bluuebunny/crossref_metadata_2025 huggingface dataset:
Style shifting and the phonetic performance of gay vs. straight
Authors: Russell Eric Louis
Published: June 2017

This article examines the phonetic characteristics of speech performed in straight and gay styles by French males. Analysis considers features shown in other languages or in antecedent literature to be associated with perceptions of sexual identity: segmental quality (vowels, /s/, liquids), suprasegmental features (pitch, duration), and a number of language-specific variables. Results suggest that straight performances are characterized by decreased segmental duration and gay performances by differential use of vowel space, especially F2, nasal vowel duration, and fundamental frequency. A closing section provides comparison of these results to previous study and to other languages, while also addressing epistemological concerns raised by questions of identity, performance, and linguistic form.
Bilingual/bisexual
Authors: Wright Lyn
Published: June 2017

Recent work in language and sexuality has emphasized globalization and multilingualism as important areas of investigation (Bucholtz & Hall 2006,Leap & Boellstorff 2003,Murray 2014). Concomitantly, other scholars have employed the construct of sexual fluidity as a metaphor for linguistic fluidity (Otsuji & Pennycook 2010,Pennycook & Otsuji 2015). Few studies, however, have examined how sexual and linguistic fluidity intersect in individual experience. This paper examines metalinguistic discourse in three fictional novels involving bisexual, bilingual characters in order to understand how talk about language informs representations of sexualities. In these texts bilingualism functions in constructing access to queer communities, authenticity, belonging, and emotional control for bisexual characters. Further, sexual and linguistic fluidity are portrayed as lifespan processes embedded in specific time periods. Such understandings point to a need for historical approaches to fluidity that capture longer timescales and multiple dimensions of linguistic and sexual desire, practice, and identity.
Social mobility as a factor in restructuring
Authors: Stell Gerald
Published: June 2017

Despite regular objections, creole research tends to regard Europeans-to-non-Europeans ratios in colonial settings as a decisive factor in degrees of restructuring. As a result, relatively high proportions of Europeans are seen as the explanation for the emergence of partially restructured varieties. Quite problematic, however, is that some colonial settings with relatively low proportions of Europeans show little historical evidence of restructuring. To address this apparent paradox while avoiding too locale-specific explanations, I attempt to sketch a unified sociolinguistic account of restructuring, or the absence thereof. Central to the account I propose is the notion of upward social mobility in colonial societies, whose linguistic impact I illustrate by means of a comparison between Orange River Afrikaans (ORA)1and Cape Malay Dutch (CMD), i.e. two partially restructured non-European varieties of Dutch that arose at the colonial Cape. I emphasize that ORA, which developed in socially fluid frontier settings, seems in certain respects to display less restructuring than CMD, which developed in increasingly segregated settings. I present the fact that Europeans were less represented where ORA developed than where CMD did as evidence that social mobility might to an extent override European/non-European demographics as a factor in degrees of restructuring. I finally discuss the extent to which a socio-historical reconstruction of ORA and CMD can shed light on historical sociolinguistic developments elsewhere than the Cape, such as in particular colonial Ibero-America.
IADA history
Authors: Weigand Edda
Published: June 2017

IADA History not only refers to the series of conferences and workshops which have been organized since the foundation of the Association but also to the discussions about a unified concept of dialogue which accompanied IADA’s activities during the last three decades. On the one hand, there is the basic question of what constitutes dialogue, while on the other hand there are multiple approaches which claim to be acknowledged as dialogic approaches. If we do not want to accept the plurality of models in the sense of ‘anything goes’ we need to address the difficult issue of how far individual models can contribute to an investigation of dialogue as a complex whole.
Spanish influence in two Tepehua languages
Authors: Watters James K.
Published: June 2017

The kinds of change brought about by Spanish influence on two Tepehua (Totonacan) languages are of three types: structure-preserving change, including borrowing of all word classes; structure-changing processes in the phonology; and the structure-preferring influence of Spanish in progressive and applicative constructions. Nonfinite verb forms and other borrowed lexical items fit within existing structures. Changes in the phonology include loss of phonemic contrast as well as change from a three-vowel to a five-vowel system. Contact has also given some preference to the periphrastic form of the progressive, and prepositional phrases over applicatives. The features characterizing Spanish influence vary widely across the generations, reflecting growing bilingualism and interference from code switching.
Some grammatical characteristics of the Spanish spoken by Lacandón and Mazahua bilinguals
Authors: Cerda Sergio Ibáñez , Corripio Israel Martínez , Mora-Bustos Armando
Published: June 2017

The native languages that are spoken in Mesoamerica have been in intense and continuous contact with Spanish for over 500 years. Those languages have been affected reciprocally in some of their structural characteristics resulting in what are called transfers (Silva-Corvalán 2001). In this paper we undertake the task of studying varieties of Spanish in contact that have not been studied so far; specifically, Spanish-Lacandón and Spanish-Mazahua. The main goal is to identify grammatical features that are not present in the standard monolingual varieties and that can be said to be transfers from the substrate languages. In particular, we discuss transfers that are also shared with other bilingual varieties such as Spanish-Nahuatl and Spanish-Otomí: (a) the absence of number agreement inside the noun phrase (NP), (b) the absence of articles in NPs and (c) the omission of the direct object differential marker a. We argue that these characteristics have their source in typological features shared by the substrate languages and that they are likely to be of an areal type. We also address the case of one grammatical transfer particular to the Spanish-Lacandón variety: the juxtaposition of two determiners inside the noun phrase. It is what we call a “local” transfer.
The impact of language contact in Nahuatl couplets
Authors: de Oca Vega Mercedes Montes
Published: June 2017

In the pre-Hispanic period, couplets were widely used in ritual or ceremonial contexts, and they prevailed in the contact period through their use in evangelical texts to convey a more indigenous character to evangelization materials. Nahuatl couplets were recreated to achieve a better reception for Catholic dogma; this textual strategy was a way to introduce new meanings into the belief system of native peoples in New Spain. As is well known, the contact between Spanish and Nahuatl led to a process of intensive borrowing. The aim of this paper is to show how this particular situation of language contact influenced the couplets employed in doctrines, sermons, confession manuals, catechisms, hymns, grammars, dictionaries and other evangelization texts. The analysis will deal with couplets that were created from borrowed lexemes from Spanish and native lexemes in Nahuatl.
Nahuatl L2 texts from Northern Nueva Galicia
Authors: Rosales Rosa H. Yáñez
Published: June 2017

This chapter examines texts written in Nahuatl by indigenous scribes whose first language was not Nahuatl. The texts come from locations in two different regions in Nueva Galicia, which was the political unit located in west and northwest New Spain: Los Altos must have had Guachichil inhabitants (one of the Chichimec groups), whereas the Sierra Madre Occidental must have had Cora (Uto-Aztecan) inhabitants. The interferences in the documents are phonological as well as morphological and differ in each group of documents.The objective of this chapter is to provide information about linguistic contact between native Mesoamerican languages since contact among them has been only scarcely documented, and to provide information about the uses of Nahuatl as a second language throughout a region whose linguistic past is still being reconstructed.
Loanwords in Apachean from indigenous languages of the Southwest
Authors: de Reuse Willem J.
Published: June 2017

Most studies of Apachean language contact have focused on Spanish borrowings into these languages, or on the more recent English language influences. In this paper, the focus is on how some indigenous Southwestern languages, belonging to the Kiowa-Tanoan, Uto-Aztecan, and Zuni families, have influenced Apachean. The evidence is rather scant, but intriguing, and includes, in addition to cases of noun borrowing, some cases of sentence particle or clitic borrowing. I argue that one common pattern was to borrow, sometimes temporarily, from another indigenous language because the Apachean word was taboo, or had to be dissimulated for some other reason. This avoidance pattern is similar to the obfuscating usage of Spanish words by Apaches when confronted with nineteenth-century English-speaking interrogators.
Language contact across the Andes
Authors: Eloranta Rita
Published: June 2017

This paper proposes a case for language contact between two genetically unrelated and extinct Andean language groups: Mochica, which was spoken on the northern coast of Peru, and Hibito and Cholón, which were spoken in the Peruvian northern eastern slopes. The analysis offers evidence of both lexical items and morphological structures that support the hypothesis of contact between these languages. After examining possible contexts of interaction, this paper concludes that the correspondences may have been a consequence of language contact associated with intercultural exchange and trade. This study argues for the value of the possible external relations between Mochica and other languages.
Snap‐N‐Send: A valid and reliable method for assessing the energy intake of elite adolescent athletes
Authors: Costello Nessan , Deighton Kevin , Dyson Joshua , Mckenna Jim , Jones Ben
Published: June 2017

To ensure that elite adolescent athletes meet their unique training, growth and maturation demands, it is imperative to have access to valid measures of energy intake. Contemporary methods demand close attention‐to‐detail, meaning that athletes often do not fully adhere to real‐time protocols. This study represents the first investigation of a real‐time dietary assessment designed using a comprehensive behaviour change framework (COM‐B). In a crossover design, 12 elite adolescent male rugby players recorded their energy intake via an estimated food diary (est‐FD) and photography‐based mobile assessment (‘Snap‐n‐Send’), combined with a 24‐h dietary recall interview. Two 4‐day assessment periods were divided into three separate recording environments: 96 h free‐living and researcher‐observed; 72 h free‐living and 10 h researcher‐observed. Assessment periods were one month apart. All foods and beverages were provided and weighed by the research team to quantify actual intakes. ‘Snap‐n‐Send’ reported a small mean bias for under‐reporting across 96 h (−0.75 MJ day−1; 95% confidence interval [CI] for bias = −5.7% to −2.2%, p < .001), 72 h (−0.76 MJ day−1; 95% CI for bias = −5.6% to −2.1%, p = .004) and 10 h (−0.72 MJ day−1; 95% CI for bias = −8.1% to −0.1%; p = .067) environments. The est‐FD reported a moderate mean bias for under‐reporting across 96 h (−2.89 MJ day−1; 95% CI for bias = −17.9% to −10.2%; p < .001), 72 h (−2.88 MJ day−1; 95% CI for bias = −17.9% to −10.1%; p < .001) and 10 h (−2.52 MJ day−1;−26.1% to −5.3%; p = .023) environments. Results evidence the ability of ‘Snap‐n‐Send’ to accurately assess the diet of elite adolescent athletes, signalling the exciting promise of this comprehensive and theoretical behavioural approach within valid dietary assessment.
Autophagy gene FIP200 in neural progenitors non–cell autonomously controls differentiation by regulating microglia
Authors: Wang Chenran , Yeo Syn , Haas Michael A. , Guan Jun-Lin
Published: June 2017

Recent studies have shown important roles for autophagy genes in the regulation of different tissue stem cells, including neural stem/progenitor cells (NSCs). However, little is known about whether autophagy can regulate NSCs through cell-extrinsic mechanisms. Here, we show that deletion of an essential autophagy gene, FIP200, in NSCs increased expression of Ccl5 and Cxcl10 in a p53-independent manner, mediating increased infiltration of microglia into the subventricular zone of both FIP200hGFAP conditional knockout (cKO) and FIP200;p53hGFAP 2cKO mice. The microglia exhibited an activated M1 phenotype consistent with their potential to inhibit differentiation of FIP200-null NSCs. Blocking either microglia infiltration or activation rescued the deficient differentiation of FIP200-null NSCs from FIP200;p53hGFAP 2cKO mice. Lastly, we showed that increased chemokine expression in FIP200-null NSCs was induced by abnormal p62 aggregate formation and activation of NF-κB signaling. Our results suggest that autophagy plays a crucial role in regulating neurogenesis and restricting local immune response in postnatal NSCs through non–cell autonomous mechanisms.
Efficiency and safety of speech recognition for documentation in the electronic health record
Authors: Hodgson Tobias , Magrabi Farah , Coiera Enrico
Published: June 2017

Objective

To compare the efficiency and safety of using speech recognition (SR) assisted clinical documentation within an electronic health record (EHR) system with use of keyboard and mouse (KBM).

Methods

Thirty-five emergency department clinicians undertook randomly allocated clinical documentation tasks using KBM or SR on a commercial EHR system. Tasks were simple or complex, and with or without interruption. Outcome measures included task completion times and observed errors. Errors were classed by their potential for patient harm. Error causes were classified as due to IT system/system integration, user interaction, comprehension, or as typographical. User-related errors could be by either omission or commission.

Results

Mean task completion times were 18.11% slower overall when using SR compared to KBM (P = .001), 16.95% slower for simple tasks (P = .050), and 18.40% slower for complex tasks (P = .009). Increased errors were observed with use of SR (KBM 32, SR 138) for both simple (KBM 9, SR 75; P < 0.001) and complex (KBM 23, SR 63; P < 0.001) tasks. Interruptions did not significantly affect task completion times or error rates for either modality.

Discussion

For clinical documentation, SR was slower and increased the risk of documentation errors, including errors with the potential to cause clinical harm compared to KBM. Some of the observed increase in errors may be due to suboptimal SR to EHR integration and workflow.

Conclusion

Use of SR to drive interactive clinical documentation in the EHR requires careful evaluation. Current generation implementations may require significant development before they are safe and effective. Improving system integration and workflow, as well as SR accuracy and user-focused error correction strategies, may improve SR performance.
Antibiotic Prescribing for Adults Hospitalized in the Etiology of Pneumonia in the Community Study
Authors: Tomczyk Sara , Jain Seema , Bramley Anna M , Self Wesley H , Anderson Evan J , Trabue Chris , Courtney D Mark , Grijalva Carlos G , Waterer Grant W , Edwards Kathryn M , Wunderink Richard G , Hicks Lauri A
Published: June 2017

Background

Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP.

Methods

From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression.

Results

Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics.

Conclusions

Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.
High-frequency monitoring of quasars with absorption lines
Authors: Cegłowski Maciej , Hayashi Takayuki J. , Kunert-Bajraszewska Magdalena , Katarzyński Krzysztof
Published: June 2017

An investigation of the origin of the broad absorption lines observed in some quasars was performed. We selected a sample of the most luminous objects and observed them with the VERA interferometer at 22 GHz. We also used a single 32-meter antenna, located near Toruń in Poland, to monitor variability of these quasars at 30 GHz. We succeed in detecting 16 out of 19 initially selected objects. The main aim of our observations was to determine the spacial orientation of the observed sources and their evolutionary status. We investigated their radio maps, performed the variability studies, and examined their radio spectra as well as the emission in the broadband frequency range. Most of the quasars from our sample seem to evolve in a similar way to young radio objects. However, radio structures of two sources may suggest that these objects are restarted active galactic nuclei. This may indicate a diversity of evolutionary stages in our sample. Six of the investigated sources were classified as candidates for the variable objects.
Evidence of Stage Shift in Women Diagnosed With Ovarian Cancer During Phase II of the United Kingdom Familial Ovarian Cancer Screening Study
Authors: Rosenthal Adam N. , Fraser Lindsay S. M. , Philpott Susan , Manchanda Ranjit , Burnell Matthew , Badman Philip , Hadwin Richard , Rizzuto Ivana , Benjamin Elizabeth , Singh Naveena , Evans D. Gareth , Eccles Diana M. , Ryan Andy , Liston Robert , Dawnay Anne , Ford Jeremy , Gunu Richard , Mackay James , Skates Steven J. , Menon Usha , Jacobs Ian J.
Published: June 2017

(Abstracted from J Clin Oncol 2017:35(13):1411–1420)

For the randomized general population, the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) investigated a new multimodal screening test using the Risk of Ovarian Cancer Algorithm (ROCA), which interprets serial CA-125 results, and transvaginal sonography as a second-line test. High sensitivity and specificity were achieved with this test.
Economic Effects of Medicaid Expansion in Michigan
Authors: Ayanian John Z. , Ehrlich Gabriel M. , Grimes Donald R. , Levy Helen
Published: June 2017

(Abstracted from N Engl J Med 2017;376(5):407–410)

The Affordable Care Act (ACA) led to Medicaid expansion in 31 American states. This article evaluates the economic consequences of the expansion of Medicaid in Michigan following the ACA.
Differences in Outcomes Between Early and Late Diagnosis of Cystic Fibrosis in the Newborn Screening Era
Authors: Coffey Michael J. , Whitaker Viola , Gentin Natalie , Junek Rosie , Shalhoub Carolyn , Nightingale Scott , Hilton Jodi , Wiley Veronica , Wilcken Bridget , Gaskin Kevin J. , Ooi Chee Y.
Published: June 2017

(Abstracted from J Pediatr 2017;181:137–145)

Cystic fibrosis (CF) affects 1 in 3000 newborns in white populations and is a recessive disorder caused by mutations in the CFTR (CF transmembrane conductance regulator) gene. Newborn screening (NBS) for this disorder is common in developed countries and in New South Wales where this study was conducted NBS has been available since July 1981.
The Effectiveness of Transcranial Direct Current Stimulation as an Add-on Modality to Graded Motor Imagery for Treatment of Complex Regional Pain Syndrome
Authors: Lagueux Émilie , Bernier Michaël , Bourgault Patricia , Whittingstall Kevin , Mercier Catherine , Léonard Guillaume , Laroche Sarah , Tousignant-Laflamme Yannick
Published: June 2017

Background:

The efficacy of Graded Motor Imagery (GMI) for the management of Complex Regional Pain Syndrome (CRPS) is supported by evidence, but its treatment effect remains generally modest. Transcranial Direct Current Stimulation (tDCS) has been advocated as an adjunct intervention to enhance the effect of motor imagery approaches in pain populations.

Objective:

The purpose of this study was to investigate the effectiveness of GMI+active tDCS compared with the GMI+sham tDCS in the treatment of CRPS type I.

Methods:

A total of 22 patients (n=11/group) were randomly assigned to the experimental (GMI+tDCS) or placebo (GMI+sham tDCS) group. GMI treatments lasted 6 weeks; anodal tDCS was applied over the motor cortex for 5 consecutive days during the first 2 weeks and once a week thereafter. Changes in pain perception, quality of life, kinesiophobia, pain catastrophizing, anxiety and mood were monitored after 6 weeks of treatment (T1) and 1-month posttreatment (T2).

Results:

GMI+tDCS induced no statistically significant reduction in pain compared with GMI+sham tDCS. Although we observed significant group differences in kinesiophobia (P=0.012), pain catastrophizing (P=0.049), and anxiety (P=0.046) at T1, these improvements were not maintained at T2 and did not reached a clinically significant difference.

Discussion:

We found no added value of tDCS combined with GMI treatments for reducing pain in patients with chronic CRPS. However, given that GMI+sham tDCS induced no significant change, further studies comparing GMI+tDCS and tDCS alone are needed to further document tDCS’s effect in CRPS.
The Role of Preoperative Radiologic Severity, Sensory Testing, and Temporal Summation on Chronic Postoperative Pain Following Total Knee Arthroplasty
Authors: Petersen Kristian K. , Simonsen Ole , Laursen Mogens B. , Arendt-Nielsen Lars
Published: June 2017

Objectives:

Knee osteoarthritis (KOA) can be associated with local and central sensitization. As an indicator of the central gain, facilitated temporal summation of pain (TSP) has been found in KOA patients. This facilitation is predictive of the development of chronic postoperative pain after total knee arthroplasty (TKA). Other studies have suggested hypoesthesia/hypoalgesia to thermal stimuli as a feature in KOA. This study investigated associations between preoperative TSP, thermal sensitivity, and radiologic severity for the development of chronic postoperative pain after TKA.

Methods:

Radiologic KOA (Kellgren and Lawrence), TSP, and thermal stimuli were collected, preoperatively. Clinical knee pain intensity (VAS 0-10) was assessed before and 12 months following TKA. Patients were categorized into a chronic postoperative pain group if they experienced <30% pain reduction of the initial pain after 12 months.

Results:

In total, 19% of the patients were categorized as chronic pain patients and presented facilitated preoperative TSP (P<0.05) and a trend towards increased heat pain threshold (P=0.077) compared with patients with normal recovery. Pearson correlations found that preoperative TSP (R=0.193; P=0.013), Kellgren and Lawrence (R=−0.168; P=0.027), warm detection threshold (R=0.195; P=0.012), and heat pain threshold (R=0.196; P=0.012) were associated with pain intensity 12 months after TKA where TSP was identified as an independent factor.

Discussion:

This study showed that preoperatively facilitated TSP in KOA patients was predictive of the development of chronic postoperative pain following TKA. Furthermore, this study is the first to find an association between preoperative hypoalgesia to heat and the development of chronic postoperative pain following TKA.
fMRI after Phalloplasty with Nerve Anastomosis in a Trans-Man Patient
Authors: Doria-Medina Roberto , Carlsson Åsa , Jönsson Emma H. , Jönsson Lars , Thorarinsson Andri , Lidén Mattias , Selvaggi Gennaro
Published: June 2017

We report on a case of a trans-man patient, who underwent penile reconstruction with the use of a radial forearm flap, urethroplasty, vaginectomy and scrotoplasty, insertion of testicle implants, and penile erection implants, similar to previously described methods. One of the requirements for an ideal phalloplasty is the preservation of erogenous sensitivity, which is often demanded by the patients for fulfilling their sexual well-being. For the first time known to us, we use a functional magnetic resonance imaging following radial forearm flap phalloplasty with nerve anastomosis to assess the cortical activation after clitoral stimulation. The patient was poked with a plastic pen on the neophallus and the groin. Regular block design with T1 and BOLD-T2* images were used. The results contradict the classic Penfield and Rasmussen homunculus, that is, the activations in the primary somatosensory cortex (S1) were bilateral with a left-sided dominance in the lateral parts of the medial postcentral gyrus (same region as the groin), and no activations were observed in the mesial parts of the postcentral gyrus. We also reported bilateral activations with a left-sided dominance in the secondary somatosensory cortex (S2) and near Broca’s area at the sylvian fissure just posterior to ramus ascendens. Our findings are similar to previous studies reporting on imaging related to genital sensitivity.
Virtual Surgical Planning for Mandibular Distraction in Infants with Robin Sequence
Authors: Resnick Cory M.
Published: June 2017

Mandibular distraction osteogenesis (MDO) successfully relieves obstructive sleep apnea in many infants with Robin sequence. Preoperative virtual surgical planning and fabrication of three-dimensionally printed cutting guides may lead to further improvements in the MDO technique and decrease the risk for damage to adjacent structures such as developing teeth and the inferior alveolar nerve. This report presents an algorithm for virtual surgical planning and three-dimensionally printing of cutting guides for MDO in infants with RS.
Shifting of the Line of Sight in Tilted Disk Syndrome
Authors: Kosekahya Pinar , Sarac Ozge , Koc Mustafa , Caglayan Mehtap , Hondur Gozde , Cagil Nurullah
Published: June 2017

Objectives:

To investigate the shifting of the line of sight (LoS) and the refractive, topographic, and aberrometric parameters that may be associated with the shifting of the LoS in eyes with tilted disk syndrome (TDS).

Methods:

Eighty left eyes of 80 subjects with TDS (Study Group) and 70 left eyes of 70 subjects with myopia and astigmatism (Control Group) were included in this study. Line-of-sight coordinates on the horizontal (x) and vertical (y) axes, refractive, topographic, and aberrometric parameters were evaluated. All parameters were compared between groups, and correlations were analyzed for the study group.

Results:

In the study group, the LoS significantly shifted to the superotemporal direction compared with the control group (P=0.022 and P=0.008 respectively). The shift on y-axis was correlated with mean cylindrical refractive error (r=−0.283, P=0.011), total root mean square (RMS) (r=0.321, P=0.004), higher-order aberration RMS (r=0.300, P=0.007), vertical coma (r=0.430, P<0.001), and vertical trefoil values (r=−0.455, P<0.001).

Conclusions:

Results demonstrated a superotemporal shifting of the LoS in eyes with TDS. As eyes with TDS have an important place among candidates for refractive and multifocal intraocular lens implantation surgeries, this shift must be accounted for to prevent decentralization and provide satisfactory outcomes.
Morphology and Function of Meibomian Glands and Other Tear Film Parameters in Junior High School Students
Authors: Mizoguchi Takanori , Arita Reiko , Fukuoka Shima , Morishige Naoyuki
Published: June 2017

Purpose:

We measured tear film parameters, including the morphology and function of meibomian glands, in junior high school students at 15 years of age.

Methods:

A total of 111 eyes of 111 students (56 males and 55 females) were enrolled in the study. The ocular symptom score (0–14), after-school study time, lipid layer thickness (LLT) of the tear film, partial blink rate, lid margin abnormalities (0–4), tear film breakup time, corneal and conjunctival epithelial damage (fluorescein staining score, 0–9), meiboscore as determined by noncontact meibography (0–6), Schirmer test value, and meibum grade (0–3) were determined. The relationships between parameters were evaluated with the Spearman correlation coefficient (ρ).

Results:

The meiboscore was 2.8 ± 1.2, and the meibum grade was 1.8 ± 1.2. The meiboscore significantly correlated with the meibum grade (ρ = 0.272, P = 0.004), Schirmer test value (ρ = −0.220, P = 0.021), and LLT (ρ = −0.264, P = 0.005). The breakup time significantly correlated with LLT (ρ = 0.261, P = 0.006), meibum grade (ρ = −0.338, P < 0.001), and fluorescein staining score (ρ = −0.214, P = 0.025). The partial blink rate significantly correlated with the Schirmer test value (ρ = −0.240, P = 0.011). The meiboscore (P < 0.001) and meibum grade (P = 0.032) were significantly greater in males than in females.

Conclusions:

The morphology and function of meibomian glands are altered even at 15 years of age, with the changes being more prominent in males than in females.
Atrial Fibrillation Symptoms and Sex, Race, and Psychological Distress
Authors: Gleason Kelly T. , Nazarian Saman , Dennison Himmelfarb Cheryl R.
Published: June 2017

Background:

Atrial fibrillation (AF) symptoms are a major component of treatment decisions for patients with AF and impact quality of life and functional ability yet are poorly understood.

Objective:

This review aimed to determine what is known about the prevalence of symptoms and the association of symptoms to AF characteristics, psychological distress, sex, and race.

Methods:

We performed a structured review of AF symptoms as of March 2016 using PubMed, EMBASE, and CINAHL and reference searches of retrieved articles. Full-text, published, peer-reviewed, English-language articles were examined. Articles were included if they reported original research data on symptom prevalence and type among patients with AF.

Results:

The 3 most common symptoms were dyspnea, palpitations, and fatigue. The results suggested that, although AF characteristics are not a significant predictor of symptoms, tachycardia, female sex, race, and psychological distress have a positive association to symptoms.

Conclusions:

There is a scarcity of research examining symptoms in AF. Furthermore, the inconsistency in measurement methods and the failure to include diverse populations in AF research make it difficult to draw definitive conclusions from the current literature. Given the prevalence of AF in the United States and the impact of symptoms on quality of life and healthcare use, further research examining predictors of symptoms and interventions to alleviate symptoms is crucial.
Do we need to screen for de-novo diabetes mellitus in chronic hepatitis C patients after a sustained virological response?
Authors: Mousa Nasser , Abdel-Razik Ahmed , Farag Raghda , Shabana Walaa , Elgamal Ayman , El-Wakeel Niveen , Elzehery Rasha , Elkashef Wagdi , Eldars Waleed
Published: June 2017

Background and aim

There are millions of chronic hepatitis C (CHC) virus-infected patients who have been treated with a combination therapy (interferon and ribavirin) and have achieved a virological response (SVR) worldwide. The aim of this study is to evaluate the risk factors for de-novo diabetes mellitus in CHC patients treated with combination therapy (interferon and ribavirin) and have achieved an SVR.

Patients and methods

A total of 214 nondiabetic CHC patients with SVR and baseline homeostasis model assessment (HOMA) less than or equal to 2 were divided into group A, which included 108 patients with a BMI less than 25, and group B, which included 106 patients with a BMI of at least 25 and less than 30. HOMA insulin resistance (IR) and BMI were measured at the baseline, at achievement of an SVR, and 1 year after achievement of an SVR. Leptin levels were assessed at baseline and 1 year after achievement of an SVR in patients with increased BMI.

Results

One year after SVR, 36 (33.33%) patients from group A developed increasing BMI with no significant changes in HOMA versus that at SVR (P=0.53), but showed a significant reduction versus baseline HOMA (P=0.02). In group B, 68 (64.1%) patients showed increased BMI of at least 25, with a significant increase in HOMA versus that at SVR (P=0.02), and with no significant reduction versus baseline HOMA (P=0.44). In group B, serum leptin showed a significant reduction 12 months after achievement of an SVR versus baseline in patients with increased BMI. Six patients from group B with increased BMI after 1 year developed de-novo IR and type two diabetes mellitus.

Conclusion

In nondiabetic CHC patients with SVR and baseline BMI of at least 25, the post-SVR increase in BMI predisposed to an increase in HOMA-IR and could be considered a predisposing factor for diabetes mellitus.
Motivating Reading Compliance
Authors: Azzarello Jo , Ogans Judy , Robertson Victoria
Published: June 2017

Getting students to complete reading assignments is often a source of frustration for nurse educators. Monte Carlo Quizzes (MCQs) were adapted for online delivery in a hybrid nursing course to encourage timely completion and deep processing of readings. Students indicated that MCQs motivated them to complete the assigned readings and to read more carefully. However, there were no significant differences on scores for other course assignments between those who completed readings and those who did not.
Consideration of Dose and Timing When Applying Interventions After Stroke and Spinal Cord Injury
Authors: Basso D. Michele , Lang Catherine E.
Published: June 2017

Background and Purpose:

Nearly 4 decades of investigation into the plasticity of the nervous system suggest that both timing and dose could matter. This article provides a synopsis of our lectures at the IV STEP meeting, which presented a perspective of current data on the issues of timing and dose for adult stroke and spinal cord injury motor rehabilitation.

Summary of Key Points:

For stroke, the prevailing evidence suggests that greater amounts of therapy do not result in better outcomes for upper extremity interventions, regardless of timing. Whether or not greater amounts of therapy result in better outcomes for lower extremity and mobility interventions needs to be explicitly tested. For spinal cord injury, there is a complex interaction of timing postinjury, task-specificity, and the microenvironment of the spinal cord. Inflammation appears to be a key determinant of whether or not an intervention will be beneficial or maladaptive, and specific retraining of eccentric control during gait may be necessary.

Recommendations for Clinical Practice:

To move beyond the limitations of our current interventions and to effectively reach nonresponders, greater precision in task-specific interventions that are well-timed to the cellular environment may hold the key. Neurorehabilitation that ameliorates persistent deficits, attains greater recovery, and reclaims nonresponders will decrease institutionalization, improve quality of life, and prevent multiple secondary complications common after stroke and spinal cord injury.
Hepatitis C in Pregnancy: Review of Current Knowledge and Updated Recommendations for Management
Authors: Page Charlotte M. , Hughes Brenna L. , Rhee Eleanor H.J. , Kuller Jeffrey A.
Published: June 2017

Importance

An estimated 1% to 2.5% of pregnant women in the United States are infected with hepatitis C virus (HCV), which carries approximately a 6% risk of mother-to-infant transmission.

Objectives

The aims of this article are to review the current evidence on HCV in pregnancy and to provide updated recommendations for management.

Evidence Acquisition

Original research articles, review articles, and guidelines on HCV in general and specifically in pregnancy were reviewed, as were drug safety profiles from the Food and Drug Administration.

Results

Pregnancy appears to have a beneficial effect on the course of maternal chronic HCV infection. However, it is associated with an increased risk of adverse fetal outcomes, including fetal growth restriction and low birth weight, and can be transmitted to the infant in utero or during the peripartum period. No perinatal intervention has been shown to reduce the risk of vertical transmission, but some may increase this risk. To date, no treatment regimens for HCV have been approved for use in pregnancy, but the new ribavirin-free, direct-acting antiviral regimens are being used with high efficacy outside pregnancy.

Conclusions and Relevance

Hepatitis C virus infection in pregnancy generally does not adversely affect maternal well-being but is associated with adverse effects on the fetus because of pregnancy complications and vertical transmission. There are currently no approved treatment regimens for HCV in pregnancy; this should be an active area of research in obstetrics.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completion of this educational activity, the obstetrician/gynecologist should be able to summarize current knowledge on the impact of pregnancy on maternal chronic hepatitis C, identify risks that maternal hepatitis C infection presents to the fetus, discuss the evidence on perinatal interventions and the risk of vertical transmission of HCV, and outline how to screen for, diagnose, and provide appropriate prenatal care for hepatitis C in pregnancy.
The Limits of Electronic Fetal Heart Rate Monitoring in the Prevention of Neonatal Metabolic Acidemia
Authors: Clark Steven L. , Hamilton Emily F. , Garite Thomas J. , Timmins Audra , Warrick Philip A. , Smith Samuel
Published: June 2017

(Abstracted from Am J Obstet Gynecol 2017;216:163.e1–163.e6)

Despite advances in technology and training, averting the neurologic injury causing hypoxia-induced fetal metabolic acidemia has not been demonstrated. By examining fetal heart rate tracings of infants with base deficit of more than 12 and base deficit of less than 8, this study seeks to assess the validity of electronic fetal heart rate monitoring (EFM) in preventing adverse metabolic acidemia–related outcomes and validate a fetal heart rate interpretation algorithm, specifically designed to assist with the management of category II fetal heart rate tracings.
Narrative Review: Sexually Transmitted Diseases and Homeless Youth—What Do We Know About Sexually Transmitted Disease Prevalence and Risk?
Authors: Caccamo Alexandra , Kachur Rachel , Williams Samantha P.
Published: June 2017

Background

Homelessness affects an estimated 1.6 million US youth annually. Compared with housed youth, homeless youth are more likely to engage in high-risk behaviors, including inconsistent condom use, multiple sex partners, survival sex, and alcohol/drug use, putting them at increased sexually transmitted disease (STD) risk. However, there is no national estimate of STD prevalence among this population.

Methods

We identified 10 peer-reviewed articles (9 unique studies) reporting STD prevalence among homeless US youth (2000–2015). Descriptive and qualitative analyses identified STD prevalence ranges and risk factors among youth.

Results

Eight studies reported specific STD prevalence estimates, mainly chlamydia, gonorrhea, and syphilis. Overall STD prevalence among homeless youth ranged from 6% to 32%. STD rates for girls varied from 16.7% to 46%, and from 9% to 13.1% in boys. Most studies were conducted in the Western United States, with no studies from the Southeast or Northeast. Youths who experienced longer periods of homelessness were more likely to engage in high-risk sexual behaviors. Girls had lower rates of condom use and higher rates of STDs; boys were more likely to engage in anal and anonymous sex. Additionally, peer social networks contributed to protective effects on individual sexual risk behavior.

Conclusions

Sexually transmitted disease prevalence estimates among homeless youth fluctuated greatly by study. Sexually transmitted disease risk behaviors are associated with unmet survival needs, length of homelessness, and influence of social networks. To promote sexual health and reduce STD rates, we need better estimates of STD prevalence, more geographic diversity of studies, and interventions addressing the behavioral associations identified in our review.
The Impact of Multiple Viral Respiratory Infections on Outcomes for Critically Ill Children*
Authors: Chauhan Jigar C. , Slamon Nicholas B.
Published: June 2017

Objective:

Advances in molecular diagnosis have led to increased testing for single and multiviral respiratory infection in routine clinical practice. This study compares outcomes between single and multiviral respiratory infections in children younger than 5 years old admitted to the PICU with respiratory failure.

Design:

Retrospective, single-center, cohort study.

Setting:

Tertiary-care, freestanding children’s hospital.

Patients:

Children younger than 5 years old admitted to the PICU with respiratory failure and positive respiratory molecular panel. Children with comorbidity or history of similar infections were excluded. After exclusions, the children were divided into single or multiviral groups. Their demographics and PICU outcomes were compared and analyzed.

Interventions:

None.

Measurements and Main Results:

Four hundred seventy-seven children with respiratory failure tested positive on respiratory panel, out of which 432 had single and 45 had multiple viruses. Children with multiple viruses had a longer PICU stay (4.5 d) compared with the single viral group (3 d; p < 0.002). Multiviral infections were associated with higher utilization of central line (odds ratio, 2.4; 95% CI, 1.3–4.6; p = 0.008) but not with the need of invasive ventilation requirement or cardiovascular dysfunction. Further analysis among invasively ventilated patients showed multiviral infections resulted in higher association of prolonged ventilation (> 7 d) (odds ratio, 3.4; 95% CI, 1.2–9.4; p = 0.01) and bacterial lower respiratory tract infection confirmed by quantitative bronchoalveolar lavage (odds ratio, 2.1; 95% CI, 1.1–11.2; p = 0.03). Infections with human rhinovirus/Enterovirus, Adenovirus, parainfluenza, and influenza formed a significantly larger proportions of cases (p = 0.00089) as multiviral infections compared with individual infections.

Conclusions:

Multiviral infections were associated with longer PICU stay, with prolonged mechanical ventilation, with bacterial lower respiratory infections, and with central line requirement. Certain common viruses resulted in higher percentages of PICU admission as multiviral infections.
Defining the Cervical Transformation Zone and Squamocolumnar Junction: Can We Reach a Common Colposcopic and Histologic Definition?
Authors: Reich Olaf , Regauer Sigrid , McCluggage W.G. , Bergeron Christine , Redman Charles
Published: June 2017

Quality assurance and research in colposcopy and cervical pathology require standardized terminologies and reporting. However, clinical and histologic definitions of the cervical transformation zone (TZ) and squamocolumnar junction (SCJ) vary considerably. We aimed to identify areas of agreement and areas where work is required to standardize the definitions of the TZ and the SCJ. We conducted a survey among the board members of the European Federation of Colposcopy member societies and members of the International Society of Gynecological Pathologists. Overall, 22 expert colposcopists and 34 gynecologic pathologists responded. There was broad agreement that the TZ is the area where squamous metaplasia has occurred. There was consensus that the original SCJ can appear colposcopically indistinct in cases of maturation of the metaplastic squamous epithelium but can be identified histologically by the presence of the so-called last cervical gland. It was agreed that the border between the metaplastic squamous epithelium and the columnar epithelium on the surface of the cervix is called the new SCJ. Areas where work is required include the questions as to whether the cervical crypts lined by columnar epithelium in the field of squamous metaplasia are an integral part of the TZ or not and whether the individual microscopic borders between the metaplastic squamous epithelium of glandular crypts and the residual columnar epithelium of glandular crypts should be considered as part of the new SCJ or not. This paper is a step in an attempt to standardize colposcopic and histologic definitions among colposcopists and pathologists.