bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Surgical Freedom Variation Across the Basilar Artery Bifurcation: Towards a Deeper Insight Into Approach Selection for Basilar Apex Aneurysms
Authors: Tayebi Meybodi Ali , Benet Arnau , Rodriguez Rubio Roberto , Yousef Sonia , Lawton Michael T
Published: March 2018

BACKGROUND

The orbitozygomatic approach is generally advocated over the pterional approach for basilar apex aneurysms. However, the impact of the extensions of the pterional approach on the obtained maneuverability over multiple vascular targets (relevant to basilar apex surgery) has not been studied before.

OBJECTIVE

To analyze the patterns of surgical freedom change across the basilar bifurcation between the pterional, orbitopterional, and orbitozygomatic approaches.

METHODS

Surgical freedom was assessed for 3 vascular targets important in basilar apex aneurysm surgery (ipsilateral and contralateral P1-P2 junctions, and basilar apex), and compared between the pterional, orbitopterional, and orbitozygomatic approaches in 10 cadaveric specimens.

RESULTS

Transitioning from the pterional to orbitopterional approach, the surgical freedom increased significantly at all 3 targets (P < .05). However, the gain in surgical freedom declined progressively from the most superficial target (60% for ipsilateral P1-P2 junction) to the deepest target (35% for contralateral P1-P2 junction). Conversely, transitioning from the orbitopterional to the orbitozygomatic approach, the gain in surgical freedom was minimal for the ipsilateral P1-P2 and basilar apex (<4%), but increased dramatically to 19% at the contralateral P1-P2 junction.

CONCLUSION

The orbitopterional approach provides a remarkable increase in surgical maneuverability compared to the pterional approach for the basilar apex target and the relevant adjacent arterial targets. However, compared to the orbitopterional, the orbitozygomatic approach adds little maneuverability except for the deepest target (ie, contralateral P1-P2 junction). Therefore, the orbitozygomatic approach may be most efficacious with larger basilar apex aneurysms limiting the control over of the contralateral P1 PCA.
Stereotypes and Evidentiality
Authors: Wood Michael
Published: March 2018

Evidentiality and stereotyping are two highly productive concepts that have recently generated interesting, and in the case of stereotypes, often politically intense, research agendas. This paper initially outlines how some of this productivity relies on a certain indeterminacy concerning the key terms. After outlining debates about the key characteristics of evidentiality and stereotypes the paper considers recent work that links evidentiality to stereotypes. Such works are found primarily in linguistics rather than in other discipline and analytical emphasis is on evidentiality rather than stereotyping. Reluctant to make claims based on ‘Western’ psychology, the linguists approach stereotyping primarily as a social process. Supporting such an approach this review highlights the need for greater analysis of the interactional contexts that deploy both evidentials and pejorative social categories. In addition, there is a need to further investigate the histories of changes in local use of evidentials and stereotypes understood as interrelated social processes.
Extragrammatical Expression of Information Source
Authors: Squartini Mario
Published: March 2018

This chapter reviews some selected lexical items expressing various semantic functions connected to the expression of information source. By focusing on a comparative analysis of what is expressed by lexical items and what can be expressed by grammatical markers of evidentiality, this survey aims to assess to what extent a comprehensive treatment of lexical and grammatical expressions of information source might shed additional light on both domains. Particular attention is paid to the interplay between external sensory evidence and subjective evaluation in verbs of direct perception and verbs of appearance (‘SEEM-verbs’). The role of the speaker as a ‘mediating filter’ between epistemic estimation and source of evidence is also discussed with respect to verbs of belief.
Evidentiality in Nambikwara Languages
Authors: Eberhard David M.
Published: March 2018

This chapter describes evidentiality as it is expressed within the Nambikwara language family of west central Brazil, a loosely related affiliation of seventeen language communities living close to the Brazil-Bolivia border. This overview limits its scope to the four varieties where evidentiality has been documented (Mamaindê, Lakondê, Sabanê, and a generic variety of Southern Nambikwara). All four of these languages share several traits that could be considered characteristics of Nambikwara evidential systems. These are: a large set of evidentials (between four and eight); sets that include inferred and reported; forms that link evidentials and tense; and the use of ‘multiple perspective’ as a way of referencing the singular or plural nature of the ‘knower’. It is this latter trait that constitutes the most salient feature of evidentiality within the family as a whole, one that deserves further attention.
Evidentiality in Boran and Witotoan Languages
Authors: Wojtylak Katarzyna I.
Published: March 2018

This chapter is the first attempt to explore how evidentiality is expressed in two neighbouring language families spoken in northwest Amazonia, Boran, and Witotoan. The evidentiality systems in Boran and Witotoan languages are not as complex as those found in languages spoken in vicinity of the Vaupés area to the north. Marking of evidentiality is more elaborate in Boran languages, with three choices available in Bora, while evidentiality distinctions in Witotoan languages are less expressive, with only two terms available in Murui. Although evidentiality choices can differ even within a single language family, a reported evidential is present in all Boran and Witotoan languages without exception. In addition to marking evidentiality, all languages show some type of optional marking that is related to expressing speaker’s certainty regarding an assertion.
Evidentials and Person
Authors: Sun Jackson T.-S.
Published: March 2018

This chapter presents an overview of salient issues regarding the correlation between evidentiality and person. A synthesis of research findings is provided and illustrated by empirical data. The person category relevant for evidentiality is shown to be the ‘speaking person’, which translates into various grammatical persons depending on the grammatical construction. The person-sensitive distribution of evidential forms is attributable to features like control, observability, and access to knowledge, and may be creatively manipulated along an evidential directness cline, such that an evidential value reserved for the speaking person may be employed to assert intimate knowledge about another person, and conversely, a reduced evidential value may be selected in self-reports to tone down first-person involvement, exhibiting ‘first-person effects’. Also elucidated herein is how the addressee’s perspective, another critical person factor in evidentiality, shapes evidential formation and selection.
Non-Propositional Evidentiality
Authors: Jacques Guillaume
Published: March 2018

This chapter deals with non-propositional evidentiality, i.e. evidential-like distinctions on markers whose scope is limited to a noun phrase. First, it presents the different types of non-propositional evidential markers, the most common of which are demonstrative pronouns and determiners. Second, it shows how non-propositional evidential markers can encode morphosyntactic parameters such as case or topicality in addition to evidentiality. Then, it describes attested non-propositional evidential categories, focusing on sensory (visual, auditory, non-visual) evidentials, as non-sensory non-propositional evidentials are extremely rare. Finally, it discusses how non-propositional evidentiality and nominal tense can interact in some languages and presents some general observations on commonalities and differences between propositional and non-propositional evidential systems.
Many Worlds Colliding
Authors: Behrens Joanna , Swanepoel Natalie
Published: March 2018

The character of historical archaeology in South Africa has been cast by the geography of its development and the historical roots of its subject matter. Arising in the south-western Cape, where Europeans collided with the nomadic Khoe and Bushmen, research agendas meshed with broader sub-disciplinary goals for a global, comparative archaeology of the last 500 years. In practice, this led to a focus on sites associated with European colonists. Investigations issuing from the ‘other side’ of these encounters were rare. In this chapter we acknowledge the important precedents set by pioneer researchers and explore how historical archaeologies in the interior offer new directions. Here encroaching colonists met established farming groups, encounters that set in motion complex and historically situated long-term entanglements. Recent and developing research in these areas signals a growing maturity within the field, enhanced by increasing collaboration among archaeologists of different sub-disciplinary persuasions, and between archaeologists and historians.
Politics and Power
Authors: Collis John , Karl Raimund
Published: March 2018

Reconstruction of Iron Age social and political structures relies initially on written sources, but classical texts are both biased in how they describe institutions, especially among other peoples, and patchy in time and space. From the mid-first millennium BC, we get details on how polities such as Athens, Sparta, and Rome functioned, but these are not representative of other Greek and Italian peoples, let alone non-Mediterranean societies. The second source of information is archaeology, especially burials, but also settlements. The chapter discusses social and political development using both a core–periphery (Mediterranean societies were more complex than those in the north) and an evolutionary model, though not one which necessarily assumes increasing complexity. The varying nature of individual power bases is also considered. A major area of contention (including between the authors) is the extent to which we can back-project documented societies into the past or into other contexts.
Ritual Sites, Offerings, and Sacrifice
Authors: Armit Ian
Published: March 2018

This chapter examines the disparate scales of ritual deposition in Iron Age Europe, from the individual/household to the wider region. It explores commonalities underlying different practices, including the pervasive interest in human remains, the deployment of ritualized violence, the formalization of religious practice, and the roles of natural, domestic, and monumental spaces. The Iron Age is notable for the ritualization of domestic life, with certain objects, including human body parts, deposited in houses. Watery places provided another focus; bodies showing heavily ritualized treatments have been found in bogs from Scandinavia to Ireland. From the middle La Tène period, more formal cult centres appear, some as foci for deposition on an enormous scale. Elsewhere, as in Ireland, ritual activity focused on ‘ancestral’ landscapes. Motivations behind acts of deposition are difficult to ascertain, but the material residues suggest a widespread concern with sacrifice as a means of securing benefits for the community.
Funerary Practices
Authors: Brun Patrice
Published: March 2018

This chapter surveys burial practices across Iron Age Europe, working outwards from the Circum-Alpine zone. During this period, only a fraction of the population was formally buried, in varying proportions over time and space. These were generally members of the political, economic, and religious elite, as is most clear in the case of richly furnished and monumental graves. Among communities of equivalent political complexity, however, some practised more modest burial, lacking clear status differentiation in their graves. Funerary practices carry ideological messages about how communities wish to appear, symbolically materializing the relations of the social group with the land on which they live and perpetuating the memory of certain people in the consciousness of the survivors. The social significance of Iron Age mortuary practices is examined: detailed analysis of differences between graves and cemeteries provides a wealth of information ranging from individual social relationships to economic and political organization.
Demographic Aspects of Iron Age Societies
Authors: Burmeister Stefan , Gebühr Michael
Published: March 2018

This chapter looks at the demography of European populations from the pre-Roman Iron Age to the Migration period, with a focus on central, northern, and north-western Europe. As well as cemetery data, it draws on contemporary textual and epigraphic sources, along with simulations. Given the diversity of societies in this large area and time span, regional variations are only to be expected. Palaeodemographic procedures and models are outlined, as well as the inherent problems of reconstructing prehistoric population profiles and densities. Age at death provides the starting point for reconstructing demographic composition, the life cycles of individuals generating mortality curves, which form the basis for calculating the age composition of the living community (expressed as a life pyramid). Divergences from the standard mortality curve or expected life pyramid, and variations between regions, require explanation, in terms of archaeological or cultural phenomena, migration being an obvious example.
Value Affordances in Students’ Probability of Persisting as a Nursing Major
Authors: Lindeman Meghan I.H. , Durik Amanda M.
Published: March 2018

This study investigated how perceptions of agentic and communal values attract students to major in and persist in nursing. Participants reported a potential major and why they were attracted to that major. Transcripts were coded for declaration and graduating with a nursing major. Results showed that students who reported being attracted to a major for communal and agentic reasons were more likely to report nursing as a potential major, declare nursing as a major, and graduate with a nursing degree. Departments are encouraged to recruit students by highlighting the communal and agentic values that nursing affords.
Universal Design for Instruction in Nursing Education: An Integrative Review
Authors: Levey Janet A.
Published: March 2018

AIM

The aim of the study was to explore the use of universal design for instruction (UDI) in nursing education.

BACKGROUND

Educators seek to employ innovative pedagogies accessible to diverse learners across learning environments. UDI, an inclusive strategy for meeting this goal is not well known in nursing education.

METHOD

An integrative review was used to meet the study’s aim. Five databases were searched for literature published between 2000 and 2013.

RESULTS

Of 45 articles retrieved, only three studies and 14 feature articles met the inclusion criteria. A literature matrix was used to synthesize major concepts to create theme labels: marginalized students as a vulnerable population, faculty lack of knowledge of UDI, reactive versus proactive instructional design, and best teaching practices.

CONCLUSION

The lack of UDI knowledge by educators is a barrier to its usage. Implications and recommendations for adopting universal design in nursing education are discussed.
Statewide At-Risk Tracking and Intervention for Nurses: Identifying and Intervening With Nursing Students at Risk of Attrition in Texas
Authors: Donnell Wendy M. , Walker Glenda C. , Miller Greg
Published: March 2018

AIM

The purpose of this study was to identify students at risk of attrition and implement interventions to decrease the risk.

BACKGROUND

The ability to identify and intervene with students deemed at risk of attrition can be a valuable tool for increasing the RN workforce. “Statewide At-Risk Tracking and Interventions for Nurses” (SATIN) involved students from 27 initial RN licensure nursing programs in Texas.

METHOD

At-risk status of each nursing student was identified, and each nursing program provided interventions based on students' needs.

RESULTS

The Weaver Reading Program was the most effective of the six intervention strategies used with SATIN participants. Lack of utilization of the interventions was the number one limitation of the study.

CONCLUSION

Use of the Weaver Reading Program as well as personal engagement with students, one-on-one mentoring, and continued time investment are recommended to all programs.
You’re Teaching Evidence-Based Practice to BSN Students…But Are They Learning?
Authors: Serfass Rebecca L. , Hagedorn Wonder Amy
Published: March 2018

Although baccalaureate nursing programs often teach evidence-based practice (EBP), the effectiveness of targeted education to facilitate progressive EBP knowledge development is unclear. Rigorous, objective evaluation is vital for faculty to determine if students’ EBP knowledge is advancing, stagnating, or declining as they progress toward program completion. In a study across multiple campuses of one traditional baccalaureate nursing program, EBP knowledge significantly improved between sophomore and junior levels, but not between junior and senior levels. These results highlight the importance of using evaluation to gauge the impact of curriculum on students’ learning and progressive EBP knowledge development.
Test Anxiety and Academic Procrastination Among Prelicensure Nursing Students
Authors: Custer Nicole
Published: March 2018

Test anxiety may cause nursing students to cope poorly with academic demands, affecting academic performance and attrition and leading to possible failure on the National Council Licensure Examination for Registered Nurses (NCLEX-RN®). Test-anxious nursing students may engage academic procrastination as a coping mechanism. The Test Anxiety Inventory and the Procrastination Assessment Scale for Students were administered to 202 prelicensure nursing students from diploma, associate, and baccalaureate nursing programs in southwestern Pennsylvania. Statistically significant correlations between test anxiety and academic procrastination were found. The majority of participants reported procrastinating most on weekly reading assignments. Students with higher grade point averages exhibited less academic procrastination.
Trends in Research on Simulation in the Teaching of Nursing: An Integrative Review
Authors: Almeida Rodrigo Guimarães dos Santos , Jorge Beatriz Maria , Souza-Junior Valtuir Duarte , Mazzo Alessandra , Martins José Carlos Amado , Negri Elaine Cristina , Mendes Isabel Amélia Costa
Published: March 2018

AIM

The aim of the study was to identify and reflect on evidence regarding the use of simulation in nursing education.

BACKGROUND

The use of simulation as a teaching strategy in nursing is expanding. It is important to check the evidence deriving from research.

METHOD

Departing from a guiding question, an international literature search was undertaken between January 2008 and March 2014 in Portuguese, English, and Spanish.

RESULTS

Out of 160 articles, 68.1 percent used simulated teaching to develop clinical reasoning; 31.9 percent used it to train skills. Most (about 91.8 percent) discussed positive aspects related to the use of simulation, including support for the teaching process and increased self-efficacy and self-confidence.

CONCLUSION

The studies indicate that appropriate tools are needed to measure the true impact of the strategy on the teaching of nursing care and the training needed to use simulation as a teaching strategy.
A Comparison Study of the Effect of Type of Grading on Clinical Simulation Performance
Authors: Reising Deanna L. , Carr Douglas E. , Gindling Sally , Barnes Roxie , Garletts Derrick , Ozdogan Zulfukar
Published: March 2018

The purpose of this study was to determine whether student performance in a simulation varied according to which grading method was used: pass/fail versus numerical grading with calculation into a course grade. Results showed that student performances were not significantly different when the pass/fail graded group was compared to the numerically graded group, even though students knew which grading schema would be used in their evaluation. The study challenges the opinion that students perform better when they know that they will be numerically graded in simulation.
A Factor Analysis of the Perceived Value of Certification Tool for Nurse Educators: Evidence for Construct Validity
Authors: Barbé Tammy , Kimble Laura P.
Published: March 2018

AIM

The purpose of this study was to examine construct validity of the Perceived Value of Certification Tool for Nurse Educators (PVCT-NE).

BACKGROUND

Preliminary testing of the PVCT-NE demonstrated content validity and strong evidence of internal consistency reliability. Construct validity evidence for the tool is lacking.

METHOD

Using data from a descriptive study about nurses' perceived value of nurse educator certification, exploratory factor analysis was used to examine whether the factor structure of the PVCT-NE was consistent with the two-factor structure reported for the original PVCT.

RESULTS

Data (n = 221) were analyzed using principal components analysis to identify factors. The observed two-factor solution and individual item loadings in this sample were consistent with the original PVCT's intrinsic and extrinsic value subscales and accounted for 64 percent of the total instrument variance.

CONCLUSION

Overall, the PVCT-NE is a valid tool to measure perceived value of certification in nurse educators.
Prevalence, Risk Factors, and Outcomes of Financial Stress in Survivors of Critical Illness
Authors: Khandelwal Nita , Hough Catherine L. , Downey Lois , Engelberg Ruth A. , Carson Shannon S. , White Douglas B. , Kahn Jeremy M. , Jones Derek M. , Key Mary D. , Reagan Wen , Porter Laura S. , Curtis J. Randall , Cox Christopher E.
Published: March 2018

Objectives:

Little is known about the experience of financial stress for patients who survive critical illness or their families. Our objective was to describe the prevalence of financial stress among critically ill patients and their families, identify clinical and demographic characteristics associated with this stress, and explore associations between financial stress and psychologic distress.

Design:

Secondary analysis of a randomized trial comparing a coping skills training program and an education program for patients surviving acute respiratory failure and their families.

Setting:

Five geographically diverse hospitals.

Participants:

Patients (n = 175) and their family members (n = 85) completed surveys within 2 weeks of arrival home and 3 and 6 months after randomization.

Measurements and Main Results:

We used regression analyses to assess associations between patient and family characteristics at baseline and financial stress at 3 and 6 months. We used path models and mediation analyses to explore relationships between financial stress, symptoms of anxiety and depression, and global mental health. Serious financial stress was high at both time points and was highest at 6 months (42.5%) among patients and at 3 months (48.5%) among family members. Factors associated with financial stress included female sex, young children at home, and baseline financial discomfort. Experiencing financial stress had direct effects on symptoms of anxiety (β = 0.260; p < 0.001) and depression (β = 0.048; p = 0.048).

Conclusions:

Financial stress after critical illness is common and associated with symptoms of anxiety and depression. Our findings provide direction for potential interventions to reduce this stress and improve psychologic outcomes for patients and their families.
Adapting the Consolidated Framework for Implementation Research to Create Organizational Readiness and Implementation Tools for Project ECHO
Authors: Serhal Eva , Arena Amanda , Sockalingam Sanjeev , Mohri Linda , Crawford Allison
Published: March 2018

The Project Extension for Community Healthcare Outcomes (ECHO) model expands primary care provider (PCP) capacity to manage complex diseases by sharing knowledge, disseminating best practices, and building a community of practice. The model has expanded rapidly, with over 140 ECHO projects currently established globally. We have used validated implementation frameworks, such as Damschroder's (2009) Consolidated Framework for Implementation Research (CFIR) and Proctor's (2011) taxonomy of implementation outcomes, combined with implementation experience to (1) create a set of questions to assess organizational readiness and suitability of the ECHO model and (2) provide those who have determined ECHO is the correct model with a checklist to support successful implementation. A set of considerations was created, which adapted and consolidated CFIR constructs to create ECHO-specific organizational readiness questions, as well as a process guide for implementation. Each consideration was mapped onto Proctor's (2011) implementation outcomes, and questions relating to the constructs were developed and reviewed for clarity. The Preimplementation list included 20 questions; most questions fall within Proctor's (2001) implementation outcome domains of ”Appropriateness“ and ”Acceptability.“ The Process Checklist is a 26-item checklist to help launch an ECHO project; items map onto the constructs of Planning, Engaging, Executing, Reflecting, and Evaluating. Given that fidelity to the ECHO model is associated with robust outcomes, effective implementation is critical. These tools will enable programs to work through key considerations to implement a successful Project ECHO. Next steps will include validation with a diverse sample of ECHO projects.
Usage and Usability of a Web-based Program for Family Caregivers of Older People in Three European Countries
Authors: Barbabella Francesco , Poli Arianna , Hanson Elizabeth , Andréasson Frida , Salzmann Benjamin , Döhner Hanneli , Papa Roberta , Efthymiou Areti , Valenza Silvia , Pelliccioni Giuseppe , Lamura Giovanni
Published: March 2018

InformCare is a European Web platform that supports informal caregivers of older people by providing access to online information and professional and peer support. The aim of this study was to assess the usage and usability of a psychosocial Web-based program carried out in three European countries (Italy, Sweden, and Germany). A mixed-methods sequential explanatory design was adopted, comprising baseline and postintervention assessments, as well as combined thematic content analysis of results and focus group findings. A convenience sample of 118 caregivers was enrolled, of whom 94 used the services offered by the program at least once. The subsamples in the three countries used the platform in different ways, with a predominance of passive strategies (eg, seeking information and reading other people's comments) for Italian caregivers, and more active usage by Swedish and German caregivers. The usability assessment showed that the platform was perceived well by Italian and German caregivers, whereas technical problems affected the Swedish sample's experiences. Focus group data highlighted user satisfaction with the online support and reliability of the environment. Recommendations for practitioners are to ensure digital training for caregivers who have lower confidence in use of the Internet, to involve different healthcare professionals in the provision of professional support, and to adequately manage online community building.
Dried Blood Spot Analysis for Therapeutic Drug Monitoring of Antipsychotics: Drawbacks of Its Clinical Application
Authors: Kloosterboer Sanne M. , de Winter Brenda C. M. , Bahmany Soma , Al-Hassany Linda , Dekker Annet , Dieleman Gwen C. , van Gelder Teun , Dierckx Bram , Koch Birgit C. P.
Published: March 2018

Background:

Dried blood spot (DBS) sampling offers a minimally invasive sampling method for therapeutic drug monitoring of antipsychotics. To facilitate implementation in clinical practice, the aim of this study was to perform a clinical validation study of a DBS method for quantification of risperidone, aripiprazole, pipamperone, and their major metabolites 9-OH risperidone and dehydro-aripiprazole in a real-life, clinical setting.

Methods:

Paired DBS and venous plasma samples were analyzed (n = 35 for risperidone, n = 21 for aripiprazole, n = 21 for pipamperone). Estimated plasma concentrations were calculated from DBS concentrations based on hematocrit and/or Deming regression formulas. Deming regression and Bland–Altman analyses were used to determine the agreement between the calculated and measured plasma concentrations. For Bland–Altman analysis, the following acceptance limit was used: for a minimum of 67% of the samples, the difference of the 2 measurements should be within 20% of their mean.

Results:

The median venous plasma levels were 0.9 mcg/L for risperidone, 14.8 mcg/L for 9-OH risperidone, 135.4 mcg/L for aripiprazole, 54.9 mcg/L for dehydro-aripiprazole, and 56.4 mcg/L for pipamperone. All antipsychotics required different correction formulas of DBS concentrations for best agreement. Subsequently, no constant or proportional bias was observed using Deming regression analysis. With Bland–Altman analyses, for risperidone, 45% of the samples were within the 20% limits; for 9-OH risperidone, 36%; for aripiprazole, 45%; for dehydro-aripiprazole, 35%; and for pipamperone, 43%.

Conclusions:

The DBS method to quantify risperidone, aripiprazole, pipamperone, and their major metabolites did not meet the acceptance criteria in the Bland–Altman analyses. Therefore, this DBS method was not clinically valid. This study shows the importance of a clinical validation study with use of Bland–Altman plots before clinical implementation.
Pharmacokinetic Therapeutic Drug Monitoring of Advagraf in More Than 500 Adult Renal Transplant Patients, Using an Expert System Online
Authors: Marquet Pierre , Bedu Anne , Monchaud Caroline , Saint-Marcoux Franck , Rérolle Jean-Philippe , Etienne Isabelle , Kamar Nassim , Moulin Bruno , Cassuto Elisabeth , Essig Marie , Woillard Jean-Baptiste
Published: March 2018

Background:

Immunosuppressant Bayesian dose adjustment (ISBA) is an online expert system, routinely used by approximately 140 transplantation centers in the world for the dose adjustment of immunosuppressive drugs in transplant patients. This system determines the area under the curve (AUC) of the drug by pharmacokinetic modeling and Bayesian estimation. The purpose of this study was to analyze tacrolimus exposure after administration of its modified-release formulation (Advagraf) in kidney allograft recipients, to optimize its therapeutic drug monitoring.

Methods:

This is a retrospective study of exposure indices measured locally [trough tacrolimus concentration (C0), C0/dose] or estimated through ISBA (AUC, AUC/dose, AUC/C0), of their evolution over posttransplantation time, and of the correlations between them.

Results:

A total of 922 requests posted by 28 different centers for routine Advagraf adjustment in 530 different patients treated with Advagraf were studied. The exposure to, and dose requirement of, tacrolimus significantly increased across the first posttransplant months before reaching steady state. The AUC:C0 ratio (on which C0 monitoring is implicitly based) was stable across the different posttransplant periods, although with high interindividual variability. C0–AUC correlation was stronger in the late than in the early posttransplant period (r
2 = 0.75 versus 0.63; P = 0.0075). Using the regression equations obtained, AUC ranges corresponding to different applicable C0 target ranges were calculated to guide dose adjustment. When one of the doses recommended was administered, the following AUC was significantly more often in the predicted target ranges (P < 0.0001).

Conclusions:

This study improves our knowledge of Advagraf pharmacokinetic variability and relations between exposure indices and the scientific background of the expert service provided through the ISBA Web site.
One-dimensional Spatial Distributions of Gamma-ray Emitting Contaminants in Field Lysimeters Using a Collimated Gamma-ray Spectroscopy System
Authors: Erdmann Bryan J. , Powell Brian A. , Kaplan Daniel I. , DeVol Timothy A.
Published: March 2018

One-dimensional scans of gamma-ray emitting contaminants were conducted on lysimeters from the RadFLEX facility at the Savannah River Nationals Laboratory (SRNL). The lysimeters each contained a contamination source that was buried in SRNL soil. A source consisted of 137Cs, 60Co, 133Ba, and 152Eu incorporated either into a solid waste form (Portland cement and reducing grout) or applied to a filter paper for direct soil exposure. The lysimeters were exposed to natural environmental conditions for 3 to 4 y. The initial contaminant activities range from 4.0 to 9.0 MBq for the solid wasteforms and 0.25 to 0.47 MBq for the soil-incorporated source. The measurements were performed using a collimated high-purity germanium gamma-ray spectrometer with a spatial resolution of 2.5 mm. These scans showed downward mobility of 60Co and 133Ba when the radionuclides were incorporated directly into the SRNL soil. When radionuclides were incorporated into the solid waste forms positioned in the SRNL soil, 137Cs exhibited both upward and downward dispersion while the other radionuclides showed no movement. This dispersion was more significant for the Portland cement than the reducing grout wasteform. Europium-152 was the only radionuclide of those studied that showed no movement within the spatial resolution of the scanner from the original placement within the lysimeter. Understanding radionuclide movement in the environment is important for developing strategies for waste management and disposal.
Alpha Air Sample Counting Efficiency Versus Dust Loading: Evaluation of a Large Data Set
Authors: Hogue M.G. , Gause-Lott S.M. , Owensby B.N. , Slack T.M. , Smiley J.J. , Burkett J.L.
Published: March 2018

Dust loading on air sample filters is known to cause a loss of efficiency for direct counting of alpha activity on the filters, but the amount of dust loading and the correction factor needed to account for attenuated alpha particles is difficult to assess. In this paper, correction factors are developed by statistical analysis of a large database of air sample results for a uranium and plutonium processing facility at the Savannah River Site. As is typically the case, dust-loading data is not directly available, but sample volume is found to be a reasonable proxy measure; the amount of dust loading is inferred by a combination of the derived correction factors and a Monte Carlo model. The technique compares the distribution of activity ratios [beta/(beta + alpha)] by volume and applies a range of correction factors on the raw alpha count rate. The best-fit results with this method are compared with MCNP modeling of activity uniformly deposited in the dust and analytical laboratory results of digested filters. A linear fit is proposed to evenly-deposited alpha activity collected on filters with dust loading over a range of about 2 mg cm−2 to 1,000 mg cm−2.
Health Physics Society Comments to U.S. Environmental Protection Agency Regulatory Reform Task Force
Authors: Ring Joseph , Tupin Edward , Elder Deirdre , Hiatt Jerry , Sheetz Michael , Kirner Nancy , Little Craig
Published: March 2018

The Health Physics Society (HPS) provided comment to the U.S. Environmental Protection Agency (EPA) on options to consider when developing an action plan for President Trump’s Executive Order to evaluate regulations for repeal, replacement, or modification. The HPS recommended that the EPA reconsider their adherence to the linear no-threshold (LNT) model for radiation risk calculations and improve several documents by better addressing uncertainties in low-dose, low dose-rate (LDDR) radiation exposure environments. The authors point out that use of the LNT model near background levels cannot provide reliable risk projections, use of the LNT model and collective-dose calculations in some EPA documents is inconsistent with the recommendations of international organizations, and some EPA documents have not been exposed to the public comment rule-making process. To assist in establishing a better scientific basis for the risks of low dose rate and low dose radiation exposure, the EPA should continue to support the “Million Worker Study,” led by the National Council on Radiation Protection and Measurement.
INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS FOR EXUDATIVE RETINAL ARTERIAL MACROANEURYSMS
Authors: Mansour Ahmad M. , Foster Robert E. , Gallego-Pinazo Roberto , Moschos Marilita M. , Sisk Robert A. , Chhablani Jay , Rojanaporn Duangnate , Sujirakul Tharikarn , Arevalo J. Fernando , Lima Luiz H. , Wu Lihteh , Charbaji Abdulrazzak , Saatci Ali O. , Mansour Hana A. , Martinez-Rubio Clara , Patel Yogin , Gangakhedkar Sankeert
Published: March 2018

Purpose:

There is no established therapy for exudative-hemorrhagic complications in primary retinal arteriolar macroaneurysm (RAM).

Methods:

Retrospective multicenter interventional study of anti-vascular endothelial growth factor in symptomatic RAMs. Central macular thickness in μm and best-corrected visual acuity in logMar were correlated with the RAM size and distance to the macula. Statistical analyses were performed using paired comparisons and Pearson correlation.

Results:

Thirty-two eyes (32 patients) were treated with a mean of 2.7 injections over a mean follow-up of 16.6 months. Initial best-corrected visual acuity correlated with the RAM size and distance to the macula (P = 0.02). Central macular thickness decreased by 131,180, and 211 μm at 1, 2, and 3 months after the first injection (P < 0.001). Best-corrected visual acuity improved by 0.47 and 0.38 Early Treatment Diabetic Retinopathy Study lines at 2 and 3 months (P = 0.005). Anti-vascular endothelial growth factor response correlated with the RAM size (P = 0.04) and the distance to the macula (P = 0.009).

Conclusion:

Symptomatic RAMs can be treated successfully with anti-vascular endothelial growth factor injections, leading to a decrease in macular edema.
WIDEFIELD SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING OF PERIPHERAL ROUND RETINAL HOLES WITH OR WITHOUT RETINAL DETACHMENT
Authors: Casswell Edward J. , Abou Ltaif Sleiman , Carr Thomas , Keane Pearse A. , Charteris David G. , Wickham Louisa
Published: March 2018

Purpose:

To describe the widefield spectral-domain optical coherence tomography features of peripheral round retinal holes, with or without associated retinal detachment (RD).

Methods:

Retrospective, observational study of 28 eyes with peripheral round retinal holes, with and without RD. Patients underwent imaging with a widefield 50-degree spectral-domain optical coherence tomography (Heidelberg Engineering, Germany) and Optos ultra-widefield imaging systems (Optos, United Kingdom).

Results:

Vitreous attachment at the site of the retinal hole was detected in 27/28 (96.4%) cases. Cases were split into three groups: RHs with RD (n = 12); RHs with subretinal fluid (n = 5), and flat RHs (n = 11), with minimal or no subretinal fluid. 91.6% retinal holes associated with subretinal fluid or RD had vitreous attachment at the site of the hole. Eighty percent had vitreous attachment at both edges of the retinal hole, in a U-shape configuration, which appeared to exert traction. By contrast, flat retinal holes had visible vitreous attachment only at one edge of the retinal hole in 45.4%.

Conclusion:

Vitreous attachment was commonly seen at the site of round retinal holes. Vitreous attachment at both edges of the retinal hole in a U-shape configuration was more commonly seen at holes associated with subretinal fluid or RD.
RETINAL CAVERNOUS HEMANGIOMA WITH INTRALESIONAL PHLEBOLITHS
Authors: Yu Michael D. , Dalvin Lauren A. , Shields Carol L.
Published: March 2018

Purpose:

To report a case of retinal cavernous hemangioma with intralesional phleboliths, simulating retinoblastoma.

Methods:

A healthy 5-month-old girl developed left esotropia and was noted to have atraumatic vitreous hemorrhage with underlying partially calcified mass, suspicious for retinoblastoma.

Results:

On examination, the visual acuity was fix and follow in the right eye and absent fixation in the left eye. Evaluation of the right eye revealed normal findings. The left eye demonstrated healthy anterior segment and dense vitreous hemorrhage with no view of the postequatorial structures, but with hazy view of the flat peripheral retina and a superonasal retinal mass, covered with fresh hemorrhage. Three white intralesional flecks, consistent with calcification, each measuring 300 μm, were visualized. B-scan ultrasonography confirmed the dense mass with several foci of calcification, suspicious for retinoblastoma, despite poor visualization on funduscopy. Prophylactic intravenous chemotherapy was delivered for globe salvage and systemic protection. At 12-month follow-up, the hemorrhage showed resolution, revealing a superonasal dark blue multilobulated mass with saccular aneurysms, measuring 16 mm in diameter, and with 3 phleboliths (intralesional calcification). Fluorescein angiography demonstrated early and midphase hypofluorescence with late-phase filling and with plasma–erythrocyte separation in some larger aneurysms, characteristic of retinal cavernous hemangioma.

Conclusion:

Retinal cavernous hemangioma can be associated with intralesional calcification (phleboliths).
Confocal Microscopy Observation of Cornea Verticillata After Vandetanib Therapy for Medullary Thyroid Carcinoma
Authors: Arriola-Villalobos Pedro , Benito-Pascual Blanca , Díaz-Valle David , Benítez-del-Castillo José M.
Published: March 2018

Purpose:

To report 2 cases of cornea verticillata (CV) after vandetanib treatment for medullary thyroid carcinoma (MTC).

Methods:

In this retrospective interventional, case-report study, 2 patients who under vandetanib treatment for MTC were referred to our ophthalmology department because of vision complaints. Both subjects underwent a complete ophthalmologic examination, including confocal microscopy (CM) using the Heidelberg Retina Tomograph and Rostock Cornea Module.

Results:

A 70-year-old man and a 43-year-old woman, both with a history of MTC under treatment with vandetanib for 5 months and 30 months, respectively, presented with blurred vision. In both patients, a mild CV pattern was observed although deposits were more evident in the male patient. CM images showed hyperreflective deposits in the corneal epithelium and subepithelial nerve plexus. Bright microdots were also seen throughout the stroma, along with a few hyperreflective keratocytes in the anterior stroma.

Conclusions:

In both patients, vandetanib seemed to be the cause of CV. The CM images supported the idea of drug–lipid complex deposits in vandetanib-induced CV.
Adult Caregiver Influenza Vaccination Through Administration in Pediatric Outpatient Clinics
Authors: Jacobs Kimberley , Posa Molly , Spellicy Whitney , Otero Jaclyn , Kelly Maria
Published: March 2018

Background:

Pediatric exposure to influenza-infected adult caregivers (AC) is a significant risk factor for developing influenza. Poor access to vaccines contributes to low adult vaccination rates. We offered adult vaccination at regularly scheduled pediatric office visits and examined barriers to improve future vaccination rates.

Methods:

Via a retrospective chart review, we identified ACs who received an influenza vaccination at 1 of 3 pediatric clinics within an academic center from August 2015 to May 2016. We screened for demographics of ACs and their children. Rates of AC vaccination and AC refusal were not measured.

Results:

A total of 297 ACs representing 518 children received their influenza vaccine at their child’s pediatric office. The mean age of ACs was 35.9 years (range, 22–70 years) and 68.5% were mothers. Most ACs (n = 294, 99%) receiving the vaccine had private insurance. Almost all ACs received their vaccination on the day of the child’s visit (n = 250, 84%). A total of 49.6% of AC’s children had high-risk illnesses. Parents of children with Medicaid were under-represented because of high parental copays (n = 3, 1%). The highest clinic vaccine participation was noted at the clinics with lowest Medicaid populations.

Conclusions:

ACs readily accepted influenza vaccination at their child’s pediatric primary care office. Increased vaccination acceptance occurred when ACs were female, had private insurance, if their child had a chronic illness and if the vaccination was offered the same day as their child’s appointment. Likely reason for low acceptance in ACs with Medicaid insurance is high cost; thus, staff, well-aware of Medicaid’s nonreimbursement, likely offered the vaccine less to these parents.
Pneumonia in HIV-exposed and Infected Children and Association With Malnutrition
Authors: Iroh Tam Pui-Ying , Wiens Matthew O. , Kabakyenga Jerome , Kiwanuka Julius , Kumbakumba Elias , Moschovis Peter P.
Published: March 2018

We evaluated the association between HIV exposed-uninfected (HEU) status, malnutrition and risk of death in Ugandan children hospitalized with pneumonia. Both HIV exposure and infection were associated with lower anthropometric indices on univariate analysis, and mid-upper arm circumference was significantly associated with overall mortality (odds ratio (OR), 0.96) in a multivariable model. HIV infection (OR 5.0) but not HEU status was associated with overall mortality. Malnutrition may contribute to poor pneumonia outcomes among HIV-infected and HEU children requiring hospitalization.
Biopsy-Proven Metastatic Merkel Cell Carcinoma to the Orbit: Case Report and Review of Literature
Authors: Cugley Dean R. , Roberts-Thomson Samuel J. , McNab Alan A. , Pick Zelda
Published: March 2018

Merkel cell carcinoma is a rare neuroendocrine tumor of subspecialized dermal mechanoreceptors, associated with immunosuppression. The usual ophthalmic presentation is an eyelid lesion. The authors present a case of biopsy-proven orbital metastatic Merkel cell carcinoma in the absence of any eyelid lesion, in an immunosuppressed patient with a history of multiple cancers. There are to the authors’ knowledge only 2 other case reports of presumed metastatic Merkel cell carcinoma to the orbit, though neither were biopsied. Despite its rarity, metastatic Merkel cell carcinoma should be included in the differential of a metastatic orbital lesion, in the patient with a known or suspected cutaneous primary. The patient has had an excellent response to combined radiotherapy and programmed death-1 inhibitor pembrolizumab, and this case highlights the potential benefit of an exciting new biologic therapy.
Bilateral Limbal Keratin-Associated Amyloidosis
Authors: Charles Norman C. , Belinsky Irina , Ahmad Habeeb
Published: March 2018

Conjunctival amyloid is usually of the immunoglobulin light chain (AL) variety. The authors report an exceptional case of bilateral limbal amyloid deposits that were identified by mass spectrometry as keratin-related specifically regarding to basal keratinocyte keratins 5 and 14. Cytokeratin-related amyloid has been described by immunohistochemical analysis of formalin-fixed cutaneous and mucous membrane lesions but not ocular tissues. The conjunctival lesion in the right eye contained intraepithelial dyskeratotic cells that extended to the surface, causing a lacy leukoplakia on clinical examination. The authors excluded the diagnosis of hereditary benign intraepithelial dyskeratosis in this patient. Collection of patient data and all protected patient health information was compliant with the Health Insurance Portability and Accountability Act.