bluuebunny/crossref_metadata_2025 huggingface dataset:
In digital we trust: Bitcoin discourse, digital currencies, and decentralized network fetishism
Authors: Baldwin Jon
Published: February 2018

This paper outlines how the digital currency and network technology of bitcoin functions and explores the context from which it emerged. Bitcoin was conceived in 2008 as an attempt to alleviate trust in government and banks which was at a low during this period of financial crisis. However, with bitcoin trust does not dissipate, rather it shifts. Trust moves from trust in banks or states to trust in algorithms and encryption software. There is a move from conventional trust in the gold standard—“In Gold We Trust”—to the trust announced on U.S. currency—“In God We Trust”—to trust in software and networks—“In Digital We Trust”. The hyperbole of bitcoin discourse is deemed to be an expression of the Californian Ideology, which itself often conceals a right-wing agenda. The paper analyses the hype behind the celebration of decentralised digital networks. It proposes that a form of network fetishism operates here. The failure of bitcoin as a currency (rather than as a hoarded commodity in an emergent bubble) and as an idea might be attributed to the failure to see how ultra-modern digital networks conceal very traditional consolidation of power and capital. The rise and fall of bitcoin, in terms of its original ambition, serves as a cautionary tale in the digital age—it reveals how ingenious innovations that might challenge power and the consolidation of capital become co-opted and colonised by capital. Finally, the paper offers a discussion of the possible progressive uses of the digital technology bitcoin has facilitated.
Capability and adversity: reframing the “causes of the causes” for mental health
Authors: Smith Michael
Published: February 2018

Scotland is well known for having the worst health in Western Europe, with the country’s premature mortality mainly driven by suicide and substance misuse, rather than physical illness. These problems only emerged relatively recently, and a similar profile of premature mortality, sometimes called “diseases of despair”, can be seen in other societies at different times. But what is “despair” in this context, and how might it exert its effects? Studies of the impact of Adverse Childhood Experiences (ACEs) on adult health consistently reveal a similar profile of morbidity, which is thought to relate to the effects of unremitting, unsupported, “toxic” stress. As models of childhood adversity expand to include a wider range of causes and powerful mitigating factors, there is a need to understand why some life events and circumstances are especially harmful. This paper argues that socioeconomic factors, childhood adversity, attachment, resilience and “toxic” stress are all consistent with a broader concept of human potential: Nussbaum’s “capabilities approach” to human development. Incorporating our understanding of health and wellbeing in the broader frame of capabilities strengthens our understanding of adversity-related harm, and might also point towards new ways of repairing the social and individual damage they cause.
Populism between direct democracy and the technological myth
Authors: De Blasio Emiliana , Sorice Michele
Published: February 2018

Abstract

In recent years, the scientific debate on populism has experienced a new momentum: on the one hand, the emergence of new populisms even in Western democracies and on the other hand, disagreement among scholars on the definition of populism. In this context, new trends have emerged—such as those concerning the link between populism and technology—along with the need to revise the traditional study paradigms, which are often difficult to operationalise. The transformation of the political sphere appears to be strongly interconnected with the digital media landscape. If the new forms of communication are the cause or the effect of processes, such as the personalisation of leadership, the verticalisation of political organisations, the presidentialisation of political parties, or the social de-legitimisation of the old “intermediate bodies”, these forms should be the subject of ongoing research. At the same time, a very simplistic storyline tries to overlap the rise of neo-populist parties with their use of communication technologies. A quality that is common to the many different populisms is an appeal to the use of direct democracy as a tool to empower citizens. Populism itself is sometimes portrayed as almost synonymous with direct democracy. At the same time, direct democracy is used by populists as a critique of the lack of participation in representative democracy and the need to make it more participatory. In this perspective, technology becomes a tool (and a storyline) to facilitate the use of direct democracy and the rise of a new form of “hyper-representation”. At the same time, concepts such as efficiency, privatisation, short-termism, newism, and meritocracy are keywords successfully used by populist leaders, technocracy élites and neo-liberal political leaders. In other words, we can highlight a strange meeting between technological storytelling about direct democracy and technocracy myths. Even among the new populist parties, the technopopulists appear to represent an important category, whose peculiarities can easily be put into evidence using some empirical tools (such as content analysis). The aim of this article is to investigate the relationships between technocracy, direct democracy’s storytelling and hyper-representation as a distinctive characteristic of neo-populisms.
Ultra-high Q terahertz whispering-gallery modes in a silicon resonator
Authors: Vogt Dominik Walter , Leonhardt Rainer
Published: February 2018

We report on the first experimental demonstration of terahertz (THz) whispering-gallery modes (WGMs) with an ultra-high quality factor of 1.5 × 104 at 0.62 THz. The WGMs are observed in a high resistivity float zone silicon spherical resonator coupled to a sub-wavelength silica waveguide. A detailed analysis of the coherent continuous wave THz spectroscopy measurements combined with a numerical model based on Mie-Debye-Aden-Kerker theory allows us to unambiguously identify the observed higher order radial THz WGMs.
Whispering resonances to the terahertz regime
Authors: Wolverton Mark
Published: February 2018

Whispering gallery mode resonators show ultrahigh-Q characteristics for THz applications.
Genetic trends and genetic correlations between 305-day milk yield, persistency and somatic cell score of Holstein cows in Brazil using random regression model
Authors: Padilha A. Haiduck , Alfonzo E. P. M. , Daltro D. S. , Torres H. A. L. , Neto J. Braccini , Cobuci J. A.
Published: February 2018

The objective was to estimate genetic correlations for persistency, milk yield and somatic cell score (SCS) in Holstein cattle in Brazil. A dataset with 190389 records of test-day milk and of test-day SCS from 21824 cows was used. Two-trait random regression model with a fourth order Legendre polynomial was used. Persistency (PS) was defined as the difference between estimated breeding values (EBV) along different days in milk using two formulae: and PS2=(EBV290–EBV90). Larger values for PS2 or lower ones for PS1 indicate higher persistency. Heritability was 0.24 for 305-day milk yield, 0.14 for SCS up to 305 days, 0.15 for PS1 and 0.14 for PS2. Genetic correlation between 305-day milk yield and SCS up to 305 days was –0.47. Genetic correlation of 305-day milk yield with PS1 and PS2 was –0.32 and 0.30, respectively. Genetic correlation of SCS up to 305 days was 0.25 with PS1 and –0.20 with PS2. The additive genetic correlations between milk yield, SCS and persistency showed that selection for higher persistency or for low somatic cell score will increase 305-day milk yield.
Breaking the rules: discovery of sexual deception in Caladenia abbreviata (Orchidaceae), a species with brightly coloured flowers and a non-insectiform labellum
Authors: Phillips Ryan D. , Peakall Rod
Published: February 2018

Caladenia is exceptional among orchid genera in that it contains both species pollinated by sexual deception and species pollinated by food-foraging insects. Whereas pollination strategies have been elucidated in some species complexes, others groups have received limited attention, hampering our ability to understand the evolution of the exceptional diversity of species and floral traits in Caladenia. Here, we conducted the first detailed pollination study of a member of the Caladenia filamentosa complex. On the basis of the brightly coloured and scented flowers exhibited by many species, it has been assumed that most members of the group are food-deceptive. However, we show that Caladenia abbreviata Hopper & A.P.Br. is pollinated by an undescribed species of Rhytidothynnus thynnine wasp via sexual deception. Floral dissections showed that the terminal glands on the sepals and petals are the primary source of the sexual attractant, supporting observations from intact flowers that pollinators frequently copulate with these floral parts. Interestingly, contact with the reproductive structures of the plant was not associated with attempted copulation. Our findings highlighted that sexual deception can evolve in lineages without dull-coloured flowers and insectiform labellum structures. Given that the orchid is apparently dependent on a single pollinator species, efforts to conserve this rare species will be dependent on the availability of the pollinator in suitable orchid habitat.
Performance improvement in a tubular heat exchanger by punched delta-winglet vortex generators
Authors: Khanoknaiyakarn C. , Promvonge P. , Thianpong C. , Skullong S.
Published: February 2018

A novel tubular heat exchanger incorporated with punched delta-winglet vortex generators (called perforated delta-winglet vortex generator, P-DWVG) is proposed for improving its thermal performance and energy saving. The P-DWVG elements are punched out from a straight tape having its width nearly equal to the tube diameter before insertion. The main aim at employing the P-DWVG insert is to produce counter-rotating vortices along the tube to promote turbulence intensity inside as well as to transport the cold fluid at the central core to the near-wall regions. The experiment was performed to study thermal behaviors in a uniform heat-fluxed tube inserted with P-DWVGs. The P-DWVGs with the attack angle of 45° were mounted periodically with three different blockage ratios (BR = 0.1, 0.2 and 0.3) and two pitch ratios (PR = 2 and 3). Air as the test fluid was varied to obtain turbulent airflow for Reynolds number (Re) in a range of 4,150-25,500. The experimental results show that the P-DWVG provides a considerable increase in the rate of heat transfer around 3.1-4.01 times whereas friction factor increases around 11.44- 34.23 times higher than the plain tube. To assess the real benefits of P-DWVGs, thermal performance factor (TEF) is examined and in the range of 1.39-1.48 where its maximum is at BR = 0.1 and PR = 2.
Strong comparison principle for 𝑝-harmonic functions in Carnot-Caratheodory spaces
Authors: Capogna Luca , Zhou Xiaodan
Published: February 2018

We extend Bony’s propagation of support argument to

C
1

C^1

solutions of the nonhomogeneous subelliptic

p
p

-Laplacian associated to a system of smooth vector fields satisfying Hörmander’s finite rank condition. As a consequence we prove a strong maximum principle and strong comparison principle that generalize results of Tolksdorf.
Mitochondrial versus nuclear gene expression and membrane protein assembly: the case of subunit 2 of yeast cytochromecoxidase
Authors: Rubalcava-Gracia Diana , Vázquez-Acevedo Miriam , Funes Soledad , Pérez-Martínez Xochitl , González-Halphen Diego
Published: February 2018

Deletion of the yeast mitochondrial gene COX2, encoding subunit 2 (mtCox2) of cytochrome c oxidase (CcO), results in a respiratory-incompetent Δcox2 strain. For a cytosol-synthesized Cox2 to restore respiratory growth, it must carry the W56R mutation (cCox2W56R). Nevertheless, only a fraction of cCox2W56Ris matured in mitochondria, allowing ∼60% steady-state accumulation of CcO. This can be attributed either to the point mutation or to an inefficient biogenesis of cCox2W56R. We generated a strain expressing the mutant protein mtCox2W56Rinside mitochondria which should follow the canonical biogenesis of mitochondria-encoded Cox2. This strain exhibited growth rates, CcO steady-state levels, and CcO activity similar to those of the wild type; therefore, the efficiency of Cox2 biogenesis is the limiting step for successful allotopic expression. Upon coexpression of cCox2W56Rand mtCox2, each protein assembled into CcO independently from its genetic origin, resulting in a mixed population of CcO with most complexes containing the mtCox2 version. Notably, the presence of the mtCox2 enhances cCox2W56Rincorporation. We provide proof of principle that an allotopically expressed Cox2 may complement a phenotype due to a mutant mitochondrial COX2 gene. These results are relevant to developing a rational design of genes for allotopic expression intended to treat human mitochondrial diseases.
Development and evaluation of a novel user interface for reviewing clinical microbiology results
Authors: Wright Adam , Neri Pamela M , Aaron Skye , Hickman Thu-Trang T , Maloney Francine L , Solomon Daniel A , McEvoy Dustin , Ai Angela , Kron Kevin , Zuccotti Gianna
Published: February 2018

Background

Microbiology laboratory results are complex and cumbersome to review. We sought to develop a new review tool to improve the ease and accuracy of microbiology results review.

Methods

We observed and informally interviewed clinicians to determine areas in which existing microbiology review tools were lacking. We developed a new tool that reorganizes microbiology results by time and organism. We conducted a scenario-based usability evaluation to compare the new tool to existing legacy tools, using a balanced block design.

Results

The average time-on-task decreased from 45.3 min for the legacy tools to 27.1 min for the new tool (P < .0001). Total errors decreased from 41 with the legacy tools to 19 with the new tool (P = .0068). The average Single Ease Question score was 5.65 (out of 7) for the new tool, compared to 3.78 for the legacy tools (P < .0001). The new tool scored 88 (“Excellent”) on the System Usability Scale.

Conclusions

The new tool substantially improved efficiency, accuracy, and usability. It was subsequently integrated into the electronic health record and rolled out system-wide. This project provides an example of how clinical and informatics teams can innovative alongside a commercial Electronic Health Record (EHR).
Expansion Thoracoplasty in Rabbit Model
Authors: Olson J. Casey , Glotzbecker Michael P. , Takahashi Ayuko , Mehta Hemal P. , Snyder Brian D.
Published: February 2018

Study Design.

In a treatment-control animal study expansion thoracoplasty (ET) was performed in a juvenile rabbit model of thoracic insufficiency syndrome (TIS) and benefits to thoracic development and respiratory function quantified. Rabbits treated early versus late were compared to age-matched normal and disease control rabbits through to skeletal maturity.

Objective.

Evaluate (1) how ET changes the natural TIS disease trajectory and (2) how timing of ET affects changes in spine growth, lung growth, and respiratory mechanics.

Summary of Background Data.

Pulmonary growth potential is thought to diminish with age; thus, early therapeutic intervention may increase pulmonary growth in children with TIS. However, no direct empirical evidence exists to support this treatment paradigm.

Methods.

Convex left scoliosis and resultant TIS was induced in 3-week-old rabbits via surgical rib tethering. We compare the efficacy of ET performed at 7 weeks and expanded at 11 weeks (early, n = 7) versus only at 11 weeks of age (late, n = 7) in preserving lung growth and respiratory function relative to normal (n = 8) and disease (n = 10) rabbits. Sequential computed tomography images and pulmonary function testing was performed to quantify spine curvature, lung growth, and respiratory volumes. At 28 weeks of age chest wall elastance was measured in vivo then acinar complexity analyzed histologically via radial alveolar counts.

Results.

ET performed early or late altered the predicted trajectory of spine deformity, pulmonary growth inhibition, and respiratory dysfunction seen in disease rabbits. Growth was not significantly different between early and late rabbits and post-treatment gains remained below those of age-matched normal rabbits. Chest wall elastance was impaired by ET and more so in early rabbits, there were no differences in pulmonary elastance.

Conclusion.

ET interrupted the natural progression of deformity and pulmonary hypoplasia associated with spine curvature in disease rabbits. However, growth benefits are only seen in cases of the most severe initial deformity and must be balanced against the further impairment to chest wall function associated with repetitive surgery.

Level of Evidence: N/A
Postoperative Complications in Dialysis-Dependent Patients Undergoing Elective Decompression Surgery Without Fusion or Instrumentation for Degenerative Cervical or Lumbar Lesions
Authors: Inoue Tetsuji , Mizutamari Masaya , Fukuda Kazuaki , Hatake Kuniaki
Published: February 2018

Study Design.

This was a single-institute retrospective study.

Objective.

To evaluate postoperative complications in dialysis-dependent patients undergoing elective cervical and lumbar decompression surgery.

Summary of Background Data.

Spinal surgery in dialysis-dependent patients is very challenging due to the high risk of serious postoperative complications and mortality associated with their fragile general condition. However, the outcome of decompression surgery alone has not been evaluated in such patients.

Methods.

An electronic medical record review showed that 338 and 615 patients had undergone cervical and lumbar spine posterior decompression, respectively. Among them, 48 and 42, respectively were dialysis-dependent patients. Postoperative complications were compared between dialysis-dependent and non–dialysis-dependent patients.

Results.

Among patients who underwent cervical decompression, the rate of perioperative blood transfusion in dialysis-dependent patients (14.6%) was significantly higher than that in non–dialysis-dependent patients (0.7%). No severe complications or mortality occurred in association with cervical decompression. The incidence of postoperative complications in dialysis-dependent patients (6.3%) was not significantly different from that in non–dialysis-dependent patients (4.1%). Among patients who underwent lumbar decompression, the rate of perioperative transfusion in dialysis-dependent patients (11.9%) was also significantly higher than that in non–dialysis-dependent patients (0.7%). With respect to severe complications among patients who underwent lumbar decompression, cerebral hemorrhage occurred in one dialysis-dependent patient, and no mortality occurred. The incidence of postoperative complications in dialysis-dependent patients (9.2%) was not significantly different from that in non–dialysis-dependent patients (6.8%).

Conclusion.

Among patients who underwent posterior decompression alone for cervical or lumbar lesions, the rate of perioperative blood transfusion was significantly higher in dialysis-dependent than in non–dialysis-dependent patients. However, the postoperative rates of severe complications and mortality were not significantly different between the two groups. Therefore, decompression surgery alone is considered a rational surgical method with less invasiveness for dialysis-dependent patients with a fragile general condition.

Level of Evidence: 3
Delayed Fatal Lumbar Artery Bleeding Following Less Invasive Posterolateral Decompression and Fusion
Authors: Ntourantonis Dimitrios , Tsekouras Vasileios , Korovessis Panagiotis
Published: February 2018

Study Design.

A case report.

Objective.

The aim of this study was to outline the potential risks of late bleeding from the segmental vessels following less invasively dorsolateral approaches to the thoracolumbar spine.

Summary of Background Data.

A low risk of major intraoperative bleeding, associated traditional dorsolateral approach to the lumbar spine is reported, but segmental arteries and great vessels may be rarely damaged. Spine surgeons who are involved with these approaches should be aware of this rare but potential dangerous vascular complication because it could be life-threatening, particularly in elderly patients with increased morbidity, and/or metastatic disease to the spine.

Methods.

A 76-year-old white woman with a comminuted osteoporotic fracture of the L1-vertebrae with spinal canal encroachment underwent a corpectomy and a 360° fusion with the use of a titanium mesh cage, through a less invasively dorsolateral approach.

Results.

Despite the lack of visible intraoperative bleeding and uneventful postoperative period, the patient died on the seventh postoperative day as a result of massive bleeding from a segmental artery at the level of L3 vertebrae body, two levels below our intervention area.

Conclusion.

This article describes a rare complication of delayed and fatal bleeding of the segmental L3 left vertebral artery following less invasively L1 corpectomy, mesh cage insertion, and pedicle screw fixation in a elderly female patient with history of two malignancies. Although injury to large vessels must always be prevented during these procedures, an injury to the segmental vessels occurs more frequently. The dorsolateral approach and other retroperitoneal approaches to the thoracolumbar region are established methods for the surgical stabilization of comminuted vertebral body fractures, especially on the hands of experienced spine surgeons. Great care should be given postoperatively for signs of bleeding and hematoma and the surgeon should be aware for these life-threatening complications.

Level of Evidence: 5
Intersurgeon Cost Variability in Anterior Cervical Discectomy and Fusion
Authors: Sielatycki J. Alex , Chotai Silky , Wick Joseph , Sivaganesan Ahilan , Devin Clinton J.
Published: February 2018

Study Design.

Retrospective review of prospective patient outcomes and cost data.

Objective.

To analyze the contribution of surgeon-specific variability in cost and patient-reported outcomes (PROs) to overall variability in anterior cervical discectomy and fusion (ACDF), whereas adjusting for patient comorbidities.

Summary of Background Data.

Cost reduction in surgical care has received increased attention. Patient factors contributing to cost variability in ACDF have been described; however, intersurgeon cost and outcome variability has received less attention in the literature.

Methods.

Adult patients undergoing elective primary ACDF by five different surgeons were analyzed from a prospective registry database. Direct and indirect 90-day costs were compared across each surgeon, along with PROs. Predicted costs were calculated based on patient co-morbidities, and an “observed versus expected” cost differential was measured for each surgeon; this O/E cost ratio was then compared with PROs.

Results.

A total of 431 patients were included in the analysis. There were no differences in comorbidities, age, smoking status, or narcotic use. There was significant variation between surgeons in total 90-day costs, as well as variation between each surgeon's observed versus expected cost ratio. Despite these surgeon-specific cost variations, there were no differences in PROs across the participating surgeons.

Conclusion.

Intersurgeon cost variation in elective ACDF persists even after adjusting for patient comorbidities. There was no apparent correlation between increased surgeon-specific costs and 90-day PROs. These findings show there is opportunity for improvement in inter-surgeon cost variation without compromise in PROs.

Level of Evidence: 3
A Nonsurgical Approach to Mesenteric Vascular Disease
Authors: Tabriziani Hossein , Ahmad Armaghan , Bergamaschi Roberto , Frishman William H.
Published: February 2018

Mesenteric ischemia is a rare disorder, with considerably high morbidity and mortality rates. It can manifest in several ways, including acute mesenteric ischemia, chronic mesenteric ischemia, nonocclusive mesenteric ischemia, mesenteric venous thrombosis, and colonic ischemia. Of these, acute mesenteric ischemia is the most severe form of intestinal ischemia, with a high mortality rate. The mainstay of therapy for mesenteric ischemia is surgical exploration and resection of infarcted bowel; however, medical therapy can play an important adjunctive role. When diagnosed early, before bowel infarction, endovascular therapy can be used as the primary treatment option. Endovascular therapy includes catheter-based thrombolysis, thromboembolectomy, and stenting. Vasodilators also play an important role in the early management of mesenteric ischemia. Anticoagulation is the main form of therapy in mesenteric venous thrombosis.
Permanent Versus Bioresorbable Implants in Orbital Floor Blowout Fractures
Authors: Seen Sophia , Young Stephanie Ming , Teo Shao Jin , Lang Stephanie S. , Amrith Shantha , Lim Thiam-Chye , Sundar Gangadhara
Published: February 2018

Purpose:

To compare the outcomes of bioresorbable and permanent implants in the reconstruction of isolated orbital floor blowout fractures.

Methods:

Retrospective series of all patients who had orbital floor fracture repair in a single tertiary trauma center from January 2005 to December 2014. The authors reviewed the case notes and CT scans of patients with orbital floor fracture repair with either bioresorbable or permanent implants. Main outcome measures were enophthalmos, diplopia, and ocular motility restriction 1.5 years after fracture repair. Implant-related complications were collected for analysis.

Results:

There were a total of 88 patients in our study. Bioresorbable implants were used in 48 patients (54.5%) while 40 patients had permanent implants (45.5%). The authors analyzed the implants used in various sizes of orbital fractures: small (<13.3 mm), medium (13.3–20 mm), and large (>20 mm). One and a half years after fracture repair, both groups had comparable clinical outcomes (n = 2 and n = 0 for diplopia for permanent and bioresorbable implant groups, respectively, n = 0 for enophthalmos for both groups and n = 1 for ocular motility limitation for both groups) overall and across all fracture sizes.

Conclusion:

Bioresorbable implants degrade after fracture healing through hydrolysis and promote the gradual transfer of functional forces to healing bone during its disintegration. The clinical outcomes of diplopia, enophthalmos, and ocular motility restriction associated with the use of resorbable implants are comparable to that of permanent implants for all fracture sizes. Their study shows that bioresorbable and permanent implants are equally safe and effective for the treatment of patients with isolated orbital floor blowout fractures.
Neuroinflammation of the spinal cord and nerve roots in chronic radicular pain patients
Authors: Albrecht Daniel S. , Ahmed Shihab U. , Kettner Norman W. , Borra Ronald J.H. , Cohen-Adad Julien , Deng Hao , Houle Timothy T. , Opalacz Arissa , Roth Sarah A. , Melo Marcos F. Vidal , Chen Lucy , Mao Jianren , Hooker Jacob M. , Loggia Marco L. , Zhang Yi
Published: February 2018

Numerous preclinical studies support the role of spinal neuroimmune activation in the pathogenesis of chronic pain, and targeting glia (eg, microglia/astrocyte)- or macrophage-mediated neuroinflammatory responses effectively prevents or reverses the establishment of persistent nocifensive behaviors in laboratory animals. However, thus far, the translation of those findings into novel treatments for clinical use has been hindered by the scarcity of data supporting the role of neuroinflammation in human pain. Here, we show that patients suffering from a common chronic pain disorder (lumbar radiculopathy), compared with healthy volunteers, exhibit elevated levels of the neuroinflammation marker 18 kDa translocator protein, in both the neuroforamina (containing dorsal root ganglion and nerve roots) and spinal cord. These elevations demonstrated a pattern of spatial specificity correlating with the patients' clinical presentation, as they were observed in the neuroforamen ipsilateral to the symptomatic leg (compared with both contralateral neuroforamen in the same patients as well as to healthy controls) and in the most caudal spinal cord segments, which are known to process sensory information from the lumbosacral nerve roots affected in these patients (compared with more superior segments). Furthermore, the neuroforaminal translocator protein signal was associated with responses to fluoroscopy-guided epidural steroid injections, supporting its role as an imaging marker of neuroinflammation, and highlighting the clinical significance of these observations. These results implicate immunoactivation at multiple levels of the nervous system as a potentially important and clinically relevant mechanism in human radicular pain, and suggest that therapies targeting immune cell activation may be beneficial for chronic pain patients.
Correlates and importance of neglect-like symptoms in complex regional pain syndrome
Authors: Wittayer Matthias , Dimova Violeta , Birklein Frank , Schlereth Tanja
Published: February 2018

Neglect-like symptoms (NLS) are frequently observed in complex regional pain syndrome (CRPS). The clinical meaning of NLS, however, is largely unknown. Therefore, this study sets out to assess the importance of NLS for patient outcome and to explore their clinical correlates. We assessed NLS in a group of 53 patients with CRPS and compared the results to 28 healthy volunteers. To define the origin of the NLS reports, we tested the subjective visual midline, performed a limb-laterality recognition test, and quantitative sensory testing. In addition, psychological and pain assessment scales were completed. Tests were analyzed with univariate and multivariate approaches. After 6 months, patients were reassessed and the influence of NLS on pain outcome was determined. Most patients reported NLS in the questionnaire, whereas subjective visual midline and limb-laterality recognition test in contrast to previous studies did not reveal perceptual disturbances. Neglect-like symptom scores were associated with pain and pain catastrophizing in acute CRPS and anxiety and thermal sensory loss in chronic CRPS. Furthermore, high NLS scores had a negative impact on pain outcome after 6 months. Our results indicate that NLS have a different meaning in acute and chronic CRPS and might be of prognostic value. Possibly, treatment should focus on reducing NLS.
Long-term use of naldemedine in the treatment of opioid-induced constipation in patients with chronic noncancer pain: a randomized, double-blind, placebo-controlled phase 3 study
Authors: Webster Lynn R. , Nalamachu Srinivas , Morlion Bart , Reddy Jyotsna , Baba Yuko , Yamada Tadaaki , Arjona Ferreira Juan C.
Published: February 2018

The long-term safety of naldemedine, a peripherally acting µ-opioid receptor antagonist, was evaluated in patients with opioid-induced constipation and chronic noncancer pain in a 52-week, randomized, double-blind, phase 3 study. Eligible adults who could be on a routine laxative regimen were randomized 1:1 to receive once-daily oral naldemedine 0.2 mg (n = 623) or placebo (n = 623). The primary endpoint was summary measures of treatment-emergent adverse events (AEs). Additional endpoints included opioid withdrawal on the Clinical Opiate Withdrawal Scale and the Subjective Opiate Withdrawal Scale, pain intensity on Numeric Rating Scale, frequency of bowel movements, and constipation-related symptoms and quality of life on the Patient Assessment of Constipation Symptoms and Patient Assessment of Constipation Quality of Life scales, respectively. Treatment-emergent AEs (naldemedine, 68.4% vs placebo, 72.1%; difference: −3.6% [95% confidence interval: −8.7 to 1.5]) and treatment-emergent AEs leading to study discontinuation (6.3% vs 5.8%; difference: 0.5% [−2.2 to 3.1)] were reported for similar proportions of patients. Diarrhea was reported more frequently with naldemedine (11.0%) vs placebo (5.3%; difference: 5.6% [2.6-8.6]). There were no meaningful differences between groups in opioid withdrawal or pain intensity. Sustained significant improvements in bowel movement frequency and overall constipation-related symptoms and quality of life were observed with naldemedine (P ≤ 0.0001 vs placebo at all time points). Naldemedine was generally well tolerated for 52 weeks and did not interfere with opioid-mediated analgesia or precipitate opioid withdrawal. Naldemedine significantly increased bowel movement frequency, improved symptomatic burden of opioid-induced constipation, and increased patients' quality of life vs placebo.
Modification of a Ventricular Assistance Device for a Hemiplegic Left Ventricular Assist Device Patient
Authors: Muslem Rahatullah , Yalcin Yunus C. , Caliskan Kadir , van der Heiden Cees , van Rhijn Hans , Bogers Ad J. J. C. , Manintveld Olivier C.
Published: February 2018

Neurologic events occur in up to 18% of patients with continuous-flow left ventricular assist devices (LVAD) and is associated with significant morbidity and mortality. The current form of the LVAD equipment is not suited to serve patients who are impaired by a stroke. By creating an assistance device for the LVAD equipment, we have been able to greatly improve the quality of life and self-dependence of a hemiplegic LVAD patient.
Electromagnetic Interference Between Left Ventricular Assist Device and a Three-Dimensional Mapping System Overcome by “Hot Mapping”
Authors: Blockhaus Christian , Waibler Hans-Peter , Gülker Jan-Erik , Meyer Florian , Klues Heinrich , Bufe Alexander , Shin Dong-In
Published: February 2018

The number of patients with implanted left ventricular assist devices is constantly increasing. Numerous patients suffer from drug-resistant ventricular tachycardias. Only a few studies and reports about ablation therapy in this cohort of patients are available. Electromagnetic interferences between the left ventricular assist device and the three-dimensional mapping system which is used for ablation has been described as disabling the investigator to create a proper map of the left ventricle. We observed that this interference is interrupted by “hot mapping” meaning that one pretends an ablation with only 5 W, permitting the creation of a clear map in areas of interference.
Resilience and Coping After Hospital Mergers
Authors: Russo Cynthia , Calo Oriana , Harrison Georgia , Mahoney Kathleen , Zavotsky Kathleen Evanovich
Published: February 2018

Objective:

The aim of this study was to explore the relationship between resilience and coping in frontline nurses working in a healthcare system that has recently undergone a merger.

Background:

Hospital mergers are common in the current healthcare environment. Mergers can provide hospital nurses the opportunity to use and develop positive coping strategies to help remain resilient during times of change.

Methods:

An anonymous-survey, quantitative, exploratory, descriptive study design was used. Data were obtained from an electronic survey that was made available to all nurses working in a 3-hospital system located in the northeast.

Results:

Overall, the results showed that, when nurses reported using positive coping strategies, they report higher levels of resilience. The levels of resilience also varied from campus to campus. The campus that has been through 2 recent mergers reported the highest levels of resilience.

Conclusion:

This study suggests that, during times of change in the workplace, if nurses are encouraged to use positive coping strategies, they may have higher levels of resilience. This changing environment provides the clinical nurse specialists/clinical nurse educators the opportunity to foster and support frontline nurses in the use of healthy coping strategies and to help improve and maintain a high level of resilience, which is critical in today’s healthcare environment.
Assessment of Recovery Following Pediatric Traumatic Brain Injury
Authors: Slovis Julia C. , Gupta Nachi , Li Natasha Y. , Kernie Steven G. , Miles Darryl K.
Published: February 2018

Objectives:

We analyzed a prospective database of pediatric traumatic brain injury patients to identify predictors of outcome and describe the change in function over time. We hypothesized that neurologic status at hospital discharge would not reflect the long-term neurologic recovery state.

Design:

This is a descriptive cohort analysis of a single-center prospective database of pediatric traumatic brain injury patients from 2001 to 2012. Functional outcome was assessed at hospital discharge, and the Glasgow Outcome Scale Extended Pediatrics or Glasgow Outcome Scale was assessed on average at 15.8 months after injury.

Setting:

Children’s Medical Center Dallas, a single-center PICU and Level 1 Trauma Center.

Patients:

Patients, 0–17 years old, with complicated-mild/moderate or severe accidental traumatic brain injury.

Measurements and Main Results:

Dichotomized long-term outcome was favorable in 217 of 258 patients (84%), 80 of 82 patients (98%) with complicated-mild/moderate injury and 133 of 172 severe patients (77%). In the bivariate analysis, younger age, motor vehicle collision as a mechanism of injury, intracranial pressure monitor placement, cardiopulmonary resuscitation at scene or emergency department, increased hospital length of stay, increased ventilator days (all with p < 0.01) and occurrence of seizures (p = 0.03) were significantly associated with an unfavorable outcome. In multiple regression analysis, younger age (p = 0.03), motor vehicle collision (p = 0.01), cardiopulmonary resuscitation (p < 0.01), and ventilator days (p < 0.01) remained significant. Remarkably, 28 of 60 children (47%) with an unfavorable Glasgow Outcome Scale at hospital discharge improved to a favorable outcome. In severe patients with an unfavorable outcome at hospital discharge, younger age was identified as a risk factor for remaining in an unfavorable condition (p = 0.1).

Conclusions:

Despite a poor neurologic status at hospital discharge, many children after traumatic brain injury will significantly improve at long-term assessment. The factors most associated with outcomes were age, cardiopulmonary resuscitation, motor vehicle collision, intracranial pressure placement, days on a ventilator, hospital length of stay, and seizures. The factor most associated with improvement from an unfavorable neurologic status at discharge was being older.
Application of Digital Diagnosis and Treatment Technique in Benign Mandibular Diseases
Authors: Ju Rui , Zeng Wei , Lian Xiaotian , Chen Gang , Yin Huaqiang , Tang Wei
Published: February 2018

Purpose:

To explore the feasibility of preoperative planning for treatment of benign mandibular lesions (BML) using digital technologies such as three-dimensional (3D) reconstruction, measurement, visualization as well as image contrast and design of neural positioning protection template (NPPT) in combination with 3D printing technology in the BML diagnosis and treatment.

Methods:

The 3D models of BML and inferior alveolar nerves (IAN) of 10 BML patients were reconstructed based on their digital imaging and communications in medicine (DICOM) data using MIMICS16.0 software. The models were used to visualize lesions and nerve contrast measurement and guide design of personalized NPPT and osteotomy after operation modality was determined in order to achieve accurate, minimally invasive operation with shortened intraoperative time.

Results:

Intraoperative NPPT application could accurately locate lesions and their scope and assist osteotomy. The measurement results were consistent with those of preoperative reconstruction and measurement. The BML were curetted completely without damage IAN. The 10 BML patients had no numbness and other discomforts in the lower lip and mandibular teeth after operation.

Conclusions:

The digital diagnosis and treatment technology is an effective method for functional treatment of BML patients and its application could achieve personalized, minimally invasive and precise treatment and save intraoperation time.
Comparison of Three Methods Used for Estimating Area of Foramen Magnum
Authors: Gocmen Mas Nuket , Cirpan Sibel , Aksu Funda , Yonguc Demirci Goksin Nilufer , Lafci Fahrioglu Sevda , Durmaz Ozan , Karabekir Selim
Published: February 2018

Objective:

To compare whether there are any differences between the 3 methods used for measure area of foramen magnum (FM) in skulls.

Methods:

The FMs of 150 skulls were examined. Antero-posterior diameter, transverse diameter were measured using by Vernier caliper. The area of the FM was calculated by using 2 different formulas as described previously by Radinsky and Teixeira.

The authors also applied stereological assessment method for estimating the surface area of FMs. The area was calculated 3 times manually using stereological point grid system for each skull.

The authors compared the mean surface area of FMs obtained from each of these 3 methods estimating surface area of FMs whether there were any significant differences in between their results.

Results:

The mean areas of the FMs estimated according to Teixeria formula, Radinsky formula, and Cavalieri stereological method were respectively as follows: 790.47 ± 99.86 mm2, 783.66 ± 99.34 mm2, and 748.06 ± 100.19 mm2. The authors observed significant differences (P < 0.05) in between the mean surface areas of FMs obtained from each of these 3 methods used for estimating the area.

Conclusion:

There were significant differences (P < 0.05) in between the mean surface areas of FMs obtained from each of these 3 methods used for estimating the area.
Refinements in Elevation of the Reconstructed Auricle: The “Zigzag Incision”
Authors: Han So-Eun , Eom Yeseul , Oh Kap Sung
Published: February 2018

Objective:

Auricular elevation with superficial temporal fascia and skin graft is widely used in microtia reconstruction using costal cartilage. However, in some patients, there has been occurrence of contraction of skin graft, which led to insufficient projection of the elevated auricle and diminished auriculocephalic angle with unfavorable long-term results. In this article, the authors introduce their multiple triangular flaps with zigzag incision to maintain stable projection and natural retroauricular sulcus appearance in auricular reconstruction patients.

Methods:

The authors have designed zigzag incision along the lateral margin of the ear framework to prepare triangular flaps targeting the root of the helix or inferior half of the auricle. Depending on the extent of remnant skin coverage, the number of triangular flaps is varied. The posterior raw surface of the ear framework was covered with triangular flaps and full-thickness skin graft.

Results:

Zigzag incision was conducted in 22 microtia patients who underwent auricular elevation using superficial temporal fascia and skin graft. Mean follow-up period was 2 years and there were no reports of occurrence of surgery-related complications, specifically skin necrosis, infection, or hematoma. The auricular projections were well maintained and auriculocephalic angle of the constructed auricles was similar to the healthy ears.

Conclusions:

The author's method comprises comparatively easy techniques and leads to good projection of the auricular angle. A zigzag incision using the triangular flaps could be an attractive surgical option for preventing shrinkage of grafted site and in achieving sufficient projection in autologous reconstructed auricle.
Endoscopic Approach for Excision of Venous Malformation of the Orbital Apex
Authors: Ruiz Devin , Rebeiz Elie E.
Published: February 2018

Introduction:

Venous malformation is a common tumor of the orbit, presenting with visual impairment and proptosis. These lesions can be excised via an external or transcranial approach, but recent advances in minimally invasive surgery have led to increased popularity of endoscopic approach.

Patient:

The authors report a 62-year-old female presenting with diplopia and proptosis, found to have a 1.7-cm venous malformation of the orbital apex. An endoscopic trans-nasal approach was undertaken for surgical resection.

Results:

The tumor was successfully removed in a single specimen, without injury to the nearby orbital anatomy. The patient experienced resolution of her presenting symptoms 3 weeks after the procedure, with no adverse effects. A review of the literature demonstrates increasing reports of similar successful cases.

Conclusion:

A minimally invasive, endoscopic resection of orbital venous malformation is possible and provides a reasonably safe and effective approach. Further large-scale studies are needed to fully explore its outcomes relative to traditional approaches
Competitive or cooperative relationships in clusters
Authors: Ayakwah Anthony , Sepulveda Leandro , Lyon Fergus
Published: February 2018

Purpose

An efficient policy supporting clustered business operations necessitates an appreciation of the dynamics of rivalry and collaborations among businesses. This paper postulates that variation in competition and cooperation can significantly influence the nature of business relationships among clustered businesses, which is essential for cluster policy particularly (Newlands, 2003) as most research on rivalry and cooperation in clusters have been in developed economies. The purpose of this paper is to seek to fill the gap in the literature in African clusters based on original empirical research.

Design/methodology/approach

The study adopts a mixed-method research design allowing for data triangulation to study two food processing clusters. The approach comprises a survey and in-depth interview with key actors along the supply chain.

Findings

The findings show that business clusters with more formal business structures tend to have minimal horizontal competition but higher vertical cooperation. Comparatively, clusters with more socially embedded milieu tend to have higher levels of cooperation and minimal competition in both vertical and horizontal relationships. The research also shows that such variations in inter-business relationships have an effect on cluster operations in terms of business access to finance, formal contract, sharing of innovation and the way they relate to different stakeholders in their supply chain.

Originality/value

This paper advances a critical case for international business theory on clusters in Africa to incorporate the distinctive business relationships in small and medium enterprises (SME) clusters. It also demonstrates how unique location-specific attributes of developing economies hold the key to sustaining the operations of SME-based clusters.