bluuebunny/crossref_metadata_2025 huggingface dataset:
International health IT benchmarking: learning from cross-country comparisons
Authors: Zelmer Jennifer , Ronchi Elettra , Hyppönen Hannele , Lupiáñez-Villanueva Francisco , Codagnone Cristiano , Nøhr Christian , Huebner Ursula , Fazzalari Anne , Adler-Milstein Julia
Published: August 2016

Objective: To pilot benchmark measures of health information and communication technology (ICT) availability and use to facilitate cross-country learning.

Materials and Methods: A prior Organization for Economic Cooperation and Development–led effort involving 30 countries selected and defined functionality-based measures for availability and use of electronic health records, health information exchange, personal health records, and telehealth. In this pilot, an Organization for Economic Cooperation and Development Working Group compiled results for 38 countries for a subset of measures with broad coverage using new and/or adapted country-specific or multinational surveys and other sources from 2012 to 2015. We also synthesized country learnings to inform future benchmarking.

Results: While electronic records are widely used to store and manage patient information at the point of care—all but 2 pilot countries reported use by at least half of primary care physicians; many had rates above 75%—patient information exchange across organizations/settings is less common. Large variations in the availability and use of telehealth and personal health records also exist.

Discussion: Pilot participation demonstrated interest in cross-national benchmarking. Using the most comparable measures available to date, it showed substantial diversity in health ICT availability and use in all domains. The project also identified methodological considerations (e.g., structural and health systems issues that can affect measurement) important for future comparisons.

Conclusion: While health policies and priorities differ, many nations aim to increase access, quality, and/or efficiency of care through effective ICT use. By identifying variations and describing key contextual factors, benchmarking offers the potential to facilitate cross-national learning and accelerate the progress of individual countries.
Team Mentoring for Interdisciplinary Team Science: Lessons From K12 Scholars and Directors
Authors: Guise Jeanne-Marie , Geller Stacie , Regensteiner Judith G. , Raymond Nancy , Nagel Joan
Published: August 2016

Purpose

Mentoring is critical for academic success. As science transitions to a team science model, team mentoring may have advantages. The goal of this study was to understand the process, benefits, and challenges of team mentoring relating to career development and research.

Method

A national survey was conducted of Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) program directors—current and former scholars from 27 active National Institutes of Health (NIH)-funded BIRCWH NIH K12 programs—to characterize and understand the value and challenges of the team approach to mentoring. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically.

Results

Responses were received from 25/27 (93%) program directors, 78/108 (72%) current scholars, and 91/162 (56%) former scholars. Scholars reported that team mentoring was beneficial to their career development (152/169; 90%) and research (148/169; 88%). Reported advantages included a diversity of opinions, expanded networking, development of stronger study designs, and modeling of different career paths. Challenges included scheduling and managing conflicting opinions. Advice by directors offered to junior faculty entering team mentoring included the following: not to be intimidated by senior mentors, be willing to navigate conflicting advice, be proactive about scheduling and guiding discussions, have an open mind to different approaches, be explicit about expectations and mentors’ roles (including importance of having a primary mentor to help navigate discussions), and meet in person as a team.

Conclusions

These findings suggest that interdisciplinary/interprofessional team mentoring has many important advantages, but that skills are required to optimally utilize multiple perspectives.
Closing the Health Care Gap in Communities: A Safety Net System Approach
Authors: Gabow Patricia A.
Published: August 2016

The goal of U.S. health care should be good health for every American. This daunting goal will require closing the health care gap in communities with a particular focus on the most vulnerable populations and the safety net institutions that disproportionately serve these communities. This Commentary describes Denver Health’s (DH’s) two-pronged approach to achieving this goal: (1) creating an integrated system that focuses on the needs of vulnerable populations, and (2) creating an approach for financial viability, quality of care, and employee engagement. The implementation and outcomes of this approach at DH are described to provide a replicable model. An integrated delivery system serving vulnerable populations should go beyond the traditional components found in most integrated health systems and include components such as mental health services, school-based clinics, and correctional health care, which address the unique and important needs of, and points of access for, vulnerable populations. In addition, the demands that a safety net system experiences from an open-door policy on access and revenue require a disciplined approach to cost, quality of care, and employee engagement. For this, DH chose Lean, which focuses on reducing waste to respect the patients and employees within its health system, as well as all citizens. DH’s Lean effort produced almost $195 million of financial benefit, impressive clinical outcomes, and high employee engagement. If this two-pronged approach were widely adopted, health systems across the United States would improve their chances of giving better care at costs they can afford for every person in society.
Depression Moderates the Relationship Between Pain and the Nonmedical Use of Opioid Medication Among Adult Outpatients
Authors: Mason Michael J. , Golladay Gregory , Jiranek William , Cameron Brian , Silverman Joel J. , Zaharakis Nikola M. , Plonski Paul
Published: August 2016

Background:

The nonmedical use of prescription medication among US adults is a growing public health problem. Healthcare providers should proactively address this problem in outpatient encounters.

Objective:

We sought to understand the interactive effects among prescription drugs, pain, and psychiatric symptoms among adult outpatients to build an empirical foundation for comprehensive screening.

Methods:

We screened 625 adult neurosurgery and orthopedic patients at a suburban satellite clinic of an urban academic medical center. A convenience sample was screened for psychiatric and substance use disorder symptoms using the American Psychiatric Association's recommended screening protocol. We tested whether psychiatric symptoms moderated the relationship between pain level and nonmedical use of prescription medicine.

Results:

Patients reported average levels of depression, anxiety, and pain symptoms, within 1 standard deviation of the screeners’ normative data. However, patients reported highly elevated levels of nonmedical use of opioids and benzodiazapines compared with national data. Controlling for age, sex, and race, pain level predicted nonprescription use of opioid and benzodiazapine medications. Patients with high levels of depression and pain were more likely to engage in the unprescribed use of opioids. Likewise, patients with reduced levels of depression and pain were protected against the unprescribed use of opioids.

Conclusions:

These findings highlight the importance of examining unprescribed medication use even with patients at moderate levels of psychiatric symptoms and pain.
Impact of Hearing Aid Technology on Outcomes in Daily Life II: Speech Understanding and Listening Effort
Authors: Johnson Jani A. , Xu Jingjing , Cox Robyn M.
Published: August 2016

Objectives:

Modern hearing aid (HA) devices include a collection of acoustic signal-processing features designed to improve listening outcomes in a variety of daily auditory environments. Manufacturers market these features at successive levels of technological sophistication. The features included in costlier premium hearing devices are designed to result in further improvements to daily listening outcomes compared with the features included in basic hearing devices. However, independent research has not substantiated such improvements. This research was designed to explore differences in speech-understanding and listening-effort outcomes for older adults using premium-feature and basic-feature HAs in their daily lives.

Design:

For this participant-blinded, repeated, crossover trial 45 older adults (mean age 70.3 years) with mild-to-moderate sensorineural hearing loss wore each of four pairs of bilaterally fitted HAs for 1 month. HAs were premium- and basic-feature devices from two major brands. After each 1-month trial, participants’ speech-understanding and listening-effort outcomes were evaluated in the laboratory and in daily life.

Results:

Three types of speech-understanding and listening-effort data were collected: measures of laboratory performance, responses to standardized self-report questionnaires, and participant diary entries about daily communication. The only statistically significant superiority for the premium-feature HAs occurred for listening effort in the loud laboratory condition and was demonstrated for only one of the tested brands.

Conclusions:

The predominant complaint of older adults with mild-to-moderate hearing impairment is difficulty understanding speech in various settings. The combined results of all the outcome measures used in this research suggest that, when fitted using scientifically based practices, both premium- and basic-feature HAs are capable of providing considerable, but essentially equivalent, improvements to speech understanding and listening effort in daily life for this population. For HA providers to make evidence-based recommendations to their clientele with hearing impairment it is essential that further independent research investigates the relative benefit/deficit of different levels of hearing technology across brands and manufacturers in these and other real-world listening domains.
Missing Data in the Field of Otorhinolaryngology and Head & Neck Surgery: Need for Improvement
Authors: Netten Anouk P. , Dekker Friedo W. , Rieffe Carolien , Soede Wim , Briaire Jeroen J. , Frijns Johan H. M.
Published: August 2016

Objective:

Clinical studies are often facing missing data. Data can be missing for various reasons, for example, patients moved, certain measurements are only administered in high-risk groups, and patients are unable to attend clinic because of their health status. There are various ways to handle these missing data (e.g., complete cases analyses, mean substitution). Each of these techniques potentially influences both the analyses and the results of a study. The first aim of this structured review was to analyze how often researchers in the field of otorhinolaryngology/head & neck surgery report missing data. The second aim was to systematically describe how researchers handle missing data in their analyses. The third aim was to provide a solution on how to deal with missing data by means of the multiple imputation technique. With this review, we aim to contribute to a higher quality of reporting in otorhinolaryngology research.

Design:

Clinical studies among the 398 most recently published research articles in three major journals in the field of otorhinolaryngology/head & neck surgery were analyzed based on how researchers reported and handled missing data.

Results:

Of the 316 clinical studies, 85 studies reported some form of missing data. Of those 85, only a small number (12 studies, 3.8%) actively handled the missingness in their data. The majority of researchers exclude incomplete cases, which results in biased outcomes and a drop in statistical power.

Conclusions:

Within otorhinolaryngology research, missing data are largely ignored and underreported, and consequently, handled inadequately. This has major impact on the results and conclusions drawn from this research. Based on the outcomes of this review, we provide solutions on how to deal with missing data. To illustrate, we clarify the use of multiple imputation techniques, which recently became widely available in standard statistical programs.
Screening, Education, and Rehabilitation Services for Hearing Loss Provided to Clients with Low Vision: Measured and Perceived Value Among Participants of the Vision-Hearing Project
Authors: McMahon Catherine M. , Schneider Julie , Dunsmore Moira , Gopinath Bamini , Kifley Annette , Mitchell Paul , Wang Jie-Jin , Leeder Stephen R.
Published: August 2016

Objectives:

Combined vision and hearing impairment, termed dual sensory impairment (DSI), is associated with poorer health outcomes compared with a single sensory loss alone. Separate systems of care exist for visual and hearing impairment which potentially limit the effectiveness of managing DSI. To address this, a Hearing Screening Education Model (HSEM) was offered to older adults attending a low-vision clinic in Australia within this pilot study. The present study aimed to evaluate the benefits of seeking help on hearing handicap, self-perceived health, and use of community services among those identified with unmet hearing needs after participation in the HSEM.

Design:

Of 210 older adults (>55 years of age) who completed the HSEM and were referred for follow-up, 169 returned for a follow-up interview at least 12 months later. Of these, 68 (40.2%) sought help, and the majority were seen by a hearing healthcare provider (89.7%). Changes in hearing handicap, quality of life, and reliance on community services between the baseline and 12-month follow-up were compared between those who sought help and those who did not. In addition, the perceived value of the HSEM was assessed.

Results:

Results showed that there was no significant difference in hearing handicap between those who sought help (mean change −1.02 SD = 7.97, p = 0.3) and those who did not (mean change 0.94 SD = 7.68, p = 0.3), p = 0.18. The mental component of the SF-36 worsened significantly between baseline and follow-up measures across the whole group (mean change −2.49 SD = 9.98, p = 0.002). This was largely driven by those not seeking help, rather than those seeking help, but was not significantly different between the two groups. Those who sought help showed a significant reduction in the use of community services compared with those who did not. Further, all participants positively viewed the HSEM’s underlying principle of greater integration between vision and hearing services.

Conclusions:

These findings suggest a need to further develop and evaluate integrated models of healthcare for older adults with DSI. It also highlights the importance of using broader measures of benefit, other than use of hearing aids to evaluate outcomes of hearing healthcare programs.
The Benefits of Increased Sensation Level and Bandwidth for Spatial Release From Masking
Authors: Jakien Kasey M. , Kampel Sean D. , Gordon Samuel Y. , Gallun Frederick J.
Published: August 2016

Objective:

Spatial release from masking (SRM) can increase speech intelligibility in complex listening environments. The goal of the present study was to document how speech-in-speech stimuli could be best processed to encourage optimum SRM for listeners who represent a range of ages and amounts of hearing loss. We examined the effects of equating stimulus audibility among listeners, presenting stimuli at uniform sensation levels (SLs), and filtering stimuli at two separate bandwidths.

Design:

Seventy-one participants completed two speech intelligibility experiments (36 listeners in experiment 1; all 71 in experiment 2) in which a target phrase from the coordinate response measure (CRM) and two masking phrases from the CRM were presented simultaneously via earphones using a virtual spatial array, such that the target sentence was always at 0 degree azimuth angle and the maskers were either colocated or positioned at ±45 degrees. Experiments 1 and 2 examined the impacts of SL, age, and hearing loss on SRM. Experiment 2 also assessed the effects of stimulus bandwidth on SRM.

Results:

Overall, listeners’ ability to achieve SRM improved with increased SL. Younger listeners with less hearing loss achieved more SRM than older or hearing-impaired listeners. It was hypothesized that SL and bandwidth would result in dissociable effects on SRM. However, acoustical analysis revealed that effective audible bandwidth, defined as the highest frequency at which the stimulus was audible at both ears, was the best predictor of performance. Thus, increasing SL seemed to improve SRM by increasing the effective bandwidth rather than increasing the level of already audible components.

Conclusions:

Performance for all listeners, regardless of age or hearing loss, improved with an increase in overall SL and/or bandwidth, but the improvement was small relative to the benefits of spatial separation.
Gender Identification Using High-Frequency Speech Energy: Effects of Increasing the Low-Frequency Limit
Authors: Donai Jeremy J. , Halbritter Rachel M.
Published: August 2016

Objective:

The purpose of this study was to investigate the ability of normal-hearing listeners to use high-frequency energy for gender identification from naturally produced speech signals.

Design:

Two experiments were conducted using a repeated-measures design. Experiment 1 investigated the effects of increasing high-pass filter cutoff (i.e., increasing the low-frequency spectral limit) on gender identification from naturally produced vowel segments. Experiment 2 studied the effects of increasing high-pass filter cutoff on gender identification from naturally produced sentences. Confidence ratings for the gender identification task were also obtained for both experiments.

Results:

Listeners in experiment 1 were capable of extracting talker gender information at levels significantly above chance from vowel segments high-pass filtered up to 8.5 kHz. Listeners in experiment 2 also performed above chance on the gender identification task from sentences high-pass filtered up to 12 kHz.

Conclusions:

Cumulatively, the results of both experiments provide evidence that normal-hearing listeners can utilize information from the very high-frequency region (above 4 to 5 kHz) of the speech signal for talker gender identification. These findings are at variance with current assumptions regarding the perceptual information regarding talker gender within this frequency region. The current results also corroborate and extend previous studies of the use of high-frequency speech energy for perceptual tasks. These findings have potential implications for the study of information contained within the high-frequency region of the speech spectrum and the role this region may play in navigating the auditory scene, particularly when the low-frequency portion of the spectrum is masked by environmental noise sources or for listeners with substantial hearing loss in the low-frequency region and better hearing sensitivity in the high-frequency region (i.e., reverse slope hearing loss).
Indices of Effortful Listening Can Be Mined from Existing Electroencephalographic Data
Authors: Wisniewski Matthew G.
Published: August 2016

Objectives:

Studies suggest that theta (~4 to 7 Hz), alpha (~8 to 12 Hz), and stimulus-evoked dynamics of the electroencephalogram index effortful listening. Numerous auditory event-related potential datasets exist, without thorough examination of these features. The feasibility of mining those datasets for such features is assessed here.

Design:

In a standard auditory-oddball paradigm, 12 listeners heard deviant high-frequency tones (10%) interspersed among low-frequency tones (90%) “near” or “far” separated in frequency.

Results:

During active listening (deviance detection; experiment 1), sustained frontal midline theta power, and gamma-band inter-trial phase coherence, were greater for the near condition. No significant “near”/“far” differences were observable during passive exposure to the same sounds (experiment 2).

Conclusions:

Increased theta power likely reflects increased utilization of cognitive-control processes (e.g., working memory) that rely on frontal cortical networks. Inter-trial phase coherence differences may reflect differences in attention-modulated stimulus encoding. Reanalysis of existing datasets can usefully inform future work on listening effort.
Neurovascular injury in acute knee dislocation: evaluation of an algorithm for selective arteriography
Authors: Roberson Troy A. , Throckmorton Thomas W. , Miller Robert H. , Smith Richard A. , Azar Frederick M.
Published: August 2016

Background:

The role of arteriography in acute knee dislocations has evolved from routine use to most authors advocating selective arteriography. Further refining and education are necessary to identify patients at increased risk of popliteal artery injury and avoid missing serious injuries while at the same time avoiding unnecessary arteriography. Our hypothesis was that selective arteriography algorithm would identify all flow-limiting popliteal artery injuries, and patients with a body mass index (BMI) over 40 will have higher rates of popliteal artery and peroneal nerve injuries than nonobese patients.

Methods:

Fifty-three patients treated for an acute knee dislocation over a 5-year period (2007-2012) were included. Patients with a normal neurovascular examination or ankle-brachial indices (ABI) greater than 0.9 were clinically observed. Those with abnormal ABI (<0.9) but palpable pulses had an arteriogram at the discretion of the attending physician, while patients with pulse discrepancy compared to the contralateral side had arteriography. Missed injuries were defined as worsening clinical examination resulting in further diagnostic evidence of vascular injury prior to discharge.

Results:

The rate of popliteal artery injury was 17% (9 of 53) and peroneal nerve injury 38% (20 of 53). There were no missed vascular injuries using the selective arteriography algorithm. Morbid obesity (BMI>40) was significantly associated with popliteal artery injury and the mean BMI was significantly higher (40 vs. 33) in patients with popliteal artery injury. Time to reduction of more than 6 hr trended toward association with popliteal artery injury while transfer from another facility was not significant. Falls from a standing height were not significantly associated with popliteal artery injury, while peroneal nerve injury was significantly higher with this ultra-low-velocity mechanism.

Conclusions:

There were no missed vascular injuries with the use of a selective arteriography algorithm. Morbid obesity and an ultra-low-velocity mechanism were associated with an increased risk of neurovascular injury in acute knee dislocations, but arteriography was not found to be mandatory in this population.
Efficiency and Safety of an Early Dose Adjustment of Ribavirin in Patients Infected With Hepatitis C Underexposed to the Drug and Treated With Peginterferon Ribavirin
Authors: Loustaud-Ratti Véronique , Maynard Marianne , Thevenon Sylvie , Pradat Pierre , Rousseau Annick , Alain Sophie , Deny Paul , Gagnieu Marie-Claude , Tran Albert , Dao Thông , Silvain Christine , Lunel-Fabiani Françoise , Picard Nicolas , Zublena Irène , Marquet Pierre , Trepo Christian ,   the RIBAJUSTE Group
Published: August 2016

Background:

Ribavirin exposure after the first dose (D0AUC0–4h) >1755 mcg·h−1·L−1 is predictive of sustained virological response (SVR) in patients with hepatitis C treated with peginterferon and ribavirin. The aim of this study was to test the benefit of ribavirin early dose adjustment based on this target in naïve patients infected with genotype 1.

Methods:

A multicenter randomized controlled trial with two parallel groups; fixed-dose (FD) group: standard of care in 2010–2011, ie, peginterferon-α2a 180 mcg·wk−1 and weight-based ribavirin 1000–1200 mg/d during 48 weeks; adapted-dose (AD) group: increase of ribavirin dose if D0AUC0–4h <1755 mcg·h−1·L−1.

Results:

A total of 221 patients were included, 110 in the AD group and 111 in the FD group with similar baseline characteristics. In the perprotocol analysis, SVR was higher in the AD group (55.1% versus 40.4%; P = 0.042), especially in patients with D0AUC0–4h <1755 mcg·h−1·L−1 (54.3% versus 31.9%; P = 0.029). In the intention-to-treat analysis, the difference was not significant (50% versus 41%; P = 0.197). Ribavirin trough concentrations (C0s) at week 4 of treatment (intention-to-treat analysis) were higher in patients achieving SVR (2.06 versus 1.72 mg/L, P = 0.003). In the subgroup of patients with AUC0–4h <1755 mcg·h−1·L−1, 46% of patients with AD achieved a C0 >2.0 mg/L versus 22% of patients with FD (P = 0.013). Grade 1 anemia (but not other grades) was more frequent in the AD group (70% versus 48%, P = 0.001). The number of dose reductions or discontinuation of ribavirin was similar in both groups.

Conclusions:

Early ribavirin dose adjustment increases SVR in patients underexposed to ribavirin without increasing grade II-IV anemia. Such a strategy could be useful in patients with no access to new antiviral drugs.
Dosage Adjustment of Dabigatran Etexilate Based on Creatinine Clearance in Patients With Cardioembolic Stroke or Atrial Fibrillation
Authors: Matsuda Shohei , Imazu Tomoko , Kimura Ryuji , Nakamura Mamoru , Matsumoto Atsushi , Murakami Teruo , Maeda Yorinobu
Published: August 2016

Background:

A recommendation for dosage adjustment of dabigatran etexilate, a prodrug of dabigatran, seems to be desirable based on creatinine clearance to avoid bleeding and stroke.

Methods:

Outpatients and inpatients having a history of cardioembolic stroke or atrial fibrillation were included. After taking dabigatran etexilate orally (75–150 mg twice daily) for at least 1 week, plasma trough concentration (Ctrough, ng/mL) of dabigatran and creatinine clearance (CLcr, mL/min) of patients according to Cockcroft and Gault equation were determined.

Results:

Among the 38 patients studied, Ctrough of dabigatran and CLcr were scattered in a range from 31.4 to 329.5 ng/mL and 15.4–133.4 mL/min, respectively. Temporal CLtotal (Temp-CLtotal) of dabigatran, estimated by dividing the daily absorbed amount of dabigatran etexilate with Ctrough of dabigatran, was linearly correlated with CLcr of patients (P = 0.0018). Based on the findings, the daily dose of dabigatran etexilate that provides Ctrough of dabigatran at approximately 70 ng/mL was estimated.

Conclusions:

A linear relationship was found between Temp-CLtotal of dabigatran and CLcr of patients. Depending on CLxr of patients, we recommend 4 different dosages of dabigatran etexilate to obtain Ctrough of dabigatran at approximately 70 ng/mL.
ACUTE MACULAR NEURORETINOPATHY AFTER RANIBIZUMAB INJECTION IN A DIABETIC PATIENT
Authors: Wheatley H. Matthew , Sarraf David
Published: August 2016

Purpose:

To report a case of acute macular neuroretinopathy occurring after intravitreal ranibizumab injection for diabetic macular edema.

Methods:

Observational clinical case report.

Results:

The patient received an intravitreal ranibizumab (0.3 mg) injection for diabetic macular edema. Three days later, he had a decline in vision associated with a central and paracentral scotoma. Optical coherence tomography (OCT) demonstrated bandlike hyperreflectivity of the outer nuclear and plexiform layers corresponding to the patient's scotoma, consistent with the diagnosis of acute macular neuroretinopathy. There was spontaneous resolution of the abnormalities observed in optical coherence tomography, but only partial resolution of the scotoma was observed 4 months after presentation.

Conclusion:

Diabetic retinopathy may be associated with acute macular neuroretinopathy. The temporal relationship between ranibizumab injection and the onset of acute macular neuroretinopathy in this case report raises the possibility of a causal relationship.
Visual Outcome and Patient Satisfaction of Low-Power-Added Multifocal Intraocular Lens
Authors: Kim Kyeong Hwan , Kim Wan Soo
Published: August 2016

Purpose:

To evaluate visual outcome and patient satisfaction following implantation of multifocal intraocular lenses (IOLs) with a +1.5 diopters (D) addition compared with monofocal IOLs.

Methods:

This prospective, nonrandomized, comparative case series involved 48 eyes (24 patients) who underwent cataract surgery with implantation of low-power-added multifocal IOLs (LS313-MF15; multifocal group) and 48 eyes (24 patients) with conventional monofocal IOLs (CTS204; monofocal group). Visual acuity (VA), defocus curves, refraction, contrast sensitivity, glare, ocular optical quality, and scores in questionnaire were assessed 6 months postoperatively.

Results:

Uncorrected VA at intermediate and near distance tended to be better in the multifocal group, with significant differences at 50 cm (P=0.03). The defocus curve showed significantly different VA at vergences of −1.5 and −2.0 D (P=0.02 and P=0.03, respectively). Results of postoperative refraction, contrast sensitivity, glare, and optical quality were similar (P>0.05), although coma-like aberration was higher in the multifocal group (P=0.04). Despite of similar levels of visual disturbances (P>0.05), disturbances in activities and spectacle use at intermediate working distance were significantly less frequent in the multifocal group (P=0.03 and P=0.04, respectively). Multifocal group showed significantly greater overall satisfaction (P=0.02).

Conclusions:

Low-power-added multifocal IOLs yielded better intermediate and near vision without increasing optical phenomena compared with monofocal IOLs.
Differences in Ocular Blood Flow Between People of African and European Descent With Healthy Eyes
Authors: Kaskan Betül , Ramezani Koosha , Harris Alon , Siesky Brent , Olinde Carine , WuDunn Darrell , Eikenberry Jennifer , Tobe Leslie A. , Racette Lyne
Published: August 2016

Purpose:

To investigate differences in ocular blood flow between people of African descent (AD) and European descent (ED) with healthy eyes.

Materials and Methods:

Retrobulbar and retinal capillary blood flow was assessed in 1 eye of 58 participants (24 AD, 34 ED) with healthy eyes with systemic blood pressure lower than 140/90. Retrobulbar blood flow was measured in the ophthalmic artery (OA), central retinal artery (CRA), nasal posterior ciliary artery (NPCA) and temporal posterior ciliary artery (TPCA). Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were assessed. Retinal capillary blood flow was assessed using mean retinal flow and avascular space defined as the percent of area measured with no blood flow. Groups were compared using t tests and Pearson correlations were compared using Fisher r-to-z transformation.

Results:

Compared with people of ED, people of AD had significantly lower EDV in the NPCA (P=0.01), and higher RI in the CRA (P=0.04) and TPCA (P=0.01). No significant differences were observed in mean retinal capillary flow or avascular area. In the CRA, a significant negative correlation was observed between pattern standard deviation and peak systolic velocity (P=0.02) in the AD group and this correlation was significantly different from that observed in the ED group (P=0.01). A significant correlation was also observed between pattern standard deviation and EDV (0.04) in the AD group.

Conclusions:

This study suggests that retrobulbar blood flow is lower in healthy eyes in persons of AD compared with ED. This may provide a mechanism through which people of AD are at increased risk for ophthalmic diseases such as glaucoma.
Comprehensive systematic review of long-term opioids in women with chronic noncancer pain and associated reproductive dysfunction (hypothalamic–pituitary–gonadal axis disruption)
Authors: Wersocki Emily , Bedson John , Chen Ying , LeResche Linda , Dunn Kate M.
Published: August 2016

A comprehensive systematic literature review of reproductive side effects in women aged 18 to 55 years treated with opioids for 1 month or longer for chronic noncancer pain. A search of 7 databases including EMBASE and Medline was undertaken (October 2014 and a limited rerun April 2016). The search contained key words for opioids (generic and specific drug names) and side effects (generic and specific reproductive). Titles were screened using predefined criteria by a single reviewer and abstracts and full texts by 2 independent reviewers. A total of 10,684 articles were identified and 12 full texts (cohort [n = 1], case–control [n = 4], cross-sectional [n = 4], case series [n = 1], and case report [n = 2] with a maximum of 41 cases in 1 article) were included covering 3 different modes of administration: oral (n = 6), intrathecal (n = 5), and transdermal (n = 1). Amenorrhoea occurred in 23% to 71% of those receiving oral or intrathecal opioids. Decreased libido was seen in 61% to 100%. Of the 10 studies that undertook hormonal assays, only 2 studies showed a statistically significant decrease in hormone levels. This review supports the view that there is a potential relationship between the use of long-term opioids in women and reproductive side effects. The evidence is however weak and the mode of administration, duration, type, and dose of opioid might influence associations. Although hormone levels were statistically significant in only 2 studies, women exhibited clinically important symptoms (decreased libido and altered menstrual cycle). Further investigation is required with larger cohorts and analysis of different delivery methods.
Vulvar Concerns in Women With a History of Abdominoplasty: A Case Series
Authors: Whitis Avery , Elas Diane E. , O'Shea Andrea , Stockdale Colleen K.
Published: August 2016

Objectives

The aim of the study was to present a series of women with a history of traditional abdominoplasty or circumferential abdominoplasty (belt lipectomy) with vulvar concerns and anatomic changes.

Methods

We describe 5 women with a history of abdominoplasty who were referred with symptoms of vulvar pain, dyspareunia, lower urinary tract symptoms, and/or lesion/mass. Physical examination revealed elevation of the clitoris on the pubic symphysis with or without retraction of the clitoral hood in each.

Results

Abdominoplasty can result in anatomic changes to the female pubic region after elevation of the mons pubis and consequent elevation of the clitoris with or without retraction of the clitoral hood. Although causation cannot be confirmed from this series, a temporal association of vulvar/clitoral pain, pelvic floor dysfunction, and anatomic alterations with or without lesions after abdominoplasty was present in each case.

Conclusions

Awareness regarding potential sequelae from anatomic alteration may lead to improved patient counseling and modified surgical techniques to avoid significant elevation of the mons pubis and vulvar commissure.
The “Central Sport Model”: Extracorporeal Membrane Oxygenation Using the Innominate Artery for Smaller Patients as Bridge to Lung Transplantation
Authors: Chicotka Scott , Rosenzweig Erika B. , Brodie Daniel , Bacchetta Matthew
Published: August 2016

Venoarterial extracorporeal membrane oxygenation (VA ECMO) may be used in patients with advanced cardiac or pulmonary failure. Arterial cannulation via the femoral arteries is suboptimal in many clinical scenarios because of associated complications and the potential for differential hypoxemia between the upper and lower body. To address these concerns, we typically use an upper body configuration (sport model) with right internal jugular and axillary or subclavian artery cannulation to allow a safe and durable means of providing VA ECMO support without differential hypoxemia. Unfortunately, this approach may not be feasible in smaller patients, whose vessels may preclude optimal use of the axillary or subclavian arteries and in those with systemic vasculopathy associated with connective tissue disorders. We describe a new approach for patients of small stature using the innominate artery through a mini-upper sternotomy in seven patients.
Associations of Preimplant Red Blood Cell Distribution Width with Clinical Outcomes Among Individuals with Left Ventricular Assist Devices
Authors: Miller P. Elliott , Houston Brian A. , Schneider Andrea L. C. , Bush Aaron L. , Whitman Glenn J. , Stevens Gerin R. , Tedford Ryan J. , Russell Stuart D.
Published: August 2016

Left ventricular assist devices (LVADs) are increasingly used for end-stage heart failure. However, post-LVAD complications are potentially devastating and remain unpredictable. The red blood cell distribution width (RDW) is a predictor of adverse events in patients with heart failure but has not been studied in the LVAD population. We reviewed laboratory results and clinical outcomes for all continuous flow LVADs implanted from 2004 to June 2014 (N = 188). Cox proportional hazards models adjusted for demographic, cardiovascular, and laboratory variables were used to assess association of preimplant RDW tertiles with mortality, gastrointestinal bleed, infection, pump thrombosis, and stroke more than 1 year of follow-up. Compared with the lowest tertile (RDW < 15.7%), the higher two tertiles (RDW 15.7–18% and RDW >18.1%) had significantly higher risks of mortality (hazard ratio (HR) 6.95 [confidence interval: 2.67–18.10] and HR 4.61 [1.74–12.21], respectively) after full adjustment. Preimplant RDW was not statistically associated with our secondary outcomes. In conclusion, higher preimplant RDW is independently associated with an increased risk of postimplant mortality and infection. Future studies are needed to understand the prognostic ability of RDW and to understand the biologic mechanism underlying this association.
Inhaled Desmopressin for Refractory Gastrointestinal Bleeding in a Patient With a HeartMate II Left Ventricular Assist Device
Authors: Hollis Ian B. , Chen Sheh-Li , Chang Patricia P. , Katz Jason N.
Published: August 2016

Patients with a durable, continuous-flow left ventricular assist device (LVAD) are commonly prescribed the combination of an oral anticoagulant and an oral antiplatelet agent as prophylaxis against device thrombosis and systemic embolic events. Current International Society of Heart and Lung (ISHLT) guidelines recommend warfarin with an INR goal of 2–3 and concomitant aspirin 81–325 mg daily for patients with a HeartMate II LVAD. Unfortunately, gastrointestinal (GI) bleeding is very common in these patients because of multiple factors including the development of arteriovenous malformations and acquired von Willebrand syndrome. If this bleeding cannot be corrected through interventional measures, it then requires at least temporary, and potentially permanent, cessation of antiplatelet or anticoagulant therapy. Patients who continue to bleed while off all antithrombotic therapies present a clinical challenge. We describe the successful management of a patient with refractory GI bleeding through the use of inhaled desmopressin.
The Intragastric Pressure Measurement
Authors: Carbone Florencia , Tack Jan , Hoffman Ilse
Published: August 2016

Background:

Impaired gastric accommodation (GA) is proposed as a main pathophysiological mechanism for functional dyspepsia (FD). At present, the gastric barostat is the criterion standard to measure GA. Hence, this procedure is invasive and it may alter gastric physiology. Recently, we proposed the measurement of intragastric pressure (IGP) by means of high‐resolution manometry during nutrient intake as a potential alternative for assessing GA in adults.

Objectives:

Our aim was first to study the feasibility of the IGP measurement with nutrient tolerance in children with FD and second to compare these results with young healthy adults.

Methods:

A high‐resolution manometry probe and a feeding tube were positioned in the proximal stomach. The IGP was measured before and during intragastric infusion of a nutrient drink (ND, 300 kcal, 60 mL/min). Subjects were asked to score their satiation and epigastric symptoms. The test ended when the subjects scored maximal satiation.

Results:

A total of 15 healthy volunteers (HVs, 21.7 ± 4.7 years, 21.1 ± 0.3 kg/m2) and 17 patients with FD (14.4 ± 0.7 years, 19.6 ± 0.7 kg/m2) participated. Patients with FD experienced mainly from postprandial fullness (86%), epigastric pain (71%), and bloating (62%). In both groups, intragastric infusion of ND induced a drop in IGP (area above the IGP curve FD: −15.5 ± 3.5 mmHg vs HVs: −18.0 ± 8.7 mmHg; P = 0.57). Patients showed impaired nutrient tolerance compared with HVs (587.6 ± 80.2 vs 936 ± 66.2 kcal; P = 0.003). All patients and HVs tolerated the catheters and could finalize the study.

Conclusions:

The measurement of IGP during intragastric ND infusion was well tolerated in children. Nutrient tolerance was reduced in children with FD compared with HVs. In the future, this may be a useful tool to assess GA accommodation and nutrient tolerance in children.
Venous Sinus Stenting in Idiopathic Intracranial Hypertension: Results of a Prospective Trial
Authors: Dinkin Marc J. , Patsalides Athos
Published: August 2016

Background:

Our goal was to evaluate the safety and efficacy of stenting of venous sinus stenosis (VSS) in patients with medically-refractory, medically-intolerant or fulminant idiopathic intracranial hypertension (IIH) in a prospective, observational study.

Methods:

Thirteen patients with IIH who were refractory or intolerant to medical therapy or who presented with fulminant visual field (VF) loss underwent stenting of VSS at the transverse-sinus sigmoid sinus junction, using a Precise Pro carotid stent system (Cordis). Inclusion criteria included papilledema-related VF loss with mean deviation (MD) worse than or equal to −6.00 dB, elevated opening pressure (OP) on lumbar puncture (LP), VSS (either bilateral or unilateral in a dominant sinus), and an elevated (≥8 mm Hg) trans-stenotic gradient (TSG). The main outcome measures were pre- to post-stent change in symptoms related to intracranial hypertension, MD (in dB) on automated (Humphrey) VFs, grade of papilledema (1–5), retinal nerve fiber layer (RNFL) thickness as measured by spectral domain optical coherence tomography (SD-OCT), TSG (mm Hg), and OP on LP (cm H20).

Results:

Improvement or resolution of headaches occurred in 84.7% of patients, pulse-synchronous tinnitus in 100%, diplopia in 100%, and transient visual obscuration in 100%. Out of 26 eyes, 21 showed an improvement in MD, with an average improvement of +5.40 dB. Of 24 eyes with initial papilledema, 20 showed an improvement in Frisen grade, (mean change in grade of 1.90). Of 23 eyes undergoing SD-OCT, 21 (91.3%) demonstrated a reduction in RNFL thickness, with a poststent mean thickness of 90.48 μm. Mean change in OP was −20 cm H2O (reduction in mean from 42 to 22 cm H20) with all subjects demonstrating a reduction, although a second stenting procedure was necessary in one patient. Complications of the stenting procedure included one small, self-limited retroperitoneal hemorrhage, transient head or pelvic pain, and one allergic reaction to contrast. No serious adverse events occurred.

Conclusions:

Stenting of VSS is safe and results in reduction of intracranial pressure in patients with IIH. This is associated with improvement in papilledema, RNFL thickness, VF parameters, and symptoms associated with intracranial hypertension.
Compound Muscle Action Potential Decrement to Repetitive Nerve Stimulation Between Hirayama Disease and Amyotrophic Lateral Sclerosis
Authors: Zheng Chaojun , Zhu Dongqing , Lu Feizhou , Zhu Yu , Ma Xiaosheng , Xia Xinlei , Weber Robert , Jiang Jianyuan
Published: August 2016

Purpose:

To compare repetitive nerve stimulation (RNS) between Hirayama disease (HD) and amyotrophic lateral sclerosis (ALS).

Methods:

The 3-Hz RNS test was performed on bilateral abductor pollicis brevis, abductor digiti minimi, middle deltoid, and upper trapezius muscles in 33 HD patients and 37 ALS patients.

Results:

In HD patients, none of tested muscles showed any abnormal decrements (≥10%). Significant decrements were observed in 73% of the ALS patients, and decrements were more frequently observed in proximal muscles (deltoid: 70.3%; trapezius: 48.6%). Illness duration did not correlate with decrement percentage in either patient group, and there was no relationship between decrement incidence and ALS diagnostic category (P > 0.05).

Conclusions:

The significantly different RNS results between ALS and HD patients support the application of RNS, especially performing RNS in proximal muscles, as a supplementary test in distinguishing these two diseases, even in the early stages. These results may also imply a difference in underlying pathophysiology between ALS and HD.
Taxonomic distribution of cryptic diversity among metazoans: not so homogeneous after all
Authors: Pérez-Ponce de León Gerardo , Poulin Robert
Published: August 2016

Cryptic diversity plagues estimates of biodiversity, conservation efforts and attempts to control diseases and invasive species. Here, we re-visit a decade-old assessment of whether or not cryptic species are homogeneously reported among higher metazoan taxa. We compiled information from an extensive survey of the literature to recover all reports of cryptic species among metazoans. After correcting for currently known species richness and research effort per taxon, we find that cryptic species are over-reported in some taxa and under-reported in others. Although several taxa showing either a lack or an excess of reported cryptic species were poorly studied invertebrate groups, we found that cryptic species were over-reported in amphibians, reptiles and crustaceans, all relatively well-studied groups. The observed heterogeneity in the distribution of reported cryptic species may reflect taxon-specific properties affecting either the propensity for cryptic species to be formed or their likelihood of being detected by conventional taxonomy. Either way, the implications of cryptic diversity may not apply equally across all taxonomic groups.
Progress, pitfalls and parallel universes: a history of insect phylogenetics
Authors: Kjer Karl M. , Simon Chris , Yavorskaya Margarita , Beutel Rolf G.
Published: August 2016

The phylogeny of insects has been both extensively studied and vigorously debated for over a century. A relatively accurate deep phylogeny had been produced by 1904. It was not substantially improved in topology until recently when phylogenomics settled many long-standing controversies. Intervening advances came instead through methodological improvement. Early molecular phylogenetic studies (1985–2005), dominated by a few genes, provided datasets that were too small to resolve controversial phylogenetic problems. Adding to the lack of consensus, this period was characterized by a polarization of philosophies, with individuals belonging to either parsimony or maximum-likelihood camps; each largely ignoring the insights of the other. The result was an unfortunate detour in which the few perceived phylogenetic revolutions published by both sides of the philosophical divide were probably erroneous. The size of datasets has been growing exponentially since the mid-1980s accompanied by a wave of confidence that all relationships will soon be known. However, large datasets create new challenges, and a large number of genes does not guarantee reliable results. If history is a guide, then the quality of conclusions will be determined by an improved understanding of both molecular and morphological evolution, and not simply the number of genes analysed.