bluuebunny/crossref_metadata_2025 huggingface dataset:
Food and Water Management in Northwest Africa
Authors: Besbes Mustapha , Chahed Jamel , Hamdane Abdelkader
Published: May 2018

Northwest African countries (NA) consume 70 percent of their renewable water resources, and groundwater overdraft has become a major problem. Blue water irrigation represents 17 percent of overall water resources and is economically significant. Green water represents 83 percent, but is not yet well evaluated, and is not considered in national water strategies, along with virtual water embedded in international food trade. Irrigation enhances local agrifood production but it has not changed the proportion of staple foods. The region remains a major net food importer and, largely due to population increase, water dependency increased from 30 percent to 50 percent between 1970 and 2010. Population forecasts predict that water demand will continue to grow, and could reach more than three times the present level. Given the blue water status, NA must develop approaches to cope with water–food challenges, based on international virtual water flow optimization and better green water valorization.
The Suffocated Cultural Heritage of Sub-Saharan Africa’s Protected Areas
Authors: Keitumetse Susan O. , Sikorei Arpakwa O.
Published: May 2018

Management of sub-Saharan protected areas is at its peak, with most countries having signed up to international conventions aimed at protecting the natural environment and collectively managing political threats that are likely to emanate from other states’ interest to harness cross-border environmental resources. These conservation efforts however are at a broader perspective that does not cater for the nuances at varying scales of environmental resources conservation and management. This article looks at the micro scale of resources management and assesses conservation of landscape at a protected world heritage area to illustrate an existing gap that needs to be addressed by accounting for each and every category of resources found in any protected landscape. To illustrate this phenomenon this article discusses insights from two protected areas of world heritage status in southern Africa: Ngorongoro Crater Conservation Park World Heritage site in Tanzania and Okavango Delta World Heritage site in Botswana.
Sidekick No More Neural Translation Control by p70 ribosomal S6 kinase 1
Authors: Bhattacharya Aditi
Published: May 2018

The p70 ribosomal S6 kinase 1 (S6K1) plays a critical role in stimulus-dependent anabolism in the body and has been the focus of intense study for diseases such as diabetes, cardiac myopathies and cancers, rather than neurological disorders. This chapter evaluates the evidence for S6K1 driven protein synthesis in the brain, its role in mediating learning and memory, dysfunction in disease, and other outstanding questions. S6K1 has been studied for several decades, almost entirely in the context of being the major mediator of translational control downstream of the mechanistic target of rapamycin complex 1 (mTORC1). Interestingly, recent work in neural systems is slowly unravelling the varied roles of S6K1 as a signal aggregator, not limited to mTORC1, to affect neural translation, thus making its involvement in brain function more nuanced than earlier thought.
Local Government
Authors: Weinstein Benjamin
Published: May 2018

This chapter considers the practices, cultures, and institutional development of local government between the Municipal Corporations Act of 1835 and the Scottish and Welsh Local Government Acts of 1994. The chapter pays special attention to local government’s centrality to Victorian conceptions of the state and to the important role which Victorians assigned to local government in furthering ‘political education’ among an ever-growing body of parliamentary voters. The chapter goes on to contrast the vitality of Victorian and early twentieth-century local government with the declining profile of local government during the second half of the twentieth century.
The Economy
Authors: Tomlinson Jim
Published: May 2018

This chapter falls into two unequal parts. The first charts, broadly chronologically, the shifting understandings, historical and historiographical, of the role of the state in economic life. The second focuses on debates about the performance of the economy, especially notions of ‘decline’ which have been central to those debates since the late nineteenth century. Variegated but overlapping senses of ‘decline’, originating in very specific historical circumstances, have overshadowed much writing on the modern British economy, with, it will be argued, often detrimental effects on our understanding. Such notions need to be historicized—placed firmly in the intellectual, ideological, and above all political contexts within which they arose.
Political Ideas and Languages
Authors: Craig David
Published: May 2018

Both politicians and historians have circled nervously around the precise relationship between political ideas and political actions in the past 200 years. This chapter evaluates the different ways in which historians have considered the role of ideas within politics and, in particular, challenges the unhelpful dichotomy of framing politics as either an ‘ideological’ or a ‘pragmatic’ activity. It is concerned, therefore, with the interactions between ideas and action, or theory and practice, and the ways in which political ‘ideas’ may be historicized, reflecting too on the implications of this for framing political action as ‘high’ or ‘low’ (or ‘popular’). Attention is paid to the importance of language in shaping political thought and action.
Political Communication
Authors: Beers Laura
Published: May 2018

This chapter offers a critical overview of the emergence of different strands of historical enquiry into political communication, a term of art rarely used in Britain until the 1960s and only taken seriously by historians from the 1980s. The chapter pays particular attention to the history of political communication in the era of mass democracy and the mass media and focuses on the relationship between the British left and the media as a lens onto wider developments. The final section examines how, particularly after the election victory of New Labour in 1997, a new generation of historians has explored the phenmenon of mediated political communication and its intersections with areas of popular culture with increasing sophistication.
The Labour Party
Authors: Black Lawrence
Published: May 2018

Whatever happened to labour history? In 2000, the Labour party’s centenary produced some dynamic and cutting-edge contributions to the field. Since then, however, some important historiographical trends, the crisis in the Co-Op, a journal occupied by debate over Communism, and the full force of New Labour have significantly thinned the ranks of self-identifying ‘labour’ historians. A discipline that was once in rude health faces novel challenges as a result. This chapter reflects on the historiographical impact of these major developments. It also assesses the current and likely future fortunes of political histories of the labour movement and the Labour party.
High Politics
Authors: Fielding Steven
Published: May 2018

A focus on the national institutions of the British state and the men who populated them was the first means by which many understood ‘political history’. This ‘high politics’ remains a popular way to understand the subject. Yet, ‘high politics’ has also been criticized by radical advocates of ‘history from below’ for its methodological and political conservatism. This chapter assesses the merits of focusing on Westminster, Whitehall, and its denizens by employing insights from political science, notably the notion of structure and agency as well as the literature associated with new institutionalism. The chapter also assesses the contribution of the ‘Peterhouse School’—one long reviled by many high-political historians as well as by historians of popular social movements—as a way of bridging the gap between the two methods of conceiving the dynamics of Britain’s modern political history.
Tories and Conservatives
Authors: Charmley John
Published: May 2018

This chapter explores some of the ways in which scholars of modern British political history have approached study of the Conservative party since 1800. The Conservatives have been the most enduring, and successful, force in modern British political history, but the sources of that success remain a matter of considerable and extensive scholarly dispute. Academic study of the party is now richer than ever before. Focusing on the fortunes of party leaders and utilizing this perspective as a window into the Conservatives’ successes and failures over the nineteenth and twentieth centuries, this chapter examines how the party has adapted itself to changing conditions.
Prime Minister and Cabinet
Authors: Blick Andrew
Published: May 2018

While British political history is frequently preoccupied with the role and actions of prime ministers and Cabinets, the formal study of those institutions remains underdeveloped. In part this is because those roles have often been imprecisely defined, and understood largely in terms of the personnel who discharged them. The value of biography, or collective biography, in analysing these subjects is therefore considered in this chapter, alongside a wider treatment how work on the offices has developed over time. Issues of change and continuity are assessed against broader developments in British political history. Building on this, the chapter considers which questions the political historian should ask of these key institutions, including how they should be defined, and what source material might best be used to advance our understanding of them.
Introduction
Authors: Brown David , Crowcroft Robert , Pentland Gordon
Published: May 2018

This chapter introduces the volume by addressing and evaluating the idea of a ‘crisis’ within post-war political history in general and the political history of Britain in particular. It establishes the rationale for the Handbook and explains its intellectual architecture. Rather than offering a neat synoptic overview of modern British political history, the emphasis here is on the multiplicity of views, interests and perspectives that inform our understanding of the political past. Identifying key areas of debate, and ways in which traditional as well as newer fields of enquiry have shaped that understanding, this chapter underlines the vibrancy, and heterogeneity, of modern British political history.
Whigs and Liberals
Authors: Packer Ian
Published: May 2018

This chapter examines some of the main historiographical trends in interpreting the nature, achievements, and fortunes of the Whig groupings of the early to mid-nineteenth century and then the Liberal party from the mid-nineteenth century to the present. In doing so it takes a fresh look at the many controversies that have raged over Whig and Liberal ideology, their perceptions of the political system, their actions in government, party organization, and their electoral successes and failures. It also reviews the fraught problem of whether and how these developments can be related to changes in society, the British political system, and prevalent intellectual trends.
The State
Authors: Harling Phil
Published: May 2018

This chapter highlights several prominent themes in both the evolution of the modern British state across the nineteenth and twentieth centuries and the literature surrounding it. A focus on questions and concerns such as the perception of the proper role, and limits, of the state, and on the interaction of the state with a developing civil society, frames an analysis of the scope and meaning of the state in modern Britain. The chapter ends by exploring opportunities for future research: how government and ‘governmentality’ might be brought into more fruitful scholarly conversation with one another; how we conceptualize the relationships between central and local government; and how historians might assess Britons’ shifting attitudes towards the state.
Normality
Authors: Heinämaa Sara , Taipale Joona
Published: May 2018

The chapter explicates the central resources that classical Husserlian phenomenology and its contemporary elaborations offer for the study of psychic disorders. We shall first discuss the phenomenological principles that enable analysis of the conditions and limits of experiencing and sense-constitution. We shall then clarify the concepts that phenomenologists have developed for the discussion of the normality and abnormality of experiencing—optimality and concordance—while also paying heed to the types of phenomena that classical and contemporary phenomenologists have tackled while developing their methods. In this vein, we will emphasize methodological factors that separate phenomenological studies of intentional experiencing from empirical studies of human behavior and psyche, on the one hand, and from alternative philosophical studies of the mind and consciousness, on the other hand. In sum, our chapter shows that phenomenology offers powerful tools for the systematic investigation of several different types of experiential disorders (such as depression and psychosis).
Owen Lattimore
Authors: Perdue Peter C.
Published: May 2018

The American scholar, traveler, political adviser, and public intellectual Owen Lattimore strongly shaped American public opinion toward China and Central Eurasia in the twentieth century, but he also wrote major works on the geography and environment of the frontiers of Asia that still influence global historians today. His writings asserted the vital importance of China’s relationship with the nomads of the steppe, including the Mongols, for defining the boundaries, cultures, and geopolitical strategy of empires and nation states. He argued for sophisticated explanations of relationships between environmental forces like climate and human culture, and he analyzed China and Central Eurasia so as to provide new perspectives on world history. This article evaluates Lattimore’s contributions to world history in the light of his dynamic political and academic life.
Deciphering the Rhizosphere and Geocaulosphere Microbiomes of Potato Following Inoculation with the Biocontrol Agent Pseudomonas fluorescens Strain LBUM223
Authors: Roquigny Roxane , Novinscak Amy , Léger Geneviève , Marcoux Nathan , Joly David L. , Filion Martin
Published: May 2018

The phenazine-1-carboxylic acid (PCA)-producing Pseudomonas fluorescens strain LBUM223 shows biocontrol potential against Streptomyces scabies, which causes common scab of potato. To better characterize the impact of inoculating this specific biocontrol agent under field conditions, the microbiomes of the rhizosphere and the geocaulosphere of potato plants were characterized using next-generation sequencing. A single initial application or biweekly applications of LBUM223 were performed up to 11 weeks after planting. Rhizosphere and geocaulosphere soils (when potato tubers were produced) were sampled every 2 weeks. Following soil DNA extractions, 16S rRNA gene amplification and sequencing were performed using the Illumina MiSeq technology. The QIIME pipeline was used for data analyses. Results were generated from 45 rhizosphere and 27 geocaulosphere samples, for which 63,502 and 44,469 different operational taxonomical units were observed. Diversity comparisons between both datasets were performed. To our knowledge, this is the first time that the geocaulosphere microbiome is characterized and compared with the rhizosphere microbiome following inoculation with a specific microorganism. Eleven phyla accounted for 95% of the diversity, with Actinobacteria, Proteobacteria, Chloroflexi, and Acidobacteria being the most abundant ones. Overall, the results obtained suggest that P. fluorescens strain LBUM223 does not significantly alter the autochthonous rhizosphere nor geocaulosphere microbiomes.
Perceptual and Structural Facilitators and Barriers to Becoming a Surgeon: A Qualitative Study of African American and Latino Surgeons
Authors: Ulloa Jesus G. , Viramontes Omar , Ryan Gery , Wells Kenneth , Maggard-Gibbons Melinda , Moreno Gerardo
Published: May 2018

Purpose

As racial and ethnic heterogeneity in the United States increases, it is important that the health care workforce, including surgery, mirror that diversity. Structural and perceptual barriers may contribute to an underrepresentation of African American and Latino surgeons. Understanding these barriers may translate into interventions and, in turn, improved diversification of the U.S. surgery workforce.

Method

In 2016, the authors conducted in-depth semistructured interviews, exploring structural and perceptual barriers that African American and Latino surgeons face. The authors used conventional qualitative techniques to analyze data and identify themes.

Results

The authors interviewed 23 participants and observed three major themes characterizing the path to becoming a surgeon: creating a path to medicine, surgical culture, and mentorship. Subthemes provided further nuance. For creating a path to medicine, the subthemes were personal attributes, family support, community assets/barriers, and minority experience. For surgical culture, the subthemes comprised quality of life, surgeon–patient relationship, and restoring health. For mentorship, the subthemes were aspirational figures, formal programs/peer support, and professional opportunities. Experiences described by African Americans and Latinos were similar, but the experiences of participants of different self-identified childhood socioeconomic status were dissimilar.

Conclusions

The path to a surgical career as experienced by African American and Latino surgeons is heavily influenced by mentors mediating their integration into surgical culture and engendering a feeling of belonging. Future surgeons from groups underrepresented in medicine would benefit from identifying aspirational figures early, a structured introduction into the rigors of the profession, and a deconstruction of negative surgical norms.
Gaps in the Substance Use Disorder Treatment Referral Process: Provider Perceptions
Authors: Blevins Claire E. , Rawat Nishi , Stein Michael D.
Published: May 2018

Objectives:

The demand for substance use disorder treatment is increasing, fueled by the opioid epidemic and the Affordable Care Act mandate to treat substance use disorders. The increased demand for treatment, however, is not being met by a corresponding increase in access to or availability of treatment. This report focuses specifically on the treatment referral process, which we have identified as 1 of the key barriers to timely and effective treatment. Difficulties in referral to substance use disorder treatment are examined through the lens of providers who make referrals (ie, referral source) and individuals who work in substance use disorder facilities (ie, referral recipient).

Methods:

Administrative officials, emergency department physicians, addiction physicians, government officials, providers, insurance officials, and mental health advocates (n = 59) were interviewed on the referral process protocol, challenges for providers and others making referrals, and issues with substance use treatment facility intake procedures.

Results:

Several main themes were identified as barriers in the process: difficulties in determining patient eligibility, lack of transparency regarding treatment capacity, referral source knowledge/understanding of options, and issues with communication between referral source and recipient. We then proposed several solutions to address specific barriers.

Conclusions:

Current gaps in the referral process cause delays to care. Improving systems would involve addressing these themes and expanding the use of appropriate treatments for the many patients in need.
Evaluation of Two Circumaural Earphones for Audiometry
Authors: Smull Clae C. , Madsen Brandon , Margolis Robert H.
Published: May 2018

Objective:

The Sennheiser HDA 200 earphone, a standard circumaural earphone used in audiometry for many years, is out of production and is replaced by the RadioEar DD450. The Sennheiser HD 280 Pro earphone is a consumer product that has characteristics that may be suitable for audiometry and may be a low-cost alternative to the DD450. The DD450 and HD 280 Pro earphones were compared with the HDA 200 for use in audiometry.

Design:

RadioEar DD450 and Sennheiser HD 280 Pro earphones were evaluated for reference equivalent threshold sound pressure levels (RETSPLs), ambient-noise attenuation, and occlusion effects. Audiometric thresholds measured on a group of normal-hearing adults were used to determine RETSPLs. Ambient-noise attenuation was determined by measuring the sound pressure in the ear canal produced by a broadband signal from a loudspeaker with and without occlusion by the earphone. Acoustic occlusion effects were determined by measuring the ear-canal sound pressure produced by a bone-conducted source with and without occlusion by the earphone. The results were compared with measurements obtained from the HDA 200 earphone.

Results:

Audiometric thresholds obtained using the DD450 earphone did not differ from those obtained with the HDA 200 earphones, indicating that the HDA 200 RETSPLs provided in the audiometer standards (ANSI S3.6-2010; ISO 389-8-2004) are transferable to the DD450. New RETSPLs for the HD 280 Pro earphone were determined from the threshold measurements. Ambient-noise attenuation provided by the DD450 was equivalent to the attenuation provided by the HDA 200. The HD 280 Pro provided less ambient-noise attenuation than the other circumaural earphones, but more than the supra-aural earphones commonly used in audiometry. The DD450 produced an occlusion effect 5 dB larger than that of the HDA 200 at 0.25 and 0.5 kHz; both earphones produced negligible occlusion effects at higher frequencies. The HD 280 Pro produced larger occlusion effects in the low frequencies than the other two earphones, with negligible occlusion effects at 1.0 kHz and above.

Conclusions:

The HDA 200 RETSPLs are transferable to the DD450. Ambient-noise attenuation and occlusion effects are similar for these two earphones. RETSPLs for the HD 280 Pro are provided. The HD 280 Pro has less ambient-noise attenuation and larger occlusion effects than the DD450 but is a viable low-cost alternative.
A Novel Indirect Reduction Technique in Ankle Syndesmotic Injuries: A Cadaveric Study
Authors: Cosgrove Christopher T. , Spraggs-Hughes Amanda G. , Putnam Sara M. , Ricci William M. , Miller Anna N. , McAndrew Christopher M. , Gardner Michael J.
Published: May 2018

Objective:

To describe a novel technique using preoperative computed tomography (CT) to plan clamp tine placement along the trans-syndesmotic axis (TSA). We hypothesized that preoperative CT imaging provides a reliable template on which to plan optimal clamp tine positioning along the TSA, reducing malreduction rates compared with other described techniques.

Methods:

CT images of 48 cadaveric through-knee specimens were obtained, and the TSA was measured as well as the optimal position of the medial clamp tine. The syndesmosis was then fully destabilized. Indirect clamp reductions were performed with the medial clamp tine placed at positions 10 degrees anterior to the TSA, along the TSA, and at both 10 and 20 degrees posterior to the TSA. The specimens were then separately reduced using manual digital pressure and palpation alone. CT was performed after each clamp and manual reduction.

Results:

On average, reduction clamp tines were within 3 ± 2 degrees of the desired angle and within 5% ± 4% of the templated location along the tibial line for all clamp reduction attempts. Palpation and direct visualization produced the overall lowest malreduction rates in all measurements: 4.9% and 3.0%, respectively. Off-axis clamping 10 degrees anterior or 20 degrees posterior to the patient-specific TSA demonstrated an increased overall malreduction rate: 15.8% and 11.3%, respectively. Significantly more over-compression occurred when a reduction clamp was used versus manual digital reduction alone (8.6% vs. 0%).

Conclusions:

Reduction clamp placement directly along an optimal clamping vector can be facilitated by preoperative CT measurements of the uninjured ankle. However, even in this setting, the use of reduction clamps increases the risk for syndesmotic malreduction and over-compression compared with manual digital reduction or direct visualization.
Hypovitaminosis D in Orthopaedic Trauma: Which Guidelines Should Be Followed?
Authors: Schiffman Brett , Summers Hobie , Bernstein Mitchell , DiSilvio Frank , Foyil Sarah , Lack William
Published: May 2018

Objective:

To evaluate the risk factors for hypovitaminosis D and to determine the baseline vitamin D supplementation associated with normal vitamin D levels at presentation.

Design:

Prospective observational study.

Setting:

Level I trauma center.

Patients:

This study included 259 adult patients undergoing operative treatment for orthopaedic trauma (OTA 11–15, 21–23, 31–34, 41–44, 61–62, 70C, 81–82, 87) between January 1, 2014, and December 31, 2014.

Intervention:

Prospective, observational study.

Main Outcomes:

Association of hypovitaminosis D with patient characteristics, injury factors, and vitamin D supplementation.

Results:

Univariate predictors of hypovitaminosis D included a lack of preinjury supplementation, non-white race, younger age, female sex, non-Medicare insurance, smoking, obesity, Charlson Comorbidity Index <2, and high-energy mechanism. On multivariate analysis, preinjury supplementation was associated with a lower risk (odds ratio: 0.31, 95% confidence interval: 0.15–0.63, P = 0.001) and non-white race was associated with a higher risk (odds ratio: 3.63, 95% confidence interval: 1.58–8.37, P = 0.001) of hypovitaminosis D. Logistic regression analysis found a dose-dependent relationship between vitamin D supplementation and hypovitaminosis D. Each 100-IU increase in vitamin D supplementation was associated with an 8% decrease in the risk of hypovitaminosis D.

Conclusions:

A lack of preinjury supplementation and non-white race were independently associated with hypovitaminosis D. Baseline supplementation consistent with Endocrine Society guidelines (2000 IU daily) was more effective than that consistent with Institute of Medicine guidelines (400 IU daily) in maintaining 25-hydroxyvitamin D above 30 ng/mL in this population.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Using a Validated Middle-Age and Geriatric Risk Tool to Identify Early (<48 Hours) Hospital Mortality and Associated Cost of Care
Authors: Lott Ariana , Haglin Jack , Saleh Hesham , Hall Jordan , Egol Kenneth A. , Konda Sanjit R.
Published: May 2018

Objectives:

(1) To demonstrate that a validated trauma triage score for middle-aged and geriatric patients could identify those at high risk of mortality within the first 2 days of hospitalization and (2) determine the cost of care for this cohort of patients.

Design:

Prospective cohort study.

Setting:

Single level 1 trauma center.

Patients:

Patients 55 years of age and older who were evaluated in the emergency department setting by orthopaedics or who met the American College of Surgeons Tier 1–3 criteria.

Intervention:

Calculation of validated trauma triage score, Score for Trauma Triage in Geriatric and Middle-aged patients, using patient's demographic, injury severity, and functional status; main outcome measurements: length of stay, inpatient mortality, time between presentation and time of death, and direct variable costs of hospitalization.

Results:

A total of 1470 consecutive patients (mean age of 72.2 ± 11.9 years) were enrolled in this study, 17 of whom died within 48 hours of presentation to the emergency department. These patients had a significantly higher trauma triage score than the rest of the cohort with a score of 50.9% ± 37.2% versus 3.3% ± 9.5%, P < 0.001 indicating that they had a mean risk of inpatient mortality of over 50%. Mean total cost per day was much higher in the cohort of patients who died within 48 hours of admission compared with all other trauma patients [$49,367 ± $79,057 vs. $3966 ± $2897 (P = 0.031)].

Conclusions:

To achieve value-based care in this high-risk cohort, targeted cost savings while improving patient outcomes and/or expediting goals-of-care and end-of-life goals is necessary and the STTGMA score allows for stratification of these patients in both mortality risk and cost profile.
Locking Plate Fixation in a Series of Bicondylar Tibial Plateau Fractures Raises Treatment Costs Without Clinical Benefit
Authors: Cavallero Matthew , Rosales Richard , Caballero Jesse , Virkus Walter W. , Kempton Laurence B. , Gaski Greg E.
Published: May 2018

Objectives:

To compare outcomes and costs between locking and nonlocking (NL) constructs in the treatment of bicondylar tibial plateau (BTP) fractures.

Design:

Retrospective cohort study.

Setting:

Level 1 academic trauma center.

Patients:

All patients who presented with complete articular, BTP fractures OTA/AO 41-C and Schatzker VI between 2013 and 2015 were screened (n = 112). Patients treated with a mode of fixation other than plate-and-screw were excluded. Fifty-six patients with a minimum follow-up of 12 months were included in the analysis.

Intervention:

Operative fixation of BTP fractures with locking (n = 29) or NL (n = 27) implants.

Main outcome measurements:

Implant cost, patient-reported outcomes (PROMIS physical function and pain interference), clinical, and radiographic outcomes.

Results:

There were no differences between the 2 groups with respect to demographics, injury characteristics, radiographic outcomes (change in alignment), or clinical outcomes (PROMIS, reoperation, nonunion, and infection). Implant costs were significantly greater in the locking group compared with the NL group (mean L, $4453; mean NL, $2569; P < 0.01).

Conclusions:

This study demonstrated improved value of treatment (less cost with no difference in clinical outcome) with NL implants for BTP fractures when dual-plate fixation strategies are performed.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Exploratory Application of Neuropharmacometabolomics in Severe Childhood Traumatic Brain Injury*
Authors: Hagos Fanuel T. , Empey Philip E. , Wang Pengcheng , Ma Xiaochao , Poloyac Samuel M. , Bayir Hülya , Kochanek Patrick M. , Bell Michael J. , Clark Robert S. B.
Published: May 2018

Objectives:

To employ metabolomics-based pathway and network analyses to evaluate the cerebrospinal fluid metabolome after severe traumatic brain injury in children and the capacity of combination therapy with probenecid and N-acetylcysteine to impact glutathione-related and other pathways and networks, relative to placebo treatment.

Design:

Analysis of cerebrospinal fluid obtained from children enrolled in an Institutional Review Board–approved, randomized, placebo-controlled trial of a combination of probenecid and N-acetylcysteine after severe traumatic brain injury (Trial Registration NCT01322009).

Setting:

Thirty-six–bed PICU in a university-affiliated children’s hospital.

Patients and Subjects:

Twelve children 2–18 years old after severe traumatic brain injury and five age-matched control subjects.

Intervention:

Probenecid (25 mg/kg) and N-acetylcysteine (140 mg/kg) or placebo administered via naso/orogastric tube.

Measurements and Main Results:

The cerebrospinal fluid metabolome was analyzed in samples from traumatic brain injury patients 24 hours after the first dose of drugs or placebo and control subjects. Feature detection, retention time, alignment, annotation, and principal component analysis and statistical analysis were conducted using XCMS-online. The software “mummichog” was used for pathway and network analyses. A two-component principal component analysis revealed clustering of each of the groups, with distinct metabolomics signatures. Several novel pathways with plausible mechanistic involvement in traumatic brain injury were identified. A combination of metabolomics and pathway/network analyses showed that seven glutathione-centered pathways and two networks were enriched in the cerebrospinal fluid of traumatic brain injury patients treated with probenecid and N-acetylcysteine versus placebo-treated patients. Several additional pathways/networks consisting of components that are known substrates of probenecid-inhibitable transporters were also identified, providing additional mechanistic validation.

Conclusions:

This proof-of-concept neuropharmacometabolomics assessment reveals alterations in known and previously unidentified metabolic pathways and supports therapeutic target engagement of the combination of probenecid and N-acetylcysteine treatment after severe traumatic brain injury in children.
Exploring Research Topics and Trends in Nursing-related Communication in Intensive Care Units Using Social Network Analysis
Authors: Son Youn-Jung , Lee Soo-Kyoung , Nam SeJin , Shim Jae Lan
Published: May 2018

This study used social network analysis to identify the main research topics and trends in nursing-related communication in intensive care units. Keywords from January 1967 to June 2016 were extracted from PubMed using Medical Subject Headings terms. Social network analysis was performed using Gephi software. Research publications and newly emerging topics in nursing-related communication in intensive care units were classified into five chronological phases. After the weighting was adjusted, the top five keyword searches were “conflict,” “length of stay,” “nursing continuing education,” “family,” and “nurses.” During the most recent phase, research topics included “critical care nursing,” “patient handoff,” and “quality improvement.” The keywords of the top three groups among the 10 groups identified were related to “neonatal nursing and practice guideline,” “infant or pediatric and terminal care,” and “family, aged, and nurse-patient relations,” respectively. This study can promote a systematic understanding of communication in intensive care units by identifying topic networks. Future studies are needed to conduct large prospective cohort studies and randomized controlled trials to verify the effects of patient-centered communication in intensive care units on patient outcomes, such as length of hospital stay and mortality.
Biologics and Cardiovascular Disease
Authors: Van Taunay John S. , Albelda M. Teresa , Frias Juan Carlos , Lipinski Michael J.
Published: May 2018

The advent of biologic therapy has enhanced our ability to augment disease in an increasingly targeted manner. The use of biologics in cardiovascular disease (CVD) has steadily increased over the past several decades. Much of the early data on biologics and CVD were derived from their use in rheumatologic populations. Atherosclerosis, myocardial infarction, and heart failure have been closely linked to the inflammatory response. Accordingly, cytokines such as tumor necrosis factor (TNF)-alpha and interleukin (IL)-1 have been targeted. Noninflammatory mediators, such as proprotein convertase subtilisin kexin type 9 (PCSK9), have been selected for therapeutic intervention as well. Furthermore, RNA interference (RNAi) therapy has emerged and may serve as another targeted therapeutic mechanism. Herein, we will review the history, obstacles, and advances in using biologic therapy for CVD.
Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis
Authors: Moslehi Nazanin , Shab-Bidar Sakineh , Ramezani Tehrani Fahimeh , Mirmiran Parvin , Azizi Fereidoun
Published: May 2018

Objective:

The associations of body mass index (BMI) and obesity with ovarian reserve are controversial. This systematic review and meta-analysis was conducted to investigate the associations in reproductive-aged women.

Methods:

PubMed and Scopus were searched up to December, 2016. Original studies on the association of BMI with ovarian reserve markers, anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), inhibin β, and antral follicle count (AFC), either according to BMI categories or a continuous variable, were selected. Analyses were stratified into three groups based on polycystic ovary syndrome (PCOS) and fertility status of women.

Results:

Of 4,055 records identified, 45 studies were eligible for inclusion. Comparing the obese with nonobese, the pooled mean differences (MDs) and 95% confidence intervals (CIs) were −1.08 (95% CIs −1.52, −0.63) ng/mL for AMH, −0.22 (95% CIs −0.39, −0.06) mIU/mL for FSH, −0.09 (95% CIs −0.60, 0.42) for AFC, and −21.06 (95% CIs −41.18, −0.85) pg/mL for inhibin β in overall populations. The MDs were significant for AMH in fertile non-PCOS and PCOS women, and for FSH only in PCOS women. Fisher's Z showed significant correlations of BMI with AMH in the overall populations (−0.15 [95% CIs −0.20, −0.11]) and in all subgroups, and with FSH in the fertile non-PCOS women (−0.16 [95% CIs −0.28, −0.04]).

Conclusion:

Ovarian reserve markers of AMH and FSH are significantly lower in obese than in nonobese women, and BMI is negatively correlated with AMH in all study populations, and with FSH in fertile non-PCOS subgroups. PCOS and fertility status do not appear to affect the associations.
Anxiety levels predict fracture risk in postmenopausal women assessed for osteoporosis
Authors: Catalano Antonino , Martino Gabriella , Bellone Federica , Gaudio Agostino , Lasco Carmen , Langher Viviana , Lasco Antonino , Morabito Nunziata
Published: May 2018

Objective:

There has been increasing interest in the association of psychiatric disorders with fracture risk. This study aimed at investigating the role of severity of anxiety in bone health.

Methods:

Multiple clinical risk factors for fractures, the Fracture Risk Assessment Tool score, the bone mineral density (BMD) at the lumbar spine and femoral neck, Hamilton Anxiety Rating Scale (HAMA) scores, Beck Depression Inventory scores, and the 36-Item Short Form Health Survey (SF-36) scores for evaluation of the quality of life were determined, and x-ray vertebral morphometry was carried out in postmenopausal women referred for osteoporosis.

Results:

Of the 192 women recruited (mean age 67.5 ± 9.5 years), participants allocated to the tertile of the lowest HAMA scores (HAMA-1) showed a lower probability of fracture than did participants with the highest scores (HAMA-3) (20.44 ± 9.3 vs 24.94 ± 13%, respectively; P = 0.01), and the same trend was observed when comparing the HAMA-2 and HAMA-3 tertiles. Women in the HAMA-3 group exhibited lower lumbar T-score vales in the lumbar spine than did women in the HAMA-1 group (−2.84 ± 1.4 vs −2.06 ± 1.2 SD, respectively; P < 0.001) and a lower T-score value in the femoral neck (−2.21 ± 0.9 vs −1.93 ± 0.6 SD, respectively; P < 0.05). Lower T-score values were observed in HAMA-3 than in HAMA-2. A higher prevalence rate of vertebral fractures was observed in HAMA-3 than in HAMA-1, but the difference was not significant. Anxiety levels were significantly related to age, menopausal age, years since menopause, and depressive symptoms, and a multiple regression analysis was predictive of reduced BMD in the lumbar spine (β = −0.00672, SE = 0.001, P = 0.0002).

Conclusion:

In postmenopausal women, anxiety levels were associated with BMD in the lumbar spine and femoral neck.
Effects of vaginal estradiol tablets and moisturizer on menopause-specific quality of life and mood in healthy postmenopausal women with vaginal symptoms: a randomized clinical trial
Authors: Diem Susan J. , Guthrie Katherine A. , Mitchell Caroline M. , Reed Susan D. , Larson Joseph C. , Ensrud Kristine E. , LaCroix Andrea Z.
Published: May 2018

Objective:

Compare the effects of a vaginal estradiol tablet and a vaginal moisturizer, each to placebo, on menopause-related quality of life and mood in postmenopausal women with moderate–severe vulvovaginal symptoms.

Methods:

A total of 302 postmenopausal women enrolled in a 12-week, double-blind, placebo-controlled randomized trial were assigned to vaginal 10 μg estradiol tablet plus placebo gel (n = 102), vaginal moisturizer plus placebo tablet (n = 100), or dual placebo (n = 100). We measured change from randomization to 12 weeks in total score of the Menopause-Specific Quality of Life (MENQOL) questionnaire. We also evaluated the four MENQOL domains, depressive symptoms as measured by the Patient Health Questionnaire 8, and anxiety symptoms as measured by the Generalized Anxiety Disorder (GAD-7) questionnaire.

Results:

Treatment with vaginal estradiol resulted in significantly greater improvement in total MENQOL scores compared to dual placebo (mean difference between arms −0.3 at 12 weeks (95% confidence interval [CI] −0.5, 0.0; P = 0.01). A statistically significant group mean difference favoring vaginal estradiol was observed for the MENQOL sexual function domain (−0.4 at 12 weeks; 95% CI −1.0, 0.1; P = 0.005), but not for any of the other domains. Treatment with vaginal moisturizer did not provide greater improvement compared to placebo in total MENQOL scores (mean difference 0.2 at 12 weeks; 95% CI −0.1, 0.4; P = 0.38) or in any of the MENQOL domains. Neither treatment group showed improvement compared with placebo in the Patient Health Questionnaire 8 or Generalized Anxiety Disorder Questionnaire .

Conclusions:

Treatment with low-dose vaginal estradiol, but not vaginal moisturizer, modestly improved menopause-related quality of life and sexual function domain scores in postmenopausal women with moderate–severe vulvovaginal symptoms.
Comparison of Bacterial Culture Results Obtained from Nasopharyngeal and Midturbinate Swabs in Children With Upper Respiratory Tract Infection Symptoms
Authors: Martin Judith M. , Simonian Anita , Muniz Gysella , Green Michael , Shaikh Nader
Published: May 2018

Paired nasopharynx and midturbinate swabs were obtained from 96 children (mean age: 2.45 years) with upper respiratory tract symptoms. Of these, 38.5% were colonized with Streptococcus pneumoniae only, 16.7% with Haemophilus influenzae only and 9.4% with both bacteria. Bacterial cultures from paired nasopharynx and midturbinate swabs demonstrated agreement for S. pneumoniae (κ = 0.75), H. influenzae (κ = 0.59) and for both pathogens (κ = 0.62). This report compares the results of bacterial cultures obtained from the nasopharynx and midturbinate specimens in children with upper respiratory tract infections.
Successful Brincidofovir Treatment of Metagenomics-detected Adenovirus Infection in a Severely Ill Signal Transducer and Activator of Transcription-1-deficient Patient
Authors: Averbuch Diana , Safadi Rifaat , Dar Daniel , Wolf Dana , Cherniak Meir , Sorek Rotem , Amit Sharon
Published: May 2018

A signal transducer and activator of transcription-1-deficient patient presented with prolonged fever, cachexia, anemia, hypoalbuminemia and finally relapsing debilitating mycobacterial osteomyelitis while receiving a previously effective antimycobacterial treatment. Progression despite rigorous workup and multiple antibiotics prompted shotgun metagenomics revealing adenovirus in liver samples. Brincidofovir led to a complete, sustained clinical recovery, including osteomyelitis, probably attributed to reversal of adenovirus-induced immune dysregulation.
Validation of a Self-Report Clinical Decision-Making Tool Using Rasch Analysis
Authors: Macauley Kelly , Brudvig Tracy , Barry Amanda , Lufkin Olivia , McEnroy Kevin , Milinazzo Andrew
Published: May 2018

Introduction.

No objective tools exist that assess the level and progression of clinical decision-making (CDM) skills in Doctor of Physical Therapy (DPT) students. Tools in other health professions exist but are not applicable or transferable to DPT education. The purpose of the current study is to validate an objective tool to assess DPT students' perceptions of their CDM skills across a curriculum.

Methods.

This is a cross-sectional, observational design study, using a convenience sample of DPT students enrolled in a DPT program. Four phases of data collection, representing four iterations of the CDM tool, are included. A self-report tool assessing CDM using a Likert scale was sent to the participants through email. Data were analyzed using Rasch analysis after each phase of data collection, which led to survey revisions and further data collection.

Results.

The tool demonstrated high internal consistency throughout the four phases of data collection. The tool measures one construct, CDM. The Likert scale levels discriminated well between the different ability levels on all items. The scores on the CDM tool provided known groups validation of the tool. The tool has a ceiling effect, floor effect, and is unable to differentiate CDM skills for DPT graduates who have been practicing for >1 year.

Discussion.

Clinical decision making is a complex, highly individualized construct. This CDM tool distinguishes the students' perceived level of CDM ability across the different class years of a DPT curriculum. The sample was one of convenience. Further research increasing the heterogeneity of the sample will assist with increasing the generalizability of the tool.
Tympanic Membrane Perforation Repair Using Porcine Small Intestinal Submucosal Grafting
Authors: Yawn Robert J. , Dedmon Matthew M. , O’Connell Brendan P. , Virgin Frank W. , Rivas Alejandro
Published: May 2018

Objective:

To evaluate the use of porcine small intestinal submucosal grafts for tympanic membrane repair.

Patients:

Adult and pediatric patients with tympanic membrane perforations with and without chronic otitits media, and perforations after removal of cholesteatoma.

Intervention:

Endoscopic or microscopic tympanic membrane repair using porcine small intestinal submucosal grafts (Biodesign).

Main Outcome Measure(s):

Perforation closure, bone and air pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS) were recorded as outcome measures.

Results:

Thirty-seven patients were included with a mean age of 25.4 years (range, 6–75), 57% men. Twenty-six cases (70%) were performed endoscopically and 34 (92%) had concomitant cartilage grafting. Three patients (8%) had postoperative pinpoint (<1% surface area) perforation, and two patients (5%) had postoperative perforation, with an overall success rate of 86.5%. The mean improvement in air-bone gap was 7.6 dB and (p = 0.006). There were no statistically significant differences in closure rates when comparing primary versus revision cases, endoscopic versus microscopic cases, size of perforation, cholesteatoma, concomitant mastoidectomy, age, tobacco exposure, or comorbid diabetes mellitus. Patients with concomitant cartilage graft were more likely to be successful when compared with those without cartilage graft (p = 0.04).

Conclusions:

Porcine small intestinal submucosal grafts are effective in the repair of the tympanic membrane. These grafts are an excellent choice in total endoscopic cases as it avoids incisions necessary for allograft harvest.