bluuebunny/crossref_metadata_2025 huggingface dataset:
Subextraction at the Discourse-Grammar interface
Authors: Frascarelli Mara , Jiménez-Fernández Ángel L.
Published: June 2017

In this paper we carry out an interface investigation of subject islands in Italian and Spanish, in which subextraction in the form of focus fronting is connected with the type of Focus implemented by the subextracted PP (Corrective vs. Mirative) and the D-properties of the subextraction site. Adopting a featural approach, we claim that subjects are not ‘absolute’ islands and variation is not idiosyncratic: subextraction is possible in the two languages under examination provided specific properties are met in the relevant D-domain and depending on the information-structural properties of the subextracted PP. More precisely, subextraction of a Corrective Focus in Italian is fully accepted from [−spec] DPs, whereas Spanish needs a [−def] feature in the same context. Subextraction to obtain a mirative interpretation, on the other hand, is only (marginally) allowed from [+def, −spec] DPs: this is attributed to the compatibility between D-features and the discourse-semantics properties of a Mirative Focus.
On the de se reading in the de se center shift in Korean
Authors: Hoe Semoon , Lim Dongsik
Published: June 2017

Korean long-distance anaphor (LDA) caki is obligatorily interpreted as de se: the attitude holder should know that the reference of caki is himself/herself. However, this restriction can be obviated when the Korean direct perceptive evidential marker –te is used. In this case, caki can be used as far as the evidence holder indicated by –te knows that the reference of caki is the attitude holder himself/herself, even when the attitude holder does not know that (Lim 2012, 2014; Lim & Lee 2012; Lim & Hoe to appear, among others). In this paper we call this puzzle de se center shift, and argue that the de se center shift in Korean should be analyzed in terms of the binding relation between an operator and caki. We also present some evidence that this puzzle should not be analyzed in terms of a pragmatically motivated binding relation, such as empathic binding and/or indirect de se (such as what is argued for Chinese ziji in Wang & Pan 2014, 2015, among others). Finally, we discuss some theoretical implications of our proposal, especially regarding the interaction between –te and different types of attitude predicates.
Two types of transitive verbs in Spanish
Authors: Fernández-Alcalde Héctor
Published: June 2017

This paper focuses on the different properties shown by two types of verbs that surface as transitive verbs in Spanish. The article tries to demonstrate that, beside regular transitive verbs taking a DP complement (e.g. Juan leyó un libro ‘Juan read a book’), other apparent transitive verbs – pseudotransitive verbs – (e.g. Juan golpeó al prisionero ‘Juan hit the prisoner’) hide a deep ditransitive structure in which a nominal argument is conflated into an abstract predicate. Subextraction, nominalization and quantifier scope data are used to support this claim. The analysis derives the different properties exhibited by these two types of verbs from their base argument structure and shows that they are independent from other syntactic mechanisms such as differential object marking.
Grammatical categories at the Lexicon-Syntax-Semantics interface
Authors: Romeu Juan
Published: June 2017

Although it is descriptively useful to classify lexical items into grammatical categories, this classification is not theoretically accurate and it requires a more fine-grained analysis.

This is possible by means of a model like the one presented in this article. In it, each node of a universal syntactic structure encodes an indecomposable semantic component (which can be altered by modifiers). Lexical items lexicalize different chunks of the structure. The category to which they are related and the differences between elements belonging to the same category depend on the chunk they lexicalize.

I show that prepositions, for instance, lexicalize different chunks of the structure around the node Rel(ation) (only Rel, Rel and a modifier or only a modifier of Rel). This explains the different behavior of lexical items included under the label preposition (as can be seen, for instance, in their different possibilities of combination).
The moral virtue of open-mindedness
Authors: Song Yujia
Published: June 2017

This paper gives a new and richer account of open-mindedness as a moral virtue. I argue that the main problem with existing accounts is that they derive the moral value of open-mindedness entirely from theepistemicrole it plays in moral thought. This view is overly intellectualist. I argue that open-mindedness as a moral virtue promotes our flourishing alongside others in ways that are quite independent of its role in correcting our beliefs. I close my discussion by distinguishing open-mindedness from what some might consider its equivalent: empathy and tolerance.
Effects of irrelevant background speech on eye movements during reading
Authors: Yan Guoli , Meng Zhu , Liu Nina , He Liyuan , Paterson Kevin B
Published: June 2017

The irrelevant speech effect (ISE) refers to the impairment of visual information processing by background speech. Prior research on the ISE has focused on short-term memory for visually presented word lists. The present research extends this work by using measurements of eye movements to examine effects of irrelevant background speech during Chinese reading. This enabled an examination of the ISE for a language in which access to semantic representations is not strongly mediated by phonology. Participants read sentences while exposed to meaningful irrelevant speech, meaningless speech (scrambled meaningful speech) or silence. A target word of high or low lexical frequency was embedded in each sentence. The results show that meaningful, but not meaningless, background speech produced increased re-reading. In addition, the appearance of a normal word frequency effect, characterised by longer fixation times on low- compared to high-frequency words, was delayed when meaningful or meaningless speech was present in the background. These findings show that irrelevant background speech can disrupt normal processes of reading comprehension and, in addition, that background noise can interfere with the early processing of words. The findings add to evidence showing that normal reading processes can be disrupted by environmental noise such as irrelevant background speech.
Maximal function characterizations for new local Hardy-type spaces on spaces of homogeneous type
Authors: Bui The Anh , Duong Xuan Thinh , Ly Fu Ken
Published: June 2017

Let

X
X

be a space of homogeneous type and let

L

\mathfrak {L}

be a nonnegative self-adjoint operator on

L
2

(
X
)

L^2(X)

enjoying Gaussian estimates. The main aim of this paper is twofold. Firstly, we prove (local) nontangential and radial maximal function characterizations for the local Hardy spaces associated to

L

\mathfrak {L}

. This gives the maximal function characterization for local Hardy spaces in the sense of Coifman and Weiss provided that

L

\mathfrak {L}

satisfies certain extra conditions. Secondly we introduce local Hardy spaces associated with a critical function

ρ
\rho

which are motivated by the theory of Hardy spaces related to Schrödinger operators and of which include the local Hardy spaces of Coifman and Weiss as a special case. We then prove that these local Hardy spaces can be characterized by (local) nontangential and radial maximal functions related to

L

\mathfrak {L}

and

ρ
\rho

, and by global maximal functions associated to ‘perturbations’ of

L

\mathfrak {L}

. We apply our theory to obtain a number of new results on maximal characterizations for the local Hardy type spaces in various settings ranging from Schrödinger operators on manifolds to Schrödinger operators on connected and simply connected nilpotent Lie groups.
R&D Concentration Under Endogenous Fixed Costs: Evidence from Genetically Modified Corn Seed
Authors: Anderson Benjamin C. , Sheldon Ian M.
Published: June 2017

We examine the role of fixed costs in research and development (R&D) in the market for genetically modified (GM) corn seed. In a mixed model of horizontal differentiation by genetic traits and vertical differentiation by productivity, we derive the empirically testable lower bounds to R&D concentration when R&D investments and market entry are jointly determined. When R&D investments translate into higher product quality, industries are said to be characterized by endogenous fixed costs such that the lower bound to R&D concentration increases with market size, but is less than the lower bound to market concentration based on sales. Using data on field trial applications of GM corn seed, we estimate the lower bound to R&D concentration, and find evidence of endogenous fixed costs with R&D concentration that is significantly greater than perfectly competitive levels. These endogenous fixed costs imply that concentration in the agricultural biotechnology industry is occurring due to the nature of R&D investment in product quality and not through anticompetitive practices. Adjusting for past merger and acquisition activity significantly raises the lower bound for infinitely‐sized markets, but has no impact upon current market sizes, implying the industry may still undergo additional consolidation.
Sequencing, de novo assembling, and annotating the genome of the endangered Chinese crocodile lizard Shinisaurus crocodilurus
Authors: Gao Jian , Li Qiye , Wang Zongji , Zhou Yang , Martelli Paolo , Li Fang , Xiong Zijun , Wang Jian , Yang Huanming , Zhang Guojie
Published: June 2017

The Chinese crocodile lizard, Shinisaurus crocodilurus, is the only living representative of the monotypic family Shinisauridae under the order Squamata. It is an obligate semi-aquatic, viviparous, diurnal species restricted to specific portions of mountainous locations in southwestern China and northeastern Vietnam. However, in the past several decades, this species has undergone a rapid decrease in population size due to illegal poaching and habitat disruption, making this unique reptile species endangered and listed in the Convention on International Trade in Endangered Species of Wild Fauna and Flora Appendix II since 1990. A proposal to uplist it to Appendix I was passed at the Convention on International Trade in Endangered Species of Wild Fauna and Flora Seventeenth meeting of the Conference of the Parties in 2016. To promote the conservation of this species, we sequenced the genome of a male Chinese crocodile lizard using a whole-genome shotgun strategy on the Illumina HiSeq 2000 platform. In total, we generated ~291 Gb of raw sequencing data (×149 depth) from 13 libraries with insert sizes ranging from 250 bp to 40 kb. After filtering for polymerase chain reaction–duplicated and low-quality reads, ~137 Gb of clean data (×70 depth) were obtained for genome assembly. We yielded a draft genome assembly with a total length of 2.24 Gb and an N50 scaffold size of 1.47 Mb. The assembled genome was predicted to contain 20 150 protein-coding genes and up to 1114 Mb (49.6%) of repetitive elements. The genomic resource of the Chinese crocodile lizard will contribute to deciphering the biology of this organism and provides an essential tool for conservation efforts. It also provides a valuable resource for future study of squamate evolution.
Equivalency of the quality of sublethal lesions after photons and high-linear energy transfer ion beams
Authors: Furusawa Yoshiya , Nakano-Aoki Mizuho , Matsumoto Yoshitaka , Hirayama Ryoichi , Kobayashi Alisa , Konishi Teruaki
Published: June 2017

The quality of the sublethal damage (SLD) after irradiation with high–linear energy transfer (LET) ion beams was investigated with low-LET photons. Chinese hamster V79 cells and human squamous carcinoma SAS cells were first exposed to a priming dose of different ion beams at different LETs at the Heavy Ion Medical Accelerator in the Chiba facility. The cells were kept at room temperature and then exposed to a secondary test dose of X-rays. Based on the repair kinetics study, the surviving fraction of cells quickly increased with the repair time, and reached a plateau in 2–3 h, even when cells had received priming monoenergetic high-LET beams or spread-out Bragg peak beams as well as X-ray irradiation. The shapes of the cell survival curves from the secondary test X-rays, after repair of the damage caused by the high-LET irradiation, were similar to those obtained from cells exposed to primary X-rays only. Complete SLD repairs were observed, even when the LET of the primary ion beams was very high. These results suggest that the SLD caused by high-LET irradiation was repaired well, and likewise, the damage caused by the X-rays. In cells where the ion beam had made a direct hit in the core region in an ion track, lethal damage to the domain was produced, resulting in cell death. On the other hand, in domains that had received a glancing hit in the low-LET penumbra region, the SLD produced was completely repaired.
Measurement Properties of Short Lower Extremity Functional Exercise Tests in People With Chronic Obstructive Pulmonary Disease: Systematic Review
Authors: Johnston Kylie N. , Potter Adrian J. , Phillips Anna
Published: June 2017

Background

An increasing variety of short functional exercise tests are reported in people with chronic obstructive pulmonary disease (COPD). Systematic review of the psychometric properties of these exercise tests is indicated.

Purpose

The aim of this study was to determine the reliability, validity, and responsiveness of short (duration < 6 min) lower extremity functional exercise tests in people with COPD.

Data Sources

Five databases were searched: MEDLINE, Embase, Scopus, AMED, and CINAHL.

Study Selection

Studies reporting psychometric properties of short functional exercise tests in people with COPD were included.

Data Extraction

Two reviewers independently extracted data and rated the quality of each measurement property using the COnsensus-based Standards for the Selection of Health Measurement INstrument (COSMIN).

Data Synthesis

Twenty-nine studies were identified reporting properties of 11 different tests. Four-meter gait speed [4MGS] and 5 repetition sit-to-stand [5STS] demonstrated high reliability (ICC = .95–.99; .97) with no learning effect (COSMIN study ratings = good–-excellent). Their validity for use as a stratification tool anchored against an established prognostic indicator (area under receiver operator characteristics curve [AUC] = 0.72–0.87; 0.82) and responsiveness to change after pulmonary rehabilitation was greatest in more frail people with COPD. Studies of the Timed “Up and Go” [TUG] test support use of a practice test and show discriminative ability to detect falls history and low six-minute walk distance (AUC = 0.77; 0.82, COSMIN ratings = fair–excellent).

Limitations

Earlier studies were limited by small sample size. Limited data of lower study quality was identified for step tests and the Two-Minute Walk Test.

Conclusions

Selected short functional exercise tests can complement established exercise capacity measures, in stratification and measuring responsiveness to change especially in people with COPD and lower functional ability.
Contraception Insurance Coverage and Receipt of Long-Acting Reversible Contraception or Depot Medroxyprogesterone Acetate on the Day of Abortion
Authors: Krashin Jamie W. , Stuart Gretchen S. , Garrett Joanne , Spector Hannah , Bryant Amy G. , Charm Samantha , Morse Jessica E.
Published: June 2017

OBJECTIVE:

To evaluate whether contraceptive insurance coverage for women who present for an abortion is associated with obtaining long-acting reversible contraception or depot medroxyprogesterone acetate (DMPA) on the day the abortion is completed.

METHODS:

We conducted a prospective cohort study of women presenting for medical or surgical abortion at a single health center in North Carolina. Eligible women were 18 years or older and fluent in English or Spanish. Data were from participant questionnaires, medical charts, and financial records. Our main exposure was whether the woman had insurance coverage for contraception at clinic intake. Our primary outcome was receiving DMPA, an intrauterine device, or a contraceptive subdermal implant on the same day of their surgical abortion or at the visit that determined their medication abortion was complete. We used univariable, bivariable, and multivariable analysis to report our findings.

RESULTS:

Five hundred seventy-five women enrolled in our cohort between September 2015 and April 2016. One hundred twenty-eight (22%) had insurance coverage and 447 (78%) did not. In the group with insurance coverage for contraception, 38% (49/128) received a long-acting reversible contraception method or DMPA compared with 7% (33/447) in the group without insurance coverage for contraception. After adjusting for confounding, women with contraceptive coverage were more than five times as likely to receive immediate postabortion contraception with one of these methods compared with women without coverage (relative risk 5.6, 95% confidence interval 3.8–8.3).

CONCLUSION:

Women with contraceptive insurance coverage on the day of their abortion were more likely to leave the abortion clinic with an intrauterine device or implant in place or receive DMPA injection compared with women without coverage.
Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring
Authors: Mendez-Figueroa Hector , Schuster Meike , Maggio Lindsay , Pedroza Claudia , Chauhan Suneet P. , Paglia Michael J.
Published: June 2017

OBJECTIVE:

To assess whether testing blood glucose four times daily compared with four times every other day would lead to similar birth weights among patients with gestational diabetes mellitus (GDM).

METHODS:

This noninferiority randomized controlled trial was conducted at five centers. After receiving a diagnosis of GDM, women tested their blood glucose every day for 7 days. After that period, compliant women without hyperglycemia requiring treatment were randomized to either blood glucose testing four times a day or every other day. Noninferiority would be declared if the mean birth weight in the every-other-day group was no higher than 165 g (5% difference assuming an average birth weight of 3,296 g) compared with the four times a day group. A total sample size of 286 women allowed noninferiority to be tested (one-sided .05 level of significance).

RESULTS:

From May 2013 to May 2016, of the 293 women with GDM who were randomized, 149 (51%) were tested four times a day and 144 (49%) were tested every other day. Between the two groups, there were no significant differences with regard to need for medical treatment, induction, gestational age at delivery, mode of delivery, rate of preeclampsia, or shoulder dystocia. Birth weight was similar between both groups and the upper bound of the 90% confidence interval (CI) was less than 165 g, establishing noninferiority with a mean difference of −41 g (90% CI −137 to 54 g). Rate of compliance with blood glucose testing was higher in the every-other-day group (89% compared with 92%, P<.01). The differences in rates of macrosomia and birth weight greater than the 95th percentile were not clinically significant. Neonatal outcomes including neonatal hypoglycemia were similar.

CONCLUSION:

Among patients with well-controlled GDM, testing blood glucose values every other day did not increase birth weight, although it did increase compliance with testing when compared with women who tested every day.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01818557.
Outpatient Hysterectomy Volume in the United States
Authors: Cohen Sarah L. , Ajao Mobolaji O. , Clark Nisse V. , Vitonis Allison F. , Einarsson Jon I.
Published: June 2017

OBJECTIVE:

To estimate the number of outpatient hysterectomies being performed annually in the United States in an effort to offer more correct estimates of hysterectomy use in light of reported decreasing inpatient case volume.

METHODS:

This is a cross-sectional analysis of State Ambulatory Surgery and Services Databases from 16 states with complete information for year 2011. Adult women undergoing hysterectomy were included. Procedure volume, route, and associated patient and surgical characteristics were calculated.

RESULTS:

There were 64,612 ambulatory hysterectomies reported; 81.5% of surgeries were performed laparoscopically and 16% vaginally. If these numbers are extrapolated to national estimates, this represents 100,000–200,000 outpatient hysterectomies per year. The strongest driver of the laparoscopic, compared with vaginal, route of hysterectomy in this data set was presence of cancer (odds ratio 4.01 [3.19–5.05], P<.001). In addition to indication for surgery, patient characteristics such as age, race, income, location, and primary payer were associated with mode of hysterectomy. The laparoscopic surgeries were associated with shorter length of stay (mean stay 0.65 days, [99% confidence interval 0.65–0.66] compared with 0.79 days [0.78–0.81], adjusted incidence rate ratio 0.89 [0.86–0.92], P<.001) and higher mean charges ($24,227 [$24,053–24,402] versus $14,068 [$13,811–14,330], P<.001) compared with vaginal surgeries.

CONCLUSION:

The perceived decline that has been reported in national hysterectomy volume may represent lack of reporting of surgeries performed in ambulatory settings. This information has considerable implications for business, public health interventions, and insurance carriers among other key stakeholders in women's health care delivery.
Serial Head and Brain Imaging of 17 Fetuses With Confirmed Zika Virus Infection in Colombia, South America
Authors: Parra-Saavedra Miguel , Reefhuis Jennita , Piraquive Juan Pablo , Gilboa Suzanne M. , Badell Martina L. , Moore Cynthia A. , Mercado Marcela , Valencia Diana , Jamieson Denise J. , Beltran Mauricio , Sanz-Cortes Magda , Rivera-Casas Ana Maria , Yepez Mayel , Parra Guido , Ospina Martinez Martha , Honein Margaret A.
Published: June 2017

OBJECTIVE:

To evaluate fetal ultrasound and magnetic resonance imaging findings among a series of pregnant women with confirmed Zika virus infection to evaluate the signs of congenital Zika syndrome with respect to timing of infection.

METHODS:

We conducted a retrospective case series of pregnant women referred to two perinatal clinics in Barranquilla and Ibagué, Colombia, who had findings consistent with congenital Zika syndrome and Zika virus infection confirmed in maternal, fetal, or neonatal samples. Serial ultrasound measurements, fetal magnetic resonance imaging results, laboratory results, and perinatal outcomes were evaluated.

RESULTS:

We describe 17 cases of confirmed prenatal maternal Zika virus infection with adverse fetal outcomes. Among the 14 symptomatic women, the median gestational age for maternal Zika virus symptoms was 10 weeks (range 7–14 weeks of gestation). The median time between Zika virus symptom onset and microcephaly (head circumference less than 3 standard deviations below the mean) was 18 weeks (range 15–24 weeks). The earliest fetal head circumference measurement consistent with microcephaly diagnosis was at 24 weeks of gestation. The earliest sign of congenital Zika syndrome was talipes equinovarus, which in two patients was noted first at 19 weeks of gestation. Common findings on fetal magnetic resonance imaging were microcephaly, ventriculomegaly, polymicrogyria, and calcifications.

CONCLUSION:

Our analysis suggests a period of at least 15 weeks between maternal Zika virus infection in pregnancy and development of microcephaly and highlights the importance of serial and detailed neuroimaging.
Multidisciplinary Clinics
Authors: Villard Li , Nordmark-Andersson Elisabeth , Crowley Brid , Straub Volker , Bertoli Marta
Published: June 2017

More than 400 acquired and genetic diseases are labeled as arthrogryposis. Because of their rarity and complexity coordinated patient management is often lacking. Multidisciplinary clinics are the ideal setting to provide coordinated and comprehensive care to patients with special needs. Two similar experiences of multidisciplinary clinics for the care of patients with arthrogryposis were reported at the Symposium on Arthrogryposis held in Saint Petersburg in September 2014. These clinics are organized to bring together professionals from several disciplines, with the aim to provide patient-centered, comprehensive clinical care, and reduce the burden of multiple medical appointments for the families.
Treatment of the Lower Extremity Contracture/Deformities
Authors: van Bosse Harold J.P. , Pontén Eva , Wada Akifusa , Agranovich Olga E. , Kowalczyk Bartłomiej , Lebel Ehud , Şenaran Hakan , Derevianko Denis V. , Vavilov Maxim A. , Petrova Ekaterina V. , Barsukov Dmitry B. , Batkin Sergey F. , Eylon Sharon , Kenis Vladimir M. , Stepanova Yulia V. , Buklaev Dmitry S. , Yilmaz Guney , Köse Oksana , Trofimova Svetlana I. , Durgut Fatih
Published: June 2017

Lower extremity deformities of patients with arthrogryposis multiplex congenita present a wide spectrum of severity and deformity combinations. Treatment goals range from merely ensuring comfortable seating and shoe wear, to fully independent and active ambulation, but the overarching intention is to help realize the patient’s greatest potential for independence and function. Treatment of hip and knee contractures and dislocations has become more interventional, whereas treatment of foot deformities has paradoxically become much less surgical. This article synopsizes the treatment strategies presented in September 2014 in Saint Petersburg, Russia at the second international symposium on arthrogryposis.
Delirium and Benzodiazepines Associated With Prolonged ICU Stay in Critically Ill Infants and Young Children*
Authors: Smith Heidi A. B. , Gangopadhyay Maalobeeka , Goben Christina M. , Jacobowski Natalie L. , Chestnut Mary Hamilton , Thompson Jennifer L. , Chandrasekhar Rameela , Williams Stacey R. , Griffith Katherine , Ely E. Wesley , Fuchs D. Catherine , Pandharipande Pratik P.
Published: June 2017

Objectives:

Delirium is prevalent among critically ill children, yet associated outcomes and modifiable risk factors are not well defined. The objective of this study was to determine associations between pediatric delirium and modifiable risk factors such as benzodiazepine exposure and short-term outcomes.

Design:

Secondary analysis of collected data from the prospective validation study of the Preschool Confusion Assessment Method for the ICU.

Setting:

Tertiary-level PICU.

Patients:

Critically ill patients 6 months to 5 years old.

Interventions:

None.

Measurements and Main Results:

Daily delirium assessments were completed using the Preschool Confusion Assessment Method for the ICU. Associations between baseline and in-hospital risk factors were analyzed for likelihood of ICU discharge using Cox proportional hazards regression and delirium duration using negative binomial regression. Multinomial logistic regression was used to determine associations between daily risk factors and delirium presence the following day. Our 300-patient cohort had a median (interquartile range) age of 20 months (11–37 mo), and 44% had delirium for at least 1 day (1–2 d). Delirium was significantly associated with a decreased likelihood of ICU discharge in preschool-aged children (age-specific hazard ratios at 60, 36, and 12 mo old were 0.17 [95% CI, 0.05–0.61], 0.50 [0.32–0.80], and 0.98 [0.68–1.41], respectively). Greater benzodiazepine exposure (75–25th percentile) was significantly associated with a lower likelihood of ICU discharge (hazard ratio, 0.65 [0.42–1.00]; p = 0.01), longer delirium duration (incidence rate ratio, 2.47 [1.36–4.49]; p = 0.005), and increased risk for delirium the following day (odds ratio, 2.83 [1.27–6.59]; p = 0.02).

Conclusions:

Delirium is associated with a lower likelihood of ICU discharge in preschool-aged children. Benzodiazepine exposure is associated with the development and longer duration of delirium, and lower likelihood of ICU discharge. These findings advocate for future studies targeting modifiable risk factors, such as reduction in benzodiazepine exposure, to mitigate iatrogenic harm in pediatric patients.
Antibiotic Therapy in Comatose Mechanically Ventilated Patients Following Aspiration: Differentiating Pneumonia From Pneumonitis*
Authors: Lascarrou Jean Baptiste , Lissonde Floriane , Le Thuaut Aurélie , Bachoumas Konstantinos , Colin Gwenhael , Henry Lagarrigue Matthieu , Vinatier Isabelle , Fiancette Maud , Lacherade Jean Claude , Yehia Aihem , Joret Aurélie , Lebert Christine , Bourdon Sandra , Martin Lefèvre Laurent , Reignier Jean
Published: June 2017

Objectives:

To determine the proportion of patients with documented bacterial aspiration pneumonia among comatose ICU patients with symptoms suggesting either bacterial aspiration pneumonia or non-bacterial aspiration pneumonitis.

Design:

Prospective observational study.

Setting:

University-affiliated 30-bed ICU.

Patients:

Prospective cohort of 250 patients admitted to the ICU with coma (Glasgow Coma Scale score ≤ 8) and treated with invasive mechanical ventilation.

Interventions:

None.

Measurements and Main Results:

The primary outcome was the proportion of patients with microbiologically documented bacterial aspiration pneumonia. Patients meeting predefined criteria for aspiration syndrome routinely underwent telescopic plugged catheter sampling during bronchoscopy before starting probabilistic antibiotic treatment. When cultures were negative, the antibiotic treatment was stopped. Of 250 included patients, 98 (39.2%) had aspiration syndrome, including 92 before mechanical ventilation discontinuation. Telescopic plugged catheter in these 92 patients showed bacterial aspiration pneumonia in 43 patients (46.7%). Among the remaining 49 patients, 16 continued to receive antibiotics, usually for infections other than pneumonia; of the 33 patients whose antibiotics were discontinued, only two subsequently showed signs of lung infection. In the six patients with aspiration syndrome after mechanical ventilation, and therefore without telescopic plugged catheter, antibiotic treatment was continued for 7 days. Mechanical ventilation duration, ICU length of stay, and mortality did not differ between the 43 patients with bacterial aspiration pneumonia and the 49 patients with non-bacterial aspiration pneumonitis. The 152 patients without aspiration syndrome did not receive antibiotics.

Conclusions:

Among comatose patients receiving mechanical ventilation, those without clinical, laboratory, or radiologic evidence of bacterial aspiration pneumonia did not require antibiotics. In those with suspected bacterial aspiration pneumonia, stopping empirical antibiotic therapy when routine telescopic plugged catheter sampling recovered no microorganisms was nearly always effective. This strategy may be a valid alternative to routine full-course antibiotic therapy. Only half the patients with suspected bacterial aspiration pneumonia had this diagnosis confirmed by telescopic plugged catheter sampling.
Treatment of Complex Fistula-in-Ano With a Nitinol Proctology Clip
Authors: Nordholm-Carstensen Andreas , Krarup Peter-Martin , Hagen Kikke
Published: June 2017

BACKGROUND:

The treatment of complex anocutaneous fistulas remains a major therapeutic challenge balancing the risk of incontinence against the chance of permanent closure.

OBJECTIVE:

The purpose of this study was to investigate the efficacy of a nitinol proctology clip for closure of complex anocutaneous fistulas.

DESIGN:

This is a single-center cohort study with retrospective analysis of all of the treated patients.

SETTINGS:

Data were obtained from patient records and MRI reports, as well as follow-up telephone calls and clinical follow-up with endoanal ultrasonography.

PATIENTS:

All of the patients were treated for high transsphincteric and suprasphincteric anocutaneous fistulas at the Digestive Disease Center, Bispebjerg Hospital, between May 2013 and February 2015.

INTERVENTIONS:

All of the patients were treated with the nitinol proctology clip.

MAIN OUTCOME MEASURES:

Primary outcome was fistula healing after proctology clip placement, as evaluated through clinical examination, endoanal ultrasonography, and MRI.

RESULTS:

The fistula healing rate 1 year after the clip procedure was 54.3% (19 of 35 included patients). At the end of follow-up, 17 (49%) of 35 patients had persistent closure of the fistula tracks. No impairment of continence function was observed. Treatment outcome was not found to be statistically associated with any clinicopathological characteristics.

LIMITATIONS:

The study is limited by its retrospective and nonrandomized design. Selection bias may have occurred, because treatment options other than the clip were available during the study period. The small number of patients means that there is a nonnegligible risk of type II error in the conclusion, and the follow-up may be too short to have detected all of the failures.

CONCLUSIONS:

Healing rates were comparable with those of other noninvasive, sphincter-sparing techniques for high-complex anocutaneous fistulas, with no risk of incontinence. Predictive parameters for fistula healing using this technique remain uncertain. See Video Abstract at http://links.lww.com/DCR/A347.
ELLIPSOID ZONE MAPPING AND OUTER RETINAL ASSESSMENT IN STARGARDT DISEASE
Authors: Arepalli Sruthi , Traboulsi Elias I. , Ehlers Justis P.
Published: June 2017

Purpose:

To quantify and correlate ellipsoid zone and photoreceptor outer segment changes with visual acuity in Stargardt disease.

Methods:

An institutional review board–approved study of 32 eyes with Stargardt disease was performed. After spectral domain optical coherence tomography, the macular cube was exported into a novel analysis tool and volumetric assessment from the ellipsoid zone to the retinal pigment epithelium was performed. Using this information, mapping was completed with en face representation of the height between the ellipsoid zone and retinal pigment epithelium. This analysis provided quantification of ellipsoid zone and photoreceptor outer segments, including atrophy (ellipsoid zone to retinal pigment epithelium thickness = 0 μm) and attenuation (ellipsoid zone to retinal pigment epithelium thickness <20 μm). These parameters were compared with visual acuity and controls (n = 12 eyes).

Results:

Visual acuity ranged from 20/30 to 20/250. The central foveal B-scan area of ellipsoid and photoreceptor outer segments was significantly less than controls (0.13 ± 0.05 mm2 vs. 0.17 ± 0.03 mm2, respectively, P = 0.0074). The central foveal B-scan mean thickness measured 22.52 ± 9.0 μm in Stargardt versus 30.0 ± 5.08 μm (P = 0.0096). Atrophy and attenuation were significantly higher in Stargardt patients (22% vs. 1%, P = 0.005 and 43% vs. 1%, P = 0.0002). Visual acuity directly correlated with ellipsoid zone/outer segment volume (R = 0.57, P < 0.005) and inversely correlated with attenuation and atrophy (R = −0.53 and −0.57; P < 0.005 for all).

Conclusion:

Eyes with Stargardt disease frequently have significant disruption of the ellipsoid zone and outer segments. This degenerative change was successfully quantified with a novel assessment platform and identified correlates with visual function. This software provides the opportunity for quantitative assessment and possible longitudinal surveillance.
How to get shortlisted for medical jobs
Authors: Gundogan Buket , Koshy Kiron , Whitehurst Katharine , Fowler Alex , Agha Riaz
Published: June 2017

Progressing up the medical career ladder is a tough business. Most medical and surgical applications center the requirement for a holistic, balanced individual. As a result, there are usually specific marking criteria in predefined sections. This article provides a guide into what employers are looking for and how best to build your portfolio in these areas.
How to deliver an oral presentation
Authors: Wellstead Georgina , Whitehurst Katharine , Gundogan Buket , Agha Riaz
Published: June 2017

Delivering an oral presentation in conferences and meetings can seem daunting. However, if delivered effectively, it can be an invaluable opportunity to showcase your work in front of peers as well as receive feedback on your project. In this “How to” article, we demonstrate how one can plan and successfully deliver an engaging oral presentation.
Microinvasive Glaucoma Stent (MIGS) Surgery With Concomitant Phakoemulsification Cataract Extraction: Outcomes and the Learning Curve
Authors: Al-Mugheiry Toby S. , Cate Heidi , Clark Allan , Broadway David C.
Published: June 2017

Purpose:

To evaluate learning effects with respect to outcomes of a microinvasive glaucoma stent (MIGS) inserted during cataract surgery in glaucoma patients.

Patients and Methods:

Single surgeon, observational cohort study of 25 consecutive Ivantis Hydrus microstent insertions, with a minimum follow-up of 12 months. A learning curve analysis was performed by assessing hypotensive effect, adverse effects, and surgical procedure duration, with respect to consecutive case number. Success was defined with respect to various intraocular pressure (IOP) targets (21, 18, 15 mm Hg) and reduction in required antiglaucoma medications. Complete success was defined as achieving target IOP without antiglaucoma therapy.

Results:

No clinically significant adverse events or learning effects were identified, although surgical time reduced with consecutive case number. Mean follow-up was 16.8 months. At final follow-up the mean IOP for all eyes was reduced from 18.1 (±3.6) mm Hg [and a simulated untreated value of 25.9 (±5.2) mm Hg] to 15.3 (±2.2) mm Hg (P=0.007; <0.0001) and the mean number of topical antiglaucoma medications was reduced from 1.96 (±0.96) to 0.04 (±0.20) (P<0.0001). Complete success (IOP<21 mm Hg, no medications) was 96% at final follow-up. Complete success (IOP<18 mm Hg, no medications) was 80% at final follow-up, but only 32% with a target IOP of <15 mm Hg (no medications).

Conclusions:

No significant learning curve effects were observed for a trained surgeon with respect to MIGS microstent insertion performed at the time of cataract surgery. Adjunctive MIGS surgery was successful in lowering IOP to <18 mm Hg and reducing/abolishing the requirement for antiglaucoma medication in eyes with open-angle glaucoma, but less successful at achieving low IOP levels (<15 mm Hg).
Total Percutaneous Cardiopulmonary Bypass for Robotic and Endoscopic Atrioventricular Valve Surgery
Authors: van der Merwe Johan , Casselman Filip , Beelen Roel , Van Praet Frank
Published: June 2017

Continuous technological advances in endoscopic-, robotic-and catheter-based cardiac interventions are paralleled by rapid evolution in cannulation strategies for circulatory support. The recent introduction of suture-based percutaneous vascular closure devices resulted in innovative strategies to deliver peripheral endovascular therapeutic devices through the iliac and femoral arteries. Percutaneous access allows rapid postoperative mobilization and potentially avoids the devastating neurolympho-vascular- and wound infection morbidities associated with conventional open surgical exposure. We routinely perform endoscopic port access surgery for all isolated atrioventricular valve pathology and extended the application of suture-based percutaneous vascular closure device to establish total percutaneous peripheral cardiopulmonary bypass in disabled, immune-suppressed, and morbidly obese patients at risk neuro-lympho-vascular- and wound infection. In this report, we provide a stepwise description of our total percutaneous peripheral cardiopulmonary bypass technique.
Gender Differences in Anxiety and Complications Early After Acute Myocardial Infarction
Authors: AbuRuz Mohannad Eid , Masa’Deh Rami
Published: June 2017

Background:

Anxiety is the earliest psychological response to acute myocardial infarction. When anxiety persists or becomes severe, it has negative consequences including increased risk for in-hospital complications. Therefore, it is necessary to determine which groups of people are at risk for high anxiety after acute myocardial infarction.

Objective:

The aim of this study was to determine whether there is a difference in anxiety levels and rate of complications based on gender early after acute myocardial infarction.

Methods:

A comparative design was used. Patients with acute myocardial infarction were interviewed within 72 hours (mean [SD], 40 [18] hours) of admission to the hospital and completed a sociodemographic and clinical questionnaire and the Anxiety Subscale of Hospital Anxiety and Depression Scale. In addition, clinical data were abstracted from the participants’ medical record after discharge.

Results:

A total of 250 patients, with a confirmed diagnosis of acute myocardial infarction, participated in this study: 163 men and 87 women. Female patients were more anxious (15.5 [3.6] vs 8.1 [2.9], P < .01) and had more complications (1.1 [1.9] vs 0.6 [0.08], P < .05) than male patients did.

Conclusions:

Anxiety is a global problem after acute myocardial infarction. Exploration of reasons why women of different cultures are at a higher risk for anxiety after acute myocardial infarction is necessary. It is of high clinical importance to determine strategies for managing anxiety in patients with or suspected to have acute myocardial infarction, especially women.
Incorporating Relationship-Based Care Into a Nurse Education Program for Managing Disruptive Patient Behaviors
Authors: Lee Betty , Del Rosario Kristian , Byron-Iyamah Cecily
Published: June 2017

Purpose:

In the hospitalized patient, stressors can be manifested as disruptive behaviors. Nursing staff confronted with disruptive behaviors from their patients or families may have difficulty delivering care and developing therapeutic relationships. The purpose of this project was to evaluate the effects of an education program using the concepts of relationship-based care with role-play and reflective practice on the knowledge, attitudes, and confidence of the nursing staff in managing disruptive patient behaviors.

Description:

Nursing staff (N = 68) from an adult medical unit participated in an interactive education program. We compared participants’ self-responses about knowledge, attitudes, and confidence before intervention and at 3-month and 1-year postintervention. The number of disruptive incidents requiring hospital security was also measured.

Outcome:

At 3-month and 1-year postintervention, staff reported higher levels of knowledge, attitudes, and confidence in managing disruptive behaviors. The number of disruptive incidents per 1000 patient days decreased from 0.78 to 0.39.

Conclusion:

Effectively managing disruptive behaviors creates a safe, healthy environment for patients and nurses. Role-play and reflective practice are useful educational methods to teach skills to manage these encounters. Clinical nurse specialists can play a key role in developing innovative education programs through interprofessional collaboration.
The Importance of Registries in the Postmarketing Surveillance of Surgical Meshes
Authors: Köckerling Ferdinand , Simon Thomas , Hukauf Martin , Hellinger Achim , Fortelny Rene , Reinpold Wolfgang , Bittner Reinhard
Published: June 2017

Objective:

To assess the role of registries in the postmarketing surveillance of surgical meshes.

Background:

To date, surgical meshes are classified as group II medical devices. Class II devices do not require premarket clearance by clinical studies. Ethicon initiated a voluntary market withdrawal of Physiomesh for laparoscopic use after an analysis of unpublished data from the 2 large independent hernia registries—Herniamed German Registry and Danish Hernia Database. This paper now presents the relevant data from the Herniamed Registry.

Methods:

The present analysis compares the prospective perioperative and 1-year follow-up data collected for all patients with incisional hernia who had undergone elective laparoscopic intraperitoneal onlay mesh repair either with Physiomesh (n = 1380) or with other meshes recommended in the guidelines (n = 3834).

Results:

Patients with Physiomesh repair had a markedly higher recurrence rate compared with the other recommended meshes (12.0% vs 5.0%; P < 0.001). In the multivariable analysis, the recurrence rate was highly significantly influenced by the mesh type used (P < 0.001). If Physiomesh was used, that led to a highly significant increase in the recurrence rate on 1-year follow-up (odds ratio 2.570, 95% CI 2.057, 3.210). The mesh type used also had a significant influence on chronic pain rates.

Conclusions:

The importance of real-world data for postmarketing surveillance of surgical meshes has been demonstrated in this registry-based study. Randomized controlled trials are needed for premarket approval of new devices. The role of sponsorship of device studies by the manufacturing company must be taken into account.
Interactional dynamics of same-sex marriage legislation in the United States
Authors: Roy Subhradeep , Abaid Nicole
Published: June 2017

Understanding how people form opinions and make decisions is a complex phenomenon that depends on both personal practices and interactions. Recent availability of real-world data has enabled quantitative analysis of opinion formation, which illuminates phenomena that impact physical and social sciences. Public policies exemplify complex opinion formation spanning individual and population scales, and a timely example is the legalization of same-sex marriage in the United States. Here, we seek to understand how this issue captures the relationship between state-laws and Senate representatives subject to geographical and ideological factors. Using distance-based correlations, we study how physical proximity and state-government ideology may be used to extract patterns in state-law adoption and senatorial support of same-sex marriage. Results demonstrate that proximal states have similar opinion dynamics in both state-laws and senators’ opinions, and states with similar state-government ideology have analogous senators’ opinions. Moreover, senators’ opinions drive state-laws with a time lag. Thus, change in opinion not only results from negotiations among individuals, but also reflects inherent spatial and political similarities and temporal delays. We build a social impact model of state-law adoption in light of these results, which predicts the evolution of state-laws legalizing same-sex marriage over the last three decades.