bluuebunny/crossref_metadata_2025 huggingface dataset:
The potential of electrocardiography for cardiac risk prediction in chronic and end-stage kidney disease
Authors: Skampardoni Sofia , Poulikakos Dimitrios , Malik Marek , Green Darren , Kalra Philip A
Published: July 2018

Cardiovascular mortality is very high in chronic and end-stage kidney disease (ESKD). However, risk stratification data are lacking. Sudden cardiac deaths are among the most common cardiovascular causes of death in these populations. As a result, many studies have assessed the prognostic potential of various electrocardiographic parameters in the renal population. Recent data from studies of implantable loop recordings in haemodialysis patients from five different countries have shed light on a pre-eminent bradyarrhythmic risk of mortality. Importantly, heart block addressed by permanent pacing system was detected in a proportion of patients during the prolonged recording periods. Standard electrocardiogram is inexpensive, non-invasive and easily accessible. Hence, risk prediction models using this simple investigation tool could easily translate into clinical practice. We believe that electrocardiographic assessment is currently under-valued in renal populations. For this review, we identified studies from the preceding 10 years that assessed the use of conventional and novel electrocardiographic biomarkers as risk predictors in chronic and ESKD. The review indicates that conventional electrocardiographic markers are not reliable for risk stratification in the renal populations. Novel parameters have shown promising results in smaller studies, but further validation in larger populations is required.
Association between circulating proprotein convertase subtilisin/kexin type 9 levels and prognosis in patients with severe chronic kidney disease
Authors: Rasmussen Laust Dupont , Bøttcher Morten , Ivarsen Per , Jørgensen Hanne Skou , Nyegaard Mette , Buttenschøn Henriette , Gustafsen Camilla , Glerup Simon , Bøtker Hans Erik , Svensson My , Winther Simon
Published: July 2018

Background

Chronic kidney disease is a risk factor for premature development of coronary atherosclerosis and mortality. A high level of proprotein convertase subtilisin/kexin type 9 (PCSK9) is a recently recognized cardiovascular risk factor and has become the target of effective inhibitory treatment. In 167 kidney transplantation candidates, we aimed to: (i) compare levels of PCSK9 with those of healthy controls, (ii) examine the association between levels of PCSK9 and low-density lipoprotein cholesterol (LDL-c) and the degree of coronary artery disease (CAD) and (iii) evaluate if levels of PCSK9 predict major adverse cardiac events (MACE) and mortality.

Methods

Kidney transplant candidates (n = 167) underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) before transplantation. MACE and mortality data were extracted from the Western Denmark Heart Registry, a review of patient records and patient interviews. A group of 79 healthy subjects were used as controls.

Results

Mean PCSK9 levels did not differ between healthy controls and kidney transplant candidates. In patients not receiving lipid-lowering therapy, PCSK9 correlated positively with LDL-c (rho = 0.24, P < 0.05). Mean PCSK9 was similar in patients with and without obstructive CAD at both CCTA and ICA. In a multiple regression analysis, PCSK9 was associated with neither LDL-c (β=−6.45, P = 0.44) nor coronary artery calcium score (β=2.17, P = 0.84). During a follow-up of 3.7 years, PCSK9 levels were not associated with either MACE or mortality.

Conclusions

The ability of PCSK9 levels to predict cardiovascular disease and prognosis does not seem to apply to a cohort of kidney transplant candidates.
The relationship between urinary albumin excretion, cardiovascular outcomes and total mortality among a large cohort of insulin-treated patients with type 2 diabetes in routine primary care practices
Authors: Anyanwagu Uchenna , Donnelly Richard , Idris Iskandar
Published: July 2018

Background

Albuminuria is a recognized diagnostic and prognostic marker of chronic kidney disease and cardiovascular (CV) risk but the well-known relationship between increments in urinary albumin:creatinine ratio (UACR) and CV outcomes and mortality has not been fully explored in insulin-treated patients with type 2 diabetes (T2D) in routine clinical care.

Methods

We investigated data for insulin users with T2D from UK general practices between 2007 and 2014. The UACR at the time of insulin initiation was measured and categorized as <10, 10– 29, 30–300 and >300 mg/g. Patients were followed up for 5 years or the earliest occurrence of all-cause mortality, non-fatal myocardial infarction or stroke. Cox proportional hazards models were fitted to estimate the risk of a composite of these events.

Results

A total of 12 725 patients with T2D (mean age 58.6 ± 13.8 years, mean haemoglobin A1c 8.7 ± 1.8%) initiating insulin therapy between 2007 and 2014 met the inclusion criteria. Compared with patients whose ACR levels at insulin initiation were <10 mg/g, the adjusted risk of the 3-point composite endpoint was 9, 30 and 98% higher in those with ACR levels between 10–29, 30–300 and >300 mg/g, respectively, after a follow-up period of 5 years. The ACR category on its own did not predict risk of all-cause mortality.

Conclusions

This study shows that in patients with T2D on insulin therapy, increased urinary ACR is independently associated with an increased risk of major adverse CV events and all-cause mortality.
Modern Surgical Management of Early Onset and Adolescent Idiopathic Scoliosis
Authors: Beauchamp Eduardo C , Anderson Richard C E , Vitale Michael G
Published: July 2018

The early principles of spinal fusion in the adolescent population focused on preventing progression while simultaneously correcting the spinal deformity. These principles have remained relatively unchanged since their introduction more than a century ago, but recent improvements in imaging, instrumentation, and corrective techniques have provided new insight on the diagnosis, management, and postoperative care of this condition. Treatment options for the management of patients with early onset scoliosis have also evolved dramatically over the last 2 decades. Further knowledge on the physiology of lung development and the detrimental effects of early fusion in the early onset scoliosis population has led to the development of growth friendly implants and other surgical techniques that allow correction of the deformity while maintaining spine, lung, and chest wall development. The following is an overview of current techniques on the management of adolescent idiopathic and early onset scoliosis to help provide guidance on the available surgical alternatives to address these conditions.
Greening the Operating Room: Results of a Scalable Initiative to Reduce Waste and Recover Supply Costs
Authors: Babu Maya A , Dalenberg Angela K , Goodsell Glen , Holloway Amanda B , Belau Marcia M , Link Michael J
Published: July 2018

Operating rooms generate 42% of a hospital's revenue and 30% of hospital waste. Supply costs are 56% of a total operating room (OR) budget. US academic medical centers use 2 million pounds ($15 million) of recoverable medical supplies annually. Forming a multidisciplinary leadership team, we analyzed sources of waste focusing on our Department of Neurosurgery. We developed an 8-wk pilot project to recycle “blue wrap,” the number 5 plastic polypropylene material that is ubiquitously used in ORs across the country to wrap instrument pans and implant trays for sterilization. Blue wrap can be baled and sold to recyclers where the material is pelletized and transformed into plastic products. During the 39 d of the pilot, we collected 1247 pounds of blue wrap (32 lbs collected daily). The cost of the pilot was $14 987 that includes a new baler ($11 200) and 5 transport carts ($3697). The revenue received from baled blue wrap was 8 cents per pound. Cost avoidance yielded $31 680.00 in savings. Implementation of this pilot across our main hospital would yield $5000 in revenue annually and $174 240 in cost avoidance. This project can be replicated at other centers and not only reduces the environmental footprint, but also helps generate additional revenue by recycling a necessary packing material that would otherwise require payment for disposal.
Steroid Use Associated With Increased Odds of 30-Day Mortality in Surgical Patients With Metastatic Spinal Tumors in the Setting of Disseminated Disease
Authors: Hobbs Jonathan G , Patel Akash S , Chaker Anisse N , Hasan Nazmul , Kumar Prateek , Ramos Edwin , Mehta Ankit I
Published: July 2018

BACKGROUND

Steroid administration is part of a standard treatment regimen in metastatic spinal cord compression, though the appropriate dose, duration, efficacy, and risks remain controversial.

OBJECTIVE

To analyze the risk of preoperative steroid use on 30-d mortality in surgical metastatic spinal tumors with dissemination disease using a large multicenter national database.

METHODS

Adult patients who underwent surgical treatment for metastatic spine tumors between 2005 and 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Demographic, preoperative risk factors, operative information, and postoperative events were extracted. Multivariate logistical regression modeling was used to investigate the association with preoperative steroid use with the outcome of interest, 30-d mortality. Other independent risk factors associated with 30-d mortality were also identified.

RESULTS

Five hundred fifty-two patients underwent surgical treatment of spinal metastases with disseminated cancer present at time of surgery. Independent risk factors of 30-d mortality included prolonged steroid use (odds ratio [OR] 2.48, 95% confidence interval [CI]: 1.22-5.04, P = .012), dependent functional status (OR 2.91, 95% CI: 1.68-5.04, P < .001), history of bleeding disorder (OR 2.80, 95% CI: 1.16-6.74, P = .021), history of smoking (OR 2.26, 95% CI: 1.11-4.61, P = .024), preoperative transfusions (OR 2.91, 95% CI: 1.02-8.29, P = .049), and preoperative infection/sepsis (OR 2.67, 95% CI: 1.18-6.08, P = .02). Our model demonstrates very strong predictive capabilities, with an area under the receiver operating characteristic curve of 0.7447.

CONCLUSION

Steroid use is associated with a significant increased risk of 30-d mortality in surgical metastatic spine tumor patients with disseminated disease. These findings warrant further investigation in controlled experimental environments.
Fascicular Ratio Pilot Study: High-Resolution Neurosonography—A Possible Tool for Quantitative Assessment of Traumatic Peripheral Nerve Lesions Before and After Nerve Surgery
Authors: Heinen Christian , Dömer Patrick , Schmidt Thomas , Kewitz Bettina , Janssen-Bienhold Ulrike , Kretschmer Thomas
Published: July 2018

BACKGROUND

Clinical and electrophysiological assessments prevail in evaluation of traumatic nerve lesions and their regeneration following nerve surgery in humans. Recently, high-resolution neurosonography (HRNS) and magnetic resonance neurography have gained significant importance in peripheral nerve imaging. The use of the grey-scale-based “fascicular ratio” (FR) was established using both modalities allowing for quantitative assessment.

OBJECTIVE

To find out whether FR using HRNS can assess nerve trauma and structural reorganization in correlation to postoperative clinical development.

METHODS

Retrospectively, 16 patients with operated traumatic peripheral nerve lesions were included. The control group consisted of 6 healthy volunteers. All imaging was performed with a 15 to 6 MHz ultrasound probe (SonoSite X-Porte; Fujifilm, Tokyo, Japan). FR was calculated using Fiji (兠) on 8-bit-images (“MaxEntropy” using “Auto-Threshold” plug-in).

RESULTS

Thirteen of 16 patients required autologous nerve grafting and 3 of 16 extra-intraneural neurolysis. There was no statistical difference between the FR of nonaffected patients’ nerve portion with 43.48% and controls with FR 48.12%. The neuromatous nerve portion in grafted patients differed significantly with 85.05%. Postoperatively, FR values returned to normal with a mean of 39.33%. In the neurolyzed patients, FR in the affected portion was 78.54%. After neurolysis, FR returned to healthy values (50.79%). Ten of 16 patients showed clinical reinnervation.

CONCLUSION

To our best knowledge, this is the first description of FR using HRNS for quantitative assessment of nerve damage and postoperative structural reorganization. Our results show a significant difference in healthy vs lesioned nerves and a change in recovering nerve portions towards a more “physiological” ratio. Further evaluation in larger patient groups is required.
Risk Factors Associated With 90-Day Readmissions After Degenerative Lumbar Fusion: An Examination of the Michigan Spine Surgery Improvement Collaborative (MSSIC) Registry
Authors: Park Paul , Nerenz David R , Aleem Ilyas S , Schultz Lonni R , Bazydlo Michael , Xiao Shujie , Zakaria Hesham M , Schwalb Jason M , Abdulhak Muwaffak M , Oppenlander Mark E , Chang Victor W
Published: July 2018

BACKGROUND

Most studies have evaluated 30-d readmissions after lumbar fusion surgery. Evaluation of the 90-d period, however, allows a more comprehensive assessment of factors associated with readmission.

OBJECTIVE

To assess the reasons and risk factors for 90-d readmissions after lumbar fusion surgery.

METHODS

The Michigan Spine Surgery Improvement Collaborative (MSSIC) registry is a prospective, multicenter, and spine-specific database of patients surgically treated for degenerative disease. MSSIC data were retrospectively analyzed for causes of readmission, and independent risk factors impacting readmission were found by multivariate logistic regression.

RESULTS

Of 10 204 patients who underwent lumbar fusion, 915 (9.0%) were readmitted within 90 d, most commonly for pain (17%), surgical site infection (16%), and radicular symptoms (10%). Risk factors associated with increased likelihood of readmission were other race (odds ratio [OR] 1.81, confidence interval [CI] 1.22-2.69), coronary artery disease (OR 1.57, CI 1.25-1.96), ≥4 fused levels (OR 1.41, CI 1.06-1.88), diabetes (OR 1.34, CI 1.10-1.63), and surgery length (OR 1.09, CI 1.03-1.16). Factors associated with decreased risk were discharge to home (OR 0.63, CI 0.51-0.78), private insurance (OR 0.79, CI 0.65-0.97), ambulation same day of surgery (OR 0.81, CI 0.67-0.97), and spondylolisthesis diagnosis (OR 0.82, CI 0.68-0.97). Of those readmitted, 385 (42.1%) patients underwent another surgery.

CONCLUSION

Ninety-day readmission occurred in 9.0% of patients, mainly for pain, wound infection, and radicular symptoms. Increased focus on postoperative pain may decrease readmissions. Among factors impacting the likelihood of 90-d readmission, early postoperative ambulation may be most easily modifiable. Optimization of preexisting medical conditions could also potentially decrease readmission risk.
Does Drain Position and Duration Influence Outcomes in Patients Undergoing Burr-Hole Evacuation of Chronic Subdural Hematoma? Lessons from a UK Multicenter Prospective Cohort Study
Authors: Glancz Laurence Johann , Poon Michael Tin Chung , Coulter Ian Craig , Hutchinson Peter John , Kolias Angelos Georgiou , Brennan Paul Martin ,   on behalf of the British Neurosurgical Trainee Research Collaborative (BNTRC)
Published: July 2018

Background

Drain insertion following chronic subdural hematoma (CSDH) evacuation improves patient outcomes.

Objective

To examine whether this is influenced by variation in drain location, positioning or duration of placement.

Methods

We performed a subgroup analysis of a previously reported multicenter, prospective cohort study of CSDH patients performed between May 2013 and January 2014. Data were analyzed relating drain location (subdural or subgaleal), position (through a frontal or parietal burr hole), and duration of insertion, to outcomes in patients aged >16 yr undergoing burr-hole drainage of primary CSDH. Primary outcomes comprised modified Rankin scale (mRS) at discharge and symptomatic recurrence requiring redrainage within 60 d.

Results

A total of 577 patients were analyzed. The recurrence rate of 6.7% (12/160) in the frontal subdural drain group was comparable to 8.8% (30/343) in the parietal subdural drain group. Only 44/577 (7.6%) patients underwent subgaleal drain insertion. Recurrence rates were comparable between subdural (7.7%; 41/533) and subgaleal (9.1%; 4/44) groups (P = .95). We found no significant differences in discharge mRS between these groups. Recurrence rates were comparable between patients with postoperative drainage for 1 or 2 d, 6.4% and 8.4%, respectively (P = .44). There was no significant difference in mRS scores between these 2 groups (P = .56).

CONCLUSION

Drain insertion after CSDH drainage is important, but position (subgaleal or subdural) and duration did not appear to influence recurrence rate or clinical outcomes. Similarly, drain location did not influence recurrence rate nor outcomes where both parietal and frontal burr holes were made. Further prospective cohort studies or randomized controlled trials could provide further clarification.
High Yield of HIV Testing in Dengue-Like Febrile Illness in Singapore
Authors: Verrall Ayesha J , Lye David C , Pada Surinder , Smitasin Nares , Lee Chun-Kiat , Khoo Mui-Joo , Koay Evelyn S , Leo Yee-Sin , Fisher Dale A , Archuleta Sophia
Published: July 2018

Where dengue virus infections are endemic, acute febrile illness is often managed as dengue fever (DF) without diagnostic testing. In a prospective study of 140 patients with clinical features of DF, 3 (2.1%) had acute HIV infection (AHI). We recommend testing for AHI in dengue-like febrile illness.
Are Invasive Procedures Effective for Chronic Pain? A Systematic Review
Authors: Jonas Wayne B , Crawford Cindy , Colloca Luana , Kriston Levente , Linde Klaus , Moseley Bruce , Meissner Karin
Published: July 2018

Objective

To assess the evidence for the safety and efficacy of invasive procedures for reducing chronic pain and improving function and health-related quality of life compared with sham (placebo) procedures.

Design

Systematic review with meta-analysis.

Methods

Studies were identified by searching multiple electronic databases, examining reference lists, and communicating with experts. Randomized controlled trials comparing invasive procedures with identical but otherwise sham procedures for chronic pain conditions were selected. Three authors independently extracted and described study characteristics and assessed Cochrane risk of bias. Two subsets of data on back and knee pain, respectively, were pooled using random-effects meta-analysis. Overall quality of the literature was assessed through Grading of Recommendations, Assessment, Development, and Evaluation.

Results

Twenty-five trials (2,000 participants) were included in the review assessing the effect of invasive procedures over sham. Conditions included low back (N = 7 trials), arthritis (4), angina (4), abdominal pain (3), endometriosis (3), biliary colic (2), and migraine (2). Thirteen trials (52%) reported an adequate concealment of allocation. Fourteen studies (56%) reported on adverse events. Of these, the risk of any adverse event was significantly higher for invasive procedures (12%) than sham procedures (4%; risk difference = 0.05, 95% confidence interval [CI] = 0.01 to 0.09, P = 0.01, I2 = 65%). In the two meta-analysis subsets, the standardized mean difference for reduction of low back pain in seven studies (N = 445) was 0.18 (95% CI = –0.14 to 0.51, P = 0.26, I2 = 62%), and for knee pain in three studies (N = 496) it was 0.04 (95% CI = –0.11 to 0.19, P = 0.63, I2 = 36%). The relative contribution of within-group improvement in sham treatments accounted for 87% of the effect compared with active treatment across all conditions.

Conclusions

There is little evidence for the specific efficacy beyond sham for invasive procedures in chronic pain. A moderate amount of evidence does not support the use of invasive procedures as compared with sham procedures for patients with chronic back or knee pain. Given their high cost and safety concerns, more rigorous studies are required before invasive procedures are routinely used for patients with chronic pain.
Factors Associated with Prescription Opioid Analgesic Use in the US Population, 2011–2014
Authors: Frenk Steven M , Lukacs Susan L , Gu Qiuping
Published: July 2018

Objective

This study examined factors associated with prescription opioid analgesic use in the US population using data from a nationally representative sample. It focused on factors previously shown to be associated with opioid use disorder or overdose. Variations in the use of different strength opioid analgesics by demographic subgroup were also examined.

Methods

Data came from respondents aged 16 years and older who participated in the National Health and Nutrition Examination Survey (2011–2014). Respondents were classified as opioid users if they reported using one or more prescription opioid analgesics in the past 30 days.

Results

Opioid users reported poorer self-perceived health than those not currently using opioids. Compared with those not using opioids, opioid users were more likely to rate their health as being “fair” or “poor” (40.4% [95% confidence interval {CI} = 34.9%–46.2%] compared with 15.6% [95% CI = 14.3%–17.1%]), experienced more days of pain during the past 30 days (mean = 14.3 [95% CI = 12.9–15.8] days compared with 2.3 [95% CI = 2.0–2.7] days), and had depression (22.5% [95% CI = 17.3%–28.7%] compared with 7.1% [95% CI = 6.2%–8.0%]). Among those who reported using opioids during the past 30 days, 18.8% (95% CI = 14.4%–24.1%) reported using benzodiazepine medication during the same period and 5.2% (95% CI = 3.5%–7.7%) reported using an illicit drug during the past six months. When opioid strength was examined, a smaller percentage of adults aged 60 years and older used stronger-than-morphine opioids compared with adults aged 20–39 and 40–59 years.

Conclusions

Higher percentages of current opioid users than nonusers reported having many of the factors associated with opioid use disorder and overdose.
Comparison of Trunk Muscle Function Between Women With and Without Diastasis Recti Abdominis at 1 Year Postpartum
Authors: Hills Nicole F , Graham Ryan B , McLean Linda
Published: July 2018

Background

A separation of the abdominal muscles at the linea alba, known as diastasis recti abdominis (DRA), can occur after childbirth. However, the impact of DRA on abdominal muscle function is not clear.

Objective

The objective was to determine if differences exist in trunk muscle function and self-reported pain and low back dysfunction between women with and without DRA at 12 to 14 months postpartum and if differences that emerge from the data are associated with the magnitude of the interrectus distance (IRD).

Design

This study was a prospective, observational, case-control study.

Methods

Women with (IRD ≥ 2.2 cm; n = 18) and without DRA (IRD < 2.2 cm; n = 22) participated. Maximal trunk flexion, extension, and rotation torque-generating capacity (Newton-meters), the Sit-Up test (0 to 3 points), and the Sitting-Rising Test (0 to 10 points), and trunk flexion, extension, and lateral flexion endurance (seconds) were measured. Pain and disability were assessed using numerical pain rating scales (0 to 100) and the Roland Morris Low Back Pain Questionnaire (0 to 24 points). Women were compared using independent t tests and Mann-Whitney U Tests. Pearson product-moment and Spearman rank correlation coefficients were used to determine associations; a = .05 was used for all tests.

Results

Women with DRA demonstrated significantly lower trunk muscle rotation torque and scored lower on the sit-up test than those without DRA. IRD was negatively correlated with both trunk rotation torque (rho = –0.367) and sit-up test score (rho = –0.514).

Limitations

The results of this study should not be generalized to women who present with moderate-to-severe IRDs or to multiparous women.

Conclusion

The presence of DRA in primiparous women at 1 year postpartum is associated with trunk rotation strength and ability to perform a sit-up.
Urban–rural differences in related factors of second-hand smoke exposure: a cross-sectional study of adult non-smokers in Northeast China
Authors: Gao Chunshi , Yao Yan , Niu Huikun , Li Lu , Li Meiqi , Qu Yangming , Wang Rui , Zhang Peng , Li Meng , Yan Shoumeng , Li Bo
Published: July 2018

Background

this study aims to examine the different factors associated with exposure to second-hand smoke (SHS) between urban and rural areas and to facilitate a reduction in SHS exposure in Northeast China.

Methods

a multistage stratified random cluster sampling design was used in this 2012 cross-sectional survey in Jilin Province, Northeast China. A total of 13 056 non-smokers were included in this study. The Rao–Scott χ2 test, multiple regression analysis and discriminant function analysis were used.

Results

the SHS prevalence among adult non-smokers was 60.2% in urban areas and 61.8% in rural areas. In urban areas, males were more likely to be exposed to SHS, while in rural areas, females were more likely to be exposed to SHS (P < 0.05). Increasing age was a protective factor against SHS exposure both in urban and rural areas (P < 0.05). Tobacco-relevant knowledge was positively associated with SHS exposure. Among urban non-smokers, high education level and engagement in manual work were risk factors for SHS exposure, and retired subjects were less likely to be exposed to SHS (P < 0.01).

Conclusions

non-smokers from urban and rural areas differ in the factors associated with SHS exposure, and urban–rural differentials, especially with regard to gender, should be considered in tobacco control.
Asymmetric Volatility Risk: Evidence from Option Markets*
Authors: Jackwerth Jens , Vilkov Grigory
Published: July 2018

Asymmetric volatility concerns the relation of returns to future expected volatility. Much is known from option prices about the marginal risk-neutral distributions (RNDs) of S&P 500 returns and of relative changes in future expected volatility (VIX). While the bivariate RND cannot be inferred from the marginals, we propose a novel identification based on long-dated index options. We estimate the risk-neutral asymmetric volatility implied correlation (AVIC) and find it to be significantly lower than its realized counterpart. We interpret the economics of the asymmetric volatility correlation risk premium and use AVIC to predict returns, volatility, and risk-neutral quantities.
Blood parameters in fattening pigs from two genetic types fed diet with three different protein concentrations1
Authors: Abeni Fabio , Petrera Francesca , Dal Prà Aldo , Rapetti Luca , Crovetto Gianni Matteo , Galassi Gianluca
Published: July 2018

The study aimed to evaluate possible differences between two genetic groups (GG) of pigs, fed diets varying in dietary CP level, in hematological and biochemical plasma profiles. The study was carried out in an experimental farm and involved 36 barrows (average BW 129 ± 11 kg) from two GG: group A (18 Italian Duroc boars × Italian Large White sows) and group D (18 DanBred Duroc), fed three experimental diets: a conventional diet and two low-protein diets (LP1 and LP2). A digestibility/balances trial was carried out on 12 pigs A and 12 pigs D that were housed individually in metabolic cages during four digestibility/balances periods. The experimental design was a factorial design, with 3 diets × 2 GG × 4 periods. The experiment lasted 56 d. Blood was sampled from jugular vein in the morning before feed distribution from all barrows in pens at the start and the end of the experimental period; a supplementary blood sample was collected from the 24 pigs at the end of the four digestibility periods (six pigs per period). Blood was analyzed for hematological and biochemical parameters and serum protein profile using automated analyzers. The GG D showed lower white blood cells (WBC), lymphocyte, and monocyte counts than A group. The GG affected several plasma metabolite concentrations: triglycerides, creatinine, Cl, Fe, alkaline phosphatase, and tartrate-resistant acid phosphatase activities were higher in D groups, while urea, albumin, Ca, Na, total bilirubin, and albumin as percentage of total protein were lower than A group. On the contrary, the dietary protein level neither affects WBC nor their populations; only a trend was reported for erythrocytes (red blood cell) and platelets. The diet affected only plasma urea and total bilirubin concentrations.
Evaluation of dietary electrolyte balance on nursery pig performance1
Authors: Jones Aaron M , Wu Fangzhou , Woodworth Jason C , Dritz Steve S , Tokach Mike D , DeRouchey Joel M , Goodband Robert D
Published: July 2018

Increasing dietary electrolyte balance (dEB) has been reported to linearly improve pig growth performance up to approximately 200 to 250 mEq/kg. However, recent data indicate that increasing dietary dEB reduced growth performance of nursery pigs. To attempt to solve this discrepancy, a total of 2,880 weanling pigs (327 × 1,050; PIC, Hendersonville, TN; 5.2 kg initial BW) were used to determine the effects of increasing dEB on nursery pig performance. Pens of pigs were blocked by BW and gender on arrival. Within block, pens were randomly assigned to one of four dietary treatments. There were 30 pigs per pen (60 pigs per double-sided feeder) and 12 replications (feeder) per treatment. Dietary treatments were fed in two phases. The phase 1 diet was based on corn–soybean meal, contained dried distillers grains with soblubles (DDGS), spray-dried whey, and specialty protein sources, and was fed from days 0 to 8. The phase 2 (days 8 to 21) diets contained corn, soybean meal, and DDGS with reduced amounts of specialty protein sources. Dietary electrolyte balance was determined using the following equation: dEB = [(Na × 434.98) + (K × 255.74) − (Cl × 282.06)] mEq/kg. The dEB of the four phase 1 diets were 84, 137, 190, and 243 mEq/kg, and dEB of the four phase 2 diets were 29, 86, 143, and 199 mEq/kg. After feeding experimental diets for 21 day, a common, commercial corn–soybean meal diet was fed to all pigs from days 21 to 35 and contained a dEB of 257 mEq/kg. During days 0 to 8, increasing dEB increased (quadratic, P < 0.05) ADG, ADFI, and G:F. From days 8 to 21, increasing dEB improved ADG (quadratic, P = 0.022) and ADFI (linear, P = 0.001), resulting in an improvement (quadratic, P = 0.001) in G:F. Overall (days 0 to 21), increasing dEB increased (linear, P < 0.05) ADG, ADFI, and improved (quadratic, P < 0.001) G:F. When a common diet was fed to all pigs from days 21 to 35, there was a linear reduction in ADG and G:F with increasing dietary dEB, but no effect of ADFI. For the overall nursery period (days 0 to 35), increasing dEB from days 0 to 21 increased (linear, P < 0.001) ADG and final BW, which was the result of increased (quadratic, P < 0.05) G:F and marginally greater (linear, P = 0.077) ADFI. In conclusion, increasing dietary dEB up to 243 and 199 mEq/kg (in phases 1 and 2, respectively) in nursery diets improved growth performance of weanling pigs.
Gender, Informal Employment and Trade Liberalization in Mexico
Authors: Ben Yahmed Sarra , Bombarda Pamela
Published: July 2018

This paper studies how import liberalization affects formal employment across gender. The theory offers a mechanism to explain how male and female formal employment shares can respond differently to trade liberalization through labor reallocation across tradable and nontradable sectors. Using Mexican data over the period 1993–2001, we find that Mexican tariff cuts increase the probability of working formally for both men and women within four-digit manufacturing industries. The formalization of jobs within tradable sectors is driven by large firms. Constructing a regional tariff measure, we find that regional exposure to import liberalization increases the probability of working formally in the manufacturing sector for both men and women, and especially for men. However in the service sectors, the probability of working formally decreases for low-skilled women.
Exploring Patient and Caregiver Perceptions of Primary Healthcare Sector Home Care for Simple Acute Wounds
Authors: Goh Ling Jia , Zhu Xiaoli
Published: July 2018

GENERAL PURPOSE:

To provide information about a study exploring patient and caregiver perceptions of home wound care for patients with simple acute wounds in Singapore.

TARGET AUDIENCE:

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES:

After completing this continuing education activity, you should be able to:

1. Assess benefits and barriers to home wound care management.

2. Analyze the methodology, results, and implications of the study.

BACKGROUND:

To control healthcare expenditure, patients with simple, acute, low-risk wounds are encouraged to perform self–wound care at home. However, patient perception of this care is not known.

OBJECTIVE:

To explore patient and caregiver perceptions of home wound care for patients with simple acute wounds in the primary healthcare sector in Singapore.

METHODS:

This study used the constructivist grounded theory approach. Nine participants from 2 polyclinics were interviewed. In vivo codes were extracted, and the constant comparative technique was applied throughout the analytical process.

RESULTS:

Fear, lack of knowledge, and the difficulty in performing care resulted in many patients avoiding self–wound care. Age, educational level, and cost did not have much impact. Participants with some first aid knowledge and those who appreciated the flexibility of self–wound care were more likely to embrace this concept. Participants also suggested that telecommunications and mobile nurses could assist in this concept.

CONCLUSIONS:

Generally, patients are willing to accept this self–wound care concept. To ensure successful implementation, nurses should encourage eligible patients to attend educational programs to prepare them to perform wound care at home.
Comparison of Preoperative Administration of Pregabalin and Duloxetine on Cognitive Functions and Pain Management After Spinal Surgery
Authors: Altiparmak Başak , Güzel Çiğdem , Gümüş Demirbilek Semra
Published: July 2018

Study Objective:

Surgical trauma is known to induce hyperalgesia, and if pain management is insufficient, it contributes to persistent pain in the postoperative period.

In this study, our primary aims were to compare the effect of pregabalin and duloxetine on postoperative pain scores and cognitive functions. Our secondary aim was to determine drug-related side effects.

Design:

This was a prospective, randomized, double-blind, placebo-controlled study.

Settings:

The study was carried out in the setting of the operating room and the surgical ward.

Patients:

Ninety-four patients, 18 to 65 years of age, ASA status I-II, scheduled for elective repair of lumbar disc herniation were enrolled in the study.

Interventions:

The patients were randomly divided into 3 groups: the first group received pregabalin 75 mg orally 1 hour before the surgery and at the postoperative 12th and 24th hours. The second group received duloxetine 60 mg orally 1 hour before the surgery. At the postoperative 12th hour, they received a placebo capsule, and, at the 24th hour, they received duloxetine 60 mg again. The third group received placebo capsules orally at all timepoints.

Measurements:

Postoperative pain evaluation was conducted using a Visual Analogue Scale at the postoperative first minute, 30th minute, first hour, and the 12th, 24th, and 48th hours. The preoperative and postoperative sixth hour cognitive functions were evaluated with Montreal Cognitive Assessment (MoCA) test.

Main Results:

There was a significant reduction in mean MoCA scores postoperatively in all groups (P<0.01). The highest MoCA score reduction was in the pregabalin group (1.83±1.31 point), then in the duloxetine group (1.16±0.82), and the least decrease was in the control group (0.49±0.61). At all timepoints, the mean Visual Analogue Scale scores of the pregabalin and duloxetine groups were similar to each other, and they were lower than that of the control group (P<0.05).

Conclusions:

Preoperative use of duloxetine 60 mg can be an useful alternative to pregabalin 75 mg, as it has a similar analgesic effect on postoperative pain, with fewer incidences of drug-related negative effects on cognitive function.
Breakdown of Neural Function under Isoflurane Anesthesia
Authors: Awal Mehraj R. , Austin Doug , Florman Jeremy , Alkema Mark , Gabel Christopher V. , Connor Christopher W.
Published: July 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Previous work on the action of volatile anesthetics has focused at either the molecular level or bulk neuronal measurement such as electroencephalography or functional magnetic resonance imaging. There is a distinct gulf in resolution at the level of cellular signaling within neuronal systems. The authors hypothesize that anesthesia is caused by induced dyssynchrony in cellular signaling rather than suppression of individual neuron activity.

Methods

Employing confocal microscopy and Caenorhabditis elegans expressing the calcium-sensitive fluorophore GCaMP6s in specific command neurons, the authors measure neuronal activity noninvasively and in parallel within the behavioral circuit controlling forward and reverse crawling. The authors compare neuronal dynamics and coordination in a total of 31 animals under atmospheres of 0, 4, and 8% isoflurane.

Results

When not anesthetized, the interneurons controlling forward or reverse crawling occupy two possible states, with the activity of the “reversal” neurons AVA, AVD, AVE, and RIM strongly intercorrelated, and the “forward” neuron AVB anticorrelated. With exposure to 4% isoflurane and onset of physical quiescence, neuron activity wanders rapidly and erratically through indeterminate states. Neuron dynamics shift toward higher frequencies, and neuron pair correlations within the system are reduced. At 8% isoflurane, physical quiescence continues as neuronal signals show diminished amplitude with little correlation between neurons. Neuronal activity was further studied using statistical tools from information theory to quantify the type of disruption caused by isoflurane. Neuronal signals become noisier and more disordered, as measured by an increase in the randomness of their activity (Shannon entropy). The coordination of the system, measured by whether information exhibited in one neuron is also exhibited in other neurons (multiinformation), decreases significantly at 4% isoflurane (P = 0.00015) and 8% isoflurane (P = 0.0028).

Conclusions

The onset of anesthesia corresponds with high-frequency randomization of individual neuron activity coupled with induced dyssynchrony and loss of coordination between neurons that disrupts functional signaling.
The Effect of Problematic Internet Use, Social Appearance Anxiety, and Social Media Use on Nursing Students' Nomophobia Levels
Authors: Ayar Dijle , Özalp Gerçeker Gülçin , Özdemir Emine Zahide , Bektaş Murat
Published: July 2018

This study examined the effect of problematic Internet use, social appearance anxiety, and social media use on nursing students' nomophobia levels. This study was conducted with 755 undergraduate nursing students. Sociodemographic data were evaluated using percentages and means. The effect of problematic Internet use, social appearance anxiety, and social media use on nomophobia levels was assessed by simple linear regression analysis. The mean age of participants was 21.4 ± 1.3; 82.5% were female, and 59.7% (n = 450) had adequate incomes. According to the regression analysis, nomophobia levels have a strong, positive, and significant relationship with the variables of problematic Internet use (β = .39, P < .000), social appearance anxiety (β = .27, P < .001), and social media dependency (β = .28, P < .001). Examining the correlation between nursing students' problematic Internet use, social appearance anxiety, and social media use levels, nomophobia levels had a positively moderate relationship with problematic Internet use (r = 0.259, P < .001), social appearance anxiety (r = 0.320, P < .001), and social media use levels (r = 0.433, P < .001). There is a direct correlation between nomophobia levels and the variables of problematic Internet use, social appearance anxiety, and social media use.
Role of Muscle Strength in Balance Assessment and Treatment in Chronic Obstructive Pulmonary Disease
Authors: McLay Rachel , O'Hoski Sachi , Beauchamp Marla K.
Published: July 2018

Purpose:

The purpose of this review is to examine the role of muscle strength in the assessment and management of balance problems among individuals with chronic obstructive pulmonary disease (COPD). Our specific aims are to (1) synthesize the literature on the role of muscle strength in balance control among older adults; (2) provide an overview of what is known about these relationships in people with COPD; and (3) describe clinical applications of assessing and training muscle strength in the context of improving balance among individuals with COPD.

Summary of Key Points:

Muscle strength is a key contributor to balance in both healthy populations and in people with COPD. Although impairments in skeletal muscle have been well studied in people with COPD, the contributions of this dysfunction to the observed balance deficits in COPD has not been as well studied to date. Furthermore, current research only supports associations between muscle strength and balance performance, and we are unable to determine cause and effect. Future research should address the impact of potential deficits in muscle power and endurance on postural control and fall risk in people with COPD.

Recommendations:

Comprehensive assessment of balance in people with COPD should include an assessment of muscle strength but also cannot ignore the many other subsystems underlying balance. When targeting muscle strength as part of a balance training program, specific considerations should be given to functional lower-body and core exercises that challenge different balance systems.
Do Lower Extremity Strength and Lower Extremity Blood Flow Predict the Score on the Functional Gait Assessment in Patients Enrolled in Phase II Cardiac Rehabilitation?
Authors: Himes Marcia K. , Moore Elizabeth S. , Robinson Barbara S. , Daniel Todd E.
Published: July 2018

Purpose:

Fall prevention, and the reduction of fall-related injuries, is critically important for preserving independence among older adults. Phase II cardiac rehabilitation (CR) is a medically supervised program allowing individuals with certain cardiac diagnoses or cardiac procedures to exercise safely. The relationship among lower extremity blood flow, lower extremity strength, and fall risk in adults who are community-dwelling has been established; however, that relationship in patients enrolled in phase II CR remains unknown.

Methods:

This cross-sectional study used exploratory analysis to determine whether the ankle brachial index (ABI) and the 30-second chair stand test (30CST) could predict the score on the functional gait assessment (FGA). A convenience sample (N = 57) of individuals aged 50 years and older, enrolled in a phase II CR program, was selected.

Results:

No correlation was found between the ABI and FGA score (r = 0.02, P = .438). A significant positive correlation was found between the 30CST and FGA score (r = 0.71, P < .001). In addition, the 30CST predicted FGA scores, accounting for 46% of the variance, F(2,54) = 23.97, P < .001, R
2 = 0.46.

Conclusions:

The 30CST could be considered for use as a quick fall-risk screening measure in the phase II CR population.
Relationship Between Advanced Maternal Age and Timing of First Developmental Evaluation in Children with Autism
Authors: Rubenstein Eric , Durkin Maureen S. , Harrington Rebecca A. , Kirby Russell S. , Schieve Laura A. , Daniels Julie
Published: July 2018

Objective:

Mothers of advanced maternal age (AMA) at childbirth (age ≥35 years) may have different perceptions of autism spectrum disorder (ASD) risk, independent of sociodemographic factors, that may affect ASD identification. We aimed to estimate associations between AMA and both age of a child's first evaluation noting developmental concerns and time from first evaluation to first ASD diagnosis.

Methods:

We used data for 8-year-olds identified with ASD in the 2008 to 2012 Autism and Developmental Disabilities Monitoring Network. We estimated differences in age at first evaluation noting developmental concerns and time to first ASD diagnosis by AMA using quantile and Cox regression.

Results:

Of 10,358 children with ASD, 19.7% had mothers of AMA. AMA was associated with higher educational attainment and previous live births compared with younger mothers. In unadjusted analyses, AMA was associated with earlier first evaluation noting developmental concerns (median 37 vs 40 mo) and patterns in time to first evaluation (hazard ratio: 1.12, 95% confidence interval: 1.06–1.18). Associations between AMA and evaluation timing diminished and were no longer significant after adjustment for socioeconomic and demographic characteristics. Children's intellectual disability did not modify associations between AMA and timing of evaluations.

Conclusion:

Advanced maternal age is a sociodemographic factor associated with younger age of first evaluation noting developmental concerns in children with ASD, but AMA was not independently associated likely, because it is a consequence or cofactor of maternal education and other sociodemographic characteristics. AMA may be a demographic factor to consider when aiming to screen and evaluate children at risk for ASD.
Ultrasound-guided Sympathetic Block of the Radial Artery with Botulinum Toxin to Treat Vasospasm
Authors: Weum Sven , de Weerd Louis
Published: July 2018

Vasospastic disorders in the hand have been treated with surgical sympathectomy and recently with botulinum toxin A (BTX) injections in the palm. The purpose of this study was to evaluate if it is possible to obtain precise administration of BTX around the radial artery using a single ultrasound-guided injection. We present a novel technique using 1 single ultrasound-guided BTX injection around the radial artery to treat vasospastic symptoms. Ten patients were included in a pilot study. All patients were referred by a rheumatologist after been diagnosed with primary or secondary Raynaud. Under ultrasound guidance, BTX was injected around the radial artery and its comitant veins 3–5 cm proximal to the wrist. Ultrasound-guided injection of BTX allowed for a precise distribution of BTX into the perivascular space of the radial artery and its comitant veins. Intravascular injection could easily be excluded. One patient reported temporary reduced grip strength, most likely due to leakage of BTX to the flexor pollicis longus muscle. No other complications were registered. All patients reported reduced number of vasospastic episodes, warmer hands, and reduced pain. Ultrasound-guided injection enables precise administration of BTX in the space surrounding the radial artery and its comitant veins. This novel approach could be a promising treatment for vasospastic disorders of the hands in patients with primary and secondary Raynaud.