bluuebunny/crossref_metadata_2025 huggingface dataset:
Journalistic Depictions of Violence against Women in India
Authors: Durham Meenakshi Gigi
Published: November 2016

News narratives of violence against women in India are part of a larger discourse of Orientalism that began in the nascent years of the British Raj and continues into the present; these narratives also reflect documented patterns of reporting on gender violence that sustain intersectional hierarchies of race and class as well as gender.

In the years leading up to British Crown rule in India, newspapers were embroiled in debates around the rare practice of sati, or the self-immolation of widows. British and Indian newspapers carried articles and commentaries both decrying and defending the practice. Arguments about sati were predicated on contests over national autonomy rather than on the gender violence at the crux of the practice. Sati is conceptually related to “bride burning,” also dubbed “dowry death,” which is reported in the news media as an effect of Indian tradition and gender culture, in contrast to the reportage on domestic violence in “First World” settings, which is depicted in terms of isolated incidents and not interpreted as a consequence of the social milieu. Female infanticide and feticide follow similar patterns of journalistic framing. Human trafficking in India is reported narrowly in terms of sex trafficking and without reference to its connections with other forms of human rights violations.

The 2012 rape and murder of Jyoti Singh Pandey in New Delhi incited widespread international and domestic media coverage of violence against women India. Analyses of this coverage revealed repeated tropes of Orientalism in the foreign news. The journalism about this crime characterized India as a place of ungovernable violence against women, overlooking the occurrence of similar crimes in the global North and thus reasserting geopolitical hierarchies of “First” and “Third” worlds. Indian news about this crime reinforced middle-class positions and values, reflecting the changing social dynamics of 21st-century India. Violence against LGBT+ populations, aggravated after the Indian Supreme Court’s re-criminalization of non-heterosexual sex in 2013, is largely unreported in the mainstream news media, although specialized LGBT+ media channels report on it regularly. Neocolonial tropes continue to circulate in news depictions of violence against Indian women, but the rising numbers of women journalists in India seek to expand the scope and depth of reporting on gender issues.
Social Emotional Learning and Inclusion in Schools
Authors: Sokal Laura , Katz Jennifer
Published: November 2016

Inclusive classrooms provide new opportunities for group membership and creation of effective learning environments. In order to facilitate the success of inclusion as an approach and philosophy, it is important that all class members as well as their teachers develop the skills to understand one another, and to communicate and work together effectively. Social emotional learning (SEL) is aimed at developing these skills and is generally defined to involve processes by which individuals learn to understand and moderate their own feelings, understand the feelings of others, communicate, resolve conflicts effectively, respect others, and develop healthy relationships. These skills are important to both children with disabilities and to those without, in terms of overall social development, perceptions of belonging, and promotion of overall mental wellness, as well as mitigation of the development of mental illness. Research suggests that SEL programming has the potential to effectively enhance children’s academic, social, and relational outcomes. Moreover, teachers who teach SEL in their classrooms have also demonstrated positive outcomes. Despite these encouraging findings, implementation of SEL has been hampered by some limitations, including the lack of a consistent definition—a limitation that in turn affects research findings; lack of teacher education in SEL, which erodes confidence in the fidelity of implementation; and concerns that current SEL programs are not sensitive to cultural differences in communities. Together, the strengths and limitations of SEL illuminate several policy implications regarding the most advantageous ways for SEL to contribute to the success of inclusion in classrooms and schools.
Trust in Education
Authors: Tschannen-Moran Megan
Published: November 2016

There is a growing awareness of the crucial role that trust plays in every aspect of a school’s functioning and especially to student outcomes. To trust another person or group is to be at ease, without anxiety or worry, in a situation of interdependence in which valued outcomes depend upon the participation and contribution of others. The trustor can rest assured that their expectations will be fulfilled based on confidence in the other party’s benevolence, honesty, openness, reliability, and competence. As citizens across the globe have become increasingly distrustful of their institutions and leaders, the trend away from trust creates a special challenge for schools because trust is so fundamental to their core mission of educating students. The philosopher Annette Baier observed that we tend to notice trust as we notice air, only when it becomes scarce or polluted. These days, it seems evident that trust in our society as a whole has indeed been disrupted and is in scarce supply. As contemporary society has grown more complex, as changing economic realities, changing demographics, and changing expectations in society have made life less predictable, we are beginning to notice trust much more. There are a number of things that make cultivating and maintaining trust in schools challenging. These include the effects of social media, and other new forms of information and the propensity for the news of potential threats to one’s well-being, as well as the well-being of one’s children and community to spread farther and faster than positive news.

Trust matters in schools and in our world because we cannot single-handedly either create or sustain many of the things we most cherish. Parents send their children to schools, trusting that they will be safe from harm, as well as guided and taught in keeping with our highest hopes for them. Schools are also invested with a significant share of a community’s collective resources in the form of tax dollars, school buildings, and local employment opportunities. In addition, schools are charged with keeping and promoting a society’s shared values and ideals. They foster and protect the collective ideals of respect, tolerance, and democracy, as well as the vision of equity of opportunity. Indeed, the future of a society rests with the quality of its schools. It is evident, then, why trust has become such a pressing issue for schools in these challenging and turbulent times.
Place-Based Education
Authors: Smith Gregory A.
Published: November 2016

Place-based education is an approach to curriculum development and instruction that directs students’ attention to local culture, phenomena, and issues as the basis for at least some of the learning they encounter in school. It is also referred to as place- and community-based education or place-conscious learning. In addition to preparing students academically, teachers who adopt this approach present learning as intimately tied to environmental stewardship and community development, two central concerns of Education for Sustainability. They aim to cultivate in the young the desire and ability to become involved citizens committed to enhancing the welfare of both the human and more-than-human communities of which they are a part. At the heart of place-based education is the belief that children of any age are capable of making significant contributions to the lives of others, and that as they do so, their desire to learn and belief in their own capacity to be change agents increase. When place-based education is effectively implemented, both students and communities benefit, and their teachers often encounter a renewed sense of professional and civic satisfaction.

In most respects, there is nothing new about place-based education. It is an attempt to reclaim elements of the learning processes most children encountered before the invention of schools. Throughout most of humanity’s tenancy on this planet, children learned directly from their own experience in the places and communities where they lived. They explored their world with peers, imitated the activities of adults, participated in cultural and religious ceremonies, and listened to the conversations and stories of their families and neighbors. Most of this learning was informal, although at important transition points such as puberty, initiation rites provided them with more direct forms of instruction about community understandings regarding the world and adult responsibilities. In this way, children grew into competent and contributing members of their society, able to care for themselves and for others in ways that sustained the community of which they were a part. This outcome with its focus on both individual and social sustainability is also the goal of place-based education.

It is important to acknowledge that a range of educational innovations over the past decades have anticipated or included elements of place-based education: outdoor education, civic education, community education, environmental education, and education for sustainability. What differentiates place-based education from many of these is its explicit focus on both human and natural environments and its concern about equity and social justice issues as well as environmental. Not all programs that call themselves place-based incorporate these elements, nor do all include opportunities for students to participate in projects that benefit others and the natural world. This, however, is the aspirational goal of place-based education and what sets it apart from similar approaches.
The Kra-Dai Languages
Authors: Luo Yongxian
Published: November 2016

Kra-Dai, also known as Tai–Kadai, Daic, and Kadai, is a family of diverse languages found in southern China, northeast India, and Southeast Asia. The number of these languages is estimated to be close to a hundred, with approximately 100 million speakers all over the world. As the name itself suggests, Kra-Dai is made up of two major groups, Kra and Dai. The former refers to a number of lesser-known languages, some of which have only a few hundred fluent speakers or even less. The latter (also known as Tai, or Kam-Tai) is well established, and comprises the best-known members of the family, Thai and Lao, the national languages of Thailand and Laos respectively, whose speakers account for over half of the Kra-Dai population.

The ultimate genetic affiliation of Kra-Dai remains controversial, although a consensus among western scholars holds that it belongs under Austronesian. The majority of Kra-Dai languages have no writing systems of their own, particularly Kra. Languages with writing systems include Thai, Lao, Sipsongpanna Dai, and Tai Lue. These use Indic-based scripts. Others use Chinese character-based scripts, such as the Zhuang and Kam-Sui in southern China and surrounding regions. The government introduced Romanized scripts in the 1950s for the Zhuang and the Kam-Sui languages. Almost every group within Kra-Dai has a rich oral history tradition.

The languages are typically tonal, isolating, and analytic, lacking in inflectional morphology, with no distinction for number and gender. A significant number of basic vocabulary items are monosyllabic, but bisyllabic and multisyllabic compounds also abound. There are morphological processes in which etymologically related words manifest themselves in groups through tonal, initial, or vowel alternations. Reduplication is a salient word formation mechanism. In syntax, the Kra-Dai languages can be said to have basic SVO word order. They possess a rich system of noun classifiers. Other features include verb serialization without overt marking to indicate grammatical relations. A number of lexical items (mostly verbs) may function as grammatical morphemes in syntactic operations. Temporal and aspectual meanings are expressed through tense-aspect markers typically derived from verbs, while mood and modality are conveyed via a rich array of discourse particles.
Frequency of Viremic Episodes in HIV-Infected Women Initiating Antiretroviral Therapy During Pregnancy: A Cohort Study
Authors: Myer Landon , Dunning Lorna , Lesosky Maia , Hsiao Nei-Yuan , Phillips Tamsin , Petro Greg , Zerbe Allison , McIntyre James A. , Abrams Elaine J.
Published: November 2016

Background.

The numbers of human immunodeficiency virus (HIV)–infected women initiating antiretroviral therapy (ART) in pregnancy are increasing rapidly with global policy changes. There are widespread concerns about ART adherence during pregnancy and postpartum but few data on viral suppression (VS) over time in these populations.

Methods.

We followed a cohort of 523 women in Cape Town, South Africa, initiating ART in pregnancy (once-daily tenofovir 300 mg, emtricitabine 200 mg, and efavirenz 600 mg) and achieving VS (<50 copies/mL). Participants provided specimens through 12 months postpartum for batched viral load (VL) testing separate from routine care. Analyses described the incidence of major (>1000 copies/mL) and minor (50–1000 copies/mL) viremic episodes (VEs) and factors associated with major VEs.

Results.

In the cohort (median age, 28 years; median pre-ART VL, 3.99 copies/mL; 3% previously defaulted ART; 24% with previous exposure to short-course antiretrovirals), the median time of follow-up from VS was 322 days. Overall, 70% maintained VS throughout follow-up, 8% experienced minor VEs only, and at least 1 major VE was documented in 22% of women. In women with VEs, peak viremia (median, 3.79 log10 copies/mL) was linearly related to pre-ART VL. The incidence of major VEs after initial VS was independently associated with younger age, ART initiation during the third trimester, previous defaulting on ART, and postpartum follow-up.

Conclusions.

Viremia appears to occur frequently, particularly postpartum, among HIV-infected women after initial VS in this setting. More intensive VL monitoring is warranted in this population; the immediate causes and long-term implications of VE require investigation.
Four Fishermen, Orson Welles, and the Making of the Brazilian Northeast*
Authors: Campbell Courtney J
Published: November 2016

In 1942 Orson Welles traveled to Brazil to film a movie about four Brazilian fishermen who had protested their labor conditions by traveling nearly 2,500 kilometers for sixty-one days from the city of Fortaleza to Rio de Janeiro on a rustic sail-raft called a jangada. Their voyage pressured Brazil’s so-called New State (Estado Novo) to recognize the fishermen’s trade as an official profession within the state’s expanding social programs and centralized labor laws. Through an analysis of the fishermen, their voyage, Orson Welles’ visit, and Brazil’s Northeast, this article examines the role of the region in both imagining and moving beyond the nation in the twentieth century. It presents press accounts, intellectual essays, music, images, film, and the Diï¿½rio dos jangadeiros – a scrapbook of sorts in which supporters from all social classes left messages for the fishermen at each port. While structurally, the fishermen’s protest pulled the most rustic element of this newly defined region into the modern legal apparatus of a centralized state, symbolically, the fishermen’s journey generated an archetypal figure that provided a way to talk about the Northeast in terms of its rusticity, developing both racialized and folkloric characteristics of its people and uniting the semi-arid backlands and the humid, tropical coast. The fishermen of the Northeast were transformed from brave labor organizers into non-threatening folkloric figures through a process of memory, narration, and forgetting. Examining the fishermen’s story as a regionally-defining moment that transcended national boundaries provides a significant case study of how, by the mid-twentieth century, the nation came to be understood as a series of interrelated regions, with one region serving as both national scapegoat and root of authentic culture.
Spinal Cord Stimulation for Refractory Angina Pectoris
Authors: Pan Xiaoxiao , Bao Hongguang , Si Yanna , Xu Chenjie , Chen Hao , Gao Xianzhong , Xie Xinyi , Xu Yajie , Sun Fan , Zeng Lingqing
Published: November 2016

Objectives:

Paresthesia-free stimulation such as high frequency and burst have been demonstrated as effective therapies for neuropathic pain. The aim of this meta-analysis was to evaluate the efficacy and safety of conventional spinal cord stimulation (SCS) in the treatment of refractory angina pectoris (RAP).

Materials and Methods:

Relevant randomized controlled trials that investigated SCS for patients with RAP were comprehensively searched in Medline, Pubmed, Embase, and Cochrane Library. Five meta-analyses were performed examining the changes in Canadian Cardiovascular Society classes, exercise time, Visual Analog Scale (VAS) scores of pain, Seattle Angina Questionnaire, and nitroglycerin use in RAP patients after SCS therapy. We analyzed standardized mean differences (MD) and 95% confidence intervals (CIs) for each outcome by Review Manager 5.0 and STATA 12.0.

Results:

A total of 12 randomized controlled trials involving 476 RAP patients were identified. A trend of reduction in the angina frequency (MD=−9.03, 95% CI, −15.70 to −2.36) and nitroglycerin consumption (MD=−0.64, 95% CI, −0.84 to −0.45) could be observed in the SCS group. Compared with the control group, SCS showed benefit on increasing exercise time (MD=0.49, 95% CI, 0.13-0.85) and treatment satisfaction (MD=6.87, 95% CI, 2.07-11.66) with decreased VAS scores of pain (MD=−0.50, 95% CI, −0.81 to −0.20) and disease perception (MD=−8.34, 95% CI, −14.45 to −2.23). However, the result did not reach the significance level in terms of physical limitation (95% CI, −8.75 to 3.38; P=0.39) or angina stability (95% CI, −7.55 to 3.67; P=0.50).

Discussion:

The current meta-analysis suggested that SCS was a potential alternative in the treatment of PAP patients. Further investigation for finding the appropriate intensity of stimulation is required before this treatment should be widely recommended and applied.
Pathogenesis and immunotherapy in cutaneous psoriasis: what can rheumatologists learn?
Authors: Alexander Helen , Nestle Frank O.
Published: November 2016

Purpose of review

This review presents our current understanding of the pathogenesis and treatment of psoriasis with a particular focus on recent areas of research and emerging concepts.

Recent findings

Psoriasis arises in genetically predisposed individuals who have an abnormal innate and adaptive immune response to environmental factors. Recent studies have identified novel genetic, epigenetic and immunological factors that play a role in the disease pathogenesis. There is emerging evidence for the role of the skin microbiome in psoriasis. Studies have shown reduced diversity and altered composition of the skin microbiota in psoriasis.

Recent advances in our understanding of the complex immunopathogenesis of psoriasis have led to the identification of crucial cytokines and cell signalling pathways that are targeted by a range of immunotherapies.
Bundled Payments for Care Improvement: Lessons Learned in the First Year
Authors: Althausen Peter L. , Mead Lisa
Published: November 2016

The Bundled Payments for Care Improvement (BPCI) initiative is the latest cost-saving program developed by the Center for Medicare and Medicaid Innovation. This model is intended to create a system for higher quality and more coordinated care at a lower cost to Medicare. It is currently an optional program for physician groups, hospitals and post-acute care providers to benefit financially from improved care models and cost containment measures. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. Under this initiative, there are certain fraud and abuse waivers in place that allow gainsharing among BPCI organizations and approved providers so long as certain requirements are met. Our practice entered this initiative for total joint arthroplasty episodes of care as well as the hip and femur fracture episode of care. The first year experience demonstrated that a significant learning curve is required. Keys for success include appropriate patient selection for elective surgery, implant pricing control, adherence to preoperative and postoperative protocols, diligent postcare care management, and appropriate choice of metrics to maximize gainsharing potential. Ultimately, the BPCI program has been a successful venture, saving our hospitals over $1.6 million in 2015. In the process, this provided an additional revenue stream for our physicians while decreasing the overall cost of care.
Comanagement and Gainsharing Opportunities for Independent Physicians
Authors: McBride Chris , Althausen Peter L.
Published: November 2016

Gainsharing and comanagament programs are both successful means of achieving physician buy-in for all cost containment programs in Orthopaedic Trauma. Under comanagement agreements, physicians are reimbursed for their time and intellectual efforts in program and algorithm creation. The cost is minimal for the hospital in return for the millions of dollars in savings they achieve. Gainsharing models can incentivize physicians to quickly adopt cost-effective implant choices, care plans, and program development. Hospital systems keep the majority of the profits, patients, and insurance carriers benefit from the cost savings and physicians receive remuneration for their efforts. Careful attention must be paid to the legal issues surrounding the Federal Anti-Kickback Statute, the Civil Monetary Penalty Law, and the Physician Self-Referral Law when setting up these agreements. The keys to success for these programs are the presence of a physician champion, economic transparency for both physicians and hospitals, accurate data collection, and adequate economic incentive for physicians to drive change in practice patterns.
Surgeon Attitudes Regarding the Use of Generic Implants: An OTA Survey Study
Authors: Walker Justin A. , Althausen Peter L.
Published: November 2016

Objectives:

To determine the role of generic orthopaedic trauma implants in the current orthopaedic trauma market, as perceived by OTA members, and investigate potential hurdles to the use of generic implants and other cost-containment measures.

Design:

Survey study.

Setting:

Not applicable.

Participants:

All active OTA members with valid e-mail addresses were invited to participate.

Intervention:

Participants completed a brief online survey with questions regarding participation in cost-containment and incentive programs, industry relationships, generic implant use, and the role of surgeons in cost containment.

Main Outcome Measures:

Survey data.

Results:

Participation in cost-containment programs (comanagement agreements, bundled payment for care improvement, and gainsharing) was found to be very low among participants (17%, 36.5%, 17%, respectively). Industry sales representatives were present in a majority of participants' cases (76.9%) the majority of time, but relatively a few surgeons (21.2%) felt their presence was necessary. Most surgeons were aware of the availability of generic implants (72.6%), but a few had adopted the use of such implants (25.5%), despite 50/52 (96.2%) prescribing generic drugs and 45/52 (86.5%) using generic products in their own households.

Conclusions:

Most participants agreed that generic orthopaedic implants have a role in cost containment, but a few have adopted these implants. The presence of sales representatives does not seem to be necessary for most surgeons, and minimizing or eliminating their presence may result in substantial savings for health care institutions. Increased education and the use of financial incentive programs may encourage improved surgeon participation in cost containment and adoption of generic implants and may help reduce health care spending.

Level of Evidence:

Level 4. See Instructions for Authors for a complete description of levels of evidence.
The multifaceted roles of inflammasome proteins in cancer
Authors: Petrilli Virginie
Published: November 2016

Purpose of review

Inflammasomes are major actors of the innate immune system, through their regulation of inflammatory caspases and maturation of IL-1β and IL-18. These multiprotein complexes have been shown to play major roles in inflammatory and metabolic diseases and have more recently been implicated in tumor development and dissemination. In this review, we address these recent findings, focusing particularly on colorectal cancer (CRC) initiation and tumor dissemination.

Recent findings

Based mostly on loss-of-function experiments in mouse models, paradoxical results were obtained as both protumoral and antitumoral activities were reported. Moreover, several studies report major inflammasome-independent functions for some of these innate receptor proteins such as absent in melanoma 2, nod-like receptor family pyrin containing 3 (NLRP3) or nod-like receptor family CARD containing 4 (NLRC4), functions exerted in epithelial cells as well as in immune cells.

The current review summarizes recent findings on the implication of inflammasomes and of absent in melanoma 2, NLRC4 and NLRP3 inflammasome-independent functions in cancer development and dissemination. Although contradictory in certain aspects, these studies highlight a lack of understanding of their mechanistic functions and regulations in cancer and the need for further investigations.
Prevalence of Multifocal Primary Hyperhidrosis and Symptom Severity Over Time: Results of a Targeted Survey
Authors: Glaser Dee Anna , Ballard Angela M. , Hunt Niquette L. , Pieretti Lisa J. , Pariser David M.
Published: November 2016

BACKGROUND

There is a paucity of data on the prevalence of multifocal primary hyperhidrosis and changes in hyperhidrosis severity over time.

OBJECTIVE

The goal of this study was to better understand multifocal primary hyperhidrosis, prevalence and distribution of hyperhidrosis by focal site, age of onset of symptoms by focal area, and change in hyperhidrosis severity over time and with seasons.

MATERIALS AND METHODS

The International Hyperhidrosis Society, through an unrestricted research grant from Revance Therapeutics, conducted an online survey of registered visitors to its Web site. Participants identified as having “excessive sweating” and opted to participate in the survey (23 questions) after an e-mail invitation.

RESULTS

The survey data illustrate that multifocal primary hyperhidrosis is more common than previously believed and that multifocal hyperhidrosis is more common than singular focal hyperhidrosis (81% of patients reported 3 or more focal hyperhidrotic sites). The data also show that sweating symptom severity does not improve with age but stays the same or gets worse and is “bothersome” throughout the year.

CONCLUSION

Recognition of the chronic and multifocal nature of primary hyperhidrosis is useful for treating hyperhidrosis patients long term and illustrates a need for treatments or treatment combinations that are effective for multiple body areas.
Effects of Linagliptin on Vessel Wall Healing in the Rat Model of Arterial Injury Under Normal and Diabetic Conditions
Authors: Eriksson Linnea , Röhl Samuel , Saxelin Robert , Lengquist Mariette , Kronqvist Malin , Caidahl Kenneth , Östenson Claes-Göran , Razuvaev Anton
Published: November 2016

Diabetic patients suffer an increased risk of restenosis and late stent thrombosis after angioplasty, complications which are related to a defective reendothelialization. Dipeptidyl peptidase-4 inhibitors have been suggested to exert a direct effect on endothelial and smooth muscle cells (SMCs). Therefore, the objective was to study if the dipeptidyl peptidase-4 inhibitor linagliptin could influence vascular repair and accelerate reendothelialization after arterial injury in healthy and diabetic animals. Diabetic Goto-Kakizaki and healthy Wistar rats were subjected to arterial injury and treated with linagliptin or vehicle. Vessel wall healing was monitored noninvasively using ultrasound, and on sacrifice, with Evans blue staining and immunohistochemistry. The effect of linagliptin on SMCs was also studied in vitro. We found that linagliptin reduced the proliferation and dedifferentiation of SMCs in vitro, and modulated the inflammatory response in the SMCs after arterial injury in vivo. However, these effects of linagliptin did not affect the neointima formation or the reendothelialization under normal and diabetic conditions. Although linagliptin did not influence vessel wall healing, it seems to possess a desirable antiproliferative influence on SMCs in vitro and an antiinflammatory effect in vivo. These pharmacological properties might carry a potential significance for favorable outcome after vascular interventions in diabetic patients.
Is vulvovaginal atrophy due to a lack of both estrogens and androgens?
Authors: Labrie Fernand , Martel Céline , Pelletier Georges
Published: November 2016

Objective:

The aim of this study was to review the preclinical data showing the role of both estrogens and androgens in the physiology of the vagina, and, most likely, in vulvovaginal atrophy of menopause.

Methods:

Mass spectrometry-based assays (validated according to the FDA guidelines) for the measurement of sex steroids, their precursors, and metabolites were used. In addition to fixation of the vagina for morphological examination, histomorphometry, immunocytochemistry, immunofluorescence, and quantitative reverse transcription polymerase chain reaction were performed.

Results:

The vaginal epithelium of the animals receiving dehydroepiandrosterone (DHEA) was made of large multilayered columnar mucous cells showing distended cytoplasmic vacuoles representative of an androgenic effect. DHEA also stimulates collagen fiber compactness of the lamina propria (second layer)—an effect essentially due to an androgenic effect, whereas stimulation by DHEA of the muscularis in the third vaginal layer is approximately 70% due to the androgenic conversion of DHEA. Stimulation of the surface area of the nerve endings, on the contrary, is exclusively androgenic. Vaginal weight stimulation by DHEA is about 50% androgenic and 50% estrogenic.

Conclusions:

Practically all studies on the influence of steroid hormones in the vagina have focused on luminal epithelial cells. Since all estrogens and androgens in postmenopausal women are made intracellularly and derive from the conversion of circulating DHEA, it is of interest to observe from these preclinical data that DHEA exerts both estrogenic and androgenic activity in the three layers of the vagina, the stimulatory effect on nerve density being 100% androgenic. Taking vaginal weight as a global parameter, the stimulatory effect of DHEA in the rat vagina is about equally estrogenic and androgenic, thus illustrating the importance of androgens in vaginal morphology and function, and the likely importance of androgens in vulvovaginal atrophy of menopause.
Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial
Authors: Garland Sheila N. , Xie Sharon X. , Li Qing , Seluzicki Christina , Basal Coby , Mao Jun J.
Published: November 2016

Objective:

Sleep disturbance is a major consequence of hot flashes among breast cancer survivors. This study evaluated the effects of electro-acupuncture (EA) versus gabapentin (GP) for sleep disturbances among breast cancer survivors experiencing daily hot flashes.

Methods:

We analyzed data from a randomized controlled trial involving 58 breast cancer survivors experiencing bothersome hot flashes at least two times per day. Participants were randomly assigned to receive 8 weeks of EA or daily GP (total dose of 900 mg/d). The primary outcome was change in the total Pittsburgh Sleep Quality Index (PSQI) score between groups at week 8. Secondary outcomes include specific PSQI domains.

Results:

By the end of treatment at week 8, the mean reduction in PSQI total score was significantly greater in the EA group than the GP group (−2.6 vs −0.8, P = 0.044). The EA also had improved sleep latency (−0.5 vs 0.1, P = 0.041) and sleep efficiency (−0.6 vs 0.0, P = 0.05) compared with the GP group. By week 8, the EA group had improved sleep duration, less sleep disturbance, shorter sleep latency, decreased daytime dysfunction, improved sleep efficiency, and better sleep quality (P < 0.05 for all) compared with baseline, whereas the GP group improved in duration and sleep quality only (P < 0.05).

Conclusions:

Among women experiencing hot flashes, the effects of EA are comparable with GP for improving sleep quality, specifically in the areas of sleep latency and efficiency. Larger randomized controlled trials with longer follow-ups are needed to confirm this preliminary finding.
Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions
Authors: Schnarrs Robert H. , Carman Claire M. , Tobin Chase , Chase Serena A. , Rossmeier Kerri A.
Published: November 2016

Background:

Human acellular dermal matrix (HADM) is commonly used to provide coverage and support for breast reconstruction. The primary purpose of this study was to evaluate the complication rates associated with breast reconstruction procedures when performed in conjunction with multiple types of HADM in a consecutive series.

Methods:

After receiving institutional review board approval, medical records from a single surgeon were retrospectively reviewed for 126 consecutive patients (170 breasts and 211 procedures) who received a breast reconstruction or revision with implantation of HADM between 2012 and 2014. Patient demographics, surgical technique, and the complication profile of 4 major types of HADM were evaluated by procedure. Complication data were primarily evaluated for infection, seroma formation, necrosis, and other complications requiring additional surgery.

Results:

The total complication rate was 19.4%. The complication rates were not statistically different between all 4 types of HADM: Alloderm (n = 143); Alloderm RTU (n = 19); FlexHD (n = 18); hMatrix (n = 32) (P > 0.05). Smokers and large-breasted women (≥500 g) had a significantly higher complication rate than the rest of the population (P < 0.01 and P < 0.03, respectively). The complication rates associated with all other patient cohorts analyzed (age, body mass index, comorbid conditions, cancer diagnosis, prepectoral technique) showed no influence on complication rates (P > 0.05).

Conclusions:

In characteristically similar cohorts, there was no statistically significant difference in complication rates based on type of HADM; however, certain risk factors and anatomy should be considered before HADM-assisted breast reconstruction.
Epidermal Graft Accelerates the Healing of Acute Wound: A Self-controlled Case Report
Authors: Bystrzonowski Nicola , Hachach-Haram Nadine , Kanapathy Muholan , Richards Toby , Mosahebi Afshin
Published: November 2016

Wound care represents a significant socioeconomic burden, with over half of chronic wounds taking up to a year to heal. Measures to accelerate wound healing are beneficial to patients and also reduce the cost and burden of wound management. Epidermal grafting (EG) is an emerging option for autologous skin grafting in the outpatient setting to improve wound healing. Although several case series have previously reported good clinical outcome with EG, the healing rate in comparison to conservative wound management is not known. In this report, we compare the weekly healing rate of 2 separate wounds in the same patient, one treated with EG and the other with dressings. The treated wound showed accelerated healing, with the healing rate being the highest at the first 2 weeks after EG. The average healing time of the treated wound was 40% faster compared with the control wound. EG accelerates healing of acute wounds, potentially reducing the healthcare cost and surgical burden.
New-onset depression following stable, slow, and rapid rate of prescription opioid dose escalation
Authors: Salas Joanne , Scherrer Jeffrey F. , Schneider Frank David , Sullivan Mark D. , Bucholz Kathleen K. , Burroughs Thomas , Copeland Laurel A. , Ahmedani Brian K. , Lustman Patrick J.
Published: November 2016

Recent studies suggest that longer durations of opioid use, independent of maximum morphine equivalent dose (MED) achieved, is associated with increased risk of new-onset depression (NOD). Conversely, other studies, not accounting for duration, found that higher MED increased probability of depressive symptoms. To determine whether rate of MED increase is associated with NOD, a retrospective cohort analysis of Veterans Health Administration data (2000-2012) was conducted. Eligible patients were new, chronic (>90 days) opioid users, aged 18 to 80, and without depression diagnoses for 2 years before start of follow-up (n = 7051). Mixed regression models of MED across follow-up defined 4 rate of dose change categories: stable, decrease, slow increase, and rapid increase. Cox proportional hazard models assessed the relationship of rate of dose change and NOD, controlling for pain, duration of use, maximum MED, and other confounders using inverse probability of treatment-weighted propensity scores. Incidence rate for NOD was 14.1/1000PY (person-years) in stable rate, 13.0/1000PY in decreasing, 19.3/1000PY in slow increasing, and 27.5/1000PY in rapid increasing dose. Compared with stable rate, risk of NOD increased incrementally for slow (hazard ratio = 1.22; 95% confidence interval: 1.05-1.42) and rapid (hazard ratio = 1.58; 95% confidence interval: 1.30-1.93) rate of dose increase. Faster rates of MED escalation contribute to NOD, independent of maximum dose, pain, and total opioid duration. Dose escalation may be a proxy for loss of control or undetected abuse known to be associated with depression. Clinicians should avoid rapid dose increase when possible and discuss risk of depression with patients if dose increase is warranted for pain.
Finasteride in Androgenic Alopecia
Authors: Zito Patrick M. , Hin Nady
Published: November 2016

By definition, a drug is a medicine or substance that exerts a physiologic effect on an organism. In dermatology, various medications and substances are utilized on a daily basis, ranging from topical treatments to anesthetics in micrographic surgery. The purpose of this section is to focus on some of the more common substances, specifically how they work, how they are utilized, and their routine alternatives (if available). The mechanism of action, usage, and alternative options of the medication finasteride are discussed.
Echocardiography for Less-Invasive Implantation of Left Ventricular Assist Devices
Authors: Magunia Harry , Schlensak Christian , Schibilsky David , Hilberath Jan N. , Rosenberger Peter , Nowak-Machen Martina
Published: November 2016

New surgical techniques aim for less-invasive implantation of left ventricular assist devices (LVADs) via small surgical incision sites. Echocardiography plays an important role during patient selection and guidance of the procedure. The surgical incision site can be identified preoperatively by transthoracic echocardiography. Intraoperative identification of left ventricular apex, de-airing, and monitoring heart function is performed by transesophageal echocardiography. This article highlights special echocardiographic considerations during less-invasive LVAD implantation surgeries.
Corticosteroids and Thiopurines, But Not Tumor Necrosis Factor Antagonists, are Associated With Cytomegalovirus Reactivation in Inflammatory Bowel Disease
Authors: Shukla Tushar , Singh Siddharth , Tandon Parul , McCurdy Jeffrey D.
Published: November 2016

Background:

The association between cytomegalovirus (CMV) reactivation and individual immunosuppressive agents in inflammatory bowel disease (IBD) has not been clearly defined. Therefore, we performed a systematic review and meta-analysis to assess this association.

Methods:

Multiple electronic databases were searched systematically through July 2015 for observational studies reporting CMV reactivation (based on serum-based or tissue-based tests) in IBD patients stratified by medication exposure. We estimated summary odds ratios (ORs) and 95% confidence intervals (CI) using random-effects model. Study quality was assessed using the Newcastle-Ottawa scale.

Results:

Sixteen observational studies were identified. As compared with nonexposed patients, exposure to corticosteroids (CS) (12 studies, 1180 patients, 52.3% exposed; OR, 2.05; 95% CI, 1.40-2.99) and thiopurines (14 studies, 1273 patients, 24.1% exposed; OR, 1.56; 95% CI, 1.01-2.39) was associated with increased risk of CMV reactivation. In contrast, as compared with patients not exposed to tumor necrosis factor (TNF) antagonists, exposure to TNF antagonists was not associated with an increased risk of CMV reactivation (7 studies, 818 patients, 18.5% exposed; OR, 1.44; 95% CI, 0.93-2.24). The results remained stable for CS and thiopurines when the analysis was limited to hospitalized patients, and by a tissue-based diagnosis. Studies were limited in the ability to assess the impact of concomitant immunosuppressive therapy, duration of medication exposure, and disease severity.

Conclusions:

On the basis of 16 observational studies, exposure to CS or thiopurines, but not TNF antagonists, was associated with an increased risk of CMV reactivation in IBD patients.
Symptom Index or Symptom Association Probability?
Authors: Abdul-Hussein Mustafa , Zhang Crystal , Castell Donald
Published: November 2016

Background:

Symptom index (SI) and symptom association probability (SAP) are popular methods used to measure symptom association in patients with gastroesophageal reflux disease (GERD).

Aim:

To investigate whether these 2 methods yield similar results in analysis of both typical and atypical GERD symptoms.

Materials and Methods:

Combined impedance-pH reflux studies of 1471 patients tested for possible GERD symptoms from January 2010 to May 2015 were reviewed. SI and SAP were analyzed for typical and atypical GERD symptoms including heartburn, regurgitation, indigestion, chest pain, cough, and throat clearing (TC). Patients who reported <3 symptom events during the 24-hour monitoring period were excluded. ON and OFF proton pump inhibitor (PPI) groups were reviewed. Kappa coefficient (κ) rather than simple percentage was used to measure the agreement rate. Simple percentage agreement is a less reliable method compared with κ.

Results:

On PPI therapy, there was a good κ between SI and SAP for regurgitation (0.68) and indigestion (0.64), moderate for heartburn (0.48) and chest pain (0.51), and poor for cough (0.33) and TC (0.29). There was a lower κ OFF PPI therapy for heartburn (0.36), regurgitation (0.44), and indigestion (0.50). But there was no difference in κ for chest pain (0.61), cough (0.29), and TC (0.33).

Conclusions:

SI and SAP showed better agreement for patients with typical GERD symptoms and even better when tested ON PPI. A better symptom association method is needed for patients with atypical GERD symptoms.
Optimal Timing of Endoscopic Retrograde Cholangiopancreatography in Acute Cholangitis
Authors: Hou Linda A. , Laine Loren , Motamedi Nima , Sahakian Ara , Lane Christianne , Buxbaum James
Published: November 2016

Objectives:

Acute cholangitis mandates resuscitation, antibiotic therapy, and biliary decompression. Our aim was to define the optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) for patients with acute cholangitis.

Methods:

Clinical data on all cases of cholangitis managed by ERCP were prospectively collected from September 2010 to July 2013. The clinical impact of the time to ERCP, defined as the time from presentation in the emergency department to the commencement of the ERCP, was determined. The primary outcome was length of hospitalization. Secondary outcomes included vasopressor use, endotracheal intubation, intensive care unit admission, and death.

Results:

ERCP was successful in 182 (92%) of 199 patients with cholangitis. Length of hospitalization was significantly longer for patients undergoing ERCP at ≥48 versus <48 hours (median 9.1 vs. 6.5 d, P=0.004) even though patients having ERCP at ≥48 hours were less sick as indicated by less frequent intensive care unit admission [odds ratio,0.3; 95% confidence interval (CI), 0.2-0.6]. Multivariate analysis revealed that hospitalization increased by 1.44 days for every day ERCP was delayed (P<0.001). Comparison of ERCP≥72 versus <72 hours revealed odds ratios of 2.6 (95% CI, 1.0-7.0) for vasopressor requirement and 3.6 (95% CI, 0.8-15.9) for mortality. Time to ERCP did not impact technical success or procedural adverse events.

Conclusions:

ERCP should be performed within 2 days of presentation as a delay of 48 or more hours is associated with disproportionate increase in hospital stay. Delay>72 hours is associated with additional adverse outcomes including hypotension requiring vasopressor support.
Molecular imaging in neuroendocrine tumors: recent advances, controversies, unresolved issues, and roles in management
Authors: Ito Tetsuhide , Jensen Robert T.
Published: November 2016

Purpose of review

The purpose is to review recent advances in molecular imaging of neuroendocrine tumors (NETs), discuss unresolved issues, and review how these advances are affecting clinical management.

Recent findings

Molecular imaging of NETs underwent a number of important changes in the last few years, leading to some controversies, unresolved issues, and significant changes in clinical management. The most recent changes are reviewed in this article. Particularly important is the rapid replacement in somatostatin receptor scintigraphy of 111In-diethylenetriamine penta-acetic acid-single-photon emission computed tomography/computed tomography (CT) by 68Ga-fluorodopa(F-D)PA), 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-peptide-PET/CT imaging, which is now approved in many countries including the USA. Numerous studies in many different types of NETs demonstrate the greater sensitivity of 68Ga-DOTA-peptide PET/CT, its high specificity, and its impact on management. Other important developments in somatostatin receptor scintigraphy/molecular imaging include demonstrating the prognostic value of both 68Ga-DOTA-peptide PET/CT and 18F-fluoro-deoxyglucose PET/CT; how their use can be complementary; comparing the sensitivities and usefulness of 68Ga-DOTA-peptide PET/CT and 18F-FDOPA PET/CT; introducing new linkers and radiolabeled ligands such as 64Cu-DOTA-peptides with a long half-life, enhancing utility; and the introduction of somatostatin receptor antagonists which show enhanced uptake by NETs. In addition, novel ligands which interact with other receptors (GLP-1, bombesin, cholecystokinin, gastric inhibitory polpeptide, integrin, chemokines) are described, which show promise in the imaging of both NETs and other tumors.

Molecular imaging is now required for all aspects of the management of patients with NETs. Its results are essential not only for the proper diagnostic management of the patient, but also for assessing whether the patient is a candidate for peptide receptor radionuclide therapy with 177Lu and also for providing prognostic value.