bluuebunny/crossref_metadata_2025 huggingface dataset:
Movement and Mobility
Authors: Moulton Elizabeth , Wilson Rosemary , Deluzio Kevin
Published: April 2019

This article provides an analysis of the concepts of movement and mobility within the context of the International Classification of Functioning, Disability, and Health (ICF) for patients' functioning, disability, and health. The methodology developed by Walker and Avant was used to clarify definitions, components, and relationships relevant to the 2 concepts and to the elements of the ICF framework. Definitions and the relationship between concepts are key information that clinicians and researchers need to measure the correct concept when they are assessing the effectiveness of interventions in nursing practice. Concept analysis findings are grounded by the notion that movement occurs when the body causes its own displacement and is explained by the basic principles of physics, human anatomy, and physiology. Mobility is then distinct because it is affected by the environment that the individual is in and can be assisted by any type of mobility aid. Mobility does not need to be generated by the individual's muscles but does need to be controlled by the individual who is mobile. An individual's mobility in his or her environment is important to his or her well-being and needs to be understood in relationship to his or her movements.
Placement of Provisional External Fixation of Pediatric Femoral Shaft Fractures Using Radiopaque Markers in the Setting of Severe Polytrauma: A Technical Report
Authors: Haidar Layla A. , Sliwinski Lisa , Warth Ryan J. , Mansour Alfred
Published: April 2019

Background:

In polytraumatic pediatric patients, life-saving or stabilizing measures must often be prioritized over permanent orthopedic solutions to a fractured extremity. The standard application of external fixation to femur fractures can be difficult in the pediatric intensive care unit setting due to the limited mobility of the patient and adaptability of C-arm radiography. We propose a technique utilizing radiopaque markers and digital radiographs in lieu of C-arm imaging to accurately plan the pin placement in a reproducible manner that eases application and reduces errant placement that may result in physeal injury.

Methods:

Two patients are reported, aged 7 and 11, involved in motor vehicle accidents who sustained multiple injuries including femur fractures which were addressed with this method. Beekley Medical 7″×7.5″ Guidelines calibrated radiopaque markers were placed on the involved thigh and a single digital radiograph was performed. On the basis of preoperative templating from the radiographic markers, the fracture site and proposed pin sites were marked and the pins were placed.

Results:

Both patients eventually had the external fixators removed and underwent definitive fixation with internal fixation. They both healed with successful union of the femoral fracture.

Conclusions:

The use of radiopaque markers reproducibly aids radiologically guided placement of threaded Shanz pins during external fixation of femur fractures in polytraumatized pediatric patients undergoing damage control orthopaedics. The technique also minimizes radiation exposure, uses equipment readily available in the hospital setting, and alleviates the need to have a radiolucent bed in the pediatric intensive care unit.

Level of Evidence:

Case report.
Large Variation in Provincial Guidelines for Urine Drug Screening During Opioid Agonist Treatment in Canada
Authors: Moss Eloise , McEachern Jasmine , Adye-White Lauren , Priest Kelsey C. , Gorfinkel Lauren , Wood Evan , Cullen Walter , Klimas Jan
Published: April 2019

Urine drug screening (UDS) is commonly used to detect or validate self-reported substance use, particularly when beginning and maintaining opioid agonist therapy. However, there is currently no summary of the published clinical practice guidelines for UDS in Canada, and no measure of the consistency with which different provinces suggest administering UDS. Therefore, we conducted a policy scan of UDS guidelines, examining the published clinical practice guidelines for each Canadian province and extracting all relevant data in March 2017. Our Canadian guideline and policy scan found that UDS frequency recommendations vary greatly among Provinces for persons receiving opioid agonist therapy for opioid use disorder.

Le dépistage des drogues par l’urine (UDS) est couramment utilisé pour détecter ou valider l’utilisation de substances auto-déclarées, en particulier lorsque l’on commence et que l’on maintient un traitement par des agonistes opioïdes (OAT). Cependant, il n’y a actuellement aucun résumé des lignes directrices de pratique clinique publiées pour le UDS au Canada, et aucune mesure de l’uniformisation avec laquelle les différentes provinces suggèrent d’administrer le UDS. Par conséquent, nous avons effectué une analyse des lignes directrices UDS, en examinant les lignes directrices de pratique clinique publiées pour chaque province canadienne et en extrayant toutes les données pertinentes en mars 2017. Notre analyse des lignes directrices et des politiques canadiennes révèle que les recommandations de fréquence UDS varient grandement d’une province à l’autre pour les personnes recevant une OAT pour trouble d’utilisation des opioïdes.
Limits for the Magnitude of M-bias and Certain Other Types of Structural Selection Bias
Authors: Flanders W. Dana , Ye Dongni
Published: April 2019

Background:

Structural selection bias and confounding are key threats to validity of causal effect estimation. Here, we consider M-bias, a type of selection bias, described by Hernán et al as a situation wherein bias is caused by selecting on a variable that is caused by two other variables, one a cause of the exposure, the other a cause of the outcome. Our goals are to derive a bound for (the maximum) M-bias, explore through examples the magnitude of M-bias, illustrate how to apply the bound for other types of selection bias, and provide a program for directly calculating M-bias and the bound.

Methods:

We derive a bound for selection bias assuming specific, causal relationships that characterize M-bias and further evaluate it using simulations.

Results:

Through examples, we show that, in many plausible situations, M-bias will tend to be small. In some examples, the bias is not small–but plausibility of the examples, ultimately to be judged by the researcher, may be low. The examples also show how the M-bias bound yields bounds for other types of selection bias and also for confounding. The latter illustrates how Lee’s bound for confounding can arise as a limiting case of ours.

Conclusions:

We have derived a new bound for M-bias. Examples illustrate how to apply it with other types of selection bias. They also show that it can yield tighter bounds in certain situations than a previously published bound for M-bias. Our examples suggest that M-bias may often, but not uniformly, be small.
Effects of N-ethylpentylone on locomotor activity and anxiety-like behavior in rats
Authors: Li Jiaolun , Lin Zebin , Tao Xiaoyi , Huang Zhibin , Zhang Yurong , Zheng Shuiqing , Wang Hao , Rao Yulan
Published: April 2019

N-ethylpentylone (NEP), a new synthetic cathinone, has been rising to be one of the most popular cathinone derivatives in recent years. However, research on NEP is rather limited. In this study, locomotor stimulation and sensitization, as well as anxiety-like behavior induced by NEP were studied in Sprague-Dawley rats, using the open field and elevated plus maze respectively. Rats were administered NEP (5, 20 or 50 mg/kg, intraperitoneal), with saline as the negative control and methamphetamine (5 mg/kg) as a positive control. Acute administration of NEP at all the doses tested significantly promoted locomotor activity, presenting an inverted U-shaped dose-effect curve. The highest activity was observed at the 20 mg/kg dose group, with the average distance traveled 18 times higher than the saline group. Repeated administration of NEP enhanced locomotor activity only at the 5 mg/kg dose group. After a week’s withdrawal, re-challenge of NEP failed to induce marked behavioral sensitization. In elevated plus maze experiments, both acute and repeated administration of 20 mg/kg NEP induced anxiolytic-like effects, while no significant alteration was observed in the 5 and 50 mg/kg dose groups. In summary, acute administration of NEP caused significantly enhanced locomotor activity in rats at all the tested doses, while repeated NEP administration enhanced locomotor activity only at a low dose (5 mg/kg), while a high dose (20 mg/kg) of NEP induced anxiolytic-like effects after both acute and repeated administration.
Estimation of Blood Sirolimus Concentration Based on Tacrolimus Concentration/Dose Normalized by Body Weight Ratio in Lung Transplant Patients
Authors: Kikuchi Masafumi , Shigeta Kensuke , Tanaka Masaki , Takasaki Shinya , Akiba Miki , Oishi Hisashi , Sado Tetsu , Matsuda Yasushi , Noda Masafumi , Okada Yoshinori , Mano Nariyasu , Yamaguchi Hiroaki
Published: April 2019

Background:

Sirolimus and tacrolimus require accurate drug dosing based on their target blood levels to produce better clinical outcomes, specifically, the avoidance of drug-induced adverse effects and the maintenance of efficacy. However, because the ideal dose of sirolimus and the schedule for measuring its blood levels are unclear in lung transplant patients, an index is required for estimating sirolimus blood concentrations. The aim of this work is to study the correlation between the trough concentration/dose normalized by body weight (C0/D) ratios of sirolimus and tacrolimus in lung transplant patients.

Methods:

Thirteen lymphangiomyomatosis patients who underwent lung transplantation and were treated with sirolimus and tacrolimus from February 2015 to July 2018 were divided into 2 groups, one receiving twice-daily (TD, n = 6) and the other once-daily (OD, n = 7) tacrolimus formulations. The correlation between the C0/D ratio of sirolimus and patient background was evaluated using Spearman's rank correlation coefficient. Correlations between sirolimus and tacrolimus C0/D ratios or doses were analyzed by single regression analysis.

Results:

Significant correlations were found between the C0/D ratios of sirolimus and tacrolimus. The regression equations from the initial data of TD and OD groups at steady state were y = 1.880x + 32.636 (adjustedR2= 0.743,P= 0.017) and y = 1.684x + 38.816 (adjustedR2= 0.919,P< 0.001), respectively. In addition, the regression equations from all data of TD and OD groups were y = 1.883x + 4.170 (adjustedR2= 0.546,P< 0.001) and y = 1.950x + 43.188 (adjustedR2= 0.898,P< 0.001), respectively. A significant correlation between the dosage of sirolimus and tacrolimus was observed only in the OD group, with relatively low accuracy.

Conclusions:

Blood sirolimus concentrations can be estimated using the C0/D ratio of tacrolimus, suggesting that the C0/D ratio of tacrolimus is an index of required sirolimus dosage and the frequency of blood sirolimus concentration measurements.
The Level of Compliance With the Use of Personal Radiation Monitoring Devices by Qualified Radiographers at Provincial Hospitals in the Tshwane District Area
Authors: Sethole Khethiwe Margaret , Ahrens Erika , Kruger Ursula
Published: April 2019

When researchers accompanied radiography students during their work integrated learning, it was observed that there is non-compliance with regards the use of personal radiation monitoring devices by radiographers in the Radiology Departments at Provincial hospitals in the Tshwane district area. The aim of this research study was to identify the level of compliance with the use of radiation monitoring devices by radiographers. A quantitative descriptive study method was used, and the data collection tool was questionnaires that were hand delivered to all settings. The sample size of radiographers was 96, and consent was received from 61 participants. The data was collated in a Microsoft Excel® spreadsheet, and the variables were statistically analyzed for frequencies and percentages. The Fisher’s exact test was used for association to answer the level of compliance and management of the radiation monitoring device. Results showed compliance of radiographers in the wearing of radiation monitoring devices but inconsistency as to where the radiation monitoring device should be worn. A lack of awareness about policies from the Radiation Board was also noted.
Personal Exposure to Radiofrequency Electromagnetic Fields Among Palestinian Adults
Authors: Lahham Adnan , Ayyad Haitham
Published: April 2019

This work deals with the assessment of personal exposure to radiofrequency electromagnetic fields and the study of temporal and spatial daily variations in a group of 24 adults from the West Bank, Palestine. Exposure was measured using a personal exposure meter EME SPY 140. Mean values of exposure levels from different radiofrequency sources were calculated using both naive and robust regression on order statistics approaches. The total daily exposure from all radiofrequency electromagnetic field sources varied widely among participants depending on their location, the mobile network they use, their activities, and their mode of transportation, ranging from about 0.2 V m−1 to 0.9 V m−1. The average total daily exposure of all participants was about 0.48 V m−1. The main contribution to the mean exposure was from WiFi 2G (45%), GSM900 uplink (19%), GSM900 downlink, and FM radiobroadcasting (each by 11%). Other sources including GSM1800, UMTS2100, WiFi 5G, DECT, TETRA, WiMAX, and TV bands all together contributed 14%. During different activities, participants were exposed to the highest exposure level while traveling and to the lowest exposure while they were sleeping. During the day, participants received the highest exposure during the time period from 1600 to 2400 h. Based on thermal effect of radiofrequency electromagnetic fields, all evaluated personal exposures comply with guidelines recommended for the general public by the International Commission on Non-Ionizing Radiation Protection.
Validation Tests of Resuspension Models for a Finite and Infinite Site
Authors: Whicker Jeffrey J. , McNaughton Michael , Ruedig Elizabeth , Fuehne David P.
Published: April 2019

Dose assessment for deposited radionuclides often requires estimates of air concentrations that are derived from measured soil concentrations. For this, dose assessors typically use literature resuspension values that, while empirically based, can vary by orders of magnitude making it difficult to provide accurate dose estimates. Despite the complexities of the physical processes involved in resuspension, the models generally used for dose assessment are relatively simplistic and rarely are the models validated for a specific site, thus making prediction of air concentrations or airborne emissions highly uncertain. Additionally, the size of the contaminated area can have an impact on downwind concentrations, yet literature values do not account for smaller-sized contaminated sites adding additional uncertainty. To test resuspension models for soil-bound radionuclides at finite and infinite spatial scales, measurements of soil and air concentrations are made at (1) a location downwind of a former outfall where 239Pu was released into the environment (a finite site), and (2) uncontaminated locations where regional air sampling provides background measurements of naturally occurring 238U in sampled dust (an infinite site). Measured air concentrations were compared to those predicted using the resuspension factor model and the mass loading model. An area factor was applied to the smaller contaminated site to account for dilution of dust from the contaminated site with dust originating from offsite locations. Results show that when properly parameterized to site conditions, resuspension models can predict air concentrations to within a factor of 10.
Characterization of Extrafocal Dose Influence on the Out-of-Field Dose Distribution by Monte Carlo Simulations and Dose Measurements
Authors: Ghareeb Firass , Lencart Joana , Oliveira Jorge , Santos João A.M.
Published: April 2019

Out-of-field scattered and transmitted extrafocal radiation may induce secondary cancer in long-term survivors of external radiotherapy. Pediatric patients have higher life expectancy and tend to receive higher secondary radiation damage due to geometric and biological factors. The goal of this study is to characterize the location and the magnitude of extrafocal dose regions in the case of three-dimensional conformal radiotherapy and volumetric arc therapy, to apply this information to clinical treatment cases, and to provide mitigation strategies. Extrafocal dose has been investigated in a Varian TrueBeam linac equipped with a high-definition 120 multileaf collimator using different physical and virtual phantoms, dose calculation (including Monte Carlo techniques), and dose measurement methods. All Monte Carlo calculations showed excellent agreement with measurements. Treatment planning system calculations failed to provide reliable results out of the treatment field. Both Monte Carlo calculations and dose measurements showed regions with higher dose (extrafocal dose areas) when compared to the background. These areas start to be noticeable beyond 11 cm from the isocenter in the direction perpendicular to the multileaf collimator leaves’ travel direction. Out-of-field extrafocal doses up to 160% of the mean dose transmitted through the closed multileaf collimator were registered. Two overlapping components were observed in the extrafocal distribution: the first is an almost elliptical blurred dose distribution, and the second is a well-defined rectangular dose distribution. Extra precautions should be taken into consideration when treating pediatric patients with a high-definition 120 multileaf collimator to avoid directing the extrafocal radiation into a radiosensitive organ during external beam therapy.
Prevalence and Severity of Psychiatric Disorders and Suicidal Behavior in Service Members and Veterans With and Without Traumatic Brain Injury: Systematic Review
Authors: Greer Nancy , Sayer Nina A. , Spoont Michele , Taylor Brent C. , Ackland Princess E. , MacDonald Roderick , McKenzie Lauren , Rosebush Christina , Wilt Timothy J.
Published: April 2019

Objectives:

Assess prevalence and severity of posttraumatic stress disorder, suicidal behavior, and depressive, substance use, and anxiety disorders in US service members or Veterans with and without a deployment-related mild traumatic brain injury (TBI) (mTBI).

Design:

Systematic review using multiple databases (January 2000 to October 2017). We included national or geographically diverse samples.

Main Measure:

Prevalence and severity of psychiatric conditions based on diagnostic codes, clinician assessments, and self-report measures with results stratified by sample type.

Results:

We identified 11 studies on the basis of national samples and 22 studies on the basis of geographically diverse samples. Traumatic brain injury severity was not always ascertained or reported. In national studies, posttraumatic stress disorder, depressive disorder, substance use disorder, and anxiety disorder prevalence were higher in those with TBI than in those without. One national sample reported prevalence of suicide attempts. Across psychiatric conditions, strength of evidence ranged from insufficient to moderate. In geographically diverse samples, the pattern of findings was similar. National studies provided insufficient evidence on psychiatric condition severity; geographically diverse studies found greater severity of posttraumatic stress disorder symptoms with mixed results for symptoms of depressive or substance use disorders.

Conclusions:

Service members and Veterans with TBI history have higher prevalence and possibly severity of selected psychiatric conditions.
Differences in Posttraumatic Stress Disorder, Depression, and Attribution of Symptoms in Service Members With Combat Versus Noncombat Mild Traumatic Brain Injury
Authors: Hardy Morgan , Kennedy Jan , Reid Matthew , Cooper Douglas
Published: April 2019

Objective:

This study compares combat-related mild traumatic brain injury (mTBI) to non-combat-related mTBI in rates of posttraumatic stress disorder (PTSD) and depression after injury, severity of postconcussive symptoms (PCSs), and attribution of those symptoms to mTBI versus PTSD.

Participants:

A total of 371 active duty service members (SMs) with documented history of mTBI, divided into combat and non-combat-related cohorts.

Design:

Retrospective cohort study.

Main Measures:

Diagnoses of PTSD and depression based on medical record review and self-report. PCSs measured using Neurobehavioral Symptom Index. Attribution of symptoms based on a rating scale asking how much mTBI, PTSD, depression, deployment, or readjustment stress contributed to current symptoms.

Results:

Prevalence of PTSD was significantly higher after a combat-related mTBI, compared with a noncombat mTBI (P= .001). Prevalence of depression did not differ between the 2 groups. PCSs were high in both combat and noncombat mTBIs, with no statistical difference between groups. SMs with PTSD reported higher PCS, regardless of combat status. SMs without PTSD attributed symptoms mainly to mTBI, whereas SMs with PTSD, regardless of combat status, were much more likely to attribute symptoms to PTSD, depression, and deployment/readjustment stress.

Conclusions:

This research contributes to our understanding of the complex interplay between mTBI and PTSD in both combat and noncombat injuries within the military population and the importance of addressing both simultaneously.
A Randomized Comparative Effectiveness Trial of Family-Problem–Solving Treatment for Adolescent Brain Injury: Parent Outcomes From the Coping with Head Injury through Problem Solving (CHIPS) Study
Authors: Wade Shari L. , Cassedy Amy E. , McNally Kelly A. , Kurowski Brad G. , Kirkwood Michael W. , Stancin Terry , Taylor H. Gerry
Published: April 2019

Objective:

To examine changes in depression and distress in parents of adolescents receiving family-problem–solving therapy (F-PST) following traumatic brain injury.

Method:

Families of adolescents hospitalized for moderate to severe traumatic brain injury were randomized to face-to-face F-PST (34), therapist-guided online F-PST (56), or self-guided online F-PST (60). Outcomes were assessed pretreatment and 6 and 9 months later. Parents rated depression and distress on the Center for Epidemiological Studies Depression Scale and the Brief Symptom Inventory, respectively. Mixed modeling was used to examine changes over time and treatment moderators.

Results:

The therapist-guided online group had significant reductions in parental depression over time. Analyses of slopes of recovery revealed differential improvement on the Center for Epidemiological Studies Depression Scale between the 2 online groups, with no significant change in depressive symptoms following self-guided F-PST. On the Brief Symptom Inventory Global Severity Index, the therapist-guided online group reported significant improvement from baseline to 6 months that was maintained at 9 months. The face-to-face and self-guided online groups reported significant reductions in distress between 6 and 9 months with corresponding large effect sizes. Differences on the Center for Epidemiological Studies Depression Scale between therapist-guided and self-guided online groups at the 9-month follow-up were more pronounced in families of lower socioeconomic status, t
103 = −2.87; P = .005.

Conclusions:

Findings provide further support for the utility of therapist-guided online F-PST in reducing parental depression and distress following pediatric traumatic brain injury and offer limited evidence of the efficacy of self-guided online treatment for these outcomes. Families of lower socioeconomic status may benefit more from therapist involvement.
Long-Term Correlates of Mild Traumatic Brain Injury on Postconcussion Symptoms After Deployment to Iraq and Afghanistan in the UK Military
Authors: Rona Roberto J. , Jones Margaret , Jones Norman , Fear Nicola T. , Wessely Simon
Published: April 2019

Objectives:

We assessed whether mild traumatic brain injury (mTBI) reported by UK service personnel between 2007 and 2009 was associated with postconcussion symptoms (PCS) 7 to 8 years later.

Setting:

United Kingdom.

Participants:

A total of 4601 service personnel all of whom had deployed to Iraq and/or Afghanistan.

Design:

Longitudinal study.

Main Outcome Measures:

Nine PCS reported in a survey carried out between 2014 and 2016. The main independent variable was mTBI reported between 2007 and 2009.

Results:

A total of 2318 (50.4%) out of 4601 participants completed the follow-up questionnaire. Mild traumatic brain injury was associated with 2 of 9 PCS. Mild traumatic brain injury at baseline was associated with dizziness at follow-up in the fully adjusted model, in comparison with either “other injury” or “no injury” group. Mild traumatic brain injury was associated with loss of concentration in comparison with “no injury” but in comparison with the “other injury” group, it was not in the fully adjusted model. The prevalence of 7 of the 9 PCS increased over time regardless of mTBI status.

Conclusions:

Mild traumatic brain injury reported in 2007-2009 was associated with dizziness and possibly with loss of concentration 7 years later but not with most PCS. The prevalence of most PCS increased over time independently of mTBI.
Treatment Limitations With PROSE (Prosthetic Replacement of the Ocular Surface Ecosystem): One Centers Experience
Authors: Schear Matthew J. , Ibrahim Kirolos , Winokur Jules , Busuioc Corina , Udell Ira , Steiner Anne
Published: April 2019

Objectives:

The prosthetic replacement of the ocular surface ecosystem (PROSE) device is used to treat difficult-to-manage ocular surface disease (OSD) and ectasia. Previous studies have demonstrated positive treatment outcomes. This study aims to document treatment failures to better tailor treatment and address limitations with its use.

Methods:

Retrospective chart review of consecutive PROSE fits performed at Northwell Health from 2012 to 2016. Reasons for patient discontinuation of treatment were documented, and potential risk factors for treatment failure were assessed.

Results:

The total number of eyes treated was 125. Fifty five eyes had ectasia, 67 had OSD, and 3 had both ectasia and OSD. A total of 8/125 (6.4%) of eyes failed treatment; 6/8 (75%) of failed treatments had worsening corneal edema, all of which had presumed risk factors for lower endothelial cell counts. Two eyes discontinued use secondary to intractable debris on the device, blurring vision. The most common diseases in patients failing therapy in descending order included: keratoconus and Fuch's dystrophy, ectasia after penetrating keratoplasty, and graft versus host disease. Those with presumed risks factors for lower endothelial cell counts (Fuch's dystrophy and patients with previous penetrating keratoplasty) were more likely to fail (22.2%) compared with those without a risk of a low endothelial cell count (1.6%).

Conclusion:

Although PROSE use has high success, corneal edema secondary to endothelial dysfunction is a potential limitation that may lead to treatment failure. Patients with lower endothelial cell counts after penetrating keratoplasty or with Fuch's dystrophy were more likely to fail treatment.
Descemet Membrane Endothelial Keratoplasty Outcomes During the Initial Learning Curve of Cornea Fellows
Authors: Pereira Nicolas Cesário , Gomes José Álvaro Pereira , Moriyama Aline Silveira , Chaves Luis Fernando , Forseto Adriana dos Santos
Published: April 2019

Purpose:

To describe the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed by cornea fellows during their initial learning curve.

Methods:

This prospective study included the first consecutive series of 53 DMEK surgeries performed by 14 corneal fellows at Sorocaba's Ophthalmological Hospital. Best spectacle-corrected visual acuity, endothelial cell density (ECD), and complications were evaluated.

Results:

Of the eyes without ocular comorbidities and with complete visual acuity measurements, 97% of 33 eyes achieved a best spectacle-corrected visual acuity of ≥20/40 in 6 months. The mean (SD) preoperative donor ECD was 2453 (361) cells/mm2, and at 6 months postoperatively, the in vivo mean ECD (SD) was found to be 1300 (587) cells/mm2, an average loss of 47%. Preparation of the DMEK graft by the cornea fellows was successful in all cases. There were 9 eyes (17%) that experienced partial graft detachment requiring rebubbling. A total of 3 eyes (5.7%) failed to clear the cornea, all of which were managed with successful secondary endothelial keratoplasty. None of the eyes experienced pupillary block.

Conclusions:

Establishing DMEK in a fellowship program was successful with the supervision of an experienced DMEK surgeon. Even without the facility of a prestripped DMEK graft by an eye bank and with no backup tissue, no surgery was canceled because of graft preparation failure. Good visual outcomes were achieved with satisfactory ECD at 6-month follow-up, with an acceptable complication rate. Even the 3 eyes that failed to clear the cornea evolved well after secondary endothelial keratoplasty by the cornea fellows.
Increasing Diagnostic Uncertainties in Children With In Utero HIV Infection
Authors: Millar Jane R. , Mvo Zodumo , Bengu Nomonde , Fillis Rowena , Sprenger Ken , Matthews Philippa C. , Archary Moherndran , Ndung’u Thumbi , Adland Emily , Puertas Maria C. , Martinez-Picado Javier , Goulder Philip
Published: April 2019

We present a case of an in utero HIV-infected child, who on day 1 of life had a positive whole blood total nucleic acid test but viral load <20 RNA copies/mL. Dried blood spot total nucleic acid testing was negative on day 1, 10 and at 3 months, while on ART prophylaxis then positive at 5 months after prophylaxis ended. Retrospective peripheral blood mononuclear cells HIV DNA testing from day 1 of life was positive, confirming in utero infection.
Association of Antiretroviral Drug Regimen With Viral Suppression in HIV-positive Children on Antiretroviral Therapy in Eswatini
Authors: Chouraya Caspian , Ashburn Kim , Khumalo Philisiwe , Mpango Lydia , Mthethwa Nobuhle , Machekano Rhoderick , Guay Laura , Mofenson Lynne M.
Published: April 2019

Background:

Global pediatric treatment goals are for 90% of known children living with HIV to be on antiretroviral therapy (ART), with 90% having viral suppression. We used enrollment data from a study evaluating a family-centered HIV care program in Eswatini to describe the ART histories and virologic outcomes of enrolled children living with HIV and identify factors associated with viral suppression (<1000 RNA copies/mL) and undetectability (<400 RNA copies/mL).

Methods:

Factors associated with viral suppression and undetectability were identified using Pearson χ2 for categorical variables and Wilcoxon rank sum tests for continuous variables.

Results:

Three hundred seventy-seven children were enrolled, median age 8.5 years. Median age at HIV diagnosis was 2.1 years; at ART initiation, 2.6 years; and ART duration at enrollment, 4.1 years. Ninety-nine percent were receiving ART; 95.2% were on first-line ART and 4.8% on second-line ART. Most children (43.1%) were receiving nevirapine-based ART (median age 9.2 years), with 31.3% on lopinavir-ritonavir-based (median age 5.4 years) and 25.5%, efavirenz-based ART (median age 10.3 years). Viral suppression (<1000 copies/mL) was observed in 77.9% and undetectability (<400 copies/mL) in 73.5% of children. The only factor significantly associated with viral suppression was ART regimen, with 72.1% of children on nevirapine-based ART versus 86.7% on efavirenz-based ART virally suppressed.

Conclusions:

Although 99% of children enrolled in the study were receiving ART, viral suppression was observed in only 77.9%, with lowest rates among children receiving nevirapine-based ART. These findings highlight the critical importance of monitoring treatment regimen for optimizing treatment outcomes for pediatric HIV.
First Case Report of Intraventricular Tigecycline in a Neonate With Extensively Drug-resistant Acinetobacter baumannii Ventriculitis
Authors: Pratheep Rathna , Ray Somosri , Mukhopadhyay Kanya , Gautam Vikas , Shafiq Nusrat , Dutta Sourabh , Saini Shiv Sajan , Bhatia Anmol
Published: April 2019

Multidrug-resistant and extensively drug-resistant Acinetobacter baumannii infections have been increasing as a cause of healthcare-associated infections in the neonatal age group. In this report, we describe a 27-week, 1028 g, preterm neonate with extensively drug-resistant A. baumannii infection complicated by ventriculitis who did not respond to intravenous and intraventricular colistin but did respond after intraventricular tigecycline. This is the first case report describing the use of intraventricular tigecycline in a neonate with ventriculitis.
Comparison of Nonpolio Enteroviruses in Children With Herpangina and Hand, Foot and Mouth Disease in Taiwan
Authors: Yang TienYu Owen , Arthur Huang Kuan-Ying , Chen Mei-Huei , Chen Pau-Chung , Huang Wan-Ting
Published: April 2019

Background:

Nonpolio enterovirus (NPEV) infections are often present with herpangina (HA) and hand, foot and mouth disease (HFMD). Most countries sample NPEVs in HFMD cases, targeting enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16) that are associated with outbreaks and severe complications. HA is also monitored in Taiwan and several other countries, but its viral characteristics are underreported.

Methods:

Through Taiwan’s National Virologic Surveillance, information regarding ~100,000 child respiratory samples (2002–2015) was linked to concurrent (0–6 days before the sampling date) outpatient records from the National Health Insurance databases, including ~15,000 HA-related and ~7000 HFMD-related samples. We assessed sample representation and NPEV positive rates, and estimated total numbers of EV-A71 and CV-A16.

Results:

There were more HA events (4.0 millions) than HFMD events (1.2 millions) in Taiwan. In every 1000 events with HFMD and HA, 6.0 and 4.1, respectively, respiratory samples were collected. The NPEV positive rate in HFMD-related samples was 48%, consistent across most sampling seasons, and predominantly EV-A71 or CV-A16 (74%). By comparison, the HA-related samples had a lower positive rate overall (43%), occasionally EV-A71 or CV-A16 (13%), and the positive rate depended strongly on HA incidence (P< 10–12). Compared with sampling HFMD alone, inclusion of HA-related information predicted an earlier onset of EV-A71 outbreak in 2011, and predicted 30% more EV-A71 cases.

Conclusions:

This is the first representative report on viral characteristics of HA. Our findings confirm that HFMD monitoring is a reliable strategy, but there is a measurable additional benefit when HA is also monitored.
Severe Human Bocavirus 1 Respiratory Tract Infection in an Immunodeficient Child With Fatal Outcome
Authors: Tabatabai Julia , Fakhiri Julia , Meyburg Jochen , Linse Kai-Philipp , Xu Man , Söderlund-Venermo Maria , Grimm Dirk , Schnitzler Paul
Published: April 2019

We report a case of lower respiratory tract infection with human bocavirus 1 (HboV1) in an immunodeficient 6-month-old boy leading to respiratory failure with fatal outcome. Polymerase chain reaction of serum/tracheal secretions revealed exceptionally high HboV1-DNA levels and immunoassays showed seroconversion indicating an acute primary HboV1 infection. All assays for other pathogens were negative, strongly suggesting that HboV1 was the causative agent in this case.
Reducing Hematologic Toxicity With Short Course Postexposure Prophylaxis With Zidovudine for HIV-1 Exposed Infants With Low Transmission Risk
Authors: Nguyen Thi Thanh Truc , Kobbe Robin , Schulze-Sturm Ulf , Blohm Martin , Hollwitz Bettina , Hertling Sandra , Becker Christina , Oommen Prasad Thomas , Laws Hans-Jürgen , Martignoni Franca , Ole Jensen Björn-Erik , Olah Karen , Schmidtke Susanne , Kreuels Benno , Vasconcelos Malte Kohns , Neubert Jennifer
Published: April 2019

Using retrospectively collected data from 383 infants born to HIV-1-infected mothers receiving antiretroviral therapy, we compared transmission rates and hematologic toxicity between infants receiving 2-week (short course) versus longer duration zidovudine postexposure prophylaxis. Short course resulted in lower hematologic toxicity without evidence of increased vertical transmission risk.
Modulation of brain networks by sumatriptan-naproxen in the inflammatory soup migraine model
Authors: Bishop James , Becerra Lino , Barmettler Gabi , Chang Pei-Ching , Kainz Vanessa , Burstein Rami , Borsook David
Published: April 2019

Migraine is a debilitating condition; however, the pharmacological effects on central nervous system networks after successful therapy are poorly understood. Defining this neurocircuitry is critical to our understanding of the disorder and for the development of antimigraine drugs. Using an established inflammatory soup model of migraine-like pathophysiology (N = 12) compared with sham synthetic interstitial fluid migraine induction (N = 12), our aim was to evaluate changes in network-level functional connectivity after sumatriptan-naproxen infusion in awake, conscious rodents (Sprague–Dawley rats). Sumatriptan-naproxen infusion functional magnetic resonance imaging data were analyzed using an independent component analysis approach. Whole-brain analysis yielded significant between-group (inflammatory soup vs synthetic interstitial fluid) alterations in functional connectivity across the cerebellar, default mode, basal ganglia, autonomic, and salience networks. These results demonstrate the large-scale antimigraine effects of sumatriptan-naproxen co-administration after dural sensitization.
Using Real-Time Adherence Feedback to Enhance Communication About Adherence to Antiretroviral Therapy: Patient and Clinician Perspectives
Authors: Hill Lauren M. , Golin Carol E. , Pack Allison , Carda-Auten Jessica , Wallace Deshira D. , Cherkur Sruthi , Farel Claire E. , Rosen Elias P. , Gandhi Monica , Asher Prince Heather M. , Kashuba Angela D. M.
Published: April 2019

New technologies for real-time adherence monitoring hold the potential to enhance antiretroviral therapy adherence interventions by providing objective information about daily medication-taking behavior. To realize this potential, we need to understand how to integrate real-time adherence feedback into existing best practices to promote antiretroviral therapy adherence at the point of care. Using in-depth interviews with 30 HIV-infected patients and 29 HIV care clinicians, our primary aims were to understand patients' and clinicians' perceptions of anticipated benefits and preferred uses of objective feedback to enhance conversations about adherence and to identify concerns about the impact of objective monitoring on patient–clinician relationships and communication. Both patients and clinicians suggested that identifying patterns of nonadherence with real-time feedback could (a) facilitate collaborative adherence problem-solving, (b) motivate patient adherence, and (c) reinforce the importance of optimal adherence. Some clinicians worried that delivery of real-time feedback could imply mistrust of patient-reported adherence and suggested careful framing of monitoring results. A few patients and clinicians were concerned that negative reactions to monitoring could discourage retention in care and reduce adherence motivation. These results indicate the potential of real-time feedback to enhance existing evidence-based adherence interventions targeting the key adherence precursors of adherence information, motivation, and behavioral skills. Guidance for the delivery of real-time adherence feedback should focus on both optimizing adherence and mitigating negative perceptions of adherence monitoring.
The Need for Cultural Inclusivity in Global Palliative Nursing
Authors: Mazanec Polly , Verga Sarah , Foley Helen , Mehta Ambereen K.
Published: April 2019

It is estimated that 11.1 million people in the United States are living with serious illness, and most people with serious illness need palliative care. Quality palliative care incorporates culturally sensitive care, and with the increasing diversity in the United States, it has become even more critical that nurses and health care professionals be prepared to meet the unique needs of those living within the diverse and underserved populations of this country. Advocating for access to palliative care for the seriously ill, culturally respectful care at the end of life, and honoring values, practices, and beliefs are essential roles of the nurse. This article presents 4 examples of individuals from diverse and potentially vulnerable US populations who face unique challenges as they deal with their life-limiting diseases and face end of life.
The Dutch Breast Implant Registry: Registration of Breast Implant–Associated Anaplastic Large Cell Lymphoma—A Proof of Concept
Authors: Becherer Babette E. , de Boer Mintsje , Spronk Pauline E. R. , Bruggink Annette H. , de Boer Jan Paul , van Leeuwen Flora E. , Mureau Marc A. M. , van der Hulst René R. J. W. , de Jong Daphne , Rakhorst Hinne A.
Published: April 2019

Background:

The Dutch Breast Implant Registry (DBIR) was established in April of 2015 and currently contains information on 38,000 implants in 18,000 women. As a clinical registry, it evaluates the quality of breast implant surgery, including adverse events such as breast implant–associated (BIA) anaplastic large cell lymphoma (ALCL). To examine the efficacy of the DBIR, the capture rate of BIA-ALCL was compared to the registration of BIA-ALCL in the Dutch Nationwide Network and Registry of Histo- and Cytopathology (PALGA) as a gold standard, in combination with matching these databases to obtain complementary information.

Methods:

All BIA-ALCL patients diagnosed and registered in The Netherlands in 2016 and 2017 were identified separately in the PALGA and DBIR databases. In addition, both databases were matched using indirect key identifiers. Pathologic information from the PALGA and clinical and device characteristics from the DBIR were obtained for all patients.

Results:

Matching of both databases gave a capture rate of BIA-ALCL in the DBIR of 100 percent (n = 6) in 2016 and 70 percent (n = 7) in 2017. In total, 17 patients were identified in the PALGA, of which 14 patients were also identified in the DBIR; three patients were not registered; and 10 patients were registered false-positive. Of all confirmed patients, symptoms, staging results, treatment, and implant information were registered.

Conclusions:

Currently, the DBIR contains 2 full registration years and captures most of the BIA-ALCL patients despite overestimation. Therefore, pathology confirmation remains essential. By matching these databases, complementary clinical and implant information could be retrieved, establishing the DBIR as an essential postmarketing surveillance system for health risk assessments.
Breast Cancer Knowledge and Decisions Made for Contralateral Prophylactic Mastectomy: A Survey of Surgeons and Women in the General Population
Authors: Hooper Rachel C. , Hsu Jessica , Duncan Anthony , Bensenhaver Jessica M. , Newman Lisa A. , Kidwell Kelly M. , Chung Kevin C. , Momoh Adeyiza O.
Published: April 2019

Background:

Decisions made to undergo contralateral prophylactic mastectomy, in women at low risk for bilateral disease, are often attributed to a lack of knowledge. This study examines the role knowledge plays in determining surgical treatment for unilateral breast cancer made by laywomen and surgeons for themselves or loved ones.

Methods:

The study cohort had three groups: (1) laywomen in the general population, (2) breast surgeons, and (3) plastic surgeons. Laywomen were recruited using Amazon Mechanical Turk Crowd Sourcing. Breast and plastic surgeons from nine states were sent electronic surveys. Demographic and contralateral prophylactic mastectomy–specific data on decisions and knowledge were collected and analyzed.

Results:

Surveys from 1333 laywomen, 198 plastic surgeons, and 142 breast surgeons were analyzed. A significantly greater proportion of laywomen in the general population favored contralateral prophylactic mastectomy (67 percent) relative to plastic (50 percent) and breast surgeons (26 percent) (p < 0.0001). Breast surgeons who chose contralateral prophylactic mastectomy were younger (p = 0.044) and female (0.012). On assessment of knowledge, 78 percent of laywomen had a low level of breast cancer knowledge. Laywomen with higher levels of breast cancer knowledge had lower odds of choosing contralateral prophylactic mastectomy (OR, 0.37; 95 percent CI, 0.28 to 0.49).

Conclusions:

Fewer women are likely to make decisions in favor of contralateral prophylactic mastectomy with better breast cancer–specific education. A knowledge gap likely explains the lower rates with which surgeons choose contralateral prophylactic mastectomy for themselves or loved ones; however, some surgeons who were predominantly young and female favor contralateral prophylactic mastectomy. Improving patient education on surgical options for breast cancer treatment is critical, with well-informed decisions as the goal.
A New Technique for Robust Stabilization in the Keystone Area during Extracorporeal Septorhinoplasty
Authors: Kamburoğlu Haldun O. , Bitik Ozan
Published: April 2019

Although extracorporeal septorhinoplasty is the most powerful technique for correcting deviated and leaning noses, many investigators have abandoned it because of keystone problems. The authors defined a new neoseptum fixation technique and used it in 10 patients in 2016. Preoperative and postoperative Nasal Obstruction Symptom Evaluation scale and peak nasal inspiratory flow measurement, and septal indexes of the patients were compared. There was statistically significant improvement in the respiratory condition of all patients. No recurrence or dorsal irregularity has been observed. This new, easily applicable, and robust fixation method of extracorporeal septorhinoplasty may be a definitive solution to prevent keystone irregularities.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.