bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Pulse Generators in a Breast Cancer Patient with in Situ Subthalamic Nucleus Deep Brain Stimulation
Authors: Son Byung-chul , Kim Joong-Seok , Park Woo-Chan , Ko Hak-cheol
Published: February 2019

Although deep brain stimulation (DBS) has been used for > 25 years in the treatment of movement disorders, no report has been published on the management of DBS pulse generators implanted in the anterior chest in patients with breast cancer who require mastectomy, radiotherapy, and future imaging studies.

We describe a 62-year-old female patient with advanced Parkinson's disease (PD) who was dependent on bilateral subthalamic nucleus (STN) DBS. She was diagnosed with cancer in her left breast. To avoid difficulties in imaging studies, surgery, and radiotherapy related to the breast cancer, bilateral pulse generators for STN DBS previously implanted in the anterior chest wall were repositioned to the anterior abdominal wall with replacement of long extension cables. During mastectomy and the relocation of the pulse generators, we were not aware of the risks of an open circuit and neuroleptic malignant-like syndrome due to our limited knowledge about how to manage DBS hardware.

Coincident breast cancer and the need for STN DBS is underreported. Considering the uncertainties in the management of pulse generators and the incidence of breast cancer, guidelines for handling DBS hardware in the setting of cancer are needed. More careful attention should be paid to performing magnetic resonance imaging in DBS-dependent patients with chronic PD.
Body Mass Index Classification Is Independently Associated with Health-Related Quality of Life after Primary Total Knee Arthroplasty: An Institutional Registry-Based Study
Authors: Steinhaus Michael E. , Buller Leonard T. , Romero Jose A. , Lee Yuo-Yu , Figgie Mark P. , McLawhorn Alexander S.
Published: February 2019

The purpose of this study was to compare the health-related quality of life (HRQoL) before and after successful total knee arthroplasty (TKA) across World Health Organization (WHO) body mass index (BMI) classifications. Through an institutional registry, patients with end-stage knee osteoarthritis who received elective primary unilateral TKA were identified and categorized based on WHO BMI classification. Age, gender, laterality, year of surgery, and Charlson–Deyo comorbidity index were recorded. The primary outcome was the EQ-5D-3L index and visual analog scale (VAS) at 2 years postoperatively. Inferential statistics and regression analyses were performed to determine associations between BMI classification and HRQoL. EQ-5D-3L index and VAS scores were significantly different across BMI classes, with higher scores in patients with lower BMI at baseline and at 2 years. There was no difference observed for the 2-year change in EQ-VAS scores between groups, but there was a statistically greater increase in index scores for more obese patients. In the regression analyses, there were statistically significant negative effect estimates for EQ-VAS and index scores associated with increasing BMI class, particularly for class III obesity. Higher BMI classification is independently associated with lower HRQoL scores 2 years after uncomplicated primary TKA, although obese patients experienced greater benefits in EQ-5D index scores following TKA. These results detail the relationship between BMI and HRQoL following TKA and suggest that preoperative weight loss may lead to improved outcomes following TKA, but also that obesity, alone, should not be a contraindication to TKA.
Is Milrinone Effective for Infants with Mild-to-Moderate Congenital Diaphragmatic Hernia?
Authors: Mears Michelle , Yang Michelle , Yoder Bradley A.
Published: February 2019

Objective Pulmonary hypertension with left ventricular dysfunction commonly occurs in congenital diaphragmatic hernia (CDH). Milrinone, a phosphodiesterase-III inhibitor with lusitropic and vasodilator effects, is used in up to 30% of CDH infants across the United States. No randomized trials have tested the efficacy or safety of milrinone in CDH neonates.

Study Design We performed a paired retrospective analysis of CDH infants to assess the efficacy of milrinone treatment (N = 24 pairs). Efficacy was assessed by change in oxygenation index (OI) and calculated pulmonary artery pressure (PAP). We evaluated safety on the basis of risks factors such as nonoperative bleeding, dysrhythmia, hypokalemia, and thrombocytopenia.

Results The median age of milrinone initiation was 18 hours (interquartile range [IQR]: 9–38) and the median duration was 127 hours (IQR: 95–194). PAP did not change from the baseline of 49 ± 11 mm Hg (milrinone) and 53 ± 11 mm Hg (no milrinone; p = 0.327). Baseline OI was 9.6 ± 6.5. There was a similar decrease in OI (median [IQR]; milrinone: 58% [16–74]; vs. no milrinone: 65% [50–71]; p = 0.221 between groups; p < 0.005 within groups). Baseline left ventricle measurements were similar. Both groups showed significant improvement over time. No adverse events were noted.

Conclusion In OI-matched untreated neonates with mild-to-moderate CDH, milrinone use was associated with neither improved OI, PAP, or left ventricular measurements, nor adverse events. Study limitations warrant prospective randomized controlled trials.
Austenite stabilisation by two step partitioning of manganese and carbon in a Mn-TRIP steel
Authors: Du P. J. , Yang D. P. , Bai M. K. , Xiong X. C. , Wu D. , Wang G. D. , Yi H. L.
Published: February 2019

In addition to manganese, carbon partitioning has been proposed in a new medium Mn-TRIP steel by two-step partitioning during the first batching annealing and the final continuous annealing. In the second-step partitioning, the cementite dissolves and blocky austenite forms with carbon enrichment, while the partition of manganese is negligible from prior lath austenite back into ferrite due to short duration. The combined partition of carbon and manganese improves both fraction and stability of retained austenite. The alloy has exhibited the product of strength and elongation of approximately 50 GPa%. It is highlighted that there is no Lüder strain in tensile curves. The microstructure evolution and relationship of microstructure and properties have been investigated and characterised carefully in this research.

This paper is part of a Thematic Issue on Medium Manganese Steels.
Metabolic regulatory mechanisms and physiological roles of functional amino acids and their applications in yeast
Authors: Takagi Hiroshi
Published: February 2019

In yeast, amino acid metabolism and its regulatory mechanisms vary under different growth environments by regulating anabolic and catabolic processes, including uptake and export, and the metabolic styles form a complicated but robust network. There is also crosstalk with various metabolic pathways, products and signal molecules. The elucidation of metabolic regulatory mechanisms and physiological roles is important fundamental research for understanding life phenomenon. In terms of industrial application, the control of amino acid composition and content is expected to contribute to an improvement in productivity, and to add to the value of fermented foods, alcoholic beverages, bioethanol, and other valuable compounds (proteins and amino acids, etc.). This review article mainly describes our research in constructing yeast strains with high functionality, focused on the metabolic regulatory mechanisms and physiological roles of “functional amino acids”, such as l-proline, l-arginine, l-leucine, l-valine, l-cysteine, and l-methionine, found in yeast.
Hopeless practical deliberation – reply to Bobier
Authors: Mueller Andy
Published: February 2019

Bobier (2017) argued that hope is necessary for practical deliberation. I will demonstrate that Bobier’s argument for this thesis fails. The problem is that one of its main premisses rests on a sufficient condition for hoping that is subject to counterexamples. I consider two ways to save the argument, but show that they are unsuccessful in doing so.
Top-Down Garbage Collector: a tool for selecting high-quality top-down proteomics mass spectra
Authors: Lima Diogo B , Silva André R F , Dupré Mathieu , Santos Marlon D M , Clasen Milan A , Kurt Louise U , Aquino Priscila F , Barbosa Valmir C , Carvalho Paulo C , Chamot-Rooke Julia
Published: February 2019

Motivation

We present the first tool for unbiased quality control of top-down proteomics datasets. Our tool can select high-quality top-down proteomics spectra, serve as a gateway for building top-down spectral libraries and, ultimately, improve identification rates.

Results

We demonstrate that a twofold rate increase for two E. coli top-down proteomics datasets may be achievable.

Availability and implementation

http://patternlabforproteomics.org/tdgc, freely available for academic use.

Supplementary information

Supplementary data are available at Bioinformatics online.
Distinct dormancy progression depending on embryonic regions during mouse embryonic diapause†
Authors: Kamemizu Chizuru , Fujimori Toshihiko
Published: February 2019

Many mammalian species undergo embryonic diapause and suspend development at the blastocyst stage before implantation, which is also known as delayed implantation. We studied the process of how mouse embryos enter a dormancy status at a cellular level. Immunofluorescent analysis of differentiation markers for epiblast, primitive endoderm, and trophectoderm suggested that cell differentiation status was maintained during 7 days in diapause. To understand the progression of cellular dormancy during diapause, we examined the expression of a transgenic cell cycle marker Fucci2 and Ki67 by antibody staining, in addition to direct counting of nuclei in embryos. From these analyses, embryos during diapause were categorized into four stages by cell number and cell cycle. Cell cycle arrest occurred from the ab-embryonic region and from the trophectoderm to the ICM in the embryonic side. We also observed cell cycle transition by live imaging of Fucci2 embryos during the reactivation in culture from dormant status. Cell cycle was initially recovered from the embryonic side of embryos and eventually spread throughout the whole embryo. We also found that embryos in later stages of diapause required a longer period of time for reactivation. From these observations, it was shown that entrance into and exit from dormant status varied depending on cell types and location of cells in an embryo. These results suggest that embryonic diapause includes multiple steps and the mechanisms involved in cellular dormancy may be distinct between embryonic regions.
Waimānalo Pono Research Hui: Establishing Protocols and Rules of Engagement to Promote Community-Driven and Culturally-Grounded Research with a Native Hawaiian Community
Authors: Keaulana Samantha , Chung-Do Jane J , Ho-Lastimosa Ilima , Hwang Phoebe W , Ho Kenneth , Radovich Theodore , Spencer Michael , Albinio Luana , Rogerson Ikaika , Keli‘iholokai LeShay , Deitschman Kirk
Published: February 2019

Research processes that are centered on western models and rooted in colonisation and racism can have deleterious effects upon disenfranchised groups, such as people of colour and indigenous communities. Community-centred and culturally-grounded processes are necessary to achieve meaningful participation and engagement in research by creating equitable protocols and ensuring beneficial outcomes. Such processes are particularly needed in indigenous populations, including the Hawaiian community. This article describes the participatory development of the community engagement protocols and rules of engagement created by a community and academic partnership called the Waimānalo Pono Research Hui (WPRH). Through monthly gatherings, academic and community partners engaged in discussions of constructing community programmes and developing research protocols that are rooted in Hawaiian wholistic values of health and well-being with indigenous methodologies. A final set of protocols and rules of engagement was developed through an iterative feedback process that was rooted not only in community-based participatory (CBPR) principles but also Hawaiian values, beliefs and way of life. Challenges and future directions are also presented.
The Rebel Economy in Civil War: Informality, Civil Networks, and Regulation Strategies
Authors: Kubota Yuichi
Published: February 2019

In civil war, rebel groups play a central role as a regulator in the management of civilian economic activities in their territory of control. While previous studies have intensively researched the impact of economic conditions on the war process and dynamics, little attention has been paid to the variation in economic policies adopted by the rebels. This paper conceptualizes the types of regulation policies imposed by the rebels against civilian economic activities and theorizes patterns and particular measures of (non)regulation taken by the rebel groups: formal regulation, deliberate connivance, and laissez-faire. The degree of economic intervention by the rebels is contingent on the extent of economic informalization within the territory and the relative capability of the economic sector. When the sector involves a large portion of the population and is densely networked, its economic potential comes to be perceived by the rebels as a threat to their incumbency. Such a threat compels them to undertake measures of regulation. In contrast, if the level of informalization is low or civilian activities are poorly backed by their network, the threat perceived by the rebels is less, in addition to which, formal regulation against such a loosely organized sector to effectively control civilian activities would be too costly. This paper proposes a number of research agendas on wartime rebel economies and their broader relevance to international relations and political science: mechanisms of rebel economies, rent and the resource curse, the process of civil-rebel relations, and rebel governance. It concludes by advancing implications for policy development; policymakers need to be scrupulous about the effectiveness of (neo)liberal economic policies in conflict-affected societies and to design postwar reconstruction by taking into consideration the legacy of rebel economies.
Outcomes of the Use of Hyaluronic Acid-Based Wound Dressings for the Treatment of Partial-Thickness Facial Burns
Authors: Yildirim Reyyan , Guner Ali , Cekic Arif Burak , Usta Mehmet Arif , Ulusahin Mehmet , Turkyilmaz Serdar
Published: February 2019

The purpose of this study was to assess clinical, functional and cosmetic outcomes of the use of hyaluronic acid-based wound dressings for partial-thickness facial burns. Patients with partial-thickness facial burns hospitalized at the Burn Center between April 2014 and April 2017 were evaluated. Data pertaining to demographic characteristics, etiology, and degree of burn and percentage of burn to TBSA were collected. Pain, infection rates, reapplication rates, length of hospital stay, duration of healing, and presence of scar formation were analyzed. Median percentage of burn to TBSA was 15% (interquartile range [IQR]: 9–20). Fifteen patients had only facial burns, while 39 patients had burns on other parts of the body in addition to the face. Nine patients had deep partial-thickness burns, while 45 had superficial partial-thickness burns. Median length of hospital stay was 7 days (IQR: 3–15) for the entire study population and 4 days (IQR: 2–7.5) for patients who had only facial burns. Median healing time was 9 days (IQR: 7–12). Fifty-one (94%) patients had a Vancouver Scar Scale score of zero at 6 months. Use of hyaluronic acid-based wound dressings for facial burns is an effective and safe option.
How Much Is Too Much? Estimating Effective Price-Hikes to Affect Smoking Behavior in Vietnam
Authors: Tran Binh Thang , Tran Dinh Trung , Nguyen Khac Minh , Nguyen Xuan Trinh Thi , Lim Min Kyung , Cho Sung-il , Oh Jin-Kyoung
Published: February 2019

Introduction

Raising the price of cigarettes is one of the most effective strategies to reduce cigarette smoking. The Vietnamese government is working toward the tobacco control goal of a 10% reduction in smoking prevalence by 2020. However, cigarette prices in Vietnam have not increased in the last two decades. The aim of this study was to estimate what cigarette prices would make smokers attempt to quit smoking, and to identify predictors of the price to quit and the intention to quit.

Methods

A cross-sectional survey was conducted with 822 male current smokers in Da Nang, Vietnam. A structured questionnaire was adapted from the International Tobacco Control project survey. Bayesian quantile regression was applied to predict factors associated with expected cigarette price.

Results

Fifty-six percent of smokers suggested a price to quit. Their median suggested price to quit per pack, 62 000 VND (2.8 USD), was 2.8 times higher than the actual current price, 22 000 VND (1.01 USD). Suggesting a lower price to quit was significantly associated with awareness of warning labels and smoke-free policies. In contrast, being a heavy smoker was significantly associated with a higher suggested price to quit across all quantiles.

Conclusions

There may be sufficient room to increase cigarette prices in Vietnam. The price to quit is associated with various factors, including non-pricing policies.

Implications

Evidence suggests that a steep increase in cigarette prices, setting a high minimum tax, and introducing a large specific tax, which are policy-induced price increases that can raise prices substantially in Vietnam, are preferable strategies. In addition to increasing price and taxes, the government should also strengthen non-pricing policies.
Psychometric Evaluation of 2 New Upper Extremity Functional Strength Tests in Children With Cerebral Palsy
Authors: Dekkers Koen J F M , Smeets Rob J E M , Janssen-Potten Yvonne J M , Gordon Andrew M , Speth Lucianne A W M , Rameckers Eugene A A
Published: February 2019

Background

For children with unilateral spastic cerebral palsy (USCP), reduced muscle strength can lead to activity limitations. However, none of the existing measures of upper extremity strength measure strength in the context of functional activities in which strength must be maintained for several seconds.

Objective

The objective of this study was to evaluate the psychometric properties of 2 newly developed functional hand and upper extremity muscle-strength tests (Cup-Task and Box-Task) in children aged 7 to 12 years with USCP.

Design

A longitudinal study design was used.

Methods

A standardized protocol with detailed descriptions of all procedures and measurements was used to determine test-retest reliability, interrater reliability, and criterion validity.

Results

A total of 86 children (53 males, 33 females, mean age = 9.3 years) with USCP participated in this study, with a subset performing each measurement. Only the results of children who were able to perform the measurement were included for analysis. Excellent test-retest reliability (intraclass correlation coefficients = 0.887–0.944; 95% confidence intervals = 0.713–0.969) and interrater reliability (intraclass correlation coefficients = 0.896–0.960; 95% confidence intervals = 0.813–0.980) were observed. The Cup-Task Affected-Hand and Box-Task were moderately correlated with maximum isometric grip strength. The Cup-Task Nonaffected-Hand had a low correlation with maximum isometric grip strength.

Limitations

Age, sex, and manual ability were not normally distributed, which could have influenced the results.

Conclusions

For children with USCP who can perform the tasks, the Cup-Task and Box-Task are reliable and valid instruments for measuring functional upper extremity muscle strength.
“Everything that I’ve Done Has Always Been Multiethnic”: Biographical Work among Leaders of Multiracial Churches
Authors: Okuwobi Oneya Fennell
Published: February 2019

Biographical work is the process of shaping a cohesive life story by selectively giving meaning to past events. The resulting biographies are not simple recitations of life events but narratives that illuminate what is valued in a person’s social context and how the person makes sense of life events and experiences over time. Drawing on 121 interviews from the Religious Leadership and Diversity Project (RLDP), this article investigates biographical work among head clergy of multiracial churches. I find that pastors of multiracial churches pattern their biographies after two predominant formula stories, laying claim to being people who are experienced with diversity and/or experienced with racial injustice. These formula stories reveal institutionalized understandings of biographies acceptable for pastors of multiracial churches that cut across denominational lines. The biographies of these leaders also reveal a shift toward diversity and away from recognition of racial injustice that has implications for the racial structure.
Caring for patients with chronic hepatitis C infection
Authors: Chaney Amanda
Published: February 2019

Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the US. This article discusses the pathophysiology of HCV infection, new treatment options, and nursing care and patient teaching for patients with chronic HCV infection.
Advances in the pathogenesis representing definite outcomes in chronic urticaria
Authors: Ensina Luis Felipe , Cusato-Ensina Ana Paula , Cardona Ricardo
Published: February 2019

Purpose of review

We reviewed in this article, the recent advances in CSU physiopathology and potential clinical and laboratory biomarkers in CSU.

Recent findings

In addition to the central role of mast cells in urticaria physiopathology, increased interest in basophils has arisen. Recent data corroborate the autoimmunity pathway as one of the main pathways in mast cell activation. The association of inflammatory cytokines, heat shock proteins and staphylococcal infection with CSU are also reviewed. C-reactive protein, D-dimers, autologous serum skin test, IgE levels and FcεRI expression in basophils have shown their potential as biomarkers for disease duration, activity, severity and/or response to treatment.

A comprehensive understanding of chronic spontaneous urticaria mechanisms is essential to find novel biomarkers and treatments. The use of these biomarkers in clinical practice will guide us in choosing the best treatment option for our patients.
High-Value Care Culture Among the Future Physician Workforce in Internal Medicine
Authors: Gupta Reshma , Steers Neil , Moriates Christopher , Wali Soma , Braddock Clarence H. , Ong Michael
Published: February 2019

Purpose

Training in high-spending regions correlates with higher spending patterns among practicing physicians. This study aimed to evaluate whether trainees’ exposure to a high-value care culture differed based on type of health system in which they trained.

Method

In 2016, 517 internal medicine residents at 12 California graduate medical education programs (university, community, and safety-net medical centers) completed a cross-sectional survey assessing perceptions of high-value care culture within their respective training program. The authors used multilevel linear regression to assess the relationship between type of medical center and High-Value Care Culture Survey (HVCCS) scores. The correlation between mean institutional HVCCS and Centers for Medicare and Medicaid Services’ Value-Based Purchasing (VBP) scores was calculated using Spearman rank coefficients.

Results

Of 517 residents, 306 (59.2%), 83 (16.1%), and 128 (24.8%) trained in university, community, and safety-net programs, respectively. Across all sites, the mean HVCCS score was 51.2 (standard deviation [SD] 11.8) on a 0–100 scale. Residents reported lower mean HVCCS scores if they were from safety-net-based training programs (β = −4.4; 95% confidence interval: −8.2, −0.6) with lower performance in the leadership and health system messaging domain (P < .001). Mean institutional HVCCS scores among university and community sites positively correlated with institutional VBP scores (Spearman r = 0.71; P < .05).

Conclusions

Safety-net trainees reported less exposure to aspects of high-value care culture within their training environments. Tactics to improve the training environment to foster high-value care culture include training, increasing access to data, and improving open communication about value.
Looking to the Future: Medical Students’ Views on Health Care Reform and Professional Responsibility
Authors: Rook Jordan M. , Winkelman Tyler N.A. , Fox Jacob A. , Pierce Jacob B. , Oot Antoinette R. , Blum James R. , Feuerbach Alec M. , Shahu Andi , Goldman Max L. , Kopp Zoe , Duffy Eamon , Robledo-Gil Talia , Tran Nhi , Davey Cynthia S. , Henschen Bruce L.
Published: February 2019

Purpose

Although medical students will influence the future U.S. health care system, their opinions on the Patient Protection and Affordable Care Act (ACA) have not been assessed since the 2016 presidential election and elimination of key ACA provisions. Understanding medical students’ views on health care policy and professional obligations can provide insight into issues that will be shaped by the next generation of physicians.

Method

From October 2017 to November 2017, the authors conducted an electronic survey of medical students from seven U.S. institutions to elicit opinions regarding the ACA and their professional responsibility to address health policy. Participant demographics and responses were tabulated, and multiple logistic regression models were used to assess the associations of demographic characteristics with student opinions.

Results

Completed surveys were returned by 1,660/4,503 (36.9%) eligible medical students. Respondent demographics were similar to national estimates. In total, 89.1% (1,475/1,660) supported the ACA, and 82.0% (1,362/1,660) reported that they understood the health care law. Knowledge of the law’s provisions was positively associated with support for the ACA (P < .001). Most students (85.8%; 1,423/1,660) reported addressing health policy to be a professional responsibility. Political affiliation was consistently associated with student opinions.

Conclusions

Most medical students support the ACA, with greater levels of support among medical students who demonstrated higher levels of objective knowledge about the law. Furthermore, students indicated a professional responsibility to engage in health policy, suggesting that tomorrow’s physicians are likely to participate in future health care reform efforts.
Massage and Medicine: An Interprofessional Approach to Learning Musculoskeletal Anatomy and Enhancing Personal Wellness
Authors: Hoffmann Darren S. , Dancing Dede , Rosenbaum Marcy
Published: February 2019

Purpose

To investigate the impact of a unique curriculum combining learning of surface anatomy and massage therapy for medical and physician assistant students.

Method

The authors conducted a randomized controlled trial in 2014 at University of Iowa Carver College of Medicine with 20 first-year students who viewed 4 hours of educational videos and participated in 11 hours of hands-on massage practice and 20 first-year students who only viewed the educational videos. Participants completed pre- and postcourse assessments of knowledge, attitudes, and personal wellness and completed a validated assessment of four dimensions of personal wellness.

Results

Hands-on group participants outscored the online-only group in postcourse knowledge assessments of surface anatomy and massage therapy principles (P< .05). Students in the hands-on group reported higher agreement with statements about perceived knowledge and beliefs about referrals and advising patients regarding massage therapy (P< .05). Students also frequently reported greater comfort administering physical examinations. Hands-on group participants had statistically significant improvements in psychological wellness during the study (P= .03), whereas online-only participants had a slight decrease (P= .09). Physical wellness was also slightly improved in the hands-on group (P= .06).

Conclusions

Findings show that integrating surface anatomy and massage therapy in an experiential course resulted in significant gains in knowledge of anatomy, understanding about interprofessional health care roles, increased confidence in clinical practice, and improved wellness. Accordingly, further development of learning experiences that incorporate basic science, interprofessional education, and techniques that promote student wellness should be encouraged.
Mapping the Mission Statements of U.S. LCME-Accredited Medical Schools: An Exploration of Organizational Communalities
Authors: Hafferty Frederic W. , Grbic Douglas , Hafferty Philip K.
Published: February 2019

Purpose

Mission statements (MSs) express an organization’s purpose and reflect the broader social environment in which they function. The authors analyze MS text to explore how medical schools can be relationally viewed and how particular thematic narratives within MSs can be deployed to associate schools in hithertofore unexplored ways.

Method

The authors analyzed the MSs (as of 1/1/2017) of 144 U.S. Liaison Committee on Medical Education–accredited schools. Using schools as their unit of analysis, they coded MSs using 44 themes. They employed content analysis to identify themes within MSs, factor analysis to identify core thematic dimensions embedded in MSs, and network analysis to examine relationships among schools based on these thematic dimensions. The authors used four standard school characteristics to examine the validity of their results.

Results

Content analysis revealed 20 core themes. Factor analysis identified four thematic dimensions: Primary Care/Diversity; Future Learning–External; Traditional; and Learning Environment–Internal. Based on the 20 core themes and using the MSs of 125 schools with nonextreme MS code counts, the authors found that schools form a complete network, and that schools form distinctive network-based clusters based on the identified factors. The four thematic dimensions were significantly differentiated across the four standard school characteristics.

Conclusions

The authors found distinctive patterns of MS linkages among schools along with thematic linkages within MS themes, supporting the contentions that medical schools can be both differentiated and connected based on their MSs and that understanding MS content must move beyond simple frequency counts of MS attributes.
Understanding the Pathophysiology, Implications, and Treatment Options of Patent Ductus Arteriosus in the Neonatal Population
Authors: Conrad Cristin , Newberry Desi
Published: February 2019

Background:

Patent ductus arteriosus (PDA) is the persistence of a fetal shunt between the pulmonary artery and the aorta. This structure normally closes in the first 3 days after birth; however, closure is delayed in up to 80% of infants born at 25 to 28 weeks of gestation. Persistent PDA results in pulmonary overcirculation and systemic hypoperfusion.

Purpose:

The purpose of this article is to review pathophysiology and treatment options for PDA.

Methods:

A literature review was conducted using PubMed, CINAHL, and Google Scholar (2013-2018). Search terms included neonate, PDA, pathophysiology, pharmacotherapy, nursing, ligation, indomethacin, ibuprofen, and acetaminophen (paracetamol).

Results:

Optimal treatment remains contentious. Options include conservative/medical, pharmacologic, and surgical management. Conservative/medical management includes mild fluid restriction, increased airway pressures, and supportive care. Pharmacologic treatment is accomplished using indomethacin, ibuprofen, or acetaminophen. Surgical intervention is by direct closure or by percutaneous ligation. Treatment may be prophylactic, presymptomatic, or symptomatic. Long-term morbidities associated with PDA include chronic lung disease, retinopathy of prematurity, and neurodevelopmental delay.

Implications for Research:

Absence of a universal scoring system for severity of PDA limits accuracy of comparisons among research studies. Lack of a consistent definition also makes it difficult to aggregate data for meta-analyses. Adoption of a consistent scoring system for hemodynamic significance would facilitate comparisons of outcomes among research studies.

Implications for Practice:

Clinicians should be aware of treatment options for PDA and their implications on neonatal outcomes. For nurses, anticipation of possible side effects is important for performance of focused assessments.
Intermodernism
Authors: Reed Pamela G.
Published: February 2019

Nursing is not only a professional practice, it is a scientific practice as well. One aspect of this practice involves development of scientific theory. In this article, I present a philosophical perspective called intermodernism for considering the content, structure, and process of scientific theory. Three types of theory structure are reviewed along with descriptions of the use of models and mechanisms in knowledge development. Practice is championed as a context that informs theory development as well as a context of theory validation and application.
Perspectives on the Unitary Transformative Person-Environment-Health Process for the Knowledge Base of Nursing
Authors: Smith Mary Jane , Fitzpatrick Joyce J.
Published: February 2019

Nursing knowledge development continues to face significant challenges, as there is not yet widespread acceptance of the important role of nursing theory in research, education, and professional practice. The purpose of this article is to describe perspectives on person, environment, health from different levels of knowledge development for the discipline of nursing. The authors recommend continued discourse among nurse scholars to advance the discipline of nursing globally.
Personalized surgery approach in severe form of osteogenesis imperfecta type III: point of view
Authors: Jeleč Željko , Primorac Dragan , Antičević Darko
Published: February 2019

Osteogenesis imperfecta (OI) is a genetic disorder characterized by fragile bones. It is our aim to illustrate variability in clinical presentation of severe form of OI. As an example of personalized surgery approach we present an 11-year-old girl with OI type III. Prior to referral to our hospital, she was treated with 18 cycles of bisphosphonates as well as with several different surgical procedures. Due to no improvement in her mobility status she underwent two additional surgeries at our hospital with a 5-month interval between them. Prior to the surgery, molecular genetic analysis was performed and the clinical diagnosis of OI was confirmed. Using the Fassier-Duval intramedullary telescoping nail, we performed correction osteotomies of both femurs and lower legs in two separate settings, with a very good final result. According to our experience, the Fassier–Duval nailing system is good option, but one should pay attention to many details while performing surgery. Thus, making treatment of OI patients very personalized. In this paper we present a unique personalized approach in OI: firstly, diagnosing COL1A1 gene mutations and secondly, performing a complex two-part surgery.
Humeral Simple Bone Cysts: Observational Versus Interventional Management
Authors: Green Natalie M. , Pagkalos Joseph , Jeys Lee M. , Stevenson Jonathan D. , Gregory Jonathan J.
Published: February 2019

Aims:

Our study aims to review the outcomes of conservative and interventional management of simple bone cysts (SBC) in the humerus.

Methods:

We retrospectively reviewed our center’s prospectively collected database. All patients with a diagnosis of a humeral SBC and a minimum of 1-year follow-up or complete healing and discharge within the first year were included. Cyst radiographic measurements were collected for all patients with available radiographs. A successful outcome included fully or partially healed cysts with persistent and recurrent cysts marked as unsuccessful.

Results:

In total, 91 patients were included in the study. Within the observational group, 44 patients (95.7%) achieved a successful outcome versus 38 patients (84.4%) in the interventional group. The 15/61 (25%) patients who were treated with observation at presentation required intervention at a later stage. The 9/30 (30%) of patients who had intervention at presentation required further additional intervention. Seven patients (11%) presenting with a fracture through a SBC went on to complete consolidation of the cystic lesion following the injury at a mean of 92.9 days (maximum, 176 d).

Conclusions:

We observed similar outcomes with conservative and interventional management in our retrospective series. We recommend observational management when a radiologic diagnosis is possible with intervention reserved for cases of diagnostic uncertainty and intrusive symptoms.

Level of Evidence:

Level III—a retrospective case comparison study.
Perioperative Ketorolac for Supracondylar Humerus Fracture in Children Decreases Postoperative Pain, Opioid Usage, Hospitalization Cost, and Length-of-Stay
Authors: Adams Alexander J. , Buczek Matthew J. , Flynn John M. , Shah Apurva S.
Published: February 2019

Background:

There is a need for improved opioid stewardship in orthopedic surgery through multimodal analgesia strategies. Perioperative administration of ketorolac in children undergoing closed reduction and percutaneous pinning (CRPP) for displaced supracondylar humerus (SCH) fracture may decrease pain, reduce opioid requirements, and decrease hospitalization costs.

Methods:

Retrospective case-control investigation of children (aged, 1 to 14) treated with CRPP for closed, modified Gartland type III extension-type SCH fractures at a single children’s hospital between 2011 and 2017. Patients that received ketorolac perioperatively (cases) were randomly matched 1:2 by sex and age (±1 y) with patients that did not receive ketorolac (controls). Data abstraction included demographic and perioperative details including inpatient Wong-Baker FACES pain ratings and analgesic requirements. Analysis included 2-tailed Mann-Whitney U and χ2 tests.

Results:

In total, 342 patients were studied including 114 cases and 228 controls. Age (mean, 6.2±2.4 y), sex ratio (M:F, 1.28:1), operative time, and number of pins used were equivalent between groups. Mean pain rating at 0 to 29 minutes postoperatively was lower in the ketorolac group (0.7±1.9) than in controls (1.4±2.6, P=0.017), as well as at 30 to 120 minutes postoperatively (1.1±2.3 and 1.7±2.8, respectively, P=0.036), as seen in Figure 1. Patients in the ketorolac group received a lower number of inpatient oxycodone doses (1.0±0.6) than control patients (1.2±0.5, P=0.003). Mean postoperative length-of-stay (LOS) was 50.0% longer for control patients (20.4±11.3 h) than the ketorolac patients (13.6±8.8 h, P<0.001). Ketorolac administration was associated with 40.4% lower inpatient hospitalization cost compared to control patients, providing a 33.8 times return on investment. There was no difference in the 90-day complication rate between patient groups (P=0.905).

Conclusions:

The complementary administration of ketorolac reduces postoperative pain and opioid use in children with displaced supracondylar humerus fractures. Perioperative ketorolac is also associated with reduced LOS following CRPP for supracondylar humerus fractures and offers significant cost savings opportunities.

Level of Evidence:

Level 3—Therapeutic: Case-Control Study.
Awareness of breast cancer incidence and risk factors among healthy women in Germany: an update after 10 years
Authors: Poehls Uwe G. , Hack Carolin C. , Wunderle Marius , Renner Stefan P. , Lux Michael P. , Beckmann Matthias W. , Fasching Peter A. , Nabieva Naiba
Published: February 2019

Early breast cancer detection programs depend for effectiveness on the participation rate, which is affected by risk factor awareness. This study investigated changes in women’s risk factor awareness between 2004 and 2016. Results from a 2004 survey of 2107 healthy women were compared with new data obtained using the same questionnaire in 2016, with 866 participants indicating their knowledge and perceptions regarding breast cancer incidence, risk factors, risk perceptions, and levels of concern. Logistic regression models assessed the influence of time point (2004 vs. 2016) on correct recognition of risk factors such as age at first childbirth, childlessness, lack of breastfeeding, hormone replacement therapy (HRT), and family history. Regression models were adjusted for common sociodemographic characteristics. Reproductive risk factors were regarded as influencing breast cancer risk less often. In 2004, age at first birth, childlessness, and lack of breastfeeding were regarded as risk factors by 24, 32, and 37%, respectively, in comparison with only 15, 18, and 23% in 2016. All changes were statistically significant. Awareness of HRT as a risk factor increased significantly (36–57%), and family history was recognized as a risk by 75 and 73% in 2004 and 2016, respectively. Most women recognized family history as a breast cancer risk factor. This did not change, reflecting the topic’s media prominence. Awareness of HRT as a risk factor increased, probably owing to public information after the large HRT studies. It is unclear why reproductive risk factors are less frequently recognized; educational programs should address this information deficit.
Evolution of the Picosecond Laser: A Review of Literature
Authors: Torbeck Richard L. , Schilling Laura , Khorasani Hooman , Dover Jeffrey S. , Arndt Kenneth A. , Saedi Nazanin
Published: February 2019

BACKGROUND

Picosecond pulse duration lasers (PS) have altered the field of dermatology. PS were initially used in tattoo removal, to optimize efficacy and reduce side effects with nanosecond domain lasers. More recently, they have been demonstrated to be effective in the treatment of pigmentary disorders, acne scarring, and photoaging.

OBJECTIVE

In this article, we critically analyze the published data on the many uses of picosecond lasers in dermatology.

MATERIALS AND METHODS

A systematic review of PubMed was conducted using the following search terms: “picosecond,” “picosecond laser,” “picosecond laser dermatology,” “picosecond laser pigment/pigmentation,” and “picosecond laser tattoo removal.” Articles ranged from 1988 until 2017.

RESULTS

Forty-one articles were identified, and 27 met inclusion criteria for review. Indications for the PS included a variety of dermatologic applications include tattoo removal, benign pigmented lesions/pigmentary disorders, acne scarring, and photoaging. Most studies demonstrated safe and effective treatment.

CONCLUSION

The development of the picosecond pulse duration is a breakthrough innovation in laser technology, changing the scope of laser treatment. Encouraging findings in tattoo pigment clearance spurred the use of PS in a wider array of dermatologic issues. The increasingly positive results and low incidence of adverse effects further substantiates PS efficacy for a variety of dermatologic uses.
Safety Studies in the Field of Liposuction: A Systematic Review
Authors: Halk Anne B. , Habbema Louis , Genders Roel E. , Hanke C. William
Published: February 2019

BACKGROUND

There is an increasing demand for safety standards for cosmetic treatments. With regard to liposuction, interdisciplinary consensus is lacking, especially regarding treatment setting and physician specialty.

OBJECTIVE

A solid, independent interpretation of scientific data on safety requires a systematic approach, which is the aim of this study.

METHODS

A systematic literature search was conducted for safety studies about liposuction through April 2017. Fatalities and/or reported serious adverse events served as outcome measures for safety.

RESULTS

Twenty-four studies were included. Factors that contributed to increased serious complication and mortality risk were: use of the (super)wet technique; use of systemic anesthetics, especially general anesthesia and intravenous sedation; execution by a plastic surgeon; execution in an operating room; and combination with other procedures.

CONCLUSION

Liposuction using tumescent local anesthesia has been shown to be the safest method of fat removal, especially if no or only minimal systemic anesthesia is used. Performance of this technique in an office-based setting has been proven to be safe beyond doubt. When systemic anesthesia is used, an outpatient or ambulatory surgery facility seems also safe. Regardless of the physician specialty, knowledge and training on the execution of the tumescent procedure are vital to ensure optimal safety.
Objective and Subjective Evaluation of Lipoinjection for Correction of Temporal Depression
Authors: Hu Xiaogen , Qi Huijie , Sun Cheng
Published: February 2019

BACKGROUND

Temporal depression is commonly found among people.

OBJECTIVE

Objective and subjective evaluation of lipoinjection for correction of temporal depression.

METHODS

From November 2012 to January 2018, 34 healthy female subjects underwent temporal augmentation by lipoinjection on both sides. Efficacy was assessed by objective and subjective parameters. The quantitative measurement of the temporal defect was obtained using molded plasticine preoperatively and 12 months after treatment. The subjective assessment consisted of excellent, good, fair, and poor results based on the patients' self-evaluations. The adverse events were recorded.

RESULTS

The follow-up period ranged from 12 to 36 months. It was found that a statistically significant difference existed between the preoperative and postoperative defect on both temples. Regarding the patients' self-evaluations, 17 patients (50.0%) reported feeling excellent, 15 patients (44.1%) as good, and 2 patients (5.9%) as fair, and no patient as poor. After the statistical analysis, it was found that the volumetric restoration rate of the grafted fat decreased as the temporal defect generally increased during the aging process. Injection-site swelling and bruising were commonly found complications; other complications were not found.

CONCLUSION

Autologous fat is inexpensive and readily available. Fat grafting is an alternative for correction of temporal depression.
Novel Classifications for Muscular Contraction of the Lower Face and Neck
Authors: Alcalá Berta E. , Bravo Bruna S.F.
Published: February 2019

BACKGROUND

Currently, there are no scales that address lower-face muscular contraction patterns, and there is only one that addresses platysmal bands.

OBJECTIVE

The goal of this article is to create scales to classify the strength and contraction patterns of the lower face and neck based on (1) the muscular anatomy and contraction patterns of the platysma and (2) the strength of the depressor anguli oris (DAO).

METHODS

Three hundred sixty patients participated in the study. Standardized photogarphs were taken in an effort to characterize muscle contraction patterns.

RESULTS

A novel classification measuring the strength of the DAO is presented. For the DAO, 4 different contraction patterns were observed: Type 1 (38%), Type 0 (26.3%), Type 2 (25.2%), and Type 3 (8.6%). The remainder (1.9%) used asymmetric contraction. For platysmal bands, 3 different contraction patterns were observed: complete contraction (64.53%), lateral contraction (19.83%), and central contraction pattern (11.73%). A small percentage of patients (3.91%) had an asymmetric contraction pattern.

CONCLUSION

Categorization of contraction of the DAO and platysmal bands into these proposed classifications provides objective measurements that can be helpful for designing treatment protocols and assessing response to treatment.