bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychology of Physical Bravery
Authors: Kugel Uri , Hausman Catherine , Black Laurie , Bongar Bruce
Published: July 2017

Research indicates that the presence of physical courage or bravery is linked to increased resilience, decreased PTSD-related symptomatology, and greater feelings of personal competence. Seligman identifies courage as a factor of strength in his positive psychology model, and courage is widely identified as a healing component in clinical psychology. Recent data collected from the Physical Courage Survey (PCS), analyzing acts of physical courage, demographic variables, and personality characteristics indicate that bravery and courage are probably impacted by both nature and nurture. More specifically, individuals who performed acts of heroism and bravery are more likely to be self-confident, be an older child, have a tendency to take risk and seek sensation, be less cautious, be resilient, have a greater sense of humor, be a leader, have a deep sense of empathy for others, and attribute their success on the battlefield to training and modeling of others.
Expanding the role of PAs in the treatment of severe and persistent mental illness
Authors: McCutchen Ben , Patel Sujay , Copeland Dawn
Published: July 2017

Patients with severe and persistent mental illness often face limited access to psychiatric and primary care. This exploratory qualitative analysis studied the effect of introducing a PA into a comprehensive outpatient psychiatric team. Early results suggest this model improves the quality and access to primary and psychiatric care.
One PA's experiences in the Netherlands, South Africa, and Australia
Authors: Kerlen Ando , Ballweg Ruth
Published: July 2017

As the PA profession develops internationally, few mechanisms let PAs move from country to country for clinical practice opportunities. The first author of this paper has worked in the civilian health sectors in two countries, the Netherlands and South Africa, and taught PA students in South Africa and Australia. He reports on PA development in each country and reflects on and compares his professional and clinical experiences.
The ICU Is Becoming a Main Battlefield for Severe Maternal Rescue in China: An 8-Year Single-Center Clinical Experience
Authors: Yuqi Liu , Tan Guoliang , Chengming Shang , Xuri Sun
Published: July 2017

Objectives:

To review the characteristics of and to identify the reasons for severe maternal admissions to the ICU.

Design:

This was an analytical, observational, open, and retrospective study.

Setting:

In our ICU.

Patients:

A total of 487 severe maternal cases were reviewed during the 8-year study period of January 2009 to December 2016.

Intervention:

None.

Measurements and Main Results:

A total of 487 severe maternal cases (12.6%) among the 3,867 patients admitted to ICU were reviewed. Of these, 361 patients were admitted for obstetric reasons, mainly pregnancy-induced hypertension (58.7%) and postpartum hemorrhage (36.8%). The remaining 126 patients were admitted for nonobstetric reasons, including cardiac-related disease (31.0%), immune-related disease (24.6%), and sepsis (20.6%). A total of 249 patients experienced combined comorbidities: the most common was a scarred uterus (100 patients; 40.2%), followed by endocrine-related disease (25.3%), immune-related disease (21.3%), and cardiac-related disease (18.1%). Central venous insertion (90.6%) was the most common intervention, followed by arterial catheter insertion (33.7%), mechanical ventilation (11.7%), blood purification (5.7%), and invasive hemodynamic monitoring (3.7%). Nine patients died during the study period, of which the death of four could have been avoided.

Conclusions:

The number of severe maternal cases has increased annually in our ICU. Although obstetric causes remained the most common reason for admission, the nonobstetric causes and basic complications were too complex, dangerous, and beyond the reach of the obstetrician with regard to monitoring and treatment. We call for a multidisciplinary team mainly composed of ICU staff to improve severe maternal outcomes.
Risk Stratification in Pediatric Acute Respiratory Distress Syndrome: A Multicenter Observational Study*
Authors: Wong Judith Ju-Ming , Phan Huu Phuc , Phumeetham Suwannee , Ong Jacqueline Soo May , Chor Yek Kee , Qian Suyun , Samransamruajkit Rujipat , Anantasit Nattachai , Gan Chin Seng , Xu Feng , Sultana Rehena , Loh Tsee Foong , Lee Jan Hau
Published: July 2017

Objectives:

The Pediatric Acute Lung Injury Consensus Conference developed a pediatric specific definition for acute respiratory distress syndrome (PARDS). In this definition, severity of lung disease is stratified into mild, moderate, and severe groups. We aim to describe the epidemiology of patients with PARDS across Asia and evaluate whether the Pediatric Acute Lung Injury Consensus Conference risk stratification accurately predicts outcome in PARDS.

Design:

A multicenter, retrospective, descriptive cohort study.

Setting:

Ten multidisciplinary PICUs in Asia.

Patients:

All mechanically ventilated children meeting the Pediatric Acute Lung Injury Consensus Conference criteria for PARDS between 2009 and 2015.

Interventions:

None.

Measurements and Main Results:

Data on epidemiology, ventilation, adjunct therapies, and clinical outcomes were collected. Patients were followed for 100 days post diagnosis of PARDS. A total of 373 patients were included. There were 89 (23.9%), 149 (39.9%), and 135 (36.2%) patients with mild, moderate, and severe PARDS, respectively. The most common risk factor for PARDS was pneumonia/lower respiratory tract infection (309 [82.8%]). Higher category of severity of PARDS was associated with lower ventilator-free days (22 [17–25], 16 [0–23], 6 [0–19]; p < 0.001 for mild, moderate, and severe, respectively) and PICU free days (19 [11–24], 15 [0–22], 5 [0–20]; p < 0.001 for mild, moderate, and severe, respectively). Overall PICU mortality for PARDS was 113 of 373 (30.3%), and 100-day mortality was 126 of 317 (39.7%). After adjusting for site, presence of comorbidities and severity of illness in the multivariate Cox proportional hazard regression model, patients with moderate (hazard ratio, 1.88 [95% CI, 1.03–3.45]; p = 0.039) and severe PARDS (hazard ratio, 3.18 [95% CI, 1.68, 6.02]; p < 0.001) had higher risk of mortality compared with those with mild PARDS.

Conclusions:

Mortality from PARDS is high in Asia. The Pediatric Acute Lung Injury Consensus Conference definition of PARDS is a useful tool for risk stratification.
Outcomes of Patient- and Family-Centered Care Interventions in the ICU: A Systematic Review and Meta-Analysis
Authors: Goldfarb Michael J. , Bibas Lior , Bartlett Virginia , Jones Heather , Khan Naureen
Published: July 2017

Objective:

To determine whether patient- and family-centered care interventions in the ICU improve outcomes.

Data Sources:

We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases from inception until December 1, 2016.

Study Selection:

We included articles involving patient- and family-centered care interventions and quantitative, patient- and family-important outcomes in adult ICUs.

Data Extraction:

We extracted the author, year of publication, study design, population, setting, primary domain investigated, intervention, and outcomes.

Data Synthesis:

There were 46 studies (35 observational pre/post, 11 randomized) included in the analysis. Seventy-eight percent of studies (n = 36) reported one or more positive outcome measures, whereas 22% of studies (n = 10) reported no significant changes in outcome measures. Random-effects meta-analysis of the highest quality randomized studies showed no significant difference in mortality (n = 5 studies; odds ratio = 1.07; 95% CI, 0.95–1.21; p = 0.27; I
2 = 0%), but there was a mean decrease in ICU length of stay by 1.21 days (n = 3 studies; 95% CI, –2.25 to –0.16; p = 0.02; I
2 = 26%). Improvements in ICU costs, family satisfaction, patient experience, medical goal achievement, and patient and family mental health outcomes were also observed with intervention; however, reported outcomes were heterogeneous precluding formal meta-analysis.

Conclusions:

Patient- and family-centered care–focused interventions resulted in decreased ICU length of stay but not mortality. A wide range of interventions were also associated with improvements in many patient- and family-important outcomes. Additional high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in the intensive care setting.
Hepatotoxicity After Immune Checkpoint Inhibitor Therapy in Melanoma
Authors: Huffman Brandon M. , Kottschade Lisa A. , Kamath Patrick S. , Markovic Svetomir N.
Published: July 2017

Objective:

To report the clinical features, treatment, and outcomes of patients with immune checkpoint inhibitor-induced hepatotoxicity.

Patients and Methods:

In this retrospective observational study, we identified patients with metastatic malignant melanoma seen in consultation and/or treated between March 2011 and March 2016. Hepatotoxicity was assessed using the Common Terminology Criteria for Adverse Events, v4.0.

Results:

Seventeen patients were identified as having any degree of hepatotoxicity by history (grade 1 to 4). Twelve of 17 were diagnosed after ipilimumab, 3 of 17 were diagnosed after pembrolizumab, and 2 of 17 after ipilimumab combined with nivolumab. Median time from first dose of immune therapy to hepatotoxicity was 52 days. Clinical symptoms were variable: asymptomatic, fatigue, myalgias, headache, abdominal pain, nausea, vomiting, confusion, and/or jaundice. Eight patients had concurrent adverse events including colitis, hypophysitis, pneumonitis, and/or rash. Immune therapy was discontinued in all patients except 3. The patients were most commonly treated with systemic corticosteroids such as prednisone. Immunosuppression was discontinued by taper over a median of 42 days; in 3 patients steroids had to be reinitiated based on clinical or laboratory worsening of liver tests. Normalization of liver tests was seen within a median of 31 days of immunosuppression initiation. One patient with grade 4 hepatotoxicity had normalization with the addition of cyclosporine.

Conclusions:

Melanoma patients treated with immune checkpoint inhibitors should be monitored regularly for hepatotoxicity. Treatment with discontinuation of therapy and initiation of corticosteroids is indicated with grade 3 or 4 hepatotoxicity. Cyclosporine may be beneficial in steroid-refractory hepatotoxicity.
The Clinical Functional Impairment Scale Development
Authors: Sandler Adrian , Wright Mary Ellen , Denslow Sheri
Published: July 2017

Objective:

The purpose of the project was to review content validity and assess the span of responses for the newly developed Clinical Functional Impairment Scale (CFIS).

Methods:

A cross-sectional, content validity process using focus groups of developmental, behavioral pediatric clinicians was conducted. After qualitative analysis of the focus group data, adjustments were made in the CFIS based on the recommendations of the content experts. A survey was conducted of clinicians participating in the online Society of Developmental and Behavioral Pediatrics Discussion Board. Clinicians reviewed 2 case studies and used the CFIS to score severity and interval change of predetermined functional impairments. The amount of spread in the answers was assessed by calculating the index of dispersion.

Results:

Qualitative analysis of the focus groups resulted in adjustment to the CFIS to 20 functional impairments, with a 5-point Likert scale of severity and a 7-point Likert scale of interval change. Ninety-four clinicians participated in the survey. The index of dispersion ranged from 0.49 to 0.88. The interval ratings of severity and interval change had lower dispersion ranges.

Conclusion:

The CFIS uses a mutual prioritization by the family and clinician of the child's functional impairments. The study demonstrated that the clinicians' ratings of the case studies were more variable in the initial symptom severity score than their ratings of symptom severity and interval change in symptoms. Further testing of the CFIS is planned using face-to-face clinical encounters and including parent/caregiver ratings of severity and interval change.
Simultaneous Surgical Treatment for Smile Dysfunction and Lagophthalmos Involving a Dual Latissimus Dorsi Flap
Authors: Homma Tsutomu , Okazaki Mutsumi , Tanaka Kentaro , Uemura Noriko
Published: July 2017

Paralytic lagophthalmos and smile dysfunction are serious complications of facial paralysis and various reconstructive procedures have been developed to treat them. Among these procedures, there is no doubt that dynamic procedures are more effective than static ones. The 1-stage simultaneous surgical treatment of these 2 dysfunctions with a dynamic procedure involving a single muscle would be ideal, but no such methods have been reported. In this article, we present a 1-stage method for the simultaneous surgical treatment involving the use of a dual latissimus dorsi muscle flap. In this method, 2 muscle flaps based on the descending and transverse branches of the thoracodorsal vessels are transferred to the face. The descending and transverse branches of the thoracodorsal nerve are sutured to separate branches of the masseteric nerve. Using this method, complete eyelid closure during strong clenching and voluntary smiling during weak clenching without eyelid closure were achieved. Although our method does not result in spontaneous smiling, we believe that it is a good option for some patients with long-standing facial paralysis.
Distraction Osteogenesis for Brachymetatarsia by Using Internal Device
Authors: Kitabata Reina , Sakamoto Yoshiaki , Nagasao Tomohisa , Kishi Kazuo
Published: July 2017

Congenital brachymetatarsia most commonly involves the fourth ray and may be combined with metacarpal shortening. Now, many reports demonstrated the usefulness of distraction osteogenesis for lengthening of the metatarsals by using an external distraction device. In this article, we treated shortening fourth metatarsal by bone lengthening using the internal distraction device. This technique has some advantages over the method of external distraction.
Microfocused Ultrasound with Visualization and Calcium Hydroxylapatite for Improving Skin Laxity and Cellulite Appearance
Authors: Casabona Gabriela , Pereira Gregório
Published: July 2017

Background:

Age-associated skin laxity contributes to worsening of cellulite appearance. This study evaluated the effects of microfocused ultrasound with visualization (MFU-V; Ultherapy) in combination with diluted calcium hydroxylapatite (CaHA; Radiesse) on cellulite appearance and on neocollagenesis.

Methods:

Twenty women (18–55 years old) with skin laxity and moderate-to-severe cellulite on the buttocks and thighs were retrospectively enrolled. MFU-V was applied using 4 and 7 MHz transducers (25 lines/transducer/site) and immediately followed by subdermal CaHA injection (1 ml/buttock or thigh). Photographs at baseline and 90 days were assessed by 2 independent, blinded evaluators using a 5-item cellulite severity scale. One subject scheduled for thighplasty received treatment with 6 different CaHA dilutions (0.3 ml/5 cm2) followed by MFU-V. Tissue specimens from each dilution site were examined under polarized light microscopy to assess neocollagenesis.

Results:

Both evaluators reported statistically significant improvements compared with baseline for each item on the cellulite severity scale (P < 0.001) with a 4.5-point improvement in mean overall score (P < 0.001) after a single MFU-V/CaHA treatment. At 90 days, histologic analysis showed peak neocollagenesis in samples treated with the 1:1 dilution, whether with CaHA alone or in combination with MFU-V. The highest conversion of collagen type III into collagen type I at month 3 occurred in samples injected with 1:1 and 1:0.6 CaHA dilutions without subsequent MFU-V treatment. Both procedures were well tolerated, and subject satisfaction was high.

Conclusions:

Combination treatment with MFU-V and diluted CaHA is effective for improving skin laxity and the appearance of cellulite on the buttocks and upper thighs.
An Unusual Presentation of an Osteoid Osteoma in the Lunate Bone
Authors: Breitenfeldt Nicole , Liodaki Maria E. , Mailänder Peter , Stang Felix
Published: July 2017

An osteoid osteoma is a rare benign tumor of the carpal bones. It is extremely rarely found in the lunate bone in patients above 30 years of age. We present a case report of a 61-year-old man with an osteoid osteoma of the left wrist, which was masked by degenerative carpal bone disease and a comorbidity of an inflammatory bowel disease. The mainstay of imaging including plain radiographs, computed tomography, magnetic resonance imaging, and bone scintigraphy led to the clinical diagnosis of a lunatomalacia. The tumor was removed by coincidence during removal of the diseased lunate bone. Postoperatively, the patient was immediately free of pain and remained free at his 3 months postoperative follow-up.
Irrigation Device Successfully Tests Valve Competence during Minimally Invasive Mitral Valve Repair
Authors: Fujita Tomoyuki , Fukushima Satsuki , Hata Hiroki , Shimahara Yusuke , Kume Yuta , Matsumoto Yorihiko , Yamashita Kizuku , Kobayashi Junjiro
Published: July 2017

Minimally invasive mitral valve repair has become standard. We hypothesized that reproducible water testing with less air contaminations may help achieve successful repair and prevent air embolism. We used a long shaft irrigation device connected to an infuser pump to water test mitral valve repair in 104 consecutive patients with severe mitral regurgitation due to type II mitral valve dysfunction. All patients underwent mitral valve repair via small right thoracotomy. Water testing was performed by simultaneously monitoring root pressure to confirm valve competence and adequate leaflet coaptation with suitable pressure. Irrigation was stopped when root pressure reached 60 mm Hg. Simultaneous transesophageal echocardiography showed a negligible amount of air introduction. Predischarge echocardiography revealed residual mitral regurgitation of less than or equal to 1 in all patients, and no patient experienced any major adverse event such as stroke or perioperative myocardial infarction. This novel water test allowed us to correctly check mitral valve competence and reduce air contamination.
A Case of Lacrimal Sac Septum Presenting With Dacryocystocele
Authors: Siapno Debrelle Lou P. , Woo Kyung In , Kim Yoon-Duck
Published: July 2017

Lacrimal sac septum is a rare structural abnormality of the lacrimal system. A 15-year-old patient presented with epiphora and a mass inferior to the left medial canthal tendon. Dacryocystography and CT-dacryocystography revealed a dilated lacrimal sac with complete obstruction. A horizontal lacrimal sac septum was found in the mid-sac region during endoscopic dacryocystorhinostomy. Histopathologic examination of the septum revealed chronic inflammation with stratified columnar epithelial cell lining consistent with the lacrimal sac.
Primary Neuroendocrine Tumor of the Orbit Presenting With Acute Proptosis
Authors: Thyparampil Preeti J. , Yen Michael T. , Dhingra Sadhna , Shetlar Debra J. , Zarrin-Khameh Neda , Musher Benjamin L.
Published: July 2017

Primary neuroendocrine tumors of the orbit are exceedingly rare and typically present with gradual, progressive exophthalmos. In this report, an otherwise healthy 64-year-old woman undergoes resection of a well-differentiated neuroendocrine tumor after presenting with acute proptosis. An extensive clinical and radiographic evaluation reveals no other evidence of disease, establishing the diagnosis of a primary neuroendocrine tumor. The case presentation is followed by a brief review of the classification, presentation, and evaluation of orbital neuroendocrine tumors.
Normalization of Congenital Venous Stasis Retinopathy Following Sclerotherapy of a Macrocystic Lymphatic Malformation
Authors: Hirabayashi Kristin E. , Kalin-Hajdu Evan , Bever Greg J. , Vagefi M. Reza , de Alba Campomanes Alejandra G. , Cooke Daniel L. , Dowd Christopher F. , Kersten Robert C.
Published: July 2017

The authors describe, for the first time to their knowledge, a case of a congenital macrocystic lymphatic malformation of the orbit with associated venous stasis retinopathy that acutely normalized after drainage and sclerotherapy of the lesion. Prenatal ultrasound revealed prominence of the left orbital soft tissue, and at birth, the patient was noted to have unilateral proptosis, tortuous retinal vessels, and intraretinal hemorrhages in all 4 quadrants in the left eye. MRI demonstrated a primarily intraconal, multiloculated, T2-hyperintense mass consistent with a lymphatic malformation. Ultrasound-guided cyst aspiration and sclerotherapy was performed, with subsequent improvement of the proptosis and resolution of the vessel tortuosity and intraretinal hemorrhages. Although venous stasis retinopathy is usually related to central retinal vein occlusion or carotid artery occlusive disease, any entity that increases orbital venous resistance can generate retinal venous dilation and intraretinal hemorrhages, including an orbital lymphatic malformation.
Determination of Optimal Coronary Flow for the Preservation of “Donation after Circulatory Death” in Murine Heart Model
Authors: Quader Mohammed , Toldo Stefano , Torrado Juan , Mishra Suraj , Mauro Adolfo G. , Mezzaroma Eleonora , Heather Reichstetter , Abbate Antonio , Kasirajan Vigneshwar , Mangino Martin
Published: July 2017

Donation after circulatory death donors (DCD) have the potential to increase the number of heart transplants. The DCD hearts undergo an extended period of warm ischemia, which mandates the use of machine perfusion preservation if they are to be successfully recovered for transplantation. Because the minimum coronary artery flow needed to meet the basal oxygen demand (DCRIT) of a DCD heart during machine perfusion preservation is critical and yet unknown, we studied this in a DCD rat heart model. Adult male rats were anesthetized, intubated, heparinized, and paralyzed with vecuronium. The DCD hearts (n = 9) were recovered 30 minutes after circulatory death whereas non-DCD control hearts (n = 12) were recovered without circulatory death. Hearts were perfused through the aorta with an oxygenated Belzer Modified Machine Perfusion Solution (A3-Bridge to Life Ltd. Columbia, SC) at 15°C or 22°C starting at a flow index of 300 ml/100 g/min and decreasing by 40 ml/100 g/min every 10 minutes. Inflow (aortic) and outflow (inferior vena cava) perfusate samples were collected serially to assess the myocardial oxygen consumption index (MVO2) and O2 extraction ratio. The DCRIT is the minimum coronary flow below which the MVO2 becomes flow dependent. The MVO2, DCRIT, and oxygen extraction ratios were higher in DCD hearts compared with control hearts. The DCRIT for DCD hearts was achieved only at 15°C and was significantly higher (131.6 ± 7 ml/100 g/min) compared with control hearts (107.7 ± 8.4 ml/100 gm/min). The DCD hearts sustain warm ischemic damage and manifest higher metabolic needs during machine perfusion. Establishing adequate coronary perfusion is critical to preserving organ function for potential heart transplantation.
Lactate serum concentrations during treatment with nucleos(t)ide analogues in hepatitis B with or without cirrhosis
Authors: Triantos Christos , Kalafateli Maria , Aggeletopoulou Ioanna , Mandellou Martha , Assimakopoulos Stelios , Tselekouni Paraskevi , Taprantzi Dimitra , Tsiaoussis Giorgos , Vourli Georgia , Anastassiou Evangelos D. , Gogos Charalambos , Labropoulou-Karatza Chrisoula , Thomopoulos Konstantinos
Published: July 2017

Objective

The aim of this study is to evaluate the clinical implications of lactate concentrations in patients with hepatitis B with or without cirrhosis during treatment with nucleos(t)ide analogues.

Patients and methods

One hundred and seven consecutive patients with chronic hepatitis B and median age 57 (24–85) years were prospectively included. Lactate concentrations were measured at baseline and at 12, 24, 36, 48, and 60 months following the baseline measurements. Eight (n=8, 7.5%) patients received lamivudine, 38 (n=38, 35.5%) patients received tenofovir, 34 (n=34, 31.8%) patients received entecavir, and 27 (n=27, 25.2%) patients received combined therapy.

Results

None of the patients developed lactic acidosis during follow-up [median: 58 (6–155) months]. Overall, no trends of the lactic acid evolution were observed over time; however, there was a nonsignificant increasing trend in patients with cirrhosis up to 24 months of treatment. This increasing trend was significant in female patients with cirrhosis (P=0.016). The age of the patients, the presence of cirrhosis, and hepatocellular carcinoma were strongly associated with the survival of all patients. In the group of cirrhotic patients, the only independent prognostic factor that was associated with patients’ survival was the Child–Pugh class.

Conclusion

None of the patients developed lactic acidosis. There is an indication of an increasing trend of lactic acid levels up to 24 months of therapy in female cirrhotic patients.
A Model for Incident Review Committees in Behavioral Health Settings
Authors: RUSS MARK J. , GREENWALD BLAINE S. , MATTSON MARLIN R.A.
Published: July 2017

Despite the fact that incident review committees have been a key component of quality improvement in behavioral health settings for decades, specific models of how these committees are structured and operate are not well described. We present a model for an incident review committee that has been implemented in 2 large, academic acute care psychiatric hospitals. We believe the model not only permitted us to efficiently and effectively review untoward incidents, but that it also provided an approach to calibrating standards of care for the institution, engaging physicians in an interdisciplinary effort, promulgating a culture of quality review and improvement throughout the organization, promoting continuity and sustainability of the incident review process, and, most importantly, driving beneficial change in clinical practice. Demonstration of the effectiveness of this model requires formal investigation.
Sural Nerve Splitting in Reverse Sural Artery Perforator Flap: Anatomical Study in 40 Cadaver Legs
Authors: Kim Hyeonwoo , Hu Julong , Chang Hak , Kim Byung Jun
Published: July 2017

Background:

The reverse sural artery perforator flap has been widely used in reconstruction of the lower extremity. However, along with the high rate of flap necrosis, sural nerve injury is one of the most frequent complications. This cadaveric study investigated a simple sural nerve preservation technique during reverse sural artery perforator flap surgery.

Methods:

Cadaver dissection was performed on 40 cadaver lower legs, to investigate the pattern of sural nerve distribution. The points where the lateral and medial sural cutaneous nerves penetrate the deep fascia were measured. The converging point of these nerves into the sural nerve was also recorded. Furthermore, the sural nerve was split until no tethering was observed, to simulate the sural nerve–sparing reverse sural artery perforator flap.

Results:

Twenty-nine legs (72.5 percent) showed the lateral and medial sural cutaneous nerves converging to become the sural nerve (combined pattern); seven (17.5 percent) and four legs (10.0 percent) demonstrated the diminished and parallel types, respectively. The distances between the lateral malleolus and the fascia-penetrating point of the lateral and medial sural cutaneous nerves were 29.9 ± 3.3 cm and 18.8 ± 5.6 cm, respectively. In the combined type, the point of convergence was 13.6 ± 4.2 cm from the lateral malleolus. Nerve splitting was successfully performed in all combined cases, without injuring the nerve fascicles.

Conclusions:

The medial sural cutaneous nerve enters the deep fascia significantly more distally than does the lateral sural cutaneous nerve. Furthermore, using nerve splitting, the medial sural cutaneous nerve can be kept intact during reverse sural artery perforator flap surgery.
Factors Associated With Prevalent HIV Infection Among Kenyan MSM: The Anza Mapema Study
Authors: Kunzweiler Colin P. , Bailey Robert C. , Okall Duncan O. , Graham Susan M. , Mehta Supriya D. , Otieno Fredrick O.
Published: July 2017

Background:

To inform future HIV treatment and care programs for men who have sex with men (MSM), we assessed the prevalence of and factors associated with previously diagnosed HIV-positive and out-of-care (PDOC) or newly diagnosed HIV-positive and out-of-care (NDOC) HIV infection among MSM enrolled in the prospective Anza Mapema cohort study.

Methods:

Participants were aged 18 years and older, reported oral or anal sex with a man in the past 6 months and were not already in HIV care or taking antiretroviral therapy in the past 3 months. At enrollment, men were tested for HIV infection and completed questionnaires through audio computer–assisted self-interview. Multinomial logistic regression was used to identify associations with PDOC or NDOC HIV infection, relative to HIV-negative status.

Results:

Among 711 enrolled men, 75 (10.5%) were seropositive including 21 PDOC and 54 NDOC men. In multivariable modeling, PDOC status was more likely than HIV-negative status among men who had experienced upsetting sexual experiences during childhood, had recently experienced MSM trauma, and did not report harmful alcohol use. NDOC infection status was more common among men aged 30 years and older and who had completed ≤8 years of education, relative to HIV-negative status.

Conclusions:

Most HIV-positive men were unaware of their infection, indicating that HIV testing and counseling services tailored to this population are needed. To improve linkage to and retention in care, HIV testing and care services for MSM should screen and provide support for those with hazardous alcohol use and those who have experienced childhood sexual abuse or MSM trauma.
Comparison of Two Different Methods for the Measurement of Gastric Residual Volume
Authors: Uysal Nurcan , Mete Samiye
Published: July 2017

The objective of this study was to determine the difference between gastric residual volume measurements without giving air compared to giving 30 ml of air via the feeding tube. This experimental study was on 60 subjects fed enterally at a university hospital. Data collection was with the 12-item “Gastric Residual Volume Measurement Instructions” and “Gastric Residual Volume Observation Form.” The same subjects composed experimental and control groups. Gastric residual volume measurements were taken before feedings at 10:00 a.m., 1:00 p.m., and 4:00 p.m. with a 60-ml syringe. First measurement was taken without giving air by withdrawing the syringe piston at 2–3 ml/second. Second measurement was applied by giving 30 ml of air and withdrawing the piston at the same speed. Student's t test was used for data analysis. A total of 180 measurements were made for each method. Gastric residual volume averages were 3.71 ± 7.97 ml without air and 3.78 ± 8.08 ml with air. The difference between averages was statistically significant (p < .05). Difficulties withdrawing the syringe piston without giving air occurred in 85% of the intermittently enterally fed patients and 22.8% of those fed continuously. Gastric residual volume measurements with air were higher than those without air. The aspiration procedure with air was easier. Gastric residual volume measurements should be made with 30 ml of air and by withdrawing the syringe piston at 2–3 ml/minute.
Differences Across Illness Perceptions in Inflammatory Bowel Disease and Their Relationships to Psychological Distress and Quality of Life
Authors: Tribbick Davina , Salzberg Michael , Connell William , Macrae Finlay , Kamm Michael , Bates Glen , Cunningham Georgina , Austin David , Knowles Simon
Published: July 2017

Patients with greater inflammatory bowel disease activity readily identify poorer psychosocial outcomes; however, the role of gender, disease type, and individual illness perceptions facets are less well known. This study aimed to characterize the role of illness perceptions, gender, and disease type on anxiety, depression, and quality of life. Eighty-one patients diagnosed with inflammatory bowel disease (39 men, mean age 35 years) attending a tertiary hospital outpatient clinic were studied. Questionnaires used included the Manitoba Index, the Brief Illness Perceptions Questionnaire, Hospital Anxiety and Depression Scale, and the World Health Organization Brief Quality of Life Scale. Female patients with active disease tended to report increased anxiety, depression, and reduced quality of life. Regarding illness perceptions, patients with Crohn disease reported significantly more concerns about its chronicity, while female patients reported being significantly more concerned about the impact of their illness on identity, chronicity, overall concern, and having a greater emotional impact. Hierarchical regression indicated that 36% of depression, 42% of anxiety, and 57% of quality of life could be accounted for by disease activity and type, gender, and illness perceptions. The findings suggest that in addition to a patient's perceived disease status, gastroenterology nurses should also be aware that patient gender and their perceptions of illness play a significant impact not only on anxiety and depression but also on quality of life. Increased disease activity is associated with more severe anxiety and depression and reduced quality of life. Female patients are also at a greater risk of reporting negative illness perceptions and increased levels of anxiety, depression, and lower quality of life.
I Would Rather Die Than Live Sedentary
Authors: Dionigi Rylee A.
Published: July 2017

This critical reflection discusses some potential positive and negative implications, with particular focus on the latter, of the promotion and participation of sport and physical activity to older people. Reflecting upon my 15 years of research on older Masters athletes (and active older people in general), I argue that the field of sports/exercise sciences needs to change its framework for leisure engagement (or physical activity) for current and future cohorts of older adults from one of blaming inactivity for disease, to a framework that values all forms of leisure, from passive to active, mental to social, etc, and one that accepts difference and diversity in aging.
Examining Chronic Disease, Pain-Related Impairment, and Physical Activity Among Middle-Aged and Older Adults in Canada
Authors: Meisner Brad A. , Linton Vanessa , Séguin Ariane , Spassiani Natasha A.
Published: July 2017

Purpose:

With high levels of chronic disease and pain-related functional impairment and low levels of physical activity (PA) among middle-aged and older adults, it is important to investigate ways to design age- and health condition–appropriate PA interventions.

Methods:

Using Canadian Community Health Survey data, relationships among chronic disease, pain-related functional impairment, covariates, and PA were examined in mid- (40-59 y; n = 36 288) and later- (60 y+, n = 44 890) life.

Results/Conclusions:

Physical activity levels varied between middle-aged and older groups according to chronic disease and pain-related functional impairment status. Results are useful for developing targeted and tailored PA interventions to support the health of current and future populations.
How Lived Body and Lived Space Intersect to Influence the Experience of Chronic Obstructive Pulmonary Disease
Authors: Genoe M. Rebecca , Zimmer Chantelle
Published: July 2017

Chronic obstructive pulmonary disease (COPD) impacts not only the body as symptoms are experienced, but also the way one experiences the environment. However, the intersection of these experiences is not well understood. Using interpretive phenomenology, we explored lived body and lived space among people with COPD. Eight participants were interviewed and transcripts were analyzed using detailed line-by-line analysis. Lived body was characterized by gaining stronger bodies yet experiencing bodily limitations. Similarly, lived space was both comfortable and threatening. Participants managed these experiences by negotiating and avoiding threatening spaces to make the best of things.
Species integrity enhanced by a predation cost to hybrids in the wild
Authors: Nilsson P. Anders , Hulthén Kaj , Chapman Ben B. , Hansson Lars-Anders , Brodersen Jakob , Baktoft Henrik , Vinterstare Jerker , Brönmark Christer , Skov Christian
Published: July 2017

Species integrity can be challenged, and even eroded, if closely related species can hybridize and produce fertile offspring of comparable fitness to that of parental species. The maintenance of newly diverged or closely related species therefore hinges on the establishment and effectiveness of pre- and/or post-zygotic reproductive barriers. Ecological selection, including predation, is often presumed to contribute to reduced hybrid fitness, but field evidence for a predation cost to hybridization remains elusive. Here we provide proof-of-concept for predation on hybrids being a postzygotic barrier to gene flow in the wild. Cyprinid fishes commonly produce fertile, viable hybrid offspring and therefore make excellent study organisms to investigate ecological costs to hybrids. We electronically tagged two freshwater cyprinid fish species (roachRutilus rutilusand breamAbramis brama) and their hybrids in 2005. Tagged fish were returned to their lake of origin, exposing them to natural predation risk from apex avian predators (great cormorant,Phalacrocorax carbo). Scanning for regurgitated tags under cormorant roosts 3–4 years later identified cormorant-killed individual fish and allowed us to directly test for a predation cost to hybrids in the wild. Hybrid individuals were found significantly more susceptible to cormorant predation than individuals from either parental species. Such ecological selection against hybrids contributes to species integrity, and can enhance species diversification.
Negative phenotypic and genetic correlation between natal dispersal propensity and nest-defence behaviour in a wild bird
Authors: Bize Pierre , Daniel Grégory , Viblanc Vincent A. , Martin Julien G. A. , Doligez Blandine
Published: July 2017

Natural selection is expected to favour the integration of dispersal and phenotypic traits allowing individuals to reduce dispersal costs. Accordingly, associations have been found between dispersal and personality traits such as aggressiveness and exploration, which may facilitate settlement in a novel environment. However, the determinism of these associations has only rarely been explored. Here, we highlight the functional integration of individual personality in nest-defence behaviour and natal dispersal propensity in a long-lived colonial bird, the Alpine swift (
Apus melba
), providing insights into genetic constraints shaping the coevolution of these two traits. We report a negative association between natal dispersal and nest-defence (i.e. risk taking) behaviour at both the phenotypic and genetic level. This negative association may result from direct selection if risk-averseness benefits natal dispersers by reducing the costs of settlement in an unfamiliar environment, or from indirect selection if individuals with lower levels of nest defence also show lower levels of aggressiveness, reducing costs of settlement among unfamiliar neighbours in a colony. In both cases, these results highlight that risk taking is an important behavioural trait to consider in the study of dispersal evolution.
Cell segregation and border sharpening by Eph receptor–ephrin-mediated heterotypic repulsion
Authors: Taylor Harriet B. , Khuong Anaïs , Wu Zhonglin , Xu Qiling , Morley Rosalind , Gregory Lauren , Poliakov Alexei , Taylor William R. , Wilkinson David G.
Published: July 2017

Eph receptor and ephrin signalling has a major role in cell segregation and border formation, and may act through regulation of cell adhesion, repulsion or tension. To elucidate roles of cell repulsion and adhesion, we combined experiments in cell culture assays with quantitations of cell behaviour which are used in computer simulations. Cells expressing EphB2, or kinase-inactive EphB2 (kiEphB2), segregate and form a sharp border with ephrinB1-expressing cells, and this is disrupted by knockdown of N-cadherin. Measurements of contact inhibition of locomotion reveal that EphB2-, kiEphB2- and ephrinB1-expressing cells have strong heterotypic and weak homotypic repulsion. EphB2 cells have a transient increase in migration after heterotypic activation, which underlies a shift in the EphB2–ephrinB1 border but is not required for segregation or border sharpening. Simulations with the measured values of cell behaviour reveal that heterotypic repulsion can account for cell segregation and border sharpening, and is more efficient than decreased heterotypic adhesion. By suppressing homotypic repulsion, N-cadherin creates a sufficient difference between heterotypic and homotypic repulsion, and enables homotypic cohesion, both of which are required to sharpen borders.
lncRNAs in development and disease: from functions to mechanisms
Authors: Delás M. Joaquina , Hannon Gregory J.
Published: July 2017

Differential expression of long non-coding RNAs (lncRNAs) during differentiation and their misregulation in cancer highlight their potential as cell fate regulators. While some example lncRNAs have been characterized in great detail, the functional
in vivo
relevance of others has been called into question. Finding functional lncRNAs will most probably require a combination of complementary approaches that will greatly vary depending on their mode of action. In this review, we discuss the different tools available to dissect genetically lncRNA requirements and how each is best suited to studies in particular contexts. Moreover, we review different strategies used to select candidate lncRNAs and give an overview of lncRNAs described to regulate development and cancer through different mechanisms.
Moral judgement by the disconnected left and right cerebral hemispheres: a split-brain investigation
Authors: Steckler Conor M. , Hamlin J. Kiley , Miller Michael B. , King Danielle , Kingstone Alan
Published: July 2017

Owing to the hemispheric isolation resulting from a severed corpus callosum, research on split-brain patients can help elucidate the brain regions necessary and sufficient for moral judgement. Notably, typically developing adults heavily weight the intentions underlying others' moral actions, placing greater importance on valenced intentions versus outcomes when assigning praise and blame. Prioritization of intent in moral judgements may depend on neural activity in the right hemisphere's temporoparietal junction, an area implicated in reasoning about mental states. To date, split-brain research has found that the right hemisphere is necessary for intent-based moral judgement. When testing the left hemisphere using linguistically based moral vignettes, split-brain patients evaluate actions based on outcomes, not intentions. Because the right hemisphere has limited language ability relative to the left, and morality paradigms to date have involved significant linguistic demands, it is currently unknown whether the right hemisphere alone generates intent-based judgements. Here we use nonlinguistic morality plays with split-brain patient J.W. to examine the moral judgements of the disconnected right hemisphere, demonstrating a clear focus on intent. This finding indicates that the right hemisphere is not only necessary but also sufficient for intent-based moral judgement, advancing research into the neural systems supporting the moral sense.
Machine learning landscapes and predictions for patient outcomes
Authors: Das Ritankar , Wales David J.
Published: July 2017

The theory and computational tools developed to interpret and explore energy landscapes in molecular science are applied to the landscapes defined by local minima for neural networks. These machine learning landscapes correspond to fits of training data, where the inputs are vital signs and laboratory measurements for a database of patients, and the objective is to predict a clinical outcome. In this contribution, we test the predictions obtained by fitting to single measurements, and then to combinations of between 2 and 10 different patient medical data items. The effect of including measurements over different time intervals from the 48 h period in question is analysed, and the most recent values are found to be the most important. We also compare results obtained for neural networks as a function of the number of hidden nodes, and for different values of a regularization parameter. The predictions are compared with an alternative convex fitting function, and a strong correlation is observed. The dependence of these results on the patients randomly selected for training and testing decreases systematically with the size of the database available. The machine learning landscapes defined by neural network fits in this investigation have single-funnel character, which probably explains why it is relatively straightforward to obtain the global minimum solution, or a fit that behaves similarly to this optimal parameterization.
Co-option of a motor-to-sensory histaminergic circuit correlates with insect flight biomechanics
Authors: Chapman Phillip D. , Bradley Samual P. , Haught Erica J. , Riggs Kassandra E. , Haffar Mouaz M. , Daly Kevin C. , Dacks Andrew M.
Published: July 2017

Nervous systems must adapt to shifts in behavioural ecology. One form of adaptation is neural exaptation, in which neural circuits are co-opted to perform additional novel functions. Here, we describe the co-option of a motor-to-somatosensory circuit into an olfactory network. Many moths beat their wings during odour-tracking, whether walking or flying, causing strong oscillations of airflow around the antennae, altering odour plume structure. This self-induced sensory stimulation could impose selective pressures that influence neural circuit evolution, specifically fostering the emergence of corollary discharge circuits. InManduca sexta, a pair of mesothoracic to deutocerebral histaminergic neurons (MDHns), project from the mesothoracic neuromere to both antennal lobes (ALs), the first olfactory neuropil. Consistent with a hypothetical role in providing the olfactory system with a corollary discharge, we demonstrate that the MDHns innervate the ALs of advanced and basal moths, but not butterflies, which differ in wing beat and flight pattern. The MDHns probably arose in crustaceans and in many arthropods innervate mechanosensory areas, but not the olfactory system. The MDHns, therefore, represent an example of architectural exaptation, in which neurons that provide motor output information to mechanosensory regions have been co-opted to provide information to the olfactory system in moths.