bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanistic Insights of an Immunological Adverse Event Induced by an Anti-KIT Antibody Drug Conjugate and Mitigation Strategies
Authors: L'Italien Lawrence , Orozco Olivia , Abrams Tinya , Cantagallo Lisa , Connor Anu , Desai Jayesh , Ebersbach Hilmar , Gelderblom Hans , Hoffmaster Keith , Lees Emma , Maacke Heiko , Schleyer Siew , Skegro Darko , Lee-Hoeflich Si Tuen
Published: April 2018

Purpose: Hypersensitivity reactions (HSRs) were observed in three patients dosed in a phase I clinical trial treated with LOP628, a KIT targeted antibody drug conjugate. Mast cell degranulation was implicated as the root cause for the HSR. Underlying mechanism of this reported HSR was investigated with an aim to identifying potential mitigation strategies.

Experimental Design: Biomarkers for mast cell degranulation were evaluated in patient samples and in human peripheral blood cell-derived mast cell (PBC-MC) cultures treated with LOP628. Mitigation strategies interrogated include pretreatment of mast cells with small molecule inhibitors that target KIT or signaling pathways downstream of FcϵR1, FcγR, and treatment with Fc silencing antibody formats.

Results: Transient elevation of serum tryptase was observed in patients 1-hour posttreatment of LOP628. In agreement with the clinical observation, LOP628 and its parental antibody LMJ729 induced degranulation of human PBC-MCs. Unexpectedly, KIT small molecule inhibitors did not abrogate mast cell degranulation. By contrast, small molecule inhibitors that targeted pathways downstream of Fc receptors blunted degranulation. Furthermore, interference of the KIT antibody to engage Fc receptors by pre-incubation with IgG or using engineered Fc silencing mutations reduced or prevented degranulation. Characterization of Fcγ receptors revealed human PBC-MCs expressed both FcγRII and low levels of FcγRI. Interestingly, increasing the level of FcγRI upon addition of IFNγ, significantly enhanced LOP628-mediated mast cell degranulation.

Conclusions: Our data suggest LOP628-mediated mast cell degranulation is the likely cause of HSR observed in the clinic due to co-engagement of the FcγR and KIT, resulting in mast cell activation. Clin Cancer Res; 24(14); 3465–74. ©2018 AACR.
Precursor T-Lymphoblastic Lymphoma Associated with t(8;9)(p11.2;q33): A Case Report and Review of the Literature
Authors: Lv Hui , Hu Shaoyan , Lu Jun , Zhai Qin , Zhai Zong , Du Zhizhuo , Sun Yina , Li Jie , He Hailong , Wang Yi
Published: April 2018

The 8p11 myeloproliferative syndrome (EMS) is an aggressive neoplasm associated with chromosomal translocations involving the fibroblast growth factor receptor 1 (FGFR1) tyrosine kinase gene on chromosome 8p11-12. A new case of a 9-year-old boy with leukocytosis, eosinophilia, and general lymphadenopathy is reported in this study. Bone marrow examination showed eosinophilic hyperplasia, with blast cells amounting to 6-7%. Karyotyping revealed cytogenetic abnormalities, including t(8;9)(p11.2;q3?3). Fluorescence in situ hybridization for the FGFR1 gene rearrangement yielded positive results. Lymph node biopsy confirmed the diagnosis of precursor T-lymphoblastic lymphoma. The patient responded to chemotherapy, and unmatched related bone marrow transplantation was performed. A successful outcome was obtained with complete cytogenetic remission maintained for 14 months to date. In the future, FGFR1 inhibitors might be specific and effective therapeutic targets for EMS. Similar cases from the literature are reviewed.
Quality of Reporting in Upper Gastrointestinal Endoscopy: Effect of a Simple Audit Intervention
Authors: Lisboa-Gonçalves Pedro , Libânio Diogo , Marques-Antunes Joana , Dinis-Ribeiro Mário , Pimentel-Nunes Pedro
Published: April 2018

Background and Aim: In contrast to colonoscopy, there are few studies regarding upper gastrointestinal (UGI) endoscopy reporting its quality and ways of improving it. Quality audits are recommended, but their influence on the abovementioned quality is not well studied. Our aim was to evaluate the quality of UGI endoscopy reports and assess the effect of a simple audit intervention on UGI endoscopy reporting quality. Methods: This was a prospective study in a tertiary referral center, including the evaluation of 1,000 consecutive reports of UGI endoscopies before an audit intervention and 250 after. The reports were analyzed according to performance measures defined by three experienced gastroenterologists. Results: Before the intervention, 51.8% of the incomplete endoscopies did not present any justification for its incompleteness and 88.1% of lesions were correctly described. Overall, 64.1% of the reports were considered as being of high quality. After the audit intervention, follow-up recommendation (53.4 vs. 80.8%, p = 0.001), correct lesion description (88.1 vs. 95.8%, p = 0.001), and correct segment description (92.2 vs. 96.4%, p = 0.020) improved significantly. The rate of unjustified incomplete endoscopies decreased significantly (51.8 vs. 28.9%, p = 0.010). The high-quality endoscopy rate improved 13.9% after the intervention (p < 0.001). Both specialists and residents improved with the audit intervention with a similar percentage of improvement in the high-quality endoscopy rate (13.9 vs. 13.4%). Conclusions: A simple audit intervention is a good way to improve the quality of reporting of UGI endoscopy, independently of degree and experience. Some of the performance measure accomplishments may depend on the software used by the endoscopy centers and it should be a priority to optimize it.
Microscopic sperm head damage and abnormalities as heat stress indicators in Australian Merino rams (Ovis aries) in Northern Patagonia, Argentina
Authors: López Armengol María Fernanda , Rubio Natalia , Sabino Guillermo Ariel , Bérgamo Nadia Soledad , Pelufo Valeria
Published: April 2018

In Northern Patagonia, the mating season starts on March 15th, when rams are submitted to summer temperatures. Exposure of rams to heat stress increases the prevalence of microscopic damage to spermatozoa, morphological abnormalities, and reductions in fertility. This study assesses the adaptive capabilities of six unshorn and six shorn Australian Merino rams, half of which were treated in a heat chamber for eight hours for five days, gradually reaching a temperature of up to 40 °C. Microscopic damage, abnormalities and ultramicroscopic alterations of the plasma membrane and the acrosome of sperm head were analysed. There were significant differences in the percentage of tailless spermatozoa and proximal cytoplasmic droplets between post-treatment periods. Temperature primarily affected the shorn rams and the sperm heads during spermiogenesis. Submicroscopic alterations were observed when the plasma membrane was present in the anterior segment. These alterations can be intact, waved, or dilated. When the plasma membrane was absent, the acrosome might be intact, dilated, and waved. In addition, the outer acrosomal membrane may completely lose its contents or have a nude nucleus. The plasma membrane assumes a waved shape as a result of the effect of temperature on the epididymis. According to this study, the tailless head, proximal cytoplasmic droplets, and the ultramicroscopic categories studied were robust indicators of semen heat stress. After ten weeks, the sperm head recovered its normal shape. Unshorn rams are better adapted to summer heat stress than shorn ones. Microscopy and transmission electron microscopy alterations have been shown to be excellent indicators of thermal stress in Australian Merino rams and may be useful tools to help sheep farmers choose when to begin the mating season, which will vary depending on the environmental conditions of the summer.
Hobbes and the Hardwick Digests
Authors: Raylor Timothy
Published: April 2018

Three student digests of uncertain origin have been identified among the Hobbes manuscripts now at Chatsworth. This article describes the physical composition and contents of the manuscripts, identifies their textual sources, adds two previously unnoticed digests to the gathering, and offers some suggestions about their character, likely dates, and provenance.
Defining and assessing the transformational nature of smart city governance: insights from four European cases
Authors: Nesti Giorgia
Published: April 2018

Smart cities are a new approach to urban development based on the extensive use of information and communication technologies and on the promotion of environmental sustainability, economic development and innovation. The article is aimed at discussing whether the adoption of a smart city approach entails the transformation of existing institutional structures and administrative practices. To this end, four cases of European smart cities are analysed: Amsterdam, Barcelona, Turin and Vienna. The article describes their models of governance, investigates the level of transformation that occurred in their governmental structures, outlines the main drawbacks and identifies possible connections with the emergent paradigm of the New Public Governance.
Oil Wealth, Winning Coalitions, and Duration of Civil Wars
Authors: Wiegand Krista , Keels Eric
Published: April 2018

New research has begun to underscore the complicated relationship between democratic institutions and the duration of civil wars. Specifically, greater constraints placed on executives often lead to considerably longer civil wars as leaders are limited in how they bargain with dissidents. This presents a puzzle as democracies are often seen as credible negotiators in international disputes. This article suggests that the size of the government’s winning coalition represents a double-edged sword. Larger winning coalitions allow governments to bargain more credibly but also place constraints on what governments can offer since peace agreements may alienate coalition members. Fortunately, future access to postwar oil wealth provides the feasibility for the governments to compensate hard-liners who may lose out on any settlement, making them more likely to allow concessions to rebels. This combined credibility of large winning coalitions and the feasibility provided by oil wealth allows for peace agreements, therefore shortening the duration of civil wars. We test these propositions by examining the conditional relationship between oil wealth and coalition size on the duration of all civil wars between 1950 and 2009.
Cultures of Cosmopolitanism
Authors: Szerszynskiand Bronislaw , Urry John
Published: April 2018

This paper is concerned with whether a ‘culture of cosmopolitanism’ is currently emerging out of massively wide-ranging ‘global’ processes. The authors develop certain theoretical components of such a culture, they consider ongoing research concerned with belongingness to different geographical entities including the ‘world as a whole’, and they present their own empirical research findings. From their media research they show that there is something that could be called a ‘banal globalism’, from focus group research they show that there is a wide awareness of the ‘global’ but that this is combined in complex ways with notions of the local and grounded, and from media interviews they demonstrate that there is a reflexive awareness of a culture of the cosmopolitan. On the basis of their data from the UK, they conclude that a ‘publicly screened’ cosmopolitan culture is emergent and likely to orchestrate much of social and political life in future decades.

The need for a constantly changing market chases the bourgeoisie over the whole surface of the globe. It must settle everywhere, establish connexions everywhere … the bourgeoisie has through its exploitation of the world market give a cosmopolitan character to production and consumption in every country … The individual creations of individual nations become common property. National one-sidedness and narrow-mindedness become more and more impossible (Marx and Engels, [1848] 1952: 46–7; emphasis added)
Daughters’ and Sons’ Remittances in Rural China: Findings From a National Survey
Authors: Gruijters Rob J.
Published: April 2018

In China, it has historically been the responsibility of sons rather than daughters to provide economic support to older parents. This study used a sample of 12,389 non-coresident children to analyze whether such gender differences persist in contemporary rural China and how they can be explained. A two-part model showed that daughters were somewhat more likely to remit to parents, although sons provided higher amounts. The support of parents by both daughters and sons was found to be strongly related to out-migration and the receipt of grandchild care, but the negative effect of marriage was stronger for daughters. These findings imply a weakening of the traditional gendered division of intergenerational support. The increased importance of daughters as a source of economic security in later life is likely to reduce parents’ preference for sons.
Comparability of students’ writing performance on TOEFL iBT and in required university writing courses
Authors: Llosa Lorena , Malone Margaret E.
Published: April 2018

Investigating the comparability of students’ performance on TOEFL writing tasks and actual academic writing tasks is essential to provide backing for the extrapolation inference in the TOEFL validity argument (Chapelle, Enright, & Jamieson, 2008). This study compared 103 international non-native-English-speaking undergraduate students’ performance on two TOEFL iBT® writing tasks with their performance in required writing courses in US universities as measured by instructors’ ratings of student proficiency, instructor-assigned grades on two course assignments, and five dimensions of writing quality of the first and final drafts of those course assignments: grammatical, cohesive, rhetorical, sociopragmatic, and content control. Also, the quality of the writing on the TOEFL writing tasks was compared with the first and final drafts of responses to written course assignments using a common analytic rubric along the five dimensions. Correlations of scores from TOEFL tasks (Independent, Integrated, and the total Writing section) with instructor ratings of students’ overall English proficiency and writing proficiency were moderate and significant. However, only scores on the Integrated task and the Writing section were correlated with instructor-assigned grades on course assignments. Correlations between scores on TOEFL tasks and all dimensions of writing quality were positive and significant, though of lower magnitude for final drafts than for first drafts. The TOEFL scores were most highly correlated with cohesive and grammatical control and had the lowest correlations with rhetorical organization. The quality of the writing on the TOEFL tasks was comparable to that of the first drafts of course assignment but not the final drafts. These findings provide backing for the extrapolation inference, suggesting that the construct of academic writing proficiency as assessed by TOEFL “accounts for the quality of linguistic performance in English-medium institutions of higher education” (Chapelle, Enright, & Jamieson, 2008, p. 21).
Alternative Forms of Energy Production and Political Reconfigurations: Exploring Alternative Energies as Potentialities of Collective Reorganization
Authors: Rumpala Yannick
Published: April 2018

To a large extent and one that is highly structuring, energy choices that are made in a society are political choices. This article aims at studying how these choices can be redirected by technological developments associated with renewable energy, thus contributing to a redistribution of opportunities and correspondingly to social reorganizations. In order to show that the development of alternative energies not only depends on technological advances but can also, in the process, reveal political potentialities, three steps are proposed. The first step will clarify the theoretical arguments in favor of an approach in terms of “technological potentialism.” Second, we will extend this approach by identifying a set of potentialities linked with renewable energies and the model that could arise from these alternative forms or approaches. Finally, we will examine how these potentialities could find paths to become effective.
Physician-Specific Maximum Acceptable Risk in Personalized Medicine: Implications for Medical Decision Making
Authors: Boeri Marco , McMichael Alan J. , Kane Joseph P. M. , O’Neill Francis A. , Kee Frank
Published: April 2018

Background. In discrete-choice experiments (DCEs), respondents are presented with a series of scenarios and asked to select their preferred choice. In clinical decision making, DCEs allow one to calculate the maximum acceptable risk (MAR) that a respondent is willing to accept for a one-unit increase in treatment efficacy. Most published studies report the average MAR for the whole sample, without conveying any information about heterogeneity. For a sample of psychiatrists prescribing drugs for a series of hypothetical patients with schizophrenia, this article demonstrates how heterogeneity accounted for in the DCE modeling can be incorporated in the derivation of the MAR. Methods. Psychiatrists were given information about a group of patients’ responses to treatment on the Positive and Negative Syndrome Scale (PANSS) and the weight gain associated with the treatment observed in a series of 26 vignettes. We estimated a random parameters logit (RPL) model with treatment choice as the dependent variable. Results. Results from the RPL were used to compute the MAR for the overall sample. This was found to be equal to 4%, implying that, overall, psychiatrists were willing to accept a 4% increase in the risk of an adverse event to obtain a one-unit improvement of symptoms – measured on the PANSS. Heterogeneity was then incorporated in the MAR calculation, finding that MARs ranged between 0.5 and 9.5 across the sample of psychiatrists. Limitations. We provided psychiatrists with hypothetical scenarios, and their MAR may change when making decisions for actual patients. Conclusions. This analysis aimed to show how it is possible to calculate physician-specific MARs and to discuss how MAR heterogeneity could have implications for medical practice.
Major Factors of Homologous Blood Transfusion in Valvular Heart Operation with Intraoperative Autologous Blood Predonation in Cases with Difficulty in Preoperative Predonation
Authors: Sato Koichi , Namura Osamu , Hanzawa Kazuhiko , Kikuchi Chizuo , Takekubo Masaru , Asami Fuyuki , Wakabayashi Takashi , Saito Takeshi , Homma Takayuki , Baba Hiroshi , Hayashi Jun-Ichi
Published: April 2018

Intraoperative autologous blood predonation is reported to be useful for the prevention of homologous blood transfusion in cardiac operations, especially in on-pump coronary artery bypass grafting (CABG). However, CABG is now performed more often off-pump than on-pump. We analyzed the major factors of homologous blood transfusion in 25 consecutive cases of valvular heart operation with intraoperative autologous blood predonation except those with preoperative autologous blood donation. Homologous blood was not transfused in 18 cases, but was in 7 cases only after cardiopulmonary bypass (CPB). The homologous transfusion was not correlated with body weight, CPB dilution or duration, or preoperative hematocrit level, but was found to correlate with age (R2=0.289, p=0.0413), bleeding output (R2=0.197, p=0.0485), and predonation blood volume (R2=0.436, p=0.0152). In conclusion, suitable intraoperative predonation may reduce the necessity for homologous blood transfusion in valvular heart operations.
Comparative Study of Different Techniques for the Sterilization of Poly-L-lactide Electrospun Microfibers: Effectiveness vs. Material Degradation
Authors: Rainer Alberto , Centola Matteo , Spadaccio Cristiano , Gherardi Giovanni , Genovese Jorge A. , Licoccia Silvia , Trombetta Marcella
Published: April 2018

Electrospinning of biopolymeric scaffolds is a new and effective approach for creating replacement tissues to repair defects and/or damaged tissues with direct clinical application. However, many hurdles and technical concerns regarding biological issues, such as cell retention and the ability to grow, still need to be overcome to gain full access to the clinical arena. Interaction with the host human tissues, immunogenicity, pathogen transmission as well as production costs, technical expertise, and good manufacturing and laboratory practice requirements call for careful consideration when aiming at the production of a material that is available off-the-shelf, to be used immediately in operative settings. The issue of sterilization is one of the most important steps for the clinical application of these scaffolds. Nevertheless, relatively few studies have been performed to systematically investigate how sterilization treatments may affect the properties of electrospun polymers for tissue engineering. This paper presents the results of a comparative study of different sterilization techniques applied to an electrospun poly-L-lactide scaffold: soaking in absolute ethanol, dry oven and autoclave treatments, UV irradiation, and hydrogen peroxide gas plasma treatment. Morphological and chemical characterization was coupled with microbiological sterility assay to validate the examined sterilization techniques in terms of effectiveness and modifications to the scaffold.

The results of this study reveal that UV irradiation and hydrogen peroxide gas plasma are the most effective sterilization techniques, as they ensure sterility of the electrospun scaffolds without affecting their chemical and morphological features.
Negative Dialysate to Sodium Gradient Does not Lead to Intracellular Volume Expansion Post Hemodialysis
Authors: Davenport Andrew
Published: April 2018

Introduction

Intradialytic hypotension remains the most common complication of routine outpatient hemodialysis treatments. There is debate as to the optimum dialysate sodium concentration, with hypotonic dialysates potentially causing intracellular swelling and hypertonic ones intracellular dehydration.

Methods

Multi-frequency bioimpedance was used to assess extracellular and intracellular fluid volumes in 53 adult hemodialysis patients. Dialysate sodium was checked by ion electrophoresis.

Results

The mean decrease in extracellular volume and intracellular volumes were 1.01 ±0.09 and 0.88 ±0.18 kg, respectively. The median dialysate to sodium gradient was −3 mmol/L (−1 to −6), with a median dialysate sodium of 136 mmol/L (136–138). There was no association between changes in body fluid composition and sodium concentrations, or gradients. The mean difference between dialysate sodium prescribed and delivered was 2.4 ±0.8 mmol/L.

Conclusions

In this study we were unable to demonstrate a relationship between predialysis serum sodium and the dialysate sodium prescribed and changes in extracellular or intracellular fluid volumes. However this study showed that using a negative sodium gradient, patients can be successfully ultrafiltrated without setting up intracompartmental fluid gradients. The caveat is that the prescribed dialysate to serum sodium gradient may differ from the actual gradient.
Fabrication of Custom-Shaped Grafts for Cartilage Regeneration
Authors: Koo Seungbum , Hargreaves Brian A. , Gold Garry E. , Dragoo Jason L.
Published: April 2018

Purpose

to create a custom-shaped graft through 3D tissue shape reconstruction and rapid-prototype molding methods using MRI data, and to test the accuracy of the custom-shaped graft against the original anatomical defect.

Methods

An iatrogenic defect on the distal femur was identified with a 1.5 Tesla MRI and its shape was reconstructed into a three-dimensional (3D) computer model by processing the 3D MRI data. First, the accuracy of the MRI-derived 3D model was tested against a laser-scan based 3D model of the defect. A custom-shaped polyurethane graft was fabricated from the laser-scan based 3D model by creating custom molds through computer aided design and rapid-prototyping methods. The polyurethane tissue was laser-scanned again to calculate the accuracy of this process compared to the original defect.

Results

The volumes of the defect models from MRI and laser-scan were 537 mm3 and 405 mm3, respectively, implying that the MRI model was 33% larger than the laser-scan model. The average (±SD) distance deviation of the exterior surface of the MRI model from the laser-scan model was 0.4±0.4 mm. The custom-shaped tissue created from the molds was qualitatively very similar to the original shape of the defect. The volume of the custom-shaped cartilage tissue was 463 mm3 which was 15% larger than the laser-scan model. The average (±SD) distance deviation between the two models was 0.04±0.19 mm.

Conclusions

This investigation proves the concept that custom-shaped engineered grafts can be fabricated from standard sequence 3-D MRI data with the use of CAD and rapid-prototyping technology. The accuracy of this technology may help solve the interfacial problem between native cartilage and graft, if the grafts are custom made for the specific defect. The major source of error in fabricating a 3D custom-shaped cartilage graft appears to be the accuracy of a MRI data itself; however, the precision of the model is expected to increase by the utilization of advanced MR sequences with higher magnet strengths.
Effects of Leukocyte Depletion on Cardiopulmonary Protection and Inflammation after Valve Surgery
Authors: Zhang Xiaohua , Zhou Chengbin , Zhuang Jian , Xiao Xuejun , Zheng Shaoyi , Xiong Weiping , Wang Wenxian , Wu Ruobin
Published: April 2018

Background

To evaluate the effects of leukocyte-depleting filtration on myocardial and pulmonary protection and the inflammatory response in patients undergoing valve surgery.

Methods

Fifty-two patients who underwent mitral valve or mitral and aortic valve replacement were randomized into two groups with or without a leukocyte-depleting filter during surgery. The filter was used from 10 minutes before the release of the aortic cross-clamp to the end of cardiopulmonary bypass.

Results

Total leukocyte and neutrophil counts showed a short-term reduction in patients undergoing leukocyte filtration, but there was no significant difference between the two groups during the study. Serum levels of cardiac troponin I were lower than that of the control group (p=0.030). Leukocyte depletion resulted in a significantly higher oxygenation index (p=0.002) and a lower respiratory index (p=0.003) compared with the control group. Serum levels of interleukin-8 were significantly elevated in patients undergoing leukocyte filtration compared with patients without leukocyte filtration (p=0.001). There were no statistically significant differences between the two groups with regards to the concentration of interleukin-6 and TNFα, or the duration of intensive care and hospital stay.

Conclusions

Leukocyte depletion is associated with improved myocardial and lung protection but does not appear to attenuate the inflammatory response in valve surgery.
Preoperative Candidate Evaluations for Retinal Prosthesis Trials
Authors: Xia Yu , Ren Qiushi
Published: April 2018

With the development of retinal prostheses, the first clinical trials for these devices are being planned or are already underway. Yet the candidate selection criteria and the preparation of early recipients have received very little attention. As clinical trials grow in scope, the need for such issues will become increasingly important. Especially in preliminary stages of clinical trials, it is absolutely vital to develop the preoperative evaluations of candidates in identifying the suitable candidate for retinal prosthesis implants. This paper addresses the preoperative evaluations of candidates that may provide insight into selecting potential candidates for retinal prosthetic devices. Screening an ideal candidate is complex and, at the minimum, should include medical evaluations, visual function tests, assessments of psychological status, motivation, expectations, as well as rehabilitation capabilities. This will ensure that appropriate candidates are selected, candidate expectations are managed, and success with the retinal prosthetic devices is maximized.
Numerical Simulation and Experimental Validation of Swirling Flow in Spiral Vortex Ventricular Assist Device
Authors: Wong Kelvin Kian Loong , Cheung Sherman Chi Pok , Yang William , Tu Jiyuan
Published: April 2018

Spiral Vortex Ventricular Assist Device (SV-VAD) supports cardiac patients with refractory heart failure. Unfortunately, thrombus formation and risk of stroke due to flow complications may lead to aggravated conditions. The hemodynamics of a continuous flow in the ventricular chamber of a SV-VAD can be analyzed using numerical simulation. Particle image velocimetry and laser Doppler anemometry are utilized for validating the simulated spiral flow in a transparent acrylic SV-VAD replica based on its cross-sectional averaged axial and tangential velocities. After validation, the relationship between swirling flow and blood cell damage is established by evaluating flow effect on thrombosis due to high shear stress. Based on our analysis, stagnancy of the flow within the SV-VAD is insignificant and its low shear stress minimizes hemolysis.
In Vitro Evaluation of Hydraulic Characteristics of Prototype Implantable Intrathecal Infusion Pump
Authors: Nam Kyoung Won , Sung Mun Hyun , Ho Kim Hyun , Gi Kim Kwang , Kim Dae Hyun , Lee Byeong Han , Jo Yung Ho
Published: April 2018

The use of the intrathecal infusion pump for therapeutic treatment and pain management is increasing. For example, one such application is the pain treatment of cancer patients suffering from severe chronic pain, where all other treatment methods have failed. This method is gaining popularity because of its high cure effect with low dosage. In this study, we developed a prototype implantable intrathecal infusion pump and evaluated its mechanical and hydraulic characteristics in vitro to determine how its performance varied under different environmental conditions. The data are reported as means (standard deviations). In the experiments, the prototype pump could control the micro-scale infusion amount, and its performance was affected by ambient temperature and pressure conditions. In a temperature change test, at a constant pressure of 1.0 atm, the minimal amounts of a bolus were 4.44 (1.07), 5.06 (1.17), and 5.54 (0.90) uL for the temperature of 27.5, 36.5, and 42°C, respectively. In a pressure change test, at a constant temperature of 36.5°C, the minimal amounts of a bolus were 5.06 (1.17), 5.94 (0.67), and 6.13 (0.39) uL for pressures of 1.0, 0.9 and 0.8 atm, respectively. These experimental results demonstrate the possibility of using the prototype pump as an implantable micro-volumetric infusion device. However, this prototype pump will have to undergo further design enhancement before being clinically feasible for such an application.
Not by bread alone
Authors: Zavershneva Ekaterina , van der Veer René
Published: April 2018

On the basis of both published and unpublished manuscripts written from 1914 to 1917, this article gives an overview of Lev Vygotsky’s early ideas. It turns out that Vygotsky was very much involved in issues of Jewish culture and politics. Rather surprisingly, the young Vygotsky rejected all contemporary ideas to save the Jewish people from discrimination and persecution by creating an autonomous state in Palestine or elsewhere. Instead, until well into 1917, Vygotsky proposed the rather traditional option of strengthening the spiritual roots of the Jews by returning to the religious writings. Socialism was rejected, because it merely envisioned the compulsory redistribution of material goods and ‘man lives not by bread alone’. It was only after the October Revolution that Vygotsky switched from arguments in favour of the religious faith in the Kingship of God to the communist belief in a Radiant Future.
Psychology, conceptual confusion, and disquieting situationism: Response to Lamiell (2018)
Authors: Banicki Konrad
Published: April 2018

In response to Lamiell’s (2018) commentary arising from my claim that both character and personality belong to “the discourse of individual differences” (Banicki, 2017, p. 56) some further clarifications are provided. At first, an interdisciplinary project lying behind my original article is sketched and the phrase “ individual differences” elucidated as having a non-technical meaning far broader than that connected with individual differences as a specific psychological research paradigm. Then, in turn, Lamiell’s criticism of the notion that the latter can serve as a sole ground for personality psychology is briefly summarised. An attempt is made to simultaneously emphasise the conceptual and logical depth of this criticism and to put into question some of its far-reaching consequences concerning the applicability (or lack thereof) of population-level data at the level of the individual. Finally, a concise remark is made about a specifically philosophical (rather than technically psychological or even psychometrical) approach to the situationism debate.
An Empirical Study on Consumer Societalness and Perception towards Social Responsibility Activities of the Corporation
Authors: Mandal Kaushik , Banerjee Sujata , Saha Sharmistha
Published: April 2018

This study intends to measure the variation of societalness of the different segments of the consumers and their perception towards the corporate activity towards social responsibility. The present study also aims to explore the attitude of the consumer towards the corporate social responsibility (CSR) activities of the company. This article is based on a survey to evaluate the societalness and the perception of the consumers. A structured questionnaire was developed and administered to the respondents in the Durgapur City, West Bengal. Independent sample t-test has been employed to compare the means of the different groups in relation to measuring the significant variation in the degree of societalness among the consumers. The study reveals that responsible activities of the company favourably affect the consumers’ thinking and do augment their attitude positively towards it. Also, the results suggest that the knowledge of the responsible activities influences the perception of the consumer while taking purchasing decision.
Bereaved Family Members’ Perceptions of the Distressing Symptoms of Terminal Patients With Cancer
Authors: Okamoto Yoshiaki , Morita Tatsuya , Tsuneto Satoru , Aoyama Maho , Kizawa Yoshiyuki , Shima Yasuo , Miyashita Mitsunori
Published: April 2018

Background:

Few data are available on bereaved family members’ perspective on the frequency of symptoms and degree of distress among terminal patients with cancer.

Methods:

We sent a questionnaire to 1472 bereaved family members of terminal patients with cancer in 20 general hospitals. The questionnaire asked them (1) to indicate which symptoms the patients had, (2) to rate on a 4-point scale the extent to which the symptom was distressing, as follows: 1 = not distressing, 2 = slightly distressing, 3 = quite distressing, and 4 = very distressing at the point of 2 weeks before the patient had died.

Results:

We analyzed 805 questionnaires for this study. Anorexia was the commonest symptom among terminal patients with cancer experienced by bereaved family members, followed by somnolence, weight loss, fatigue, and pain. Anorexia was the most distressing symptom among terminal patients with cancer experienced by bereaved family members, followed by weight loss, pain, edema, and dyspnea.

Conclusions:

Anorexia and weight loss were frequent symptoms and bereaved family members felt very distressing. Furthermore, there are not means of effective treatment now. Thus, we think that further study in this field is necessary.
Lingual Frenulum Phenotypes in Brazilian Infants With Congenital Zika Syndrome
Authors: Fonteles Cristiane Sá Roriz , Marques Ribeiro Erlane , Sales Aragão Santos Marinisi , Ferreira Pequeno Leite Rebeka , Sales Assunção Gabryela , Monteiro André Jalles , Santos Pessoa André Luiz , Giacheti Célia Maria , Cavalcante Kerbage Sáile , Ribeiro Thyciana Rodrigues , Pamplona de Góes Cavalcanti Luciano
Published: April 2018

Objective:

The present study aimed to evaluate lingual frenulum in children affected by congenital Zika syndrome (CZS) and to analyze the association of lingual frenulum phenotypes with other variables.

Design:

This present work had a cross-sectional, descriptive study design.

Setting:

This study was carried out in Fortaleza (Brazil). The health professionals provided tertiary level of care. Data collection occurred during a multidisciplinary task force for evaluating infants affected by CZS in December 2 to 3, 2016.

Patients:

Fifty-four patients with CZS (1-12 months old; 32 girls and 22 boys) were recruited from a population of 70 infants.

Interventions:

A multidisciplinary group comprised of speech-language pathologist/audiologists and pediatric dentists evaluated all patients through an intraoral examination and a specific tongue maneuver protocol for infants.

Main Outcome Measures:

Lingual frenulum visibility was the primary outcome measure. Before initiating the study, we hypothesized that children with CZS had an absent lingual frenulum.

Results:

Lingual frenula were visible in 34 (63%) infants, whereas in 20 (37%) infants lingual frenula visibility required a specific maneuver to retract the tongue. Six of 20 infants presented posteriorly positioned lingual frenula that were visible after maneuver. Lingual frenula were covered by mucous tissue in 14 infants. Presence of posterior frenulum was associated with dysphagia ( P = 0.038). However, the presence of dysphagia in a multivariate model did not associate with the presence of a posterior lingual frenulum ( P = .069) or neurologic symptoms ( P = .056).

Conclusion:

Children with CZS showed predominance of a posterior lingual frenula covered by an overlapping curtain-like mucous membrane.
Speech in 5-Year-Olds With Cleft Palate With or Without Cleft Lip Treated With Primary Palatal Surgery With Muscle Reconstruction According to Sommerlad
Authors: Klintö Kristina , Falk Evelina , Wilhelmsson Sara , Schönmeyr Björn , Becker Magnus
Published: April 2018

Objective:

To evaluate speech in 5-year-olds with cleft palate with or without cleft lip (CP±L) treated with primary palatal surgery in 1 stage with muscle reconstruction according to Sommerlad at about 12 months of age.

Design:

Retrospective study.

Setting:

Primary care university hospital.

Participants:

Eight 5-year-olds with cleft soft palate (SP), 22 with cleft soft/hard palate (SHP), 33 with unilateral cleft lip and palate, and 17 with bilateral CLP (BCLP).

Main Outcome Measures:

Percent oral consonants correct (POCC), percent consonants correct adjusted for age (PCC-A), percent oral errors, percent nonoral errors, and variables related to velopharyngeal function were analyzed from assessments of audio recordings by 3 independent speech-language pathologists.

Results:

The median POCC was 75.4% (range: 22.7%-98.9%), median PCC-A 96.9% (range: 36.9%-100%), median percent oral errors 3.4% (range: 0%-40.7%), and median percent nonoral errors 0% (range: 0%-20%), with significantly poorer results in children with more extensive clefts. The SP group had significantly less occurrence of audible nasal air leakage than the SHP and the BCLP groups. Before age 5 years, 1.3% of the children underwent fistula surgery and 6.3% secondary speech improving surgery. At age 5 years, 15% of the total group was perceived as having incompetent velopharyngeal function.

Conclusions:

Speech was poorer in many children with more extensive clefts. Children with CP±L had poorer speech compared to normative data of peers without CP±L, but the results indicated relatively good speech compared to speech of children with CP±L in previous studies.
Improvement in Quality of Life Following Operative Correction of Midtarsal Charcot Foot Deformity
Authors: Kroin Ellen , Chaharbakhshi Edwin O. , Schiff Adam , Pinzur Michael S.
Published: April 2018

Background:

Patients with Charcot foot arthropathy report a poor quality of life following the development of deformity. Their quality of life is often not improved with “successful” historic accommodative treatment. There is increased current interest in operative correction of the acquired deformity with the stated goals of achieving both the traditional goals of resolution of infection and limb salvage as well as the desire to improve quality of life. The Short Musculoskeletal Functional Assessment (SMFA) outcomes instrument appears to be a valid tool for evaluating this complex patient population.

Methods:

Twenty-five consecutive patients undergoing operative reconstruction for nonplantigrade midtarsal Charcot foot arthropathy completed the SMFA patient-reported outcomes instrument prior to surgery, with 24 completing it at 1 year following the surgery. One patient died during the year following surgery from unrelated causes.

Results:

There was an 11.5-point (95% confidence interval [CI]: –19.7 to −3.2) decrease in the standardized functional index ( P = .01). Similarly, there was a 12.4-point (95% CI: –22.5 to −2.3) decrease in the standardized bother index ( P = .02). The standardized daily activity index demonstrated a 19.6-point decrease (95% CI: –30.5 to −8.6, P = .002), and there was a 14.7-point (95% CI: –24.1 to −5.3) decrease in the standardized emotion index ( P = .004). There was no meaningful change in the standardized arm/hand index ( P = .81).

Conclusion:

The results of this investigation demonstrate that successful operative reconstruction of midtarsal Charcot foot arthropathy improved quality of life. This supports the modern paradigm shift from immobilization during the active phase of the disease process followed by simple accommodation of the acquired deformity to the modern interest in operative correction to allow the use of commercially available therapeutic footwear.

Level of Evidence:

Level IV, case series.
Simulation Training for Vascular Access Interventions
Authors: Davidson Ingemar J.A. , Yoo Min C. , Biasucci Daniel G. , Browne Patrick , dees Cathy , Dolmatch Bart , Gallieni Maurizio , La Greca Antonio , Korndorffer James R. , Nolen Billy , O'Rear Sandy , Peden Eric , Pittiruti Mauro , Reed Gary , Scott Daniel , Slakey Douglas
Published: April 2018

Training and learning in the field of access for dialysis, including peritoneal and hemodialysis and access for oncologic patients, is well suited for the use of simulators, simulated case learning, and root cause analysis of adverse outcomes and team training. Simulators range over a wide spectrum from simple suture learning devices, inexpensive systems for venous puncture simulation, such as a turkey breast or leg with a pressurized tunneled rubber or graft conduit, to sophisticated computer designed simulators to teach interventional procedures such as vascular access angiogram, balloon angioplasty and stent placing. Team training capitalizes on the principles used in aviation, known as crew resource Management (CRM) or Human Factor (HF). The objectives of team training are to improve communication and leadership skills, to use checklists to prevent errors, to promote a change in the attitudes towards vascular access from learning through mistakes in a non-punitive environment, to impacting positively the employee performance and to increase staff retention by making the workplace safer, more efficient and user-friendly.
A Real-World Community Health Worker Care Coordination Model for High-Risk Children
Authors: Martin Molly A. , Perry-Bell Kenita , Minier Mark , Glassgow Anne Elizabeth , Van Voorhees Benjamin W.
Published: April 2018

Health care systems across the United States are considering community health worker (CHW) services for high-risk patients, despite limited data on how to build and sustain effective CHW programs. We describe the process of providing CHW services to 5,289 at-risk patients within a state-run health system. The program includes 30 CHWs, six care coordinators, the Director of Care Coordination, the Medical Director, a registered nurse, mental health specialists, and legal specialists. CHWs are organized into geographic and specialized teams. All CHWs receive basic training that includes oral and mental health; some receive additional disease-specific training. CHWs develop individualized care coordination plans with patients. The implementation of these plans involves delivery of a wide range of social service and coordination support. The number of CHW contacts is determined by patient risk. CHWs spend about 60% of their time in an office setting. To deliver the program optimally, we had to develop multiple CHW job categories that allow for CHW specialization. We created new technology systems to manage operations. Field issues resulted in program changes to improve service delivery and ensure safety. Our experience serves as a model for how to integrate CHWs into clinical and community systems.
Prolonged Exposure Therapy for Experiential Avoidance: A Case-Series Study
Authors: Ghafoori Bita
Published: April 2018

Past research has found that experiential avoidance (EA) is a type of avoidance that is common in individuals who report distress associated with traumatic events. No treatment studies to date have evaluated potential changes in EA associated with prolonged exposure therapy (PE), an empirically supported treatment for traumatic distress. This case series presents outcomes associated with treatment by PE for five adults who presented with posttraumatic stress disorder (PTSD), comorbid generalized anxiety disorder (GAD), and problematic EA. PTSD, GAD, depression, and EA symptoms were monitored at baseline, post-treatment, and 1-month follow-up. The five participants reported decreases in PTSD to below clinical cutoff criteria at post-treatment, all five participants reported decreases in depression at post-treatment, and four of the participants showed decreases in GAD and EA at post-treatment. In comparing pre-treatment to 1-month follow-up scores, all the participants reported decreases in PTSD, GAD, depression, and all but one participant reported a decrease in EA. The findings of this study suggest that PE may be a helpful treatment for individuals reporting EA.
C-MAC© videolaryngoscopy: The anaesthetic assistant’s view
Authors: Jones Lydia , Mulcahy Kathleen , Fox Jeremy , Cook Tim M , Kelly Fiona E
Published: April 2018

Although videolaryngoscopy plays a major role in the 2015 Difficult Airway Society guidelines, the impact on anaesthetic assistant working practices and training has not previously been reported. We surveyed anaesthetic assistants in our hospital to document their experience with using the C-MAC© videolaryngoscope (48 practitioners, 100% response rate). Improvements in the following were reported: patient safety 100%; ability to see whether laryngoscopy is difficult 98%; ability to anticipate the ‘next step’ 98%; team-working and human factors 96%; ability to call a senior anaesthetist more quickly 94%; assessment or adjustment of cricoid force application 92%, understanding of laryngeal anatomy 92%; training in intubation 98%; training in cricoid force application 87%. Concerns were primarily about local issues such as decontamination and blade availability. Ninety percent reported that the clinical benefit outweighed any additional workload. In conclusion, the C-MAC© videolaryngoscope is judged by anaesthetic assistants to confer numerous advantages for their working practice and training.
Diathermy smoke shown to be hazardous, so why are we not protecting ourselves?
Authors: Stanley Kirsty
Published: April 2018

Diathermy smoke has been studied for over three decades and data has been collected to establish its composition. Although its full structure has not been established, the compounds confirmed pose a health hazard to all exposed. Recommendations suggest that theatre staff need to protect themselves using smoke evacuating systems and masks. This review looks at the compliance of theatre staff within these guidelines and the reasons behind noncompliance.