bluuebunny/crossref_metadata_2025 huggingface dataset:
Depiction
Authors: Blumson Ben
Published: June 2017

How do pictures represent? A traditional answer is that whereas a word is connected to what it represents via an arbitrary convention, a picture is connected to what it represents via resemblance. This is the motivating idea behind resemblance theories of pictorial representation. The contemporary debate about pictures in analytic philosophy began with Nelson Goodman’s attack on the resemblance theory in his classic Languages of Art (Goodman 1968, cited under Structural Theories). Goodman proposed abandoning the naive resemblance theory for structural theories, according to which the differences between linguistic and pictorial representation are structural features of the syntax and semantics of language and pictures—Goodman argued that whereas, for example, language is digital, pictures are analogue. Goodman’s immediate successors were swayed by his critique of resemblance theories but not by his defense of the structural theory, which emphasized the idea that the connection between a picture and what it represents is merely arbitrary. Because the illusion theory had found few adherents, this led to the development of more sophisticated perceptual theories of pictorial representation—in particular, seeing-in theories, according to which we see-in a picture what it represents, and recognition theories, according to which a picture represents via our ability to recognize things. Another way to develop a perceptual theory of pictorial representation is taken by projective theories, which analyze pictorial representation in terms of geometrical projections of scenes onto flat surfaces—so a picture of a scene, according to projective theories, is closely akin to the result of tracing the outline of that scene upon a window. The major contemporary works on projective theories are found in the psychology of picture perception, but they are obviously equally relevant to the philosophical issues raised in the aesthetics literature. In light of these historical developments, it is natural to see the various theories of pictorial representation as competitors. But, in fact, the various theories are not obviously inconsistent with each other, and most sophisticated theories borrow elements from their competitors—perceptual theories, for example, can accommodate resemblance in a subsidiary role, and even Goodman suggests that habituation to our system of pictorial representation explains the resemblance of pictures to what they represent. A recent development involves the construction of self-consciously hybrid theories, which attempt to combine the advantages of competing accounts. (For images more generally, rather than pictures in particular, see the separate Oxford Bibliographies in Philosophy article Images.)
Rate Manuscript (Oxford, Bodleian Library, MS Ashmole 61)
Authors: Matlock Wendy
Published: June 2017

Oxford, Bodleian Library, MS Ashmole 61 is often referred to as the Rate manuscript after the codex’s scribe, who signs the name nineteen times throughout the volume of 162 paper folia and often adds drawings of fish and roses at the ends of texts. The codex measures about 418 mm by 140 mm. It likely was produced for urban household use, given its strong interest in domestic life, including practical material for household maintenance such as recipes and accounting advice along with poems for lay devotion and popular entertainment. Watermark evidence suggests production dates between 1479 and 1610, but the scribe’s hand precludes a date after the first decade of the 16th century, so scholars typically use c. 1500 to date the manuscript. Dialect places Rate in Leicestershire. Little otherwise is known about Rate, but his careless copying and idiosyncratic editing combined with the codex’s unusual format suggest he was an amateur scribe producing the volume for his own or his household’s use. The manuscript compiles forty-one works, although some numbers include multiple or incomplete texts. Its eclectic contents, primarily in Middle English excluding macaronic works and three Latin epigrams, range from short didactic poems and prayers to long devotional treatises like The Northern Passion. It includes literature from a wide range of times and places. Among the earlier are the late-13th-century Saint Eustace and The King and His Four Daughters, which translates part of Robert Grosseteste’s Anglo-Norman Le Château d’Amour, but a majority date to the 15th century. Some are extant only in the Rate manuscript; for example, The Debate of the Carpenter’s Tools and The Feasts of All Saints and All Souls are unique. Other texts, however, circulated widely in later medieval England (e.g., A Prayer to the Virgin Mary, preserved in forty other manuscripts and itself excerpted from the immensely popular Speculum Christiani). Ashmole 61 is noteworthy for its five popular romances: four are signature Middle English tail-rhyme romances—Sir Isumbras, The Erle of Tolous, Lybeaus Desconus, and Sir Cleges—and the fifth is Sir Orfeo. It also includes two comic poems in tail-rhyme stanzas, Sir Corneus and King Edward and the Hermit. The manuscript as a whole compiles works concerning good manners, correct conduct, and the claims of the afterlife, issues of great interest to 15th-century readers. It is often compared to other 15th-century miscellanies, such as Cambridge University Library MS Ff.2.38; Edinburgh National Library of Scotland MS Advocates 19.3.1; Oxford, Bodleian Library MS Rawlinson C. 83; and the Lincoln Thornton MS.
Material Culture
Authors: McDonnell Terence E. , Vercel Kelcie
Published: June 2017

Beginning with many of its earliest writings, sociology has a long tradition of theorizing the role of objects and material culture in social life. In the middle of the 20th century, these themes were taken up again by major sociological and anthropological thinkers who inspired a resurgence of interest in the study of objects. The sociology of culture and art began to address the production and reception of objects, while scholars from anthropology, cultural studies, and media studies began to develop a robust body of work around material culture. These two fields have somewhat different takes on the study of objects. Sociological accounts tend to be people focused, examining how institutional characteristics of art worlds shape the objects produced, and focusing explanations of meaning-making on the social position of the audience more so than the symbolic qualities of the object. Alternatively, material culture approaches tend to be object focused, engaging objects as symbols that help explain how people organize subcultures, create solidarity through exchange, or express social status. A turn toward materiality, originating from anthropology but taken up more recently in sociology, privileges the material qualities of objects and how they shape the use and symbolic meaning of objects. This work on objects raises the question of how sociologists should incorporate objects into accounts of action. This question has sparked an ongoing cross-disciplinary debate about whether objects have agency. Research in science and technology studies, alongside studies of craft and sport, have brought attention to how objects act back, shaping how knowledge is produced. Objects have also been understood as mechanisms of power, by shaping categories and morality, ritualizing icons, stabilizing social relations as instruments of the states and institutions, and structuring action through the built environment. These robust and vibrant areas of research make a strong case for the incorporation of objects into theories of power and knowledge.
Activist Media
Authors: Clark Rosemary , Erdener Jasmine , Ferrari Elisabetta , Yang Guobin
Published: June 2017

Activist media refer to media forms that serve activist purposes. Activism can be radical or moderate; media have multiple forms, encompassing television, photography, cartoons, radio, newspapers, zines, the Internet, and even the body. We use both concepts in a broad rather than narrow sense in order to be more inclusive in selecting our entries. Many studies of alternative media, radical media, citizen media, underground press, and social movement media fall under our broad definition of activist media. Mainstream media do not, even though sometimes they help to stir or deter contention and sometimes are appropriated by activists. Activist media are not a new phenomenon. In fact, the rise of modern social movements and nationalism in the 18th century coincided with the development of print capitalism. In the early days of the Internet, many independent web sites, discussion lists, and personal websites were activist media. Dominant digital media platforms of the 21st century, such as Facebook, Twitter, YouTube, and Weibo in China, are commercial enterprises; they resemble mainstream media more than activist media. Yet some of their spaces are used so deliberately and persistently by citizens or civil society groups to voice dissent or make political claims that they take on functions of activist media. Examples are hashtag activism such as #WhyIStayed and #Ferguson.
Bacterial Diversity in Freshwater
Authors: Lindström Eva S.
Published: June 2017

The tree of life, describing the evolutionary relationships among organisms, is totally dominated by bacteria. In a regular ecology textbook, the number of bacterial and Archaeal examples are, however, few. Microorganisms are in many respects understudied, and we do not yet know if they follow similar “rules” as other organisms: for instance, regarding patterns in diversity over time and space. Further, bacteria play important roles in biogeochemical cycles, and, therefore, it is also important to understand if and how this enormous diversity is related to the role bacteria play in ecosystems. Despite methodological developments (see Historical Overview and Methods) that led to an exponential increase in the amount of data over time, we are still only scratching the surface of the diversity of freshwater bacteria (see Measuring Alpha Diversity), and few general patterns in diversity have emerged. Some typical freshwater bacterial groups have been identified (see Marine and Freshwater Bacterioplankton and Typical Freshwater Bacteria), and some important environmental steering factors are known (see Biogeography of Freshwater Bacteria). Further, a consistent pattern appears to be that alpha diversity decreases along lake and river chains because of inoculation of bacteria from species-rich soils (see Patterns in Alpha Diversity). Some findings of bacterial alpha diversity further indicate that bacterial diversity may not always follow the same rules as in larger organisms, challenging some established textbook “truths” regarding what is influencing diversity in general. But more data are needed for certain conclusions. Future work should also include the identification of the true (active) players and their possible importance for ecosystem functioning (see Identifying Contributors to Community Functioning).
Automated Identification of Northern Leaf Blight-Infected Maize Plants from Field Imagery Using Deep Learning
Authors: DeChant Chad , Wiesner-Hanks Tyr , Chen Siyuan , Stewart Ethan L. , Yosinski Jason , Gore Michael A. , Nelson Rebecca J. , Lipson Hod
Published: June 2017

Northern leaf blight (NLB) can cause severe yield loss in maize; however, scouting large areas to accurately diagnose the disease is time consuming and difficult. We demonstrate a system capable of automatically identifying NLB lesions in field-acquired images of maize plants with high reliability. This approach uses a computational pipeline of convolutional neural networks (CNNs) that addresses the challenges of limited data and the myriad irregularities that appear in images of field-grown plants. Several CNNs were trained to classify small regions of images as containing NLB lesions or not; their predictions were combined into separate heat maps, then fed into a final CNN trained to classify the entire image as containing diseased plants or not. The system achieved 96.7% accuracy on test set images not used in training. We suggest that such systems mounted on aerial- or ground-based vehicles can help in automated high-throughput plant phenotyping, precision breeding for disease resistance, and reduced pesticide use through targeted application across a variety of plant and disease categories.
A Prospective Study of Age-dependent Changes in Propofol-induced Electroencephalogram Oscillations in Children
Authors: Lee Johanna M. , Akeju Oluwaseun , Terzakis Kristina , Pavone Kara J. , Deng Hao , Houle Timothy T. , Firth Paul G. , Shank Erik S. , Brown Emery N. , Purdon Patrick L.
Published: June 2017

Background

In adults, frontal electroencephalogram patterns observed during propofol-induced unconsciousness consist of slow oscillations (0.1 to 1 Hz) and coherent alpha oscillations (8 to 13 Hz). Given that the nervous system undergoes significant changes during development, anesthesia-induced electroencephalogram oscillations in children may differ from those observed in adults. Therefore, we investigated age-related changes in frontal electroencephalogram power spectra and coherence during propofol-induced unconsciousness.

Methods

We analyzed electroencephalogram data recorded during propofol-induced unconsciousness in patients between 0 and 21 yr of age (n = 97), using multitaper spectral and coherence methods. We characterized power and coherence as a function of age using multiple linear regression analysis and within four age groups: 4 months to 1 yr old (n = 4), greater than 1 to 7 yr old (n = 16), greater than 7 to 14 yr old (n = 30), and greater than 14 to 21 yr old (n = 47).

Results

Total electroencephalogram power (0.1 to 40 Hz) peaked at approximately 8 yr old and subsequently declined with increasing age. For patients greater than 1 yr old, the propofol-induced electroencephalogram structure was qualitatively similar regardless of age, featuring slow and coherent alpha oscillations. For patients under 1 yr of age, frontal alpha oscillations were not coherent.

Conclusions

Neurodevelopmental processes that occur throughout childhood, including thalamocortical development, may underlie age-dependent changes in electroencephalogram power and coherence during anesthesia. These age-dependent anesthesia-induced electroencephalogram oscillations suggest a more principled approach to monitoring brain states in pediatric patients.
Earliest English Definitions of Anaisthesia and Anaesthesia
Authors: Haridas Rajesh P.
Published: June 2017

The earliest identified English definition of the word anaisthesia was discovered in the first edition (1684) of A Physical Dictionary, an English translation of Steven Blankaart’s medical dictionary, Lexicon Medicum Graeco-Latinum. This definition was almost certainly the source of the definition of anaesthesia which appeared in Dictionarium Anglo-Britannicum (1708), a general-purpose English dictionary compiled by the lexicographer John Kersey. The words anaisthesia and anaesthesia have not been identified in English medical or surgical publications that antedate the earliest English dictionaries in which they are known to have been defined.
Functional outcome of displaced intercondylar fractures of the humerus in children and adolescents
Authors: Marengo Lorenza , Andreacchio Antonio , Alberghina Flavia , Dimeglio Alain , Canavese Federico
Published: June 2017

The main aim of this study was to retrospectively evaluate the clinical, functional, and radiographic outcome of displaced intercondylar fractures of the humerus in children and adolescents, and evaluate upper-extremity function with the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH), the hypothesis being that intercondylar fractures have poorer functional outcome than do other upper-limb fractures. The mean age at the time of injury was 11.9±2.5 years (range: 7.5–15.8 years). The male–female ratio was 3.5 : 1. Using the Toniolo & Wilkins classification, 13 (72%) fractures were classified as type II and five (28%) as type III. The overall complication rate was 50%. The mean Quick DASH score was 9±11 (range: 0–31.8). Displaced intercondylar fractures of the humerus, although uncommon in skeletally immature patients, are characterized by poorer clinical and functional outcome compared with other pediatric humerus and elbow fractures. Minimally displaced fractures with articular surface displacement of less than 2 mm can be safely managed with closed reduction and percutaneous fixation, but any greater intra-articular displacement requires open reduction and internal fixation, which means a higher complication rate and poorer functional outcome should be expected, especially in patients older than 10 years.
Induction of Endogenous Neural Stem Cells By Extracorporeal Shock Waves After Spinal Cord Injury
Authors: Shin Dong-Cheul , Ha Kee-Yong , Kim Young-Hoon , Kim Jang-Woon , Cho Yoo-Kyung , Kim Sang-Il
Published: June 2017

Study Design.

Animal experimental study

Objectives.

The purpose of this study is to investigate the effects of extracorporeal shock waves (ESWs) on endogenous neural stem cells (NSCs) proliferation after spinal cord injury (SCI).

Summary of Background Data.

Exogenous stem cell transplantation for SCI still has many limitations to be addressed such as ideal cell sources, timing of transplantation, and fate of the transplanted cells. Moreover, the efficacy is another issue owing to a peculiar pathologic condition in the chronic phase of SCI.

Methods.

Contusive SCI was made using 24 Sprague-Dawley rats, and ESWs were applied at post-injury 4 weeks in rats. Proliferation and differentiation of endogenous NSCs (DCX, Sox-2) and axonal sprouting (GAP-43 and MAP-2) were observed at 6 weeks after application of ESWs. Differentiation of the activated neural stem cells was also investigated by coexpression of neuronal/glial cell markers (GFAP, Neu N, and CC-1). Immunofluorescence staining and western blotting were performed for quantitative analysis, and these results were compared with those in the control group. For clinical assessment, the BBB locomotor rating scale was performed.

Results.

More proliferation of endogenous neural stem cells was noted in the experimental groups, and these activated cells were mainly founded in the ependymal layer of the central canal and the injured posterior horn. Differentiation into neuronal and glial cells was also noted in a limited number of cells. With respect to axonal regeneration, GAP-43 and MAP-2 expressions in the experimental groups were also significantly higher than those in the control group. During 6 weeks’ clinical observation following ESWs application, functional improvement of the hindlimb was observed without clinical deterioration by trials.

Conclusion.

Collectively, these findings indicate that ESWs on the chronic phase of SCI induce activation of endogenous NSCs and consequent functional improvement.

Level of Evidence: N/A
Sex-specific effect of RNASEL rs486907 and miR-146a rs2910164 polymorphisms’ interaction as a susceptibility factor for melanoma skin cancer
Authors: Sangalli Antonella , Orlandi Elisa , Poli Albino , Maurichi Andrea , Santinami Mario , Nicolis Morena , Ferronato Silvia , Malerba Giovanni , Rodolfo Monica , Gomez Lira Macarena
Published: June 2017

The genetics of melanoma is complex and, in addition to environmental influences, numerous genes are involved or contribute toward melanoma predisposition. In this study, we evaluated the possible interaction between miR-146a and one of its putative targets ribonuclease L (RNASEL) in the risk of sporadic melanoma. Polymorphisms rs2910164 in miR-146a and rs486907 in the RNASEL gene have both independently been associated with the risk of different cancers, and an interaction between them has been observed in nonmelanoma skin cancer. Polymorphisms rs2910164 G/C and rs486907 A/G were genotyped by restriction fragment length polymorphism analysis in 304 sporadic melanoma patients and 314 control individuals. Genotype distribution between cases and controls for each of the two polymorphisms was compared using Fisher’s exact test. Epistasis between the two polymorphisms was tested by a logistic regression model. In the present study, we observed a sex-specific effect of the miR-146a rs2910164 C allele restricted to individuals carrying the RNASEL rs486907 A allele as well. Men carrying this allelic combination have the highest risk of melanoma, whereas it seems to have no effect or even an opposite relationship to melanoma risk in the female population. The results reported in the present study suggest a sex-specific interaction between miR-146a and RNASEL genes in melanoma skin cancer susceptibility, and could account for possible discordant results in association studies when stratification according to sex is not performed.
Effect of Postoperative Dressing on Excisions Performed on the Leg: A Comparison Between Zinc Oxide Compression Dressings Versus Standard Wound Care
Authors: Thompson Carol B. , Wiemken Timothy L. , Brown Timothy S.
Published: June 2017

BACKGROUND

Wound healing on the legs may be complicated by delayed healing and other postoperative problems. Two potential postoperative wound care regimens for sutured excisions on the legs include a standard pressure dressing and zinc oxide compression dressings. Limited data exist comparing the efficacy of these 2 options.

OBJECTIVE

To compare outcomes of standard postoperative wound care dressing versus postoperative use of a zinc oxide compression dressings for sutured repairs on the legs.

METHODS

In this retrospective cohort study, healing time and complication rate of 44 patients treated with standard dressing and 36 patients treated with zinc oxide compression dressings were compared.

RESULTS

At 19 days, 91.7% of patients receiving zinc oxide dressing were fully healed, whereas only 65.9% of patients receiving standard wound care were healed. Complications were noted in 6 of the patients receiving standard dressing (13.6%); no complications occurred in the zinc oxide dressing group.

CONCLUSION

Zinc oxide compression dressings were a practical option for postoperative wound care, with decreased incidence of delayed wound healing, and fewer complications versus standard postoperative wound dressing.
ELECTROPHYSIOLOGICAL CHARACTERIZATION OF MACULAR TELANGIECTASIA TYPE 2 AND STRUCTURE–FUNCTION CORRELATION
Authors: Okada Mali , Robson Anthony G. , Egan Catherine A. , Sallo Ferenc B. , Esposti Simona Degli , Heeren Tjebo F. C. , Fruttiger Marcus , Holder Graham E.
Published: June 2017

Purpose:

To investigate the electrophysiological features of macular telangiectasia Type 2 and their relationship to structure as determined by optical coherence tomography imaging.

Methods:

Forty-two eyes from 21 patients enrolled in the Macular Telangiectasia Natural History Observation Study were reviewed. All patients had full-field and pattern electroretinography (ERG; PERG) with some patients additionally having multifocal electroretinography (mfERG; N = 15) or electrooculography (N = 12). Multiple linear regression modeling assessed the relationship between the ellipsoid zone break size on optical coherence tomography and the central mfERG response.

Results:

Full-field ERG and electrooculography were normal in all eyes. Six eyes (14%) from five patients had subnormal PERG P50 amplitudes. Twenty-two of 30 eyes (73%) had reduced central or paracentral stimulus on mfERG. There was a significant correlation between ellipsoid zone break size and both the P1 amplitude (R2 = 0.37, P = 0.002) and P1:N1 ratio (R2 = 0.32, P = 0.002) of the central response on mfERG.

Conclusion:

The electrophysiological findings in macular telangiectasia Type 2 are those of localized central dysfunction and are consistent with the structural data available from imaging and histologic studies. The ellipsoid zone break size correlates with mfERG reduction. The reduced mfERG P1:N1 ratio is consistent with inner retinal dysfunction.
EFFECT OF DARK ADAPTATION AND BLEACHING ON BLUE LIGHT REFLECTANCE IMAGING IN MACULAR TELANGIECTASIA TYPE 2
Authors: Okada Mali , Heeren Tjebo F. C. , Egan Catherine A. , Rocco Vincent , Bonelli Roberto , Fruttiger Marcus
Published: June 2017

Purpose:

In patients with macular telangiectasia Type 2, blue light reflectance imaging reveals an oval, parafoveal area in the macula that has increased reflectance compared with its surrounding. Here, we examine how dark adaptation and photobleaching can affect the blue light reflectance imaging pattern.

Methods:

Prospective study of patients with macular telangiectasia enrolled in the MacTel Natural History Observation Study. After dark adaptation, a sequence of images was obtained with a confocal scanning laser ophthalmoscope at 488 nm. Change of reflectance patterns was analyzed over time.

Results:

Eighteen eyes from 16 patients were analyzed. Initially, increased reflectivity in the parafoveal area resulted in higher gray values compared with the paramacular surrounding on blue light reflectance imaging. The difference between parafoveal and paramacular reflectance intensity decreased steadily during imaging, from 17.7 gray-value units (95% confidence interval: 12.1–23.2) down to 2.8 (95% confidence interval: −0.8 to 6.5) after around 30 seconds, and recovered after 5 minutes of dark adaptation.

Conclusion:

A bleaching effect was evident in our study. Understanding these changes is important for both diagnosis and assessment of blue light reflectance phenotype in patients with macular telangiectasia and could also provide further insights into the pathophysiology of this disease.
Comparative effectiveness of laparoscopic versus open prostatectomy for men with low-risk prostate cancer: a matched case-control study
Authors: Parikh Rahul R. , Patel Amil , Kim Sinae , Kim Isaac Yi , Goyal Sharad
Published: June 2017

Background:

Little data exist on effect of undergoing laparoscopic prostatectomy(LP) versus open prostatectomy(OP) upon 30-day mortality rates among low-risk prostate cancer patients.

Materials and methods:

Using the National Cancer Database, we identified men (2004 to 2013) with biopsy-proven, low-risk prostate cancer who met the eligibility criteria: N0, M0, T-stage≤2A, PSA≤10 ng/mL, and Gleason score=6. We utilized a 1:N matched case-control study, with cases and controls matched by race, insurance status, Charlson-Deyo comorbidity score, surgical margin status, and facility type to investigate the short-term comparative effectiveness of LP versus OP.

Results:

Among the 448,773 patients in the National Cancer Database with low-risk prostate cancer, 116,359 patients met the above inclusion criteria. The target group was restricted to patients who received LP or OP, thus, leaving 44,720 patients for the study. The use of LP (compared with OP) was associated with patients with privately insured patients, treatment at an academic/research centers, high-volume hospitals, and white race (all P<0.01). LP was less frequently utilized for black patients, those who received treatment at community centers, and for those with Medicaid insurance(all P<0.01). The odds ratio of death for surgery type (laparoscopy vs. open) was estimated at 0.31 (95% confidence interval, 0.135–0.701; P<0.05). Thus, the risk of death within 30 days was 69% lower with LP compared with OP.

Conclusions:

We found that the 30-day mortality rate among low-risk prostate cancer patients is significantly lower among patients who received LP when compared with OP, with various clinicopathologic parameters associated with its preferential use.
Vulvodynia—Younger Age and Combined Therapies Associate With Significant Reduction in Self-Reported Pain
Authors: Aalto Anu P. , Vuoristo Silja , Tuomaala Heidi , Niemi Riikka J. , Staff Synnöve M. , Mäenpää Johanna U.
Published: June 2017

Objectives

Eight percent of women have vulvodynia (VD), a chronic pain disorder with unknown etiology. The aim of our study was to assess the efficacy of given VD treatments measured by numerical rating scale (NRS) for pain and patients' quality of life.

Materials and Methods

Study material consisted of a retrospective VD patient cohort (N = 70). Data were collected by postal questionnaires and review of the medical records.

Results

We report here a statistically significant reduction in NRS only with combination of therapies (median NRS before treatments 8 vs median NRS 4 after treatments, p < .001) but not with any individual therapy alone, i.e., physiotherapy, topical medications, oral pharmaceutical therapy, sexual counseling by a trained nurse, sacral neuromodulation, and laser treatment or surgery. Older age (>30) and frequent (≥6) outpatient clinic visits associated with a significantly minor reduction in NRS (p = .03 and p = .04, respectively).

Conclusions

The results of this retrospective study suggest that an effective, multimodality-based treatment is most beneficial for VD patients and VD at older age may represent a subtype more resistant to therapy.
Exercise Performance During the First Two Years After Left Ventricular Assist Device Implantation
Authors: Marko Christiane , Xhelili Endri , Lackner Thomas , Zimpfer Daniel , Schima Heinrich , Moscato Francesco
Published: June 2017

Exercise performance of patients with left ventricular assist devices (LVADs) improves after postimplant cardiac rehabilitation (CR). Few studies assess the effectiveness of a CR and its long-term effect of exercise performance. For this purpose, we retrospectively analyzed data from LVAD patients, who underwent a stationary CR twice after pump implantation. Data from exercise training and cardiopulmonary exercise tests (CPETs) were analyzed. Fifteen patients (age: 57 ± 10 years, male 87%) were admitted to the rehabilitation clinic twice 39 ± 18 and 547 ± 197 days after LVAD implantation. An improvement from the beginning to the end of the second CR was observed in bicycle ergometer training (14.0 ± 8.8 vs. 35.7 ± 14.7 W; p < 0.001), in muscular strength (e.g., leg press: 41 ± 10 vs. 53 ± 14 kg; p < 0.001), and in 6 minute walk distance (421 ± 126 m vs. 480 ± 133 m; p = 0.040). Between the first and the second CR, improvement in all the training modules was observed as well as an increase in CPETs peak workload (56 ± 24 vs. 83 ± 26 W; p < 0.001) but not in peak oxygen consumption (12.3 ± 3.2 vs. 12.2 ± 4.0 ml/min/kg; p = 0.906). Thus, over long implant periods, patients showed improvement of their exercise performance in the submaximal load range, but no change in the aerobic capacity was observed.
Clinical and Histopathologic Features of Colorectal Adenocarcinoma in Crohn’s Disease
Authors: Galata Christian , Hirsch Daniela , Reindl Wolfgang , Post Stefan , Kienle Peter , Boutros Michael , Gaiser Timo , Horisberger Karoline
Published: June 2017

Goals:

The aim of this study was to assess the histopathologic characteristics of colorectal carcinomas (CRC) in patients with Crohn’s disease (CD).

Background:

A higher frequency of microsatellite instability (MSI) is seen in mucinous compared with nonmucinous CRC which suggests that its pathogenesis involves distinct molecular pathways. Several publications reported a higher percentage of mucinous adenocarcinoma in CD patients with CRC. So far, there has been no investigation of MSI in CD patients with mucinous CRC.

Study:

The medical records of patients who underwent surgery for CRC were reviewed and those with a history of CD identified. The data of histologic classification and MSI status of the tumor were investigated.

Results:

Fourteen patients with CD-associated CRC were identified (5 female, 9 male) resulting in 20 CRC in total. Histologic investigation revealed 7 adenocarcinomas without a mucinous or signet ring cell component. All other CRCs harbored a mucinous (n=11) and/or signet ring cell (n=6) component. All tumors assessed for MSI were found to be microsatellite stable.

Conclusions:

Our data indicate that CRCs with signet ring cell and mucinous components were much more common in patients with CD than in patients with sporadic CRC. This observation suggests that CRC in CD represent an own entity with distinct histopathologic and molecular features. This may implicate potential consequences for diagnosis and therapy of CRC in CD in the future as well as new factors to identify patients with an increased risk for developing CRC in CD.
Depression and insomnia among individuals with celiac disease or on a gluten-free diet in the USA: results from a national survey
Authors: Zylberberg Haley M. , Demmer Ryan T. , Murray Joseph A. , Green Peter H.R. , Lebwohl Benjamin
Published: June 2017

Background

There is uncertainty regarding the prevalence of psychiatric illnesses in patients with celiac disease (CD) and people who avoid gluten (PWAG) without a diagnosis of CD.

Participants and methods

We obtained data from 22 274 participants from the 2009–2014 National Health and Nutrition Examination Survey to compare the prevalence of depression, insomnia, quality-of-life variables, and psychotropic medication use in CD participants and PWAGs to controls. We used multivariable logistic regression to assess for independent associations between CD/PWAG status and the outcomes of these variables.

Results

Depression was present in 8.2% of controls compared with 3.9% of participants with CD (P=0.18) and 2.9% of PWAGs (P=0.002). After adjustment for age, sex, race, income, and access to healthcare, PWAGs maintained lower odds of depression compared with controls (odds ratio=0.25; 95% confidence interval: 0.12–0.51; P=0.0001). The prevalence estimates of sleep difficulty among controls (27.3%) compared to participants with CD or PWAGs were 37.7% (P=0.15) and 34.1% (P=0.11). Those with diagnosed CD had increased odds of sleep difficulty (odds ratio=2.41; 95% confidence interval 1.04–5.60), but this was no longer significant after multivariable adjustment (P=0.17).

Conclusion

Among a nationally representative US sample, participants with CD overall showed no increased odds of depression or sleep difficulty. PWAGs showed lower odds of depression compared with controls. Future research should investigate the relationship between a diagnosis of CD and the development of psychiatric conditions.
Natural History, Pathogenesis, and Treatment of Evans Syndrome in Children
Authors: Mantadakis Elpis , Farmaki Evangelia
Published: June 2017

Primary Evans syndrome (ES) is defined by the concurrent or sequential occurrence of immune thrombocytopenia and autoimmune hemolytic anemia in the absence of an underlying etiology. The syndrome is characterized by a chronic, relapsing, and potentially fatal course requiring long-term immunosuppressive therapy. Treatment of ES is hardly evidence-based. Corticosteroids are the mainstay of therapy. Rituximab has emerged as the most widely used second-line treatment, as it can safely achieve high response rates and postpone splenectomy. An increasing number of new genetic defects involving critical pathways of immune regulation identify specific disorders, which explain cases of ES previously reported as “idiopathic”.
Understanding and Promoting Birth Satisfaction in New Mothers
Authors: Hinic Katherine
Published: June 2017

Purpose:

The purpose of this study was to examine the impact of select maternal psychosocial and experiential factors on birth satisfaction of new mothers during early postpartum.

Study Design and Methods:

This is a descriptive correlational study exploring the relationships among birth satisfaction, breastfeeding self-efficacy, and perceived stress in 107 new mothers in the first 4 days postpartum. Instruments used included the Birth Satisfaction Scale-Revised, the Perceived Stress Scale, the Breastfeeding Self-Efficacy Scale-Short Form, and a researcher-generated demographic form. Quantitative analysis included descriptive statistics, correlation, one-way Analysis of Variance, and multiple linear regression.

Results:

Birth satisfaction was negatively correlated with perceived stress (r = -.299, p < .05) and positively correlated with feeling prepared for birth (rho = .243, p < .05) and breastfeeding self-efficacy (r = .226, p < .05). The predictive model for birth satisfaction was significant (R
2 = .204, F [6, 99] = 4.225, p = .001), explaining approximately 20.4% of variance in birth satisfaction in the sample.

Clinical Implications:

Stress reduction and management, establishment of realistic expectations for labor and birth, and promotion of togetherness with newborn immediately after birth are nursing priorities to promote birth satisfaction.
Life-Threatening and Suspicious Lesions Caused by Mechanical Cardiopulmonary Resuscitation
Authors: Milling Louise , Leth Peter Mygind , Astrup Birgitte Schmidt
Published: June 2017

Chest compression devices for mechanical cardiopulmonary resuscitation (CPR) have become more common. Here, we report the case of a young woman who attempted resuscitated with LUCAS™2 after she was found unconscious at home. At autopsy, we found extensive intramuscular hemorrhages in posterior neck, between the scapulae, and in the lumbar region. Investigation of internal organs showed injuries to the lung, spleen, and kidney. The extension of the injuries gave rise to suspicion of homicide by smothering, which police investigation subsequently did not support. The pattern of injury could be attributed to automatic compression decompression CPR with LUCAS™2.

The injuries may have been lethal had the patient survived. For the forensic pathologists, it is important to remain updated on developments in treatment techniques to avoid pitfalls when interpreting injury.

Larger studies, prospective or retrospective, may be able to qualify the possible risks of automatic compression decompression CPR even further.
Promoters and Barriers to Implementation of Tracheal Intubation Airway Safety Bundle: A Mixed-Method Analysis*
Authors: Finn Davis Katherine , Napolitano Natalie , Li Simon , Buffman Hayley , Rehder Kyle , Pinto Matthew , Nett Sholeen , Jarvis J. Dean , Kamat Pradip , Sanders Ronald C. , Turner David A. , Sullivan Janice E. , Bysani Kris , Lee Anthony , Parker Margaret , Adu-Darko Michelle , Giuliano John , Biagas Katherine , Nadkarni Vinay , Nishisaki Akira
Published: June 2017

Objectives:

To describe promoters and barriers to implementation of an airway safety quality improvement bundle from the perspective of interdisciplinary frontline clinicians and ICU quality improvement leaders.

Design:

Mixed methods.

Setting:

Thirteen PICUs of the National Emergency Airway Registry for Children network.

Intervention:

Remote or on-site focus groups with interdisciplinary ICU staff. Two semistructured interviews with ICU quality improvement leaders with quantitative and qualitative data-based feedbacks.

Measurements and Main Results:

Bundle implementation success (compliance) was defined as greater than or equal to 80% use for tracheal intubations for 3 consecutive months. ICUs were classified as early or late adopters. Focus group discussions concentrated on safety concerns and promoters and barriers to bundle implementation. Initial semistructured quality improvement leader interviews assessed implementation tactics and provided recommendations. Follow-up interviews assessed degree of acceptance and changes made after initial interview. Transcripts were thematically analyzed and contrasted by early versus late adopters. Median duration to achieve success was 502 days (interquartile range, 182–781). Five sites were early (median, 153 d; interquartile range, 146–267) and eight sites were late adopters (median, 783 d; interquartile range, 773–845). Focus groups identified common “promoter” themes—interdisciplinary approach, influential champions, and quality improvement bundle customization—and “barrier” themes—time constraints, competing paperwork and quality improvement activities, and poor engagement. Semistructured interviews with quality improvement leaders identified effective and ineffective tactics implemented by early and late adopters. Effective tactics included interdisciplinary quality improvement team involvement (early adopter: 5/5, 100% vs late adopter: 3/8, 38%; p = 0.08); ineffective tactics included physician-only rollouts, lack of interdisciplinary education, lack of data feedback to frontline clinicians, and misconception of bundle as research instead of quality improvement intervention.

Conclusions:

Implementation of an airway safety quality improvement bundle with high compliance takes a long time across diverse ICUs. Both early and late adopters identified similar promoter and barrier themes. Early adopter sites customized the quality improvement bundle and had an interdisciplinary quality improvement team approach.
Severe Upper Airway Obstruction After Intraoperative Transesophageal Echocardiography in Pediatric Cardiac Surgery: A Retrospective Analysis*
Authors: Michel Jörg , Hofbeck Michael , Schineis Christian , Kumpf Matthias , Heimberg Ellen , Magunia Harry , Schmid Eckhard , Schlensak Christian , Blumenstock Gunnar , Neunhoeffer Felix
Published: June 2017

Objectives:

The aim of this study was to evaluate if there is a correlation between the use of intraoperative transesophageal echocardiography and an increased rate of extubation failure and to find other risk factors for severe upper airway obstructions after pediatric cardiac surgery.

Design:

Retrospective analysis.

Setting:

Cardiac PICU.

Patients:

Patients 24 months old or younger who underwent surgery for congenital heart disease with cardiopulmonary bypass were retrospectively enrolled and divided into two groups depending on whether they received an intraoperative transesophageal echocardiography or not. We analyzed all cases of early reintubations within 12 hours after extubation due to a documented upper airway obstruction.

Intervention:

None.

Measurements and Main Results:

From a total of 424 patients, 12 patients (2.8%) met our criteria of early reintubation due to upper airway obstruction. Ten of 207 children in the transesophageal echocardiography group had to be reintubated, whereas only two of the 217 children in the control group had to be reintubated (4.8% vs 0.9%; p = 0.018). Logistic regression analysis showed a significant correlation between use of intraoperative transesophageal echocardiography and extubation failure (odds ratio, 5.64; 95% CI, 1.18–27.05; p = 0.030). There was no significant relationship among sex (odds ratio, 4.53; 95% CI, 0.93–22.05; p = 0.061), weight (odds ratio, 1.07; 95% CI, 0.82–1.40; p = 0.601), duration of surgery (odds ratio, 1.04; 95% CI, 0.74–1.44; p = 0.834), duration of mechanical ventilation (odds ratio, 1.00; 95% CI, 0.99–1.00; p = 0.998), and occurrence of trisomy 21 (odds ratio, 3.47; 95% CI, 0.83–14.56; p = 0.089).

Conclusions:

Although the benefits of intraoperative transesophageal echocardiography during pediatric cardiac surgery are undisputed, it may be one factor which could increase the rate of severe upper airway obstruction after extubation with the need for reintubation. We suggest to take precautions before extubating high-risk patients, especially in young male children with genetic abnormalities after cardiac surgery with cardiopulmonary bypass.
Workload of Team Leaders and Team Members During a Simulated Sepsis Scenario
Authors: Tofil Nancy M. , Lin Yiqun , Zhong John , Peterson Dawn Taylor , White Marjorie Lee , Grant Vincent , Grant David J. , Gottesman Ronald , Sudikoff Stephanie N. , Adler Mark , Marohn Kimberly , Davidson Jennifer , Cheng Adam
Published: June 2017

Objectives:

Crisis resource management principles dictate appropriate distribution of mental and/or physical workload so as not to overwhelm any one team member. Workload during pediatric emergencies is not well studied. The National Aeronautics and Space Administration-Task Load Index is a multidimensional tool designed to assess workload validated in multiple settings. Low workload is defined as less than 40, moderate 40–60, and greater than 60 signify high workloads. Our hypothesis is that workload among both team leaders and team members is moderate to high during a simulated pediatric sepsis scenario and that team leaders would have a higher workload than team members.

Design:

Multicenter observational study.

Setting:

Nine pediatric simulation centers (five United States, three Canada, and one United Kingdom).

Patients:

Team leaders and team members during a 12-minute pediatric sepsis scenario.

Interventions:

National Aeronautics and Space Administration-Task Load Index.

Measurements and Main Results:

One hundred twenty-seven teams were recruited from nine sites. One hundred twenty-seven team leaders and 253 team members completed the National Aeronautics and Space Administration-Task Load Index. Team leader had significantly higher overall workload than team member (51 ± 11 vs 44 ± 13; p < 0.01). Team leader had higher workloads in all subcategories except in performance where the values were equal and in physical demand where team members were higher than team leaders (29 ± 22 vs 18 ± 16; p < 0.01). The highest category for each group was mental 73 ± 13 for team leader and 60 ± 20 for team member. For team leader, two categories, mental (73 ± 17) and effort (66 ± 16), were high workload, most domains for team member were moderate workload levels.

Conclusions:

Team leader and team member are under moderate workloads during a pediatric sepsis scenario with team leader under high workloads (> 60) in the mental demand and effort subscales. Team leader average significantly higher workloads. Consideration of decreasing team leader responsibilities may improve team workload distribution.
Kinematic Gait Changes Following Serial Casting and Bracing to Treat Toe Walking in a Child With Autism
Authors: Barkocy Marybeth , Dexter James , Petranovich Colleen
Published: June 2017

Purpose:

To evaluate the effectiveness of serial casting in a child with autism spectrum disorder (ASD) exhibiting a toe-walking gait pattern with equinus contractures.

Summary of Key Points:

Although many children with ASD toe walk, little research on physical therapy interventions exists for this population. Serial casting has been validated for use in idiopathic toe walking to increase passive dorsiflexion and improve gait, but not for toe walking in children with ASD. Serial casting followed by ankle-foot orthosis use was implemented to treat a child with ASD who had an obligatory equinus gait pattern. Gait analysis supported improvements in kinematic, spatial, and temporal parameters of gait, and the child maintained a consistent heel-toe gait at 2-year follow-up.

Statement of Conclusion and Recommendations for Clinical Practice:

Serial casting followed by ankle-foot orthosis use is a viable treatment option for toe walking in children with ASD.
A Progressive Running Program for an Adolescent With Cerebral Palsy
Authors: Lewis Jessica
Published: June 2017

Purpose:

To describe the physical therapy intervention and outcomes for a 20-week progressive running program.

Summary of Key Points:

A 12-year-old boy with spastic diplegic cerebral palsy, Gross Motor Function Classification System level II, participated in a 20-week running program. The 6-minute walk test and the 88-item and 66-item versions of the Gross Motor Function Measure (GMFM) were administered at baseline and program completion. After completion of the program, the participant exceeded thresholds for minimally clinically important differences on the GMFM-66 total score and GMFM-88 Dimension D and E scores. He improved gait speed and distance walked during the 6-minute walk test.

Conclusions and Recommendations for Clinical Practice:

Participation in a progressive running program is a feasible intervention to promote improvements in walking speed and gross motor function in some adolescents with spastic diplegic cerebral palsy in Gross Motor Function Classification System level II.