bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantification of image contrast of infarcts on computed tomography scans
Authors: Gomolka RS , Chrzan RM , Urbanik A , Kazmierski R , Grzanka AD , Nowinski WL
Published: January 2017

Introduction

Accurate identification of infarcts in non-contrast computed tomography (NC-CT) scans of the brain is fundamental in the diagnosis and management of patients with stroke. Quantification of image contrast properties at the boundaries of ischemic infarct regions in NC-CT can contribute to a more precise manual or automatic delineation of these regions. Here we explore these properties quantitatively.

Methods

We retrospectively investigated 519 NC-CT studies of 425 patients with clinically confirmed ischemic strokes. The average and standard deviation (SD) of patients’ age was 67.5 ± 12.4 years and the average(median)±SD time from symptoms onset to NC-CT examination was 27.4(12)±35.7 h. For every scan with an ischemic lesion identified by experts, the image contrast of the lesion vs. normal surrounding parenchyma was calculated as a difference of mean Hounsfield Unit (HU) of 1–5 consecutive voxels (the contrast window width) belonging to the lesion and to the parenchyma. This contrast was calculated at each single voxel of ischemic lesion boundaries (previously delineated by the experts) in horizontal and vertical directions in each image. The distributions of obtained horizontal, vertical and both contrasts combined were calculated among all 519 NC-CTs.

Results

The highest applicative contrast window width was identified as 5 voxels. The ischemic infarcts were found to be characterized by 6.60 HU, 8.28 HU and 7.55 HU mean values for distributions of horizontal, vertical and combined contrasts. Approximately 40–50% of the infarct boundary voxels were found to refer to the image contrast below 5 HU.

Conclusion

Low image contrast of ischemic lesions prevents accurate delineation of the infarcts in NC-CT.
Radiologic and histologic features of the T2 hyperintensity rim of meningiomas on magnetic resonance images
Authors: Uchida Hiroyuki , Hirano Hirofumi , Moinuddin FM , Hanaya Ryosuke , Sadamura Yuko , Hosoyama Hiroshi , Yonezawa Hajime , Tokimura Hiroshi , Yamahata Hitoshi , Arita Kazunori
Published: January 2017

A hyperintensity rim is often seen at the brain–tumor interface of meningiomas upon T2-weighted (T2WI) magnetic resonance imaging (MRI), and it is referred to as the cerebrospinal fluid (CSF) space; however, the true nature of the rim remains unclear. We surveyed the MRI findings and the histopathologic characteristics of such rims. Our study population consisted of 53 consecutive patients who underwent meningioma removal at our hospital. The intensity of the rim on MRI scans obtained with different imaging sequences was assessed in all patients. We used 22 tumors for histopathologic investigation: tissue samples were acquired from both the tumor surface and from a deep intratumoral site. Of the 53 meningiomas, 37 (69.8%) manifested a hyperintensity rim on T2WI (T2-rim). The other 16 showed neither a hyperintense nor a hypointense rim on their T2WI. An enhancement effect corresponding to the rim was observed in 28 of the 37 (75.7%) T2-rim positive tumors. While 9 among the 37 tumors with a T2-rim (24.3%) did not show rim enhancement, they showed low intensity on fluid-attenuated inversion recovery (FLAIR) images. The microvascular density in the tumor capsule was significantly greater in the 12 T2-rim and rim enhancement positive tumors than in 10 tumors that were T2-rim negative or T2-rim positive, but rim enhancement-negative ( p < 0.001, Mann–Whitney U test). We found that 75.7% of T2 hyperintense rims that were detected at the brain–meningioma interface reflected a microvascular-rich capsule layer, rather than the CSF space.
Coronal clival cleft in CHARGE syndrome
Authors: Mahdi Eman , Whitehead Matthew T
Published: January 2017

CHARGE syndrome is a genetic disorder with multi-systemic congenital anomalies, most commonly including coloboma, heart malformations, choanal atresia, developmental delay, and genital and ear anomalies. The diagnostic criteria for CHARGE syndrome has been refined over the years. However, there are limited reports describing skullbase and craniocervical junction abnormalities. These osseous malformations are often under recognized, especially on MRI. We report here a case of CHARGE syndrome with colobomas, cleft lip and palate, patent ductus arteriosus, undescended testes, and a coronal clival cleft which has not been previously depicted in CHARGE syndrome. The presence of a coronal clival cleft should alert the radiologist to examine the ears, eyes, palate, choana, and olfactory centers for other signs of CHARGE syndrome.
Imaging of sialadenitis
Authors: Abdel Razek Ahmed Abdel Khalek , Mukherji Suresh
Published: January 2017

Sialadenitis is an inflammation or infection of the salivary glands that may affect the parotid, submandibular and small salivary glands. Imaging findings vary among unilateral or bilateral salivary gland enlargement, atrophy, abscess, ductal dilation, cysts, stones and calcification. Imaging can detect abscess in acute bacterial suppurative sialadenitis, ductal changes with cysts in chronic adult and juvenile recurrent parotitis. Imaging is sensitive for detection of salivary stones and stricture in obstructive sialadenitis. Immunoglobulin G4-sialadenitis appears as bilateral submandibular gland enlargement. Imaging is helpful in staging and surveillance of patients with Sjögren’s syndrome. Correlation of imaging findings with clinical presentation can aid diagnosis of granulomatous sialadenitis. Post-treatment sialadenitis can occur after radiotherapy, radioactive iodine or surgery.
Pseudoaneurysm formation due to rupture of intracranial aneurysms: Case series and literature review
Authors: Nomura Motohiro , Mori Kentaro , Tamase Akira , Kamide Tomoya , Seki Syunsuke , Iida Yu , Nakano Tatsu , Kawabata Yuichi , Kitabatake Taro , Nakajima Teruyuki , Yasutake Kiyoyuki , Egami Kei , Takahashi Tatsunori , Takahashi Mitsuyuki , Yanagimoto Kunio
Published: January 2017

Background

Intracranial pseudoaneurysm formation due to a ruptured non-traumatic aneurysm is extremely rare. We describe the radiological findings and management of pseudoaneurysms due to ruptured cerebral aneurysms in our case series and previously reported cases.

Patients and methods

Four additional and 20 reported patients presenting with subarachnoid hemorrhage (SAH) are included. Radiological findings and clinical features of these patients were reviewed.

Results

In our series, three-dimensional computed tomographic angiography (3D-CTA) and/or angiography showed an irregular- or snowman-shaped cavity extending from the parent artery. The radiological examination additionally revealed delayed filling and retention of contrast medium. These findings were the same as previously reported cases. One patient underwent direct clipping of the true aneurysm. For the other three patients with aneurysms at the basilar and anterior communicating arteries, the true portion of the aneurysm was embolized with platinum coils. During the procedures, care was taken not to insert the coils into the distal pseudoaneurysm portion to prevent rupture. The review of 24 cases revealed that the location of the aneurysms was most frequent in the anterior communicating artery (41.7%), and 86.7% of patients were in a severe stage of SAH (>Grade 3 in WFNS or Hunt & Kosnik grading) implying abundant SAH.

Conclusions

Pseudoaneurysm formation in SAH after non-traumatic aneurysm rupture is rare. However, in cases with an irregular-shaped aneurysm cavity, pseudoaneurysm formation should be taken into consideration.
Acute necrotizing encephalopathy causing human bocavirus
Authors: Ergul Ayse Betul , Altug Umit , Aydin Kursad , Guven Ahmet Sami , Altuner Torun Yasemin
Published: January 2017

Acute necrotizing encephalopathy is characterized by multiple, symmetrical lesions involving the thalamus, brainstem, cerebellum, and white matter and develops secondarily to viral infections. Influenza viruses are the most common etiological agents. Here, we present the first case of acute necrotizing encephalopathy to develop secondarily to human bocavirus.

A 3-year-old girl presented with fever and altered mental status. She had had a fever, cough, and rhinorrhea for five days. The patient was admitted to the intensive care unit with an initial diagnosis of encephalitis when vomiting, convulsions, and loss of consciousness developed. Signs of meningeal irritation were detected upon physical examination. There was a mild increase in proteins, but no cells, in the cerebrospinal fluid (CSF). Brain magnetic resonance imaging showed symmetrical, heterogeneous hyperintensities bilaterally in the caudate nuclei and putamen. Ammonium, lactate, tandem mass spectroscopy, and urine organic acid were normal. No bacteria were detected in the CSF cultures. Human bocavirus was detected in a nasopharyngeal aspirate using real-time PCR, while no influenza was detected. Oseltamivir, acyclovir, 3% hypertonic saline solution, and supportive care were used to treat the patient, who was discharged after two weeks. She began to walk and talk after one month of physical therapy and complete recovery was observed after six months.

Human bocavirus is a recently identified virus that is mainly reported as a causative agent in respiratory tract infections. Here, we present a case of influenza-like acute necrotizing encephalopathy secondary to human bocavirus infection.
Effective treatment with a new protocol using tissue-type plasminogen activator thrombolysis for pump thrombosis with the HVAD device
Authors: Schrage Benedikt , Grahn Hanno , Wagner Florian M , Bernhardt Alexander , Rybczynski Meike , Blankenberg Stefan , Reichenspurner Hermann , Barten Markus J
Published: January 2017

Background:

Pump thrombosis is a major complication of the continuous flow left ventricular assist device. Pump exchange is seen as the therapeutic gold standard. In this study, we report on our experience with using tissue-type plasminogen activator thrombolysis for therapy of pump thrombosis.

Methods:

We report on our experience with treatment of continuous flow left ventricular assist device pump thrombosis with the HVAD using tissue-type plasminogen activator thrombolysis in nine patients with 16 thrombotic events. In all events we used a uniform treatment protocol.

Results:

All patients presented with a sufficient anticoagulation and had symptoms of heart failure. However, all patients were haemodynamically stable. Six of nine patients presented with a mean arterial pressure above 85 mm Hg and every patient presented with an infection. In all events we achieved short-term success with resolution of the pump thrombosis within a median time of nine hours. Three of nine patients developed recurrent pump thrombosis after >60 days. Besides one case of nonfatal intracranial haemorrhage and one case of minor bleeding, there were no adverse events.

Conclusion:

Our data indicates that using a uniform treatment protocol that builds on usage of tissue-type plasminogen activator thrombolysis might be an effective tool for treatment of continuous flow left ventricular assist device pump thrombosis in haemodynamically stable patients. Additionally, our data indicates that infection may be a potential trigger for pump thrombosis.
Evaluation and outcome of M plasty for the management of doughnut scrotum
Authors: Mylarappa Prasad , Puvvada Sandeep , Nayak K Arvind , D Ramesh
Published: January 2017

Introduction:

Penoscrotal transposition is a rare anomaly of the external genitalia. They can be classified as complete or incomplete based on degrees of positional exchange between the penis and the scrotum. Both forms are known to be associated with hypospadias and multiple surgeries are required for complete correction. Most surgeries performed for the correction of penoscrotal transposition involve making a complete circular incision around the root of the scrotum, which often results in massive penile lymphoedema and often delays the correction of hypospadias. The M plasty technique can prevent the incidence of lymphoedema by preserving the dorsal penile skin.

Objective:

To evaluate the effectiveness of M plasty for the correction of penoscrotal transposition.

Materials and methods:

Sixteen patients underwent M plasty for incomplete penoscrotal transposition. An ‘M’-shaped incision was made at the base of the scrotum and the scrotal halves were dissected and brought down posterior and caudal to the penis and sutured primarily.

Results:

All patients showed excellent cosmetic results. There was minimal postoperative oedema with no vascular compromise to penile or scrotal skin.

Conclusion:

M plasty is an excellent technique for the correction of penoscrotal transposition. The low incidence of penile lymphoedema could be attributed to the preservation of the dorsal penile skin. This procedure provides an excellent cosmetic appearance and also allows for early correction of hypospadias.
Delayed diagnosis of lymphogranuloma venereum-associated colitis in a man first suspected to have rectal cancer
Authors: Bancil Aaron S , Alexakis Christopher , Pollok Richard
Published: January 2017

Lymphogranuloma venereum-associated colitis is a diagnosis that should not be missed. The following case represents the importance of a thorough history, including the importance of the sexual history to prevent the misdiagnosis of these patients.
Women in senior post-graduate medicine career roles in the UK: a qualitative study
Authors: Curtis Anthony , Eley Lizzie , Gray Selena , Irish Bill
Published: January 2017

Objectives

This qualitative study sought to elicit the views, experiences, career journeys and aspirations of women in senior post-graduate medical education roles to identify steps needed to help support career progression.

Design

In-depth semi-structured telephone interviews.

Setting

UK.

Participants

Purposive sample of 12 women in a variety of senior leadership roles in post-graduate medical education in the UK.

Main outcome measures

Self reported motivating influences, factors that helped and hindered progress, key branch points, and key educational factors and social support impacting on participants' career in postgraduate medicine.

Results

Respondents often reported that career journeys were serendipitous, rather than planned, formal or well structured. Senior women leaders reported having a high internal locus of control, with very high levels of commitment to the NHS. All reported significant levels of drive, although the majority indicated that they were not ambitious in the sense of a strong drive for money, prestige, recognition or power. They perceived that there was an under-representation of women in senior leadership positions and that high-quality female mentorship was particularly important in redressing this imbalance. Social support, such a spouse or other significant family member, was particularly valued as reaffirming and supporting women’s chosen career ambition. Factors that were considered to have hindered career progression included low self-confidence and self-efficacy, the so-called glass ceiling and perceived self-limiting cultural influences. Factors indirectly linked to gender such as part-time versus working full time were reportedly influential in being overlooked for senior leadership roles. Implications of these findings are discussed in the paper.

Conclusion

Social support, mentorship and role modelling are all perceived as highly important in redressing perceived gender imbalances in careers in post-graduate medical education.
Knowledge and perceptions of national and provincial tuberculosis control programme managers in Pakistan about the WHO Stop TB strategy: a qualitative study
Authors: Khan Wasiq Mehmood , Smith Helen , Qadeer Ejaz , Hassounah Sondus
Published: January 2017

Objective

To understand how national and provincial tuberculosis programme managers in Pakistan perceive and engage with the Stop TB strategy, its strengths, weaknesses and their experience in its implementation. National and provincial tuberculosis programme managers play an important role in effective implementation of the Stop TB strategy.

Design

A qualitative interview study was conducted with 10 national and provincial tuberculosis programme managers to understand how they perceive and engage with the Stop TB strategy, its strengths, weaknesses and their experience in its implementation. Managers were selected purposively; 10 managers were interviewed (six national staff and four from provincial level).

Participants

National and provincial tuberculosis programme managers in Pakistan. Managers were selected purposively; 10 managers were interviewed (six national staff and four from provincial level).

Setting

National and provincial tuberculosis programmes in Pakistan

Main outcome measures

1. Knowledge and perceptions of national and provincial tuberculosis programme managers about the Stop TB strategy 2. Progress in implementing the strategy in Pakistan 3. Significant success factors 4. Significant implementation challenges 5. Lessons learnt to scale up successful implementation.

Results

The managers reported that most progress had been made in extending DOTS, health systems strengthening, public -private mixed interventions, MDR-TB care and TB/HIV care. The four factors that contributed significantly to progress were the availability of DOTS services, the public-private partnership approach, comprehensive guidance for TB control and government and donor commitment to TB control.

Conclusion

This study identified three main challenges as perceived by national and provincial tuberculosis programme managers in terms of implementing the Stop TB strategy: 1. Inadequate political commitment, 2. Issue pertaining to prioritisation of certain components in the TB strategy over others due to external influences and 3. Limitations in the overall health system. To improve the tuberculosis control programme in the country political commitment needs to be enhanced and public -private partnerships increased. This can be done through government prioritisation of TB control at both national and provincial levels; donor-funded components should not receive undue attention; and partnerships with the private health sector, health institutions not yet covered by DOTS services, non-governmental organisations and patient coalitions should be increased.
Waiting for the real dragon
Authors: Collet Christian
Published: January 2017

Southeast Asia is the world’s most diverse and rapidly modernizing region, yet one where modernization theory is challenged (e.g. Bell et al., 1995) and where allegiance to authoritarian regimes appears trenchant (Chang et al., 2013; Dalton and Shin, 2014). Using the AsiaBarometer, I consider the influence of modernization and allegiance on potential democratization by analyzing an established indicator of assertive change: tolerance of homosexuality (Inglehart and Welzel, 2005: Ch. 5, forthcoming). The findings reveal differences between Southeast Asians and the West and between citizens in the Sinic and Indic subregions. Exposure to foreign cultures produces a significant increase in tolerance among Sinicized citizens, but has no meaningful effect on those in Indic states. Patriotism and trust in civil society also boost tolerance among Sinicized citizens, but reduce the probability of tolerance among citizens in Indic states. The strong linkage between sexual tolerance and gender equality driven by social factors and secularism in the West does not manifest in Southeast Asia. While the findings suggest potential for change in the Sinicized region, they underscore the different effects that globalization and allegiance may have on citizens living under Southeast Asia’s variety of regimes.
A Simplified Technique for Interventional Extracardiac Fontan
Authors: Prabhu Sudesh , Anderson Ben , Ward Cameron , Karl Tom , Alphonso Nelson
Published: January 2017

Purpose:

We report a simple technique for an interventional extracardiac Fontan (ECF) procedure.

Description:

At the preparatory stage along with a bidirectional cavopulmonary connection (BCPC; cardiopulmonary bypass), a short piece of polytetrafluoroethylene (PTFE) tube graft is anastomosed to the inferior surface of the right pulmonary artery. Another longer PTFE graft is anastomosed to the transected inferior vena cava (IVC). A large medial opening in the lower PTFE graft is anastomosed to an atriotomy. These two PTFE tubes are anastomosed with a pericardial patch interposed between them. During the later interventional Fontan procedure, this pericardial patch is perforated using radiofrequency, and a covered stent is positioned entirely within the PTFE tubes, eliminating the window into the common atrium and leaving no intrapulmonary prosthetic material.

Evaluation:

The hemodynamics after the preparatory stage is similar to those following a BCPC, with uninterrupted flow from the IVC to the right atrium. On completion, there is a nonfenestrated Fontan circuit.

Conclusion:

Our technique of interventional Fontan, anatomically and hemodynamically, mimics a standard ECF procedure.
Echocardiographic Diagnosis of Left Main Coronary Artery Atresia
Authors: Weigand Justin D. , Gowda Srinath , Lorber Richard , Madan Nitin
Published: January 2017

This case describes an infantile presentation of left main coronary artery atresia (LMCAA), which involves complete absence of the left coronary ostium and left main coronary artery. The echocardiographic features of LMCAA that assist in making this diagnosis are detailed. Important imaging features that distinguish LMCAA from anomalous left coronary artery from the pulmonary artery are highlighted.
Preoperative Feeding Neonates With Cardiac Disease
Authors: Scahill Carly J. , Graham Eric M. , Atz Andrew M. , Bradley Scott M. , Kavarana Minoo N. , Zyblewski Sinai C.
Published: January 2017

Background:

The potential for necrotizing enterocolitis (NEC) in neonates requiring cardiac surgery has contributed largely to wide feeding practice variations and a hesitation to initiate enteral feeding during the preoperative period, specifically those patients with hypoplastic left heart syndrome.

Methods:

A retrospective chart review of neonates undergoing cardiac surgery at a single institution between July 2011 and July 2013 was performed. The primary objective of this study was to determine if preoperative feeding was associated with NEC in neonates requiring cardiac surgery. Univariable and multivariable analyses were performed to evaluate the relationship between preoperative feeding and NEC. Secondary outcomes including growth failure, total ventilator days, total length of stay, and tube-assisted feeds at discharge were analyzed.

Results:

One hundred thirty consecutive neonates who required cardiac surgery were included in the analysis. Preoperative feeding occurred in 61% (n = 79). The overall prevalence of NEC was 9% (12/130), including three neonates with surgical NEC. There was no difference in the prevalence of NEC between the preoperative feeding and nil per os (NPO) groups. Preoperative NPO status was associated with longer ventilator-dependent days ( P = .01) but was not associated with worsened growth failure, longer length of stay, or increased prevalence of tube-assisted feeds at discharge.

Conclusion:

In this study cohort, preoperative feeding was associated with a low prevalence of NEC. Larger prospective studies evaluating the safety and benefits of preoperative feeding in cardiac neonates are warranted.
Short-Term Results of Sinus of Valsalva Aneurysm Repair
Authors: Abralov Khakimjon , Alimov Amonjon
Published: January 2017

Background:

We retrospectively analyzed 65 patients who underwent surgical repair of sinus of Valsalva aneurysm over the last 27 years.

Methods:

From January 1, 1988, to October 1, 2015, a total of 65 patients with sinus of Valsalva aneurysm underwent surgical repair in our hospital. There were 41 males (63%) and 24 females (37%), and their age ranged from 5 to 50 years (mean 23 ± 10 years, median 21 years). Out of the 65 patients, 45 (69%) had ruptured sinus of Valsalva aneurysm, 46 (70%) had a ventricular septal defect, and 22 (34%) had aortic valve insufficiency. The ruptured sinus of Valsalva was repaired with patch in 12 cases and direct suturing in 33 cases. The aortic valve was replaced in five patients and the aortic root was replaced in five patients.

Results:

Sixty patients (92%) survived the 30-day operative interval. At one year follow-up, only two patients had complications: infective endocarditis and sepsis, which lead to septic shock (n = 1) and paraprosthetic leakage and mitral valve regurgitation (n = 1). All the other patients were well and in New York Heart Association functional class I or II.

Conclusion:

In this relatively high-risk population, repair of SVA can be achieved with satisfactory early results.
Effects of Exercise Restriction on Patients With Anomalous Aortic Origin of a Coronary Artery
Authors: Elias Matthew D. , Meza James , McCrindle Brian W. , Brothers Julie A. , Paridon Stephen , Cohen Meryl S.
Published: January 2017

Background:

Management of young patients with anomalous aortic origin of a coronary artery (AAOCA) may involve exercise restriction. We sought to identify the association of exercise restriction with changes over time in body mass index (BMI) and exercise capacity in this cohort.

Methods:

We performed a retrospective review of patients with AAOCA seen at The Children’s Hospital of Philadelphia between January 1, 1998, and August 31, 2014. Linear mixed model repeated-measures analysis assessed changes in BMI and exercise capacity.

Results:

We included 72 patients with a median age at presentation of 12.6 years (interquartile range: 10.1-15.8) and mean follow-up of 3.6 ± 3.0 years. The majority had an anomalous right coronary artery (71%) and interarterial ± intramural coronary course (90%). Surgery was performed in 54%, more often in those with interarterial/intramural course ( P < .001) and symptoms ( P = .003). Most patients (82%) were exercise-restricted on presentation, and restricted patients were older than those who were not restricted ( P = .01). There was no significant difference between restricted and nonrestricted patients in initial BMI z scores, percentage of patients with BMI over 85th percentile (26%) or exercise capacity variables. In univariable analysis, exercise restriction over time was not associated with change in BMI z score ( P = .25) or change in exercise variables. Restriction was not associated with significant change in these variables in multivariable analysis.

Conclusions:

Although further investigation is warranted to determine the degree of adherence to exercise restriction, the recommendation of restriction alone is not associated with increasing BMI or decreasing exercise performance in the short-term.
Surgical Site Infection After Pediatric Cardiothoracic Surgery
Authors: Sochet Anthony A. , Cartron Alexander M. , Nyhan Aoibhinn , Spaeder Michael C. , Song Xiaoyan , Brown Anna T. , Klugman Darren
Published: January 2017

Background:

Surgical site infection (SSI) occurs in 0.25% to 6% of children after cardiothoracic surgery (CTS). There are no published data regarding the financial impact of SSI after pediatric CTS. We sought to determine the attributable hospital cost and length of stay associated with SSI in children after CTS.

Methods:

We performed a retrospective, matched cohort study in a 26-bed cardiac intensive care unit (CICU) from January 2010 through December 2013. Cases with SSI were identified retrospectively and individually matched to controls 2:1 by age, gender, Risk Adjustment for Congenital Heart Surgery score, Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery category, and primary cardiac diagnosis and procedure.

Results:

Of the 981 cases performed during the study period, 12 with SSI were identified. There were no differences in demographics, clinical characteristics, or intraoperative data. Median total hospital costs were higher in participants with SSI as compared to controls (US$219,573 vs US$82,623, P < .01). Children with SSI had longer median CICU length of stay (9 vs 3 days, P < .01), hospital length of stay (18 vs 8.5 days, P < .01), and duration of mechanical ventilation (2 vs 1 day, P < .01) and vasoactive administration (4.5 vs 1 day, P < .01).

Conclusions:

Children with SSI after CTS have an associated increase in hospital costs of US$136,950/case and hospital length of stay of 9.5 days/case. The economic burden posed by SSI stress the importance of infection control surveillance, exhaustive preventative measures, and identification of modifiable risk factors.
Percutaneous Transhepatic Fontan-Kreutzer Completion of Hepatic Vein Inclusion
Authors: Juaneda Ignacio , Peirone Alejandro , Ferrero Guadagnoli Adolfo , Contreras Alejandro , Orozco Santiago , Diaz Juan , Kreutzer Christian
Published: January 2017

We report the case of an 11-year-old girl with heterotaxy syndrome, dextrocardia, and azygos continuation of an interrupted inferior vena cava who had developed pulmonary arteriovenous fistulas after a Kawashima procedure consisting of bilateral superior cavopulmonary anastomoses. She presented with profound cyanosis, fatigue, and failure to thrive. An operative procedure to direct hepatic vein effluent to the pulmonary circulation was performed with placement of an extracardiac conduit between the hepatic veins and the left pulmonary artery. Persistence of cyanosis led to investigation, which led to the discovery of an unintentionally excluded right hepatic vein. A percutaneous transhepatic catheter intervention was performed in which a vascular plug was implanted to occlude the “missed” right hepatic vein, redirecting the flow through intrahepatic venovenous channels to the conduit. Clinical condition and arterial oxygen saturation were substantially improved one year after the two-step hepatic vein inclusion procedure.
A Return to Work Program for an Employee With Resolving Vertigo
Authors: Lurati Ann Regina
Published: January 2017

Vertigo is a disorder that affects equilibrium. Symptoms include a loss of balance with nausea and vomiting. Employees diagnosed with vertigo can return to work safely; however, they may need workplace restrictions and accommodation as symptoms may persist for months. This article reviews the evaluation and treatment of vertigo with back-to-work recommendations.
Rocky Mountain Spotted Fever
Authors: Phillips Jennan
Published: January 2017

The tick-borne disease Rocky Mountain spotted fever (RMSF) can have deadly outcomes unless treated appropriately, yet nonspecific flu-like symptoms complicate diagnosis. Occupational health nurses must have a high index of suspicion with symptomatic workers and recognize that recent recreational or occupational activities with potential tick exposure may suggest RMSF.
Rehabilitation's Contribution to Industrial Health
Authors: McCahan J. F.
Published: January 2017

During the past few years there has been increasing interest in rehabilitation, but rarely do we find the various aspects fitted properly into the total picture. The glamorous, more dramatic, orthopedic conditions, the situations of which headlines and heart warming human interest stories are made, receive the major share of attention. The amputee, the paraplegic, these are synonymous with the problem of rehabilitation in the minds of many. The “unglamorous light work” placements, accomplished daily within industry to help an employee partially disabled by illness or injury do not reach the headlines, but they are undoubtedly of tremendous importance in the total problem of rehabilitation; probably far more so than the glamor cases.

Fundamentally, rehabilitation means assisting an individual to return to as great a degree of social and economic self-sufficiency as he is able to achieve. Thus the worker who sustains a fractured wrist and is temporarily assigned work that he can do with his uninjured hand is part of today's rehabilitation effort. The employee who returns after eight weeks absence due to a coronary attack, is rehabilitated by permanent assignment to a less arduous job. These cases do not make the headlines. They are part of the daily, unobtrusive, but very important contribution that an effective in-plant medical program makes to the problem of rehabilitation. It is relatively unsung but it is a vitally significant part of the rehabilitation needs in this country.
MINA and the Advisory Councils
Authors: Watson Edna
Published: January 2017

Management and Medical Advisory Councils are an important professional innovation of the AAIN. Both the national organization and many of the local groups have adopted this method of promoting better understanding among those concerned with industrial health. Often the Council sessions are treated almost as workshops with the nurse, management and medical representatives all contributing suggestions toward the solution of specific problems of industrial administration, policy, or health. In the following article Mrs. Edna Watson describes the information and work of the Advisory Councils of the Mid-Indiana Industrial Nurses Association. The experience of this group should prove valuable to other AAIN groups in establishing similar councils or in planning programs for existing councils.
Has Financial Crisis Affected the Announcement Gains of Indian Cross-border Acquisitions?
Authors: Rani Neelam , Asija Aman
Published: January 2017

The failure of an unparalleled large number of financial institutions during the global financial crisis of 2007–2008 resulted in a freeze of global credit markets. The financial crisis has affected the capital markets around the world. In contrast, the global financial crisis has facilitated the strategic asset-seeking ambitions of emerging market multinationals. The objective of the present article is to examine the market response to cross-border acquisition by Indian companies during 2003– 2015 by conducting event study. We have also compared the acquisition gains before and after the financial crisis. The acquisition gains for the event window (–1, 1) are 2.06 per cent for the entire period 2003–2015 for a sample of 430 announcements. Two-thirds of the acquisitions experienced positive abnormal returns. The abnormal returns are positive and significant for the entire event window of 41 days. The empirical findings also suggest that the CAAR on the event day for pre-crisis period is 4.28 per cent compared to CAAR of 1.70 per cent during post-crisis period. Results are statistically significant. It is evident that market response has muted after the financial crisis.
Estimating Option-implied Risk Aversion for Indian Markets
Authors: Sinha Sonalika , Kamaiah Bandi
Published: January 2017

What do nearly 1.5 lakh observations of options data say about risk preferences of Indian investors? This paper explores a nonparametric technique to compute probability density functions (PDFs) directly from NIFTY 50 option prices in India, based on the utility preferences of the representative investor. Use of probability density functions to estimate investor expectations of the distribution of future levels of the underlying assets has gained tremendous popularity over the last decade. Studying option prices provides information about the market participants’ probability assessment of the future outcome of the underlying asset. We compare the forecast ability of the risk-neutral PDF and risk-adjusted density functions to arrive at a unique index of relative risk aversion for Indian markets. Results indicate that risk-adjusted PDFs are reasonably better forecasts of investor expectations of future levels of the underlying assets. We find that Indian investors are not neutral to risk, contrary to the theoretical assumption of risk-neutrality among investors. The computed time-series of relative risk aversion overcomes the limitations of the VIX (implied volatility index) to yield a more reliable index, particularly useful for the Indian markets. Validity of the computed index is established by comparing with existing measures of risk and the relationships are found to be consistent with market expectations.
Meta-analysis of Value of Statistical Life Estimates
Authors: Majumder Agamoni , Madheswaran S.
Published: January 2017

Value of Statistical Life (VSL) is one of the most debatable areas in economics. However, VSL is frequently used as a policy instrument for evaluating various safety, health and environmental regulations. Policymakers have to undertake the difficult task of assigning monetary value to the reduction of various health and mortality risks while analyzing safety policies. Compensating wage differential (CWD) for job risks acts as a reference point for valuing mortality risks while VSL serves as a basis to analyze these benefits of risk reduction policies. However, it has been observed in the recent past that VSL estimates vary substantially across various studies. Therefore, it has become necessary for researchers and policymakers to understand the source of this variation in order to aid policymaking. This paper attempts to bring together some of the emerging issues in VSL literature and presents a meta-analysis that is based on 34 observations from 30 hedonic wage-based VSL studies. The results of this meta-analysis show that certain emerging areas in VSL literature such as worker’s compensation benefits, age and long-term health-related job risk require more emphasis and further examination.
Mean Glenoid Defect Size and Location Associated With Anterior Shoulder Instability
Authors: Gottschalk Lionel J. , Bois Aaron J. , Shelby Marcus A. , Miniaci Anthony , Jones Morgan H.
Published: January 2017

Background:

There is a strong correlation between glenoid defect size and recurrent anterior shoulder instability. A better understanding of glenoid defects could lead to improved treatments and outcomes.

Purpose:

To (1) determine the rate of reporting numeric measurements for glenoid defect size, (2) determine the consistency of glenoid defect size and location reported within the literature, (3) define the typical size and location of glenoid defects, and (4) determine whether a correlation exists between defect size and treatment outcome.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

PubMed, Ovid, and Cochrane databases were searched for clinical studies measuring glenoid defect size or location. We excluded studies with defect size requirements or pathology other than anterior instability and studies that included patients with known prior surgery. Our search produced 83 studies; 38 studies provided numeric measurements for glenoid defect size and 2 for defect location.

Results:

From 1981 to 2000, a total of 5.6% (1 of 18) of the studies reported numeric measurements for glenoid defect size; from 2001 to 2014, the rate of reporting glenoid defects increased to 58.7% (37 of 63). Fourteen studies (n = 1363 shoulders) reported defect size ranges for percentage loss of glenoid width, and 9 studies (n = 570 shoulders) reported defect size ranges for percentage loss of glenoid surface area. According to 2 studies, the mean glenoid defect orientation was pointing toward the 3:01 and 3:20 positions on the glenoid clock face.

Conclusion:

Since 2001, the rate of reporting numeric measurements for glenoid defect size was only 58.7%. Among studies reporting the percentage loss of glenoid width, 23.6% of shoulders had a defect between 10% and 25%, and among studies reporting the percentage loss of glenoid surface area, 44.7% of shoulders had a defect between 5% and 20%. There is significant variability in the way glenoid bone loss is measured, calculated, and reported.
Effects of Sex and Fatigue on Biomechanical Measures During the Drop-Jump Task in Children
Authors: Briem Kristín , Jónsdóttir Kolbrún Vala , Árnason Árni , Sveinsson Þórarinn
Published: January 2017

Background:

Female athletes have a higher rate of anterior cruciate ligament (ACL) injury than males from adolescence and into maturity, which is suggested to result from sex-specific changes in dynamic movement patterns with maturation. Few studies have studied movement strategies and response to fatigue in children.

Purpose:

To evaluate the effect of fatigue on biomechanical variables associated with increased risk for ACL injury during a drop-jump (DJ) performance in children.

Study Design:

Controlled laboratory study.

Methods:

A total of 116 children (mean age, 10.4 years) were recruited from local sports clubs and performed 5 repetitions of a DJ task before and after a fatigue protocol. Kinematic and kinetic data from initial contact (IC) to the first peak vertical ground reaction force (vGRF) were analyzed for both limbs, including limb and fatigue as within-subject factors for analyses between boys and girls. Pearson correlation coefficients were calculated to identify associations between variables of interest.

Results:

Girls demonstrated greater peak vGRF values than boys (by 8.1%; P < .05), there were greater peak vGRF values for the right limb than the left (by 6.2%; P < .001), and fatigue led to slightly greater values ( P < .05). Although weak, the correlation between peak vGRF values and knee flexion excursion was stronger for girls ( r = –0.20) than boys ( r = –0.08) ( P < .006). Fatigue resulted in greater knee flexion angles at IC and less excursion during landing, more so for girls (by 6.1° vs 1.4°; interaction, P < .001), although the knee flexion moment was generally lowered by fatigue ( P < .001). Limb asymmetry in knee flexion moments was more pronounced for boys than for girls (interaction, P < .05), contrary to that seen in frontal plane knee moments, where asymmetry was much greater in girls than boys (interaction, P < .001).

Conclusion:

Even as young athletes, girls and boys seem to adopt dissimilar movement strategies and are differently affected by fatigue.

Clinical Relevance:

Injury prevention programs should be considered at an earlier age in an effort to lower the risk of ACL injury in athletes.
“Kinda Like a Man and a Woman Thing”: The Construction and Reification of Gender Hegemony in a Women’s Prison
Authors: Gorga Allison
Published: January 2017

This article examines how a hegemonic gender regime is constructed and maintained by persons with bodies marked as female. Using semistructured interviews with prisoners in a women’s prison, I demonstrate how a gender dichotomy is replicated among a population of primarily women in which certain styles of masculinity and femininity are posited as complimentary and situated within a gender hierarchy. Prisoners cocreated and maintained an ideal definition of masculinity—“studs”—that centered on status, resources, and heteronormative sexual patterns, whereas femininities—“femmes”—were subordinated and their gender practices devalued. Studs were subjected to greater levels of social control and were stigmatized for stepping out of the prescribed bounds of normative stud behavior. Although several respondents also contested or challenged hypermasculinities in the prison, this contestation often reified gender and sexual expectations for studs. The presence of such a gender regime in a women’s prison suggests that the global system of masculine dominance is an obstinate social construct.
Beyond “Just Do It”
Authors: Landon Adam C. , Tarrant Michael A. , Rubin Donald L. , Stoner Lee
Published: January 2017

Study abroad is believed to be a transformative learning experience for students. However, the extent to which study abroad adds value beyond what is possible on campus needs to be demonstrated. In this paper, we document the learning outcomes assessment undertaken by a faculty-led study-abroad program at a large university in the U.S. Southeast. Specifically, we describe the development of a theory-based pedagogical model of global citizenship for short-term study abroad and efforts to document student learning associated with its constructs. The results of these efforts indicate that when student learning outcomes and study-abroad pedagogy are aligned with theory, and rigorously assessed, the opportunity to demonstrate learning is possible, and opportunities for instructional improvement present themselves.
Are There Barriers for Professional Development of Women Dentists? A Qualitative Study in Saudi Arabia
Authors: Rajeh M. , Nicolau B. , Pluye P. , Qutob A. , Esfandiari S.
Published: January 2017

Globally, there is an upward trend in the number of women applying to dental schools and entering the profession of dentistry. Women dentists aim to advance their careers; however, differences exist between men and women dentists regarding leadership positions and work titles. For example, in Saudi Arabia, women usually occupy lower ranked positions than men in the Saudi public sector, and they are, therefore, paid less than their male counterparts. This study aimed to explore the possible barriers to Saudi women dentists’ professional advancement using a qualitative descriptive study design. Specifically, semistructured in-depth interviews were conducted with 13 women practicing dentistry in the Makkah region of Saudi Arabia. The interviews were audio-recorded and transcribed verbatim, and the data were interpreted using qualitative content analysis (NVivo 11; QRS International). The results revealed 4 challenges that might delay the participants’ career development. These include family-related challenges, sociocultural challenges, workplace challenges, and transportation issues. From this perspective, some perceived barriers to the professional development of women dentists were found that might not be unique to Saudi Arabia, and the article’s suggestions and recommendations aim to minimize the effects of these barriers impeding women’s advancement in dentistry in Saudi Arabia.

Knowledge Transfer Statement: This study makes an important contribution to knowledge on this topic. These results will aid policy makers’ efforts to create supportive work environments through gender-specific incentives that meet the current professional and family needs of women dentists, particularly those in Saudi Arabia.
A Mural Erased: Urban Art, Local Politics and the Contestation of Public Space in Mashhad
Authors: Zarkar Rustin
Published: January 2017

Over the decade following the 1979 Revolution, Iran’s urban landscape was dramatically refashioned by municipality-led beautification programmes aimed at rejuvenating cityscapes through new public art installations. The newly established government sought to erase or subvert the symbols and public displays of the old regime and replace them with a new visual vocabulary situated within the grand narrative of the Islamic Republic. City streets, boulevards, squares and building façades became sites for a new imagery that championed a revolutionary form of Islam and advocated anti-imperialist and anti-American sentiments, replacing wartime murals with more hopeful visual motifs. This photo-essay captures the public art installations in the city of Mashhad, revealing how the municipality’s beautification programme is directly affected by local politics, in an attempt to offer a fuller picture of modern life and politics in Iran.