bluuebunny/crossref_metadata_2025 huggingface dataset:
In-House Manufacture of Sterilizable, Scaled, Patient-Specific 3D-Printed Models for Rhinoplasty
Authors: Bekisz Jonathan M , Liss Hannah A , Maliha Samantha G , Witek Lukasz , Coelho Paulo G , Flores Roberto L
Published: July 2018

Background

Rhinoplasty relies on clear patient communication and precise execution of a three-dimensional (3D) plan to achieve optimal results. As 3D imaging and printing continue to grow in popularity within the medical field, rhinoplasty surgeons have begun to leverage these resources as an aid to preoperative planning, patient communication, and the technical performance of this challenging operation.

Objectives

Utilizing departmentally available resources and open-access 3D imaging platforms, we have developed an affordable, reproducible protocol for rapid in-house virtual surgical planning (VSP) and subsequent manufacture of 3D-printed rhinoplasty models.

Methods

Preoperative 3D photographic images underwent virtual rhinoplasty using a freely available 3D imaging and sculpting program (BlenderTM [Version 2.78, Amsterdam, The Netherlands]). Once the ideal postoperative result was digitally achieved, scaled, sterilizable, and patient-specific 3D models of the preoperative and ideal postoperative result were manufactured in-house using a departmentally owned 3D printer.

Results

3D-printed models have successfully been manufactured and employed for 12 patients undergoing rhinoplasty. The average time to prepare a set of pre- and postoperative models was 3 hours, while the printing process required 18 to 24 hours per model. Each set of surgical models can be manufactured at a total materials cost of approximately $5.00.

Conclusions

We describe an affordable means to construct sterilizable, scaled, patient-specific 3D-printed models for rhinoplasty. This technique may become of increasing interest to academic and cosmetic centers as hardware costs of 3D printers continue to fall.

Level of Evidence: 4
Manual Lymph Drainage and Fascial Release for the Treatment of Chylous Ascites Following Radical Nephrectomy: A Case Report
Authors: Kramp Mary Ellen
Published: July 2018

Background:

Chylous ascites is “a rare complication of retroperitoneal and mediastinal surgery caused by the unrecognized interruption of major retroperitoneal lymphatic channels and establishment of a lymphoperitoneal fistula.” Chylous ascites occurs 1% to 2% of the time and typically only after surgical injury to the retroperitoneal lymph glands, vessels, or cysterna chyle. Risk factors include manipulation of the para-aortic and superior mesenteric artery root areas, retroperitoneal invasion, focal chronic pancreatitis, having more than 32 lymph nodes removed, several positive lymph nodes, and early enteral feeding.

Case Description:

Six weeks postradical nephrectomy with complete lymphadenectomy of the periaortic nodes, a 60-year-old otherwise healthy, independent woman was found to have a high-volume chylous ascites. The leakage was attempted to be controlled by a low-fat diet, but she still required 4 paracentesis procedures to remove chylous fluid from her abdomen. Total parenteral nutrition was advised, and the patient declined and referred herself to physical therapy. Other than diet restrictions, she was active and had no functional deficits.

Clinical Impression:

It had been 6 months since her nephrectomy with lymphadenectomy, it was probable that there was fascial restriction that was preventing closure of the lymphatic vessel wound and allowing chyle to continually leak into the abdomen.

Intervention:

The chylous ascites was addressed by physical therapy with manual lymph drainage to facilitate the evacuation of fluid out of the abdomen plus fascial releases to mobilize adhesions that may have been impacting the healing of the deep abdominal lymphatic vessels.

Measurements and Results:

Upon initial examination, her abdomen measured 102 cm at the umbilicus and had multiple large pockets of fluid on the ultrasound scan. On her fourth visit 16 days later, her abdomen measured 81 cm with no appreciable pockets of fluid noted. An 8-week follow-up visit revealed no return of fluid in the abdomen. She was able to return to a normal diet.

Discussion:

Further research is warranted to determine if fascial release and manual lymph drainage is a viable treatment of chylous ascites.
Oncology EDGE Task Force on Prostate Cancer Outcomes: A Systematic Review of Outcome Measures for Functional Mobility
Authors: Davies Claire C. , Colon Genevieve , Geyer Hannah , Pfalzer Lucinda , Fisher Mary Insana
Published: July 2018

Background:

The medical treatment of prostate cancer results in multiple impairments in body structure and declines functional abilities, resulting in activity limitations and participation restrictions. Measurement of functional mobility is an essential outcome measure in survivorship care.

Purpose:

The purpose of this systematic review is to make recommendations of the best measurement tools to assess functional mobility in men treated for prostate cancer based on psychometric properties and clinical utility.

Methods:

Multiple electronic databases were searched from February to March 2014. Studies of tools used to assess functional mobility were included if they met the following criteria: reported psychometric properties, were clinically feasible methods, and were published in the English language. Each outcome measure was reviewed independently and rated by 2 reviewers separately. A single Cancer EDGE (Evaluation Database to Guide Effectiveness) Task Force Outcome Measure Rating Form was completed for each category of functional mobility assessment, and a recommendation was made using the 4-point Cancer EDGE Task Force Rating Scale.

Results:

Of the original 38 373 articles found, 87 were included in this review.

Conclusion:

Seven tests are highly recommended by the Oncology EDGE Task Force, 2-Minute Walk Test and 6-Minute Walk Test, 10-Meter Timed Walk, Timed Up and Go, 5 times sit to stand, based on good clinical utility and psychometric properties.
Documenting Medical Necessity for Palliative Care and Degenerative or Chronic Conditions
Authors: Wilson Christopher M. , Boright Lori
Published: July 2018

Recently, the Centers for Medicare & Medicaid Services (CMS) clarified that an expectation for functional or clinical improvement was not a requirement to receive payment for physical therapy services. This includes many life-threatening, chronic, or degenerative conditions. This clarification requires a different approach to clinical documentation and clinical decision-making. The onus rests on the physical therapist and the physical therapist assistant to clearly document medical necessity and that interventions required the skill of a physical therapist. Many other private insurance providers still require an expectation of clinical improvement to justify payment for physical therapy.
What Is Clinically Important in Lymphedema Management? A Systematic Review
Authors: Tidhar Dorit , Armer Jane M. , Stewart Bob R.
Published: July 2018

Objective:

To summarize published reports on the clinical effectiveness of conservative lymphedema management by reporting on outcomes that use anchor- and distribution-based approaches.

Data Sources:

MEDLINE and EBSCO databases from inception to April 2017.

Study Selection:

Articles were selected if they included an estimate for minimal clinically important difference (MCID).

Data Synthesis:

Twenty-four articles involving 938 patients met our inclusion criteria. Years of publication ranged from 1991 to 2016. Of these, 16 studies examined outcomes after the intervention was completed. The other 8 studies tested the reliability of measurement tools. Data were stratified according to different outcomes: limb volume (20 studies, 785 patients), symptoms (6 studies, 288 patients), skin changes (1 study, 28 patients), infection rate (5 studies, 255 patients), quality of life (4 studies, 148 patients), and strength, function, endurance, fitness, and disability (3 studies, 89 patients). Most studies covered cancer-related lymphedema (22/23), especially as related to breast cancer (19/22). Large heterogeneity was found in the methods of estimations with regard to improvement, exacerbation, and stability of lymphedema.

Conclusion:

There is limited evidence to draw conclusions regarding the recommended MCIDs for different populations, outcomes, and periods of time. Further studies are needed to facilitate the process of improving clinical care of lymphedema.
Effect of Common Medications on Breast Cancer-Related Lymphedema
Authors: Tesar Emily , Armer Jane M.
Published: July 2018

Background:

It is estimated that 15% to 28% of breast cancer survivors suffer from breast cancer–related lymphedema (BCRL). As the population of survivors grows, so does their risk for developing other chronic diseases such as cardiac disease, type II diabetes, chronic obstructive pulmonary disease, and other cancers. Minimal literature exists about the effect that medications taken for other chronic conditions have on BCRL.

AIMS:

The purpose of this article is to highlight how common medications can impact peripheral and generalized edema, thereby contributing to lymphedema, and outline ongoing research.

Methods:

This article also identifies 6 classifications of chronic disease medications with known profiles for potentiating edema that could mimic or exacerbate lymphedema.
Behavioral Change Strategies to Improve Physical Activity After Cancer Treatment
Authors: Berkman Amy M. , Gilchrist Susan C.
Published: July 2018

Physical activity is associated with a decreased risk of mortality among cancer survivors and promotes heart health in a population of patients with cancer at risk for cardiovascular disease. Unfortunately, the majority of cancer survivors do not meet national physical activity guidelines. A wide range of strategies, including education, coaching, and behavioral change theories, have been used in interventions aimed at increasing physical activity among cancer survivors. We sought to review the most compelling practices to inform oncology rehabilitation programs focused on improving physical activity among cancer survivors. We identify both effective and ineffective strategies for behavioral change, as well as highlight areas where more research focus is needed to improve physical activity among cancer survivors.
Skeletal muscle and solitary bone metastases from malignant melanoma: multimodality imaging and oncological outcome
Authors: Gómez-León Nieves , Pacheco-Barcia Vilma , Ballesteros Ana I. , Fraga Javier , Colomer Ramon , Friera Alfonsa
Published: July 2018

Malignant melanoma solitary metastases to bone or skeletal muscle occur in 0.8% of patients. The aim of this study was to evaluate features of skeleton and muscle metastases with multimodality imaging and review the oncological outcome. Thirteen patients with melanoma metastases from January 2006 to February 2016 were included. Histologic confirmation was obtained. Imaging studies included computed tomography (CT), MRI, and/or positron emission tomography/CT. Treatment received and BRAF status were recorded. Differences in BRAF status and overall survival (OS) were analyzed using the χ
2-test. Associations between OS and metastases were analyzed using Cox proportional models. Nine (69%) patients showed osseous involvement. Lower extremity bones were affected in three (23%) patients: first toe, right calcaneal spurs, and knee. The spine was involved in three (23%) patients. In two (15%) patients, the pelvic bones were involved. In one (8%) patient, the temporal bone was affected. Nine (70%) patients had a history of malignant melanoma, with a median time to progression of 28 months. The median OS was 18 months: 24 months in patients with a history of melanoma and 3 months in patients with metastases at first diagnosis. The median follow-up duration was 28 months. BRAF mutant versus wild-type tumors showed significant differences in OS (P=0.03). The hazard ratio for death in the metastatic group at diagnosis was 6.83, 95% confidence interval: 1.060–144.072 (P=0.04). Solitary metastases from melanoma to the skeleton and muscle are rare. CT, MRI, and positron emission tomography/CT are useful for the evaluation of musculoskeletal findings. Image findings are not definitive for diagnosing a malignant solitary lesion; thus, a pathologic confirmation with a biopsy is recommended.
Heart Rate and Blood Pressure Assessment by Physical Therapists in the Outpatient Setting—An Observational Study
Authors: Millar A. Lynn , Village David , King Tiffany , McKenzie Germyn , Lee Jody , Lopez Coronel
Published: July 2018

Purpose:

Although physical therapists (PTs) are equipped and trained with the knowledge of the importance of vital sign assessment and cardiovascular risk factors, there seems to be a discrepancy between the practice guidelines and the actual practice in the clinic. Therefore, the purpose of this study was to observe the frequency with which PTs take and record heart rate (HR) and blood pressure (BP) in the orthopedic outpatient setting during therapy sessions.

Methods:

Physical therapists from 6 area clinics were observed, including 15 licensed PTs, during 74 patient sessions. The frequency with which the PTs measured patients' BP and HR during initial assessment and/or follow-up treatment sessions was documented. Physical therapist demographics and patient diagnosis, comorbidities, age, and sex were recorded.

Results:

Of the 74 patient sessions, 15 were initial visits, 54 were follow-up, and 5 were discharge sessions. Although 26% (n = 19) of the patients had hypertension as a comorbidity, initial HR and BP were only taken in 2 sessions, and only once taken after exercise.

Conclusions:

Within our limited sample, PTs in outpatient settings were not following HR and BP screening or exercise monitoring practice guidelines. This could put patients at risk for cardiovascular incidents during therapy sessions.
Provision of Physical Therapy at a Long-Term Acute Care Hospital for Patients Awaiting Lung Transplantation: A Case Report With 3 Participants
Authors: Thrush Aaron , Skrzat Julie
Published: July 2018

Introduction:

Although the number of individuals awaiting lung transplantation is increasing, little is known about the impact of physical therapy (PT), particularly among candidates who require prolonged hospitalization and high levels of supplemental oxygen. This article describes the provision and outcomes of PT for 3 lung transplant candidates at a long-term acute care hospital (LTACH).

Case Presentation:

Each patient was admitted to a hospital with exacerbation of lung disease and, after being medically stabilized and listed for transplant, transferred to our LTACH for continued medical care of his tenuous medical state. Patients participated in PT to maintain their function and remain candidates for transplant, and to promote improved outcomes after transplant. Length of stay varied from 21 to 107 days.

Results:

All patients made clinically important improvements in Six-Minute Walk Test distance. Physical therapy was scheduled 5 times per week and was completed 95% of the time.

Conclusions:

All 3 patients made significant gains despite end-stage disease and exceptionally low pulmonary reserve, and were able to participate in daily PT during prolonged hospitalizations. The results demonstrate the potential for favorable functional improvements in a subset of people with more severe disease and more critical ongoing medical needs than previously described in the literature.
Background and Expertise of Faculty Teaching Cardiovascular and Pulmonary Content in Entry-Level DPT Programs
Authors: Bartlo Pamela , Lefebvre Kristin , Wellmon Robert
Published: July 2018

Purpose:

The purposes of this study were (1) to examine the qualifications and expertise of individuals teaching cardiovascular and pulmonary physical therapy (CVP-PT) content at entry-level DPT education programs and (2) to determine the amount of time devoted to the content and method of delivery.

Methods:

A survey sent through email to 206 program directors of accredited DPT programs assessed institutional demographics, the faculty teaching the CVP-PT content, and the method of delivery. The responses were examined descriptively using frequency counts and percentages.

Results:

There was a 49.5% response rate with 102 completed surveys. Among faculty teaching CVP-PT content, 54% had a PhD/EdD, 32% a DPT, and 19% had other degrees. Only 43% teaching the CVP-PT content had a Cardiovascular and Pulmonary Clinical Specialist (CCS) certification. Approximately, 83% of the institutions employed a full-time faculty member to teach the CVP-PT content. Most programs used a single course to deliver the CVP-PT content and 84% reported the use of simulation for CVP-PT content delivery.

Conclusions:

These results demonstrated that entry-level DPT programs responding to the survey had qualified faculty with CVP-PT expertise and that there is a need to encourage further professional development of faculty with CCS credentials.
Clinical Markers of Exercise Intensity as a Surrogate for Blood Lactate Levels Only During Low-Intensity Exercise in Patients With Coronary Artery Disease
Authors: Gurovich Alvaro N. , Heiser Brittany , Hayes Chase , Marshall Emily , Roath Stephanie , Kabous Neil G.
Published: July 2018

Purpose:

To determine if clinical markers of exercise intensity, such as heart rate (HR) and rate of perceived exertion (RPE), reflect physiological demands, measured via blood lactate (La) levels, during a graded exercise test (GXT) in cardiac patients.

Methods:

Thirty-one subjects (19 men and 12 women; age, 58 ± 12 years) were recruited for a GXT. Heart rate, RPE, and La were assessed at rest and after each GXT stage. Pearson correlations were performed between variables (percentage of maximal HR [%HRmax], RPE, La). Bland–Altman analyses were performed to determine agreement between La and %HRmax and RPE.

Results:

Overall, 113 GXT stages were included in the analysis. It was found that La correlated with RPE (r = 0.72; P < .01) and %HRmax (r = 0.76; P < .01); %HRmax correlated with RPE (r = 0.76; P < .01). However, there was no agreement between La and RPE (72.6% of the sample laid outside 95% CI [−0.25, 0.25 mmol/L]) and between La and %HRmax (85% of the sample laid outside 95% CI [0.54, 1.04 mmol/L]).

Conclusions:

The significant associations between La, %HRmax, and RPE could be explained by the direct relationship between these variables that occur during the increasing exercise intensity, characteristic of a GTX. However, HR and RPE should not be used as a surrogate to a La-based descriptor of exercise intensity in patients with coronary artery disease exercising at high intensity.
Body Position Affects Ultrasonographic Measurement of Diaphragm Contractility
Authors: Brown Christopher , Tseng Shih-Chiao , Mitchell Katy , Roddey Toni
Published: July 2018

Purpose:

(1) Determine whether ultrasonography can detect differences in diaphragm contractility between body positions. (2) Perform reliability analysis of diaphragm thickness measurements in each test condition.

Methods:

We used a repeated-measures experimental design with 45 healthy adults where 3 B-mode ultrasound images were collected at peak-inspiration and end-expiration in supine, sitting, and standing. Mean diaphragm thickening fractions were calculated for each test position. Statistical significance was tested using 1-way repeated-measures analysis of variance with planned comparisons. For reliability analysis, the intraclass correlation coefficient (3, 3) was calculated.

Results:

Mean diaphragm thickening fraction increased from 60.2% (95% confidence interval [CI] 53.0%, 67.9%) in supine, to 96.5% (95% CI 83.2%, 109.9%) while seated and to 173.8% (95% CI 150.5%, 197.1%) while standing. Body position was a significant factor overall (P < .001), as were comparisons between each individual position (P < .001). Intraobserver reliability was excellent (>0.93) for all body positions tested.

Conclusions:

Ultrasound imaging detected positional differences in diaphragm contractility. The effect of gravitational loading on diaphragm length-tension, and body position-mediated changes in intra-abdominal pressure may explain the differences found. Future research should address methodological concerns and apply this method to patients participating in early mobilization programs in the intensive care unit.
Partners of Individuals with Borderline Personality Disorder: A Systematic Review of the Literature Examining Their Experiences and the Supports Available to Them
Authors: Greer Holly , Cohen Jacqueline N.
Published: July 2018

Over a third of individuals with borderline personality disorder (BPD) are in long-term romantic partnerships, yet little is known about the experiences of their partners. Because difficulties in interpersonal relationships are a hallmark of BPD, it is especially important to understand the support needs of their romantic partners. This systematic review investigates the experiences of romantic partners of adult individuals with BPD and the interventions designed to support them. Twenty-two articles were found, 13 of which pertained to partner experiences and 9 to interventions. Thematic analysis was used to identify three main themes in the descriptions of partners’ experiences: emotional challenges, dual roles as both a romantic partner and parental/therapeutic figure, and lack of control. The available interventions, which consisted of educational and skills-based programs with limited efficacy data, addressed only a small portion of the subthemes identified in the literature describing partners’ experiences. The discrepancy between the needs identified in the partner-experience literature and the interventions available suggests a need to develop and evaluate more partner-oriented programming. Such programming should use psychoeducation, peer support, and individual- and relationship-based skills development to address and therefore improve the experiences of partners of individuals with BPD.
ASYMMETRIC HYDROXYCHLOROQUINE MACULAR TOXICITY WITH APHAKIC FELLOW EYE
Authors: Mack Heather G. , Fuzzard Dujon R. W. , Symons R. C. Andrew , Heriot Wilson J.
Published: July 2018

Background/Purpose:

Retinal toxicity associated with antimalarial drug use in inflammatory conditions is well described and may be more common than previously recognized. Antimalarial drugs bind to melanin in ocular tissues, particularly the retinal pigment epithelium, but the mechanism of toxicity and its relation to light is unclear.

Methods:

Case report.

Results:

A 62-year-old white woman with erosive rheumatoid arthritis developed hydroxychloroquine toxicity in her phakic eye, with her aphakic fellow eye only mildly affected.

Conclusion:

We report the clinical evaluation of this rare case of asymmetrical hydroxychloroquine retinopathy and present a hypothesis regarding the mechanism of drug toxicity.
Optimized thiopurine therapy before withdrawal of anti-tumour necrosis factor-α in patients with Crohn’s disease
Authors: Bohn Thomsen Sandra , Kiszka-Kanowitz Marianne , Theede Klaus , Gluud Lise Lotte , Mertz Nielsen Anette
Published: July 2018

Objective

Two meta-analyses have found that the risk of relapse in Crohn’s disease (CD) was ~40 and 50% 1 and 2 years, respectively, after withdrawal of anti-tumour necrosis factor-α (anti-TNFα). The aim of this study was to evaluate relapse rates in CD when thiopurine therapy was optimized before anti-TNFα withdrawal.

Patients and methods

An observational study was conducted including patients with CD in remission with optimized thiopurine therapy before anti-TNFα withdrawal. We defined optimized thiopurine therapy as 6-thioguanine levels of at least 150 nmol/mmol haemoglobin (∼300 pmol×108 red blood cells) and clinical/biochemical remission as Harvey-Bradshaw Index of 5 or less and faecal calprotectin of 200 µg/g or less.

Results

We included 33 patients (median age: 31 years, 55% males, and median disease duration: 7 years) followed for a median of 36 months. A total of three (9%) patients relapsed during the first year and six patients (in total 27%) relapsed after 2 years. After 2 years, none of the additional patients relapsed. The disease duration and duration of anti-TNFα treatment and faecal calprotectin levels before inclusion did not predict relapse. Calprotectin levels of at least 180 after 1 year predicted relapse at year 2.

Conclusion

This study found that 73% of patients with CD maintained remission (>2 years) when thiopurine therapy was optimized before withdrawal of anti-TNFα. Additional prospective evidence is needed to confirm the findings.
The Effects of Holy Name Meditation on Spiritual Well-being, Depression, and Anxiety of Patients With Cancer
Authors: Yong Jinsun (Sr. Julianna) , Park Junyang (Fr. John) , Kim Juhu , Kim Pyeongman (Fr. Justino) , Seo Im-Sun , Lee Hun
Published: July 2018

This study was conducted to evaluate the effects of the Holy Name Meditation on cancer patients’ spiritual well-being, anxiety, depression, and pain. Twenty-eight patients were enrolled in the control group, and 18 patients were selected for the experimental group. Only the patients in the experimental group completed 5 weeks of the Holy Name Meditation Program. All participants were surveyed to assess spiritual well-being (Spiritual Well-Being Scale), anxiety and depression (Symptom Checklist 90-R), and pain (numeric pain rating scale). There were no significant differences between the two groups' general characteristics, but the baseline survey revealed that anxiety and depression levels were higher in the experimental group. Analyzing the results after controlling the baseline scores of anxiety and depression showed that spiritual well-being was increased (F = 4.80, P = .034), whereas anxiety (F = 4.98, P = .031) and depression (F = 7.28, P = .010) were decreased after the intervention. No difference in pain was found between the two groups. The Holy Name Meditation Program was thus effective in enhancing cancer patients' spiritual well-being and decreasing their anxiety and depression. Therefore, it is recommended that Holy Name Meditation be provided in clinical settings to reduce the psychosocial and spiritual suffering of cancer patients.
The Effects of Guided Imagery on Comfort in Palliative Care
Authors: Coelho Adriana , Parola Vitor , Sandgren Anna , Fernandes Olga , Kolcaba Katharine , Apóstolo João
Published: July 2018

Guided imagery (GI) is a nonpharmacological intervention that is increasingly implemented in different clinical contexts. However, there have been no studies on the effect of GI on the comfort of inpatients of palliative care (PC) units. Therefore, the aim of this study was to evaluate the effects of GI on the comfort of patients in PC. A 1-group, pretest-posttest, pre-experimental design was used to measure differences in heart rate, respiratory rate, pain, and comfort in patients (n = 26) before and after a 2-session GI program. The intervention featuring GI increased comfort, measured by an Abbreviated Holistic Comfort Scale and the visual analog comfort scale (P < .001), and decreased heart rate (P < .001), respiratory rate (P < .001), and pain, as measured by the (numerical) visual analog pain scale (P < .001). This study demonstrates that the use of an intervention featuring GI increases the comfort of oncology patients admitted to a PC unit. The use of GI by nurses is inexpensive, straightforward to implement, and readily available and may result in the provision of comfort care.
Outcomes of a Dignity Therapy/Life Plan Intervention for Patients With Advanced Cancer Undergoing Chemotherapy
Authors: Dose Ann M. , McCabe Pamela J. , Krecke Catherine A. , Sloan Jeff A.
Published: July 2018

Dignity therapy is a psychosocial intervention provided at the end of life to improve patient outcomes, but many persons cannot complete it because of health decline. Patients also reprioritize their life plans as death becomes imminent. As part of meeting standards to provide psychosocial palliative care simultaneously with cancer treatment, we provided a dignity therapy/life plan intervention to 18 patients with advanced pancreatic or lung cancer receiving cancer treatment. The study aim was to evaluate patient-reported outcomes of dignity therapy/life plan. Dignity therapy entailed interviews during 3 outpatient oncology encounters, which then became a legacy document for family. Participants documented life goals as their life plan. Distress, quality of life, spirituality, dignity, and purpose in life were measured at baseline, immediately after intervention, and 3 months later. No variables were significantly different from baseline to postintervention and 3 months later, except for less distress between baseline and 3 months (P = .04). Although this intervention did not show improvements in outcomes, patients with advanced disease receiving active treatment typically experience worsening symptoms overall. Maintaining psychosocial outcomes may be preventing further morbidity in an advanced cancer population during treatment and bears further exploration. Given our small sample size, further research is warranted.
A Unique, Hybrid Approach to the Clinical Immersion Experience
Authors: Lindell Deborah , Koppelman Catherine , Marchi Nadine
Published: July 2018

Through clinical immersion experiences (IEs), prelicensure nursing students work with a registered nurse preceptor to experience their schedule and patient assignment. IEs can have advantages for the practice and academic partners and individual students. However, there are also challenges to providing IEs, particularly for healthcare organizations. Collaborative planning and results are reported of a promising IE model, the hybrid immersion experience, which addressed the disadvantages and resulted in positive outcomes for all stakeholders.
Molecular Profiling of Hyalinizing Clear Cell Carcinomas Revealed a Subset of Tumors Harboring a Novel EWSR1-CREM Fusion
Authors: Chapman Erin , Skalova Alena , Ptakova Nikola , Martinek Petr , Goytain Angela , Tucker Tracy , Xiong Wei , Leader Mary , Kudlow Brian A. , Haimes Josh D. , Hayes Malcolm M. , Bohus Peter , Miesbauerova Marketa , Lee Cheng-Han , Ng Tony L.
Published: July 2018

We describe a novel gene fusion, EWSR1-CREM, identified in 3 cases of clear cell carcinoma (CCC) using anchored multiplex polymerase chain reaction, a next-generation sequencing–based technique. CCC is a low-grade salivary tumor recently characterized to have EWSR1-ATF1 fusions in the majority of cases. Three cases of malignant tumor presenting in the base of tongue, lung, and nasopharynx were studied. All cases shared a clear cell morphology with hyalinized stroma, presence of mucin and p63 positivity and were initially diagnosed as mucoepidermoid carcinoma but were negative for evidence of any of the expected gene fusions. Anchored multiplex polymerase chain reaction demonstrated a EWSR1-CREM fusion in all 3 cases to confirm a diagnosis of CCC. This finding is biologically justified as CREM and ATF1 both belong to the CREB family of transcription factors. EWSR1-CREM fusions have not been previously reported in CCC and have only rarely been reported in other tumors. We show that the ability to discover novel gene variants with next-generation sequencing–based assays has clinical utility in the pathologic classification of fusion gene-associated tumors.
Orbital Air Embolism After Intravenous Injection
Authors: Rossiter-Thornton Michael , Varma Aditya , Verma Nitin , Hewitt Alex W.
Published: July 2018

An asymptomatic air embolism in the right superior ophthalmic vein was discovered incidentally during a cerebral computed tomography, most likely due to a preceding intravenous fluid bolus. This case illustrates the potential risk of air emboli being propagated to the cerebral venous circulation during routine injections and fluid resuscitation.
Imaging Striatal Dopamine Release Using a Non-Genetically Encoded Near-Infrared Fluorescent Catecholamine Nanosensor
Authors: Beyene Abraham G. , Delevich Kristen , Bonis-O’Donnell Jackson Travis Del , Piekarski David J. , Lin Wan Chen , Wren Thomas A. , Yang Sarah J. , Kosillo Polina , Yang Darwin , Wilbrecht Linda , Landry Markita P.
Published: July 2018

Neuromodulation plays a critical role in brain function in both health and disease. New optical tools, and their validation in biological tissues, are needed that can image neuromodulation with high spatial and temporal resolution, which will add an important new dimension of information to neuroscience research. Here, we demonstrate the use of a catecholamine nanosensor with fluorescent emission in the 1000-1300 nm near-infrared window to measure dopamine transmission in ex vivo brain slices. These near-infrared catecholamine nanosensors (nIRCats) represent a broader class of nanosensors that can be synthesized from non-covalent conjugation of single wall carbon nanotubes (SWNT) with single strand oligonucleotides. We show that nIRCats can be used to detect catecholamine efflux in brain tissue driven by both electrical stimulation or optogenetic stimulation. Spatial analysis of electrically-evoked signals revealed dynamic regions of interest approximately 2 microns in size in which transients scaled with simulation intensity. Optogenetic stimulation of dopaminergic terminals produced similar transients, whereas optogenetic stimulation of glutamatergic terminals showed no effect on nIRCat signal. Bath application of nomifensine prolonged nIRCat fluorescence signal, consistent with reuptake blockade of dopamine. We further show that the chemically synthetic molecular recognition elements of nIRCats permit measurement of dopamine dynamics in the presence of dopamine receptor agonists and antagonists. These nIRCat nanosensors may be advantageous for future use because i) they do not require virus delivery, gene delivery, or protein expression, ii) their near-infrared fluorescence facilitates imaging in optically scattering brain tissue and is compatible for use in conjunction with other optical neuroscience tool sets, iii) the broad availability of unique near-infrared colors have the potential for simultaneous detection of multiple neurochemical signals, and iv) they are compatible with pharmacology. Together, these data suggest nIRCats and other nanosensors of this class can serve as versatile new optical tools to report dynamics of extracellular neuromodulation in the brain.
Stationary Equations for Non-Markovian Biochemical Systems
Authors: Zhang Jiajun , Zhou Tianshou
Published: July 2018

We develop a new approach for stochastic analysis of biochemical reaction systems with arbitrary distributions of waiting times between reaction events. Specifically, we derive a stationary generalized chemical master equation for a non-Markovian reaction network. Importantly, this equation allows to transform the original non-Markovian problem into a Markovian one by introducing a mean reaction propensity function for every reaction in the network. Furthermore, we derive a stationary generalized linear noise approximation for the non-Markovian system, which is convenient to the direct estimation of the stationary noise in state variables. These derived equations can have broad applications, and exemplars of two representative non-Markovian models provide evidence of their applicability.
Episodic Control as Meta-Reinforcement Learning
Authors: Ritter S , Wang JX , Kurth-Nelson Z , Botvinick M
Published: July 2018

Recent research has placed episodic reinforcement learning (RL) alongside model-free and model-based RL on the list of processes centrally involved in human reward-based learning. In the present work, we extend the unified account of model-free and model-based RL developed by Wang et al. (2018) to further integrate episodic learning. In this account, a generic model-free “meta-learner” learns to deploy and coordinate among all of these learning algorithms. The meta-learner learns through brief encounters with many novel tasks, so that it learns to learn about new tasks. We show that when equipped with an episodic memory system inspired by theories of reinstatement and gating, the meta-learner learns to use the episodic and model-based learning algorithms observed in humans in a task designed to dissociate among the influences of various learning strategies. We discuss implications and predictions of the model.
The first complete mitochondrial genome of marigold pest thrips,Neohydatothrips samayunkur(Sericothripinae) and comparative analysis
Authors: Kumar Vikas , Tyagi Kaomud , Kundu Shantanu , Chakraborty Rajasree , Singha Devkant , Chandra Kailash
Published: July 2018

The complete mitogenomes in order Thysanoptera is limited to subfamily Thripinae heretofore. In the present study, we sequenced the first mitochondrial genome ofNeohydatothrips samayunkur(15,295 bp), a member of subfamily Sericothripinae. The genome was characterized by 13 protein-coding genes (PCGs), 22 transfer RNA genes (tRNAs), two ribosomal RNA genes (rRNAs) and three control regions (CRs). This mitogenome had two overlapping regions of 4 bp and twenty four intergenic spacers accounting for 165 bp. All the tRNA had typical cloverleaf secondary structures, except fortrnV and trnSwhich lacked DHU stem and loop. The mitogenomes ofN. samayunkurwas highly rearranged with many unique features as compared to other thrips mitogenomes,atp6andnad1were terminated with TAG and TGA stop codons respectively; location oftrnL2,trnA,trnC, andtrnVwas rearranged; and the first control region (CR1) was upstream ofnad6.The phylogenetic analysis of 13 PCGs implementing maximum likelihood and Bayesian inference showed the clustering ofN. samayunkurwithScirtothrips dorsalissupporting theScirtothripsgenus-group and Sericothripinae morphology based relationships. Generation of more mitogenomes from different hierarchical level in the order Thysanoptera is required to understand the gene rearrangements, phylogeny and evolutionary relationships.
Finite element analysis of magnetohydrodynamic flow over flat surface moving in parallel free stream with viscous dissipation and Joule heating
Authors: Chaudhary Santosh , Choudhary Mohan Kumar
Published: July 2018

Purpose

The purpose of this paper is to investigate two-dimensional viscous incompressible magnetohydrodynamic boundary layer flow and heat transfer of an electrically conducting fluid over a continuous moving flat surface considering the viscous dissipation and Joule heating.

Design/methodology/approach

Suitable similarity variables are introduced to reduce the governing nonlinear boundary layer partial differential equations to ordinary differential equations. A numerical solution of the resulting two-point boundary value problem is carried out by using the finite element method with the help of Gauss elimination technique.

Findings

A comparison of obtained results is made with the previous work under the limiting cases. Behavior of flow and thermal fields against various governing parameters like mass transfer parameter, moving flat surface parameter, magnetic parameter, Prandtl number and Eckert number are analyzed and demonstrated graphically. Moreover, shear stress and heat flux at the moving surface for various values of the physical parameters are presented numerically in tabular form and discussed in detail.

Originality/value

The work is relatively original, as very little work has been reported on magnetohydrodynamic flow and heat transfer over a continuous moving flat surface. Viscous dissipation and Joule heating are neglected in most of the previous studies. The numerical method applied to solve governing equations is finite element method which is new and efficient.
Influence of wire’s surface topography on interwire contact performance of simple spiral strand
Authors: Meng Fanming , He Jing , Gong Xiansheng
Published: July 2018

Purpose

The purpose of this study is to research the influence of wire’s surface topography on interwire contact performance of simple spiral strand.

Design/methodology/approach

The mechanical model of the simple spiral strand imposed by a tensile load is first established, into which the surface topography, Poisson’s ratio effect and radial deformation are incorporated simultaneously. Meanwhile, the Gaussian and non-Gaussian rough surfaces of the steel wires are obtained with the fast Fourier transform (FFT) and digital filter technology. Then, the rough interwire contact performance of the simple spiral strand is calculated by using conjugate gradient method and FFT.

Findings

As compared with smooth wire surface, both the longitudinal orientation for the Gaussian wire surface and large kurtosis or small skewness for the non-Gaussian surface yield a small contact pressure and stress.

Originality/value

This study conducts detailed discussion of the influence of wire’s surface topography on the interwire contact performance for the simple spiral strand and gives a beneficial reference for the design and application of a wire rope.
Implications of Central banks’ negative policy rates on financial stability
Authors: Kay Benjamin S.
Published: July 2018

Purpose

While central bankers have widely discussed the trade-offs of negative interest rates on monetary policy, the consequences of negative rates on financial stability are less well understood. The purpose of this paper is to examine the likely and possible financial stability consequences of a negative rates policy with particular focus on banks, short-term funding markets, foreign exchange markets, asset managers, pension funds and insurers.

Design/methodology/approach

It draws from international experience with negative interest rates to identify financial stability threats posed to any economy by negative interest rates, and it also highlights where the US experience is likely to differ.

Findings

In time, financial market threats and other logistical issues of a negative interest rate policy can be managed or overcome. Even cumulatively, these threats are likely to be small as long as the rates remain only modestly negative. However, if the rates remain negative for long periods or they become more sharply negative, the rewards of avoiding negative rates increase.

Originality/value

Does the negative interest rate policy directly or through these challenges of implementation present a substantial obstacle to achieving financial stability objectives? As policy rates go negative in a greater share of the global economy, the financial stability consequences remain poorly understood and under discussed.
Innovation in education: what works, what doesn’t, and what to do about it?
Authors: Serdyukov Peter
Published: July 2018

Purpose

The purpose of this paper is to present an analytical review of the educational innovation field in the USA. It outlines classification of innovations, discusses the hurdles to innovation, and offers ways to increase the scale and rate of innovation-based transformations in the education system.

Design/methodology/approach

The paper is based on a literature survey and author research.

Findings

US education badly needs effective innovations of scale that can help produce the needed high-quality learning outcomes across the system. The primary focus of educational innovations should be on teaching and learning theory and practice, as well as on the learner, parents, community, society, and its culture. Technology applications need a solid theoretical foundation based on purposeful, systemic research, and a sound pedagogy. One of the critical areas of research and innovation can be cost and time efficiency of the learning.

Practical implications

Several practical recommendations stem out of this paper: how to create a base for large-scale innovations and their implementation; how to increase effectiveness of technology innovations in education, particularly online learning; how to raise time and cost efficiency of education.

Social implications

Innovations in education are regarded, along with the education system, within the context of a societal supersystem demonstrating their interrelations and interdependencies at all levels. Raising the quality and scale of innovations in education will positively affect education itself and benefit the whole society.

Originality/value

Originality is in the systemic approach to education and educational innovations, in offering a comprehensive classification of innovations; in exposing the hurdles to innovations, in new arguments about effectiveness of technology applications, and in time efficiency of education.
Attributions of service quality: immigrant customers’ perspective
Authors: Sichtmann Christina , Micevski Milena
Published: July 2018

Purpose

This study aims to investigate whether and how strongly cultural (mis)matches influence immigrant customers’ satisfaction, as well as if this relationship is mediated by cultural or service employee performance attributions. In addition, the authors test whether attributions differ depending on the service delivery outcome (success vs failure).

Design/methodology/approach

The 2 (origin of service employee: Austria or Turkey) × 2 (service delivery outcome: success or failure) scenario-based experiment includes 120 Turkish immigrant customers in Austria.

Findings

Contrary to previous research, the results indicate that in an immigrant customer context, cultural (mis)match does not influence customer satisfaction. The service delivery outcome is a boundary condition. With a positive service delivery outcome, immigrant customers attribute the results to the cultural background of the employee if it is the same as their own, but they attribute success to employees’ performance if they belong to the immigration destination culture. For negative service delivery outcomes, neither cultural nor performance attributions arise.

Originality/value

This study is the first to focus specifically on immigrant customer behavior in a high-involvement service context. The results challenge the predictions of social identity theory and the similarity-attraction paradigm and highlight that the immigrant context is unique. In this context, attributions play a key role in determining customer satisfaction.
The implementation of the concept of environmental carrying capacity into spatial management of cities
Authors: Świąder Małgorzata
Published: July 2018

Purpose

Uncontrolled and unsustainable urban development has a significant impact on the overall quality of the environment. Contemporary spatial management does not take into account the non-economic conditions of ecosystem functions and their biophysical limits, which results in a deterioration of the environment. Furthermore, urban development continues all over the world, which is associated with a projected population increase, particularly in cities. Therefore, there is need to include analyses in the field of environmental carrying capacity (ECC) for more sustainable spatial management and development. The ECC concept is a tool for sustainable development of human settlements. It could be defined as threshold level of anthropopressure, which the environment is able to balance and withstand without serious degradation and irreversible changes. The use of ECC assessment will help ensure the needs of the city’s residents, which are conditioned by the environment. The paper aims to discuss this issue.

Design/methodology/approach

This review study presents an overview of the ECC concept and its potential for use in spatial management at local level, especially for cities. The content analysis introduces definitions of spatial management and others main actions of spatial economy as well as the definitions of ECC. The overview of existing ECC models is a part of presented review.

Findings

The paper shows the ECC approach from global to local level on Poland as an example country.

Originality/value

The literature review identified that the idea of ECC could be a useful concept and tool for sustainable spatial development and management. This concept allows for verification of the resources and environmental state of given territory unit. Therefore, the assessment of ECC allows to verify if development of given area, for instance country, region or even city, is conducted within the framework of sustainable principles. Despite this, the assessment of ECC is not taken into account when future spatial management is defined. Thus, this circumstance could be a reason for this research area development.