bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of incidentally diagnosed pulmonary artery dissection in patients with pulmonary arterial hypertension
Authors: Nuche Jorge , Montero Cabezas Jose Manuel , Alonso Charterina Sergio , Escribano Subías Pilar
Published: October 2018

Pulmonary artery dissection is a rare entity, usually discovered post-mortem. In recent years, reported cases of living patients with a pulmonary artery dissection are growing and represent a challenging situation for clinicians.
Dissecting the main sequence: AGN activity and bulge growth in the local Universe
Authors: McPartland C , Sanders D B , Kewley L J , Leslie S K
Published: October 2018

Local galaxies from the Sloan Digital Sky Survey (SDSS) are used to provide additional support for an evolutionary pathway in which active galactic nucleus activity is associated with star formation quenching. Composite, Seyfert 2, and LINER galaxies account for ∼60 per cent of all star formation in massive galaxies (M⋆ > 1010.5 M⊙). Inclusion of these galaxies results in a ‘turnover’ in the star formation rate and stellar mass (SFR−M⋆) relation for massive galaxies. Our analysis shows that bulge growth has already occurred in the most massive galaxies (M⋆ > 1010.5 M⊙), and bulges continue to grow as galaxies quench and redden, (g − r)  = 0.5 → 0.75. Significant bulge growth is also occurring in low mass starburst galaxies (M⋆ < 1010.5 M⊙) at 0.5 dex above the ‘main sequence’ (MS), where we find an increase in B/T from 0.1 → 0.3 and bluer colours, (g − r) < 0.25 compared to low-mass galaxies on the MS.
A Large Database Analysis of Rates of Aneurysm Screening, Elective Treatment, and Subarachnoid Hemorrhage in Patients With Polycystic Kidney Disease
Authors: Wilkinson D Andrew , Burke James F , Nadel Jeffrey L , Maher Cormac O , Chaudhary Neeraj , Gemmete Joseph J , Heung Michael , Thompson B Gregory , Pandey Aditya S
Published: October 2018

BACKGROUND

Professional societies provide conflicting guidelines on aneurysm screening in patients with polycystic kidney disease (PKD), and the rate of subarachnoid hemorrhage (SAH) is poorly understood.

OBJECTIVE

To evaluate screening, elective treatment, and the rate of SAH in patients with known PKD.

METHODS

We examined longitudinally linked claims data from a large private insurer, identifying screening, elective treatment, aneurysmal subarachnoid hemorrhage (aSAH) and secured aneurysmal SAH (saSAH) in 2004 to 2014 amongst patients with known PKD.

RESULTS

We identified 20 704 patients diagnosed with PKD. Among patients with an initial PKD diagnosis, 51/446 (15.9%) underwent angiographic screening within 2 yr. Forty aneurysms were treated electively in 48 868 yr at risk in PKD patients (82/100K patient yr, 95% confidence interval [CI] 60-112) vs 24 elective treatments in 349 861 yr at risk in age- and sex-matched controls (7/100K patient yr, 95% CI 5-10, P < .0001). Eleven admissions for aSAH were identified in PKD patients (23/100K patient yr, 95% CI 13-41) and 22 admissions for aSAH in controls (6/100K patient yr, 95% CI 4-10), giving an incidence rate ratio (IRR) of 3.6 (95% CI 1.7-7.4, P < .0001) and a comorbidity-adjusted IRR of 3.1 (95% CI 1.4-6.9). The incidence of saSAH was proportionally even higher in PKD patients than controls, 16 vs 2/100K patient years, IRR 9.5 (95% CI 3.3-27.5, P < .0001).

CONCLUSION

Screening in PKD is performed only selectively, though resulting rates of elective treatment were over 10× those of controls. Despite screening and treatment, the rate of SAH remains significantly elevated over that of controls.
Measurement of Electronic Cigarette Frequency of Use Among Smokers Participating in a Randomized Controlled Trial
Authors: Yingst Jessica , Foulds Jonathan , Veldheer Susan , Cobb Caroline O , Yen Miao-Shan , Hrabovsky Shari , Allen Sophia I , Bullen Christopher , Eissenberg Thomas
Published: October 2018

Background

The United States Food and Drug Administration has prioritized understanding the dependence potential of electronic cigarettes (e-cigs). Dependence is often estimated in part by examining frequency of use; however measures of e-cig use are not well developed because of varying product types. This study used an e-cig automatic puff counter to evaluate the value of self-reported e-cig use measures in predicting actual use (puffs).

Methods

Data were collected from a two-site randomized placebo-controlled trial evaluating the effects of e-cigs on toxicant exposure in smokers attempting to reduce their cigarette consumption. Participants randomized to an e-cig condition self-reported their e-cig frequency of use (times per day—one “time” consists of around 15 puffs or lasts around 10 minutes) on the Penn State Electronic Cigarette Dependence Index (PSECDI) and kept daily diary records of the number of puffs per day from the e-cig automatic puff counter. A linear mixed-effects model was used to determine the predictive value of the times per day measure. Correlations were used to further investigate the relationship.

Results

A total of 259 participants with 1165 observations of e-cig use were analyzed. Self-reported e-cig use in times per day was a significant predictor of e-cig puffs per day (p < .01). The Spearman correlation between measures was r equal to .58. Examination of individual participant responses revealed some potential difficulties reporting and interpreting times per day because of the difference in use patterns between cigarettes and e-cigs.

Conclusion

This study provides evidence that the self-reported PSECDI measure of times per day is a significant predictor of actual frequency of e-cig puffs taken.

Implications

Self-reported measures of e-cig frequency of use are predictive of actual use, but quantifying e-cig use in patterns similar to cigarettes is problematic.
Theorems A and B for dagger quasi-Stein spaces
Authors: Bambozzi Federico
Published: October 2018

In this article, we use the homological methods of the theory of quasi-abelian categories and results from functional analysis to prove Theorems A and B for (a broad sub-class of) dagger quasi-Stein spaces. In particular, we show how to deduce these theorems from the vanishing, under certain hypothesis, of the higher derived functors of the projective limit functor. Our strategy of the proof generalizes and puts in a more formal framework Kiehl’s proof for rigid quasi-Stein spaces.
QUANTITATIVE ESTIMATION OF EXPOSURE INHOMOGENEITY IN TERMS OF EYE LENS AND EXTREMITY MONITORING FOR RADIATION WORKERS IN THE NUCLEAR INDUSTRY
Authors: Yoshitomi H , Kowatari M , Hagiwara M , Nagaguro S , Nakamura H
Published: October 2018

To manage the equivalent doses for radiation workers, exposure inhomogeneity is an important factor in the decision-making process related to protection measures and additional monitoring. Our previous study proposed the methodology to evaluate the inhomogeneity of exposure quantitatively. In this study, we applied proposed method to five different types of actual exposure situations encountered in the nuclear industry. Two of them were conventionally characterized as homogeneous exposure, and the other three were conventionally characterized as inhomogeneous exposure. The evaluation of homogeneity exposure was conducted using Monte Carlo calculations with two simplified models, which were then verified with phantom experiments. Consequently, all of the evaluations reproduced the experimental results, implying that our proposed method would be applicable for actual work conditions in the nuclear industry. Furthermore, the two presumed homogeneous exposure situations were found to be rather inhomogeneous because of the contribution of positrons and the limited source region. The results also show that the worker’s posture has an impact on the inhomogeneity rather than the energy of incident radiation in nuclear works. The investigation also implies that obtaining the information on the most probable posture of the exposed worker, as well as the existence of the weekly penetrating radiation such as β± ray as a main source of exposure would be the key for more precise estimation.
The Impact of 3 Different Distraction Techniques on the Pain and Anxiety Levels of Children During Venipuncture
Authors: Inan Gamze , Inal Sevil
Published: October 2018

Objectives:

Invasive procedures are important causes of pain and anxiety during hospitalization. This study aimed to evaluate the effect of 3 different distraction methods on the pain and anxiety levels of children during venipuncture.

Methods:

This was a randomized controlled trial conducted with 180 children of 6 to 10 years of age; data were collected in the months of August to November 2016. Participants were randomized in 4 groups; the children in group 1 watched cartoon movies (CM), the children in group 2 played video games (VG), the children in group 3 were distracted by their parents’ verbal interactions (PI), whereas no distraction method was used on the children in group 4 (control group). The levels of anxiety and pain perception were evaluated independently based on the feedback from the children, the nurse observer, and the parents. The Children Fear Scale was used to evaluate anxiety levels and the Wong-Baker Pain Scale was used to evaluate the pain levels of the children.

Result:

The difference between the groups based on both the anxiety levels and pain scores during venipuncture was statistically significant (P<0.05). The lowest level of anxiety and pain perception was reported in the VG group. The scores observed both in the CM group and the PI group were significantly lower than in the control group (P<0.05).

Discussion:

The distraction techniques of playing VG, watching CM, and PI appear to be effective in reducing anxiety and pain perception in children during the procedure of venipuncture. The most effective method was playing VG.
Parent Factors are Associated With Pain and Activity Limitations in Youth With Acute Musculoskeletal Pain
Authors: Clementi Michelle A. , Faraji Pari , Poppert Cordts Katrina , MacDougall Kelsey , Wilson Anna , Palermo Tonya M. , Lewandowski Holley Amy
Published: October 2018

Objectives:

Biopsychosocial models emphasize the influence of parent/family factors on pediatric chronic pain. Little is known about how parent factors differ across the acute to chronic pain continuum, or contribute to youths’ pain experience in the acute pain period. The purpose of the study was to describe parent factors in youth with acute musculoskeletal pain (n=84) compared with youth with chronic pain (n=60) and youth without pain (n=61). Further, within the acute pain sample, we tested parent factors as predictors of child pain characteristics, as well as the moderating role of child sex on associations.

Methods:

Participants were 205 youth (age, 10 to 17) and one biological parent per child. Children reported on their own pain and activity limitations. Parents reported on their own chronic pain, somatization, and protective pain responses.

Results:

Parents of youth with acute pain had higher prevalence of chronic pain and greater somatization than parents of youth without pain. Parents of youth with acute and chronic pain did not differ. Linear regressions within the acute pain sample revealed presence of parent chronic pain and protective behavior were associated with child pain. Moreover, parent somatization was associated with child activity limitations. Within the acute pain sample, associations between parent protectiveness and child pain were moderated by child sex, with relationships stronger for female children.

Discussion:

Findings highlight the importance of parent factors on pain experiences of youth with acute musculoskeletal pain. Future longitudinal research can elucidate temporal associations that underlie how parent factors may impact transition from acute to chronic pain.
Perspectives on Dexmedetomidine Use for Neurosurgical Patients
Authors: Lin Nan , Vutskits Laszlo , Bebawy John F. , Gelb Adrian W.
Published: October 2018

The α2-adrenergic receptor agonist dexmedetomidine has sedative, anxiolytic, analgesic, and sympatholytic effects. The potential advantages of neuroprotection, minimal impact on neuronal function, stable hemodynamics, opioid and anesthesia sparing effects, and minimal respiratory depression during awake procedures render it an effective anesthetic adjuvant in various neurosurgical settings. However, both the benefits and drawbacks of the use dexmedetomidine in neuroanesthesia should be considered. This narrative review will summarize the applications of dexmedetomidine in various neurosurgical settings, highlighting evidence regarding both its common and controversial uses.
Comparison of Short-term Outcomes After Lumbar Fusion Between an Orthopedic Specialty Hospital and Tertiary Referral Center
Authors: Kreitz Tyler M. , Tarazona Daniel , Padegimas Eric M. , Foltz Carol , Kepler Christopher K. , Anderson David Greg , Vaccaro Alexander R. , Hilibrand Alan S. , Schroeder Gregory D.
Published: October 2018

Study Design.

A retrospective review of all elective single-level lumbar fusions performed at a single orthopedic specialty hospital (OSH) and tertiary referral center (TRC).

Objective.

This study compared the perioperative outcomes for lumbar fusion procedures performed at an OSH and TRC.

Summary of Background Data.

The role of an OSH for lumbar fusion procedures has not been defined.

Methods.

A large institutional database was searched for single-level lumbar fusions performed between 2013 and 2016. Comparisons were made between procedures performed at the OSH and TRC in terms of operative time, total operating room (OR) time, length of stay (LOS), inpatient rehabilitation utilization, postoperative 90-day readmission, reoperation, and mortality rates.

Results.

A total of 101 patients at the OSH and 481 at the TRC were included. There was no difference in gender, age, age adjusted Charlson comorbidity Index (AACCI), body mass index, mean number of concomitant levels decompressed, and use of interbody fusion between OSH and TRC patients. The mean operative time (149.5 vs. 179.7 minutes, P < 0.001), total OR time (195.1 vs. 247.9 minutes, P < 0.001), and postoperative LOS (2.61 vs. 3.73 days, P < 0.001) were significantly shorter at the OSH. More patients required postoperative inpatient rehabilitation at the TRC (7.1% vs. 2%, P < 0.001). There was no difference in 90-day readmission or reoperation rates. There was one mortality at the TRC and two patients required transfer from the OSH to the TRC due to medical complications. Regression analysis demonstrated that procedures performed at the TRC (P < 0.001), total OR time (P = 0.004), AACCI (P < 0.001), current smokers (P = 0.048), and number of decompressed levels (P = 0.032) were independent predictors of LOS.

Conclusion.

Lumbar fusion procedures may be safely performed at both the OSH and TRC. OSH utilization may demonstrate safe reduction in operative time, total OR time, and postoperative LOS in the appropriately selected patients.

Level of Evidence: 3
Preparation is the Only Shortcut You Need in Surgery: A Guide to Surgical Rehearsals for Hand and Upper Extremity Transplantation
Authors: Gittings Daniel J. , Mendenhall Shaun D. , Ben-Amotz Oded , Mirrer Joshua T. , Hardaker William M. , Levin Lawrence Scott
Published: October 2018

As upper extremity transplantation is becoming more accepted worldwide, the demand for a fresh tissue cadaveric training model for this procedure is increasing and necessary to assure surgical success. Surgical rehearsals can decrease operative time, improve technique, and reduce errors made on the actual day of surgery. The purpose of this article is to describe a method for surgical rehearsal of upper extremity transplantation using cadaveric specimens based on the clinical experience of an academic institution with an active transplantation program. The logistics of rehearsal setup, equipment, and modified version of procedural checklists are described.
A systematic review of the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause
Authors: Biehl Colton , Plotsker Olivia , Mirkin Sebastian
Published: October 2018

Objective:

We updated a systematic review to evaluate the totality of evidence available for the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause (GSM) based on published randomized controlled trials.

Methods:

We searched theCochrane Library,Ovid,PubMed,Medline,Embase, andClinicaltrials.govfor English-language articles from database inception to June 2018. Our search consolidated 2,086 potential sources to 53 full-text articles that were reviewed and found relevant to our systematic review.

Results:

We identified 53 studies that met the inclusion criteria that evaluated the efficacy and safety of vaginal estrogen versus placebo or other hormone and nonhormone controls. Compared with placebo, all vaginal estrogens demonstrated superiority in objective endpoints and subjective endpoints of GSM, whereas some trials demonstrated superiority versus placebo in urogenital symptoms. No significant difference was observed between various dosages and dosage forms of vaginal estrogen products. Vaginal estrogen showed superiority over vaginal lubricants and moisturizers for the improvement of objective clinical endpoints of vulvovaginal atrophy but not for subjective endpoints. Unopposed vaginal estrogens seemed safe, although studies were not powered to detect a long-term estrogenic side effect.

Conclusion:

Estrogen products were found to be clinically effective for the treatment of GSM with doses as low as 4 μg. Vaginal estrogen products seem to be safe with few adverse effects, although there is a lack of long-term controlled clinical trial safety data. This review supports the use of commercially available vaginal estrogen therapies as an effective and safe first-line therapy for the treatment of moderate-to-severe GSM.
Anatomically Based Optimization of Outcomes in Middle Eastern Rhinoplasy
Authors: Ghareeb Fouad Mohammed , Nassar Ahmed Tharwat , Talaab Ahmed Abdelaziz , Alkashty Sherief
Published: October 2018

Background:

The predominant character in the Middle Eastern noses is the thick skin, weak cartilages, amorphous bulbous nasal tip, and high incidence of postoperative supra-tip swelling, compared with the Caucasian noses. The purpose of this study was to describe some anatomical findings and find techniques to improve outcomes in these patients.

Methods:

This is retrospective study in 624 patients of Middle Eastern origin, where the characteristic anatomical findings are described and the surgical endeavors to combat their detrimental effect on the outcomes of rhinoplasty are explained.

Results:

The results have shown that in these 624 patients, 365 patients had excellent results, 223 patients had average results, while 36 patients had poor results.

Conclusion:

The nasal shape depends on the skin (skin barring) or the cartilages (cartilage barring), or both (skin and cartilage sharing). Middle Eastern patients are toward the skin barring category with the lateral crus of the lower lateral cartilage very broad with a lateral fibrous attachment replacing the minor (sesamoid) cartilages leading to ill definition of the alae from the sides of the nose. Outcomes in these patients were improved by identification and release of these lateral attachment to improve the bulbous tip and define the alar subunit from the side of the nose. Cephalic rotation is achieved mainly by M-shaped excision of the inner lining of the vestibule and the caudal part of the septum. Other methods described to combat the strong skin memory and allow skin to configure after surgery.
MACULAR DEHISCENCE–ASSOCIATED EPIRETINAL PROLIFERATION IN EYES WITH FULL-THICKNESS MACULAR HOLE
Authors: Takahashi Hiroyuki , Inoue Makoto , Itoh Yuji , Koto Takashi , Hirota Kazunari , Kita Yoshiyuki , Hirakata Akito
Published: October 2018

Purpose:

To determine the characteristics of the macular dehiscence–associated epiretinal proliferations (EPs) in eyes with full-thickness macular holes (MHs).

Methods:

The presence of EPs and the integrity of the retinal microstructures in eyes with MHs were determined by spectral domain optical coherence tomography in 390 eyes of 379 patients (29–89 years). The clinical findings, closure of the MH, the preoperative and postoperative best-corrected visual acuity, and the microstructural changes were compared between eyes with and without EPs.

Results:

Epiretinal proliferations were detected in 31 of 390 eyes (7.9%). The preoperative best-corrected visual acuity and duration of reduced vision were not significantly different in the group with and without EPs (P = 0.09, P = 0.28). The axial lengths were significantly longer (P = 0.001), MH stage more advanced (P = 0.006), and the incidence of epiretinal membranes (P < 0.001) and intraretinal splitting (P < 0.001) were higher in eyes with EP. The EP was significantly correlated with the length of the ellipsoid zone defects (P < 0.001) and medium-reflective bridging tissue over the closed MH (P < 0.001). The closure rates and postoperative best-corrected visual acuities were not significantly different between the two groups (P > 0.99, P = 0.99).

Conclusion:

The presence of EP was correlated with retinal microstructural changes and may support postoperative visual improvements with medium-reflective bridging tissue over the closed MH.
Machine learning–based prediction of clinical pain using multimodal neuroimaging and autonomic metrics
Authors: Lee Jeungchan , Mawla Ishtiaq , Kim Jieun , Loggia Marco L. , Ortiz Ana , Jung Changjin , Chan Suk-Tak , Gerber Jessica , Schmithorst Vincent J. , Edwards Robert R. , Wasan Ajay D. , Berna Chantal , Kong Jian , Kaptchuk Ted J. , Gollub Randy L. , Rosen Bruce R. , Napadow Vitaly
Published: October 2018

Although self-report pain ratings are the gold standard in clinical pain assessment, they are inherently subjective in nature and significantly influenced by multidimensional contextual variables. Although objective biomarkers for pain could substantially aid pain diagnosis and development of novel therapies, reliable markers for clinical pain have been elusive. In this study, individualized physical maneuvers were used to exacerbate clinical pain in patients with chronic low back pain (N = 53), thereby experimentally producing lower and higher pain states. Multivariate machine-learning models were then built from brain imaging (resting-state blood-oxygenation-level-dependent and arterial spin labeling functional imaging) and autonomic activity (heart rate variability) features to predict within-patient clinical pain intensity states (ie, lower vs higher pain) and were then applied to predict between-patient clinical pain ratings with independent training and testing data sets. Within-patient classification between lower and higher clinical pain intensity states showed best performance (accuracy = 92.45%, area under the curve = 0.97) when all 3 multimodal parameters were combined. Between-patient prediction of clinical pain intensity using independent training and testing data sets also demonstrated significant prediction across pain ratings using the combined model (Pearson's r = 0.63). Classification of increased pain was weighted by elevated cerebral blood flow in the thalamus, and prefrontal and posterior cingulate cortices, and increased primary somatosensory connectivity to frontoinsular cortex. Our machine-learning approach introduces a model with putative biomarkers for clinical pain and multiple clinical applications alongside self-report, from pain assessment in noncommunicative patients to identification of objective pain endophenotypes that can be used in future longitudinal research aimed at discovery of new approaches to combat chronic pain.
Cardiovascular outcome trials in type 2 diabetes: A nurse practitioner perspective
Authors: Kruger Davida F.
Published: October 2018

To provide an overview of cardiovascular outcome trials (CVOT) with once-weekly glucagon-like peptide-1 receptor agonists (GLP-1RAs), and other recent CVOTs, and to discuss the implications for the management of patients with type 2 diabetes (T2D). Details of completed and ongoing CVOTs of glucose-lowering drugs from primary articles and ClinicalTrials.gov were collated and critically reviewed for information relating to patient populations and primary outcomes. Cardiovascular outcome trials have demonstrated the cardiovascular (CV) safety of a number of new glucose-lowering drugs. Recent trials suggest that some glucose-lowering drugs—including the once-weekly GLP-1RA semaglutide (post hoc analysis) and once-daily liraglutide—may reduce the risk of CV events in patients with T2D and high CV risk. Given their prime role in managing treatment choices for patients with T2D, nurse practitioners should strongly consider prescribing therapies, such as GLP-1RAs, that offer improved glycemic control, weight loss, a low risk of hypoglycemia, and beneficial CV outcomes.
Hepatitis B surface antigen loss after discontinuing nucleos(t)ide analogue for treatment of chronic hepatitis B patients is persistent in White patients
Authors: Suárez Emilio , Buti María , Rodríguez Manuel , Prieto Martín , Pascasio-Acevedo Juan M. , Casanovas Teresa , Crespo Javier , Tapiador Juan Arenas Ruiz , Gómez-Rodríguez Rafael , Figueruela Blanca , Diago Moisés , Morillas Rosa M. , Zozaya José M. , Calleja José L. , Casado Marta , Molina Esther , Fuentes Javier , Simón Miguel A.
Published: October 2018

Objective

The objective of this study was to determine the long-term clinical outcome and persistence of hepatitis B surface antigen (HBsAg) loss after discontinuation of treatment.

Background

The prognosis of patients with chronic hepatitis B (CHB) treated with nucleos(t)ide analogues (NAs) who discontinue treatment after loss of HBsAg remains largely unknown, particularly in White patients.

Patients and methods

We analysed a cohort of patients with CHB who discontinued NA treatment after loss of HBsAg. A total of 69 patients with hepatitis-B-e antigen-positive or hepatitis-B-e antigen-negative CHB with undetectable HBsAg during NA treatment were included after discontinuation of treatment, and followed up for a median period of 37.8 months (interquartile range: 23.8–54.6 months).

Results

At the end of follow-up, none of the patients showed spontaneous reappearance of HBsAg and only one patient had detectable hepatitis B virus DNA (22 IU/ml). Another patient negative for HBsAg and anti-HBs developed hepatitis B virus reactivation without elevated transaminases after treatment with corticosteroids and vincristine for dendritic cell neoplasm, 38 months after withdrawal of the antiviral treatment. Regarding clinical outcome, a patient with cirrhosis developed hepatocellular carcinoma, 6.6 years after discontinuing treatment. None of the patients had hepatic decompensation or underwent liver transplantation.

Conclusion

HBsAg clearance after discontinuing NAs in patients with CHB is persistent and associated with good prognosis. The risk for developing hepatocellular carcinoma persists among patients with cirrhosis.
The Impact of Chain Standardization on Nursing Home Staffing
Authors: Banaszak-Holl Jane , Intrator Orna , Li Jiejin , Zheng Qing , Stevenson David G. , Grabowski David C. , Hirth Richard A.
Published: October 2018

Background:

Standardization in production is common in multientity chain organizations. Although chains are prominent in the nursing home sector, standardization in care has not been studied. One way nursing home chains may standardize is by controlling the level and mix of staffing in member homes.

Objectives:

To examine the extent to which standardization occurred in staffing, its relative presence across different types of chains, and whether facilities became more standardized following acquisition by a chain.

Research Design:

We estimated predictors of the difference between facility and chain staffing using Generalized Estimating Equations with 2000–2010 data.

Subjects:

This study included nursing homes nationally, excluding hospital-based homes and homes in Alaska, Hawaii, and the District of Columbia.

Measures:

Chain ownership was coded from text identifying chain names. Two nurse staffing measures were used: staff hours per resident day and staff mix.

Results:

Very large for-profit chain nursing homes and large nonprofits had less variation in staff hours per resident day (P<0.001) but greater variation in staffing mix (P<0.001) compared with the chain average nationally. Large for-profit chains and medium nonprofit chains had greater dispersion on staff hours per resident day (P<0.001), while large nonprofit chains had greater dispersion in staffing mix (P<0.001). The difference between facility and chain staffing decreased over time.

Conclusions:

The largest chains (for-profit and nonprofit) had less staffing variation compared with national standards, suggesting they were best at implementing corporate practices. Following ownership changes, staffing converged towards chain averages over time, suggesting standardization takes time to implement.
Effects of capacitive and resistive electric transfer therapy in patients with knee osteoarthritis: a randomized controlled trial
Authors: Coccetta Carlo A. , Sale Patrizio , Ferrara Paola E. , Specchia Alessandro , Maccauro Giulio , Ferriero Giorgio , Ronconi Gianpaolo
Published: October 2018

Capacitive and resistive electric transfer (CRET), an endogenous diathermy treatment, has been demonstrated to reduce pain and improve quality of life in numerous orthopedic degenerative and inflammatory problems but not in knee osteoarthritis (KOA). The aim of this prospective randomized controlled trial was to evaluate whether a 2-week program of CRET can reduce pain, stiffness and functional limitations in KOA compared with a sham treatment. Patients with KOA were randomly assigned to a study group (n = 31) or a control one (n = 22). The study group underwent six intermittent CRET applications, whereas the controls underwent a sham protocol without application of energy. The outcome measures were the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) (primary outcome) and the visual analogue scale (VAS) for pain and Medical Research Council Scale (secondary outcomes). All patients were evaluated before treatment (T0), at the end of treatment (T1), and at 1 (T2) and 3 months after treatment (T3). Results showed that CRET significantly improved strength, physical function and pain in patients with KOA. In the study group a reduction in WOMAC and VAS scores was observed at T1, T2, and T3 compared with T0. No significant changes of WOMAC and VAS scores were observed in the control group across all time points. Considering the small number of sessions, low cost and long-term benefits, CRET might be a useful therapeutic option for the conservative management of KOA to reduce pain, stiffness and functional limitation.
Provision of Sexually Transmitted Infection Services in a Mobile Clinic Reveals High Unmet Need in Remote Areas of South Africa: A Cross-sectional Study
Authors: Hoffman Charlotte M. , Mbambazela Nontembeko , Sithole Phumzile , Morré Servaas A. , Dubbink Jan Henk , Railton Jean , McIntyre James A. , Kock Marleen M. , Peters Remco P.H.
Published: October 2018

Background

The burden of sexually transmitted infections (STIs) in areas of sub-Saharan Africa with poor access to health care services is not well documented. In remote areas of South Africa, we investigated the prevalence of STIs and approaches to providing STI services through a mobile clinic.

Methods

We recruited 251 adult women visiting a mobile clinic that normally provides general health education and screening services, but not STI care. Clinical and sexual history was obtained and vaginal specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium infection and for Candida albicans and bacterial vaginosis.

Results

Laboratory test was positive for 133 (53%) of 251 women for at least 1 STI: C. trachomatis was observed in 52 (21%) women, N. gonorrhoeae in 39 (16%) women, T. vaginalis in 81 (32%) women and M. genitalium in 21 (8%) women. Eighty-one (32%) women met the criteria for vaginal discharge syndrome, of which 58% (47/81) would have been treated accurately. Among asymptomatic women 84 (49%) of 170 were diagnosed with an STI but untreated under the syndromic approach. We could not identify factors associated with asymptomatic STI infection.

Conclusions

There is a high unmet need for STI care in rural South African settings with poor access to health care services. Provision of STI services in a mobile clinic using the syndromic management approach provides a useful approach, but would have to be enhanced by targeted diagnostics to successfully address the burden of infection.
Pain and Sedation Management: 2018 Update for the Rogers’ Textbook of Pediatric Intensive Care
Authors: Walker Tracie , Kudchadkar Sapna R.
Published: October 2018

Objectives:

To review important articles on pain, sedation, sleep, and delirium in the field of pediatric critical care published subsequent to the fifth edition of the Rogers’ Textbook of Pediatric Critical Care.

Data Sources:

The U.S. National Library of Medicine PubMed was searched for a combination of the term “pediatric” and the following terms: “sedation,” “sedation protocol,” “pain,” “pain score,” “neuromuscular blockade,” “delirium,” and “sleep.” Titles and abstracts resulting from the search were screened for full-text review and potential inclusion. Authors also included recent key articles they were aware of with direct relevance to the topics.

Study Selection and Data Extraction:

The authors selected articles for inclusion based on their relevance and clinical significance if they were published subsequent to the fifth edition of the textbook.

Data Synthesis:

Selected articles were grouped together by categories similar to specific sections of the pain and sedation chapter in the textbook and included pain, sedation, sleep, and delirium.

Conclusions:

Recent research into pediatric pain and sedation management has focused on optimizing the choice of sedative medications, in particular by increasing the use and understanding of nonopioid and nonbenzodiazepine options such as ketamine and alpha-2 agonists. Delirium has emerged as a significant morbidity in the critically ill pediatric patient, and recent articles have concentrated on the use of validated screening tools to determine the epidemiology and risk factors in specific populations, including patients with cardiac disease and those receiving extracorporeal membrane oxygenation. A consistent theme in the most recent literature is the role of titrated but effective sedation, quality improvement to increase delirium recognition, and optimizing the pediatric intensive care environment to promote sleep.
Corticosteroid Tapering Regimens in Rheumatic Disease
Authors: Campbell Ashley M. , Martin Jennifer R. , Erstad Brian L.
Published: October 2018

Background/Objective

Corticosteroids have long been used to effectively treat rheumatic disorders, but adverse effects associated with extended-duration regimens generate disagreement among clinicians regarding optimal tapering strategies. The objective of this systematic review was to assess clinical outcomes of differing tapering regimens after corticosteroid monotherapy in adults with rheumatic disorders.

Methods

A systematic review of Medline/PubMed, Embase, Cochrane, International Pharmaceutical Abstracts, Web of Science, Scopus, Global Index Medicus, American College of Rheumatology, gray literature, and reference lists up to June 27, 2018, was conducted by 2 authors. Randomized controlled trials, case-control studies, and prospective observational studies comparing at least 2 tapering strategies of medium- to high-dose (>7.5 mg but ≤100 mg oral prednisone equivalent daily), extended-duration (≥10 days) corticosteroids were included if they reported at least 1 efficacy and 1 adverse effect parameter.

Results

Two studies met criteria for the review, which included 62 patients. One study examined a prednisolone versus a modified release prednisone taper for giant cell arteritis and suggested 80% (n = 4) and 85.7% (n = 6) remission rates, respectively, at 26 weeks. The other study examined a methylprednisolone versus a prednisone taper for polymyalgia rheumatica and reported 100% and 89% remission rates, respectively, at 26 weeks. Adverse effects reported between the 2 studies included sleep, hyperglycemia, infection, and fractures. However, the studies were not powered to detect differences in these outcomes.

Conclusions

There is no high-level evidence to guide tapering until discontinuation after extended courses of medium- to high-dose treatment regimens, as current guidelines rely heavily on expert opinion and small case series with a trial-and-error approach. This review supports the need for additional research to shift tapering recommendations to a more evidence-based practice.
Characterization of Diffuse Gliomas With Histone H3-G34 Mutation by MRI and Dynamic 18F-FET PET
Authors: Vettermann Franziska J. , Felsberg Jörg , Reifenberger Guido , Hasselblatt Martin , Forbrig Robert , Berding Georg , la Fougère Christian , Galldiks Norbert , Schittenhelm Jens , Weis Joachim , Albert Nathalie L. , Schüller Ulrich
Published: October 2018

Background

Recent data suggest that diffuse gliomas carrying mutations in codon 34 of the H3 histone family 3A protein represent a very rare, distinct subgroup of IDH–wild type malignant astrocytic gliomas. However, characteristics detectable by MRI and 18F-FET PET in H3-G34-mutant gliomas are unknown.

Methods

We report on MRI and 18F-FET PET findings in 8 patients from 4 German centers with H3-G34-mutant diffuse gliomas. MRI analyses included multifocality, contrast enhancement, necrosis, cysts, hemorrhages, calcification, and edema. 18F-FET PET characteristics were evaluated on the basis of static 18F-FET PET parameters, such as maximal tumor-to-background ratio (TBRmax) and biological tumor volume (BTV), as well as the minimal time-to-peak (TTPmin) obtained from dynamic 18F-FET PET data.

Results

MRI showed multifocal lesions in 2 of 8, contrast enhancement in 6 of 8, necrosis in 3 of 8, cysts in 3 of 8, hemorrhage in 1 of 8, and calcifications in 1 of 8 patients. None of the tumors showed marked peritumoral edema. However, all 8 H3-G34-mutant gliomas were characterized by a high uptake intensity on 18F-FET PET with a median TBRmax of 3.4 (range, 2.5–11.7) and a relatively diffuse uptake pattern leading to a large BTV (median, 41.9 mL; range, 7.5–115.6). Dynamic PET data revealed a short median TTPmin of 12.5 minutes.

Conclusions

MRI features of diffuse gliomas with H3-G34 mutation may present very heterogeneously with some cases not even fulfilling the imaging criteria of high-grade glioma. In contrast, in 18F-FET PET, these tumors show an extensive and diffuse tracer uptake resulting in large BTV with a high TBRmax and a short TTPmin, thus resembling PET characteristics of aggressive high-grade gliomas, namely, glioblastomas.
Dolphins simplify their vocal calls in response to increased ambient noise
Authors: Fouda Leila , Wingfield Jessica E. , Fandel Amber D. , Garrod Aran , Hodge Kristin B. , Rice Aaron N. , Bailey Helen
Published: October 2018

Ocean noise varies spatially and temporally and is driven by natural and anthropogenic processes. Increased ambient noise levels can cause signal masking and communication impairment, affecting fitness and recruitment success. However, the effects of increasing ambient noise levels on marine species, such as marine mammals that primarily rely on sound for communication, are not well understood. We investigated the effects of concurrent ambient noise levels on social whistle calls produced by bottlenose dolphins (
Tursiops truncatus
) in the western North Atlantic. Elevated ambient noise levels were mainly caused by ship noise. Increases in ship noise, both within and below the dolphins' call bandwidth, resulted in higher dolphin whistle frequencies and a reduction in whistle contour complexity, an acoustic feature associated with individual identification. Consequently, the noise-induced simplification of dolphin whistles may reduce the information content in these acoustic signals and decrease effective communication, parent–offspring proximity or group cohesion.
An assessment of the role of the falx cerebri and tentorium cerebelli in the cranium of the cat (
Felis silvestris catus
)
Authors: Sellés de Lucas Víctor , Dutel Hugo , Evans Susan E. , Gröning Flora , Sharp Alana C. , Watson Peter J. , Fagan Michael J.
Published: October 2018

The falx cerebri and the tentorium cerebelli are two projections of the dura mater in the cranial cavity which ossify to varying degrees in some mammalian species. The idea that the ossification of these structures may be necessary to support the loads arising during feeding has been proposed and dismissed in the past, but never tested quantitatively. To address this, a biomechanical model of a domestic cat (
Felis silvestris catus
) skull was created and the material properties of the falx and tentorium were varied for a series of loading regimes incorporating the main masticatory and neck muscles during biting. Under these loading conditions, ossification of the falx cerebri does not have a significant impact on the stress in the cranial bones. In the case of the tentorium, however, a localized increase in stress was observed in the parietal and temporal bones, including the tympanic bulla, when a non-ossified tentorium was modelled. These effects were consistent across the different analyses, irrespective of loading regime. The results suggest that ossification of the tentorium cerebelli may play a minor role during feeding activities by decreasing the stress in the back of the skull.
Elephant trunks form joints to squeeze together small objects
Authors: Wu Jianing , Zhao Yichao , Zhang Yunshu , Shumate David , Braccini Slade Stephanie , Franklin Scott V. , Hu David L.
Published: October 2018

Wild African elephants are voracious eaters, consuming 180 g of food per minute. One of their methods for eating at this speed is to sweep food into a pile and then pick it up. In this combined experimental and theoretical study, we elucidate the elephant’s unique method of picking up a pile of food by compressing it with its trunk. To grab the smallest food items, the elephant forms a joint in its trunk, creating a pillar up to 11 cm tall that it uses to push down on food. Using a force sensor, we show the elephant applies greater force to smaller food pieces, in a manner that is required to solidify the particles into a lump solid, as calculated by Weibullian statistics. Elephants increase the height of the pillar with the force required, achieving up to 28% of the applied force using the self-weight of the pillar alone. This work shows that elephants are capable of modulating the force they apply to granular materials, taking advantage of their transition from fluid to solid. In the future, heavy robotic manipulators may also form joints to compress and lift objects together.
Simultaneous measurements of three-dimensional trajectories and wingbeat frequencies of birds in the field
Authors: Ling Hangjian , Mclvor Guillam E. , Nagy Geoff , MohaimenianPour Sepehr , Vaughan Richard T. , Thornton Alex , Ouellette Nicholas T.
Published: October 2018

Tracking the movements of birds in three dimensions is integral to a wide range of problems in animal ecology, behaviour and cognition. Multi-camera stereo-imaging has been used to track the three-dimensional (3D) motion of birds in dense flocks, but precise localization of birds remains a challenge due to imaging resolution in the depth direction and optical occlusion. This paper introduces a portable stereo-imaging system with improved accuracy and a simple stereo-matching algorithm that can resolve optical occlusion. This system allows us to decouple body and wing motion, and thus measure not only velocities and accelerations but also wingbeat frequencies along the 3D trajectories of birds. We demonstrate these new methods by analysing six flocking events consisting of 50 to 360 jackdaws (Corvus monedula) and rooks (Corvus frugilegus) as well as 32 jackdaws and 6 rooks flying in isolated pairs or alone. Our method allows us to (i) measure flight speed and wingbeat frequency in different flying modes; (ii) characterize the U-shaped flight performance curve of birds in the wild, showing that wingbeat frequency reaches its minimum at moderate flight speeds; (iii) examine group effects on individual flight performance, showing that birds have a higher wingbeat frequency when flying in a group than when flying alone and when flying in dense regions than when flying in sparse regions; and (iv) provide a potential avenue for automated discrimination of bird species. We argue that the experimental method developed in this paper opens new opportunities for understanding flight kinematics and collective behaviour in natural environments.
Thermometer screens and the geographies of uniformity in nineteenth-century meteorology
Authors: Naylor Simon
Published: October 2018

By the 1860s a number of thermometer stands, screens and boxes were being used at public observatories and in private settings. The ultimate object of these humble pieces of scientific infrastructure was to protect the thermometers from precipitation and radiation. In response to concerns over the quality of designs and the comparability of results a trial of the various apparatuses was staged at Strathfield Turgiss, Hampshire, in 1868, and subsequent discussions were organized by Britain's Meteorological Society (from 1883 the Royal Meteorological Society). In an attempt to guarantee uniformity of exposure, the Society recommended the adoption of the Stevenson screen, a double-louvred box designed by Thomas Stevenson in 1866. It was promoted as an essential part of the Society's network of second-order and climatological stations across England. Despite the Meteorological Society's aim of overcoming the idiosyncrasies of geography through recourse to a uniform pattern screen, their chosen design ended up embodying a particular geography: the aesthetic and moral codes of the suburban domestic garden.
The reappearance of Galileo's original Letter to Benedetto Castelli
Authors: Camerota Michele , Giudice Franco , Ricciardo Salvatore
Published: October 2018

This article describes an important manuscript discovered recently in the Royal Society archives, and presents evidence that it is the holograph of Galileo's 
Letter to Benedetto Castelli
of 21 December 1613. It was in this letter that Galileo first set out his ideas on the relation between science and religion, and defended Copernican astronomy from charges of being contrary to the Holy Scriptures. The text of the 
Letter 
has hitherto been known only through manuscript copies, namely the 12 used by Antonio Favaro in his critical edition of 1895. Despite his magisterial work, Favaro did not manage to locate Galileo's autograph and was forced to rely exclusively on copies. The 
Letter to Castelli 
preserved at the Royal Society is of remarkable interest. By comparison with the other extant manuscript copies by different hands, its wording seems to be theologically more daring and compromising. The discovery of this autograph is therefore one of the most important in Galilean studies in recent decades, shedding new light on his intricate relations with the Roman Catholic Church in these years.