bluuebunny/crossref_metadata_2025 huggingface dataset:
Using drug knowledgebase information to distinguish between look-alike-sound-alike drugs
Authors: Cheng Christine M , Salazar Alejandra , Amato Mary G , Lambert Bruce L , Volk Lynn A , Schiff Gordon D
Published: April 2018

Objective

To extract drug indications from a commercial drug knowledgebase and determine to what extent drug indications can discriminate between look-alike-sound-alike (LASA) drugs.

Methods

We extracted drug indications disease concepts from the MedKnowledge Indications module from First Databank Inc. (South San Francisco, CA) and associated them with drugs on the Institute for Safe Medication Practices (ISMP) list of commonly confused drug names. We used high-level concepts (rather than granular concepts) to represent the general indications for each drug. Two pharmacists reviewed each drug’s association with its high-level indications concepts for accuracy and clinical relevance. We compared the high-level indications for each commonly confused drug pair and categorized each pair as having a complete overlap, partial overlap or no overlap in high-level indications.

Results

Of 278 LASA drug pairs, 165 (59%) had no overlap and 58 (21%) had partial overlap in high-level indications. Fifty-five pairs (20%) had complete overlap in high-level indications; nearly half of these were comprised of drugs with the same active ingredient and route of administration (e.g., Adderall, Adderall XR).

Conclusions

Drug indications data from a drug knowledgebase can discriminate between many LASA drugs.
Changes in Jewish Attitudes Towards the Arabic Language During the Nineteenth–Twentieth Centuries
Authors: Shraybom-Shivtiel Shlomit
Published: April 2018

The changing attitudes of the Jewish population in Palestine, later The State of Israel, toward the Arabic language was affected by the historical and social changes that occurred in the Middle East and the changing relations between Jews and Arabs. From the beginning of the revival of the Jewish community in Palestine in the nineteenth century until the end of the twentieth century, one can perceive quite a sharp decline in the Jewish public’s attitude toward Arabic. From being an essential instrument for accommodation in the region and later an important source for the revival of Hebrew, up to a being a channel of hope for dialogue between Jews and Arabs, it eventually became amongst the Jewish Israeli public a language to be taught mainly for governmental needs. Still, appeals by Israeli intellectuals reverberated, calling for the teaching of Arabic for a better understanding of the Arab neighbours and the Middle East.
Economic Impact of Aging on the Initial Spine Care of Patients With Acute Spine Trauma: From Bedside to Teller
Authors: Furlan Julio C , Fehlings Michael G , Craven B Catharine
Published: April 2018

BACKGROUND

Aging of the population has prompted an escalation of service utilization and costs in many jurisdictions including North America. However, relatively little is known on the economic impact of old age on the management of acute spine trauma (AST).

OBJECTIVE

To examine the potential effects of age on the service utilization and costs of the management of patients with acute spine trauma.

METHODS

This retrospective cohort study included consecutive patients with AST admitted to an acute spine care unit of a Canadian quaternary university hospital between February, 2002 and September, 2007. The study population was grouped into elderly (≥65 yr) and younger individuals. All costing data were converted and updated to US dollars in June/2017.

RESULTS

There were 55 women and 91 men with AST (age range: 16-92 yr, mean age of 49.9 yr) of whom 37 were elderly. The mean total hospital costs for initial admission after AST in the elderly (USD $19 338 ± $4892) were significantly greater than among younger individuals (USD $13 775 ± $1344). However, elderly people had significantly lower per diem total, fixed, direct, and indirect costs for AST than younger individuals. Both groups were comparable regarding the proportion of services utilized in the acute care hospital.

CONCLUSION

Given the escalating demand for surgical and nonsurgical spine treatment in the age of aging population, the timely results of this study underline key aspects of the economic impact of the spine care of the elderly. Further investigations are needed to fulfill significant knowledge gaps on the economics of caring for elderly with AST.
Toward Optimizing VEMP: Calculating VEMP Inhibition Depth With a Generic Template
Authors: Noij Kimberley S. , van Tilburg Mark J. , Herrmann Barbara S. , Marciniak Piotr , Rauch Steven D. , Guinan John J.
Published: April 2018

Objectives:

Cervical vestibular evoked myogenic potentials (cVEMP) indirectly reveal the response of the saccule to acoustic stimuli through the inhibition of sternocleidomastoid muscle electromyographic response. VEMP inhibition depth (VEMPid) is a recently developed metric that estimates the percentage of saccular inhibition. VEMPid provides both normalization and better accuracy at low response levels than amplitude-normalized cVEMPs. Hopefully, VEMPid will aid in the clinical assessment of patients with vestibulopatholgy. To calculate VEMPid a template is needed. In the original method, a subject’s own cVEMP was used as the template, but this method can be problematic in patients who do not have robust cVEMP responses. We hypothesize that a “generic” template, created by assembling cVEMPs from healthy subjects, can be used to compute VEMPid, which would facilitate the use of VEMPid in subjects with pathological conditions.

Design:

A generic template was created by averaging cVEMP responses from 6 normal subjects. To compare VEMPid calculations using a generic versus a subject-specific template, cVEMPs were obtained in 40 healthy subjects using 500, 750, and 1000 Hz tonebursts at sound levels ranging from 98 to 123 dB peSPL. VEMPids were calculated both with the generic template and with the subject’s own template. The ability of both templates to determine whether a cVEMP was present or not was compared with receiver operating characteristic curves.

Results:

No significant differences were found between VEMPid calculations using a generic template versus using a subject-specific template for all frequencies and sound levels. Based on the receiver operating characteristic curves, the subject-specific and generic template did an equally good job at determining threshold. Within limits, the shape of the generic template did not affect these results.

Conclusions:

A generic template can be used instead of a subject-specific template to calculate VEMPid. Compared with cVEMP normalized by electromyographic amplitudes, VEMPid is advantageous because it averages zero when there is no sound stimulus and it allows the accumulating VEMPid value to be shown during data acquisition as a guide to deciding when enough data has been collected.
Effects of Combined Lower Thoracic Epidural/General Anesthesia on Pain Control in Patients Undergoing Elective Lumbar Spine Surgery
Authors: Thepsoparn Marvin , Sereeyotin Jariya , Pannangpetch Patt
Published: April 2018

Study Design.

Randomized controlled trial.

Objective.

Our objective was to compare postoperative pain relief and operating field condition of single-shot, low-thoracic epidural anesthesia combined with general anesthesia versus general anesthesia alone.

Summary of Background Data.

Prior studies have suggested that continuous epidural analgesia provides better postoperative pain relief and less intraoperative blood loss, but with the risk of the epidural catheter contaminating the surgical field.

Methods.

A total of 22 patients scheduled for elective lumbar spine surgery were enrolled and randomly allocated into two groups. Group B (block) received a single-shot epidural block with 0.25% bupivacaine plus 4 mg of morphine with a total volume of 10 mL before receiving general anesthesia with desflurane, and cisatracurium. Group G (general) received general anesthesia alone with desflurane, cisatracurium, and any systemic analgesia deemed appropriate by the attending anesthesiologist. Postoperative pain score, opioid consumption, intraoperative blood loss, surgical field rating score, and other side effects were recorded at the postanesthesia care unit (PACU) and at 24 hours postoperatively.

Results.

Both groups were comparable for age, sex, body mass index, and American Society of Anaesthesiologists physical status. Fentanyl consumption was significantly lower (P < 0.05) for group B (block) at the PACU and 24 hours. Mean fentanyl consumption at PACU was 20 μg for group B and 85 μg for group G. At 24 hours mean fentanyl consumption was 80 μg for group B and 386 μg for group G. Pain measured with numerical rating scale, surgical field rating score, blood loss, and complications were similar in both groups.

Conclusion.

Single-shot low-thoracic epidural anesthesia combined with general anesthesia provides better pain control than general anesthesia alone.

Level of Evidence: 2
Feasibility and Safety of Intravascular Temperature Management for Severe Heat Stroke: A Prospective Multicenter Pilot Study
Authors: Yokobori Shoji , Koido Yuichi , Shishido Hajime , Hifumi Toru , Kawakita Kenya , Okazaki Tomoya , Shiraishi Shinichirou , Yamamura Eiji , Kanemura Takashi , Otaguro Takanobu , Matsumoto Gaku , Kuroda Yasuhiro , Miyake Yasufumi , Naoe Yasutaka , Unemoto Kyoko , Kato Hiroshi , Matsuda Kiyoshi , Matsumoto Hisashi , Yokota Hiroyuki
Published: April 2018

Objectives:

Heat stroke is a life-threatening condition with high mortality and morbidity. Although several cooling methods have been reported, the feasibility and safety of treating heat stroke using intravascular temperature management are unclear. This study evaluated the efficacies of conventional treatment with or without intravascular temperature management for severe heat stroke.

Design:

Prospective multicenter study.

Setting:

Critical care and emergency medical centers at 10 tertiary hospitals.

Patients:

Patients with severe heat stroke hospitalized during two summers.

Interventions:

Conventional cooling with or without intravascular temperature management.

Measurements and Main Results:

Cooling efficacy, Sequential Organ Failure Assessment score, occurrence rate of serious adverse events, and prognosis based on the modified Rankin Scale and Cerebral Performance Category. Patient outcomes were compared between five centers that were prospectively assigned to perform conventional cooling (control group: eight patients) and five centers that were assigned to perform conventional cooling plus intravascular temperature management (intravascular temperature management group: 13 patients), based on equipment availability. Despite their higher initial temperatures, all patients in the intravascular temperature management group reached the target temperature of 37°C within 24 hours, although only 50% of the patients in the control group reached 37°C (p< 0.01). The intravascular temperature management group also had a significant decrease in the Sequential Organ Failure Assessment score during the first 24 hours after admission (4.0 vs 1.5;p= 0.04). Furthermore, the intravascular temperature management group experienced fewer serious adverse events during their hospitalization, compared with the control group. The percentages of favorable outcomes at discharge and 30 days after admission were not statistically significant.

Conclusions:

The combination of intravascular temperature management and conventional cooling was safe and feasible for treating severe heat stroke. The results indicate that better temperature management may help prevent organ failure. A large randomized controlled trial is needed to validate our findings.
Development and Pilot Testing of a Measure of Potential Barriers and Facilitators to the Use of a Standardized Assessment Tool
Authors: Lam Wai Shun Priscilla , Bottari Carolina
Published: April 2018

Introduction:

Standardized assessment tools (SATs) are essential to evidence-based assessment practices. Identifying what impedes clinicians' use of a SAT can help tailor strategies promoting its use in clinical practice. This article presents the development of the “Measure of potential barriers and facilitators to the Use of a Standardized assessment Tool (MUST)” questionnaire. Preliminary findings are also reported from pilot testing in which the MUST was used to investigate occupational therapists' (OTs) perceptions of potential barriers and facilitators to the use of the Activities of Daily Living Profile (ADL Profile), a SAT evaluating independence in everyday activities of cognitively impaired adults.

Methods:

The MUST was administered to 41 OTs attending continuing education workshops on the ADL Profile. Internal consistency was explored using Chronbach alpha. Descriptive statistics were used to analyze scores for each statement.

Results:

Internal consistency for subscales related to clinicians' characteristics (α = 0.7) and to the SAT's characteristics (α = 0.8) were adequate but lower for the subscale related to the clinical setting (α = 0.6). OTs' perceptions of potential barriers were associated with: OTs' perceived self-efficacy; ADL Profile's applicability to OTs' clienteles; ADL Profile's compatibility with values promoted in the work setting and with clients' preferences; limited peer support; time to implement the ADL Profile.

Discussion:

The MUST, a theory-informed questionnaire, may prove useful in identifying potential barriers needing to be addressed in continuing education training promoting the use of SATs by clinicians. The MUST is quick to administer and initial testing provides support for its internal consistency.
Three-Dimensional Modeling for Crohn’s Fistula-in-Ano: A Novel, Interactive Approach
Authors: Lam David , Yong Eric , D’Souza Basil , Woods Rodney
Published: April 2018

BACKGROUND:

Pelvic MRI allows for clear delineation of anatomy in Crohn’s fistula-in-ano, although its interpretation is often difficult for nonradiologists.

OBJECTIVE:

The aim was to develop a 3-dimensional model where fistula tracts and their relationship to the sphincter complex can be accurately defined, which can then be rotated in multiple axes by the surgeon.

DESIGN:

A 3-dimensional model was created based on MRI images. An additional 3-dimensional T2-weighted sequence was added to the existing MRI protocol to obtain high-resolution images. Segmentation of the fistula tract and volume rendering of the segmented tract were performed to create the final model.

SETTINGS:

This was a single-center study conducted in Victoria, Australia.

PATIENTS:

All of the patients who had pelvic MRI for fistulating Crohn’s disease between March 2016 and March 2017 had the additional MRI sequence.

INTERVENTIONS:

Postprocessing of MRI images was performed by a single radiologist.

RESULTS:

Total acquisition time for MRI images was extended to 31 minutes compared with the standard 2-dimensional protocol lasting 25 minutes. Additional postprocessing time used to create the model was ≈15 minutes. Two clinical vignettes using this model are presented and compared with conventional 2-dimensional MRI images to highlight the use of the 3-dimensional modeling technique.

LIMITATIONS:

This technique involves a semiautomatic process of fistula tract segmentation that requires radiologist expertise and additional postprocessing time.

CONCLUSIONS:

This 3-dimensional modeling technique enables accurate identification of tracts in Crohn’s fistula-in-ano and improves spatial orientation for the surgeon. The model has the potential to be an invaluable preoperative tool to guide operative decision-making, as well as enabling the assessment of response to medical or surgical therapy.
Controlling for Frailty in Pharmacoepidemiologic Studies of Older Adults
Authors: Cuthbertson Carmen C. , Kucharska-Newton Anna , Faurot Keturah R. , Stürmer Til , Jonsson Funk Michele , Palta Priya , Windham B. Gwen , Thai Sydney , Lund Jennifer L.
Published: April 2018

Background:

Frailty is a geriatric syndrome characterized by weakness and weight loss and is associated with adverse health outcomes. It is often an unmeasured confounder in pharmacoepidemiologic and comparative effectiveness studies using administrative claims data.

Methods:

Among the Atherosclerosis Risk in Communities (ARIC) Study Visit 5 participants (2011–2013; n = 3,146), we conducted a validation study to compare a Medicare claims-based algorithm of dependency in activities of daily living (or dependency) developed as a proxy for frailty with a reference standard measure of phenotypic frailty. We applied the algorithm to the ARIC participants’ claims data to generate a predicted probability of dependency. Using the claims-based algorithm, we estimated the C-statistic for predicting phenotypic frailty. We further categorized participants by their predicted probability of dependency (<5%, 5% to <20%, and ≥20%) and estimated associations with difficulties in physical abilities, falls, and mortality.

Results:

The claims-based algorithm showed good discrimination of phenotypic frailty (C-statistic = 0.71; 95% confidence interval [CI] = 0.67, 0.74). Participants classified with a high predicted probability of dependency (≥20%) had higher prevalence of falls and difficulty in physical ability, and a greater risk of 1-year all-cause mortality (hazard ratio = 5.7 [95% CI = 2.5, 13]) than participants classified with a low predicted probability (<5%). Sensitivity and specificity varied across predicted probability of dependency thresholds.

Conclusions:

The Medicare claims-based algorithm showed good discrimination of phenotypic frailty and high predictive ability with adverse health outcomes. This algorithm can be used in future Medicare claims analyses to reduce confounding by frailty and improve study validity.
Multiple Symmetric Lipomatosis: New Classification System Based on the Largest German Patient Cohort
Authors: Schiltz Daniel , Anker Alexandra , Ortner Christine , Tschernitz Sebastian , Koller Michael , Klein Silvan , Felthaus Oliver , Schreml Julia , Schreml Stephan , Prantl Lukas
Published: April 2018

Background:

Multiple symmetric lipomatosis (MSL) is defined as a disorder of nonencapsulated adipose tissue growth. Its prevalence is indicated as 1:25,000 and affects, as stated in the literature, mainly Mediterranean males (male:female ratio of 15:1). Phenotypes are still classified as defined by Donhauser in 1991. We report clinical and phenotypic data of the largest patient cohort investigated in Germany so far.

Methods:

Forty-five patients diagnosed with MSL at the University Hospital Regensburg between 2007 and 2017 were photographed, clinically examined, and blood samples were taken. Based on the photographs (n = 33), 11 independent observers assessed patients using the Donhauser classification. Furthermore, the bodies of all patients were subdivided into 12 body areas, and the viewers had to indicate all MSL-affected areas per patient. Prevalence was calculated, comorbidities were assessed, and blood samples were analyzed.

Results:

According to the established Donhauser classification, less than 50% of the patients could be classified. Therefore, based on the constellations of MSL-affected body areas, a new classification that divides phenotypes of MSL into 5 types (Ia, Ib, Ic, II, and III) was set up and was able to cover 100% of our patients. The male to female ratio was found to be 1:2.5 (male:female). Prevalence of MSL in the catchment area was found to be 1:25,000. Hypercholesterinemia and hypothyroidism were frequent comorbidities, and blood analyses were normal besides a hypercholesterinemia.

Discussion:

The new proposed classification system describes 5 subtypes and allowed to classify all assessed patients. Male to female ratio (1:2.5) contradicted most previous publications.
Graft Detachment Pattern After Descemet Membrane Endothelial Keratoplasty Comparing Air Versus 20% SF6 Tamponade
Authors: Siebelmann Sebastian , Lopez Ramos Sebastian , Scholz Paula , Matthaei Mario , Schrittenlocher Silvia , Heindl Ludwig M. , Bachmann Björn , Cursiefen Claus
Published: April 2018

Purpose:

The change from air to 20% sulfur hexafluoride (SF6) as anterior chamber tamponade for Descemet membrane endothelial keratoplasty (DMEK) significantly reduced the rebubbling rate. Nonetheless, underlying mechanisms are not completely understood. In this study, we investigate the morphology of graft detachments after DMEK depending on the tamponade and its influence on postoperative rebubbling.

Methods:

In this retrospective analysis of prospective data of 204 consecutive patients who underwent DMEK with 100% air, or 20% SF6, we compared the SF6 group with the air group regarding the number, lateral and axial diameter and localization of detachments, visual acuity (BSCVA), and incidence of rebubbling after 1 week (T1), after 1 (T2), 3 (T3), 6 (T4), and 12 (T5) months postoperatively.

Results:

The air group showed more detachments at all time points. Detachments in this group were of a larger axial diameter at T1, T4, and T5 and of a larger lateral diameter at T1, T3, T4, and T5 compared with the SF6 group. Patients receiving SF6 needed fewer rebubblings at T1 compared with patients receiving air (12.1% vs. 29.1%, P = 0.003), but not at T2 (15.1% vs. 19.1%, P = 0.56). There was no difference in postoperative BSCVA between the groups.

Conclusions:

Early graft attachment after DMEK, which is improved by the use of SF6 as anterior chamber tamponade, is important for the overall rebubbling rate and improves wound-healing mechanisms between the graft and recipient cornea. Faster resolving air tamponade is associated with extended detachments especially inferiorly and mid-peripherally, but has no negative effect on the long-term BSCVA.
Clinically Significant Drug Interactions Among Human Immunodeficiency Virus–Positive Patients on Antiretroviral Therapy in an Outpatient Setting
Authors: Monday Lea M. , Veltman Jennifer
Published: April 2018

Human immunodeficiency virus (HIV) treatment is complicated by antiretrovirals prone to clinically significant drug interactions (CSDIs). Objectives were to examine relationships of patient and medication characteristics and provider training level with CSDIs in an outpatient HIV clinic. A clinical pharmacist reviewed medication lists of randomly selected adult HIV-positive patients on antiretrovirals for accuracy and presence of a CSDI, defined as grade C, D, or X using Lexicomp software. Characteristics were compared between patients with and without CSDIs by χ2 tests for categorical variables and t tests for continuous variables. Associations between these parameters and CSDIs (presence vs absence) were evaluated by logistic regression. Associations between provider type (infectious disease physician [IDMD], infectious disease fellow [Fellow], and nurse practitioner [NP]) and number of CSDIs per patient, and provider response to being informed of a CSDI were analyzed by χ2 tests.

Of 107 records reviewed, 405 CSDIs were identified in 83 (76%) patient records. Clinically significant drug interaction presence was associated with older age, increased medications, protease inhibitor-based regimen, and medication list inaccuracies. Patients with and without CSDIs did not differ in sex, race, HIV viral load, or nonnucleoside reverse-transcriptase inhibitor regimen. Older age (odds ratio [95% confidence interval], 3.53 [1.21–11.64]) and a protease inhibitor-based regimen (odds ratio [95% confidence interval], 8.49 [2.18–46.07]) were associated with having a CSDI. Fellows were more likely to report being unaware of CSDIs than IDMDs and NPs and to request additional information versus IDMDs and NPs. These findings suggest that providers may benefit from involving a pharmacist to identify and educate about CSDIs.
A Qualitative Investigation of the Self-Perceived Health Behavior Changes in Seniors After Their Transitions Into a Retirement Home
Authors: Haney Danielle B. , Fletcher Paula C. , Robertson-Wilson Jennifer E.
Published: April 2018

Purpose/Aims:

It is important for seniors to engage in positive health behaviors to reduce the incidence of health-related consequences associated with aging. The purpose of this research study was to examine self-perceived changes in physical activity, nutrition, and alcohol consumption behaviors of seniors living in a retirement home through consideration of previous behaviors and self-perceptions of behavior changes.

Design:

A qualitative research design was used for this study.

Methods:

Semistructured one-on-one interviews were conducted with 9 Canadian women living in a retirement home.

Results:

Two key themes, each with 3 subthemes, highlighted the various factors that influenced changes in health behaviors. The 2 themes consisted of (a) aging and adapting and (b) the transition: give a little to gain a lot.

Conclusions:

Participants’ insights revealed the importance of maintaining a positive attitude, the influence of the social environment on health behaviors, and the nutritional sacrifices of retirement living. Future research should investigate ways in which nurses can assist seniors in enhancing health behaviors throughout transitions into retirement homes.
Distinguishing the Clinical Nurse Specialist From Other Graduate Nursing Roles
Authors: Mohr Lynn D. , Coke Lola A.
Published: April 2018

Purpose:

Today’s healthcare environment poses diverse and complex patient care challenges and requires a highly qualified and experienced nursing workforce. To mitigate these challenges are graduate nursing roles, each with a different set of competencies and expertise. With the availability of many different graduate nursing roles, both patients and healthcare professionals can be confused in understanding the benefit of each role. To gain the maximum benefit from each role, it is important that healthcare providers and administrators are able to distinguish the uniqueness of each role to best use the role and develop strategies for effective collaboration and interprofessional interaction. The purpose of this article was to define the role, educational preparation, role differences, and practice competencies for the clinical nurse specialist (CNS), nurse practitioner, clinical nurse leader, and nurse educator/staff development educator roles. A second purpose was to provide role clarity and demonstrate the unique value the CNS brings to the healthcare environment.

Description:

Using evidence and reviewing role competencies established by varying organizations, each role is presented with similarities and differences among the roles discussed. In addition, collaboration among the identified roles was reviewed, and recommendations were provided for the new and practicing CNSs.

Outcomes:

Although there are some similarities among the graduate nursing roles such as in educational, licensing, and certification requirements, each role must be understood to gain the full role scope and benefit and glean the anticipated outcomes.

Conclusions:

Healthcare providers must be aware of the differences in graduate nursing roles, especially in comparing the CNS with other roles to avoid confusion that may lead to roles being underused with a limited job scope. The CNS provides a unique set of services at all system outcome levels and is an essential part of the healthcare team especially in the acute care setting.
Risk Factors for Oral Human Papillomavirus Infection Among Young Men Who Have Sex With Men—2 Cities, United States, 2012–2014
Authors: Oliver Sara E. , Gorbach Pamina M. , Gratzer Beau , Steinau Martin , Collins Tom , Parrish Adam , Kerndt Peter R. , Crosby Richard A. , Unger Elizabeth R. , Markowitz Lauri E. , Meites Elissa
Published: April 2018

Background

Men who have sex with men (MSM) are at risk for cancers attributable to human papillomavirus (HPV), including oropharyngeal cancer. Human papillomavirus vaccination is recommended for US MSM through age 26 years. Oral HPV infection is associated with oropharyngeal cancer. We determined oral HPV prevalence and risk factors among young MSM.

Methods

The Young Men's HPV study enrolled MSM aged 18 through 26 years from clinics in Chicago and Los Angeles during 2012 to 2014. Participants self-reported demographics, sexual behaviors, vaccination and human immunodeficiency virus (HIV) status. Self-collected oral rinse specimens were tested for HPV DNA (37 types) by L1-consensus PCR. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for risk factors associated with oral HPV among participants not previously vaccinated.

Results

Oral HPV was detected in 87 (9.4%) of 922; 9-valent vaccine types were detected in 37 (4.0%) of 922. Among HIV-positive participants, 17 (19.3%) of 88 had oral HPV detected. Oral HPV was more prevalent among those reporting first sex at 18 years of age or younger (aPR, 2.44; 95% CI, 1.16–5.12); HIV infection (aPR, 1.99; 95% CI, 1.14–3.48); greater than 5 sex partners within the past month (aPR, 1.93; 95% CI, 1.13–3.31); performing oral sex on greater than 5 partners within the last 3 months (aPR, 1.87; 95% CI, 1.12–3.13); and having greater than 5 male sex partners within the last 3 months (aPR, 1.76; 95% CI, 1.08–2.87). Only 454 (49.2%) of 922 were aware that HPV can cause oropharyngeal cancers.

Conclusions

Many oral HPV infections were with types targeted by vaccination. Oral HPV infections were significantly associated with HIV and sexual behaviors. Fewer than half of participants were aware that HPV could cause oropharyngeal cancer.
NordiQC Assessments of PAX8 Immunoassays
Authors: Røge Rasmus , Nielsen Ole , Bzorek Michael , Nielsen Søren , Vyberg Mogens
Published: April 2018

This paper is number 3 in a series developed through a partnership between ISIMM and NordiQC for the purpose of reporting research assessing the performance characteristics of immunoassays in an external proficiency testing program.
Prospective Analyses of Cytokine Mediation of Sleep and Survival in the Context of Advanced Cancer
Authors: Steel Jennifer L. , Terhorst Lauren , Collins Kevin P. , Geller David A. , Vodovotz Yoram , Kim Juliana , Krane Andrew , Antoni Michael , Marsh James W. , Burke Lora E. , Butterfield Lisa H. , Penedo Frank J. , Buysse Daniel J. , Tsung Allan
Published: April 2018

Objective

The aims of this study were to examine the potential association between sleep problems, symptom burden, and survival in patients with advanced cancer.

Methods

A prospective study of 294 patients with gastrointestinal cancer administered questionnaires assessing sleep, depression, anxiety, stress, pain, fatigue, and health-related quality of life. Serum levels of cytokines including interleukin (IL)-1α, IL-1β, tumor necrosis factor α, IL-10, IL-2, and interferon-γ were measured to assess biological mediation between sleep and survival. Survival was measured as time from diagnosis to death.

Results

Fifty-nine percent of patients reported poor sleep quality, 53% reported poor sleep efficiency, 39% reported sleep latency greater than 30 minutes, and 45% reported sleeping less than 6 hours or greater than 10 hours. We found a significant association between sleep duration and symptom burden. Shorter sleep duration was significantly associated with higher levels of fatigue (r= −0.169,p= .01), pain (r= −0.302,p= .01), anxiety (r= −0.182,p= .01), depression (r= −0.172,p= .003), and lower levels of quality of life (r= 0.240,p= .01). After adjustment for demographic, psychological, and disease-specific factors, short sleep duration was associated with reduced survival (hazard ratio [HR] linear = 0.485, 95% confidence interval = 0.275–0.857) and there was also evidence for a quadratic pattern (HR quadrati = 1.064, 95% confidence interval = 1.015–1.115) suggesting a curvilinear relationship between sleep duration and survival. Interleukin 2 was the only cytokine significantly related to survival (HR = 1.01,p= .003) and sleep duration (β = −30.11,p= .027). When of IL-2 was added to the multivariable model, short and long sleep (β = −0.557,p= .097; β = 0.046,p= .114) were no longer significantly related to survival, suggesting mediation by IL-2.

Conclusion

Sleep duration was associated with symptom burden and poorer survival and IL-2 was found to mediate the association between sleep and survival. Screening and treatment of sleep problems in patients diagnosed with cancer are warranted.
Modified Rotational Anterior Segmental Osteotomy for Prevention of Common Complication (Aged Appearance)
Authors: Choi Bong-Kyoon , Lee Won , Lo Lun-Jou , Yang Eun-Jung
Published: April 2018

Although anterior segmental osteotomy (ASO) is powerful procedures in treating the patient who has bimaxillary dentoalveolar protrusion, there is significant change in all soft and hard tissue parameters. Soft tissue changes in response to ASO can have a deleterious effect of an aged appearance. To prevent this aged appearance, the authors tried to rotate the maxillary anterior segment rather than simply posteriorly translating the segments. The application of a clockwise pivot rotation method during ASO can prevent overcorrection by controlling the degree of setback of the piriform aperture, and it can also affect convexity of the facial profile.
A Step-By-Step Technique for the Piezosurgical Removal of Fractured Implants
Authors: Messina Antonello Maria , Marini Luca , Marini Ettore
Published: April 2018

With the increasing popularity of dental implants, the removal of fractured implants has become a major challenge for clinicians. Several tools can be used for the removal of osseointegrated implants; however, few of these have the characteristics of easy control, selective cutting, and rapid healing. In this study, the authors describe a step-by-step technique for the removal of osseointegrated fractured implants via multiple peri-implant osteotomies performed using a piezoelectric device and appropriate inserts. All patients ended with primary wound closure without any soft tissue dehiscence and no healing problems during the postoperative period. As the use of ultrasonic inserts enables precise and selective cuts, piezosurgical implant removal is an attractive alternative to trephine burs or rotary drills.
Thornwaldt Cyst
Authors: Cetinkaya Erdem Atalay
Published: April 2018

Thornwaldt cyst (Tc) is a benign mass, usually localized in the median plan of the nasopharynx. It is generate from permanent notochord remainings. The pharyngeal bursa—being an embryological residual—occurs in 3% of healthy adults. Closing of the orifice of a nasopharyngeal bursa results in the occurrence of Tc. When the Tc become infected or inflamed, causing to signs. The general indications for radiologic study in patients are nasopharyngeal symptoms, headache, seizures, and dizziness. Computed tomography is less effective than magnetic resonance imaging in the detection and characterization of Tc. On histopathologic study, the walls of Tc are seen to be infiltrated vaguely by lymphocytes and absent lymph follicles. Asymptomatic patients do not necessitate surgery, whereas symptomatic cysts need surgical treatment by a transnasal or transoral access. Marsupialization is the method of option to avoid recurrence. This review provides fundamental knowledge on Tc from an objective perspective.
Odontogenic Keratocysts as First Manifestation of Nevoid Basal Cell Carcinoma Syndrome: Surgical Management and Immunohistochemical Analysis
Authors: dos Santos Jessica Luana , Delgado Renata Zoraida Rizental , de Oliveira Greison Rabelo , Rangel Ana Lúcia Carrinho Ayroza
Published: April 2018

Nevoid Basal Cell Carcinoma Syndrome (NBCCS), also known as Gorlin syndrome, is a rare autosomal dominant disorder, with no gender predilection. Individuals with NBCCS are commonly diagnosed between 17 and 35 years old and can present multiple basal cell carcinomas scattered throughout the body, presence of recurrent and early-onset odontogenic keratocysts (OKCs) and skeletal abnormalities. This article describes a case of a 13-year-old white boy who referred complaining of facial asymmetry. Extraoral examination revealed volumetric increase displacing the nasal ala from the right side and extended to the zygomatic bone. The intraoral evaluation showed mixed dentition with moderate degree of malocclusion. In addition, bilateral vestibular fornix swelling was observed in the upper canine region. An increase in volume was also detected on the hard palate on the right side. Computed tomography revealed multiple hypodense lesions with cystic appearance. The aspiration was positive, with a yellowish aspirate of serous consistency of all lesions. Given the numerous lesions, it was decided to decompress them for posterior enucleation procedures. In addition to other manifestations, the patient was diagnosed with NBCCS. Although common, the occurrence of OKCs in pediatric patients, especially in multiple lesions, is highly indicative of NBCCS, and its investigation should be considered, even in the absence of other signs of this syndrome. Synchronous decompression was satisfactory and can be used in similar cases of multiple cystic lesions.
Clinical Importance of a Cytokine Network in Major Burns
Authors: Matsuura Hiroshi , Matsumoto Hisatake , Osuka Akinori , Ogura Hiroshi , Shimizu Kentaro , Kang Sujin , Tanaka Toshio , Ueyama Masashi , Shimazu Takeshi
Published: April 2018

Major burns elicit an acute inflammatory response including various inflammatory cytokines. Cytokines play mutual interacting roles in inflammatory diseases. There is little evidence of the clinical significance of the cytokine network in patients with major burns. This study aimed to investigate the clinical significance of the cytokine network in patients with major burn. This prospective observational study comprising 38 patients with major burns (total body surface area (%TBSA) ≥ 20%) and 12 healthy controls was conducted from April 2014 to December 2016. Blood samples were collected from patients at six points: day 1, day 2, days 3–5, 1 week, 2 weeks, and 1 month after the burn injury. Inflammatory cytokines (interferon [IFN]-α, IFN-γ, interleukin [IL]-1β, IL-6, IL-8, IL-12/IL-23p40, IL-17A, monocyte chemotactic protein-1 [MCP-1], TNF-α), and anti-inflammatory cytokines (IL-4, IL-10) were measured. Twenty-eight-day mortality, %TBSA, prognostic burn index (PBI) and Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were evaluated. Hierarchical clustering analysis and network visualization showed one cluster and network, respectively. Both were formed by four cytokines including IL-6, IL-8, IL-10, and MCP-1 on days 1 and 2, suggesting the presence of a cytokine network in the early hospital phase. Each cytokine showed significant associations with the SOFA score within 5 days and 1 month after burn injury. Cox regression analysis highlighting days 1 and 2 showed significant correlation of IL-6, IL-8, and IL-10 with 28-day mortality. We showed a cytokine network and its relation with prognosis and injury severity on days 1 and 2 and suggest that this cytokine network may play a role in major burns.
“No-Go Considerations” for In Situ Simulation Safety
Authors: Bajaj Komal , Minors Anjoinette , Walker Katie , Meguerdichian Michael , Patterson Mary
Published: April 2018

Summary Statement

In situ simulation is the practice of simulation in the actual clinical environment and has demonstrated utility in the assessment of system processes, identification of latent safety threats, and improvement in teamwork and communication. Nonetheless, performing simulated events in a real patient care setting poses potential risks to patient and staff safety. One integral aspect of a comprehensive approach to ensure the safety of in situ simulation includes the identification and establishment of “no-go considerations,” that is, key decision-making considerations under which in situ simulations should be canceled, postponed, moved to another area, or rescheduled. These considerations should be modified and adjusted to specific clinical units. This article provides a framework of key essentials in developing no-go considerations.
Reproducible evaluation of classification methods in Alzheimer’s disease: framework and application to MRI and PET data
Authors: Samper-González Jorge , Burgos Ninon , Bottani Simona , Fontanella Sabrina , Lu Pascal , Marcoux Arnaud , Routier Alexandre , Guillon Jérémy , Bacci Michael , Wen Junhao , Bertrand Anne , Bertin Hugo , Habert Marie-Odile , Durrleman Stanley , Evgeniou Theodoros , Colliot Olivier ,   for the Alzheimer’s Disease Neuroimaging Initiative1,   the Australian Imaging Biomarkers and Lifestyle flagship study of ageing2
Published: April 2018

A large number of papers have introduced novel machine learning and feature extraction methods for automatic classification of Alzheimer’s disease (AD). However, while the vast majority of these works use the public dataset ADNI for evaluation, they are difficult to reproduce because different key components of the validation are often not readily available. These components include selected participants and input data, image preprocessing and cross-validation procedures. The performance of the different approaches is also difficult to compare objectively. In particular, it is often difficult to assess which part of the method (e.g. preprocessing, feature extraction or classification algorithms) provides a real improvement, if any. In the present paper, we propose a framework for reproducible and objective classification experiments in AD using three publicly available datasets (ADNI, AIBL and OASIS). The framework comprises: i) automatic conversion of the three datasets into a standard format (BIDS); ii) a modular set of preprocessing pipelines, feature extraction and classification methods, together with an evaluation framework, that provide a baseline for benchmarking the different components. We demonstrate the use of the framework for a large-scale evaluation on 1960 participants using T1 MRI and FDG PET data. In this evaluation, we assess the influence of different modalities, preprocessing, feature types (regional or voxel-based features), classifiers, training set sizes and datasets. Performances were in line with the state-of-the-art. FDG PET outperformed T1 MRI for all classification tasks. No difference in performance was found for the use of different atlases, image smoothing, partial volume correction of FDG PET images, or feature type. Linear SVM and L2-logistic regression resulted in similar performance and both outperformed random forests. The classification performance increased along with the number of subjects used for training. Classifiers trained on ADNI generalized well to AIBL and OASIS, performing better than the classifiers trained and tested on each of these datasets independently. All the code of the framework and the experiments is publicly available.
Uncertainty in contextual and kinematic cues jointly modulate motor resonance in primary motor cortex
Authors: Cretu Andreea Loredana , Ruddy Kathy , Germann Maria , Wenderoth Nicole
Published: April 2018

Contextual information accompanying others’ actions modulates “motor resonance”, i.e. neural activity within motor areas that is elicited by movement observation. One possibility is that we weight and combine such information in a Bayesian manner according to their relative uncertainty. Therefore, contextual information becomes particularly useful when others’ actions are ambiguous. It is unclear, however, whether this uncertainty modulates the neural activity in primary motor cortex (M1) during movement observation. Here we applied single-pulse transcranial magnetic stimulation (TMS) while subjects watched different grasping actions. We operationalized motor resonance as grip specific modulation of corticomotor excitability measured in the index (FDI) versus the little finger abductor (ADM). We experimentally modulated either the availability of kinematic information (Exp. 1) or the reliability of contextual cues (Exp. 2). Our results indicate that even in the absence of movement kinematics, reliable contextual information is enough to trigger significant muscle-specific corticomotor excitability changes in M1 (p<.0001) which are strongest when both kinematics and contextual information are available (p<.005). These findings suggest that bottom-up mechanisms that activate motor representations as a function of the observed kinematics, and top-down mechanisms which activate motor representations associated with arbitrary cues converge in M1 in a statistically optimal manner.
Learning and Forgetting Using Reinforced Bayesian Change Detection
Authors: Moens Vincent , Zénon Alexandre
Published: April 2018

Agents living in volatile environments must be able to detect changes in contingencies while refraining to adapt to unexpected events that are caused by noise. In Reinforcement Learning (RL) frameworks, this requires learning rates that adapt to past reliability of the model. The observation that behavioural flexibility in animals tends to decrease following prolonged training in stable environment provides experimental evidence for such adaptive learning rates. However, in classical RL models, learning rate is either fixed or scheduled and can thus not adapt dynamically to environmental changes. Here, we propose a new Bayesian learning model, using variational inference, that achieves adaptive change detection by the use of Stabilized Forgetting, updating its current belief based on a mixture of fixed, initial priors and previous posterior beliefs. The weight given to these two sources is optimized alongside the other parameters, allowing the model to adapt dynamically to changes in environmental volatility and to unexpected observations. This approach is used to implement the “critic” of an actor-critic RL model, while the actor samples the resulting value distributions to choose which action to undertake. We show that our model can emulate different adaptation strategies to contingency changes, depending on its prior assumptions of environmental stability, and that model parameters can be fit to real data with high accuracy. The model also exhibits trade-offs between flexibility and computational costs that mirror those observed in real data. Overall, the proposed method provides a general framework to study learning flexibility and decision making in RL contexts.

Author summary

In stable contexts, animals and humans exhibit automatic behaviour that allows them to make fast decisions. However, these automatic processes exhibit a lack of flexibility when environmental contingencies change. In the present paper, we propose a model of behavioural automatization that is based on adaptive forgetting and that emulates these properties. The model builds an estimate of the stability of the environment and uses this estimate to adjust its learning rate and the balance between exploration and exploitation policies. The model performs Bayesian inference on latent variables that represent relevant environmental properties, such as reward functions, optimal policies or environment stability. From there, the model makes decisions in order to maximize long-term rewards, with a noise proportional to environmental uncertainty. This rich model encompasses many aspects of Reinforcement Learning (RL), such as Temporal Difference RL and counterfactual learning, and accounts for the reduced computational cost of automatic behaviour. Using simulations, we show that this model leads to interesting predictions about the efficiency with which subjects adapt to sudden change of contingencies after prolonged training.