bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunodeficiency
Authors: Provan Drew , Baglin Trevor , Dokal Inderjeet , de Vos Johannes , Theodoulou Angela
Published: August 2018

Congenital immunodeficiency syndromes - Acquired immune deficiencies - HIV infection and AIDS - Therapy of HIV infection
Haematological investigations
Authors: Provan Drew , Baglin Trevor , Dokal Inderjeet , de Vos Johannes , Kaur Mammit
Published: August 2018

Full blood count - Blood film - Plasma viscosity - ESR - Haematinic assays - Haemoglobin electrophoresis - Haptoglobin - Schumm’s test - Kleihauer test - Reticulocytes - Urinary haemosiderin - Ham’s test - Immunophenotyping - Cytogenetics - Human leucocyte antigen (HLA) typing
Expedition medicine
Authors: Johnson Chris , Anderson Sarah R. , Johnson Chris , Dykes Linda , Warrell David A. , Winser Shane
Published: August 2018

Wilderness travel - Scope of expedition medicine - Risk of death - Illness on expeditions - Conditions requiring hospital evacuation - Meeting the challenge
Emergencies: diagnosis
Authors: Dallimore Jon , Albert Edi , Dallimore Jon , Siderfin Charlie
Published: August 2018

History and examination: an introduction for non-clinicians - Clinical measurements - Illness assessment form
Emergencies: trauma
Authors: Dallimore Jon , Albert Edi , Briggs Spike , Dallimore Jon , Dhillon Sundeep , Hearns Stephen , Lockey David , Thompson Julian
Published: August 2018

Initial response to an incident - Triage - Assessment of a casualty - Airway - Breathing - Circulation - Neck and other spinal injuries - Disability - Exposure and environmental control - Secondary survey - Continuing care - Blast injuries - Lightning
Long-Term Hearing Outcomes Following Stereotactic Radiosurgery in Vestibular Schwannoma Patients—A Retrospective Cohort Study
Authors: Santa Maria Peter L , Shi Yangyang , Gurgel Richard K , Corrales C Eduardo , Soltys Scott G , Santa Maria Chloe , Murray Kevin , Chang Steven D , Blevins Nikolas H , Gibbs Iris C , Jackler Robert K
Published: August 2018

BACKGROUND

An understanding of the hearing outcomes is needed for treatment counseling for patients with vestibular schwannomas (VS).

OBJECTIVE

To determine long-term hearing results following stereotactic radiosurgery (SRS) for VS and identify any influential variables.

METHODS

Tertiary hospital retrospective cohort.

RESULTS

There were 579 tumors (576 patients) treated with SRS. Eighty-two percent (473) of tumors had ≥1 yr and 59% (344 ≥3 yr follow-up. In the 244 tumor ears, with measurable hearing before SRS who were followed ≥1 yr, 14% (31) had improved hearing, 13% (29) unchanged hearing, and 74% (158) had worsened hearing. In 175 patients with ≥3 yr follow-up and who had measurable hearing pretreatment, 6% (11 ears) improved hearing, 31% (54 ears) unchanged hearing, and 63% (110 ears) had worsened hearing. Patients with tumors with larger target volumes (P = .040) and with neurofibromatosis type 2 (NF2; P = .017) were associated with poorer hearing (P = .040). Patients with word recognition scores (WRS) of 50% or poorer had tumors with a larger volume (P = .0002), larger linear size (P = .032), and NF2 (P = .045). Traditionally reported hearing outcomes using the Gardner Robertson maintenance of PTA ≤50 db or WRS ≥50% were 48% at 3 yr, which overestimates hearing outcomes compared to the above reporting standards.

CONCLUSION

Hearing declines over time in VS treated with SRS in a high proportion of cases. The frequency and magnitude of long-term hearing decline following SRS argues against prophylactic radiation for small tumors in hearing ears with undetermined growth behavior.
Koos Classification of Vestibular Schwannomas: A Reliability Study
Authors: Erickson Nicholas J , Schmalz Philip G R , Agee Bonita S , Fort Matthew , Walters Beverly C , McGrew Benjamin M , Fisher Winfield S
Published: August 2018

BACKGROUND

The Koos classification of vestibular schwannomas is designed to stratify tumors based on extrameatal extension and compression of the brainstem. While this classification system is widely reported in the literature, to date no study has assessed its reliability.

OBJECTIVE

To assess the intra- and inter-rater reliability of the Koos classification system.

METHODS

After institutional review board approval was obtained, a cross-sectional group of the Magnetic Resonance imagings of 40 patients with vestibular schwannomas varying in size comprised the study sample. Four raters were selected to assign a Koos grade to 50 total scans. Inter- and intrarater reliability were calculated and reported using Fleiss’ kappa, Kendall's W, and Intraclass correlation coefficient (ICC).

RESULTS

Inter-rater reliability was found to be substantial when measured using Fleiss' kappa (.71), extremely strong using Kendall's W (.92), and excellent as calculated by ICC (.88).

Intrarater reliability was perfect for 3 out of 4 raters as assessed using weighted kappa, Kendall's W and ICC, with the intrarater agreement for the fourth rater measured as extremely high.

CONCLUSION

We have demonstrated that the Koos classification system for vestibular schwannoma is a reliable method for tumor classification. This study lends further support to the results of current literature using Koos grading system. Further studies are required to evaluate its validity and utility in counseling patients with regard to outcomes.
Single-atom catalyst: a rising star for green synthesis of fine chemicals
Authors: Zhang Leilei , Ren Yujing , Liu Wengang , Wang Aiqin , Zhang Tao
Published: August 2018

The green synthesis of fine chemicals calls for a new generation of efficient and robust catalysts. Single-atom catalysts (SACs), in which all metal species are atomically dispersed on a solid support, and which often consist of well-defined mononuclear active sites, are expected to bridge homogeneous and heterogeneous catalysts for liquid-phase organic transformations. This review summarizes major advances in the SAC-catalysed green synthesis of fine chemicals in the past several years, with a focus on the catalytic activity, selectivity and reusability of SACs in various organic reactions. The relationship between catalytic performance and the active site structure is discussed in terms of the valence state, coordination environment and anchoring chemistry of single atoms to the support, in an effort to guide the rational design of SACs in this special area, which has traditionally been dominated by homogeneous catalysis. Finally, the challenges remaining in this research area are discussed and possible future research directions are proposed.
High-Flow Nasal Cannula Practice Patterns Reported by Neonatologists and Neonatal Nurse Practitioners in the United States
Authors: Eklund Wakako Minamoto , Scott Patricia A.
Published: August 2018

Background:

High-flow nasal cannula (HFNC) is widely used to treat neonatal respiratory conditions. Significant evidence emerged in recent years to guide practice, yet current practice patterns and their alignment with the evidence remain unknown.

Purpose:

To examine current HFNC practice patterns and availability of clinical practice guidelines used in neonatal intensive care units in the United States.

Methods/Analysis:

A nonexperimental, descriptive study was designed using a web-based survey to elicit a convenience sample of US neonatal providers. Quantitative data were analyzed using descriptive statistics, χ2 tests were used to test for differences among the categories, and post hoc comparisons among each combination of categories were conducted using a Bonferroni-corrected α of .05 to determine significance as appropriate.

Results:

A total of 947 responses were analyzed (626 neonatologists and 321 neonatal nurse practitioners). Univariate analyses suggested wide variations in practice patterns. One-third of the respondents used clinical guidelines, the majority utilized HFNC devices in conjunction with nasal continuous positive airway pressure, more than two-thirds used HFNC as a primary respiratory support treatment, and among all respondents, significant differences related to HFNC device types were reported.

Implications for Practice:

US providers revealed wide practice variations related to HFNC therapy. In addition, type of device used appears to impact practice patterns and approaches. Use of standardized guidelines was reported by one third of the respondents, and as such may be the contributing factor for wide practice variations.

Implications for Research:

Future Research is needed to target aspects of practice where practice variations exist, or practice is not supported by evidence. Significant practice differences related to the device types should be considered in future research design.
Changing Hearing Performance and Sound Preference With Words and Expectations: Meaning Responses in Audiology
Authors: Hodgetts William E. , Aalto Daniel , Ostevik Amberley , Cummine Jacqueline
Published: August 2018

Objectives:

In this article, we explore two manipulations of “meaning response,” intended to either “impart” meaning to participants through the manipulation of a few words in the test instructions or to “invite” meaning by making the participant feel involved in the setting of their preferred sound.

Design:

In experiment 1, 59 adults with normal hearing were randomly assigned to one of the two groups. Group 1 was told “this hearing in noise test (HINT) you are about to do is really hard,” while the second group was told “this HINT test is really easy.” In experiment 2, 59 normal-hearing adults were randomly assigned to one of two groups. Every participant was played a highly distorted sound file and given 5 mystery sliders on a computer to move as often and as much as they wished until the sound was “best” to them. They were then told we applied their settings to a new file and they needed to rate their sound settings on this new file against either (1) another participant in the study, or (2) an expert audiologist. In fact, we played them the same sound file twice.

Results:

In experiment 1, those who were told the test was hard performed significantly better than the easy group. In experiment 2, a significant preference was found in the group when comparing “my setting” to “another participant.” No significant difference was found in the group comparing “my setting” to the “expert.”

Conclusions:

Imparting or inviting meaning into the context of audiological outcome measurement can alter outcomes even in the absence of any additional technology or treatment. These findings lend support to a growing body of research about the many nonauditory factors including motivation, effort, and task demands that can impact performance in our clinics and laboratories.
Advances in the early diagnosis and therapy of inclusion body myositis
Authors: Lilleker James B.
Published: August 2018

Purpose of review

To describe recent advancements in diagnostic and therapeutic approaches to inclusion body myositis (IBM).

Recent findings

Our understanding of the implications of anti-cytosolic 5′-nucleotidase 1A autoantibody status in IBM and other diseases is increasing. Muscle imaging using magnetic resonance techniques and ultrasound is increasingly being performed and characteristic patterns of muscle involvement may help with diagnosis. Longitudinal imaging studies are likely to help with monitoring and as an outcome measure in clinical trials. Recent small-scale studies of Arimoclomol and Rapamycin have shown promising results and further investigation of these medications is ongoing. Exercise is likely to form an increasingly important facet of management of patients with IBM, but the optimal type of exercise programme to enrol patients in is not yet determined.

Antibody testing and muscle imaging results may improve our ability to diagnose IBM and the availability of effective disease modifying treatments targeting novel non-inflammatory pathways could soon become a reality. It remains the duty of those involved in the management of patients with IBM to facilitate involvement in clinical trials and other research studies.
Insights into myofibroblasts and their activation in scleroderma: opportunities for therapy?
Authors: Gyftaki-Venieri Dafni A. , Abraham David J. , Ponticos Markella
Published: August 2018

Purpose of review

The persistence of myofibroblasts is a key feature of fibrosis and in fibrotic diseases including scleroderma. This review evaluates the emerging concepts of the origins and cell populations that contribute to myofibroblasts and the molecular mechanisms that govern phenotypic conversion and that highlight opportunities for new interventional treatments in scleroderma.

Recent findings

Studies have defined heterogeneity in fibroblast-like cells that can develop into myofibroblast in normal wound healing, scarring and fibrosis. Characterizing these distinct cell populations and their behaviour has been a key focus. In addition, the overarching impact of epigenetic regulation of genes associated with inflammatory responses, cell signalling and cell communication and the extracellular matrix (ECM) has provided important insights into the formation of myofibroblast and their function. Important new studies include investigations into the relationship between inflammation and myofibroblast production and further evidence has been gathered that reveal the importance of ECM microenvironment, biomechanical sensing and mechanotransduction.

This review highlights our current understanding and outlines the increasing complexity of the biological processes that leads to the appearance of the myofibroblast in normal functions and in diseased tissues. We also focus on areas of special interest in particular, studies that have therapeutic potential in fibrosis and scleroderma.
Evidence-based Recommendations for Pediatric Orthopaedic Practice
Authors: Mulpuri Kishore , Schaeffer Emily K. , Sanders James , Zaltz Ira , Kocher Mininder S.
Published: August 2018

Background:

The evidence-based approach to guide clinical practice has gained great importance in the medical field. High-quality evidence is of paramount importance to inform clinical decision-making and optimize patient outcomes. The generation of high-quality evidence relies on sound methodology and study design to facilitate appropriate interpretation and subsequent application of the clinical findings. The purpose of this review is to objectively critique the methodological design and clinical findings of 2 pediatric orthopaedic studies on children with cerebral palsy (CP) to assess their potential to impact clinical practice.

Methods:

This is the second in a series of evidence-based reviews in pediatric orthopaedics. The pediatric orthopaedic literature was reviewed for randomized controlled trials (RCTs) published in 2015 and 2016. One RCT was selected from the journal Pediatrics, and one RCT was selected from the journal Developmental Medicine and Child Neurology, both investigating the use of botulinum toxin for the treatment of spastic equinus in children with CP. These RCTs were subjected to in-depth methodological review by orthopaedic surgeons with advanced research degrees and a PhD researcher. Two clinical experts then reviewed the articles to rate the clinical impact or value of each study. Methodological and clinical reviews were compiled, and a final recommendation on impact to change clinical practice was made based on both review components at the consensus of the panel.

Results:

The first study reviewed investigated the single-dose efficacy and safety of botulinum neurotoxin type-A (1BoNT-A) in children with CP-associated spasticity and equinus foot deformity. The reviewers deemed the placebo-controlled study to be of sound design, and conclusions appropriate for the methodology used and clinical findings. Although findings suggest 1BoNT-A may provide benefit in treating equinus foot deformity, the optimal dose for achieving maximal impact on functional improvement remains undetermined. The second study reviewed investigated the impact of multiple dosing schedules on spastic equinus in CP. Although of relatively sound design, this study was limited by a small sample size and lack of justification for the chosen effect size. Without further study, no recommendation to change clinical practice could be made.

Conclusions:

Both RCTs reviewed were superiority studies, the first demonstrating efficacy of botulinum toxin over placebo, the second showing no significant difference in 4- and 12-monthly botulinum toxin injections.

Significance:

Despite a positive result demonstrating an effect of botulinum toxin treatment on spastic equinus in CP, the long-term functional impact and optimal dose remains to be determined. In addition, the negative result in the second study demonstrates the need for a noninferiority trial design to appropriately demonstrate no difference between 2 treatment options.
The Recognition, Incidence, and Management of Spinal Cord Monitoring Alerts in Pediatric Cervical Spine Surgery
Authors: Mohammad Waleed , Lopez Denise , Isley Michael , Phillips Jonathan H.
Published: August 2018

Background:

Perioperative spinal cord injury and postoperative neurological deficits are the major complications in spinal surgery. Monitoring of spinal cord function is of crucial importance. Somatosensory evoked potentials and transcranial electric motor-evoked potentials are now widely used in cervical spine surgery. Although much has been written on spinal cord monitoring in adult spinal surgery, very little has been published on the incidence and management of monitoring of cervical spine surgery in the pediatric population. The goal of this research was to review the recognition, incidence, and management of spinal cord monitoring in pediatric patients undergoing cervical spine surgery over the course of twenty years in a single institution. We postulate spinal cord monitoring alerts in pediatric cervical spine surgery are underreported.

Methods:

An IRB-approved retrospective single institution review of pediatric cervical spine cases from 1997 to 2017 was performed. Both the surgeon’s dictated operative note and the neuromonitoring team’s dictated note were reviewed for each case, and both were cross referenced and correlated with one another to ensure no alerts were missed. All monitoring changes were assumed to be significant and reported. The incidence of alerts, type of changes, and corrective maneuvers were noted. New postoperative neurological injuries were recorded.

Results:

From 1997 to 2017 fifty-three patients underwent a total of 69 procedures involving the cervical spine. Fourteen procedures (20%) were not monitored, whereas 55 procedures were 80%. There were 12 procedures (21.8%) complicated by neuromonitoring alerts.

Conclusions:

The number of cases complicated by alerts doubles that previously reported, and it is important to note there were no new permanent neurological deficits recorded over the study period. Corrective strategies were implemented once the operating surgeon was notified of the neuromonitoring alert. Aborting the case was then considered if corrective strategies failed to restore baseline neurophysiology.

Level of Evidence:

Level IV.
Magnetic Intramedullary Lengthening Nails and MRI Compatibility
Authors: Gomez Charles , Nelson Scott , Speirs Joshua , Barnes Samuel
Published: August 2018

Background:

Magnetic intramedullary nails (IMNs) are fully implantable lengthening devices that became available in the United States in 2011 for the correction of limb length discrepancies. This device represents a major advancement in the field of limb lengthening surgery as it is typically tolerated better than external fixation. Unlike traditional IMNs, surgeons recommend routine removal following limb lengthening. One such reason involves patient safety as it pertains to magnetic resonance imaging (MRI). Theoretical concerns with MRI exposure include implant migration, implant heating, and involuntary elongation of the lengthening mechanism. Our study seeks to investigate the effects of MRI on intramedullary magnetic lengthening nails.

Methods:

Twenty-five intramedullary magnetic nails were studied. One nail was placed within the magnetic field to measure maximum magnetic force. Nails were then scanned using standard knee MRI protocols, 12 in 3 T and 12 in 1.5 T MRI scanners. The following parameters were measured: (1) distraction of the implants after MRI exposure, (2) temperature before and after MRI, and (3) internal distraction force before and after MRI.

Results:

Maximum magnetic force was found to be 2 lbs. There was no involuntary distraction of the implants after MRI. Temperature increase of 3.3°C was found in the femoral nails and 3.6°C in the tibial nails that were exposed to 3 T MRI. This increase did not reach or exceed physiological temperature of 37°C. Distraction force was reduced by 61.7% in the femoral nails and 89.6% in the tibial nails after subjected to 3 T MRI. There was no reduction in distraction force after exposure to 1.5 T MRI.

Conclusions:

Recommendations for routine removal of magnetic IMNs for safety concerns should be reconsidered. Exposure to 3 T MRI should be avoided in patients who are still undergoing lengthening or with plans for future lengthening with magnetic IMNs.

Clinical Relevance:

To assess patient safety and implant function after magnetic IMNs have been exposed to MRI.
Posterolateral Versus Posterior Interbody Fusion in Lumbar Degenerative Spondylolisthesis
Authors: Urquhart Jennifer C. , Alnaghmoosh Nabeel , Gurr Kevin R. , Bailey Stewart I. , Tallon Corinne , Dehens Shauna , Rosas Arellano M. Patricia , Bailey Christopher S.
Published: August 2018

Study Design:

This was a retrospective study of 2 different fusion techniques for the treatment of lumbar degenerative spondylolisthesis.

Objective:

To determine whether posterior lumbar interbody fusion (IF) is associated with improved patient-rated satisfaction and functional outcome when compared with posterolateral fusion (PLF).

Summary of Background Data:

IF and PLF are widely used surgical approaches in the treatment of spondylolisthesis. Numerous studies have compared IF and PLF techniques, but inconsistent results, heterogeneous cohorts, and conflicting scientific evidence have made it difficult to reach a consensus on the optimal fusion technique.

Materials and Methods:

A consecutive cohort of 87 patients who had single-level degenerative spondylolisthesis and either PLF or IF were identified from a prospectively maintained database. Short Form-36 physical and mental component score, Oswestry Disability Index, back and leg pain, and complication rate were assessed to 24 months postoperatively. Patient characteristics, clinical outcome, and complications were compared between groups.

Results:

Of the 87 patients identified, 29 patients (33%) had PLF and 58 patients (67%) had IF. Patient follow-up was ≥85%. Foraminal stenosis (PLF, 13.8% vs. IF, 34.5%; P=0.046) was more common among the participants in the IF group. Intraoperative and postoperative complications were not different between groups (P>0.05). The reoperation rate was 3.4% in the PLF group and 10.3% in the IF group (P=0.416). Patients in the PLF group experienced similar gains in improvement in all outcome measures as those in the IF group (P>0.05). Four patients in the IF group and 3 in the PLF group were lacking evidence of radiographic fusion. These patients did have increased moderate back pain compared with patients demonstrating radiographic fusion but did not differ in any other postoperative outcomes measures.

Conclusions:

Type of fusion, IF or PLF, does not affect patient outcome or postoperative complication rates.

Level of Evidence

Level IV.
Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial*
Authors: Salter Ryan , Bailey Michael , Bellomo Rinaldo , Eastwood Glenn , Goodwin Andrew , Nielsen Niklas , Pilcher David , Nichol Alistair , Saxena Manoj , Shehabi Yahya , Young Paul
Published: August 2018

Objectives:

To evaluate knowledge translation after publication of the target temperature management 33°C versus 36°C after out-of-hospital cardiac arrest trial and associated patient outcomes. Our primary hypothesis was that target temperature management at 36°C was rapidly adopted in Australian and New Zealand ICUs. Secondary hypotheses were that temporal reductions in mortality would be seen and would have accelerated after publication of the target temperature management trial.

Design:

Retrospective cohort study (January 2005 to December 2016).

Setting:

The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation adult patient database containing greater than 2 million admission episodes from 186 Australian and New Zealand ICUs.

Patients:

Sixteen-thousand two-hundred fifty-two adults from 140 hospitals admitted to ICU after out-of-hospital cardiac arrest.

Interventions:

The primary exposure of interest was admission before versus after publication of the target temperature management trial.

Measurements and Main Results:

The primary outcome variable to evaluate changes in temperature management was lowest temperature in the first 24 hours in ICU. The primary clinical outcome variable of interest was inhospital mortality. Secondary outcomes included proportion of patients with fever in the first 24 hours in ICU. Mean ± sd lowest temperature in the first 24 hours in ICU in pre- and posttarget temperature management trial patients was 33.80 ± 1.71°C and 34.70 ± 1.39°C, respectively (absolute difference, 0.98°C [99% CI, 0.89–1.06°C]). Inhospital mortality rate decreased by 1.3 (99% CI, –1.8 to –0.9) percentage points per year from January 2005 until December 2013 and increased by 0.6 (99% CI, –1.4 to 2.6) percentage points per year from January 2014 until December 2016 (change in slope 1.9 percentage points per year [99% CI, –0.6 to 4.4]). Fever occurred in 568 (12.8%) of 4,450 pretarget temperature management trial patients and 853 (16.5%) of 5,184 posttarget temperature management trial patients (odds ratio, 1.35 [99% CI, 1.16–1.57]).

Conclusions:

The average lowest temperature of postcardiac arrest patients in the first 24 hours in ICU rose after publication of the target temperature management trial. This change was associated with an increased frequency of fever not seen in the target temperature management trial.
Plexiform Xanthomatous Tumor, Variety of Xanthoma or Subtype of Fibrohistiocytic Tumors?
Authors: Illán-Gambín Francisco José , Encabo-Durán Belén , Romero-Pérez David , Álvarez-Chinchilla Pedro , Niveiro-de Jaime María
Published: August 2018

Plexiform xanthomatous tumor was proposed as an independent neoplasm within fibrohistiocytic tumor group a few years ago. The arguments were based on their different clinical features as well as their own morphological and immunohistochemical findings. Nevertheless, it has not been widely studied yet, and there are few reports about this entity. Regarding a case, we reviewed the diagnostic characteristics of this underdiagnosed tumor.
Decomposition Analysis to Identify Intervention Targets for Reducing Disparities
Authors: Jackson John W. , VanderWeele Tyler J.
Published: August 2018

There has been considerable interest in using decomposition methods in epidemiology (mediation analysis) and economics (Oaxaca–Blinder decomposition) to understand how health disparities arise and how they might change upon intervention. It has not been clear when estimates from the Oaxaca–Blinder decomposition can be interpreted causally because its implementation does not explicitly address potential confounding of target variables. While mediation analysis does explicitly adjust for confounders of target variables, it typically does so in a way that effectively entails equalizing confounders across racial groups, which may not reflect the intended intervention. Revisiting prior analyses in the National Longitudinal Survey of Youth on disparities in wages, unemployment, incarceration, and overall health with test scores, taken as a proxy for educational attainment, as a target intervention, we propose and demonstrate a novel decomposition that controls for confounders of test scores (e.g., measures of childhood socioeconomic status [SES]) while leaving their association with race intact. We compare this decomposition with others that use standardization (to equalize childhood SES [the confounders] alone), mediation analysis (to equalize test scores within levels of childhood SES), and one that equalizes both childhood SES and test scores. We also show how these decompositions, including our novel proposals, are equivalent to implementations of the Oaxaca–Blinder decomposition but provide a more formal causal interpretation for these decompositions.
The Effect of Electrical Load Shedding on Pediatric Hospital Admissions in South Africa
Authors: Gehringer Christian , Rode Heinz , Schomaker Michael
Published: August 2018

Background:

South Africa faced repeated episodes of temporary power shutdowns, or load shedding, in 2014/2015. The effect of load shedding on children’s health is unknown.

Methods:

We determined periods of load shedding using Twitter, Facebook, and data from the City of Cape Town. We obtained the number of unscheduled hospital admissions between June 2014 and May 2015 from Red Cross Children’s Hospital, Cape Town, and weather data from the South African Weather Service. We used quasi-Poisson regression models to explore the relationship between number of hospital admissions and load shedding, adjusted for season, weather, and past admissions. Based on assumptions about the causal process leading to hospital admissions, we estimated the average treatment effect, that is, the difference in expected number of admissions per day had there been load shedding each day or on any of the preceding 2 days compared with if there had not been any load shedding.

Results:

We found a 10% increase (95% confidence interval: 4%, 15%) in hospital admissions for days where load shedding was experienced on the same day, or no more than 2 days prior, compared with when there was no load shedding in the past 2 days. The increase was more pronounced during weekdays (12% [7%, 18%] vs. 1% [−9%, 11%]), and for specific diagnoses (e.g., respiratory system: 14% [2%, 26%]). The average treatment effect was estimated as 6.50 (5.12, 7.87) highlighting that about 6 additional admissions a day could be attributed to load shedding.

Conclusions:

The association we measured is consistent with our hypothesis that failures of the power infrastructure increase risk to children’s health. See video abstract at, http://links.lww.com/EDE/B409.
EPIRETINAL MEMBRANE REMOVAL WITH FOVEAL-SPARING INTERNAL LIMITING MEMBRANE PEELING
Authors: Russo Andrea , Morescalchi Francesco , Gambicorti Elena , Cancarini Anna , Costagliola Ciro , Semeraro Francesco
Published: August 2018

Purpose:

To compare the retinal sensitivity after complete internal limiting membrane (ILM) peeling with that after foveal-sparing ILM peeling during vitrectomy for Type I epiretinal membrane.

Methods:

This was a prospective, randomized, comparative study. Thirty-eight eyes were randomized to undergo complete peeling of the ILM (CP group) or peeling with foveal sparing (FS group). The main outcome measures were foveal and perifoveal retinal sensitivity, visual acuity, and central retinal thickness.

Results:

Foveal retinal sensitivity showed a significant improvement in the FS group (2.82 ± 0.85 dB, P = 0.037) versus a slight drop in the CP group (−0.66 ± 0.48 dB, P = 1). Perifoveal retinal sensitivity slightly improved in both groups (0.47 ± 0.37 dB, P = 1 in the CP group and 0.79 ± 0.42 dB, P = 0.77 in the FS group), showing a similar trend without significant differences. Significant improvements were observed in both visual acuity and central retinal thickness in both groups. However, three cases in the FS group showed epiretinal membrane recurrence and required revision surgery with complete ILM removal.

Conclusion:

Internal limiting membrane peeling may reduce retinal sensitivity and significantly increase the incidence of microscotomas. However, the higher epiretinal membrane recurrence rate after the foveal-sparing technique limits the effectiveness of this procedure. Further studies must be conducted to determine if it is safe to leave a portion of the ILM in front of the fovea.
ADALIMUMAB THERAPY FOR REFRACTORY BIRDSHOT CHORIORETINOPATHY
Authors: Huis in het Veld Paulien I. , van Asten Freekje , Kuijpers Robert W.A.M. , Rothova Aniki , de Jong Eiko K. , Hoyng Carel B.
Published: August 2018

Purpose:

To report the outcome of using adalimumab to treat birdshot chorioretinopathy.

Methods:

Retrospective case series of 19 patients (38 eyes) with HLA-A29–positive birdshot chorioretinopathy who received adalimumab treatment. Patients had been refractory to previous standard systemic immunomodulatory therapy. They received biweekly subcutaneous injections of 40 mg of adalimumab. Outcome measures were change in visual acuity, fluorescein angiography, and optical coherence tomography features, the concomitant use of immunosuppressive drugs, and the occurrence of adverse effects between 1 year before, at baseline, and after 1 year of adalimumab treatment.

Results:

Mean Snellen visual acuity at 1-year follow-up was 20/28, an improvement from 20/43 at the start of the treatment (P = 0.011) and equal to the visual acuity 1 year before the treatment (20/29). Only 2 of the 9 patients who had complete fluorescein angiography and optical coherence tomography results after the 1 year of treatment were completely free of inflammation signs at the end of the follow-up. Half (53%) of 17 patients were receiving adalimumab monotherapy after 1 year of treatment, an increase from 21% at the start of treatment (P = 0.047). Three of the 19 patients reported possible side effects; 2 discontinued treatment within 1 year.

Conclusion:

The results suggest that adalimumab is effective at improving visual acuity and at tapering concomitant immunomodulatory therapy, in patients with refractory birdshot chorioretinopathy. However, complete remission is rarely achieved.
CENTRAL SEROUS CHORIORETINOPATHY ASSOCIATED WITH STEROID ENEMA
Authors: Peiris Timothy J. , El Rami Hala E. , Sun Jennifer K.
Published: August 2018

Background/Purpose:

To report a case of acute recurrent central serous chorioretinopathy that developed after a regimen of corticosteroid enemas and suppositories.

Methods:

Observational case report. Fluorescein angiography and spectral domain optical coherence tomography.

Results:

A 47-year-old male patient with ulcerative colitis managed through hydrocortisone enemas presented to clinic with a 1-day history of blurry vision of his left eye. Posterior segment examination revealed subretinal fluid in the superotemporal macula of the left eye extending centrally. After diagnosis of acute central serous chorioretinopathy, the patient was advised to taper steroid enemas and his visual symptoms and subretinal fluid resolved within the month. Seven years later, several months after using steroid suppositories for the first time since the original central serous chorioretinopathy episode, asymptomatic subretinal fluid accumulation with foveal sparing was found on routine ophthalmic examination. Three months later, most of this fluid had resolved with minimal residual subretinal fluid on clinical examination.

Conclusion:

Acute central serous chorioretinopathy may develop after corticosteroid enema or suppository use, a route of administration that has not been previously reported in association with the disease.
BRANCH RETINAL ARTERY WALL RUPTURE AND SUBSEQUENT OCCLUSION DURING PARS PLANA VITRECTOMY WITH MEMBRANE PEEL
Authors: Garrity Sean T. , Govetto Andrea , Hubschman Jean Pierre
Published: August 2018

Purpose:

To report a case of branch retinal artery wall rupture and subsequent branch retinal artery occlusion occurring during a routine pars plana vitrectomy with epiretinal membrane and internal limiting membrane peeling.

Methods:

Case report. Multimodal imaging including fluorescein angiography, spectral domain optical coherence tomography (OCT), en face OCT, and OCT angiography were performed.

Results:

An 86-year-old woman presented with a symptomatic epiretinal membrane in the right eye. Pars plana vitrectomy with epiretinal membrane and internal limiting membrane peel was performed. During the peel, spontaneous preretinal and intraretinal hemorrhage emanating from an adjacent branch retinal artery developed. At postoperative Week 1, OCT showed retinal thinning and hyperreflectivity suggestive of vascular accident. At postoperative Year 1, OCT imaging revealed retinal atrophy while fluorescein angiography demonstrated the arterial occlusion, and OCT angiography illustrated reduction in retinal perfusion in the region of the branch retinal artery occlusion.

Conclusion:

The authors report an unusual case of retinal arterial wall rupture and hemorrhaging during routine pars plana vitrectomy with membrane peel resulting in a branch retinal artery occlusion and subsequent retinal atrophy. Surgeons must limit stress on the underlying retina during membrane peel to avoid this surgical complication.
RETINAL DYSTROPHY IN A PATIENT WITH McARDLE DISEASE
Authors: Alsberge Joseph B. , Chen Judy J. , Zaidi Ali A. , Fu Arthur D.
Published: August 2018

Purpose:

To report a case of pattern dystrophy in a patient with McArdle disease, a rare autosomal recessive disorder of glycogen metabolism.

Methods:

Case report.

Results:

A 29-year-old woman with a history of muscle biopsy–confirmed McArdle disease presented with fundus findings consistent with pattern dystrophy. Multimodal imaging, including optical coherence tomography and fundus autofluorescence, was performed.

Conclusion:

To our knowledge, this is the third reported case of pattern dystrophy in a patient with McArdle disease.
PHENOTYPIC HETEROGENEITY IN A FAMILY WITH X-LINKED FAMILIAL EXUDATIVE VITREORETINOPATHY WITH PREVENTION OF VISUAL LOSS IN AN AFFECTED MALE CHILD WITH LASER TREATMENT IN INFANCY
Authors: Flores Pimentel Mariana A. , De la Huerta Irina , Duncan Jacque L. , Slavotinek Anne M. , Moore Anthony T. , de Alba Campomanes Alejandra G.
Published: August 2018

Purpose:

To present the scope of prenatal diagnosis and early treatment of patients with clinically heterogeneous phenotypic retinal dysplasia associated with NDP gene variants.

Methods:

Retrospective. Review of electronic medical records.

Results:

Twenty-nine–year-old woman known to carry a NDP gene variant presented to the eye clinic for consultation and risk assessment at her second pregnancy. Her 11-year-old son had bilateral retinal detachment, despite surgical treatment. The family declined prenatal testing. The patient was born full term, was examined, and underwent genetic testing after birth. He was found to have bilateral retinal avascular periphery abnormalities and preretinal hemorrhages on the left eye. The patient received bilateral laser treatment at 2 months of age. He was found to be doing well at 16 months after treatment with adequate visual acuity and flat maculae. The asymptomatic mother and maternal grandfather of the proband were found to have retinal periphery abnormalities with unremarkable posterior pole and excellent visual acuity.

Conclusion:

NDP gene variants associated with X-linked familial exudative vitreoretinopathy phenotype benefit from early treatment. Providers who take care of these patients need to monitor closely the pregnancy and delivery of a male child born to a female carrier to offer appropriate and timely treatment.
Tenofovir Disoproxil Fumarate Use during Pregnancy and Infant Bone Health: the Tenofovir in Pregnancy Pilot Study
Authors: Kourtis Athena P. , Wiener Jeffrey , Wang Liming , Fan Bo , Shepherd John A. , Chen Lili , Liu Wei , Shepard Colin , Wang Linhong , Wang Ailin , Bulterys Marc
Published: August 2018

The effects of maternal tenofovir use on infant bone mineral content (BMC) and bone mineral density (BMD) were evaluated in a pilot study of HIV/Hepatitis B-coinfected pregnant women in China. BMD and BMC were assessed at age 6 months of life in 14 tenofovir-exposed and 13 unexposed infants. Trends toward lower BMC and BMD were observed in infants exposed to maternal tenofovir but were not statistically significant.
Metastatic Salivary Ductal Carcinoma to the Mastoid Segment of the Facial Nerve
Authors: Fabie Joshua E. , Hatch Jonathan L. , Cross Ashley W. , Oyer Samuel L. , Neskey David M. , McRackan Theodore R.
Published: August 2018

Objective:

To describe salivary ductal carcinoma (SDC) presenting as an isolated lesion of the mastoid segment of the facial nerve

Patients:

A 70-year-old man presenting with weakness of his right lower lip that progressed to complete facial paralysis over a span of 2 weeks.

Main Outcome Measures:

Clinical case records, immunohistochemical analyses, and radiological analyses including magnetic resonance imaging and positron emission tomography-computed tomography.

Results:

Nodular enhancement along the mastoid segment of the facial nerve was identified without any mass within the parotid on magnetic resonance imaging or regional/distant disease on positron emission tomography-computed tomography. Pathologic analysis of tissue obtained from a right parotidectomy, neck dissection, and transmastoid resection of the vertical segment of the facial nerve revealed a benign parotid gland with malignant glands identified intra- and perineurally within the central aspect of the gland.

Conclusions:

SDC is one of the most aggressive salivary malignancies and typically presents as a rapidly enlarging mass in the involved gland. Although SDC's clinical course is characterized by early metastasis, isolated neural invasion has not been reported in the absence of an identifiable primary tumor within the gland of origin. The present case illustrates the clinical history and treatment of the first case of a SDC presenting as an isolated facial nerve lesion from perineural spread.
Pediatric free flap reconstruction for head and neck defects
Authors: Roasa Francis V. , Castañeda Samantha S. , Mendoza Daniel Jose C.
Published: August 2018

Purpose of review

The aim of this study was to review recent literature on the use of pediatric free flap reconstruction for head and neck defects with focus on skull base, congenital deformities, mandibular reconstruction and operative considerations.

Recent findings

Reconstruction of the skull base depends on the defect size, location, bony involvement, and pedicle length with a variety of flaps to choose from. Free flaps may be used to correct congenital anomalies due to facial clefts and syndromic causes requiring bony and tissue bulk. Preservation of the condyle together with free flap mandibular reconstruction has better growth potential. Delayed repair of mandibular defects may be an option especially for patients with malignancy. Chemotherapy and radiation therapy may inhibit the growth potential of the mandible. The use of running or coupled arterial anastomosis is associated with an increased immediate complication.

Pediatric free flap reconstruction is a reasonable option for various head and neck defects such as skull base, congenital, and mandibular defects.
Exploration of Relationships Between Postoperative Pain and Subsyndromal Delirium in Older Adults
Authors: Denny Dawn L. , Such Tami L.
Published: August 2018

Background

Subsyndromal delirium is associated with serious adverse outcomes of longer lengths of stay, increased long-term care admissions, and higher 6-month mortality rates. Postoperative pain is a risk factor for delirium, but the relationship between pain and the severity of subclinical delirium symptoms is unclear. A better understanding will inform nursing interventions to reduce adverse outcomes associated with delirium symptoms.

Objectives

The purpose of this correlational study was to determine the relationship between pain and subsyndromal delirium in older adults following joint replacement surgery.

Methods

Delirium assessments were completed on postoperative Days 1, 2, and 3 for 49 adults of ages 65 years or older following joint replacement surgery. Multiple linear regression was used to analyze data for relationships between postoperative pain and subsyndromal delirium and, secondarily, postoperative opioid intake and subsyndromal delirium while accounting for known preoperative risk factors.

Results

Increased age, cognitive impairment, current smoking, and higher levels of self-reported pain were significantly related to subsyndromal delirium (p < .001). After accounting for preoperative risk factors of age, cognitive status, smoking status, and opioid intake, pain was significantly related to subsyndromal delirium (β = .28, p < .05); however, opioid intake did not contribute to subsyndromal delirium.

Discussion

Higher pain levels were significantly related to subsyndromal delirium when age, cognitive status, smoking status, and opioid intake were accounted for (p < .05), although opioid intake was not significantly related to subsyndromal delirium after accounting for age, cognitive status, smoking status, and pain. Nurses caring for older adults who undergo joint replacement surgery are encouraged to ensure effective pain management to reduce onset and severity of delirium symptoms.
Using Reflexive Thinking to Establish Rigor in Qualitative Research
Authors: Rettke Horst , Pretto Manuela , Spichiger Elisabeth , Frei Irena Anna , Spirig Rebecca
Published: August 2018

Background

Reflexivity can be helpful in developing the methodological rigor necessary to attaining trustworthy qualitative study results.

Objectives

The aim of this study was to evaluate strategies of critical reflexive thinking during a qualitative enquiry rooted in a mixed-methods study.

Methods

Guided by the questions of Rolfe and colleagues from 2001 (“what,” “so what,” and “now what”), we applied reflexive thinking to all aspects of the investigation.

Results

Critical reflexive thinking strongly supported our efforts to establish methodological rigor and helped reveal shortcomings.

Discussion

Effective strategical use of reflexive thinking takes concerted effort. Both time and space are essential to applying reflexive thinking throughout the qualitative research process.
Development, Psychometric Assessment, and Predictive Validity of the Postpartum Childcare Stress Checklist
Authors: Dennis Cindy-Lee , Brown Hilary K. , Brennenstuhl Sarah
Published: August 2018

Background

Childcare stress has been shown to predict postpartum depression; however, there is little research exploring and validating the dimensions of childcare stress instruments such that preventive interventions can be created.

Objectives

The aim of this study was to develop and psychometrically test an instrument to measure parental perceptions of postpartum childcare stress.

Methods

Using research based on postpartum stress and childcare stress, the Postpartum Childcare Stress Checklist (PCSC) was developed, and content validity was judged by experts. The PCSC was psychometrically assessed in a cohort of 541 women in a health region near Vancouver, Canada, who were followed to 8 weeks postpartum in 2002. The psychometric assessment analyses comprised internal consistency, exploratory factory analysis, concurrent validity, and predictive validity.

Results

The 19-item PCSC had good internal consistency (Kuder–Richardson Formula 20 coefficient: 0.81). Exploratory factor analysis revealed the following dimensions: (a) relationship with the partner, (b) caring for the infant, (c) maternal social interactions, and (d) establishing a new routine. Predictive validity analyses showed that PCSC total and subscale scores at 4 weeks were positively correlated with depressive symptomatology, anxiety, and perceived stress and negatively correlated with global and partner support at 8 weeks postpartum.

Discussion

The PCSC is a measure of childcare stress with excellent reliability and validity. Upon further testing, it may be used to identify women and couples in need of greater support, individualize postpartum care, and evaluate the effectiveness of preventive interventions.