bluuebunny/crossref_metadata_2025 huggingface dataset:
Skeletal muscle wasting in chronic kidney disease: the emerging role of microRNAs
Authors: Robinson Kate A , Baker Luke A , Graham-Brown Matthew P M , Watson Emma L
Published: August 2019

Skeletal muscle wasting is a common complication of chronic kidney disease (CKD), characterized by the loss of muscle mass, strength and function, which significantly increases the risk of morbidity and mortality in this population. Numerous complications associated with declining renal function and lifestyle activate catabolic pathways and impair muscle regeneration, resulting in substantial protein wasting. Evidence suggests that increasing skeletal muscle mass improves outcomes in CKD, making this a clinically important research focus. Despite extensive research, the pathogenesis of skeletal muscle wasting is not completely understood. It is widely recognized that microRNAs (miRNAs), a family of short non-coding RNAs, are pivotal in the regulation of skeletal muscle homoeostasis, with significant roles in regulating muscle growth, regeneration and metabolism. The abnormal expression of miRNAs in skeletal muscle during disease has been well described in cellular and animal models of muscle atrophy, and in recent years, the involvement of miRNAs in the regulation of muscle atrophy in CKD has been demonstrated. As this exciting field evolves, there is emerging evidence for the involvement of miRNAs in a beneficial crosstalk system between skeletal muscle and other organs that may potentially limit the progression of CKD. In this article, we describe the pathophysiological mechanisms of muscle wasting and explore the contribution of miRNAs to the development of muscle wasting in CKD. We also discuss advances in our understanding of miRNAs in muscle–organ crosstalk and summarize miRNA-based therapeutics currently in clinical trials.
Networks and systemic risk in the financial system
Authors: Gai Prasanna , Kapadia Sujit
Published: August 2019

The complex web of exposures and interlinkages across the financial system highlights the relevance of network analysis in understanding systemic risk and guiding the design of financial regulation. This paper discusses how network models—and those based on epidemiological approaches in particular—offer a compelling description of the structure of real-world financial systems and shed light on different contagion mechanisms seen during the global financial crisis. We also review how these insights may inform macroprudential risk assessment and policy in the areas of stress-testing the financial system and the regulation of systemically important institutions. The role of non-bank financial intermediation and social networks in shaping financial system risk is also briefly considered.
Accessibility of emergency contraception for adolescents in Quebec community pharmacies
Authors: Soper Katie , Di Meglio Giuseppina
Published: August 2019

Objective

Access to effective contraceptives, including emergency contraception (EC), is critical to reducing unintended adolescent pregnancy. This study evaluates the accessibility of Ln-EC (levonorgestrel EC) for adolescents in Quebec community pharmacies.

Methods

We conducted an anonymous self-administered electronic survey of Quebec community pharmacists between June 1, 2016 and October 31, 2016. Pharmacists were asked about the availability of Ln-EC in their pharmacy, whether they prescribed Ln-EC, and their experience with adolescents who requested Ln-EC.

Results

Five hundred and ninety-one pharmacists responded, with representation from across the province. Ninety-five per cent had Ln-EC in stock. Most pharmacists (90%) reported being comfortable prescribing Ln-EC, though they were less comfortable prescribing to adolescents than to adults (*P<0.001). Pharmacists also reported that cost and confidentiality are barriers to accessing Ln-EC for some adolescents.

Conclusions

This study indicates that availability and pharmacist comfort are not likely to be barriers to Ln-EC use for adolescents. On the other hand, cost and/or confidentiality do represent a barrier for some adolescents. This study lays the groundwork for a national study examining the accessibility of EC for adolescents.
Soccer-related head injuries—analysis of sentinel surveillance data collected by the electronic Canadian Hospitals Injury Reporting and Prevention Program
Authors: Zutrauen Sarah , McFaull Steven , Do Minh T
Published: August 2019

Background

Participating in sports is a great way to gain physical, psychological, and social benefits. However, it also carries the risk of injury. Soccer is one of the most popular sports worldwide, and in recent years, there have been concerns about potential vulnerabilities to head injuries.

Objectives

To investigate soccer-related head injuries (SRHIs), using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) surveillance system. Specifically, we aim to compare characteristics of SRHI cases to all head injury cases within the eCHIRPP database.

Methods

Descriptive analyses of emergency department (ED) injury surveillance data (2011 to 2017) for individuals aged 5 to 29 years from all participating eCHIRPP sites. Computation of proportionate injury ratios (PIR) comparing SRHIs to all head injuries reported to eCHIRPP, and 95% confidence intervals (CI).

Results

A total of 3,970 SRHIs were reported to eCHIRPP. Injuries were from contact with another player, the ball, ground, goal-post, and other causes. Of the injuries caused by contact with the ball, 9% were from purposely directing the ball with the head (heading). A higher proportion of concussions (PIR=1.32, 95% confidence interval [CI]: 1.27 to 1.37) and minor closed head injuries (PIR=1.20, 95% CI: 1.15 to 1.26) were observed in soccer players. Higher proportions of head injuries occurred in organized soccer and soccer played outdoors. However, admission to the ED for a SRHI was rare (PIR=0.40, 95% CI: 0.30 to 0.55).

Conclusions

Overall, elevated proportions of brain injuries were observed among soccer players, however, these injuries were unlikely to result in a hospital admission. Moreover, purposely heading the ball contributed to few ED visits.
Perceptions of uncertainties about carrier results identified by exome sequencing in a randomized controlled trial
Authors: Umstead Kendall L , Han Paul K J , Lewis Katie L , Miller Ilana M , Hepler Charlotte L , Thompson Lydia J , Wolfsberg Tyra G , Nguyen Anh-Dao , Fredriksen Mark T , Gibney Gretchen , Turbitt Erin , Biesecker Leslie G , Biesecker Barbara B
Published: August 2019

How individuals perceive uncertainties in sequencing results may affect their clinical utility. The purpose of this study was to explore perceptions of uncertainties in carrier results and how they relate to psychological well-being and health behavior. Post-reproductive adults (N = 462) were randomized to receive carrier results from sequencing through either a web platform or a genetic counselor. On average, participants received two results. Group differences in affective, evaluative, and clinical uncertainties were assessed from baseline to 1 and 6 months; associations with test-specific distress and communication of results were assessed at 6 months. Reductions in affective uncertainty (∆x̅ = 0.78, 95% CI: 0.53, 1.02) and evaluative uncertainty (∆x̅ = 0.69, 95% CI: 0.51, 0.87) followed receipt of results regardless of randomization arm at 1 month. Participants in the web platform arm reported greater clinical uncertainty than those in the genetic counselor arm at 1 and 6 months; this was corroborated by the 1,230 questions asked of the genetic counselor and residual questions reported by those randomized to the web platform. Evaluative uncertainty was associated with a lower likelihood of communicating results to health care providers. Clinical uncertainty was associated with a lower likelihood of communicating results to children. Learning one’s carrier results may reduce perceptions of uncertainties, though web-based return may lead to less reduction in clinical uncertainty in the short term. These findings warrant reinforcement of clinical implications to minimize residual questions and promote appropriate health behavior (communicating results to at-risk relatives in the case of carrier results), especially when testing alternative delivery models.
Subclinical Auditory Neural Deficits in Patients With Type 1 Diabetes Mellitus
Authors: AlJasser Arwa , Uus Kai , Prendergast Garreth , Plack Christopher J.
Published: August 2019

Objectives:

Diabetes mellitus (DM) is associated with a variety of sensory complications. Very little attention has been given to auditory neuropathic complications in DM. The aim of this study was to determine whether type 1 DM (T1DM) affects neural coding of the rapid temporal fluctuations of sounds, and how any deficits may impact on behavioral performance.

Design:

Participants were 30 young normal-hearing T1DM patients, and 30 age-, sex-, and audiogram-matched healthy controls. Measurements included electrophysiological measures of auditory nerve and brainstem function using the click-evoked auditory brainstem response, and of brainstem neural temporal coding using the sustained frequency-following response (FFR); behavioral tests of temporal coding (interaural phase difference discrimination and the frequency difference limen); tests of speech perception in noise; and self-report measures of auditory disability using the Speech, Spatial and Qualities of Hearing Scale.

Results:

There were no significant differences between T1DM patients and controls in the auditory brainstem response. However, the T1DM group showed significantly reduced FFRs to both temporal envelope and temporal fine structure. The T1DM group also showed significantly higher interaural phase difference and frequency difference limen thresholds, worse speech-in-noise performance, as well as lower overall Speech, Spatial and Qualities scores than the control group.

Conclusions:

These findings suggest that T1DM is associated with degraded neural temporal coding in the brainstem in the absence of an elevation in audiometric threshold, and that the FFR may provide an early indicator of neural damage in T1DM, before any abnormalities can be identified using standard clinical tests. However, the relation between the neural deficits and the behavioral deficits is uncertain.
Pediatric Orthopaedists Are Not Immune: Characterizing Self-reported Burnout Rates Among POSNA Members
Authors: Carter Cordelia W. , Talwalkar Vishwas , Weiss Jennifer M. , Schwend Richard M. , Goldberg Michael J.
Published: August 2019

Background:

There are no published data characterizing burnout rates for pediatric orthopaedic surgeons. The primary purpose of this study was to identify the rates of self-reported personal and team burnout among members of the Pediatric Orthopaedic Society of North America (POSNA). A secondary aim was to determine whether specific demographic variables were more likely to be associated with self-reported burnout.

Methods:

During its 2018 annual meeting, the POSNA Wellness Taskforce launched a web-based survey in which members were asked to respond to 2 previously validated questions related to personal and team burnout. The survey was distributed by a closed POSNA membership e-mail list and responses were analyzed anonymously. Descriptive statistics were calculated. Pearson χ2 testing was used to analyze differences in burnout rates as a function of age and sex.

Results:

A total of 615 POSNA members completed the survey, a 47% response rate. Overall, 38% reported personal burnout and 46% reported team burnout. Women were more likely to report both personal (P<0.001) and team burnouts (P<0.005). Members aged 40 to 59 years were more likely to report personal burnout, irrespective of sex (P<0.001). Members aged 50 to 59 years were more likely than those in other age groups to report team burnout (P<0.001). There was no significant association found between the presence of burnout and either race, ethnicity, LGBTQ status, or educational background.

Conclusions:

As a group, pediatric orthopaedists report moderately high rates of both personal and team member burnout. Individual-specific factors such as age and sex may play an important role in determining one’s risk for experiencing burnout. Recognizing that burnout affects a significant minority of POSNA members is a crucial first step.

Level of Evidence:

Level III.
Hospitalizations Associated with Respiratory Syncytial Virus and Influenza in Children, Including Children Diagnosed with Asthma
Authors: Goldstein Edward , Finelli Lyn , O’Halloran Alissa , Liu Patrick , Karaca Zeynal , Steiner Claudia A. , Viboud Cecile , Lipsitch Marc
Published: August 2019

Background:

There is uncertainty about the burden of hospitalization associated with respiratory syncytial virus (RSV) and influenza in children, including those with underlying medical conditions.

Methods:

We applied previously developed methodology to Health Care Cost and Utilization Project hospitalization data and additional data related to asthma diagnosis/previous history in hospitalized children to estimate RSV and influenza-associated hospitalization rates in different subpopulations of US children between 2003 and 2010.

Results:

The estimated average annual rates (per 100,000 children) of RSV-associated hospitalization with a respiratory cause (ICD-9 codes 460–519) present anywhere in the discharge diagnosis were 2,381 (95% CI(2252,2515)) in children <1 year of age; 710.6 (609.1, 809.2) (1 y old); 395 (327.7, 462.4) (2 y old); 211.3 (154.6, 266.8) (3 y old); 111.1 (62.4, 160.1) (4 y old); 72.3 (29.3, 116.4) (5–6 y of age); 35.6 (9.9,62.2) (7–11 y of age); and 39 (17.5, 60.6) (12–17 y of age). The corresponding rates of influenza-associated hospitalization were lower, ranging from 181 (142.5, 220.3) in <1 year old to 17.9 (11.7, 24.2) in 12–17 years of age. The relative risks for RSV-related hospitalization associated with a prior diagnosis of asthma in age groups <5 y ranged between 3.1 (2.1, 4.7) (<1 y old) and 6.7 (4.2, 11.8) (2 y old; the corresponding risks for influenza-related hospitalization ranged from 2.8 (2.1, 4) (<1y old) to 4.9 (3.8, 6.4) (3 y old).

Conclusion:

RSV-associated hospitalization rates in young children are high and decline rapidly with age. There are additional risks for both RSV and influenza hospitalization associated with a prior diagnosis of asthma, with the rates of RSV-related hospitalization in the youngest children diagnosed with asthma being particularly high.
Short-Duration High-Intensity Interval Exercise Training Is More Effective Than Long Duration for Blood Pressure and Arterial Stiffness But Not for Inflammatory Markers and Lipid Profiles in Patients With Stage 1 Hypertension
Authors: Aghaei Bahmanbeglou Neda , Ebrahim Khosrow , Maleki Majid , Nikpajouh Akbar , Ahmadizad Sajad
Published: August 2019

Purpose:

The present study compared the effects of 2 different high-intensity interval training (HIIT) protocols on arterial stiffness, lipid profiles, and inflammatory markers in hypertensive patients.

Methods:

Thirty hypertensive (stage 1) patients, aged 48.0 ± 3.2 yr, were randomly allocated to the short-duration HIIT (SDHIIT, n = 10), long-duration HIIT (LDHIIT, n = 10), and control (n = 10) groups. After a 2-wk preparatory phase of continuous mild training, patients in the SDHIIT group performed 8 wk of HIIT including 27 repetitions of 30-sec activity at 80% to 100% of

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2peak interspersed with 30-sec passive/active (10%-20% of

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2peak) recovery. Patients in the LDHIIT group performed 8 wk of HIIT, 32 min/session including 4 repetitions of 4-min activity at 75% to 90% of

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2peak interspersed with 4-min passive/active (15%-30% of

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2peak) recovery. Blood pressure (BP), pulse wave velocity (PWV), inflammatory markers, and lipid profiles were measured before and after training.

Results:

Significant (P < .05) reductions in systolic blood pressure and PWV were found following 2 training protocols, though, only the changes in PWV following the SDHIIT were significantly different than those in the LDHIIT and control groups. Interleukin-6 and triglycerides decreased and interleukin-10 increased significantly (P < .01) following both HIIT programs, whereas the differences between the 2 training protocols were not statistically significant. C-reactive protein and lipids did not change significantly following HIIT.

Conclusions:

Performing HIIT improves systolic blood pressure and inflammatory markers in patients with stage 1 hypertension irrespective of the HIIT intensity and duration, and PWV improvement is intensity related.
Disrupted Glycocalyx as a Source of Ocular Surface Biomarkers
Authors: Argüeso Pablo
Published: August 2019

The glycocalyx is a dense and diverse coat of glycans and glycoconjugates responsible for maintaining cell surface integrity and regulating the interaction of cells with the external environment. Transmembrane mucins such as MUC1 and MUC16 comprise a major component of the epithelial glycocalyx and are currently used to monitor disease progression in cancer. At the ocular surface, multiple lines of evidence indicate that abnormal expression of the enzymes responsible for glycan biosynthesis during pathological conditions impairs the glycosylation of transmembrane mucins. It is now becoming clear that these changes contribute to modify the interaction of mucins with galectin-3, a multimeric lectin crucial for preserving the ocular surface epithelial barrier. This review highlights the potential of using the epithelial glycocalyx as a reliable source for the generation of biomarkers to diagnose and monitor ocular surface disease.
Long-term Immunogenicity and Safety of the AS04-adjuvanted Human Papillomavirus–16/18 Vaccine in Four- to Six-year-old Girls
Authors: Lin Lan , Macias Parra Mercedes , Sierra Victor Y. , Salas Cespedes Albino , Granados Maria Angelica , Luque Adriana , Karkada Naveen , Castrejon Alba Maria Mercedes , Romano-Mazzotti Luis , Borys Dorota , Struyf Frank
Published: August 2019

Background:

The burden of human papillomavirus (HPV) diseases is high in Latin America. HPV vaccines licensed from 2006 onwards offer protection against most HPV-related cancers, especially when introduced into national immunization programs. Barriers to optimal vaccine uptake are, however, lowering the impact of adolescent HPV vaccination programs. Immunization of children might overcome these barriers and be a strategy of choice for some countries.

Methods:

This multicenter phase III randomized, controlled, single-blind study (NCT01627561) was conducted in Colombia, Mexico and Panama to assess safety and immunogenicity of 2-dose vaccination with AS04-adjuvanted HPV-16/18 vaccine in girls 4–6 years of age. We report safety outcomes and anti–HPV-16/18 antibody titers measured by enzyme-linked immunosorbent assay in HPV-vaccinated girls that were followed over a 36-month period.

Results:

Over 36 months (ie, 30 months after the second vaccine dose), among 74 girls included in the HPV group, 1 serious adverse event unrelated to vaccination has been reported. No withdrawal because of (serious) adverse events has been reported. At month 36, all girls in the per-protocol–cohort were still seropositive for anti–HPV-16 and anti–HPV-18 with geometric mean concentrations of 1680.6 and 536.4 enzyme-linked immunosorbent assay units/mL, respectively.

Conclusions:

The AS04-adjuvanted HPV-16/18 vaccine administered according to a 2-dose schedule to girls 4–6 years of age induced a high and sustained immunologic response with an acceptable safety profile during the 30 months following vaccination.
Scholarship in Neuroscience Nursing
Authors: Hickey Joanne , Duffy Lisa V. , Hinkle Janice L. , Prendergast Virginia , Rhudy Lori M. , Sullivan Cindy , Villanueva Nancy E.
Published: August 2019

BACKGROUND: Scholarship is a hallmark of all professions and includes research and practice scholarship. Building the science for practice and care is a major responsibility of each profession. METHODS: The purpose of this article is to define clinical science as it applies to neuroscience nursing as well as to establish the foundation for the work of the Clinical Science Committee of the American Association of Neuroscience Nursing. CONCLUSIONS: Research scholars conduct investigations for discovery of new knowledge. Practice scholars develop clinical knowledge through clinical practice and experience and an inquiring mindset that questions why and how certain methods or processes contribute to the achievement of certain outcomes; they look for better ways to improve processes of care and practice that will achieve optimal evidence-based outcomes. Scholarship in both research and practice domains is critical to the advancement of neuroscience nursing. Many opportunities exist for neuroscience nurses to contribute to clinical science.
First Pediatric Experience With a Novel, Adhesive Adapter Retained, Bone Conduction Hearing Aid System
Authors: Osborne Max Sallis , Child-Hymas Anne , Gill Jaspreet , Lloyd Mark Sheldon , McDermott Ann Louise
Published: August 2019

Objectives:

To assess the audiological outcomes, practicalities, and impact on quality of life of a new, nonimplantable, adhesive retained bone conduction hearing aid in children.

Study design:

A prospective, single-subject repeat measure, cohort study.

Setting:

Community and in pediatric assessment center.

Patients:

Twenty-one children aged between 5 and 15 years with a conductive hearing loss of >/=25 dB HL in the better hearing ear.

Intervention:

Audiological comparisons were made using pure-tone thresholds; unaided, with a softband aid, and with the new adhesive retained bone conducting system.

Main Outcome Measures:

Comparison of hearing threshold levels. Data analysis via paired t-testing, significance set at p value <0.01. Quality of life was assessed via the Glasgow Children's Benefit Inventory and a 10 cm linear analogue scale. A hearing aid review questionnaire provided insight into practical use.

Results:

Statistically significant improvement in thresholds of 7.3 dB HL (p=0.0001) was demonstrated with the adhesive system as compared with softband aids. After 4 weeks of usage, the mean hearing thresholds for the adhesive hearing system improved from 55 dB HL ± 2.4 to 31 dB HL± 7.9 in unaided and aided conditions.

Improvements in QOL were demonstrated with LAS and GCBI. Four children reported mild skin reactions. Eighty-six percent reported improved self-confidence.

Conclusion:

The adhesive aid produces comparable audiological results to the commercial softband hearing aids. It provides an excellent alternative in the treatment of conductive hearing loss without the possible complications and costs of a surgical intervention. Furthermore, it preserves skin envelope over the mastoid for those who wish to proceed with an autologous pinna reconstruction in the future.
Differences in edge artifacts between 68Ga- and 18F-PET images reconstructed using point spread function correction
Authors: Amakusa Shinji , Matsuoka Koki , Baba Shingo , Yoshida Tsuyoshi , Sasaki Masayuki
Published: August 2019

Objective

Edge artifacts have been reported on in relation to 18F-PET using point spread function correction algorithms. The positron range of 68Ga is longer than 18F, and this difference is thought to result in different edge artifacts. The purpose of this study is to clarify the difference in edge artifacts in PET images using point spread function correction in 68Ga- and 18F-PET.

Methods

We used a National Electrical Manufacturers Association International Electrotechnical Commission body phantom. The phantom was filled severally with 68Ga and 18F solution. The PET data were obtained over a 90 minutes period using a True Point Biograph 16 scanner. The images were then reconstructed with the ordered subset expectation maximization with point spread function correction. The phantom image analyses were performed by a visual assessment of the PET images and profiles, and an absolute recovery coefficient, which was the ratio of the maximum radioactivity of any given hot sphere to its true radioactivity.

Results

The ring-like edge artifacts of 68Ga-PET were less prominent than those in 18F-PET. The relative radioactivity profiles of 68Ga-PET showed low overshoots of the maximum radioactivity although high overshoots did appear in 18F-PET. The absolute recovery coefficients of 68Ga-PET were smaller than those of 18F-PET.

Conclusion

The edge artifacts of 68Ga-PET were less prominent than those of 18F-PET, and their overshoots were smaller. The difference in the positron range between 68Ga and 18F may possibly result in the difference in edge artifacts of images reconstructed using the point spread function correction algorithm.
Comparison of diagnostic precision for bone metastasis of primary breast cancer between BONENAVI version 1 and BONENAVI version 2
Authors: Okada Yukinori , Matsushita Shoichiro , Nakajima Yasuo , Yamaguchi Keiichiro , Okuda Itsuko , Kojima Yasuyuki , Tsugawa Koichiro
Published: August 2019

Objective

The aim of this study was to compare the diagnostic precision of bone scintigraphy with BONENAVI version 1 and BONENAVI version 2 in bone metastasis of primary breast cancer.

Methods

The subjects were 56 consecutive patients (all women, mean age 59 ± 12.7 years) who underwent bone scintigraphy with 99mTc-MDP and were diagnosed with bone metastasis of primary breast cancer from January 2012 to November 2014. Bone scintigraphy was performed with BONENAVI version 1 and BONENAVI version 2 to calculate artificial neural network (ANN), bone scan index (BSI), and hot-spot values, with ANN ≥ 0.5 considered to reflect bone metastasis for the calculation of sensitivity. Mean ANN, BSI, hot-spot values, and sensitivity were compared between BONENAVI version 1 and BONENAVI version 2, with P < 0.05 considered a significant difference.

Results

With BONENAVI version 1, mean ANN was 0.73 ± 0.29, BSI was 1.47 ± 1.85, the hot-spot value was 12.4 ± 12.5, and sensitivity was 76.8% (43/56). With BONENAVI version 2, the mean ANN was 0.86 ± 0.19, BSI was 1.53 ± 2.09, hot-spot value was 12.9 ± 15.6, and sensitivity was 94.6% (53/56). BONENAVI version 2 yielded significantly better ANN and sensitivity than BONENAVI version 1 (both P < 0.01).

Conclusion

BONENAVI version 2 has improved sensitivity for detecting bone metastasis of primary breast cancer compared to BONENAVI version 1.
Are superior cervical sympathetic ganglia avid on whole body 68Ga-PSMA-11 PET/magnetic resonance?: a comprehensive morphologic and molecular assessment in patients with prostate cancer
Authors: Bialek Ewa J. , Malkowski Bogdan
Published: August 2019

Objectives

Recent reports warn against erroneous mistaking of celiac and stellate sympathetic ganglia for metastatic lymph nodes on multimodal prostate-specific membrane antigen (PSMA)-ligand PET imaging. The aim was to check the intensity of 68Ga-PSMA-11 uptake and magnetic resonance (MR) features of superior cervical ganglia (SCG) on PET/MR imaging.

Methods

In 89 patients 106 SCG were reliably identified on 68Ga-PSMA-11 PET/MR. For each SCG, qualitative assessment (visual subjective avidity, diffusion restriction, shape, and the presence of central hypointensity) and quantitative measurements [dimensions, maximal standardized uptake value (SUVmax), mean apparent diffusion coefficient (ADC)] were performed.

Results

Mean SUVmax in SCG amounted to 1.88 ± 0.63 (range: 0.87–4.42), with considerable metabolic activity (SUVmax ≥ 2) in 37.7% of SCG; mean thickness was 3.18 ± 1.08 mm. In subjective visual evaluation, SCG avidity was classified as mistakable or potentially mistakable with underlying malignancy in 32.1% of cases. Mean ADC values amounted 1749.83 ± 428.83 × 10−6 mm2/s. In visual assessment, 74.5% of ganglia showed moderate to high diffusion restriction. An oval or longitudinal shape on transverse MR plane was presented by 59.4% of SCG. The central hypointensity was detected on MR T2-weighted images only in 10.4% of SCG.

Conclusion

SCG, similar to other sympathetic ganglia, show 68Ga-PSMA-11 uptake. SCG avidity may be of significance, especially in view of frequently occurring SCG oval or longitudinal shape, and moderate to high diffusion restriction in visual assessment, potentially suggesting malignancy on transverse MR plane. Diagnostic imaging specialists and clinicians should be aware of the above.
Reliability and validity of on-road driving tests in vulnerable adults: a systematic review
Authors: Sawada Tatsunori , Tomori Kounosuke , Hamana Haruka , Ohno Kanta , Seike Yosuke , Igari Yo , Fujita Yoshio
Published: August 2019

The on-road driving test is considered a ‘gold standard’ evaluation; however, its validity and reliability have not been sufficiently reviewed. This systematic review aimed to map out and synthesize literature regarding on-road driving tests using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Cochrane Library, PubMed, CINAHL, and Web of Science databases were searched from initiation through February 2018. All articles addressing reliability or validity of on-road driving tests involving adult rehabilitation patients were included. The search output identified 513 studies and 36 articles, which were included in the review. The Washington University Road Test/Rhode Island Road Test, performance analysis of driving ability, test ride for investigating practical fitness-to-drive, and K-score demonstrated high reliability and validity in regard to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. The Washington University Road Test/Rhode Island Road Test and test ride for investigating practical fitness-to-drive were analyzed based on Classical Test Theory techniques, and performance analysis of driving ability and K-score were analyzed based on Item Response Theory techniques. The frequency of studies were Washington University Road Test/Rhode Island Road Test (n=9), Test Ride for Investigating Practical fitness-to-drive (n=8), performance analysis of driving ability (n=4), and K-score (n=1). From the viewpoint of accuracy and generalization, the Washington University Road Test/Rhode Island Road Test, test ride for investigating practical fitness-to-drive, and performance analysis of driving ability were identified as highly qualified concerning on-road driving tests. However, the ability to assess real-world driving depends on various environmental conditions.
Informal Dance Intervention Improves BMI and Functional Gait in an Adolescent With Cerebral Palsy: A Case Report
Authors: Owens Meghan , Silkwood-Sherer Debbie
Published: August 2019

Purpose:

This case study examined the effects of incorporating Informal Dance Intervention into traditional therapy sessions on body mass index and functional walking in an adolescent girl with cerebral palsy.

Case Description:

A 15-year-old adolescent girl, Gross Motor Function Classification System Level II, participated in Informal Dance Intervention twice weekly in 2, 16 session phases. Sixty-minute sessions focused on waltzing, contra dancing, square dancing, and belly dancing to improve timing, endurance, vestibular functioning, and core strength.

Conclusions:

Waist circumference decreased, walking speed increased on the 6-Minute Walk Test and Timed Up and Down Stairs, balance confidence increased per the Activities-specific Balance Confidence Scale, and vestibular functioning improved per changes in the Functional Gait Assessment.

Recommendations for Clinical Practice:

Incorporating Informal Dance Intervention, in conjunction with therapy, may be motivating and improve overall health for adolescents with cerebral palsy to combat their tendency of increased sedentary lifestyle.
Our Experience Managing Difficult Accidental Chainsaw Trauma
Authors: Cascino Flavia , Pini Niccolò , Giovannoni Maria Elisa , Aboh Ikenna Valentine , Gabriele Guido , Niccolai Gianluca , Zerini Federico , Amadi Jude Ugochukwu , Gennaro Paolo
Published: August 2019

Background:

Chainsaw and circular-saw injuries represent a rare condition within the maxillofacial region. The purpose of this clinical report is to describe the injuries and the clinical and surgical management of these rare traumas.

Methods:

In this clinical report, 11 patients presenting themselves to the emergency room in the hospital “Policlinico Le Scotte,” Siena, from March 2016 to September 2017 with severe chainsaw and circular-saw injuries, were included. All of the patients underwent general anesthesia and surgical treatment. This study describes 3 of the 11 patients with saw injuries.

Results:

No complications occurred during surgeries and a good primary closure of the wound margins were achieved in all patients. However, after surgery, the authors experienced some complications in 2 patients: the 1st one displayed chewing problems due to extensive local edema; the 2nd one developed a total loss of vision in his left eye, even though there was no damage inflected to the eye ball during the trauma or surgery.

Conclusion:

All the patients were followed during the 1st year after surgery. The authors evaluated the patients at 3 months, 6 months, and after 1 year, and none of them developed complications or alterations related to the trauma. However, 1 patient is still experiencing loss of vision and he is under constant specialized follow-up.
Relationship Between Lacrimal Bone Thickness and Lacrimal Sac in Chronic Dacryocystitis
Authors: Bulgurcu Suphi , Idil Mehmet , Pekçevik Yeliz , Cukurova Ibrahim
Published: August 2019

Background:

Chronic inflammation in the lacrimal sac may lead to thickening of the surrounding bony tissues. This study aimed to assess the thickness of lacrimal bone surrounding the lacrimal sac, and the thickness of maxilla, based on the presence of purulent secretion in the lacrimal sac in patients who underwent EDCR.

Material and Methods:

Lacrimal bone thickness and the maximum and midpoint maxillary bone thickness of 70 patients (mean age of 49.07 years) who underwent EDCR, were assessed along 3 planes (upper, middle, and lower) using CT of the paranasal sinus. The patients were divided into 2 groups: the 1 who had purulent secretion in the lacrimal sac during the intraoperative period (Group 1) and another who did not have purulent secretion (Group 2).

Results:

No significant difference was detected between the 2 groups in terms of maximum and midpoint maxillary bone thickness. The increase in the thickness of lacrimal bone in Group 1 was statistically significant in all the 3 planes as compared to that in Group 2. Cutoff values for the thickness of the upper, middle, and lower plane of lacrimal bone were detected to be 0.710 mm, 0.685 mm, and 0.675 mm, respectively.

Conclusion:

The presence of purulent secretion in the lacrimal sac, along with the detected increase in the thickness of the lacrimal bone, as assessed by CT, offers an insight on the lacrimal sac before the surgery.
The Utility of an Open-Access Surgical Simulator to Enhance Surgeon Training
Authors: Volk Angela S. , Eisemann Bradley S. , Dibbs Rami P. , Perdanasari Aurelia T. , Braun Tara L. , Marsack Kristina P.
Published: August 2019

Background:

Smile Train, an international children's charity committed to improving cleft care around the world, empowers local medical professionals in developing countries to provide quality comprehensive cleft care in their own communities. As part of their sustainable model, Smile Train developed a web-based, interactive virtual simulator to improve surgical training of cleft procedures for surgeons around the world, replicating the anatomical and technical steps involved in cleft surgery. This study evaluated the simulator as a tool for enhancing surgical training.

Methods:

A pre-test and questionnaire addressing cleft care, surgical knowledge, and confidence level was administered to surgeons-in-training at an academic institution. Participants completed 3 simulator modules followed by a post-test and questionnaire to measure changes in knowledge and confidence levels.

Results:

Sixteen surgeons-in-training participated in this study. The mean score on the knowledge examination increased after reviewing the modules for both junior residents (33.1%–64.4%) and senior residents (46.9%–70.8%). Reviewing the modules increased participants’ confidence in the knowledge of cleft anatomy, understanding of surgical procedures, and ability to follow along meaningfully while assisting in operations.

Conclusions:

The Smile Train Virtual Surgery Simulator increased knowledge and reported surgeon confidence in understanding and assisting in cleft lip surgery, signifying its usefulness as a training tool for surgeons-in-training. Virtual simulation is a valuable resource for improving understanding and competence of the craniofacial surgeon while serving as an educational resource to other members of the comprehensive cleft care team, patients, and families.
Effects of Septoplasty on Tp-e Interval and Tp-e/QT Ratio in Patients With Nasal Septal Deviation
Authors: Taşolar Hakan , Karataş Mehmet , Demiröz Aslan Duygu
Published: August 2019

Objectives:

There are multiple nasal airway pathologies leading to upper airway obstruction, and one of the most common ones is nasal septum deviation (NSD). Our study aimed to evaluate the effect of nasal septal surgery in patients with NSD on ventricular arrhythmogenesis using the novel electrocardiographic parameters, Tp-e interval, and Tp-e/QT ratio.

Methods:

This retrospective cross-sectional study included 102 consecutive patients diagnosed with NSD. All participants completed a validated outcomes instrument (the NOSE scale), echocardiographic and electrocardiographic evaluation before and 3 months after septoplasty. The degree of nasal septal deviation was evaluated with the Dreher classification.

Results:

All of the electrocardiography parameters (except heart rate and QTmin) were significantly decreased with the septoplasty operation. Electrocardiographic parameters have significantly decreased especially in marked NSD patients. (Δ = difference between the preoperative and postoperative values) ΔNOSE was positively correlated both ΔcTp-e (r = 0.348, P < .001) and ΔcTp-e/QT values (r = 0.536, P < .001).

Conclusion:

Consequently, marked NSD was associated with increased risk of arrhythmogenesis, which were too much improved after septoplasty. So, treatment of especially marked NSD not only reduces otolaryngological complaints, but also leads to improvement of ventricular repolarization parameters.
Factors associated with organ donation by trauma patients in Nova Scotia
Authors: Hetherington Alexandra , Erdogan Mete , Cameron Adam , Lanteigne Sara , Beed Stephen D. , Green Robert S.
Published: August 2019

BACKGROUND

Trauma patients represent a significant pool of potential organ donors (PODs), and previous research suggests that this population is underutilized for organ donation (OD). Our objective was to assess factors associated with OD in the trauma population.

METHODS

We retrospectively analyzed OD in Nova Scotia over a 7-year period (2009–2016) using data from the Nova Scotia Trauma Registry and Nova Scotia Legacy of Life Donor Registry. All trauma patients who died in the hospital were included. Multiple logistic regression was used to assess factors associated with donation. We also evaluated characteristics, donation types, and reasons for nondonation among trauma PODs.

RESULTS

There were 689 trauma-related deaths in all hospitals in NS during the study period, of which 39.8% (274 of 689) met the Nova Scotia Trauma Registry definition of a POD. Data on OD were available for 108 of these patients who were referred to the Legacy of Life Program. The conversion rate was 84%. Compared with nondonors, organ donors were significantly younger, had a higher Abbreviated Injury Scale head score and a lower scene Glasgow Coma Scale score, were more likely to suffer ischemia from drowning or asphyxia and to require air transport, and were less likely to have comorbidities. Regression analysis showed that donation was associated with younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95–0.99) and lower Glasgow Coma Scale score at the scene (OR, 0.76; 95% CI, 0.66–0.88). Odds of donation were increased with air transport compared with land ambulance (OR, 8.27; 95% CI, 2.07–33.08) and injury within Halifax Regional Municipality compared with injury outside Halifax Regional Municipality (OR, 4.64; 95% CI, 1.42–15.10). Among the 60 referred PODs who did not donate, family refusal of consent was the most common reason (28 [46.7%] of 60).

CONCLUSION

Younger age, greater severity of injury, and shorter time to tertiary care were associated with OD in trauma patients.

LEVEL OF EVIDENCE

Prognostic and Epidemiological, Level III.
Where should new parkrun events be located? Modelling the potential impact of 200 new events on geographical and socioeconomic inequalities in access and participation
Authors: Schneider PP , Smith RA , Bullas AM , Bayley T , Haake SSJ , Brennan A , Goyder E
Published: August 2019

Background

parkrun, an international movement which organises free weekly 5km running events, has been widely praised for encouraging inactive individuals to participate in physical activity. Recently, parkrun received funding to establish 200 new events across England, specifically targeted at deprived communities. This study aims to investigate the relationships between geographic access, deprivation, and participation in parkrun, and to inform the planned expansion by proposing future event locations.

Methods

We conducted an ecological spatial analysis, using data on 455 parkrun events, 2,842 public green spaces, and 32,844 English census areas. Poisson regression was applied to investigate the relationships between the distances to events, deprivation, and parkrun participation rates. Model estimates were incorporated into a location-allocation analysis, to identify locations for future events that maximise deprivation-weighted parkrun participation.

Results

The distance to the nearest event (in km) and the Index of Multiple Deprivation (score) were both independently negatively associated with local parkrun participation rates. Rate ratios were 0.921 (95%CI = 0.921-0.922) and 0.959 (0.959-0.959), respectively. The recommended 200 new event locations were estimated to increase weekly runs by 6.9% (from 82,824 to 88,506). Of the additional runs, 4.1% (n=231) were expected to come from the 10% most deprived communities.

Conclusion

Participation in parkrun is wide spread across England. We provide recommendations for new parkrun event location, in order to increase participation from deprived communities. However, the creation of new events alone is unlikely to be an effective strategy. Further research is needed to study how barriers to participation can be reduced.

Online Map, data, and source code

An interactive online map is available here, and the annotated R source code and all data that were used to generate the results of this study are provided on a repository.
Physician Suicide: A Scoping Review to Highlight Opportunities for Prevention
Authors: Leung Tiffany I. , Pendharkar Sima S. , Chen Chwen-Yuen Angie , Snyder Rebecca
Published: August 2019

Objective

The aim of this scoping review is to map the current landscape of published research and perspectives on physician suicide. Findings could serve as a roadmap for further investigations and potentially inform efforts to prevent physician suicide.

Methods

Ovid MEDLINE, PsycInfo, and Scopus were searched for English-language publications from August 21, 2017 through April 28, 2018. Inclusion criteria were a primary outcome or thesis focused on suicide (including suicide completion, attempts, and thoughts or ideation) among medical students, postgraduate trainees, or attending physicians. Opinion articles were included. Studies that were non-English, or those that only mentioned physician burnout, mental health or substance use disorders were excluded. Data extraction was performed by two authors.

Results

The search yielded 1,596 articles, of which 347 articles passed to the full-text review round. The oldest article was an editorial from 1903; 210 (60.3%) articles were published from 2000 to present. Authors originated from 37 countries and 143 (41.2%) were opinion articles. Most discussed were suicide risk factors and culture of practice issues, while least discussed themes included public health and postvention.

Conclusions

Consistency and reliability of data and information about physician suicides could be improved. Data limitations partly contribute to these issues. Also, various suicide risk factors for physicians have been explored, and several remain poorly understood. Based on this scoping review, a public health approach, including surveillance and early warning systems, investigations of sentinel cases, and postvention may be impactful next steps in preventing physician deaths by suicide.
Explaining the outcomes of the ‘Clean India’ campaign: institutional behaviour and sanitation transformation in India
Authors: Curtis Val
Published: August 2019

Introduction

Whilst many less developed countries are struggling to provide universal access to safe sanitation, in the last five years India has almost reached its target of eliminating open defaecation. The object of this study was to understand how the Indian Government effected this sanitation transformation.

Methods

The study employed interviews with 17 actors in the Government’s ‘Clean India’ programme across the national capital and four states which were analysed using a theory of change grounded in Behaviour Centred Design.

Results

The Swachh Bharat Mission (Gramin) claims to have improved the coverage of toilets in rural India from 39% to over 95% of households between 2014 and mid 2019. From interviews with relevant actors we constructed a theory of change for the programme in which high-level political support and disruptive leadership changed environments in districts, which led to psychological changes in district officials, which, in turn, led to changed behaviour concerning sanitation programming. The Prime Minister’s setting of the ambitious goal to eliminate open defecation by the 150th birthday of Mahatma Gandhi (October 2019) galvanised government bureaucracy, while early success in 100 flagship districts reduced the scepticism of government employees, a cadre of 500 young professionals placed in districts imparted new ideas and energy, social and mass media was used to engage and motivate the public and key players, and new norms of ethical behaviour were demonstrated by leaders. As a result, district officials engaged emotionally with the programme and felt pride at their achievements in ridding villages of open defecation.

Conclusions

Though many challenges remain, Governments seeking to achieve the Sustainable Development Goal of universal access to safe sanitation can emulate the success of India’s Swachh Bharat Mission.

SUMMARY BOXES

What is already known?

At least 47 countries are not on track to reach the Sustainable Development Goal of universal access to safe sanitation by 2030 and some 0.6 billion people are still defecating in the open.

It is not clear how governments in low income countries can be galvanised to act to resolve this pressing public health problem.

What are the new findings?

The experience of the Clean India programme suggests that countries can almost eliminate open defecation.

The success of the programme was due to factors including: the setting of ambitious targets; the use of modern communications strategies and monitoring technology; and the provision of visible reward and recognition for employees.

What do the new findings imply?

Disruptive leadership is needed to create working environments where sometimes jaded civil servants are given an opportunity to make a difference.

Politicians who embrace the cause of sanitation may find that there are votes in toilets.