bluuebunny/crossref_metadata_2025 huggingface dataset:
Turning Language and Communication into Productive Resources
Authors: Del Percio Alfonso
Published: May 2018

Sociolinguistic production has recently turned its attention to the analysis of language and communication in multinational corporations. Scholars have explained that, under current capitalist conditions, language and communication have been resignified by managers, consultants, and marketing specialists as economic assets that contribute to the individualization or customization of products and services. This chapter discusses the techniques, tactics, and forms of expertise through which language and communication are governed and then turned into productive resources within multinational corporations. Drawing on an ethnographic documentation of the management of language and communication within a Swiss multinational, the chapter demonstrates that corporate actors’ policing of language and communication is not merely linguistic policing. Rather, it is a means to discipline and express control over those actors producing language and communication. That is to say, such forms of policing are a method of enhancing multinationals’ productivity and securing their competitiveness under changing market conditions.
Advice Recipients
Authors: Van Swol Lyn M. , Paik Jihyun Esther , Prahl Andrew
Published: May 2018

This chapter examines the psychology of advice recipients, focusing on research predominantly conducted using the Judge Advisor System, in which a participant “judge” receives advice from one or more advisors but has ultimate responsibility for making the decision. First, it reviews methods of typical Judge Advisor System experiments. Next, it surveys the research to explore why decision makers often do not seek out advice, focusing on the costs of advice and decision-maker overconfidence. It then examines why decision makers underutilize the advice they receive due to factors like confirmation bias, egocentric discounting, and power. In addition, factors that increase the utilization of advice, such as trust, advisor confidence, and advisor expertise, are considered. Finally, the influence of advice-recipient power and reception to computerized advice are examined in depth. Finally, advice to decision makers about how to seek and utilize advice to make better decisions is provided.
The Jesuit Rites Controversy
Authors: Collani Claudia von
Published: May 2018

The rites controversies in China and India were part of a larger debate on the status of rites and customs in an already global world and within global Catholicism. To understand the deeper meanings of Chinese and Indian concepts and rites and assess their compatibility with Christianity, the Jesuits proposed a method based on dialogue with the local literati. First tolerated, the method of accommodation was finally forbidden by the Catholic Church in the early eighteenth century out of fear of religious syncretism, which led to the stigmatization of other cultures’ rites as “pagan” and “superstitious.” Therefore, Christianity remained a foreign and marginal religion in the East until the reform of the liturgy in the twentieth century, when the Indian ritual practices were accepted. After the decree “Ad Gentes” by Vatican II, the Catholic Church endeavored to bridge the gap between cultures and religions, partly created during the rites controversy.
Political Parties
Authors: Hawkins Angus
Published: May 2018

This chapter examines the emergence, roles, and meanings of ‘party’ within British politics from the late eighteenth century to the present day. It traces the transition from ‘mixed’ government to ‘parliamentary’ government and ultimately to ‘party’ government. The altered function and nature of political parties within these shifting constitutional contexts is assessed. How parties functioned at the parliamentary and local level is also explored. It moves on to consider how historians have approached different aspects of party activity—their organization of the contest for power in Parliament; specific party histories; embodiments of ideology; how parties have organized themselves; winning elections—and evaluates the role of the idea of a ‘two-party system’ within British politics and historiography as the ‘natural’ alignment of party activity.
Conclusion
Authors: Isendahl Christian , Stump Daryl
Published: May 2018

This chapter reflects on the state of the field and assesses what the approaches represented in this volume collectively can achieve; the strengths, weaknesses, and potential of historical ecology and applied archaeology and the overlap between them. Definitions drawing on the discourse developed in the volume of both concepts are offered, and the opportunities and challenges of inter- and transdisciplinary research are summarized. The future of a usable past is discussed by contextualizing volume chapters in relation to the Sustainable Development Goals. It is suggested that research in the fields of historical ecology and applied archaeology follows three main approaches: (1) generating case studies of the past as difference, elucidating phenomena in the past that may suggest alternative possibilities to those observed in the present; (2) informing phenomena observed in the present by generating analogous case studies from the past; and (3) detailing the dynamics of long-term human–environmental processes.
Liberace’s Musical/Material Appeal
Authors: Raykoff Ivan
Published: May 2018

Inspired by the celebrated pianist-bandleaders Eddy Duchin and Carmen Cavallaro and the cinematic technique of José Iturbi in Hollywood films, pianist-entertainer Liberace (1919–1987) developed a distinctive and highly successful aesthetic and performance style that prioritized visual spectacle and emphasized the tactile elements of his playing. As evident in his first Soundies from 1943, then his nationally syndicated television show in the 1950s, Liberace highlighted the physicality and materiality of his music-making, an approach that later evolved into the signature props and flashy costumes of his live stage shows. The new medium of television enabled Liberace to integrate the traditions of Romantic pianism with new genres of popular music in a highly embodied manner that appealed to his fans as much as it bothered his critics invested in music’s physical and material transcendence.
Development of a Pseudomonas putida cell-free protein synthesis platform for rapid screening of gene regulatory elements
Authors: Wang He , Li Jian , Jewett Michael C
Published: May 2018

Cell-free protein synthesis (CFPS) systems enable the production of protein without the use of living, intact cells. An emerging area of interest is to use CFPS systems to characterize individual elements for genetic programs [e.g. promoters, ribosome binding sites (RBS)]. To enable this research area, robust CFPS systems must be developed from new chassis organisms. One such chassis is the Gram-negative Pseudomonas bacteria, which have been studied extensively for their diverse metabolism with promises in the field of bioremediation and biosynthesis. Here, we report the development and optimization of a high-yielding (198 ± 5.9 µg/ml) batch CFPS system from Pseudomonas putida ATCC 12633. Importantly, both circular and linear DNA templates can be applied directly to the CFPS reaction to program protein synthesis. Therefore, it is possible to prepare hundreds or even thousands of DNA templates without time-consuming cloning work. This opens the possibility to rapidly assess and validate genetic part performance in vitro before performing experiments in cells. To validate the P. putida CFPS system as a platform for prototyping genetic parts, we designed and constructed a library consisting of 15 different RBSs upstream of the reporter protein sfGFP, which covered an order of magnitude range in expression. Looking forward, our P. putida CFPS platform will not only expand the protein synthesis toolkit for synthetic biology but also serve as a platform in expediting the screening and prototyping of gene regulatory elements.
Volatile Compounds Emitted by Diverse Verticillium Species Enhance Plant Growth by Manipulating Auxin Signaling
Authors: Li Ningxiao , Wang Wenzhao , Bitas Vasileios , Subbarao Krishna , Liu Xingzhong , Kang Seogchan
Published: May 2018

Some volatile compounds (VC) play critical roles in intra- and interspecies interactions. To investigate roles of VC in fungal ecology, we characterized how VC produced by Verticillium spp., a group of broad-host-range soilborne fungal pathogens, affect plant growth and development. VC produced by 19 strains corresponding to 10 species significantly enhanced the growth of Arabidopsis thaliana and Nicotiana benthamiana. Analysis of VC produced by four species revealed the presence of diverse compounds, including those previously shown to affect plant growth. Using A. thaliana, we investigated the mechanism underpinning plant growth enhancement by Verticillium dahliae VC. Allometric analysis indicated that VC caused preferential resource allocation for root growth over shoot growth. Growth responses of A. thaliana mutants defective in auxin or ethylene signaling suggested the involvement of several components of auxin signaling, with TIR3 playing a key role. AUX1, TIR1, and AXR1 were also implicated but appeared to play lesser roles. Inhibition of auxin efflux using 1-naphthylphthalamic acid blocked VC-mediated growth enhancement. Spatial and temporal expression patterns of the auxin-responsive reporter DR5::GUS indicated that the activation of auxin signaling occurred before enhanced plant growth became visible. Results from this study suggest critical yet overlooked roles of VC in Verticillium ecology and pathology.
The Relationship of Multiplanar Distal and Uniplanar Proximal Interlocking Screws to Neurovascular Structures with the Depuy Synthes Humeral Nail-EX: An Anatomic Study
Authors: Steinmetz Garrett , Tobey Jonathan , Skinner Spencer , Hickerson Lindsay
Published: May 2018

Objective:

To determine the proximity of neurovascular structures to multiplanar distal interlocking screws and proximal interlocking devices for an antegrade inserted humeral nail.

Methods:

Humeral nails (Depuy Synthes Humeral Nail-EX, Paoli, PA) were inserted into 10 matched cadavers with 3 distal interlocking trajectories: anterior to posterior (A-P), anterolateral to posteromedial, and anteromedial to posterolateral (AM-PL). The distance of the screw path and screw head to the radial, lateral antebrachial cutaneous nerve (LACN), and median nerves and the brachial artery was measured. Proximally, the distance of spiral blades and/or interlocking screws to the axillary nerve was measured.

Results:

The median distance of the screw path/screw head inserted (A-P) to the LACN was 0 mm/0 mm in the left arm and 3.5 mm/1.6 mm in the right arm. The median distance of the screw path/screw head inserted AM-PL to the median nerve was 7.08 mm/0 mm in the left arm and 0 mm/0.12 mm in the right arm. The median distance of the screw path/screw head inserted AM-PL to the brachial artery was 4.05 mm/3.83 mm in the left arm and 2.19 mm/2.84 mm in the right arm. The humeral head was radiographically divided into 3 zones. The average distances of the axillary nerve to interlocking devices placed into zone 2 and zone 3 of the humeral head are 14.65 mm and 1.07 mm, respectively.

Conclusions:

When using the DePuy Synthes Humeral Nail-EX, AM-PL screws may risk the median nerve and brachial artery; thus, this trajectory is not recommended. The LACN may be at risk with A-P and to a lesser degree, anterolateral to posteromedial screws. Proximally, interlocking devices in zone 3 of the humeral head may risk the axillary nerve.
Time-Driven Activity-Based Costing in Fracture Care: Is This a More Accurate Way to Prepare for Alternative Payment Models?
Authors: McCreary Dylan L. , White Melissa , Vang Sandy , Plowman Brad , Cunningham Brian P.
Published: May 2018

Objectives:

To use surgical treatment of isolated ankle fractures as a model to compare time-driven activity-based costing (TDABC) and our institution's traditional cost accounting (TCA) method to measure true cost expenditure around a specific episode of care.

Methods:

Level I trauma center ankle fractures treated between 2012 and 2016 were identified through a registry. Inclusion criteria were age greater than 18 years and same-day ankle fracture operation. Exclusion criteria were pilon fractures, vascular injuries, soft-tissue coverage, and external fixation. Time for each phase of care was determined through repeated observations. The TCA method at our institution uses all hospital costs and allocates them to surgeries using a relative value method.

Results:

A total of 35 patients met the inclusion/exclusion criteria, 18 were men and 17 were women. Age at time of surgery was 47 ± 15 years. Time from injury to surgery was 10 ± 4 days. Operative time was 86 ± 30 minutes, Post-anesthesia care unit (PACU) time was 87 ± 27 minutes, and secondary recovery time was 100 ± 56 minutes. Average cost was significantly lower for the TDABC method ($2792 ± 734) than the TCA method ($5782 ± 1348) (P < 0.001). There was no difference between methods for implant cost ($882 ± 507 for Traditional Accounting (TA) and $957 ± 651 for TDABC, P = 0.593). TCA produced a significantly greater cost (P < 0.01) in every other category.

Conclusions:

As orthopaedics transitions to alternative payment models, accurate costing will become critical to maintaining a successful practice. TDABC may provide a better estimate of the cost of the resources necessary to treat a patient.
Revenue for Initial Orthopaedic Trauma Care: Effects of Patient and Injury Characteristics
Authors: Flanagan Christopher D. , Rascoe Alexander S. , Wang David M. , Vallier Heather A.
Published: May 2018

Objective:

To characterize the charges and collections associated with the initial inpatient management of trauma patients who undergo operative fracture management.

Design:

Retrospective.

Setting:

Level 1 trauma center.

Participants:

Four hundred forty consecutive, adult, trauma patients.

Intervention:

Fixation for fracture of the spine, pelvis, acetabulum, and/or femur fractures.

Main Outcome Measures:

Professional and technical (facility) charges and collections from the initial inpatient management and 6 months of subsequent related care.

Results:

Patients were predominantly male (74.3%) and white (63.2%) with a mean age of 41 years and mean injury severity score of 18.5. Uninsured (self-pay) patients represented the largest payer class (35.0%), and 34.5% of all patients were unemployed. Professional and technical charges totaled US $12,382,028 (US $28,140/patient) and US $39,682,225 (US $90,187/patient), respectively. Injury severity score, longer lengths of stay (LOS), and the presence of a complication were positive predictors of initial charges (P < 0.0001; adjusted R
2 = 0.799). Professional and technical collections totaled US $2,418,096 (US $5,496/patient) and US $16,921,959 (US $38,459/patient) (percent of charge: 21.5% vs. 41.3%; P < 0.0001). Of the self-pay patients, 34.4% had no collections, resulting in potential lost revenue of US $2,513,988. Greater collections were predicted to occur in females, employed patients, and those with insurance (P < 0.0001; adjusted R
2 = 0.35).

Conclusions:

Trauma patients often present without insurance, which compromises hospital revenue. Expectedly, charges are higher in more severely injured patients, those with longer LOS, and those experiencing complications. A bundled model will proportionately decrease reimbursements for a given episode of care in the event of longer LOS or occurrence of complications.
Derivation and Validation of a Biomarker-Based Clinical Algorithm to Rule Out Sepsis From Noninfectious Systemic Inflammatory Response Syndrome at Emergency Department Admission: A Multicenter Prospective Study*
Authors: Mearelli Filippo , Fiotti Nicola , Giansante Carlo , Casarsa Chiara , Orso Daniele , De Helmersen Marco , Altamura Nicola , Ruscio Maurizio , Castello Luigi Mario , Colonetti Efrem , Marino Rossella , Barbati Giulia , Bregnocchi Andrea , Ronco Claudio , Lupia Enrico , Montrucchio Giuseppe , Muiesan Maria Lorenza , Di Somma Salvatore , Avanzi Gian Carlo , Biolo Gianni
Published: May 2018

Objectives:

To derive and validate a predictive algorithm integrating a nomogram-based prediction of the pretest probability of infection with a panel of serum biomarkers, which could robustly differentiate sepsis/septic shock from noninfectious systemic inflammatory response syndrome.

Design:

Multicenter prospective study.

Setting:

At emergency department admission in five University hospitals.

Patients:

Nine-hundred forty-seven adults in inception cohort and 185 adults in validation cohort.

Interventions:

None.

Measurements and Main Results:

A nomogram, including age, Sequential Organ Failure Assessment score, recent antimicrobial therapy, hyperthermia, leukocytosis, and high C-reactive protein values, was built in order to take data from 716 infected patients and 120 patients with noninfectious systemic inflammatory response syndrome to predict pretest probability of infection. Then, the best combination of procalcitonin, soluble phospholipase A2 group IIA, presepsin, soluble interleukin-2 receptor α, and soluble triggering receptor expressed on myeloid cell-1 was applied in order to categorize patients as “likely” or “unlikely” to be infected. The predictive algorithm required only procalcitonin backed up with soluble phospholipase A2 group IIA determined in 29% of the patients to rule out sepsis/septic shock with a negative predictive value of 93%. In a validation cohort of 158 patients, predictive algorithm reached 100% of negative predictive value requiring biomarker measurements in 18% of the population.

Conclusions:

We have developed and validated a high-performing, reproducible, and parsimonious algorithm to assist emergency department physicians in distinguishing sepsis/septic shock from noninfectious systemic inflammatory response syndrome.
Facilitators of and Barriers to mHealth Adoption in Older Adults With Heart Failure
Authors: Cajita Maan Isabella , Hodgson Nancy A. , Lam Katherine Wai , Yoo Sera , Han Hae-Ra
Published: May 2018

The purpose of this descriptive, exploratory study was to assess the perceptions of older adults with heart failure regarding the use of mobile technology and to identify potential facilitators of and barriers to mHealth adoption. Semistructured interviews were used to collect data. Transcripts were analyzed using qualitative content analysis. The findings indicated that older adults do not base their intention to use mHealth solely on perceived ease of use and perceived usefulness, as outlined in the Technology Acceptance Model. The following themes emerged from the content analysis: facilitators included previous experience with mobile technology, willingness to learn mHealth, ease of use, presence of useful features, adequate training, free equipment, and doctor's recommendation; barriers included lack of knowledge regarding how to use mHealth, decreased sensory perception, lack of need for technology, poorly designed interface, cost of technology, and limited/fixed income. Overall, the findings suggest that older adults are willing to use mobile health technology, albeit with reservations. Future researchers who seek to implement mHealth-based interventions should address person-related, technology-related, and contextual barriers, and simultaneously capitalize on the influence of potential facilitators, such as a physician's recommendation, to promote mHealth adoption.
Self-tracking of Physical Activity in People With Type 2 Diabetes
Authors: Kooiman Thea J.M. , de Groot Martijn , Hoogenberg Klaas , Krijnen Wim P. , van der Schans Cees P. , Kooy Adriaan
Published: May 2018

The purpose of this study was to determine the efficacy of an online self-tracking program on physical activity, glycated hemoglobin, and other health measures in patients with type 2 diabetes. Seventy-two patients with type 2 diabetes were randomly assigned to an intervention or control group. All participants received usual care. The intervention group received an activity tracker (Fitbit Zip) connected to an online lifestyle program. Physical activity was analyzed in average steps per day from week 0 until 12. Health outcome measurements occurred in both groups at baseline and after 13 weeks. Results indicated that the intervention group significantly increased physical activity with 1.5 ± 3 days per week of engagement in 30 minutes of moderate-vigorous physical activity versus no increase in the control group (P = .047). Intervention participants increased activity with 1255 ± 1500 steps per day compared to their baseline (P < .010). No significant differences were found in glycated hemoglobin A1c, with the intervention group decreasing −0.28% ± 1.03% and the control group showing −0.0% ± 0.69% (P = .206). Responders (56%, increasing minimally 1000 steps/d) had significantly decreased glycated hemoglobin compared with nonresponders (−0.69% ± 1.18% vs 0.22% ± 0.47%, respectively; P = .007). To improve effectiveness of eHealth programs, additional strategies are needed.
Magnesium Citrate Protects Against Vascular Calcification in an Adenine-induced Chronic Renal Failure Rat Model
Authors: Yao Zhihui , Xu Yang , Ma Weidong , Sun Xin-Yuan , Jia Shan , Zheng Yang , Liu Xiaohuan , Fan Yajie , Wang Congxia
Published: May 2018

Background:

Hypomagnesemia was identified as a strong risk factor for cardiovascular disease in patients with chronic renal failure (CRF). However, the effects of magnesium (Mg) on vascular calcification (VC) have not been fully elucidated. Thus, we aim to determine the effects of Mg citrate (MgCit) on VC in CRF rats.

Methods:

Rats were divided into 5 groups: group 1 (normal diet), group 2 (normal diet with MgCit), group 3 (the VC model of CRF induced by 0.75% adenine and 0.9% phosphorus diet from day 1 to day 28), group 4 (group 3 treated with low-dose MgCit from day 1 to day 42), and group 5 (same as group 3 except the high-dose MgCit). All rats were killed at day 43 with collection of blood and aortas. Then, serum biochemical parameters, VC-related staining, calcium and P contents, alkaline phosphatase contents and activity, expression of alpha smooth muscle actin, and runt-related transcription factor 2 (RUNX2) in aortas were assessed.

Results:

Group 3 had extensive VC. The VC degree decreased in groups 4 and 5 in a dose-depended manner with reduced calcium content, P levels, alkaline phosphatase content and activity, and protein levels of RUNX2 and increased protein levels of alpha smooth muscle actin in aortas.

Conclusions:

MgCit exerted a protective role in VC in adenine-induced CRF rats; thus, it may be a potential drug for the prevention of VC in patients with CRF.
Paradoxical Effects of Sodium–Calcium Exchanger Inhibition on Torsade de Pointes and Early Afterdepolarization in a Heart Failure Rabbit Model
Authors: Chang Po-Cheng , Lu Yu-Ying , Lee Hui-Ling , Lin Shien-Fong , Chu Yen , Wen Ming-Shien , Chou Chung-Chuan
Published: May 2018

Calcium homeostasis plays an important role in development of early afterdepolarizations (EADs) and torsade de pointes (TdP). The role of sodium–calcium exchanger (NCX) inhibition in genesis of secondary Ca2+ rise and EAD-TdP is still debated. Dual voltage and intracellular Ca2+ optical mapping were conducted in 6 control and 9 failing rabbit hearts. After baseline electrophysiological and optical mapping studies, E4031 was given to simulate long QT syndrome. ORM-10103 was then administrated to examine the electrophysiological effects on EAD-TdP development. E4031 enhanced secondary Ca2+ rise, EADs development, and TdP inducibility in both control and failing hearts. The results showed that ORM-10103 reduced premature ventricular beats but was unable to suppress the inducibility of TdP or EADs. The electrophysiological effects of ORM-10103 included prolongation of action potential duration (APD) and increased APD heterogeneity in failing hearts. ORM-10103 had a neutral effect on the amplitude of secondary Cai rise in control and heart failure groups. In this model, most EADs generated from long-short APD junction area. In conclusion, highly selective NCX inhibition with ORM-10103 reduced premature ventricular beat burden but was unable to suppress secondary Ca2+ rise, EADs development, or inducibility of TdP. The possible electrophysiological mechanisms include APD prolongation and increased APD heterogeneity.
Burden of Human Metapneumovirus and Respiratory Syncytial Virus Infections in Asthmatic Children
Authors: Furuta Takashi , Hasegawa Shunji , Mizutani Makoto , Iwai Takashi , Ohbuchi Noriko , Kawano Shoji , Tashiro Norimichi , Uchida Masashi , Hasegawa Masanari , Motoyama Masashi , Sekino Takaomi , Nakatsuka Kenji , Ichihara Kiyoshi , Shirabe Komei , Ohga Shouichi
Published: May 2018

Background:

Human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) are the leading causes of acute respiratory illness in children. Clinical burden of each infection on the respiratory distress in asthmatic patients remains unclear. The purpose of the study was to clarify the effect of these infections on the severity of asthmatic children in the seasonal outbreaks.

Methods:

A total of 1,217 pediatric inpatients with hMPV (n = 114) or RSV (n = 1,103) infection in Yamaguchi prefecture, Japan, between 2011 and 2014 were enrolled. Bronchial asthma was defined as having more than 3 episodes of wheezing illness over 1 year of age. Infection was determined by the positive antigen test for each virus in the nasal specimens.

Results:

The number of patients peaked at age 12–15 months in hMPV infection and at age 0–3 months in RSV infection. The proportion of hypoxic patients (40–50%) did not differ at any age between hMPV-infected and RSV-infected children. In the analysis of date from > 1 year old patients with hypoxia, hMPV-infection group was older (P = 0.036), and more frequently had history of asthma (P = 0.015) or abnormal chest roentgenogram (P < 0.001) than RSV-infection group. Multivariate analysis indicated that the hypoxia-associated factors were history of asthma in both hMPV (odds ratio [OR]: 15.8; P < 0.001) and RSV infections (OR, 2.2; P = 0.005), higher body temperature in hMPV infection (OR, 2.2; P = 0.009), and younger age in RSV infection (OR, 1.4; P = 0.004).

Conclusions:

Outbreaks of hMPV, rather than, RSV infection may have a greater impact on the development of hypoxic respiratory illness in asthmatic children.
Pharmacokinetic Monitoring of Vancomycin in Cystic Fibrosis
Authors: Fusco Nicholas M. , Prescott William A. , Meaney Calvin J.
Published: May 2018

Background:

A correlation between vancomycin (VAN) trough concentrations (VTC) and area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio (AUC/MIC) has not been established in children/adolescents with cystic fibrosis (CF). The primary objective of this study was to determine the correlation between measured VTCs and AUC/MIC using population-based pharmacokinetics.

Methods:

A retrospective cohort study of children/adolescents diagnosed with CF, 6 to <18 years of age, treated with VAN for methicillin-resistant Staphylococcus aureus infection was conducted. The relationship between final VTCs and calculated AUC/MIC was assessed using Pearson and Spearman correlations. All tests were 2-tailed with alpha set at 0.05.

Results:

Thirty children/adolescents, 7 to 17 years of age (median age 15 year; interquartile range: 9–17 years), were included. The mean final VAN dose was 58.03 ± 18.58 mg/kg/d, and the median final VTC was 12.6 (11–13.6) mg/L. The mean AUC/MIC was 355.34 ± 138.46 (Le model) versus 426.79 ± 178.92 (Stockmann model; P = 0.089). No correlation existed between VTCs and AUC/MIC using either the model by Le (r = 0.140; P = 0.461) or Stockmann (r = 0.115; P = 0.564). Using the Stockmann model, VAN dose (mg/kg/dose) was found to have a strong positive correlation with AUC (r = 0.8874; P < 0.0001) and AUC/MIC (r = 0.7877; P < 0.0001).

Conclusions:

VTCs did not correlate with AUC or AUC/MIC. Further research is needed to determine which estimate of VAN treatment efficacy is most appropriate for children and adolescents with CF infected with methicillin-resistant Staphylococcus aureus.
Case Series and Systematic Review of Radiation Outcomes for Endolymphatic Sac Tumors
Authors: Wick Cameron C. , Eivaz Nathan A. , Yeager Lauren H. , Hunter Jacob B. , Isaacson Brandon , Kutz Joe Walter
Published: May 2018

Objective:

Surgery is the primary treatment modality for endolymphatic sac tumors (ELST). Two case examples are presented to highlight some rare instances when radiation therapy may be used. The outcomes following radiation therapy for ELST are controversial. This report systematically reviews those outcomes and compares results between external beam radiation and stereotactic radiosurgery.

Data Source:

In accordance with PRISMA guidelines a systematic literature search of the Ovid Medline, Embase, Scopus, Cochrane library, and clinicaltrails.gov databases was performed in August 2017.

Study Selection:

Twenty-two studies met inclusion criteria and report ELST outcomes following radiation therapy. Additional data on tumor size, previous surgery, radiation modality, and radiation dosing was collected.

Data Extraction:

The methodological quality was independently assessed by three reviewers. The included studies were small, heterogeneous case reports with a low level of evidence, and several sources of bias.

Data Synthesis:

The primary outcome was tumor control following radiation, defined as no growth. A comparative analysis of external beam versus stereotactic radiation was performed.

Conclusion:

Forty-six tumors from 42 patients were independently analyzed. The overall tumor control rate was 67.4%. When analyzing patients in which tumor was present at the time of radiation, external beam radiation controlled 9 of 19 tumors (47.4%) while stereotactic radiosurgery controlled 14 of 18 tumors (77.8%). The effect size of 30.4% favors stereotactic radiosurgery, but the wide confidence interval (−4.4 to 57.4%) limits what conclusions can be drawn. Radiation for ELST remains controversial and more long-term data is needed.
The Hemopump™, The First Intravascular Ventricular Assist Device
Authors: Wampler Richard , Frazier O. H.
Published: May 2018

Development of durable left ventricular assist devices (LVADs), based on rotary flow blood pumps, began in earnest after the successful implantation of a catheter-mounted axial flow blood pump via intravascular access in 1988. This device, the Hemopump, successfully supported the circulation of a patient in cardiogenic shock secondary to acute rejection of a transplanted heart. Duration of support was 46 hours, resulting in complete recovery of cardiac function and hospital discharge. In effect, this sentinel event demonstrated that continuous-flow blood pumps could be used to support patients in cardiogenic shock. This held true in spite of many widely held paradigms against rotary blood pumps regarding blood damage, diminished pulsatility, and thrombosis. At this writing, 50,000 patients have been implanted with durable LVADs based on rotary blood pumps as a bridge to cardiac transplantation or destination support as long as 10 years.
Does preoperative enteral or parenteral nutrition reduce postoperative complications in Crohn’s disease patients: a meta-analysis
Authors: Brennan Gregory T. , Ha Iris , Hogan Christopher , Nguyen Emily , Jamal M. M. , Bechtold Matthew L. , Nguyen Douglas L.
Published: May 2018

Objectives

Crohn’s disease (CD) patients frequently develop complications that require surgery for management. The high prevalence of malnutrition in CD patients presents a challenge because poor preoperative nutritional status has been shown to increase postoperative complications. In this study, we assessed whether preoperative enteral nutrition (EN) or total parenteral nutrition (TPN) decreases postoperative complications in CD patients.

Materials and methods

A three-point systematic and comprehensive literature search was carried out on multiple databases followed by a meta-analysis with results presented as odds ratio (OR) using two models, the Mantel-Haenszel model and the DerSimonian and Laird model. The I
2 measure of inconsistency was utilized to assess heterogeneity. If statistically significant heterogeneity was identified, the results underwent a separate sensitivity analysis.

Results

Five studies met inclusion criteria totaling 1111 CD patients. The rate of postoperative complications in the group receiving preoperative nutrition (EN or TPN) support was 20.0% compared with 61.3% in the group who had standard care without nutrition support [OR=0.26, 95% confidence interval (CI): 0.07–0.99, P<0.001]. Postoperative complications occurred in 15.0% of patients in the group who received preoperative TPN compared with 24.4% in the group who did not (OR=0.65, 95% CI: 0.23–1.88, P=0.43). Postoperative complications occurred in 21.9% in the group who received preoperative EN compared with 73.2% in the group that did not received preoperative EN (OR=0.09, 95% CI: 0.06–0.13, P<0.001).

Conclusion

Preoperative nutrition supplementation reduces postoperative complications in CD patients. In particular, EN in CD patients before undergoing surgery is superior to standard of care without nutrition support with a number needed to treat of 2. There is a trend toward TPN being superior to standard of care without nutrition support, but this trend did not reach statistical significance. Further studies are necessary to evaluate specific components in EN or TPN that may be most beneficial for CD patients requiring surgical intervention.
Pancreatic Lipomatous Hamartoma
Authors: Tanaka Mariko , Ushiku Tetsuo , Ikemura Masako , Takazawa Yutaka , Igari Toru , Shimizu Michio , Yamaguchi Hiroshi , Fukushima Noriyoshi , Sakuma Kei , Arita Junichi , Sakamoto Yoshihiro , Hasegawa Kiyoshi , Watadani Takeyuki , Nakai Yousuke , Koike Kazuhiko , Fukayama Masashi
Published: May 2018

Pancreatic masses consisting of lipomatous components clinically include lipoma, liposarcoma, lipomatous pseudohypertrophy of the pancreas, fat-containing neoplasms such as perivascular epithelioid cell tumor, and malignant neoplasm with lipoid degeneration. We present pancreatic lipomatous hamartoma, which has not been reported hitherto. A solid pancreatic mass was detected from a computed tomographic scan check-up in each of 3 cases of Japanese men. Macroscopically, well-demarcated solid lipomatous masses were detected at the uncus, body, and tail of the pancreas, respectively. Microscopically, the masses predominantly consisted of mature adipocytes with no atypia, but contained characteristics components of pancreatic hamartoma, such as small ducts, a well-preserved acinar structure, and/or fibrous stroma. On the basis of the unique features, lack of islets and absence of periductal elastic fibers, these tumors are a distinct variant of pancreatic hamartoma. Furthermore, high-mobility group AT-hook 2 expression in the fibro-adipocytes of this tumor indicated that these cells are an integral component of the pancreatic lipomatous hamartoma. Consequently, the unique tumors described herein are pancreatic lipomatous hamartoma, which must be discriminated from other lipomatous lesions of the pancreas.
Intraobserver and Interobserver Variability in the Assessment of Dysplasia in Ampullary Mucosal Biopsies
Authors: Allard Felicia D. , Goldsmith Jeffrey D. , Ayata Gamze , Challies Tracy L. , Najarian Robert M. , Nasser Imad A. , Wang Helen , Yee Eric U.
Published: May 2018

Endoscopic mucosal biopsies of the ampulla of Vater (AmpBx) are obtained to histologically assess for dysplasia or carcinoma. However, biopsy material is often scant and a host of factors can induce histologic changes that pose diagnostic challenges. We sought to investigate observer variability in interpretation of AmpBx and the impact clinical data may have on diagnostic interpretation. Thirty-one cases from institutional archives were selected, including 12 cases of reactive atypia (RA), 8 indefinite for dysplasia (ID), and 11 showing low-grade dysplasia (LGD). Slides were independently reviewed at 3 time points with and without clinical information by 6 pathologists who categorized the biopsies RA, ID, or LGD. Following the reviews, intraobserver and interobserver agreement was assessed. Review of AmpBx without clinical data showed fair (κ, 0.27), poor (κ, 0.07), and good (κ, 0.42) interobserver agreement for diagnoses of RA, ID, and LGD, respectively. Interobserver agreement improved for LGD (κ, 0.66 and 0.73) when clinical information was provided; however, agreement remained fair for RA (κ, 0.4 and 0.42) and poor-to-fair for ID (κ, 0.17 and 0.25). When follow-up data were reviewed, all cases that reached unanimous agreement had that diagnosis substantiated by subsequent endoscopic or histologic findings. The same was true of 13 of 19 cases that reached majority consensus. Given the potential clinical consequences of these diagnoses combined with the significant intraobserver and interobserver variability found in this study, we conclude that better-defined diagnostic criteria and consensus reads on difficult cases would assist in the histologic assessment of these challenging cases.
Delirium Screening and Management in Inpatient Rehabilitation Facilities
Authors: Oh-Park Mooyeon , Chen Peii , Romel-Nichols Vickie , Hreha Kimberly , Boukrina Olga , Barrett A. M.
Published: May 2018

Delirium is an acute and fluctuating disturbance in cognition attention and awareness that is often a reflection of abnormal physiological condition of an individual. Delirium is highly prevalent among an older population and is associated with high mortality, poor medical and functional outcomes, and high healthcare cost. Delirium often has iatrogenic triggers, and it has been recognized as a quality indicator of healthcare organizations. Despite its high prevalence and significance, more than 50% of the delirium cases are underrecognized by healthcare professionals and remained untreated. Most patients in inpatient rehabilitation facilities are older adults with multiple risk factors for delirium including operation, intensive care stay, multiple co-morbidities, and impaired mobility. Early detection, intervention, and primary prevention of delirium will allow patients to avoid additional morbidities and reach their maximum functional potential during their rehabilitation stay. After the systematic implementation of delirium screening in our inpatient rehabilitation facility, we found that 10.3% of patients were screened positive for delirium at admission. This review discusses the systematic implementation of screening and intervention for delirium as well as the epidemiology of delirium to increase the awareness and guide clinical practice for clinicians in inpatient rehabilitation facilities.
Family Socioeconomic Status, Cortisol, and Physical Health in Early Childhood: The Role of Advantageous Neighborhood Characteristics
Authors: Roubinov Danielle S. , Hagan Melissa J. , Boyce W. Thomas , Adler Nancy E. , Bush Nicole R.
Published: May 2018

Objective

Children from families with lower socioeconomic status (SES) evidence greater physiological dysregulation and poorer health. Despite recognition of environmental contributors, little is known about the influence of neighborhood characteristics. The present study examined the moderating role of community-level risks and resources on the relation of family SES to children's daily cortisol output and physical health during the kindergarten year.

Methods

In fall and spring of kindergarten, children's (N= 338) daily total cortisol was measured and parents and teachers rated children's global physical health. Parents reported family SES. Neighborhood characteristics were assessed using the Child Opportunity Index, a population-level tool that evaluates the quality of multiple domains of neighborhood attributes.

Results

In fall, children reared in lower SES family environments had higher cortisol when residing in lower quality (lower opportunity) neighborhoods (b= −.097,p< .001), but there was no relation between family SES and children's cortisol in more advantaged (higher opportunity) neighborhoods (b= −.023,p= .36). Lower family SES was prospectively associated with poorer physical health in spring (controlling for fall health) only among children living in lower opportunity neighborhoods (b= −.250,p= .018) and was unrelated to physical health among children residing in higher opportunity neighborhoods (b= .042,p =.70).

Conclusions

Higher opportunity neighborhoods may protect against the negative consequences of low family SES on children's stress physiology and physical health. Public health interventions that bolster neighborhood opportunities may benefit young children reared in socioeconomically disadvantaged family environments.
Diagnosis and treatment of histoplasmosis in solid organ transplant patients
Authors: Gajurel Kiran , Dhakal Reshika , Deresinski Stan
Published: May 2018

Purpose of review

Unlike immunocompetent hosts, solid organ transplant (SOT) recipients with posttransplant histoplasmosis (PTH) often present with disseminated disease and have an attributable mortality of approximately 10%. In this review, we discuss currently available diagnostic tests and treatment strategies in PTH.

Recent findings

None of the available tests have a 100% diagnostic accuracy. Histoplasma antigen assays are the most sensitive commercially available tests. However, crossreactivity of histoplasma antigen with aspergillus galactomannan and false positive histoplasma antigen tests because of rabbit antithymocyte globulin may cause difficulty in interpreting positive test results in transplant recipients. Molecular assays such as amplification and sequencing of ‘panfungal’ portions of the 28S ribosomal RNA from clinical specimens appear to be promising.

Lipid formulations of amphotericin B and itraconazole are the drugs of choice in the treatment of PTH. Other extended spectrum azoles also appear to be effective, but, like itraconazole, problems with drug interactions and prolongation of the QTc interval (except for isavuconazole, which shortens the QTc interval) remain. Mycophenolate therapy is associated with severe disease and should be stopped during active disease and, if feasible, calcineurin inhibitors and steroids should be reduced.

A combination of various tests (culture, antigen tests, nucleic amplification tests, etc.) should be used to optimize diagnostic yield. The role of unbiased next generation sequencing for early diagnosis and newer azoles in the treatment needs to be further explored.
Treatment of cryptococcosis in non-HIV immunocompromised patients
Authors: Henao-Martínez Andrés F. , Chastain Daniel B. , Franco-Paredes Carlos
Published: May 2018

Purpose of review

Cryptococcosis has become a common opportunistic infection among non-HIV immunocompromised hosts. Recent reports have shown the incidence of Cryptococcosis among HIV-negative immunocompromised patients reaches close to half of the overall cases reported in the USA. Management of this infection in this population carries unique challenges. We aim to review relevant and recent research findings to develop treatment recommendations for this type of population.

Recent findings

Most of the recommendations for the management of non-HIV immunocompromised host are extrapolated from HIV studies. Cryptococcosis among non-HIV patients is common but often overlooked. Some clinical factors, when present, may increase the risk of Cryptococcosis among HIV-negative patients and appropriate screening and assessment for the disease is necessary. Treating clinicians should consider a longer duration of induction with Amphotericin B depending on the type of host, immunocompromised state, antifungal response and presence of neurological complications. Baseline fluconazole resistance can reach up to 12%, which is an important consideration for cryptococcal meningitis relapses or suboptimal responses to therapy.

Cryptococcusspp. conveys a high disease burden among immunocompromised hosts. Clinicians must consider numerous variables and factors in a dynamic way to offer the best possible treatment and to monitor their response to therapy. Due to the high cost and associated toxicities, we still need new affordable therapies and studies among non-HIV immunocompromised patients.
Hospital Anxiety and Depression Scale Score Is an Independent Factor Associated With the EuroQoL 5-Dimensional Descriptive System in Patients With Rheumatoid Arthritis
Authors: Hattori Yosuke , Katayama Masao , Kida Daihei , Kaneko Atsushi
Published: May 2018

Objective

This study aimed to examine anxiety and depression experienced by patients with rheumatoid arthritis (RA) using EuroQoL 5-Dimensional Descriptive System (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) scores.

Methods

We analyzed 1005 Japanese patients with RA. Stepwise multiple linear regression analysis was performed to evaluate the independent influence of variables on EQ-5D and HADS scores. Pearson correlation coefficients were also calculated to explore relationships between variables.

Results

The mean EQ-5D score was 0.74 for all patients (mean age, 63.2 years; mean disease duration, 13.6 years; mean Health Assessment Questionnaire Disability Index [HAQ-DI], 0.78; mean HADS total [HADS-T] score, 10.3; mean disease activity score assessed by 28 joints based on CRP [DAS28-CRP], 2.8). The EQ-5D score was strongly correlated with HAQ-DI and was moderately correlated with age, Steinbrocker functional class, HADS-T score, tender joint count assessed by 28 joints, pain on a visual analog scale (pain-VAS), patient's global assessment of disease activity (general-VAS), and DAS28-CRP. The HADS-T score was moderately correlated with HAQ-DI, pain-VAS, general-VAS, and DAS28-CRP. Factors that influenced the EQ-5D score included HAQ-DI (β = −0.533), pain-VAS (β = −0.128), HADS-T score (β = −0.142), DAS28-CRP (β = −0.187), and prednisolone use (β = −0.056). Factors that influenced the HADS score included HAQ-DI (β = 0.348), general-VAS (β = 0.145), disease duration (β = 0.094), and worklessness (β = 0.083).

Conclusions

The HADS score is an independent factor associated with EQ-5D in patients with RA. Our findings suggest that the assessment of anxiety and depression is essential in achieving better quality of life for patients with RA.