bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Comprehensive Culture Change Adoption via the Household Model Enhance Nursing Home Residents’ Psychosocial Well-being?
Authors: Hermer Linda , Bryant Natasha S , Pucciarello Madeline , Mlynarczyk Carolina , Zhong Bridget
Published: December 2017

Background and Objectives

Several studies suggest that to substantially improve residents’ psychosocial well-being, traditional-model nursing homes should redesign themselves as small, homelike “households” along with comprehensively adopting other aspects of “culture change,” a set of reforms meant to improve residents’ quality of life. But this evidence mainly comes from qualitative studies. This comparative, observational study tested quantitatively whether residents in a household-model nursing home that had comprehensively adopted culture change reforms displayed greater positive affect, increased cognitive engagement, more extensive social interactions with staff and greater use of the environment than did residents at partial culture-change-adopting facilities with traditional, institutional environments.

Research Design and Methods

Household-model residents were matched on clinical and demographic factors with residents at two institutional control facilities that had partially adopted culture change and were observed for 8 hours each. To provide potentially converging evidence, aides and nurses were also observed. Finally, a culture change implementation assessment was conducted.

Results

The implementation assessment showed that the household-model home had implemented culture change beyond national norms, whereas the control facilities were U.S.-typical partial adopters. It also revealed that household-model staff cared for residents in a more person-centered manner. Observation analyses revealed that household-model residents spent less time idle and less time stationary at wheelchair hubs. Moreover, although household-model residents did not spend the most time in the dining area overall, they spent the greatest percentage of time there talking with staff, displaying positive affect, and displaying active engagement. Finally, household-model residents and staff spent the most time in task-oriented interactions, including personal care.

Discussion and Implications

These results suggest that the intended psychosocial benefits materialize in household-model facilities, particularly in the dining area and in resident–staff relationships. The findings raise the possibility that facilities may be able to achieve these outcomes without entirely redesigning their environment.
Examining the Association Between Psychiatric Disorders and Cocaine Binges: Results From the COSMO Study
Authors: Juteau Louis-Christophe , Roy Élise , Berbiche Djamal , Arruda Nelson , Bruneau Julie , Jutras-Aswad Didier
Published: December 2017

Objectives:

Although cocaine binges and mental health problems have both been identified as significant risk factors for different health hazards, little is known about the relationship between mental health and cocaine binging. Hence, the aim of this study is to examine the association between psychiatric disorders and cocaine binge.

Methods:

Participants were part of a prospective cohort study of individuals who either smoke or inject cocaine. The dependent variable, namely a cocaine binge within the past month, was defined as the repetitive use of large quantities of cocaine until the individual was unable to access more of the drug or was physically unable to keep using. Psychiatric disorders were assessed using the Composite International Diagnostic Interview and the Diagnostic Interview Schedule questionnaires. Logistic regression models were performed to examine the association between cocaine binging and psychiatric disorders, adjusting for potential confounders.

Results:

Of the 492 participants, 24.4% reported at least 1 cocaine binging episode during the prior month. Among the study population, 48.0% met the criteria for antisocial personality disorder (ASPD), 45.5% for anxiety disorders, and 28.2% for mood disorders. Participants with ASPD were more likely to binge (adjusted odds ratio 1.73, 95% confidence interval 1.10–2.73), whereas those with a mood disorder were not. The association between anxiety disorders and cocaine binging was significant only in univariate analyses.

Conclusion:

ASPD increased the odds of reporting cocaine binge in our study population. These results highlight the need for a better understanding of the specific dimensions of ASPD that contribute to the increased risk of unsafe drug use behaviors.
Environmental Health
Authors: Valentine-Maher Sarah K. , Butterfield Patricia G. , Laustsen Gary
Published: December 2017

Human health is substantially impacted by the state of the environment, and environmental degradation has a disproportionate impact on persons with less immediate access to financial and social power. This article calls for upstream nursing action to address the natural environment in order to turn about health injustices and improve health for all. Such action would move nursing towards a greater actualization of the nursing environmental domain. The health impacts of climate change, air and water quality, and toxic chemical exposure are substantiated and specific policy leadership recommendations are proposed. Recommended actions include work to build environmental health literacy and empowerment, advocacy for regulatory protection and enforcement, and environmental engagement within health care systems.
School Nurses' Awareness and Attitudes Toward Commercial Sexual Exploitation of Children
Authors: Fraley Hannah E. , Aronowitz Teri , Jones Emily J.
Published: December 2017

Human trafficking is a global, multibillion-dollar industry. Most victims are female and more than half are children. At-risk youth continue to attend school with school nurses on the frontline of this health crisis. Using the Peace and Power Conceptual Model, a mixed-methods study was conducted to explore school nurses' awareness, attitudes, and role perceptions in the prevention of commercial sexual exploitation of children. Six peace-power versus power-over power themes and 4 subthemes were identified: “exposure/knowledge, “collaboration,” “role boundaries,” and “creating respite space.” Policy efforts should focus on improving practice conditions for school nurses to support the prevention of commercial sexual exploitation of children.
PARACENTRAL ACUTE MIDDLE MACULOPATHY IN PURTSCHER RETINOPATHY
Authors: Rivera-De La Parra David , Fromow-Guerra Jans
Published: December 2017

Purpose:

To describe paracentral acute middle maculopathy associated with Purtscher retinopathy, particularly in Purtscher flecken lesions as a retinal complication in a case secondary to fractures of long bones.

Methods:

Case report.

Results:

A 16-year-old boy with bilateral paracentral scotomata presented with bilateral paracentral acute middle maculopathy as part of Purtscher retinopathy in both eyes as consequence of tibia and fibula fractures.

Conclusion:

Paracentral acute middle maculopathy is one of the optical coherence tomography findings in Purtscher retinopathy.
Magnetic Resonance Enterography Cannot Replace Upper Endoscopy in Pediatric Crohn Disease
Authors: Church Peter C. , Kuint Ruth Cytter , Ledder Oren , Navas‐López Victor M. , Sladek Malgorzata , Brückner Annecarin , Baldassano Robert N. , Weiss Batia , Yerushalmi Baruch , Saeed Shehzad A. , Hyams Jeffrey , Otley Anthony , Griffiths Anne M. , Turner Dan , Greer Mary‐Louise C. ,   ImageKids Study group
Published: December 2017

Objectives:

Although magnetic resonance enterography (MRE) can accurately reflect ileal inflammation in pediatric Crohn disease (CD), there are no pediatric data on the accuracy of MRE to detect upper gastrointestinal tract (UGI) lesions. We aimed to compare MRE and esophagogastroduodenoscopy (EGD) in detecting the spectrum and severity of UGI disease in children.

Methods:

This is an ancillary study of the prospective multi‐center ImageKids study focusing on pediatric MRE. EGD was performed within 2 weeks of MRE (at disease onset or thereafter) and explicitly scored by SES‐CD modified for the UGI and physician global assessment. Local and central radiologists scored the UGI region of the MRE blinded to the EGD. Accuracy of MRE compared with EGD was examined using correlational coefficients (r) and area under receiver operating characteristic curves (AUC).

Results:

One hundred and eighty‐eight patients were reviewed (mean age 14 ± 1 years, 103 [55%] boys); 66 of 188 (35%) children had macroscopic ulcerations on EGD (esophagus, 13 [7%]; stomach, 34 [18%]; duodenum, 45 [24%]). Most children had aphthous ulcers, but 10 (5%) had larger ulcers (stomach, 2 [1%]; duodenum, 8 [4%]). There was no agreement between local and central radiologists on the presence or absence of UGI inflammation on MRE (Kappa = −0.02, P = 0.71). EGD findings were not accurately detected by MRE, read locally or centrally (r = −0.03 to 0.11, P = 0.18–0.88; AUC = 0.47–0.55, P = 0.53–1.00).No fistulae or narrowings were identified on either EGD or MRE.

Conclusions:

MRE cannot reliably assess the UGI in pediatric CD and cannot replace EGD for this purpose.
Treatment of Chronic Hepatitis C Virus Infection in Children
Authors: Indolfi Giuseppe , Hierro Loreto , Dezsofi Antal , Jahnel Jörg , Debray Dominique , Hadzic Nedim , Czubkowski Piotr , Gupte Girish , Mozer‐Glassberg Yael , van der Woerd Wendy , Smets Françoise , Verkade Henkjan J. , Fischler Björn
Published: December 2017

Objectives:

In 2017, the European Medicines Agency and the Food and Drug Administration approved the use of the fixed‐dose combination of ledipasvir/sofosbuvir and of the combination of sofosbuvir and ribavirin for treatment of adolescents (12–17 years or weighing >35 kg) with chronic hepatitis C virus (HCV) genotype 1, 4, 5, and 6 and genotype 2 and 3 infections, respectively. Although trials with direct‐acting antivirals are ongoing for younger children, the only available treatment in the United States and Europe for those <12 years is still the dual therapy of pegylated interferon and ribavirin. There is currently a lack of a systematic approach to the care of these patients. The Hepatology Committee of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition developed an evidence‐based position paper for the management of chronic HCV infection in children.

Methods:

A systematic literature search and meta‐analysis were performed using MEDLINE and Embase from June 1, 2007 to June 1, 2017. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. European Society of Pediatric Gastroenterology, Hepatology and Nutrition Committee members voted on each recommendation, using the nominal voting technique.

Results:

The efficacy of the different direct‐acting antivirals combinations tested was higher, the relapse and the treatment discontinuation rates lower when compared to pegylated interferon and ribavirin.

Conclusions:

This position paper addresses therapeutic management issues including goals, endpoints, indications, contraindications, and the optimal treatment regimen in children with chronic HCV infection.
Adherence to the Gluten‐free Diet and Health‐related Quality of Life in an Ethnically Diverse Pediatric Population With Celiac Disease
Authors: Mager Diana R. , Marcon Margaret , Brill Herbert , Liu Amanda , Radmanovich Kristin , Mileski Heather , Nasser Roseann , Alzaben Abeer , Carroll Matthew W. , Yap Jason , Persad Rabin , Turner Justine M.
Published: December 2017

Objectives:

Celiac disease (CD) is an autoimmune disease that requires lifelong adherence to a gluten‐free diet (GFD). Adherence to the GFD in childhood may be poor and adversely influence health‐related quality of life (HRQOL). The study purpose was to determine sociodemographic and socioeconomic factors influencing adherence to the GFD and HRQOL in a multiethnic cohort of youth with CD.

Methods:

A multisite (Edmonton, Hamilton, Toronto) study examining child‐parent HRQOL in youth with CD (n = 243) and/or mild gastrointestinal complaints (GI‐CON; n = 148) was conducted. Sociodemographic (age, child‐parental age/education/ethnicity/place of birth), anthropometric (weight, height, body mass index), disease (diagnosis, age at diagnosis, duration, Marsh score, serology), household characteristics (income, family size, region, number of children/total household size), HRQOL (Peds TM4.0/KINDL and Celiac Disease DUX), GI Complaints (PedsQL: Gastrointestinal Symptom Scale) and gluten intake were measured.

Results:

Younger age (<10 years), non‐Caucasian ethnicity (parent/child), and presence of GI symptoms were associated with the highest rates of adherence to the GFD in CD children (P < 0.05). CD children (parent/child) had higher HRQOL (average, composite domains) than GI‐CON (P < 0.05), but CD children were comparable to healthy children. Lack of GI symptoms, non‐Caucasian ethnicity and age (<10 years) were associated with increased HRQOL in composite/average domains for CD (P < 0.05).

Conclusions:

Child‐parent perceptions of HRQOL in a multiethnic population with CD are comparable to healthy reference populations, but significantly higher than in parent/child GI‐CON. Adherence to the GFD in ethnically diverse youth with CD was related to GI symptoms, age of the child, and ethnicity of the parent‐child.
Magnetic Resonance Imaging Findings in Neonatal Hemochromatosis
Authors: Alenezi Khaled , Kamath Binita M. , Siddiqui Iram , Tomlinson Christopher , Chavhan Govind B.
Published: December 2017

Background:

There are limited data on utility of magnetic resonance imaging (MRI) in the assessment of suspected neonatal hemochromatosis (NH).

Objectives:

The aim of the study was to present our experience with utilization of multi‐echo sequence MRI technique in the evaluation of NH and to compare MRI findings in infants with and without NH.

Methods:

MRI performed for suspected NH were retrospectively reviewed to note the presence and severity of iron deposition (ID) in liver, spleen, pancreas, and kidneys on multi‐echo sequences. Findings were compared in infants with and without NH.

Results:

Of 20 infants (9 boys and 11 girls; median age of 12.5 days) included in the study, 7 of 20 had NH and 13 of 20 were assigned to the non‐NH group. Higher degree of pancreatic ID was seen in the NH group (P = 0.001) with 4 of 7 evaluable pancreas showing moderate‐to‐severe degree and 1 of 7 showing mild degree of ID whereas none of the 13 infants in non‐NH group showed moderate or severe degree of pancreatic ID. Even though the severity of hepatic ID was higher in NH group (P = 0.033), variable severity of hepatic ID was seen in both groups with most infants in both groups showing moderate‐to‐severe degree of ID. The severity of splenic ID was not particularly associated with any group (P = 0.774) but there was no moderate or severe degree of ID in NH. Renal ID was seen in two infants in non‐NH group.

Conclusions:

A moderate‐to‐severe degree of pancreatic ID seen on MRI tends to be associated with NH and should be sought to establish a timely diagnosis of NH. Presence and severity of hepatic ID cannot be used for differentiation of NH from other causes of neonatal liver failure.
Seasonal Association of Pediatric Functional Abdominal Pain Disorders and Anxiety
Authors: Pollard Katharine L. , Campbell Christina , Squires Megan , Palsson Olafur , van Tilburg Miranda A.L.
Published: December 2017

Objectives:

Abdominal pain–related pediatric functional gastrointestinal disorders (AP‐FGIDs) are defined by abdominal discomfort or pain that may provide obstacles to everyday activities, such as school attendance. It has been reported that AP‐FGID symptoms may be reduced in summer, but it is unclear what drives this seasonal variation. This pilot study aimed to explore whether the seasonal variation in AP‐FGID symptoms could be explained by various psychological and behavioral factors.

Methods:

Parents of children with AP‐FGID symptoms completed online questionnaires on symptoms, anxiety, parental responses to pain, sleep, diet, and physical activity once during spring months and again in the summer months.

Results:

In a sample of 34 participants who completed both questionnaires, 22 reported improvements during the summer months. These participants reported a significantly higher seasonal decrease in anxiety than participants whose children's symptoms did not improve from spring to summer (mean decrease 2.21 vs 0.08, P = 0.017). Both groups reported equal improvements in sleep and decreased stress from spring to summer. Neither group experienced statistically significant seasonal change in physical activity or fruit, vegetables, dairy, or caffeine consumption.

Conclusions:

This study suggests that amelioration of gastrointestinal symptoms in pediatric patients with AP‐FGID during summer months is associated with amelioration of anxiety in the same time period. It is not yet clear whether decreased anxiety is the cause or effect of decreased AP‐FGID symptoms.
The Impact of Labiaplasty on Sexuality
Authors: Turini Tatiana , Weck Roxo Ana Cláudia , Serra-Guimarães Fernando , Abreu Maria Lidia , de Castro Cláudio Cardoso , Aboudib José Horácio , Nahas Fábio Xerfan
Published: December 2017

Background:

Labiaplasty is one of the aesthetic procedures that has shown the greatest increase in the number of operations in recent years, although the absolute number of these procedures is still very low. Labia minora hypertrophy causes not only functional discomfort and sexual difficulties, but also embarrassment and aesthetic concern. The aim of this study was to assess the impact of labiaplasty on the patient’s quality of life, self-esteem, and sexual function.

Methods:

Twenty-four consecutive sexually active patients, who expressed the desire to undergo labiaplasty, were divided into two groups of 12 patients each: the intervention group that underwent labiaplasty immediately after responding the first questionnaires, and the control group that received no intervention during the study period. All patients were assessed for health-related quality of life, self-esteem, and sexual function using the Brazilian Portuguese versions of the Medical Outcomes Study 36-Item Short Form Health Survey, the Brazilian version of the Rosenberg Self-Esteem scale, and the Female Sexual Function Questionnaire, respectively. The questionnaires were administered at inclusion and at 3 and 6 months later in both groups. Comparisons within and between groups were performed. Statistical analysis was performed at a significance level of p < 0.05.

Results:

No significant differences in Rosenberg Self-Esteem scale or Medical Outcomes Study 36-Item Short Form Health Survey score were found in either group during the study period. However, a significant improvement was found in the Female Sexual Function Questionnaire total score in the pain and enjoyment domains.

Conclusion:

Labiaplasty had a positive impact on sexual functioning of the study population.
Work-Related Musculoskeletal Injuries in Plastic Surgeons in the United States, Canada, and Norway
Authors: Khansa Ibrahim , Khansa Lara , Westvik Tormod S. , Ahmad Jamil , Lista Frank , Janis Jeffrey E.
Published: December 2017

Background:

Musculoskeletal injuries are more common among surgeons than among the general population. However, little is known about these types of injuries among plastic surgeons specifically. The authors’ goals were to evaluate the prevalence, nature, causes, and potential solutions of these musculoskeletal injuries among plastic surgeons in three different countries: the United States, Canada, and Norway.

Methods:

A survey was e-mailed to plastic surgeons in the United States, Canada, and Norway, soliciting their demographics, practice description, history of musculoskeletal issues, potential causes of these symptoms, and proposed suggestions to address these injuries. The prevalence of various musculoskeletal symptoms was calculated, and predictors of these symptoms were evaluated using multivariate logistic regression.

Results:

The survey was sent to 3314 plastic surgeons, with 865 responses (response rate, 26.1 percent); 78.3 percent of plastic surgeons had musculoskeletal symptoms, most commonly in the neck, shoulders, and lower back. U.S. surgeons were significantly more likely to have musculoskeletal symptoms than Norwegian surgeons (79.5 percent versus 69.3 percent; p < 0.05); 6.7 percent of all respondents required surgical intervention for their symptoms. The most common causative factors were long surgery duration, tissue retraction, and prolonged neck flexion. The most common solutions cited were core-strengthening exercises, stretching exercises, and frequent adjustment of table height during surgery.

Conclusions:

Plastic surgeons are at high risk for work-related musculoskeletal injuries. Ergonomic principles can be applied in the operating room to decrease the incidence and severity of those injuries, and to avoid downstream sequelae, including the need for surgery.
Adverse Event Incidences following Facial Plastic Surgery Procedures: Incorporating FACE-Q Data to Improve Patient Preparation
Authors: Fleury Christopher M. , Schwitzer Jonathan A. , Hung Rex W. , Baker Stephen B.
Published: December 2017

Background:

Before creation and validation of the FACE-Q by Pusic et al., adverse event types and incidences following facial cosmetic procedures were objectively measured and reported by physicians, potentially leading to misrepresentation of the true patient experience. This article analyzes and compares adverse event data from both FACE-Q and recent review articles, incorporating patient-reported adverse event data to improve patient preparation for facial cosmetic procedures.

Methods:

FACE-Q adverse event data were extracted from peer-reviewed validation articles for face lift, rhinoplasty, and blepharoplasty, and these data were compared against adverse effect risk data published in recent Continuing Medical Education/Maintenance of Certification and other articles regarding the same procedures.

Results:

The patient-reported adverse event data sets and the physician-reported adverse event data sets do contain overlapping elements, but each data set also contains unique elements. The data sets represent differing viewpoints. Furthermore, patient-reported outcomes from the FACE-Q provided incidence data that were otherwise previously not reported.

Conclusions:

In the growing facial cosmetic surgery industry, patient perspective is critical as a determinant of success; therefore, incorporation of evidence-based patient-reported outcome data will not only improve patient expectations and overall experience, but will also reveal adverse event incidences that were previously unknown. Given that there is incomplete overlap between patient-reported and physician-reported adverse events, presentation of both data sets in the consultation setting will improve patient preparation. Furthermore, use of validated tools such as the FACE-Q will allow surgeons to audit themselves critically.
Smoking as an Independent Risk Factor for Postoperative Complications in Plastic Surgical Procedures: A Propensity Score–Matched Analysis of 36,454 Patients from the NSQIP Database from 2005 to 2014
Authors: Toyoda Yoshiko , Fu Rose H. , Li Lu , Otterburn David M. , Rohde Christine H.
Published: December 2017

Background:

Smoking has been associated with wound healing complications and overall morbidity in multiple specialties, including plastic surgery. From 2005 to 2014, smoking prevalence among U.S. adults decreased from 20.9 percent to 16.8 percent. This study aims to investigate whether smoking prevalence among plastic surgery patients paralleled the national trend and whether smoking was an independent risk factor for postoperative complications.

Methods:

The 2005 to 2014 American College of Surgeons National Surgical Quality Improvement Program database was used to examine smoking prevalence and 30-day postoperative complications in 36,454 patients who underwent common plastic surgical procedures with extensive planes of dissection. Patients were propensity score–matched for demographics and comorbidities. Smokers were stratified by pack-years.

Results:

Compared to the national trend, a significantly smaller percentage of plastic surgical patients were smokers (p = 0.01), with a less dramatic decline in prevalence. Smokers had significantly increased deep incisional surgical-site infections, incisional dehiscence, and reoperation (p < 0.01 for all). However, superficial surgical-site infection rates were not significantly different (p = 0.18). Smokers with 11 or more pack-years had significantly increased deep surgical-site infection (p < 0.01) and reoperations (p < 0.01). There were no significant differences in graft/prosthesis/flap loss (p = 0.07), bleeding (p = 0.40), sepsis (p = 0.87), or venous thromboembolism (p = 0.16) rates between smokers and nonsmokers.

Conclusions:

This is the first large-scale propensity score–matched database analysis isolating smoking as a risk factor for postoperative complications in plastic surgical procedures. Smoking was an independent risk factor for deep incisional surgical-site infection, incisional dehiscence, and reoperation. Interestingly, superficial surgical-site infection rates were not significantly different. The authors recommend continued judicious patient selection and preoperative smoking counseling to optimize postoperative outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Corset Trunkplasty: Recommended with Abdominal Skin Laxity and Open Cholecystectomy Scar
Authors: Acevedo Edwin , Nadhan Kumar S. , Everett Marc , Moya Alexander , Bradley James P.
Published: December 2017

Background:

Patients undergoing abdominoplasty with previous upper abdominal wall scars are at an increased risk for postoperative complications. The corset trunkplasty is a newer technique to treat abdominal wall laxity of the entire anterolateral abdomen while incorporating any previous open cholecystectomy scar. The authors performed a comparative outcomes study to determine whether the corset procedure would decrease the incidence of postoperative complications in patients with abdominal wall laxity and an open cholecystectomy scar when compared with traditional abdominoplasty.

Methods:

A retrospective study was performed on patients who underwent traditional and corset abdominoplasty. Patients were divided into four groups: traditional with scar, corset with scar, traditional no scar, and corset no scar. Evaluated metrics included procedure time, postoperative length of stay, complications, reoperations, and readmission rates.

Results:

Fifty-eight subjects were included in the study (traditional with scar, n = 15; corset with scar, n = 13; traditional no scar, n = 15; and corset no scar, n = 15). Demographics were similar among groups: body mass index, 33.7 kg/m2; age, 44.3 years; and American Society of Anesthesiologists status, 2.5. The corset procedure took longer than the traditional method, regardless of whether a scar was present (146.1 minutes versus 125.7 minutes). However, the traditional with scar group had the greatest length of stay and higher complication, readmission, and reoperation rates. The corset with scar group had comparable outcomes to the corset no scar and traditional no scar groups.

Conclusions:

The corset trunkplasty procedure resulted in fewer adverse outcomes compared with traditional abdominoplasty in patients with previous open cholecystectomy scar. Its use should be considered in patients with significant abdominal wall laxity and existing upper abdominal surgical scars.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Presence of Intratumoral Calcifications and Vasculature Is Associated With Poor Overall Survival in Clear Cell Renal Cell Carcinoma
Authors: Li Chuanzi , Cen Dongzhi , Liu Zaiyi , Liang Changhong
Published: December 2017

Purpose

The objective of this study was to explore the prognostic significance of the preoperative computed tomography (CT) features in clear cell renal cell carcinoma.

Patients and Methods

The clinical data and CT data from 210 patients (1 grade 1, 84 grade 2, 92 grade 3, and 32 grade 4) generated with The Cancer Imaging Archive were reviewed. Overall survival was assessed using Kaplan-Meyer analysis. The relationship between CT features and survivals were evaluated using univariate and multivariable Cox regression analysis.

Results

The follow-up occurred between 13 and 3989 days (median, 1405 days; mean, 1434 days).On univariate Cox regressions, 4 preoperative CT features (intratumoral calcifications: yes vs no hazard ratio [HR], 2.054; 95% confidence interval [CI], 1.231–3.428; renal vein invasion: yes vs no HR, 2.013; 95% CI, 1.218–3.328; collecting system invasion: yes vs no HR, 2.139; 95% CI, 1.286–3.558; gross appearance of intratumoral vasculature: yes vs no HR, 2.385; 95% CI, 1.454–3.915) were significantly associated with overall survival (all P < 0.05). On multivariable Cox regression analysis, predictors of mortality in clear cell renal cell carcinoma were the presence of intratumoral calcifications (HR, 1.718; 95% CI, 1.014–2.911; P = 0.044) and gross appearance of intratumoral vasculature (HR, 2.137; 95% CI, 1.284–3.557; P = 0.003).

Conclusions

Presence of intratumoral calcifications and vasculature can be potential prognostic features to screen patients for unfavorable prognosis.
Destructive Fibrosarcoma of the Maxillary Sinus
Authors: Ekinci Adnan , Karataş Duran , Yetiş Abdurrahman , Erenler Behice Hande , Ozcan Muge
Published: December 2017

Paranasal fibrosarcoma of nasal cavity and paranasal sinuses is a very rare malignant tumor. It is usually presented with nasal obstruction and epistaxis. In this clinical report, clinical symptoms, pathogenesis, and treatment principles of a paranasal fibrosarcoma originating from the right maxillary sinus and obstructing the right nasal passage are discussed.

A 55-year-old male patient was admitted to the authors clinic with complaints of nasal obstruction and epistaxis lasting for 2 years. Anterior rhinoscopy revealed a mass lesion which obstructed the right nasal passage and caused frequent epistaxis. An opacity consistent with soft tissue lesion which was originated from the right maxillary sinus and filled the right nasal passage was observed in paranasal tomography. Magnetic resonance imaging revealed that the mass lesion was contrasted. Tumor was seen to erode orbital floor, and lateral and anterior walls of the maxillary sinus. Biopsy result was reported as papilloma. The patient was treated with Denker approach as anterior wall of the maxillary sinus was eroded by the tumor lesion and the mass lesion was excised. The patient received postoperative radiotherapy as pathological diagnosis was reported as paranasal fibrosarcoma.
A Giant Osteoma of the Ethmoid Sinus
Authors: Ishii Tatsuyuki , Sakamoto Yoshiaki , Miwa Tomoru , Yoshida Kazunari , Kishi Kazuo
Published: December 2017

Osteomas are slow-growing, benign bony tumors. Most are asymptomatic. Paranasal sinus osteoma in the pediatric population is rare; hence, there are few reports of symptomatic osteomas. The authors report the case of a giant ethmoid sinus osteoma in an 11-year-old girl who presented with diplopia and proptosis. Total excision and reconstruction of the medial orbital wall were performed via a coronal approach. The postoperative period was uneventful, the child's vision improved, and a good cosmetic result was obtained.
Changes in Corneal Curvature After Epiblepharon Surgery in Children
Authors: Lee Dong Hyun , Jung Jae Ho , Ahn Jung Hyo
Published: December 2017

Purpose:

We aimed to determine the change in corneal topography for 2-different corneal zones and 4-quadrants after epiblepharon correction in children.

Methods:

We retrospectively reviewed 39 patients (74 eyes) who underwent epiblepharon surgery. Keratometry measurements of corneal curvature were performed for 2 optical zones defined as circular areas with a radius of 3 and 5 mm from the corneal apex. Each optical zone was divided into quadrants (nasal, superior, temporal, and inferior). Keratometry readings for each quadrant of zone were compared between the preoperative and postoperative examinations (at 1, 3, and 6 months). The correlation between corneal astigmatism and curvature change was analyzed for each quadrant of the 3-mm optical zone.

Results:

At 1 month postoperatively, the inferior and superior quadrants of the 3-mm optical zone became significantly flatter compared with the preoperative state, and this phenomenon became more pronounced at 3 months postoperatively (P < 0.05). However, no significant postoperative change in corneal curvature was noted for any quadrant of the 5-mm optical zone. There was a statistically significant correlation between the change in astigmatism and corneal curvature for the superior and inferior quadrants of the 3-mm optical zone (R = 0.394, P < 0.05; R = 0.460, P < 0.05; respectively).

Conclusions:

Astigmatism reduction was affected by corneal flatness in the inferior rather than the superior quadrant. Epiblepharon surgery results in reduction of corneal steepness at the vertical axis of the 3-mm optical zone, which correlates to astigmatism reduction.
Hibernation-Based Approaches in the Treatment of Hemorrhagic Shock
Authors: Wolf Andrea , Lusczek Elizabeth R. , Beilman Gregory J.
Published: December 2017

Hemorrhagic shock is the leading cause of preventable death after trauma. Hibernation-based treatment approaches have been of increasing interest for various biomedical applications. Owing to apparent similarities in tissue perfusion and metabolic activity between severe blood loss and the hibernating state, hibernation-based approaches have also emerged for the treatment of hemorrhagic shock. Research has shown that hibernators are protected from shock-induced injury and inflammation. Utilizing the adaptive mechanisms that prevent injury in these animals may help alleviate the detrimental effects of hemorrhagic shock in non-hibernating species. This review describes hibernation-based preclinical and clinical approaches for the treatment of severe blood loss. Treatments include the delta opioid receptor agonist D-Ala2-Leu5-enkephalin (DADLE), the gasotransmitter hydrogen sulfide, combinations of adenosine, lidocaine, and magnesium (ALM) or D-beta-hydroxybutyrate and melatonin (BHB/M), and therapeutic hypothermia. While we focus on hemorrhagic shock, many of the described treatments may be used in other situations of hypoxia or ischemia/reperfusion injury.
Inhibition of RHO Kinase by Fasudil Attenuates Ischemic Lung Injury After Cardiac Arrest in Rats
Authors: Wei Jian , Wang Peng , Li Yi , Dou Qingli , Lin Jiali , Tao Wuyuan , Lin Jinle , Fu Xuan , Huang Zitong , Zhang Wenwu
Published: December 2017

Lung injury is a common complication after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR), and Rho kinase (ROCK) may be involved in the process of this injury. In this study, we aimed to study the effects of ROCK inhibition by fasudil on lung injury induced by asphyxial CA and CPR in rats. A total of 130 rats were randomized into three groups: Sham, Control, and Fasudil intervention group. Animals in the Fasudil intervention group were intraperitoneally administered with 10 mg/kg of the drug, 1 h before inducing CA. Rats in the Control group received equivalent volume of saline and were subjected to the same experimental procedures with as the Fasudil group. Blood was collected and lungs were harvested at 3, 6, 12, 24, and 48 h after return of spontaneous circulation (ROSC) for blood gas and biochemical analysis. Fasudil significantly increased the partial pressure of oxygen and pH in arterial blood, as well as attenuated lung histological injury and lung edema after ROSC. Additionally, it significantly decreased lung inflammatory response (decreased levels of tumor necrosis factor-α and interleukin-6, and myeloperoxidase activity) and oxidative stress (decreased malonaldehyde level and increased superoxide dismutase activity) after ROSC. Using western blot analysis, we found that fasudil inhibited both isoforms ROCK1 and ROCK2, and intercellular adhesion molecule-1; nevertheless, it increased vascular endothelial cadherin protein expression after ROSC. Our study suggested that the Rho kinase signaling pathway is critical for CA-induced lung injury and fasudil has protective effects on lung injury after CA and CPR.
Development of a trauma system and optimal placement of trauma centers using geospatial mapping
Authors: Horst Michael A. , Jammula Shreya , Gross Brian W. , Bradburn Eric H. , Cook Alan D. , Altenburg Juliet , Morgan Madison , Von Nieda Danielle , Rogers Frederick B.
Published: December 2017

BACKGROUND

The care of patients at individual trauma centers (TCs) has been carefully optimized, but not the placement of TCs within the trauma systems. We sought to objectively determine the optimal placement of trauma centers in Pennsylvania using geospatial mapping.

METHODS

We used the Pennsylvania Trauma Systems Foundation (PTSF) and Pennsylvania Health Care Cost Containment Council (PHC4) registries for adult (age ≥15) trauma between 2003 and 2015 (n = 377,540 and n = 255,263). TCs and zip codes outside of PA were included to account for edge effects with trauma cases aggregated to the Zip Code Tabulation Area centroid of residence. Model assumptions included no previous TCs (clean slate); travel time intervals of 45, 60, 90, and 120 minutes; TC capacity based on trauma cases per bed size; and candidate hospitals ≥200 beds. We used Network Analyst Location-Allocation function in ArcGIS Desktop to generate models optimally placing 1 to 27 TCs (27 current PA TCs) and assessed model outcomes.

RESULTS

At a travel time of 60 minutes and 27 sites, optimally placed models for PTSF and PHC4 covered 95.6% and 96.8% of trauma cases in comparison with the existing network reaching 92.3% or 90.6% of trauma cases based on PTSF or PHC4 inclusion. When controlled for existing coverage, the optimal numbers of TCs for PTSF and PHC4 were determined to be 22 and 16, respectively.

CONCLUSIONS

The clean slate model clearly demonstrates that the optimal trauma system for the state of Pennsylvania differs significantly from the existing system. Geospatial mapping should be considered as a tool for informed decision-making when organizing a statewide trauma system.

LEVEL OF EVIDENCE

Epidemiological study/Care management, level III.
Pediatric appendicitis: Is referral to a regional pediatric center necessary?
Authors: Hodges Maggie M. , Burlew Clay Cothren , Acker Shannon N. , Moore Ernest E. , Roosevelt Genie E. , Schubert Anna , Hill Lauren R.S. , Partrick David A. , Bensard Denis
Published: December 2017

BACKGROUND

Acute appendicitis is the most common emergent surgical procedure performed among children in the United States, with an incidence exceeding 80,000 cases per year. Appendectomies are often performed by both pediatric surgeons and adult general/trauma and acute care (TACS) surgeons. We hypothesized that children undergoing appendectomy for acute appendicitis have equivalent outcomes whether a pediatric surgeon or a TACS surgeon performs the operation.

METHODS

A retrospective chart review was performed for patients 6 to 18 years of age, who underwent appendectomy at either a regional children's hospital (Children's Hospital of Colorado [CHCO], n = 241) or an urban safety-net hospital (n = 347) between July 2010 and June 2015. The population of patients operated on at the urban safety-net hospital was further subdivided into those operated on by pediatric surgeons (Denver Health Medical Center [DHMC] pediatric surgeons, n = 68) and those operated on by adult TACS surgeons (DHMC TACS, n = 279). Baseline characteristics and operative outcomes were compared between these patient populations utilizing one-way analysis of variance and χ2 test for independence.

RESULTS

When comparing the CHCO and DHMC TACS groups, there were no differences in the proportion of patients with perforated appendicitis, operative time, rate of operative complications, rate of postoperative infectious complications, or rate of 30-day readmission. Length of stay was significantly shorter for the DHMC TACS group than that for the CHCO group.

CONCLUSIONS

Our data demonstrate that among children older than 5 years undergoing appendectomy, length of stay, risk of infectious complications, and risk of readmission do not differ regardless of whether they are operated on by pediatric surgeons or adult TACS surgeons, suggesting resources currently consumed by transferring children to hospitals with access to pediatric surgeons could be allocated elsewhere.

LEVEL OF EVIDENCE

Therapeutic/Care management, level III.
A minimal “push-pull” bistability model explains oscillations between quiescent and proliferative cell states
Authors: Krishna Sandeep , Laxman Sunil
Published: December 2017

A minimal model for oscillating between quiescent and growth/proliferation states, dependent on the availability of a central metabolic resource, is presented. From the yeast metabolic cycles (YMCs), metabolic oscillations in oxygen consumption are represented as transitions between quiescent and growth states. We consider metabolic resource availability, growth rates, and switching rates (between states) to model a relaxation oscillator explaining transitions between these states. This frustrated bistability model reveals a required communication between the metabolic resource that determines oscillations, and the quiescent and growth state cells. Cells in each state reflect memory, or hysteresis of their current state, and “push-pull” cells from the other state. Finally, a parsimonious argument is made for a specific central metabolite as the controller of switching between quiescence and growth states. We discuss how an oscillator built around the availability of such a metabolic resource is sufficient to generally regulate oscillations between growth and quiescence, through committed transitions.
Sex-determination and sex chromosomes are shared across the radiation of dioeciousNepenthespitcher plants
Authors: Scharmann Mathias , Grafe T. Ulmar , Metali Faizah , Widmer Alex
Published: December 2017

Plants with separate sexes (dioecy) represent a minority but dioecy has evolved multiple times independently in plants. Our understanding of sex determination systems in plants and of the ecological factors and molecular changes associated with the evolution of dioecy remain limited. Here, we study the sex-determination system in dioecious plants that lack heteromorphic sex chromosomes and are not amenable to controlled breeding:Nepenthespitcher plants. We genotyped wild populations of flowering males and females of threeNepenthestaxa using ddRAD-seq, and sequenced a male inflorescence transcriptome. We developed a novel statistical tool (privacy rarefaction) to distinguish true sex-specificity from stochastic noise in high-throughput sequencing data. Our results support XY-systems in all threeNepenthestaxa and inSilene latifoliawhich was used as a positive control for its known XY-system. The male-specific region of the Y chromosome showed little conservation among the threeNepenthestaxa, except for the essential pollen development gene DYT1 which was also male-specific in additional taxa. Hence, this homomorphic XY sex-determination system likely has a unique origin older than the crown of the genusNepenthesat c. 17.7 My. In addition to the characterisation of the previously unknown sex chromosomes ofNepenthes, our work contributes an innovative, highly sensitive statistical method to efficiently detect sex-specific genomic regions in wild populations in general.
Direct teaching of industrial manipulators using current sensors
Authors: Yuan Jian-jun , Wang Shuai , Wan Weiwei , Liang Yanxue , Yang Luo , Liu Yifan
Published: December 2017

Purpose

The aim of this paper is to implement direct teaching of industrial manipulators using current sensors. The traditional way to implement teaching is either to use a teaching pedant, which is time consuming, or use force sensors, which increases system cost. To overcome these disadvantages, a novel method is explored in the paper by using current sensors installed at joints as torque observers.

Design/methodology/approach

The method uses current sensors installed at each joint of a manipulator as torque observers and estimates external forces from differences between joint-driven torque computed based on the values of current sensors and commanded values of motor-driven torque. The joint-driven torque is computed by cancelling out both pre-calibrated gravity and friction resistance (compensation). Also, to make the method robust, the paper presents a strategy to detect unexpected slowly drifts and zero external forces and stop the robot in those situations.

Findings

Experimental results demonstrated that compensating the joint torques using both pre-calibrated gravity and friction resistance has performance comparable to a force sensor installed on the end effector of a manipulator. It is possible to implement satisfying direct teaching without using force sensors on 7 degree of freedom manipulators with large mass and friction resistance.

Originality/value

The main contribution of the paper is that the authors cancel out both pre-calibrated gravity and friction resistance to improve the direct teaching using only current sensors; they develop methods to avoid unsafe situations like slow drifts. The method will benefit industrial manipulators, especially those with large mass and friction resistance, to realize flexible and reliable direct teaching.
Model for developing trust on US construction projects
Authors: Issa Raja R.A. , Olbina Svetlana , Zuppa Dino
Published: December 2017

Purpose

The purpose of this paper is to identify the factors found on US construction projects that are perceived by contractors to strengthen or weaken trust between contracting stakeholders and to develop a framework for evaluating these relationships.

Design/methodology/approach

A comprehensive framework containing a number of factors (54) that could impact trust on construction projects was first developed. A survey questionnaire was then developed and administered via phone to contractors selected from the Engineering News Record top 400 US construction companies. The survey findings were then used to develop a trust model and case studies were used to validate and revise the trust model.

Findings

A trust model is developed that helps large US contractors measure and improve trust with other stakeholders on their projects.

Practical implications

Large US contractors are now provided with a tool not previously available to help them measure and improve trust between the different contracting parties on construction projects which can help them decrease project time and costs, and improve project results.

Originality/value

The proposed trust model adds a number of different dimensions to the existing trust models found in the literature and as such improves the contractor’s ability to foster and enhance trust on a US construction project.