bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasal Duplication Combined with Cleft Lip and Palate: Surgical Correction and Long-Term Follow-Up
Authors: Long Kanharith , Yamaguchi Kazuaki , Lonic Daniel , Long Vanna , Chhoeurn Vuthy , Lo Lun-Jou
Published: October 2017

Background:

Diprosopus dirrhinus, or nasal duplication, is a rare entity of partial craniofacial duplication.

Methods:

The case we present is the first report of diprosopus dirrhinus associated with complete cleft lip and palate. The baby was born in Cambodia at full term by normal vaginal delivery with no significant perinatal and family history. Physical examination revealed significant facial deformity due to the duplicated nose and the left complete cleft lip/palate on the right subset.

Results:

There were 4 nostrils; both medial apertures including the cleft site were found to be 10–15 mm deep cul-de-sac structures without communication to the nasopharynx. The upper third of the face was notable for hypertelorism with a duplication of the soft-tissue nasion and glabella. Between the 2 nasal dorsums, there was a small cutaneous depression with a lacrimal fistula in the midline. Surgical treatment included the first stage of primary lip and nose repair and the second stage of palatoplasty.

Conclusions:

The patient was followed up at the age of 10 years showing satisfactory results for both aesthetic and functional aspects. Further management in the future will be required for the hypertelorism and nasal deformity.
Quality and Variability of Cardiovascular Rehabilitation Delivery
Authors: Somanader Deborah S. , Chessex Caroline , Ginsburg Liane , Grace Sherry L.
Published: October 2017

Purpose:

Cardiac care, including cardiovascular rehabilitation (CR), is most effective if it is high-quality. The aim of this study was to describe CR quality, using the recently developed Canadian Cardiovascular Society CR quality indicators (QIs). Difference in quality between CR sites was also assessed.

Methods:

Secondary analysis was conducted on an observational, prospective, multisite CR program evaluation cohort. A convenience sample of patients from 1 of 3 CR programs was approached at their first CR visit, and consenting participants completed a survey. Clinical data were extracted from charts pre- and postprogram. Of the 30 CR QIs, 21 (70.0%) were assessable: 10 process, 9 outcome, and 2 structure QIs.

Results:

Of 411 consenting patients, 209 (53.0%) completed CR. The greatest quality was observed for assessment of blood pressure (98.1%), communication with primary health care at CR discharge (94.2%), and patient enrollment (94.0%). The lowest quality was observed for wait time from hospital discharge (9.2%), assessments of blood glucose (42.1%), and lipid control (53.0%). Of the 7 QIs that had an established benchmark, quality for 2 (28.6%) was above the benchmark (particularly assessment of blood pressure). Significant between-site differences were observed in 11 (64.7%) QIs. The magnitude of quality differences between sites was largest for assessment of lipid control (72.6%), assessment of blood glucose control (69.0%), and wait time in median days from referral to enrollment (30.6 days).

Conclusion:

There is wide variability in CR program quality, both overall and between CR sites. Quality improvement in particular aspects of CR care is required.
PREVALENCE OF POLYPOIDAL CHOROIDAL VASCULOPATHY IN WHITE PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION
Authors: Lorentzen Thomas D. , Subhi Yousif , Sørensen Torben L.
Published: October 2017

Purpose:

Polypoidal choroidal vasculopathy (PCV) is a disease with significant inter-ethnical differences. In this study, we systematically review the literature on the prevalence of PCV in whites referred with a diagnosis of exudative age-related macular degeneration (AMD).

Methods:

We searched PubMed, Embase, the Cochrane Library, and the Web of Science on 24 March, 2017 for studies evaluating the prevalence of PCV in white patients with exudative AMD. Data extraction and risk of bias assessments were performed in duplicate. Studies were included for a qualitative review and a meta-analysis, including subgroup analysis for differences in age and sex.

Results:

We included data from 11 studies (>2,200 participants). For diagnosis, indocyanine green angiography was used together with a set of supporting criteria on fundus examination and optical coherence tomography. Extramacular location was more prevalent in eyes with PCV. Drusen was present in the fellow eye in 17% to 27%. Pooled prevalence of PCV in white patients with exudative AMD was 8.7% (confidence interval 95%: 7.2%–10.3%). Patients with PCV were 3.7 years (confidence interval 95%: 2.1 years–5.3 years) younger than those with other exudative AMD. Sex did not differ significantly.

Conclusion:

Polypoidal choroidal vasculopathy is not a rare subtype of exudative AMD in whites—it is present in approximately one in 11 patients.
Early haemorrhage control and management of trauma-induced coagulopathy: the importance of goal-directed therapy
Authors: Stensballe Jakob , Henriksen Hanne H. , Johansson Pär I.
Published: October 2017

Purpose of review

The aim of this study was to discuss the recent developments in trauma-induced coagulopathy and the evolvement of goal-directed therapy.

Recent findings

Mortality from major trauma continues to be a worldwide problem, and massive haemorrhage remains a major cause in 40% of potentially preventable trauma deaths. Development of trauma-induced coagulopathy challenges 25–35% of the patients further increasing trauma mortality. The pathophysiology of coagulopathy in trauma reflects at least two distinct mechanisms: Acute traumatic coagulopathy, consisting of endogenous heparinization, activation of the protein C pathway, hyperfibrinolysis and platelet dysfunction, and resuscitation associated coagulopathy. Clear fluid resuscitation with crystalloids and colloids is associated with dilutional coagulopathy and poor outcome in trauma. Haemostatic resuscitation is now the backbone of trauma resuscitation using a ratio-driven strategy aiming at 1:1:1 of red blood cells, plasma and platelets while applying goal-directed therapy early and repeatedly to control trauma-induced coagulopathy.

Trauma resuscitation should focus on early goal-directed therapy with use of viscoelastic haemostatic assays while initially applying a ratio 1:1:1 driven transfusion therapy (with red blood cells, plasma and platelets) in order to sustain normal haemostasis and control further bleeding.
Risks and management of long-term corticosteroid use in chronic rhinosinusitis
Authors: Campbell Raewyn G.
Published: October 2017

Purpose of review

The purpose of this review is to provide an update on the use and risks of long-term corticosteroids in the management of chronic rhinosinusitis (CRS).

Recent findings

Long-term use of systemic corticosteroids is not indicated in the management of CRS due to the associated side effects and potential complications. Therefore, recent research has focused on the safety and efficacy of topical corticosteroid, particularly second-generation corticosteroids, and their modes of administration. Second-generation corticosteroids are more potent and have less systemic bioavailability than their first-generation counterparts. However, caution must be taken with concomitant use of more than two types of corticosteroids (topical, systemic, inhaled etc.) and also with their dosage and frequency of administration to avoid adrenal suppression, growth suppression in children, elevated intraocular pressure or epistaxis. Research is ongoing into therapies that may reduce corticosteroid resistance which has been demonstrated in some nasal polyps.

Corticosteroids play an essential role in the management of CRS; however, use must be tailored to the patient-specific disease and requires ongoing review and regular reevaluation by their physician.
Long QTc During Methadone Maintenance
Authors: Westermeyer Joseph , Thuras Paul , Yoon Gihyun , Batres-y-Carr Tegan
Published: October 2017

Our goal consisted of describing the 4-year prevalence, contributors, and interventions for long QTc's in methadone maintenance treatment. Cardiologists' diagnosis of long QTc defined case-ness in 62 patients. Long QTc categories, drawn from epidemiological reports, encompassed 440 to 469 (borderline), 470 to 499 (moderate), and 500+ milliseconds (severe). Data collection included electrocardiograms, demographic characteristics, contributors to long QTc, and interventions-plus-outcomes (defined by resolution of long QTc). Of 62 patients, 21 had 39 long QTc episodes—a 4-year case prevalence of 34%, and an annual episode incidence of 15.7 per 100. Contributing factors identified in 36 of 39 episodes consisted of medication management (n = 19), illicit drug use (n = 11), and other factors (n = 6). Long QTc reverted to normal in 38 of 39 episodes. Of 21 patients, 12 (57%) experienced one or two recurrences. Methadone maintenance treatment physicians normalized most episodes as outpatients, often in collaboration with patients' primary care physicians. One fifth of episodes required hospitalization and other specialty care. Lack of timely QTc normalization may have accounted for one sudden death.
High-Quality Carbohydrates and Physical Performance
Authors: Kanter Mitch
Published: October 2017

While all experts agreed that protein needs for performance are likely greater than believed in past generations, particularly for strength training athletes, and that dietary fat could sustain an active person through lower-intensity training bouts, current research still points to carbohydrate as an indispensable energy source for high-intensity performance.
Postmortem Vitreous Humor Magnesium Does Not Elevate in Salt Water Drowning When the Immersion Time Is Less Than an Hour
Authors: Tse Rexson , Kuo Ta-Chen , Kesha Kilak , Garland Jack , Garland Sarah , Anne Sravan , Elstub Hannah , Cala Allan
Published: October 2017

Background

Elevation in postmortem vitreous humor sodium and chloride (PMVSC) in salt water drowning (SWD) when the immersion time is less than 1 hour (SWD1) is hypothesized to result from electrolyte changes in blood from salt water inhalation/ingestion during drowning. After approximately 1 hour after death, electrolytes may diffuse into the vitreous humor via the eye coverings. Another abundant element in salt water is magnesium, which is approximately 50 times higher in concentration than the blood and vitreous humor magnesium levels. Magnesium is able to diffuse across the eye coverings but not as easily through the blood-ocular barrier. With these properties, we hypothesize that postmortem vitreous magnesium (PMVM) would not be elevated in SWD1 but become elevated in SWD with immersion times greater than 1 hour (SWD>1).

Aim

The aim of this article was to investigate the differences in PMVM and PMVSC between nonimmersion deaths, SWD1, and SWD>1.

Methods

This is a 1-year retrospective study comparing PMVM and PMVSC in nonimmersion deaths, SWD1, and SWD>1.

Results

Postmortem vitreous magnesium is significantly higher in SWD>1 than SWD1 and nonimmersion deaths, with no significant difference between SWD1 and nonimmersion deaths. Postmortem vitreous humor sodium chloride is statistically higher in SWD1 and SWD>1 than nonimmersion deaths.

Conclusions

As a conclusion, PMVSC elevates and PMVM does not elevate in SWD1.
Towards a neurobiological understanding of pain in chronic pancreatitis: mechanisms and implications for treatment
Authors: Olesen Søren S. , Krauss Theresa , Demir Ihsan Ekin , Wilder-Smith Oliver H. , Ceyhan Güralp O. , Pasricha Pankaj J. , Drewes Asbjørn M.
Published: October 2017

Introduction:

Chronic pancreatitis (CP) is a disease characterized by inflammation of the pancreas resulting in replacement of the normal functioning parenchyma by fibrotic connective tissue. This process leads to progressively impairment of exocrine and endocrine function and many patients develop a chronic pain syndrome.

Objectives:

We aimed to characterize the neurobiological signature of pain associated with CP and to discuss its implications for treatment strategies.

Methods:

Relevant basic and clinical articles were selected for review following an extensive search of the literature.

Results:

Pathophysiological changes in the peripheral (pancreatic gland) and central nervous system characterize the pain syndrome associated with CP; involved mechanisms can be broken down to 3 main branches: (1) peripheral sensitization, (2) pancreatic neuropathy, and (3) neuroplastic changes in the central pain pathways. Disease flares (recurrent pancreatitis) may accelerate the pathophysiological process and further sensitize the pain system, which ultimately results in an autonomous and self-perpetuating pain state that may become independent of the peripheral nociceptive drive. These findings share many similarities with those observed in neuropathic pain disorders and have important implications for treatment; adjuvant analgesics are effective in a subset of patients, and neuromodulation and neuropsychological interventions may prove useful in the future.

Conclusion:

Chronic pancreatitis is associated with abnormal processing of pain at the peripheral and central level of the pain system. This neurobiological understanding of pain has important clinical implications for treatment and prevention of pain chronification.
Three-Dimensional Computer-Assisted Two-Layer Elastic Models of the Face
Authors: Ueda Koichi , Shigemura Yuka , Otsuki Yuki , Fuse Asuka , Mitsuno Daisuke
Published: October 2017

To make three-dimensional computer-assisted elastic models for the face, we decided on five requirements: (1) an elastic texture like skin and subcutaneous tissue; (2) the ability to take pen marking for incisions; (3) the ability to be cut with a surgical knife; (4) the ability to keep stitches in place for a long time; and (5) a layered structure. After testing many elastic solvents, we have made realistic three-dimensional computer-assisted two-layer elastic models of the face and cleft lip from the computed tomographic and magnetic resonance imaging stereolithographic data. The surface layer is made of polyurethane and the inner layer is silicone. Using this elastic model, we taught residents and young doctors how to make several typical local flaps and to perform cheiloplasty. They could experience realistic simulated surgery and understand three-dimensional movement of the flaps.
Managing Alar Flare in Rhinoplasty
Authors: Rohrich Rod J. , Malafa Menyoli M. , Ahmad Jamil , Basci Deniz S.
Published: October 2017

Alar flare is a common feature that contributes to the width of the lower third of the nose. In the right patient, alar flare reduction can improve nasal harmony and facial aesthetic balance; however, it is also difficult to correct if conducted inappropriately or overzealously. The unique anatomy and diverse morphologies of the alar lobule, and the dynamic relationship between flare and changes in tip projection, must be considered. The authors provide guidelines for flare reduction: when it is appropriate and how to tailor the excision pattern to safely and effectively refine nasal width. Alar flare is classified into three types according to alar rim shape on basal view analysis. By designing the excision pattern based on specific flare type, the lower third of the nose is narrowed without creating an operated appearance.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
The Effect of Processing Technique on Fat Graft Survival
Authors: Canizares Orlando , Thomson Jennifer E. , Allen Robert J. , Davidson Edward H. , Tutela John P. , Saadeh Pierre B. , Warren Stephen M. , Hazen Alexes
Published: October 2017

Background:

Wide variations in fat graft survival have been reported. The authors hypothesize that treating the adipose tissue on Telfa gauze creates a processed lipoaspirate with a more functional adipokine profile that improves fat graft survival.

Methods:

Suction-assisted lipoaspirate was harvested from humans and was either processed by centrifugation, rolled on Telfa gauze, or left unprocessed. Progenitor cell populations were quantified and characterized by flow cytometry. Glycerol-3-phosphate dehydrogenase assay was used to measure the functional adipocytes. The lipoaspirates were grafted into (n = 45) wild-type mice and harvested to assess fat graft persistence. Vascular endothelial growth factor and platelet-derived growth factor-BB secretions were measured by enzyme-linked immunosorbent assay technique.

Results:

Centrifuged lipoaspirate had a greater number of progenitor cells per gram of tissue than Telfa-processed and unprocessed lipoaspirate. However, Telfa-processed lipoaspirate had a greater number of functional adipocytes (0.104 U/ml) than centrifuged (0.080 U/ml) and unprocessed lipoaspirate (0.083 U/ml) on glycerol-3-phosphate dehydrogenase assay (p < 0.05). After 10 weeks of grafting, it had greater fat graft persistence (70.9 ± 6.2 percent) than centrifuged (56.7 ± 5.5 percent) and unprocessed lipoaspirate (42.2 ± 2.7 percent) (p < 0.05). It also maintained a greater secretion of vascular endothelial growth factor and platelet-derived growth factor-BB at weeks 1 and 2 than centrifuged and unprocessed lipoaspirate. Furthermore, CD31 staining demonstrated an increase in vascular density of the Telfa-processed lipoaspirate at week 2 compared with the centrifuged lipoaspirate (37 ± 1 percent and 14 ± 4 percent per high-power field; p < 0.05).

Conclusions:

Lipoaspirate processing technique has a significant impact on fat graft survival rate. Increasing the number of functional adipocytes by processing the fat on Telfa gauze may augment the secretion of angiogenic and mitogenic adipokines within the graft, thereby improving its survivability.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Optimizing Somatostatin Receptor Imaging in Patients With Neuroendocrine Tumors
Authors: Kunikowska Jolanta , Lewington Valerie , Krolicki Leszek
Published: October 2017

Aim

The presence of somatostatin receptors in neuroendocrine tumors allows visualization with radiolabeled somatostatin analogs in vivo. The aim of this prospective study was to compare somatostatin receptor imaging using 99mTc-HYNICTOC with 68Ga-DOTATATE (DOTA-DPhe1,Tyr3-octreotate) with respect to sensitivity, specificity, and impact upon clinical decision making.

Methods

Sixty-eight patients (30 men, 38 women; aged 56.4 ± 13.5 years) with disseminated, histologically proven neuroendocrine tumor were enrolled. All patients with previous 99mTc-HYNICTOC (Tektrotyd; POLATOM, Otwock, Poland) underwent 68Ga-DOTATATE PET/CT. Both examinations were compared on a per-patient and per-lesion basis.

Results

The sensitivity, specificity, positive and negative predictive values, and accuracy of 68Ga-DOTATATE and 99mTc-HYNICTOC were 100% versus 82%, 85% versus 69%, 97% versus 92%, 100% versus 47%, and 97% versus 79%, respectively.

Concordant results were observed in 58 patients (49/68 positive on both 68Ga-DOTATATE and 99mTc-HYNICTOC and 9/68 negative in both examinations). Ten of 68 patients had 68Ga-DOTATATE–positive, 99mTc-HYNICTOC–negative studies. Two hundred eighteen lesions were detected using 99mTc-HYNICTOC, compared with 546 lesions using 68Ga-DOTATATE (P < 0.0001). 68Ga-DOTATATE detected a higher number of lesions in bone and lymph nodes, liver, intestine, and pancreas and had a higher sensitivity for subcentimeter abnormalities than 99mTc-HYNICTOC. 68Ga-DOTATATE led to management change in 23 (34%) of 68 patients.

Conclusions

68Ga-DOTATATE has a higher sensitivity than 99mTc-HYNICTOC for the detection of neuroendocrine tumors. 68Ga-DOTATATE proved superior to 99mTc-HYNICTOC in detecting subcentimeter skeletal, lymph node, and liver metastases. 68Ga-DOTATATE PET/CT changed clinical decision making in one third of patients.
68Ga-DOTATATE Uptake in a Soft Tissue Metastasis From Clear Cell Renal Cell Cancer
Authors: Vamadevan S. , Le K. , Shen L. , Stevanovic A. , Loh H. , Mansberg R.
Published: October 2017

A 64-year-old man with a history of metastatic clear cell renal cell cancer was referred for progress 68Ga-DOTATATE PET/CT imaging. 68Ga-DOTATATE PET/CT imaging demonstrated increased DOTATATE uptake (SUVmax 13.8) in the left thigh localized to a soft tissue lesion. Cytopathology of the resected lesion was in keeping with a clear cell renal cell cancer metastasis. This case illustrates that 68Ga-DOTATATE accumulation in a soft tissue lesion can be due to a clear cell renal cell cancer metastasis.
Improving the Clinical Skills Performance of Graduating Medical Students Using “WISE OnCall,” a Multimedia Educational Module
Authors: Szyld Demian , Uquillas Kristen , Green Brad R. , Yavner Steven D. , Song Hyuksoon , Nick Michael W. , Ng Grace M. , Pusic Martin V. , Riles Thomas S. , Kalet Adina
Published: October 2017

Introduction

“Transitions to residency” programs are designed to maximize quality and safety of patient care, as medical students become residents. However, best instructional or readiness assessment practices are not yet established. We sought to study the impact of a screen-based interactive curriculum designed to prepare interns to address common clinical coverage issues (WISE OnCall) on the clinical skills demonstrated in simulation and hypothesize that performance would improve after completing the module.

Methods

Senior medical students were recruited to participate in this single group prestudy/poststudy. Students responded to a call from a standardized nurse (SN) and assessed a standardized patient (SP) with low urine output, interacted with a 45-minute WISE OnCall module on the assessment and management of oliguria, and then evaluated a different SP with low urine output of a different underlying cause. Standardized patients assessed clinical skills with a 37-item, behaviorally anchored checklist measuring clinical skills (intraclass correlation coefficient [ICC], 0.55–0.81). Standardized nurses rated care quality and safety and collaboration and interprofessional communication using a 33-item literature-based, anchored checklist (ICC, 0.47–0.52). Standardized patient and SN ratings of the same student performance were correlated (r, 0.37–0.62; P < 0.01). Physicians assessed clinical reasoning quality based on the students’ patient encounter note (ICC, 0.55–0.68), ratings that did not correlate with SP and SN ratings. We compared pre-post clinical skills performance and clinical reasoning. Fifty-two medical students (31%) completed this institutional review board –approved study.

Results

Performance as measured by the SPs, SNs, and the postencounter note all showed improvement with mostly moderate to large effect sizes (range of Cohen’s d, 0.30–1.88; P < 0.05) after completion of the online module. Unexpectedly, professionalism as rated by the SP was poorer after the module (Cohen’s d, −0.93; P = 0.000).

Discussion

A brief computer-based educational intervention significantly improved graduating medical students' clinical skills needed to be ready for residency.
Surgical Simulation Training Reduces Intraoperative Cataract Surgery Complications Among Residents
Authors: Staropoli Patrick C. , Gregori Ninel Z. , Junk Anna K. , Galor Anat , Goldhardt Raquel , Goldhagen Brian E. , Shi Wei , Feuer William
Published: October 2017

Introduction

This retrospective consecutive case series examined whether training on a surgical simulator reduces intraoperative complication rates among novice ophthalmology residents learning cataract surgery.

Methods

Beginning July 2014, training on the Eyesi simulator became mandatory for novice postgraduate year 3 ophthalmology residents before live cataract surgery at our institution. Complication rates of the 11 simulator-trained residents (study group) were compared with their immediate 11 simulator-naive predecessors (comparison group). Only straightforward cataract cases (according to standardized preoperative criteria) where postgraduate year 3 residents served as the primary surgeon were included. Complication data were obtained from Morbidity and Mortality records and compared using Fisher exact test. A survey was administered to the residents to gauge the perceived utility of simulation training.

Results

The simulator-trained group (n = 501 cataract cases) and the simulator-naive comparison group (n = 454 cases) were analyzed. The complication rate in the simulator group was 2.4% compared with 5.1% in the comparison group (P = 0.037, Fisher exact test). Both the mean posterior capsule tear rate and vitreous prolapse rate in the simulator group were 2.2% compared with 4.8% in the comparison group (P = 0.032, Fisher exact test). The survey had a response rate of 100% (11/11), and 91% (10/11) of respondents felt that the training was “extremely worthwhile” and should be mandatory.

Conclusions

The addition of surgical simulation training was associated with a significantly reduced rate of complications, including posterior capsule tears and vitreous prolapse, among novice postgraduate year 3 residents. There is a perceived utility among residents to incorporate virtual simulation into surgical training.
Considering Face, Rights, and Goals
Authors: Loo May Eng , Krishnasamy Charmaine , Lim Wee Shiong
Published: October 2017

Summary Statement

The rapport between facilitators and learners contributes to a conducive learning environment during simulation debriefing, but a theory to guide rapport management (RM) is lacking. The RM model is a potentially relevant conceptual framework because it describes three interrelated components of rapport—face, rights, and goals—which, when threatened, affect the rapport between interactants. This critical review explores how studies in the simulation debriefing literature describing postevent facilitator-guided debriefing approaches can be viewed through the lens of the RM model. All 34 identified studies alluded to at least one component of rapport, with less than half alluding to all three. There is preliminary evidence that the management of all three components of rapport during debriefing may contribute to improving short-term learning outcomes. Future studies could explore how the RM model can be used to guide debriefing approaches in various contexts and clarify why or how these approaches work.
Successful Use of Escitalopram for the Treatment of Visual Hallucinations in Patients With Parkinson Disease
Authors: Bergman Joseph , Lerner Paul P. , Sokolik Shmuel , Lerner Vladimir , Kreinin Anatoly , Miodownik Chanoch
Published: October 2017

Introduction

Patients with Parkinson disease (PD) frequently experience visual hallucinations (VH). Visual hallucinations are most often viewed as an adverse effect of antiparkinsonian treatment. Possible treatments for this disturbance include a reduction of antiparkinsonian medications, adding atypical antipsychotics, or cholinesterase inhibitors. Some studies demonstrated that selective serotonin reuptake inhibitors may be an optional treatment for patients experiencing psychosis or agitation in dementia. Currently, there is no standard recommended treatment for VH in patients with PD. We present here our clinical experience with escitalopram (selective serotonin reuptake inhibitor) for treating this disturbance.

Methods

Thirteen patients with PD (8 men and 5 women; age range 67–83 years) experiencing VH were openly treated with escitalopram 10 or 15 mg/d as add-on. Efficacy was assessed at baseline, then after 4 and 8 weeks of treatment using Clinical Global Impression-Severity and Clinical Global Impression-Improvement.

Results

At the end of the 4th week of treatment, of 13 patients, 11 subjects demonstrated improvement, and in only 2 patients were there no changes in their condition. After an additional 4 weeks, 2 of the responders showed very significant improvement, 6 demonstrated much improvement, and 3 patients demonstrated minimal improvement. Only 1 patient showed no change in his condition. One additional patient stopped taking escitalopram after 5 weeks because of an absence of improvement in his state.

Conclusions

Escitalopram was well tolerated as treatment of VH in PD patients. This medication could be a promising optional therapy for this disturbance; however, further randomized controlled and bigger studies are necessary.
Refractory Giant Cell Arteritis Complicated by Vision Loss From Optic Atrophy and Maculopathy Associated With Pachymeningitis
Authors: Uribe Jorge A. , Aggarwal Ishita , Witthayaweerasak Juthamat , Liao Y. Joyce , Berry Gerald J. , Sab Umesh K. , Weyand Cornelia M.
Published: October 2017

Background:

We describe a 75-year-old woman who experienced vision loss in her left eye due to biopsy-proven giant cell arteritis (GCA). She subsequently developed pachymeningitis causing refractory headaches and bilateral optic neuropathy and maculopathy.

Methods:

Case report with literature review.

Results:

Eighteen months after the initial diagnosis of GCA, imaging studies in our patient demonstrated pachymeningeal enhancement, and meningeal biopsy confirmed lymphoplasmacytic tissue infiltrates with low frequencies of IgG4+ plasma cells. Laboratory investigation revealed the presence of 3 antiretinal antibodies and antimyeloperoxidase antibodies, consistent with autoimmune retinopathy. Treatment with B-cell–depleting anti-CD20 antibodies suppressed meningeal inflammation and prevented further vision loss.

Conclusions:

This case illustrates that bilateral vision loss and chronic headaches in patients with GCA may result from retina-directed autoimmunity and pachymeningitis.
How the human brain introspects about one’s own episodes of cognitive control
Authors: Soto David , Theodoraki Mona , Paz-Alonso Pedro M.
Published: October 2017

Metacognition refers to our capacity to reflect upon our experiences, thoughts and actions. Metacognition processes are linked to cognitive control functions that allow keeping our actions on-task. But it is unclear how the human brain builds an internal model of one’s cognition and behaviour. We conducted 2 fMRI experiments in which brain activity was recorded ‘online’ as participants engaged in a memory-guided search task and then later ‘offline’ when participants introspected about their prior experience and cognitive states during performance. In Experiment 1 the memory cues were task-relevant while in Experiment 2 they were irrelevant. Across Experiments, the patterns of brain activity, including frontoparietal regions, were similar during on-task and introspection states. However the connectivity profile amongst frontoparietal areas was distint during introspection and modulated by the relevance of the memory cues. Introspection was also characterized by increased temporal correlation between the default-mode network (DMN), frontoparietal and dorsal attention networks and visual cortex. We suggest that memories of one’s own experience during task performance are encoded in large-scale patterns of brain activity and that coupling between DMN and frontoparietal control networks may be crucial to build an internal model of one’s behavioural performance.
Membrane Diffusion Occurs by a Continuous-Time Random Walk Sustained by Vesicular Trafficking
Authors: Goiko Maria , de Bruyn John R. , Heit Bryan
Published: October 2017

Diffusion in cellular membranes is regulated by processes which occur over a range of spatial and temporal scales. These processes include membrane fluidity, inter-protein and inter-lipid interactions, interactions with membrane microdomains, interactions with the underlying cytoskeleton, and cellular processes which result in net membrane movement. The complex, non-Brownian diffusion that results from these processes has been difficult to characterize, and moreover, the impact of factors such as membrane recycling on membrane diffusion remains largely unexplored. We have used a careful statistical analysis of single-particle tracking data of the single-pass plasma membrane protein CD93 to show that the diffusion of this protein is well-described by a continuous-time random walk in parallel with an aging process mediated by membrane corrals. The overall result is an evolution in the diffusion of CD93: proteins initially diffuse freely on the cell surface, but over time, become increasingly trapped within diffusion-limiting membrane corrals. Stable populations of freely diffusing and corralled CD93 are maintained by an endocytic/exocytic process in which corralled CD93 is selectively endocytosed, while freely diffusing CD93 is replenished by exocytosis of newly synthesized and recycled CD93. This trafficking not only maintained CD93 diffusivity, but also maintained the heterogeneous distribution of CD93 in the plasma membrane. These results provide insight into the nature of the biological and biophysical processes that can lead to significantly non-Brownian diffusion of membrane proteins, and demonstrate that ongoing membrane recycling is critical to maintaining steady-state diffusion and distribution of proteins in the plasma membrane.
Molecular basis of CENP-C association with the CENP-A nucleosome at yeast centromeres
Authors: Xiao Hua , Wang Feng , Wisniewski Jan , Shaytan Alexey K. , Ghirlando Rodolfo , FitzGerald Peter C. , Huang Yingzi , Wei Debbie , Li Shipeng , Landsman David , Panchenko Anna R. , Wu Carl
Published: October 2017

Histone CENP-A-containing nucleosomes play an important role in nucleating kinetochores at centromeres for chromosome segregation. However, the molecular mechanisms by which CENP-A nucleosomes engage with kinetochore proteins are not well understood. Here, we report the finding of a new function for the budding yeast Cse4/CENP-A histone-fold domain interacting with inner kinetochore protein Mif2/CENP-C. Strikingly, we also discovered that AT-rich centromere DNA has an important role for Mif2 recruitment. Mif2 contacts one side of the nucleosome dyad, engaging with both Cse4 residues and AT-rich nucleosomal DNA. Both interactions are directed by a contiguous DNA- and histone-binding domain (DHBD) harboring the conserved CENP-C motif, an AT hook, and RK clusters (clusters enriched for arginine–lysine residues). Human CENP-C has two related DHBDs that bind preferentially to DNA sequences of higher AT content. Our findings suggest that a DNA composition-based mechanism together with residues characteristic for the CENP-A histone variant contribute to the specification of centromere identity.
The crystal structure of theYersinia pestisiron chaperone YiuA reveals a basic triad binding motif for the chelated metal
Authors: Radka Christopher D. , Chen Dongquan , DeLucas Lawrence J. , Aller Stephen G.
Published: October 2017

Biological chelating molecules called siderophores are used to sequester iron and maintain its ferric state. Bacterial substrate-binding proteins (SBPs) bind iron–siderophore complexes and deliver these complexes to ATP-binding cassette (ABC) transporters for import into the cytoplasm, where the iron can be transferred from the siderophore to catalytic enzymes. InYersinia pestis, the causative agent of plague, theYersiniairon-uptake (Yiu) ABC transporter has been shown to improve iron acquisition under iron-chelated conditions. The Yiu transporter has been proposed to be an iron–siderophore transporter; however, the precise siderophore substrate is unknown. Therefore, the precise role of the Yiu transporter inY. pestissurvival remains uncharacterized. To better understand the function of the Yiu transporter, the crystal structure of YiuA (YPO1310/y2875), an SBP which functions to present the iron–siderophore substrate to the transporter for import into the cytoplasm, was determined. The 2.20 and 1.77 Å resolution X-ray crystal structures reveal a basic triad binding motif at the YiuA canonical substrate-binding site, indicative of a metal-chelate binding site. Structural alignment and computational docking studies support the function of YiuA in binding chelated metal. Additionally, YiuA contains two mobile helices, helix 5 and helix 10, that undergo 2–3 Å shifts across crystal forms and demonstrate structural breathing of the c-clamp architecture. The flexibility in both c-clamp lobes suggest that YiuA substrate transfer resembles the Venus flytrap mechanism that has been proposed for other SBPs.
Military leadership development strategies: implications for training in non-military organizations
Authors: Kirchner Michael , Akdere Mesut
Published: October 2017

Purpose

The purpose of this paper is to explore how branches of the USA military conduct leadership development of their members to build on existing knowledge of effective approaches. The military, often credited for its ability to develop leadership competencies, has been overlooked and offers a new context for consideration in training. Training strategies presented may offer organization leaders new insight into enhancing current leadership development programs.

Design/methodology/approach

A review of accessible military doctrine in recent decades was conducted to determine leadership development methodology for possible transferability into industry.

Findings

The military’s diverse perspectives on service member leadership development offered insightful methods for application in commercial training. Four development strategies were identified and are discussed.

Research limitations/implications

The purpose of the military is unique from non-military organizations and, as such, each of the leadership development training approaches may not be applicable or feasible for traditional employees. Further exploration of leadership development in the US military is required to better understand the impact of the training.

Originality/value

A review of existing literature revealed little evidence of examining the military’s approach to developing leaders, even though employers claim to hire veterans because of their leadership abilities. Each of the identified development components are distinguishable from traditional leadership programs and present readers a series of opportunities to consider.
Measuring flood resilience: a fuzzy logic approach
Authors: Oladokun Victor Oluwasina , Proverbs David G. , Lamond Jessica
Published: October 2017

Purpose

Flood resilience is emerging as a major component of an integrated strategic approach to flood risk management. This approach recognizes that some flooding is inevitable and aligns with the concept of “living with water.” Resilience measurement is a key in making business case for investments in resilient retrofits/adaptations, and could potentially be used to inform the design of new developments in flood prone areas. The literature is, however, sparse on frameworks for measuring flood resilience. The purpose of this paper is to describe the development of a fuzzy logic (FL)-based resilience measuring model, drawing on a synthesis of extant flood resilience and FL literature.

Design/methodology/approach

An abstraction of the flood resilience system followed by identification and characterization of systems’ variables and parameters were carried out. The resulting model was transformed into a fuzzy inference system (FIS) using three input factors: inherent resilience, supportive facilities (SF) and resident capacity.

Findings

The resulting FIS generates resilience index for households with a wide range of techno-economic and socio-environmental features.

Originality/value

It is concluded that the FL-based model provides a veritable tool for the measurement of flood resilience at the level of the individual property, and with the potential to be further developed for larger scale applications, i.e. at the community or regional levels.
Freedom, competition and bank efficiency in Sub-Saharan Africa
Authors: Sarpong-Kumankoma Emmanuel , Abor Joshua , Aboagye Anthony Q.Q. , Amidu Mohammed
Published: October 2017

Purpose

This study aims to consider the effect of financial (banking) freedom and competition on bank efficiency.

Design/methodology/approach

With data from 11 Sub-Saharan African countries over the period 2006-2012, the study estimates both competition (market power) and bank cost efficiency using the same stochastic frontier framework. Subsequently, Tobit models, including instrumental variable Tobit regression, are used to assess how financial freedom affects the relationship between competition and bank efficiency.

Findings

The results show that increase in market power (less competition) leads to greater bank cost efficiency, but the effect is weaker with higher levels of financial freedom. This is not consistent with the quiet life hypothesis.

Practical implications

Policymakers usually take the view that opening up banking markets to greater competition may lead to higher efficiency. However, the results have shown that allowing banks to maintain some level of market power may be necessary to ensure banking system efficiency.

Originality/value

This study deepens the understanding of the inconsistent relationship between competition and bank efficiency, by using the same framework to measure both competition and efficiency, and by providing new empirical evidence on how the level of financial freedom affects this relationship.
Workplace energy conservation at Michigan State University
Authors: Allen Summer , Marquart-Pyatt Sandra T.
Published: October 2017

Purpose

This research contributes to the literature on workplace energy conservation by examining the predictors of individual employee behaviors and policy support in a university. The purpose of this research is to better understand what factors influence energy conservation behaviors in this setting to inform programs and interventions.

Design/methodology/approach

This project gathered survey data from employee-occupants of three campus buildings. Ordinary least squares regression analyses were used to investigate the theory of planned behavior (TPB) and attitudes-behavior-constraints (ABC) models examining what drives energy behaviors.

Findings

This study finds a large proportion of respondents would support energy use reduction policies, more technology-based interventions and increased use of renewable sources. Respondents report positive attitudes toward individual energy conservation behavior but mild agreement with the influence of social norms. Self-efficacy reports also are positive. Although the TPB model is not fully supported in this group, the ABC model appears to perform well.

Originality/value

In addition to adding to the relatively limited data on employee energy-saving behaviors in the university workplace, this study provides initial evidence that the ABC model is pertinent to this behavioral context. It also provides specific, usable data about policies and actions that campus community members might deem feasible and acceptable to relevant university offices.
Variation of greenness across China’s universities: motivations and resources
Authors: Zhao Wanxia , Zou Yonghua
Published: October 2017

Purpose

This study aims to examine the cross-institutional variation in university greenness and analyze its underlying dynamics.

Design/methodology/approach

This study constructs a University Greenness Index (UGI) and conducts multivariate regression.

Findings

This study finds variation within two dimensions; in the vertical dimension, top-tier universities have significantly higher UGIs than tier-2 universities, and in the horizontal dimension, agricultural and forest, engineering and technology and generalist universities have significantly higher UGIs than other specialist universities. The dynamics underlying the greenness variation lies in different universities’ motivations and resources, which are associated with China’s higher education administrative system, especially the mechanism by which funding is allocated.

Research limitations/implications

The Internet-search-based greenness index has some inherent limitations. First, there exists a gap between green information expression and real green achievement. Second, this research may be difficult to apply to other countries, because of the specific characteristics of China’s higher education system.

Practical implications

Based on the empirical results, two policy implications can be generated. First, for the problem of the vertical dimension variation, related institutional transformation should be launched to promote university greenness. Second, for the problem of the horizon dimension variation, specialist universities can take advantage of an interdisciplinary approach to promote greenness.

Originality/value

This research helps scholars and administrators to better understand the progress being made and the achievements realized with regard to green university initiatives in China.
Analyzing the response to epidemics: concept of evidence-based Haddon matrix
Authors: Anparasan Azrah , Lejeune Miguel
Published: October 2017

Purpose

The purpose of this paper is to propose a novel evidence-based Haddon matrix that identifies intervention options for organizations and governments responding to an epidemic in a developing economy.

Design/methodology/approach

A literature review of articles published within a year of the cholera outbreak in Haiti. Two separate types of literature sources are used – academic and non-academic – to apprehend the value and role of interventions implemented and/or identified.

Findings

The Haddon matrix helps break down the challenges involved in the containment of an epidemic into smaller, manageable components. This research shows that the matrix enables visualization of past evidence, help dissect various informational sources, and increase collaboration across humanitarian organizations. It will also serve as a building block for academics to identify new research directions to respond to epidemic outbreaks.

Research limitations/implications

The analysis focuses on the cholera epidemic in Haiti. Future work will be directed to generalize the identified recommendations and insights to a broader context.

Originality/value

This paper presents an evidence-based Haddon matrix that infers recommendations and insights based on past evidence for each phase (pre-event, response, and post-event) and factor (agent, host, physical environment, and socio-cultural environment) of an epidemic and for various stakeholders (humanitarian organizations, governments, and academics). The matrix provides a structured framework to identify interventions and best practices to address challenges during an epidemic outbreak.