Board-Eligible Family Physicians
Authors: Peabody Michael R. , Young Aaron , Peterson Lars E. , O’Neill Thomas R. , Pei Xiaomei , Arnhart Katie , Chaudhry Humayun J. , Puffer James C.
Published: February 2019

Purpose

Lack of specialty board certification has been reported as a significant physician-level predictor of receiving a disciplinary action from a state medical board. This study investigated the association between family physicians receiving a disciplinary action from a state medical board and certification by the American Board of Family Medicine (ABFM).

Method

Three datasets were merged and a series of logistic regressions were conducted examining the relationship between certification status and disciplinary actions when adjusting for covariates. Data were available from 1976 to 2017. Predictor variables were gender, age, medical training degree type, medical school location, and the severity of the action.

Results

Of the family physicians in this sample, 95% (114,454/120,443) had never received any disciplinary action. Having ever been certified was associated with a reduced likelihood of ever receiving an action (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.30, 0.40; P < .001), and having held a prior but not current certification at the time of the action was associated with an increase in receiving the most severe type of action (OR = 3.71; 95% CI = 2.24, 6.13; P < .001).

Conclusions

Disciplinary actions are uncommon events. Family physicians who had ever been ABFM certified were less likely to receive an action. The most severe actions were associated with decreased odds of being board certified at the time of the action. Receiving the most severe action type increased the likelihood of physicians holding a prior but not current certification.
Management of severe congenital flexion deformity of the knee using Ilizarov method
Authors: Leonchuk Sergey S. , Novikov Konstantin I. , Subramanyam Koushik N. , Shikhaleva Natalya G. , Pliev Mairbek K. , Mundargi Abhishek V.
Published: February 2019

The aim of this study was to examine the effectiveness of Ilizarov method in severe congenital flexion deformity of the knee. This was a retrospective study of eight consecutive bilateral cases (five girls and three boys, with mean age of 4 years, involving 16 knees) with minimum 2-year follow-up. Four patients had multiple congenital contractures and two patients each had popliteal pterygium syndrome and complete tibial hemimelia. All patients were treated with Ilizarov fixator and gradual correction (additional soft tissue releases in three knees). Six patients had bilateral foot and ankle deformity treated with the same fixator, and cases with tibial hemimelia had centralization of fibula and quadriceps reconstruction. Flexion deformity could be corrected in all cases. Mean duration of dynamic phase was 78.5 (55–108) days, that of static phase was 42.4 (7–100) days, and total duration of external fixation was 120.9 (87–186) days. At mean follow-up of 34.5 (23–60) months, flexion deformity improved from the preoperative value of 74.9° (50°–130°) to 13.7° (10°–16°), and passive arc of motion of knee improved from the preoperative value of 38.8° (20°–55°) to 83.6° (55°–110°). Both were statistically significant (P < 0.0001). All patients (previously nonambulatory) were ambulatory with brace and support. All patients faced pin-tract and skin complications that were successfully managed. Ilizarov method is effective in severe congenital flexion deformity of the knee in improving ambulatory status. Realignment of quadriceps mechanism and limb mechanical axis (including ankle and foot deformities) must be given due importance. Minor recurrences of deformity must be expected in all cases.
The Sagittal Thoracic Modifier Component of the Lenke Classification System in Moderate and Severe Adolescent Idiopathic Scoliosis
Authors: El-Fiky Tarek , Elsagheer Hesham , Darwish Mohamed , Essmat Hesham , Kamal Raafat , Hasan Ahmed , Shoukry Fahmy , Allam Yasser
Published: February 2019

Study Design:

A prospective radiographic study.

Summary of Background Data:

As the importance of the spinal sagittal profile becomes increasingly evident, there is a need to ensure that the measuring methods used to evaluate thoracic kyphosis (TK) are both accurate and reproducible.

Objective:

The purpose of the following study was to determine the intraobserver and interobserver variability of measurements of the sagittal profile in moderate and severe thoracic scoliosis.

Methods:

Five experienced Faculty Spine surgeons independently reviewed thirty standing long 30-inch cassette lateral radiographs of preoperative moderate and severe curves ≥50 degrees of adolescent idiopathic scoliosis (AIS) patients on 2 different occasions. The parameters measured were the vertebral endplate clarity and measurability of the sagittal angle from D5 to D12 and categories of thoracic sagittal modifier. κ statistics and Intraclass Correlation Coefficient (ICC) were used for analysis.

Results:

The interobserver percentage of agreement for the Sagittal modifier was 58% in both trials. The mean κ coefficient value was only moderate 0.43 (range, 0.14–0.66) for both trials. The number of the vertebral endplates that were difficult to identify was 201 of 300 measurements (67%). There was a predominance of difficulty to identify vertebral endplate clarity in all curve types.

Conclusions:

The results of this study yielded poor to moderate interobserver reliability of the thoracic sagittal profile component of the Lenke classification system in moderate and severe AIS. This was attributed to the difficulty in identification of the vertebral endplates. The current standard lateral radiographs routinely used in AIS patients have inherent difficulties and limitations to visualize, identify, and analyze the thoracic endplates in moderate and severe curves.
Effect of Prehospital Blood Draws on Length of Stay for Chest Pain Patients in the Emergency Department
Authors: DuCharme Brooke , Macci Bires Angela , Montanye Evan , Khan Muhammad , DuCharme Scott , Linse Matthew , Carlson Jestin N
Published: February 2019

This article provides research of cardiac biomarkers being drawn in the prehospital setting compared with the emergency department (ED) on intervals critical to the diagnosis of acute myocardial infarction. This is a retrospective chart review of patients brought to the ED of a single, urban teaching hospital by a single emergency medical service (EMS) agency with a chief complaint of “chest pain.” We abstracted specific patient characteristics, intervals, positive troponin values, and rates of hemolysis from hospital records utilizing a custom data abstraction tool designed for this study through consensus of the authors. Data were compared between patients who did and did not have prehospital laboratory work performed for cardiac biomarkers utilizing parametric and nonparametric tests when appropriate. Of the initial 49 patients identified, 41 met inclusion criteria; 20 patients (49%) did not have prehospital EMS laboratory results drawn while 21 (51%) patients did have prehospital laboratory results drawn. Overall, 17% (7/41) had positive cardiac biomarkers. The groups were similar with regard to age, gender, race, and medical history. Median time (interquartile range) in minutes, from ED arrival to laboratory results available was shorter for patients with EMS laboratory results compared with those without EMS laboratory results: 53 (45-64) versus 71 (54-95) (P = .02). Time from ED arrival to disposition decision (P = .39) and total ED length of stay (P = .12) were similar between groups. In this preliminary study, prehospital laboratory results were associated with shorter times from ED arrival to the results being available.
Quality of Life and Persistent Symptoms After Uncomplicated Acute Diverticulitis
Authors: van Dijk Stefan T. , Daniels Lidewine , de Korte Niels , Stockmann Hein B. , Vrouenraets Bart C. , J. Consten Esther C. , B. van der Hoeven Joost A. , Faneyte Ian F. , W. Dijkgraaf Marcel G. , Boermeester Marja A.
Published: February 2019

BACKGROUND:

Although acute diverticulitis and its recurrence are well studied, little is known about the period after these attacks have passed. Many patients appear to be affected by persistent symptoms that impair quality of life. The few published studies on this topic are mostly limited by the lack of CT confirmation of the acute diverticulitis diagnosis, low numbers of patients, or cross-sectional design.

OBJECTIVE:

This study longitudinally evaluated quality of life and symptoms after antibiotic or observational treatment of uncomplicated acute diverticulitis.

DESIGN:

This was an observational study of randomized clinical trial data.

SETTINGS:

This study was conducted at a single tertiary care center.

PATIENTS:

Patients with CT-proven, primary, left-sided, uncomplicated acute diverticulitis were randomly assigned to observational or antibiotic treatment.

MAIN OUTCOME MEASURES:

Quality of life was assessed using questionnaires (EuroQol 5D, Short Form-36, and Gastrointestinal Quality of Life Index) at baseline and 3, 6, 12, and 24 months after random assignment. Patients were considered to have persistent symptoms when specific quality-of-life scores at the 12- and 24-month follow-ups were among the lowest 16% of scores measured in a healthy reference group.

RESULTS:

A total of 528 patients were included. No difference was detected between the observational and antibiotic groups in any quality-of-life score during follow-up. Overall, 32.2% to 38.2% of patients had persistent symptoms after 1 or 2 years, depending on which questionnaire (sub)score was assessed. Risk factors for persistent symptoms based on to the Gastrointestinal Quality of Life index GI symptoms score included a mean pain score ≥3.75 (OR = 2.77 (95% CI, 1.60–4.80)) during the first 10 days of disease and prolonged (≥28 d) time to recovery (OR = 2.25 (95% CI, 1.31–3.88)). Flatulence, rumblings, bloating, fullness, and many stools were the top 5 complaints at the 12- and 24-month follow-ups.

LIMITATIONS:

The study was limited by possible selection bias of patients included in a randomized controlled trial.

CONCLUSIONS:

More than one third of patients experience persistent symptoms after an episode of acute uncomplicated diverticulitis. Long-term quality of life is comparable after initial antibiotic or observational treatment. See Video Abstract at http://links.lww.com/DCR/A916.
Short-term Outcomes of Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Vessel-Sealing Device Hemorrhoidectomy for Grade III to IV Hemorrhoids: A Prospective Randomized Multicenter Trial
Authors: Trenti Loris , Biondo Sebastiano , Kreisler Moreno Esther , Sanchez-Garcia Jose L. , Espin-Basany Eloy , Landaluce-Olavarria Aitor , Bermejo-Marcos Elena , Garcia-Martinez Maria T. , Alías Jiménez David , Jimenez Fernando , Alonso Adolfo , Manso Maria B.
Published: February 2019

BACKGROUND:

Transanal hemorrhoidal dearterialization with mucopexy and vessel-sealing device hemorrhoidectomy seem to reduce postoperative pain compared with classic excisional hemorrhoidectomy, but whether one of them is superior remains unclear.

OBJECTIVE:

We compared transanal hemorrhoidal dearterialization with mucopexy and vessel-sealing device hemorrhoidectomy.

DESIGN:

This was a multicenter, randomized controlled trial.

SETTING:

The study was conducted at 6 Spanish centers.

PATIENTS:

Patients aged ≥18 years with grade III to IV hemorrhoids were included.

INTERVENTIONS:

Patients were randomly assigned to transanal hemorrhoidal dearterialization with mucopexy (n = 39) or vessel-sealing device hemorrhoidectomy (n = 41).

MAIN OUTCOME MEASURES:

Primary outcome was the mean postoperative number of days in which patients needed nonsteroidal anti-inflammatory drugs. Secondary outcomes were postoperative pain, 30-day morbidity, patient satisfaction, Vaizey score, hemorrhoid symptoms score, return to work, and quality of life.

RESULTS:

More patients were still taking analgesia in the vessel-sealing device hemorrhoidectomy group during the second postoperative week compared with the transanal hemorrhoidal dearterialization with mucopexy group (87.8% vs 53.8%; p = 0.002). For the transanal hemorrhoidal dearterialization with mucopexy group, analgesia consumption continued until day 10.1 (mean; SD = 7.22 d), whereas in the vessel-sealing device hemorrhoidectomy group it continued until day 15.2 (mean; SD = 8.70 d; p = 0.006). The mean daily average pain was similar during the first (p = 0.900) and second postoperative weeks (p = 0.265). Mean operative time was higher for the transanal hemorrhoidal dearterialization with mucopexy group versus the vessel-sealing device hemorrhoidectomy group (45 min; range, 40–60 vs 20 min; range, 15–41 min; p < 0.001). Postoperative complications rate, use of laxatives, patient satisfaction, Vaizey score, hemorrhoids symptoms score, return to work, and quality of life at 1 month after surgery were similar between groups.

LIMITATIONS:

The main limitation of this study was that the 2 groups did not contain equal numbers of grade III and IV hemorrhoids.

CONCLUSIONS:

Transanal hemorrhoidal dearterialization with mucopexy is associated with a shorter need for postoperative analgesia compared with vessel-sealing device hemorrhoidectomy. See Video Abstract at http://links.lww.com/DCR/A915.

TRIAL REGISTRATION:

clinicaltrials.gov identifier: NCT02654249.
Determination of Endogenous Concentrations of Uracil and Dihydrouracil in Dried Saliva Spots by LC-MS/MS: Method Development, Validation, and Clinical Application
Authors: Antunes Marina Venzon , Raymundo Suziane , Cezimbra da Silva Anne Caroline , Muller Victoria Vendramini , Vicente Neto Olavo José , Schwartsmann Gilberto , Linden Rafael
Published: February 2019

Background:

The aim of this study was to develop and validate a liquid chromatography–tandem mass spectrometry (LC-MS/MS) assay for the measurement of uracil (U) and dihydrouracil (UH2) concentrations in dried saliva spots (DSSs), for the evaluation of dihydropyrimidine dehydrogenase (DPD) enzyme activity.

Results:

Nine 18-mm diameter DSS discs were extracted with acetate:isopropyl alcohol (85:15, vol/vol) and analyzed by LC-MS/MS. The assay was linear in the range of 10–1000 ng·mL−1, with accuracy between 89% and 112% and precision between 5.7% and 13%. The metabolic ratio [UH2]/[U] was stable in DSS for up to 9 days at 45°C. Concentrations of U and UH2, as well as the metabolic ratio, were highly concordant between matrices. Using a metabolic ratio classification cutoff of 1.16 for the identification of slow DPD metabolizers, 98.7% concordance was achieved between SS and saliva.

Conclusions:

DSS samples could be a useful alternative for DPD activity screening, particularly in locations with limited access to highly equipped laboratories.
Exercise Testing and Exercise Rehabilitation for Patients With Atrial Fibrillation
Authors: Keteyian Steven J. , Ehrman Jonathan K. , Fuller Brittany , Pack Quinn R.
Published: February 2019

Introduction and Purpose:

Atrial fibrillation (AF) is a common cardiac arrhythmia associated with an increasing prevalence with advancing age. It is associated with dyspnea, exercise intolerance, and increased risk for clinical events, especially stroke and heart failure. This article provides a concise review of exercise testing and rehabilitation in patients with persistent or permanent AF.

Clinical Considerations:

The first goal in the treatment of AF is to reduce symptoms (eg, palpitations) and a fast ventricular rate. The second goal is to reduce the risk of a stroke. Exercise testing and rehabilitation may be useful once these goals are achieved. However, there are no large, randomized exercise training trials involving patients with AF, and what data are available comes from single-site trials, secondary analyses, and observational studies.

Exercise Testing and Training:

There are no specific indications for performing a graded exercise test in patients with AF; however, such testing may be used to screen for myocardial ischemia or evaluate chronotropic response during exertion. Among patients with AF, exercise capacity is 15% to 20% lower and peak heart rate is higher than in patients in sinus rhythm. Exercise rehabilitation improves exercise capacity, likely improves quality of life, and may improve symptoms associated with AF. Whole-body aerobic exercise is recommended.

Atrial fibrillation is a common cardiac condition and in these patients, exercise rehabilitation favorably improves exercise capacity. However, prospective randomized controlled trials are needed to better define the effects of exercise training on safety; quality of life; clinical outcomes; and central, autonomic, and peripheral adaptations.
Health care staff responses to disinvestment—A systematic search and qualitative thematic synthesis
Authors: Mitchell Deb , Bowles Kelly-Ann , O'Brien Lisa , Bardoel Anne , Haines Terry
Published: February 2019

Background

Health care services must deliver high-quality, evidence-based care that represents sound value. Disinvestment is the process of withdrawing resources from any existing health care practices that deliver low gain for their cost and reallocating these toward practices that are more effective, efficient, and cost-effective, thus benefiting patients and the community.

Purpose

This is the first review to examine the responses of health care staff to disinvestment and investigate the factors that increase the likelihood of these staff accepting disinvestment or reallocation of resources from the health services they provide.

Methods

We conducted a systematic search of five electronic databases using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) framework. A critical appraisal process of the quality of the included studies was performed by two authors. We undertook a thematic synthesis of the qualitative data to develop an overarching narrative.

Results

Twelve studies were identified for synthesis and all found that the disinvestment process was challenging and controversial for those health care staff involved. Negative staff reactions to disinvestment identified were anxiety, disempowerment, distrust, and feelings of being dismissed and disrespected. Engagement with disinvestment was observed when staff were invited to participate in a process they considered transparent and in the best interests of the community.

Practice Recommendations

Health care staff have a strong professional identity associated with autonomy in their decision making in the provision of health care services. Disinvestment from a service that health care staff can usually choose to provide threatens this identity. Engaging clinical champions to lead change, using rigorous patient outcome data, and transparent decision-making processes may assist health care staff to embrace a new identity as innovators and accept disinvestment in low-value health care.
COMPARISON BETWEEN SEVERAL OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY DEVICES AND INDOCYANINE GREEN ANGIOGRAPHY OF CHOROIDAL NEOVASCULARIZATION
Authors: Corvi Federico , Cozzi Mariano , Barbolini Erika , Nizza Dario , Belotti Maria , Staurenghi Giovanni , Giani Andrea
Published: February 2019

Purpose:

To compare indocyanine green angiography and four different optical coherence tomography angiography (OCTA) devices and to test their reproducibility in the evaluation of choroidal neovascularization (CNV).

Methods:

This study was an observational case series of Type 1 and Type 2 CNV presenting at the Eye Clinic, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, imaged with indocyanine green angiography and four different OCTA devices: prototype PlexElite (Carl Zeiss Meditec), prototype Spectralis OCTA (Spectralis; Heidelberg Engineering, Heidelberg, Germany), Optovue RTVue XR Avanti (Optovue, Inc, Fremont, CA), and AngioPlex (Cirrus 5000 HD-OCT; Carl Zeiss Meditec, Inc, Dublin, CA). Optical coherence tomography angiography examinations were performed using a 3 × 3-mm or 6 × 6-mm volume scan pattern to capture the full lesion. The mean area of CNV, vessel density, and fractal dimension were compared between the devices.

Results:

Seventeen eyes of 17 patients with CNV were enrolled. The CNV area was significantly larger in indocyanine green angiography than in the OCTA devices. Moreover, the four different instruments produced measurements with different mean values of CNV area, vessel density, and fractal dimension. The Bland–Altman analysis revealed that the limits of agreement for the comparisons were not acceptable.

Conclusion:

The choroidal neovascularization area is larger when imaged with standard indocyanine green angiography than with different OCTA devices with different algorithms, wavelengths, and scan patterns. The differences between several OCTA devices in the evaluation of quantitative parameters of CNV, such as CNV area, vessel density, and fractal dimension, suggest the necessity to standardize OCTA measurements for research and clinical practice.
Is Student Stress Related to Personality or Learning Environment in a Physician Assistant Program?
Authors: Wardley C. Sonia , Applegate E. Brooks , Almaleki A. Deyab , Van Rhee James A.
Published: February 2019

Purpose

The purpose of this research was to study the impact of students' personalities and 2 different learning environments—lecture-based learning (LBL) and problem-based learning (PBL)—on the stress perceived by 5 cohorts of physician assistant (PA) students.

Methods

Students rated their stress related to family obligations, financial concerns, schoolwork, relocation, and overall stress on 6 occasions over the course of the 2-year program. Personalities of students were assessed using the California Psychological Inventory 7 months into the program. Students' expectations and observations of their learning environments were measured using the PA School Learning Environment Survey at the beginning and end of the didactic year.

Results

Personalities of LBL and PBL students were very similar, but LBL students who scored higher on the Independence concept were less stressed about their schoolwork. The LBL students, in general, were more discontented with their learning environment, but this finding was not related to higher schoolwork-related stress. In contrast, PBL students' personalities were not related to stress, and PBL students also rated some dimensions of their learning environment higher than they had expected. However, those PBL students who rated the PBL environment less favorably also reported higher schoolwork-related stress.

Conclusions

High stress perceived by LBL students was related to some personality concepts but not to the students' learning environment, despite their overall disappointment with that environment. The PBL students were more stressed by schoolwork, although their stress was not related to personality. Problem-based learning students, except for those most highly stressed, tended to rate their learning environment more favorably.
Sitting Up Vertigo. Proposed Variant of Posterior Canal Benign Paroxysmal Positional Vertigo
Authors: Scocco Darío H. , García Iván E. , Barreiro María A.
Published: February 2019

Objective:

To describe a variant of posterior canal benign paroxysmal positional vertigo (BPPV).

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Fifteen patients with symptoms of BPPV and oculomotor evidence of activation of posterior semicircular canal (P-SCC) cupula that arises when sitting up from Dix-Hallpike maneuver (DH).

Intervention:

All patients were examined with videonystagmography and underwent brain magnetic resonance imaging (MRI).

Results:

All patients showed up-beating nystagmus with ipsilateral torsional component when coming up from right or left side DH. Most patients described vertiginous symptoms when sitting up from bed and many described severe non-positional disequilibrium. Eight patients had been treated with Epley canalith repositioning maneuver (CRM) at our clinic for posterior canal BPPV. Four of them were re-tested within an hour for CRM effectiveness and the rest, a week later. Three patients had been diagnosed with BPPV and were being treated with CRM in other institutions. Four patients showed these findings but they had not previously undergone CRM. All patients were treated with CRM without success, but they resolved their positional vertigo by means of Brandt Daroff exercises. No patient showed evidence of central vestibular disorder.

Conclusion:

We propose a P-SCC canalolithiasis limited to the periampullar portion by means of an anatomical restriction of distal movement of the otoconial debris. This syndrome seems to be more frequent early after CRM of classical P-SCC canalolithiasis. Close attention to ocular movement on sitting up after DH on patients is warranted.
Disease knowledge and self-management behavior of COPD patients in China
Authors: Yang Hua , Wang Huijun , Du Liying , Wang Ying , Wang Xiujin , Zhang Ruimin
Published: February 2019

This study aims to investigate the disease knowledge and self-management behavior of patients with chronic obstructive pulmonary disease (COPD) in the respiratory ward of a tertiary hospital in China, and analyze the relationship between these.

A total of 360 COPD patients were surveyed using the internationally validated COPD Questionnaire (COPD-Q), the COPD Patients’ Self-Management Behavior Scale and a general sociodemographic questionnaire, and 346 valid responses were obtained.

The results revealed that the surveyed COPD patients scored an average of 4.90 ± 2.50 points (maximal of 13 points) on the COPD-Q and 117.23 ± 20.56 points on the COPD Self-Management Behavior Scale, in which 86.1% of COPD patients were classified as having low to medium levels of self-management behavior. Pearson correlation analysis revealed that the total points on the COPD Self-Management Behavior Scale, symptom management, daily life management, emotional management and information management were all positively correlated to the disease knowledge of COPD (P < .01). In addition to COPD knowledge, the multiple regression analysis revealed that age, marital status and place of residence could also affect self-management behavior.

The level of disease knowledge and self-management behaviors of patients with COPD is rather low in China. COPD knowledge level was found to correlate with the level of self-management behavior. Health education that enhances the disease knowledge of COPD patients might thereby be necessary to help improve self-management behavior.
Diagnostic accuracy of γ-glutamyl transpeptidase-to-platelet ratio for predicting hepatitis B-related fibrosis: a meta-analysis
Authors: Lian Ming-Jian , Zhang Jia-Qin , Chen Shi-Dong , Zhang Dong-Dong , Yang Yuan-Yuan , Hong Guo-Lin
Published: February 2019

Background and aim

Emerging published data on the accuracy of γ-glutamyl transpeptidase-to-platelet ratio (GPR) for diagnosing hepatitis B virus (HBV)-related fibrosis are inconsistent. The aim of this study was to systematically review the performance of GPR for diagnosing HBV-related significant fibrosis, severe fibrosis, and cirrhosis.

Patients and methods

A comprehensive literature search of PubMed, Web of Science, and EMBASE was conducted before July 2018. Study selection was performed according to inclusion and exclusion criteria. The relevant parameters of eligible studies were abstracted. The methodological quality was assessed according to the Quality Assessment of Diagnostic Accuracy Studies. Areas under summary receiver operating characteristic curves, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratios were used to examine the GPR accuracy for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis.

Results

A total of 10 studies including 5882 patients with HBV infection underwent liver biopsy were incorporated. The prevalence of significant fibrosis, severe fibrosis, and cirrhosis were 58% (range: 22–72%), 36% (range: 10–55%), and 19% (range: 2–33%), respectively. Areas under summary receiver operating characteristic curves of GPR for predicting significant fibrosis, severe fibrosis, and cirrhosis were 0.733, 0.777, and 0.796, respectively. Subgroup analysis was performed according to geographical region and histological scoring system with similar results.

Conclusion

GPR has moderate diagnostic accuracy for predicting HBV-related significant fibrosis, severe fibrosis, and cirrhosis, and further studies with large sample size, rigorous design, multicenter study population are urgently needed.