bluuebunny/crossref_metadata_2025 huggingface dataset:
A stabilized algorithm for multi-dimensional numerical differentiation
Authors: Zhao Zhenyu , Meng Zehong , Zhao Liang , You Lei , Xie Ou
Published: April 2016

We develop a multi-dimensional numerical differentiation method in this paper. To obtain stable numerical derivatives, the Tikhonov regularization method in Hilbert scales is proposed to deal with illposedness of the problem. The penalty term in Tikhonov functional is more general so that we can choose the regularization parameter without the smoothness parameter and the a priori bound of exact solution. Numerical examples are also presented to check the effectiveness of the method.
A Steiner point candidate-based heuristic framework for the Steiner tree problem in graphs
Authors: Zhang Hao , Ye Dong-Yi , Guo Wen-Zhong
Published: April 2016

The underlying models of many practical problems in various engineering fields are equivalent to the Steiner tree problem in graphs, which is a typical NP-hard combinatorial optimization problem. Thus, developing a fast and effective heuristic for the Steiner tree problem in graphs is of universal significance. By analyzing the advantages and disadvantages of the fast classic heuristics, we find that the shortest paths and Steiner points play important roles in solving the Steiner tree problem in graphs. Based on the analyses, we propose a Steiner point candidate-based heuristic algorithm framework (SPCF) for solving the Steiner tree problem in graphs. SPCF consists of four stages: marking [Formula: see text] points, constructing the Steiner tree, eliminating the detour paths, and [Formula: see text]-based refining stage. For each procedure of SPCF, we present several alternative strategies to make the trade-off between the effectiveness and efficiency of the algorithm. By finding the shortest path clusters between vertex sets, several methods are proposed to mark the first type of Steiner point candidates [Formula: see text]. The solution qualities of the classic heuristics are effectively improved by looking [Formula: see text] points as terminals. By constructing a Voronoi diagram, a series of methods are suggested to mark the second type of Steiner point candidates [Formula: see text]. The feasible solution quality is efficiently improved by employing the [Formula: see text] points as the insertable key-vertices in key-vertex insertion local search method. Numerical experiments show that the proposed strategies are all effective for improving the solution quality. Compared with other effective algorithms, the proposed algorithms can achieve better solution quality and speed performance.
Sudden loss of vision
Authors: Mahgoub Kareem , Butt Gibran
Published: April 2016

Even small deteriorations in vision can be worrying for patients, due to the huge impact it may have on their daily activities. When this change is severe, sudden and possibly accompanied with pain, this anxiety becomes considerably magnified. This article will cover some of the common causes of sudden loss of vision, how they can be diagnosed and subsequently managed.
Postnatal perineal problems
Authors: Field Alexander , Mistry Megha , Field Elizabeth
Published: April 2016

The majority of the women in the UK who deliver a baby vaginally sustain perineal trauma that requires suturing. GPs are frequently consulted by women regarding perineal health after delivery, either with specific concerns or opportunistically at the 6–8 week routine postnatal check. The aim of this article is to explore the common presentations and underlying pathologies of postpartum perineal problems, their management in primary care and when to refer. We also aim to emphasise the need for a holistic approach and to consider where perineal problems fit into the broader picture of postnatal health.
Taking back control
Authors: Lyon-Maris Johnny
Published: April 2016

Workload, fear of litigation, ever-increasing patient demand, and the confrontation involved with refusing patient or colleague requests have led to a culture of just saying ‘Yes’. This article looks at the causes of those stresses and gives practical suggestions that may help the clinician to say ‘No’ in a supportive way, reducing inappropriate demand and educating the patients, their carers, and other health and social care professionals to use the service correctly. In this way, primary care clinicians will start to take back control of their professional lives, resulting in better and more appropriate care for the patients, who must be involved and responsible for their own health. The author recognises this approach to be controversial but feels that ‘more of the same’ is not an option for primary care.
Current approaches for optimizing the benefit of biologic therapy in ulcerative colitis
Authors: Sofia M. Anthony , Rubin David T.
Published: April 2016

As biologic-based medication options for ulcerative colitis expand, our understanding of their optimal use in clinical practice is advancing as well. The appropriate use of combination therapy with immunomodulators can reduce the immunogenicity of biologic agents and raise serum drug levels of the biologic. A treat-to-target strategy with objective assessments of disease activity clearly defines the goals of biologic drug treatment. Mucosal healing is an evolving treatment goal and is associated with long-term remission and reduced incidence of colectomy. Furthermore, regular reassessments and therapeutic drug monitoring can allow clinicians to make evidence-based changes in therapy. Biologic drug de-escalation or re-initiation are less well developed topics, but are emerging areas of study. We review the evidence underlying these advances and a modern approach to the use of biologic therapy in ulcerative colitis.
Low-dose azathioprine is effective in maintaining remission in steroid-dependent ulcerative colitis: results from a territory-wide Chinese population-based IBD registry
Authors: Shi Hai Yun , Chan Francis K. L. , Leung Wai Keung , Li Michael K. K. , Leung Chi Man , Sze Shun Fung , Ching Jessica Y. L. , Lo Fu Hang , Tsang Steven W. C. , Shan Edwin H. S. , Mak Lai Yee , Lam Belsy C. Y. , Hui Aric J. , Chow Wai Hung , Wong Marc T. L. , Hung Ivan F. N. , Hui Yee Tak , Chan Yiu Kay , Chan Kam Hon , Loo Ching Kong , Ng Carmen K. M. , Lao Wai Cheung , Harbord Marcus , Wu Justin C. Y. , Sung Joseph J. Y. , Ng Siew C.
Published: April 2016

Background:

Whether low-dose azathioprine (AZA) is effective in maintaining remission in patients with steroid-dependent ulcerative colitis (UC) remains unclear. We assessed the efficacy and safety of low-dose AZA in a Chinese population with UC.

Methods:

We identified steroid-dependent UC patients in clinical remission on AZA maintenance therapy from a territory-wide IBD Registry. Standard- and low-dose AZA were defined as at least 2 mg/kg/day and less than 2 mg/kg/day, respectively. Relapse rates were analyzed by Kaplan–Meier analysis and compared using log-rank test.

Results:

Among 1226 UC patients, 128 (53% male, median duration on AZA 44 months) were included. Median maintenance AZA dose was 1.3 mg/kg/day. 97.7% of the patients were on concomitant oral 5-aminosalicylic acid. Cumulative relapse-free rates in patients on standard-dose and low-dose AZA were 71.2%, 52.8% and 45.2%, and 71.8%, 55.3% and 46.2% at 12, 24 and 36 months, respectively ( p = 0.871). Relapse rate within 12 months was higher in patients who withdrew compared with those who maintained on AZA (52.6% versus 29.4%; p = 0.045). Mean corpuscular volume increased after AZA therapy in both of the low-dose [median (interquartile range, IQR): 88.2 (81.4–92.2) versus 95.1 (90.1–100.9) fl, p < 0.001] and standard-dose subgroups [median (IQR) 86.8 (76.9–89.9) versus 94.7 (85.9–99.7) fl, p < 0.001]. Leukopenia occurred in 21.1% of the patients. Patients on standard dose had a higher risk for leukopenia than those on low-dose AZA [odds ratio (OR) 3.9, 95% CI 1.9–8.2, p < 0.001].

Conclusions:

In the Chinese population, low-dose AZA is effective for maintaining remission in steroid-dependent UC patients. Standard-dose AZA was associated with more than threefold increased risk of leukopenia.
The intestinal microbiome, barrier function, and immune system in inflammatory bowel disease: a tripartite pathophysiological circuit with implications for new therapeutic directions
Authors: Vindigni Stephen M. , Zisman Timothy L. , Suskind David L. , Damman Christopher J.
Published: April 2016

We discuss the tripartite pathophysiological circuit of inflammatory bowel disease (IBD), involving the intestinal microbiota, barrier function, and immune system. Dysfunction in each of these physiological components (dysbiosis, leaky gut, and inflammation) contributes in a mutually interdependent manner to IBD onset and exacerbation. Genetic and environmental risk factors lead to disruption of gut homeostasis: genetic risks predominantly affect the immune system, environmental risks predominantly affect the microbiota, and both affect barrier function. Multiple genetic and environmental ‘hits’ are likely necessary to establish and exacerbate disease. Most conventional IBD therapies currently target only one component of the pathophysiological circuit, inflammation; however, many patients with IBD do not respond to immune-modulating therapies. Hope lies in new classes of therapies that target the microbiota and barrier function.
Predictors of pain response in patients undergoing endoscopic ultrasound-guided neurolysis for abdominal pain caused by pancreatic cancer
Authors: Minaga Kosuke , Kitano Masayuki , Sakamoto Hiroki , Miyata Takeshi , Imai Hajime , Yamao Kentaro , Kamata Ken , Omoto Shunsuke , Kadosaka Kumpei , Sakurai Toshiharu , Nishida Naoshi , Chiba Yasutaka , Kudo Masatoshi
Published: April 2016

Background:

Interventional endoscopic ultrasound (EUS)-guided procedures such as EUS-guided celiac ganglia neurolysis (EUS-CGN) and EUS-guided broad plexus neurolysis (EUS-BPN) were developed to treat abdominal cancer-associated pain; however, these procedures are not always effective. The aim of this study was to explore predictors of pain response in EUS-guided neurolysis for pancreatic cancer-associated pain.

Methods:

This was a retrospective analysis of prospectively collected data of 112 consecutive patients who underwent EUS-BPN in our institution. EUS-CGN was added in cases of visible celiac ganglia. The neurolytic-spread area was divided into six sections and evaluated by post-procedural computed tomography scanning. Pain intensity was assessed using a visual analog scale (VAS), and a decrease in VAS scores by ⩾3 points after neurolysis was considered a good pain response. Univariable and multivariable logistic regression analyses were performed to explore predictors of pain response at 1 and 4 weeks, and complications.

Results:

A good pain response was obtained in 77.7% and 67.9% of patients at 1 and 4 weeks, respectively. In the multivariable analysis of these patients, the combination method (EUS-BPN plus CGN) was a significant positive predictive factor at 1 week (odds ratio = 3.69, p = 0.017) and 4 weeks (odds ratio = 6.37, p = 0.043). The numbers of neurolytic/contrast spread areas (mean ± SD) were 4.98 ± 1.08 and 4.15 ± 1.12 in patients treated with the combination method and single method, respectively ( p < 0.001). There was no significant predictor of complications.

Conclusions:

EUS-BPN in combination with EUS-CGN was a predictor of a good pain response in EUS-guided neurolysis for pancreatic cancer-related pain. The larger number of neurolytic/contrast spread areas may lead to better outcomes in patients receiving combination treatment.
Targeted chemotherapy with nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in metastatic breast cancer: which benefit for which patients?
Authors: Palumbo Raffaella , Sottotetti Federico , Bernardo Antonio
Published: April 2016

The therapeutic goals in metastatic breast cancer (MBC) remain palliative in nature, aimed at controlling symptoms, improving or maintaining quality of life and prolonging survival. The advent of new drugs and new formulations of standard agents has led to better outcomes in patients with advanced or metastatic disease. These developments have also allowed a tailored therapeutic approach, in which the molecular biology of the tumour, the treatment history, and patient attitudes are taken into account in the decision-making process. Targeting drug delivery to the tumour is a promising mean of increasing the therapeutic index of highly active agents such as the taxanes, and nanoparticle albumin-bound paclitaxel ( nab-paclitaxel), the first nanotechnology-based drug developed in cancer treatment, is one such advance. Data from randomized trials support the efficacy of single-agent nab-paclitaxel as first-line and further treatment lines in MBC at the registered 3-weekly schedule of 260 mg/m2, but emerging evidence suggests its activity as a weekly regimen or combined with other agents in various clinical scenarios. Thus, nab-paclitaxel seems to offer flexibility in terms of dosing schedules, allowing physicians to tailor the dose according to different clinical situations. This paper reviews the clinical trial background for nab-paclitaxel in MBC, focusing on specific ‘difficult-to-treat’ patient populations, such as taxane-pretreated or elderly women, as well as those with triple-negative, HER2-positive and poor-prognostic-factors disease. Moving beyond evidence-based information, ‘real life’ available experiences are also discussed with the aim of providing an update for daily clinical practice.
The Autobiographical Author Through Time
Authors: Dunlop William L. , Guo Jen , McAdams Dan P.
Published: April 2016

We examined continuity and change in the tendencies to construct a life story (i.e., narrative identity) that was redemptive or contaminated in nature. In Study 1, college freshmen and seniors wrote accounts of several autobiographical key scenes pertinent to narrative identity twice over a 3-year period. In Study 2, midlife adults provided, via a semistructured interview, key scenes twice over a 5-year period and also indicated whether their employment status had changed between assessments. Across studies, the rank-order consistency of redemptive and contaminated stories was moderate and low to moderate, respectively. In Study 1, the frequency of redemptive and contaminated stories increased throughout college. Furthermore, the frequency of contaminated stories decreased following graduation. In Study 2, changes in employment status corresponded with reduced redemptive imagery. These results suggest a possible narrative acculturation of young adults as well as a correspondence between changes in life circumstances and narrative identity.
Victims’ Race and Sex Leads to Eyewitness Misidentification of Perpetrator’s Phenotypic Stereotypicality
Authors: Davies Paul G. , Hutchinson Shirley , Osborne Danny , Eberhardt Jennifer L.
Published: April 2016

Eyewitness misidentification is the primary cause of wrongful convictions in North America. Discovering a discernible pattern to these errors is a critical step toward creating procedures that reduce the occurrence of these tragic mistakes. To these ends, we hypothesized that both the victims’ race and the victims’ sex may impact eyewitness identification for perpetrators of certain crime types. In two experiments, we demonstrated that a Black male drive-by shooter’s level of phenotypic stereotypicality is accurately identified by eyewitnesses only when the victims are Black males. Specifically, when eyewitnesses believe the victims are White or female, the drive-by shooter’s level of Black phenotypic stereotypicality is falsely elevated. In contrast, when a Black male perpetrator is suspected of committing a stereotypically non-Black crime (i.e., serial killing), the perpetrator’s level of phenotypic stereotypicality is accurately identified regardless of the victims’ race or sex.
Evaluating the Domain Specificity of Mental Health–Related Mind-Sets
Authors: Schroder Hans S. , Dawood Sindes , Yalch Matthew M. , Donnellan M. Brent , Moser Jason S.
Published: April 2016

Mind-sets are beliefs regarding the malleability of self-attributes. Research suggests they are domain-specific, meaning that individuals can hold a fixed (immutability) mind-set about one attribute and a growth (malleability) mind-set about another. Although mind-set specificity has been investigated for broad attributes such as personality and intelligence, less is known about mental health mind-sets (e.g., beliefs about anxiety) that have greater relevance to clinical science. In two studies, we took a latent variable approach to examine how different mind-sets (anxiety, social anxiety, depression, drinking tendencies, emotions, intelligence, and personality mind-sets) were related to one another and to psychological symptoms. Results provide evidence for both domain specificity (e.g., depression mind-set predicted depression symptoms) and generality (i.e., the anxiety mind-set and the general mind-set factor predicted most symptoms). These findings may help refine measurement of mental health mind-sets and suggest that beliefs about anxiety and beliefs about changeability in general are related to clinically relevant variables.
A quality review of smartphone applications for the management of pain
Authors: Portelli Pamela , Eldred Clare
Published: April 2016

Smartphone applications (apps) are recent innovations that have not been studied extensively. The lack of regulatory body assessing the content of existing apps means that their quality is often unknown. This review aims to assess the quality of smartphone apps that claim to provide information and treatment for pain conditions. It assesses the degree to which apps adhere to evidence-based practices in psychological research for pain management and which stand the best chance of being effective for consumers. Another aim is to identify potential apps health-care professionals may wish to recommend to clients. Pain management apps on the official iPhone and Android stores were searched in January 2014. Those containing a psychological component in the app description were downloaded and rated for quality using a checklist devised by two researchers. The checklist was based on cognitive behavioural therapy (CBT) guidelines since the latter is the most effective intervention for computerized programs. A total of 195 apps met inclusion criteria. Although CBT is a promising alternative to traditional psychological interventions, only six apps endorsed theoretical reference to CBT principles. Existing apps are often constructed by lay people or software developers, with little input from health-care professionals. Pain apps sometimes promise a solution to pain without a consideration of app content. The development of evidence-based apps and rigorous evaluation of any long-term outcomes are important in enhancing understanding of the potential of these apps.
Movember: Twitter Conversations of a Hairy Social Movement
Authors: Jacobson Jenna , Mascaro Christopher
Published: April 2016

Movember is an annual “month-long celebration of the moustache” where men grow a mustache and raise money in the largest philanthropic endeavor for men’s health. Movember is predominantly an online campaign, and consequently, participants have actively embraced social media; this is evidenced in the 1,879,994 tweets collected during Movember 2012 in this research project. This article presents an analysis of Movember that examines how individuals use the numerous syntactical features of Twitter to engage in conversation and share information in order to develop a nuanced understanding of how people are utilizing social media as part of the social movement. While Movember has been successful in gaining traction on social media, the Twitter data point to surprising conclusions that have implications for understanding non-profits and social movements online. The following study provides two main contributions to existing sociotechnical social movement literature using a mixed-methods approach. First, the findings suggest that there is limited true conversation taking place although the stated purpose of the campaign is to facilitate conversation. Second, the findings identify that participants are more engaged with Movember as a branded movement than engaged in health promotion. While the tweets are conversational in form, they are largely not conversational in function, which points to Twitter being used as a broadcast tool in this context. These findings have broad implications for understanding how social media is used to engage individuals in social campaigns and engage with each other and share information.
The ethics of ethical debates in peace and conflict research: Notes towards the development of a research covenant
Authors: Brewer John D
Published: April 2016

This article outlines the case for peace and conflict researchers to formulate a research covenant to better shape their ethical obligations and responsibilities. This is an urgent necessity given that ethical debates have in some proponents become emotive and are not conducted in an ethical manner. In coming to this assessment, the article reviews trends in the research ethics literature and draws out some of the generic issues addressed in a review of the personal reflexivity that an assortment of individual peace and conflict researchers have engaged in when recounting their fieldwork experiences. These generic issues are reformulated in an attempt to codify appropriate ethical practice in peace and conflict research, and they go towards determining the contents of the research covenant. It is suggested that the research covenant is a more ethical way to debate the ethics of peace and conflict research.
Centrality and the dual-projection approach for two-mode social network data
Authors: Everett Martin G
Published: April 2016

Research using techniques from social network analysis have expanded dramatically in recent years. The availability of network data and the recognition that social network techniques can provide an additional perspective have contributed to this expansion. Social network data are not always in a standard network form and, in many instances, consists of two distinct groups with ties between groups and no within group ties. For example, people attending events or meetings, authors collaborating on research outputs, or directors on boards of companies. Such data are known as two-mode data. Recently, Everett and Borgatti suggested a general approach for analyzing two-mode data. They suggested forming two one-mode data sets, analyzing these separately, and then recombining the results using the original data. One under-explored area in their work is in how this method can be applied to centrality problems; an issue we seek to begin to address here.
Ethnicity and ethnic group measures in social survey research
Authors: Connelly Roxanne , Gayle Vernon , Lambert Paul S
Published: April 2016

This article is a review of issues associated with measuring ethnicity and using ethnicity measures in social science research. The review is oriented towards researchers who undertake secondary analyses of large-scale multipurpose social science datasets. The article begins with an outline of two main approaches used in social surveys to measure ethnicity, the ‘mutually exclusive category’ approach and the ‘multiple characteristics’ approach. We also describe approaches to the use of ethnicity measures in cross-national comparative research. We emphasise the value of sensitivity analyses. We also encourage researchers to carefully consider the possible relationships between ethnicity and other important variables in order to avoid spurious interpretations of the effects of ethnicity.
Courting Corporate Philanthropy in Public Education
Authors: Gurn Alex M.
Published: April 2016

The last few decades have been ones of complexity and contradiction. Long-term socio-economic restructuring has produced deep and growing wealth disparities, leveling great constraints on urban public schools that must confront the social and educational repercussions of chronic poverty. Long-standing political austerity, coupled with fallout from the great recession, has rendered private/corporate sector solutions to public problems increasingly expedient. Corporations have aggressively encroached into the gaps in provisions to public education, addressing problems that hyper-concentrated wealth has helped to engender. This literature review examines ideological debates surrounding one aspect of this shifting landscape: corporate philanthropic partnerships in education. Exploring research from education and business, this article rethinks the underlying assumptions, motivations, and implications of two bodies of literature and wider discourses that take counter-related positions on the role of corporate social participation: (a) public–private partnerships (PPPs) as manna and (b) PPPs as privatizations in education.
Privately Provided Accommodation Service Quality and Customer Satisfaction
Authors: Mugambwa Joshua , Mugerwa George William , Mutumba Wilson Williams , Muganzi Claire , Namubiru Bridget , Waswa Yusuf , Kayongo Isaac Newton
Published: April 2016

Privately provided accommodation is a growing service in Uganda’s higher education sector due to education liberalization and demand for education. This research took a case study of Nsamizi Training Institute of Social Development (NTISD) to determine the relationship between privately provided accommodation service quality and customer satisfaction. Specifically, the objectives of the study were (a) to find out the relationship between security and NTISD students’ satisfaction with privately provided accommodation, and (b) to find out the hierarchical level of importance of NTISD student satisfaction of the three service quality dimensions (reliability, security, and tangibles) with privately provided accommodation. Using quantitative and qualitative modes of data analysis and a sample of 300 students from 20 private hostels, this study established a strong positive significant relationship between security and satisfaction regarding privately provided accommodation. This implies that accommodation service providers should increase the quality of security so as to increase the satisfaction of students regarding privately provided accommodation. The study established the hierarchical order of importance from the most important service quality dimension, respectively, as follows: reliability, security, and tangibles. Therefore, private accommodation service managers should pay extra attention to the dimensions in the same order.
Proto-Nationalisms as Sub-Text for the Crisis of Governance in Nigeria
Authors: Olaiya Taiwo Akanbi
Published: April 2016

There are several accounts of the genealogy and manifestations of the myriad governance crises, which Nigeria continues to face five decades after independence. Although no single account is sufficient to explain the governance misadventures, one key point resonating is that progress and development have proved elusive over the years. In this article, we seek to move away from the dominant characterization of this governance crisis as deriving directly from the consequences of a monolithic oil economy, a deeply fractured and volatile political terrain, or even corrupt and patrimonial rule. Instead, the article locates the root of Nigeria’s governance crisis in the queer pattern of the emergence, reinvention, and manipulation of proto-nationalisms characterized not by any nationalistic quest for independence and spatial liberation but one pursued to gain foothold in governance and to partake in its perquisites. Invariably, the post-colonial nation-states that emerged at independence in many African countries, for the most part, neither followed through with any logical expression of genuine nationalism nor mobilized toward a shared vision of nationhood. The article shows how individuals and groups within the polity soon became locked in contested and irreconcilable positions that further made the construction of a truly nationalistic identity difficult, if not forlorn. This article submits that successive post-colonial administrations unimaginatively followed the divide-and-rule traditions of the colonial state and thus failed to mobilize the popular support required for the construction of a broad-based national identity that is key to managing the protracted governance crises the country has experienced since independence.
Potential Cost Savings From Reduction of Regional Variation in Medicare Spending
Authors: Song Yunjie
Published: April 2016

Potential cost savings estimated from reduction of regional variation in Medicare spending are considerable but questioned. This article evaluates the validity of the principal methods that have been used in the estimations of the potential savings. Three estimation approaches were identified. The first approach uses adjusted expenditures to calculate avoidable costs, but adjusted expenditures can be independent of avoidable costs, and measurement errors are not controlled. The second approach uses an outcome variable to replace its causal factors, and is not acceptable because the association between the outcomes and the causes is untestable. The final approach uses surveys to directly measure physician beliefs and patient preferences, but the sole study using this approach is weakened by sample selection biases and incomplete controls. A development of reliable measures and a switch of observation from clinic settings to geographic contexts could make the estimations more convincing.
The Determinants of Early Refractive Error on School-Going Chinese Children
Authors: Jayaraman K. , Iranmanesh Mohammad , Liang Chuan Chin , Iranmanesh Mahboobeh
Published: April 2016

Refractive error is a common social issue in every walks of human life, and its prevalence recorded the highest among Chinese population, particularly among people living in southern China, Hong Kong, Thailand, Singapore, and Malaysia. Refractive error is the simplest disorder to treat and supposed to cost the effective health care intervention. The present study included 168 Chinese school-going children aged 10 to 12 years; they were selected from different schools of urban Malaysia. It was surprising to see that 112 (66.7%) children had the early onset of refractive error; refractive error was also detected late among the primary school or secondary school students. The findings revealed that the determinants of refractive error among Chinese children were personal achievements and machine dependence. The possible reasons for the above significant factors emerged could be attributed to the inbuilt culture and traditions of Chinese parents who insist that their children should be hardworking and focus on school subjects so that their parents allow them to use luxury electronic devices.
Ectopic ACTH Production Leading to Diagnosis of Underlying Medullary Thyroid Carcinoma
Authors: Matheny Leslee N. , Wilson Jessica R. , Baum Howard B. A.
Published: April 2016

Medullary thyroid carcinoma (MTC) has been described as a source of ectopic ACTH secretion in patients with Cushing’s syndrome. This is an infrequent association, occurring in less than 1% of MTC cases. Among these, it is even more unusual for an initial diagnosis of hypercortisolism to lead to the discovery of underlying MTC. Here we present a case of a patient with weakness, diarrhea, and hypokalemia who was found first to have Cushing’s syndrome and later diagnosed with metastatic MTC. The patient was treated initially with oral agents to control his hypercortisolism, then with an etomidate infusion after experiencing intestinal perforation. He also received vandetanib therapy targeting his underlying malignancy, as this has been shown to reverse clinical signs of Cushing’s syndrome in patients with MTC and subsequent ectopic ACTH secretion. Bilateral adrenalectomy was ultimately required. Medullary thyroid carcinoma should be considered in patients presenting with Cushing’s syndrome due to ectopic ACTH secretion, and a multimodality treatment approach is often required.
Pure Red Cell Aplasia Following Interleukin-2 Therapy
Authors: Dutcher Janice P. , Fan Wen , Wiernik Peter H.
Published: April 2016

A 61-year-old woman with metastatic renal cell carcinoma underwent systemic treatment with high-dose interleukin-2 (IL-2). Anemia requiring transfusion of 1 unit of packed red blood cells (PRBCs) was required during the second week of IL-2 therapy. One month following completion of high-dose IL-2 treatment, she was hospitalized for severe, symptomatic anemia and received 5 units of PRBCs. She was referred back for evaluation. A complete hematologic evaluation was performed including antiviral serology, evaluation for hemolysis, complete iron studies, and finally bone marrow aspiration and biopsy. The diagnosis was pure red cell aplasia, and no inciting viral cause could be ascertained. She required PRBCs for 5 months following IL-2 therapy. It was concluded that IL-2 was the cause of her red cell aplasia. This subsequently resolved spontaneously, and she had normal hemoglobin and hematocrit, respectively, 1 and 2 years after treatment.
An Unusual Triad in Pediatric Neurology
Authors: Hendriksen Ruben G. F. , Aalbers Marlien W. , Hendriksen Jos G. M. , de Die-Smulders Christine E. M. , Hoogland Govert , Vles Johan S. H.
Published: April 2016

We present a case of an unusual triad in pediatric neurology: a currently 12-year-old boy with cerebral palsy and epilepsy who was later also diagnosed with Duchenne muscular dystrophy. We describe the clinical path that resulted in this exceptional diagnosis. This case report illustrates how different neurological disorders may overshadow each other. In addition, it demonstrates that every child with cerebral palsy and either an atypical clinical course or with inexplicable laboratory values—as well as every infant boy born to a theoretical Duchenne muscular dystrophy carrier—should be subjected to additional investigations.
The Perception of Auditory Motion
Authors: Carlile Simon , Leung Johahn
Published: April 2016

The growing availability of efficient and relatively inexpensive virtual auditory display technology has provided new research platforms to explore the perception of auditory motion. At the same time, deployment of these technologies in command and control as well as in entertainment roles is generating an increasing need to better understand the complex processes underlying auditory motion perception. This is a particularly challenging processing feat because it involves the rapid deconvolution of the relative change in the locations of sound sources produced by rotational and translations of the head in space (self-motion) to enable the perception of actual source motion. The fact that we perceive our auditory world to be stable despite almost continual movement of the head demonstrates the efficiency and effectiveness of this process. This review examines the acoustical basis of auditory motion perception and a wide range of psychophysical, electrophysiological, and cortical imaging studies that have probed the limits and possible mechanisms underlying this perception.
FII Inflows into Indian IPOs and its Impact on the Indian Stock Market
Authors: Agarwal Baishali
Published: April 2016

Foreign portfolio investments (FPIs) gained momentum in India, particularly, in the post-liberalization period. On the other hand, the Indian primary market acts as the prime platform for corporate capital formation especially through the initial public offering (IPO). The foreign institutional investments have always been known for their volatile nature and quick reversal. This article is an attempt to identify how the foreign institutional investments in the Indian IPO segment augment financial development, and to what extent such investment can be considered close to real investments by being in the primary market.
Inherited platelet disorders: toward DNA-based diagnosis
Authors: Lentaigne Claire , Freson Kathleen , Laffan Michael A. , Turro Ernest , Ouwehand Willem H.
Published: April 2016

Variations in platelet number, volume, and function are largely genetically controlled, and many loci associated with platelet traits have been identified by genome-wide association studies (GWASs).1 The genome also contains a large number of rare variants, of which a tiny fraction underlies the inherited diseases of humans. Research over the last 3 decades has led to the discovery of 51 genes harboring variants responsible for inherited platelet disorders (IPDs). However, the majority of patients with an IPD still do not receive a molecular diagnosis. Alongside the scientific interest, molecular or genetic diagnosis is important for patients. There is increasing recognition that a number of IPDs are associated with severe pathologies, including an increased risk of malignancy, and a definitive diagnosis can inform prognosis and care. In this review, we give an overview of these disorders grouped according to their effect on platelet biology and their clinical characteristics. We also discuss the challenge of identifying candidate genes and causal variants therein, how IPDs have been historically diagnosed, and how this is changing with the introduction of high-throughput sequencing. Finally, we describe how integration of large genomic, epigenomic, and phenotypic datasets, including whole genome sequencing data, GWASs, epigenomic profiling, protein–protein interaction networks, and standardized clinical phenotype coding, will drive the discovery of novel mechanisms of disease in the near future to improve patient diagnosis and management.
Resurgence of Vaccine-Preventable Diseases in the United States: Anesthetic and Critical Care Implications
Authors: Porteous Grete H. , Hanson Neil A. , Sueda Lila Ann A. , Hoaglan Carli D. , Dahl Aaron B. , Ohlson Brooks B. , Schmidt Brian E. , Wang Chia C. , Fagley R. Eliot
Published: April 2016

Vaccine-preventable diseases (VPDs) such as measles and pertussis are becoming more common in the United States. This disturbing trend is driven by several factors, including the antivaccination movement, waning efficacy of certain vaccines, pathogen adaptation, and travel of individuals to and from areas where disease is endemic. The anesthesia-related manifestations of many VPDs involve airway complications, cardiovascular and respiratory compromise, and unusual neurologic and neuromuscular symptoms. In this article, we will review the presentation and management of 9 VPDs most relevant to anesthesiologists, intensivists, and other hospital-based clinicians: measles, mumps, rubella, pertussis, diphtheria, influenza, meningococcal disease, varicella, and poliomyelitis. Because many of the pathogens causing these diseases are spread by respiratory droplets and aerosols, appropriate transmission precautions, personal protective equipment, and immunizations necessary to protect clinicians and prevent nosocomial outbreaks are described.
Obstetric Anesthesia Workforce Survey: A 30-Year Update
Authors: Traynor Andrea J. , Aragon Meredith , Ghosh Debashis , Choi Ray S. , Dingmann Colleen , Vu Tran Zung , Bucklin Brenda A.
Published: April 2016

BACKGROUND:

Obstetric Anesthesia Workforce Surveys were conducted in 1981, 1992, and 2001, and the 10-year update was conducted in 2012. Anesthesia providers from US hospitals were surveyed to identify the methods used to provide obstetric anesthesia. Our primary hypothesis was that the provision of obstetric anesthesia services has changed in the past 10 years.

METHODS:

A sample of hospitals was generated based on the number of births per year and US census region. Strata were defined as follows: I ≥ 1500 annual births (n = 341), II ≥ 500 to 1499 annual births (n = 438), and III < 500 annual births (n = 414). Contact email information for the anesthesia provider in charge of obstetric services was obtained by phone call. Electronic questionnaires were sent through email.

RESULTS:

Administration of neuraxial (referred to as “regional” in previous surveys) labor analgesia was available 24 hours per day in all stratum I hospitals responding to the survey. Respondents across all strata reported high rates of in-house coverage, with 86.3% (95% confidence interval [CI] = 82.7%–90%) of stratum I providers reporting that they provided in-house anesthesiology services for obstetrics. The use of patient-controlled epidural analgesia in stratum I hospitals was reported to be 35% in 2001 and 77.6% (95% CI = 73.2%–82.1%) in this survey. Independent Certified Registered Nurse Anesthetists were reported to provide obstetric anesthesia services in 68% (95% CI = 57.9%–77.0%) of stratum III hospitals. Although 76% (95% CI = 71.2%–80.3%) of responding stratum I hospitals allow postpartum tubal ligations, 14% report inadequate staffing to provide anesthesia either always or at off-hours.

CONCLUSIONS:

Since 2001, there have been significant changes in how responding hospitals provide obstetric anesthesia care and staff the labor and delivery ward. Obstetric anesthesia surveys, updated every 10 years, continue to provide information about changes in obstetric anesthesia practice.
Pain After Unilateral Total Knee Arthroplasty: A Prospective Randomized Controlled Trial Examining the Analgesic Effectiveness of a Combined Adductor Canal Peripheral Nerve Block with Periarticular Infiltration Versus Adductor Canal Nerve Block Alone Versus Periarticular Infiltration Alone
Authors: Sawhney Monakshi , Mehdian Hossein , Kashin Brian , Ip Gregory , Bent Maurice , Choy Joyce , McPherson Mark , Bowry Richard
Published: April 2016

BACKGROUND:

Total knee arthroplasty is a painful surgery that requires early mobilization for successful joint function. Multimodal analgesia, including spinal analgesia, nerve blocks, periarticular infiltration (PI), opioids, and coanalgesics, has been shown to effectively manage postoperative pain. Both adductor canal (AC) and PI have been shown to manage pain without significantly impairing motor function. However, it is unclear which technique is most effective. This 3-arm trial examined the effect of AC block with PI (AC + PI) versus AC block only (AC) versus PI only (PI). The primary outcome was pain on walking at postoperative day (POD) 1.

METHODS:

One hundred fifty-one patients undergoing unilateral total knee arthroplasty were included. Patients received either AC block with 30 mL of 0.5% ropivacaine or sham block. PI was performed intraoperatively with a 110-mL normal saline solution containing 300 mg ropivacaine, 10 mg morphine, and 30 mg ketorolac. Those patients randomly assigned to AC only received normal saline knee infiltration.

RESULTS:

On POD 1, participants who received AC + PI reported significantly lower pain numeric rating scale scores on walking (3.3) compared with those who received AC (6.2) or PI (4.9) (P < 0.0001). Participants who received AC reported significantly higher pain scores at rest and knee bend compared with those who received AC + PI or PI (P < 0.0001). The difference in pain scores between participants who received AC + PI and those who received AC was 2.83 (95% confidence interval, 1.58–4.09) and the difference between those who received AC + PI and those who received PI was 1.61 (95% confidence interval, 0.37–2.86). On POD 2, participants who received AC + PI reported significantly less pain on walking (4.4) compared with those who received AC (5.6) or PI (5.6) (P = 0.006). On POD 2, there was no difference between the groups for pain at rest or knee bending. Participants who received AC used more IV patient-controlled analgesia on POD 0. There was no difference between the groups regarding distance walked.

CONCLUSIONS:

Participants who received AC + PI reported significantly less pain on walking on PODs 1 and 2 compared with those who received AC only or PI only.
Patient-Controlled Analgesia Plus Background Opioid Infusion for Postoperative Pain in Children: A Systematic Review and Meta-Analysis of Randomized Trials
Authors: Hayes Jason , Dowling Jeremiah J. , Peliowski Arie , Crawford Mark W. , Johnston Bradley
Published: April 2016

BACKGROUND:

Bolus administration of opioids via a patient-controlled analgesia (PCA) device is widely used in the postoperative pediatric population. PCA devices have been shown to provide superior analgesia and greater patient satisfaction compared with intermittent administration. Studies comparing the efficacy of PCA with and without a background infusion for postoperative analgesia in children vary considerably in terms of dosing and methodologic quality, making it difficult for practitioners to derive clinically useful information. The purpose of this meta-analysis was to assess whether the addition of a background infusion to PCA bolus administration of an opioid analgesic is more effective (defined as lower pain scores) than PCA bolus alone in the postoperative population specific to children.

METHODS:

We searched Medline, Embase, and CENTRAL from inception to January 2015 for registered and ongoing trials included in the meta-Register of Controlled Trials and ClinicalTrials.gov, and reference lists of review articles and included articles. Study selection was randomized controlled studies comparing PCA bolus with PCA bolus plus background infusion for postoperative analgesia in children aged 0 to 18 years and adolescents aged 13 to 21 years undergoing any form of surgery that used patient-reported pain scores as an outcome measure. Two reviewers independently extracted data on patient and study characteristics, interventions, and outcomes from included studies using standardized data extraction forms. Seven trials met our eligibility criteria. Data were analyzed using Review Manager version 5.3. Meta-analyses were performed for outcomes that were defined similarly and reported in 2 or more studies, including patient-reported pain scores, nausea and/or vomiting, sedation, and opioid consumption. We independently assessed the risk of bias for each outcome and the certainty in the estimates of effect for critically important outcomes (pain scores, nausea and/or vomiting, excessive sedation) using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Subgroup analyses based on dose of background infusion (high versus low dose) and risk of bias (low versus high/unclear) were performed.

RESULTS:

There were no significant differences found with respect to pain scores 12 and 24 hours after surgery, opioid consumption, or risk of adverse events with the addition of a background opioid infusion to PCA opioid bolus doses. The quality of the evidence was deemed to be low to very low.

CONCLUSIONS:

There was no significant difference in outcomes with the addition of an opioid background infusion to PCA bolus doses of opioid. Further high-quality studies are required.