bluuebunny/crossref_metadata_2025 huggingface dataset:
Expert‐level classification of ventilatory thresholds from cardiopulmonary exercising test data with recurrent neural networks
Authors: Zignoli Andrea , Fornasiero Alessandro , Stella Federico , Pellegrini Barbara , Schena Federico , Biral Francesco , Laursen Paul B.
Published: March 2019

First and second ventilatory thresholds (VT1 and VT2) represent the boundaries of the moderate‐heavy and heavy‐severe exercise intensity. Currently, VTs are primarily detected visually from cardiopulmonary exercise test (CPET) data, beginning with an initial data screening followed by data processing and statistical analysis. Automated VT detection is a challenging task owing to the high signal to noise ratio typical of CPET data. Recurrent neural networks describe a machine learning form of Artificial Intelligence that can be used to uncover complex non‐linear relationships between input and output variables. Here we proposed detection of VTs using a single neural network classifier, trained with a database of 228 laboratory CPET data. We tested the neural network performance against the judgement of 7 couples of board‐certified exercise‐physiologists on 25 CPET tests. The neural network achieved expert‐level performances across the tasks (mean absolute error was 9.5% (r = 0.79) and 4.2% (r = 0.94) for VT1 and VT2, respectively). Estimation errors are compatible with the typical error of the current gold standard visual methodology. The neural network demonstrated VT detecting and exercise intensity level classifying at a high competence level. Neural networks could potentially be embedded in CPET hardware/software to extend the reach of exercise physiologists beyond their laboratories.
Under pressure: Ano1 mediates pressure sensing in the lymphatic system
Authors: Tembo Maiwase , Carlson Anne E.
Published: March 2019

Tembo and Carlson reflect on recent work describing a new role for Ano1 in lymphatic collecting vessels.
Zeta functions associated to admissible representations of compact 𝑝-adic Lie groups
Authors: Kionke Steffen , Klopsch Benjamin
Published: March 2019

LetGGbe a profinite group. A strongly admissible smooth representationϱ\varrhoofGGoverC{\mathbb {C}}decomposes as a direct sumϱ≅⨁π∈Irr(G)mπ(ϱ)π\varrho \cong \bigoplus _{\pi \in \text {Irr}(G)} m_\pi (\varrho ) \, \piof irreducible representations with finite multiplicities mπ(ϱ)m_\pi (\varrho )such that, for every positive integernn, the numberrn(ϱ)r_n(\varrho )of irreducible constituents of dimensionnnis finite. Examples arise naturally in the representation theory of reductive groups over nonarchimedean local fields. In this article we initiate an investigation of the Dirichlet generating function\[<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="zeta Subscript rho Baseline left-parenthesis s right-parenthesis equals sigma-summation Underscript n equals 1 Overscript normal infinity Endscripts r Subscript n Baseline left-parenthesis rho right-parenthesis n Superscript negative s Baseline equals sigma-summation Underscript pi element-of Irr left-parenthesis upper G right-parenthesis Endscripts StartFraction m Subscript pi Baseline left-parenthesis rho right-parenthesis Over left-parenthesis dimension pi right-parenthesis Superscript s Baseline EndFraction">ζϱ(s)=∑n=1∞rn(ϱ)n−s=∑π∈Irr(G)mπ(ϱ)(dim⁡π)s\zeta _\varrho (s) = \sum \nolimits _{n=1}^\infty r_n(\varrho ) n^{-s} = \sum \nolimits _{\pi \in \text {Irr}(G)} \frac {m_\pi (\varrho )}{(\dim \pi )^s}\]associated to such a representationϱ\varrho.

Our primary focus is on representationsϱ=IndHG(σ)\varrho = \text {Ind}_H^G(\sigma )of compactpp-adic Lie groupsGGthat arise from finite-dimensional representationsσ\sigmaof closed subgroupsHHvia the induction functor. In addition to a series of foundational results—including a description in terms ofpp-adic integrals—we establish rationality results and functional equations for zeta functions of globally defined families of induced representations of potent pro-ppgroups. A key ingredient of our proof is Hironaka’s resolution of singularities, which yields formulae of Denef type for the relevant zeta functions.

In some detail we consider representations of open compact subgroups of reductivepp-adic groups that are induced from parabolic subgroups. Explicit computations are carried out by means of complementing techniques: (i) geometric methods that are applicable via distance-transitive actions on spherically homogeneous rooted trees, and (ii) thepp-adic Kirillov orbit method. Approach (i) is closely related to the notion of Gelfand pairs and works equally well in positive defining characteristic.
Simplicity of algebras associated to non-Hausdorff groupoids
Authors: Clark Lisa , Exel Ruy , Pardo Enrique , Sims Aidan , Starling Charles
Published: March 2019

We prove a uniqueness theorem and give a characterization of simplicity for Steinberg algebras associated to non-Hausdorff ample groupoids. We also prove a uniqueness theorem and give a characterization of simplicity for the

C

∗

C^{*}

-algebra associated to non-Hausdorff étale groupoids. Then we show how our results apply in the setting of tight representations of inverse semigroups, groups acting on graphs, and self-similar actions. In particular, we show that the

C

∗

C^{*}

-algebra and the complex Steinberg algebra of the self-similar action of the Grigorchuk group are simple but the Steinberg algebra with coefficients in

Z

2

\mathbb {Z}_2

is not simple.
Ultrasound vs Endoscopy, Surgery, or Pathology for the Diagnosis of Small Bowel Crohn’s Disease and its Complications
Authors: Bollegala Natasha , Griller Nadia , Bannerman Heather , Habal Mohammed , Nguyen Geoffrey C
Published: March 2019

Background

In patients with inflammatory bowel disease, we strive to achieve mucosal healing, as this has been shown to decrease the risk of disease flares, hospitalization, and surgery. For this reason, we must use objective measures of mucosal healing to inform our clinical decision-making and can no longer rely on patient symptoms alone. Assessment of small bowel Crohn’s disease (SBCD) is particularly challenging given its lack of accessibility via standard endoscopic techniques. Ultrasound (US) represents a readily available, cost-effective, minimally invasive, radiation-free alternative for the assessment of small bowel disease. In this study, we performed a systematic review to determine the accuracy of ultrasound in diagnosing SBCD and its complications as compared with endoscopic visualization, surgery, and/or pathology.

Methods

We searched MEDLINE, EMBASE, and CENTRAL. Prospective cohort studies published up to March 2017 were reviewed. References meeting all eligibility criteria were assessed at the full-text level by 2 independent reviewers. Sensitivity and specificity were collected where available.

Results

A total of 2817 unique references were identified. Twenty-two studies were included. All studies were at low–moderate risk of bias based on the Quality Assessment of Diagnostic Accuracy Studies criteria. Transabdominal US (TAUS) yielded moderately high sensitivity and specificity for the diagnosis of SBCD and its postoperative recurrence. Detection was more accurate for severe postoperative recurrence. The diagnostic accuracy of US in stricture and abscess detection was high. Contrast enhancement improved the detection of abscess. Diagnostic detection of fistulas was of moderate accuracy. Entero-enteric fistulization and entero-mesenteric fistulization were most clearly identified.

Conclusions

Ultrasound can be used to diagnose SBCD in those with known or suspected Crohn’s disease. It can be used to detect postoperative recurrence and can accurately identify abscesses and fistulas, especially with the aid of contrast enhancement.
Assessing effects of genetic, environmental, and biotic gradients in species distribution modelling
Authors: Lowen J Benjamin , Hart Devorah R , Stanley Ryan R E , Lehnert Sarah J , Bradbury Ian R , DiBacco Claudio
Published: March 2019

To develop more reliable marine species distribution models (SDMs), we examine how genetic, climatic, and biotic interaction gradients give rise to prediction error in marine SDM. Genetic lineages with distinct ecological requirements spanning genetic gradients have yet to be treated separately in marine SDM, which are often constrained to modeling the potential distribution of one biological unit (e.g. lineage or species) at a time. By comparing SDM performance for the whole species or where observation and predictions were partitioned among geographically discontinuous genetic lineages, we first identified the appropriate biological unit for modeling sea scallop. Prediction errors, in particular contiguous omissions at the northern range margins were effectively halved in genetic lineage SDM (Total error=15%) verses whole species SDM. Remaining SDM prediction error was strongly associated with: i) Sharp climatic gradients (abrupt and persistent spatial shifts in limiting temperatures) found within continental shelf breaks and bottom channels. ii) A biotic gradient in the predation of sea scallop juveniles by the sand star within the Hudson Shelf USA. Our findings highlight how the accuracy of marine SDM is dependent on capturing the appropriate biological unit for modeling (e.g. lineages rather than species) and adequately resolving limiting abiotic and biotic interaction gradients.
What are the results of venoarterial extracorporeal membrane oxygenation bridging to heart transplantation?
Authors: Urban Marian , Siddique Aleem , Merritt-Genore HelenMari , Um John
Published: March 2019

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether heart transplantation is a viable treatment option in patients in refractory cardiogenic shock who could not be weaned off venoarterial extracorporeal membrane oxygenation (VA ECMO). Altogether, 373 papers were found using the reported search, of which 7 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Evidence is derived from 3 papers based on registry analysis, 1 multi-institutional study and 3 single-institution reviews. Early post-transplant mortality of ECMO-bridged recipients ranges from 18.7% to 33.3% and 1-year survival from 44.6% to 72.0%. High acuity of recipient illness reflected by poor renal function, mechanical ventilation, advanced age, elevated serum lactate predict inferior outcome. We conclude that heart transplantation results in patients bridged with VA ECMO are inferior when compared to published outcome of non-bridged recipients. In the era of severe organ shortage and intense public and regulatory scrutiny of the results, the decision to transplant a patient directly of VA ECMO needs to be made on a case-by-case basis. Potential gain in decreasing the waiting list mortality of these critically ill patients needs to be weighed against poorer post-transplantation mortality rates and mid- and long-term outcomes.
The Role of the IACUC in the Absence of Regulatory Guidance
Authors: Leland Stuart E , Straeter Pamela A , Gnadt Beverly Jan
Published: March 2019

Institutional Animal Care and Use Committees (IACUCs) occasionally face regulatory requirements for which clear guidance may not be available. Either the regulating body has chosen not to provide such guidance or the guidance may be minimal or even ambiguous. Such guidance may be desirable when institutions have research needs, in which case IACUCs are left to their own interpretation to develop internal policies, procedures, and documents. Typically, this is approached by an IACUC working with partners in the laboratory animal community and may involve input from regulators who can provide context as well as parameters to consider. Over time, shared institutional experiences and documentation coalesce to create a general framework that provides a baseline for others to consider as templates for further policy elaboration or development. The strength of this approach relies on the ability to share freely, including having unobstructed access to such documents.
Reflective Modular Forms: A Jacobi Forms Approach
Authors: Wang Haowu
Published: March 2019

We give an explicit formula to express the weight of $2$-reflective modular forms. We prove that there is no $2$-reflective lattice of signature $(2,n)$ when $n\geq 15$ and $n\neq 19$ except the even unimodular lattices of signature $(2,18)$ and $(2,26)$. As applications, we give a simple proof of Looijenga’s theorem that the lattice $2U\oplus 2E_8(-1)\oplus \langle -2n\rangle $ is not $2$-reflective if $n>1$. We also classify reflective modular forms on lattices of large rank and the modular forms with the simplest reflective divisors.
Exposure to second-hand smoking as a predictor of fetal loss: Egypt Demographic and Health Survey 2014
Authors: Yaya Sanni , Bishwajit Ghose
Published: March 2019

Background

Exposure to tobacco smoking during pregnancy has been shown to be associated with elevated risk of adverse pregnancy outcomes such as miscarriage and stillbirth. However, little is known regarding the association between passive smoking and birth outcomes. This study aims to measure the prevalence of passive smoking and assess its relationship with adverse birth outcomes.

Methods

Self-reported birth outcomes (stillbirth/miscarriage/abortion) was the dependent variable that was regressed against self-reported exposure to household smoking along with various individual and community-level factors. We used propensity score matching to identify the sample and used regression analysis to quantify the association between passive smoking and birth outcomes. Sensitivity analysis was conducted to check for the robustness of the associations.

Results

Of the 5540 women studied, about half (50.3%, 95% CI=49.3–51.3) reported being exposed to smoking by household members. The prevalence of stillbirth was 14.6% (95% CI=13.9–15.3). In the logistic regression analysis, the confounder-adjusted OR of stillbirth in relation to exposure to smoking was 1.321 (95% CI=1.150–1.517). In the subgroup analysis, we found that the association was significant among certain age groups only.

Conclusion

The findings of the present study imply a mildly positive association between the occurrence of stillbirth and exposure to smoking in the household.
Democracy and Compliance with Human Rights Treaties: The Conditional Effectiveness of the Convention for the Elimination of All Forms of Discrimination against Women
Authors: Hill Daniel W , Watson K Anne
Published: March 2019

Research on international human rights law suggests that the beneficial effects of treaties depend on the strength of democratic political institutions. However, democracies are, by definition, compliant with many provisions in treaties that protect civil and political rights. Additionally, theories of compliance derive from a focus on civil and political rights rather than on other rights, so we lack a good understanding of whether predictions hold for other kinds of rights. We examine compliance with the Convention for the Elimination of All Forms of Discrimination against Women (CEDAW), which protects rights that are distinct from those that characterize democratic governance. To measure compliance, we create a new indicator of women's rights that offers several advantages over existing indicators. We examine the conditional effect of CEDAW using models that allow for heterogenous treaty effects. This helps to adjudicate between theories that expect treaties to be most effective in highly democratic countries and those that expect them to be most effective among partial democracies. Our findings do not support either expectation and suggest that effectiveness does not depend on democracy, at least in the case of CEDAW. This points to the need to enrich existing theories of ratification and compliance by accounting for differences in the nature of the rights protected by different treaties.
CILP-2 is a novel secreted protein and associated with insulin resistance
Authors: Wu Tong , Zhang Qin , Wu Shaobo , Hu Wenjing , Zhou Tingting , Li Ke , Liu Dongfang , Gu Harvest F , Zheng Hongting , Zhu Zhiming , Li Ling , Yang Gangyi
Published: March 2019

Genetic association studies have implicated that cartilage intermediate layer protein 2 (CILP-2) confers the risk susceptibility for type 2 diabetes (T2DM). However, it is still unknown whether CILP-2 is involved in the regulation of glucose homeostasis and insulin resistance (IR). In the current study, we initially observed that CILP-2 as a secreted protein was detected in both conditioned medium and lysates of cells transfected with an overexpressed vector. We then found that circulating CILP-2 levels had a progressive increase from normal to impaired glucose tolerance (a pre-diabetic status) and then to diabetes, which was correlated positively with waist-to-hip ratio, triglyceride, fasting blood glucose, 2-h blood glucose after glucose overload, HbA1c, fasting insulin, 2-h plasma insulin after glucose overload, and homeostasis model assessment of insulin resistance but negatively with HDL-C. CILP-2 expression was increased in the liver and muscle but decreased in adipose tissues of obese mice or T2DM patients. Furthermore, we demonstrated that CILP-2 circulating levels were affected by OGTT and Exenatide. CILP-2 overexpression resulted in impaired glucose tolerance and hepatic IR in vivo and increased PEPCK expression whereas suppressed phosphorylation of insulin receptor and Akt kinase in vitro. Based on these findings, we have identified a direct interaction between CILP-2 and PEPCK and suggested that CILP-2 plays an important role in the regulation of hepatic glucose production.
Temporal Variation in Species Abundance and Richness of Culicoides (Diptera: Ceratopogonidae) in a Tropical Equatorial Area
Authors: Gusmão Gaudino Marco Cantanhede , Brito Gustavo Almeida , Moraes Leandro Santos , Bandeira Maria Da Conceição Abreu , Rebêlo José Manuel Macário
Published: March 2019

The aim of this study was to investigate whether temperature, rainfall, and humidity influence the annual distribution of Culicoides Latreille 1809, species abundance and richness in rural areas on São Luís Island in the state of Maranhão, Brazil. Biting midges were collected in housing for domestic animals in the peridomestic areas of 10 homes. A CDC light trap was installed in each peridomestic area from 6:00 p.m. to 6:00 a.m. once a month for 12 mo. In total, 23,633 individuals belonging to 26 Culicoides species were captured. The most abundant species were Culicoides diabolicus Hoffman, 1925 (27.43%), C. ignacioi Forattini, 1957 (25.9%), C. flavivenulus Costa Lima, 1937 (15.53%), C. insignis Lutz, 1913 (10.66%), C. filariferus Hoffman, 1939 (6.21%), C. boliviensis Spinelli & Wirth, 1984 (6.07%), C. foxi Ortíz, 1950 (2.83%), and C. leopoldoi Ortíz, 1951 (2.54%). Species richness and abundance were greater during the rainy season (24 species; 88% of the individuals) than during the dry season (18 species; 12% of individuals). However, persistent rain on the days the midges were collected or in the preceding 24 h adversely affected abundance. Mean monthly maximum temperature and rainfall on the day of the collection adversely affected Culicoides abundance and richness.
Breast Edema Following Breast-Conserving Surgery and Radiotherapy: Patient-Reported Prevalence, Determinants, and Effect on Health-Related Quality of Life
Authors: Young-Afat Danny A , Gregorowitsch Madelijn L , van den Bongard Desirée H , Burgmans Ine , van der Pol Carmen C , Witkamp Arjen J , Bijlsma Rhodé M , Koelemij Ron , Schoenmaeckers Ernst J , Jonasse Yvette , van Gils Carla H , Verkooijen Helena M
Published: March 2019

Background

The association between lymphedema of the arm and impaired health-related QoL (HR-QoL) has led to changes in clinical practice. However, data on lymphedema of the breast (ie, breast edema) are lacking. We prospectively evaluated patient-reported prevalence and determinants of breast edema and its effect on patient-reported HR-QoL and breast pain.

Methods

We prospectively included 836 patients undergoing breast-conserving surgery followed by radiotherapy between October 2013 and October 2016 (UMBRELLA cohort). Patient-reported breast edema, HR-QoL, and breast pain were assessed by means of European Organisation for Research and Treatment of Cancer-C30/BR23 before starting radiotherapy and at 3, 6, 12, and 18 months thereafter. We assessed which patient, tumor, and treatment characteristics were associated with breast edema. With mixed-effects models, we assessed the impact of breast edema on patient-reported HR-QoL domains and breast pain over time, adjusting for confounders.

Results

Within a median follow-up of 28 months (interquartile range [IQR] = 15), 207 (24.8%) patients reported breast edema at some point in time. Prevalence of breast edema was highest at 6 months (12.4%, 95% confidence interval [CI] = 10.0 to 14.7). Larger tumor size, oncoplastic surgery, axillary lymph node dissection, locoregional radiotherapy, radiotherapy boost on the tumor bed, and adjuvant chemotherapy were associated with breast edema. Breast edema was independently associated with more breast pain and with poorer QoL, physical functioning, and body image.

Conclusions

Breast edema occurs frequently within the first year after breast-conserving surgery and radiotherapy and is independently associated with impaired HR-QoL and more breast pain. This information is important for use in clinical practice and should be discussed with patients during shared decision making.
The volumetric rate of normal type Ia supernovae in the local Universe discovered by the Palomar Transient Factory
Authors: Frohmaier C , Sullivan M , Nugent P E , Smith M , Dimitriadis G , Bloom J S , Cenko S B , Kasliwal M M , Kulkarni S R , Maguire K , Ofek E O , Poznanski D , Quimby R M
Published: March 2019

We present the volumetric rate of normal type Ia supernovae (SNe Ia) discovered by the Palomar Transient Factory (PTF). Using strict data-quality cuts, and considering only periods when the PTF maintained a regular cadence, PTF discovered 90 SNe Ia at z ≤ 0.09 in a well-controlled sample over three years of operation (2010–2012). We use this to calculate the volumetric rate of SN Ia events by comparing this sample to simulations of hundreds of millions of SN Ia light curves produced in statistically representative realizations of the PTF survey. This quantifies the recovery efficiency of each PTF SN Ia event, and thus the relative weighting of each event. From this, the volumetric SN Ia rate was found to be $r_\mathrm{ v}=2.43\pm 0.29\, \text{(stat)}_{-0.19}^{+0.33}\text{(sys)}\times 10^{-5}\, \rm{SNe\,yr}^{-1}\, \text{Mpc}^{-3}\, h_{70}^{3}$. This represents the most precise local measurement of the SN Ia rate. We fit a simple SN Ia delay-time distribution model, ∝ t−β, to our PTF rate measurement combined with a literature sample of rate measurements from surveys at higher redshifts. We find β ∼ 1, consistent with a progenitor channel governed by the gravitational inspiral of binary white dwarfs.
The enigmatic binary system HD 5980
Authors: Hillier D John , Koenigsberger Gloria , Nazé Yaël , Morrell Nidia , Barbá Rodolfo H , Gamen Roberto
Published: March 2019

The Small Magellanic Cloud multiple system HD 5980 contains a luminous blue variable (LBV) that underwent a major eruption in 1994, and whose current spectrum is that of a hydrogen-rich Wolf–Rayet (WR) star. Since the eruption, the wind mass-loss rate has been declining while wind speeds have been steadily increasing. Observations obtained in 2014 when Star A (the LBV) eclipses Star B indicate that the fitted mass-loss rate and luminosity have reached the lowest values ever determined for such spectra: $\dot{M}$  = 4.5 × 10−5$\mathrm{M}_\odot \, \hbox{yr}^{-1}$, L  = 1.7 × 106 L⊙. In addition, the radius of the LBV’s continuum-emitting region is similar to that derived from the eclipse light curves of the late 1970s. Hence, it appears to have attained a similar ‘low’ state to that of the late 1970s. While a good fit to the emission spectrum is obtained using a cmfgen model, there are discrepancies in the UV. In particular, the extent of the observed absorption profiles is ∼1000 km s−1 greater than predicted by the emission-line intensities. Further, HST UV observations obtained in 2016, when Star A is eclipsed by Star B, show unusual P Cygni profiles that are not easily explained. Surprisingly the 2016 emission-line spectrum is similar to that at the opposite eclipse obtained in 2014. The complex UV profiles are likely to arise as a consequence of the dynamics of the wind–wind collision and radiative braking, both of which will cause significant departures from spherical symmetry, and have a strong orbital phase dependence. However, other scenarios, such as intrinsically aspherical winds, cannot be ruled out.
Who Profits from Patents? Rent-Sharing at Innovative Firms*
Authors: Kline Patrick , Petkova Neviana , Williams Heidi , Zidar Owen
Published: March 2019

This article analyzes how patent-induced shocks to labor productivity propagate into worker compensation using a new linkage of U.S. patent applications to U.S. business and worker tax records. We infer the causal effects of patent allowances by comparing firms whose patent applications were initially allowed to those whose patent applications were initially rejected. To identify patents that are ex ante valuable, we extrapolate the excess stock return estimates of Kogan et al. (2017) to the full set of accepted and rejected patent applications based on predetermined firm and patent application characteristics. An initial allowance of an ex ante valuable patent generates substantial increases in firm productivity and worker compensation. By contrast, initial allowances of lower ex ante value patents yield no detectable effects on firm outcomes. Patent allowances lead firms to increase employment, but entry wages and workforce composition are insensitive to patent decisions. On average, workers capture roughly 30 cents of every dollar of patent-induced surplus in higher earnings. This share is roughly twice as high among workers present since the year of application. These earnings effects are concentrated among men and workers in the top half of the earnings distribution and are paired with corresponding improvements in worker retention among these groups. We interpret these earnings responses as reflecting the capture of economic rents by senior workers, who are most costly for innovative firms to replace.
The impact of market-oriented reforms on inequality in transitional countries: new evidence from Cuba
Authors: Romanò Sara , Barrera Davide
Published: March 2019

In the 1990s, the Cuban government implemented a set of market-oriented reforms in order to cope with the economic crisis caused by the collapse of the Soviet Union. These reforms were followed by a sharp increase in inequality. This rise in inequality can be best understood by looking at what profitable economic exchanges are made possible to which actors by the reforms. Using survey data specifically collected in Havana, we show that new opportunities to accumulate wealth accrue to actors who occupy positions whereby they can legitimately access exchanges that take place in hard currency. This advantage holds for both entrepreneurs and state employees, who work for state-owned enterprises operating in emergent sectors (intrapreneurs), suggesting that the distinction between market and plan is not paramount to explain inequality. Furthermore, actors that do not have legitimate access to exchanges in hard currency benefit from their personal ties to those actors that do.
Text Mining Method for Studying Medication Administration Incidents and Nurse-Staffing Contributing Factors
Authors: Härkänen Marja , Vehviläinen-Julkunen Katri , Murrells Trevor , Paananen Jussi , Rafferty Anne Marie
Published: March 2019

Incident reporting systems are being implemented globally, thus increasing the profile and prevalence of incidents, but the analysis of free-text descriptions remains largely hidden. The aims of the study were to explore the extent to which incident reports recorded staffing issues as contributors to medication administration incidents. Incident reports related to medication administration (N = 1012) were collected from two hospitals in Finland between January 1, 2013, and December 31, 2014. The SAS Enterprise Miner 13.2 and its Text Miner tool were used to excavate terms and descriptors and to uncover themes and concepts in the free-text descriptions of incidents with (n = 194) and without (n = 818) nurse staffing–related contributing factors. Text mining included (1) text parsing, (2) text filtering, and (3) modeling text clusters and text topics. The term “rush/hurry” was the sixth most common term used in incidents where nurse-staffing was identified as a contributing factor. Nurse-staffing factors, however, were not pronounced in clusters or in text topics of either data set. Text mining offers the opportunity to analyze large free-text mass and holds promise for providing insight into the antecedents of medication administration incidents.
PROPHYLACTIC LASER TREATMENT TO DECREASE THE INCIDENCE OF RETINAL DETACHMENT IN FELLOW EYES OF IDIOPATHIC GIANT RETINAL TEARS
Authors: Verhoekx Jennifer S. N. , van Etten Peter G. , Wubbels Rene J. , van Meurs Jan C. , van Overdam Koen A.
Published: March 2019

Purpose:

To evaluate the effectiveness of prophylactic 360° laser treatment in the fellow eye of patients with unilateral idiopathic giant retinal tear (GRT) to prevent the occurrence of a (macula-off) retinal detachment.

Methods:

We conducted a retrospective, nonrandomized case–control study. Clinical data of consecutive patients, undergoing surgery for idiopathic GRT, between 2003 and 2015 were analyzed. The data collected included GRT, retinal detachment, and RTs in the fellow eye.

Results:

We included 129 patients who underwent surgery for an idiopathic GRT, with a mean follow-up period of 107 months. In the observation group, a retinal detachment developed in the fellow eye in 22/51 patients (43.1%), leading to a macula-off detachment in 9/51 patients (17.6%). By contrast, in the prophylactic 360° laser group, only 10/78 (12.8%) patients developed a retinal detachment, leading to a macula-off detachment in 1/78 patient (1.3%). This difference was statistically significant.

Conclusion:

This study suggests that prophylactic 360° laser treatment in the fellow eye of patients with an idiopathic GRT decreased the incidence of retinal detachment, lowering the high risk of visual loss due to a macula-off retinal detachment.
Kappa opioid signaling in the right central amygdala causes hind paw specific loss of diffuse noxious inhibitory controls in experimental neuropathic pain
Authors: Phelps Caroline E. , Navratilova Edita , Dickenson Anthony H. , Porreca Frank , Bannister Kirsty
Published: March 2019

Diffuse noxious inhibitory controls (DNICs) is a pain-inhibits-pain phenomenon demonstrated in humans and animals. Diffuse noxious inhibitory control is diminished in many chronic pain states, including neuropathic pain. The efficiency of DNIC has been suggested to prospectively predict both the likelihood of pain chronification and treatment response. Little is known as to why DNIC is dysfunctional in neuropathic pain. Here, we evaluated DNIC in the rat L5/L6 spinal nerve ligation (SNL) model of chronic pain using both behavioral and electrophysiological outcomes. For behavior, nociceptive thresholds were determined using response to noxious paw pressure on both hind paws as the test stimulus before, and after, injection of a conditioning stimulus of capsaicin into the left forepaw. Functionally, the spike firing of spinal wide-dynamic-range neuronal activity was evaluated before and during noxious ear pinch, while stimulating the ipsilateral paw with von Frey hairs of increased bending force. In both assays, the DNIC response was significantly diminished in the ipsilateral (ie, injured) paw of SNL animals. However, behavioral loss of DNIC was not observed on the contralateral (ie, uninjured) paw. Systemic application of nor-binaltorphimine, a kappa opioid antagonist, did not ameliorate SNL-induced hyperalgesia but reversed loss of the behavioral DNIC response. Microinjection of nor-binaltorphimine into the right central amygdala (RCeA) of SNL rats did not affect baseline thresholds but restored DNIC both behaviorally and electrophysiologically. Cumulatively, these data suggest that net enhanced descending facilitations may be mediated by kappa opioid receptor signaling from the right central amygdala to promote diminished DNIC after neuropathy.
An NPY Y1 receptor antagonist unmasks latent sensitization and reveals the contribution of protein kinase A and Epac to chronic inflammatory pain
Authors: Fu Weisi , Nelson Tyler S. , Santos Diogo F. , Doolen Suzanne , Gutierrez Javier J.P. , Ye Na , Zhou Jia , K. Taylor Bradley
Published: March 2019

Peripheral inflammation produces a long-lasting latent sensitization of spinal nociceptive neurons, that is, masked by tonic inhibitory controls. We explored mechanisms of latent sensitization with an established four-step approach: (1) induction of inflammation; (2) allow pain hypersensitivity to resolve; (3) interrogate latent sensitization with a channel blocker, mutant mouse, or receptor antagonist; and (4) disrupt compensatory inhibition with a receptor antagonist so as to reinstate pain hypersensitivity. We found that the neuropeptide Y Y1 receptor antagonist BIBO3304 reinstated pain hypersensitivity, indicative of an unmasking of latent sensitization. BIBO3304-evoked reinstatement was not observed in AC1 knockout mice and was prevented with intrathecal co-administration of a pharmacological blocker to the N-methyl-D-aspartate receptor (NMDAR), adenylyl cyclase type 1 (AC1), protein kinase A (PKA), transient receptor potential cation channel A1 (TRPA1), channel V1 (TRPV1), or exchange protein activated by cAMP (Epac1 or Epac2). A PKA activator evoked both pain reinstatement and touch-evoked pERK expression in dorsal horn; the former was prevented with intrathecal co-administration of a TRPA1 or TRPV1 blocker. An Epac activator also evoked pain reinstatement and pERK expression. We conclude that PKA and Epac are sufficient to maintain long-lasting latent sensitization of dorsal horn neurons that is kept in remission by the NPY-Y1 receptor system. Furthermore, we have identified and characterized 2 novel molecular signaling pathways in the dorsal horn that drive latent sensitization in the setting of chronic inflammatory pain: NMDAR→AC1→PKA→TRPA1/V1 and NMDAR→AC1→Epac1/2. New treatments for chronic inflammatory pain might either increase endogenous NPY analgesia or inhibit AC1, PKA, or Epac.
Cannabis-related emergencies in children and teens
Authors: Chen Yih-Chieh , Klig Jean E.
Published: March 2019

Purpose of review

To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population.

Recent findings

There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use. The range of presentations documented in the recent literature spans gastrointestinal, psychiatric and cardiorespiratory effects, in addition to traumatic injuries and accidental ingestions by younger children. Complications of chronic cannabis use, such as ‘cannabis hyperemesis syndrome’, depression, psychosis or cognitive impairment, are now recognized outcomes and even more are likely to emerge.

An array of cannabis-related symptoms is possible from acute use or exposure. Common presentations include acute intoxication, hyperemesis, depression and acute physical injuries from impaired psychomotor function. Uncommon presentations include cardiorespiratory effects, and a range of symptoms in young children that include hyperkinesis and coma. Clinical vigilance is needed to suspect and clinically diagnose cannabis exposure in the emergency department.
Evaluation of Baseline Cardiac Function by Echocardiography and its Association With Nutritional Status in Pediatric Cancer Patients at The Indus Hospital in Karachi, Pakistan
Authors: Muhammad Sadia , Belgaumi Asim F. , Ashraf Muhammad S. , Akhtar Saleem , Iftikhar Sundus , Raza Muhammad R. , Yakoob Mohammad Y.
Published: March 2019

Introduction:

Evidence on conducting baseline echocardiogram before starting chemotherapy in pediatric cancer patients is limited from developing countries where malnutrition and infections are common and which may result in cardiac dysfunction.

Materials and Methods:

A prospective, observational study was conducted from October 2016 to May 2017 at The Indus Hospital, Karachi, Pakistan, among children 1 to 16 years of age suffering from cancer. Echocardiography was performed before starting chemotherapy. Associations between body mass index and cardiac abnormalities were studied.

Results:

A total of 384 children met the inclusion criteria. The median (interquartile range) age was 8.0 (5.0 to 12.0) years and 62.0% (n=238) were male individuals. Twenty-two of 384 (5.7%) children had systolic dysfunction. Four of 22 had moderate-systolic and one of 22 had mild systolic dysfunction, for whom the therapy was altered, and they were treated without anthracyclines. Four of these 5 patients died, and only 1 of 5 survived through high-risk protocol. Seventeen of 22 children had low–normal systolic dysfunction. We found no evidence of an association between body mass index for age and abnormal left ventricular ejection fraction and abnormal fractional shortening (P-trend=0.587; 0.487, respectively). No associations were found of weight-for-age and height-for-age with these outcomes.

Conclusions:

In developing countries, echocardiograms should be expeditiously performed and technology made more accessible to rule out cardiac dysfunction and avoid delay in chemotherapy. Malnutrition was not associated with cardiac dysfunction.
Homozygous pArg610del Mutation Unusually Associated With Severe Delay of Growth in 2 Acid Sphingomyelinase Deficiency–affected Sibs
Authors: Naifar Manel , Kallel Faten , HadjKacem Faten , Boudabous Hela , Kallel Rim , Boudawara Tahia , Messaoud Olfa , Tbib Neji , Charfi Nadia , Abid Mohamed , Froissart Roseline , Messedi Sondes Hdiji , Ayedi Fatma
Published: March 2019

Background:

Typically, patients with Acid Sphingomyelinase Deficiency (ASMD) because of p.Arg610del mutation, have mild phenotype with normal linear growth.

Observation:

We reported the case of 2 Tunisian brothers who have been referred for splenomegaly, polyadenopathies, pubertal, and growth delay. Molecular testing of SMPD1 gene revealed the presence of a homozygous p.Arg610del mutation. Lysosphingomyelin and its isoform-509 were both increased confirming ASMD for both cases. Growth hormone deficiency was highly suspected but growth hormone response after stimulating tests was acceptable for both patients.

Conclusions:

There is no correlation between phenotype-genotype in case of p.Arg610del mutation that could be associated to a severe delay of growth.
Minimal Detectable Change for Gait Speed Depends on Baseline Speed in Individuals With Chronic Stroke
Authors: Lewek Michael D. , Sykes Robert
Published: March 2019

Background and Purpose:

Given the heterogeneity of mobility outcomes after stroke, the purpose of this study was to examine how the minimal detectable change (MDC) for gait speed varies based on an individual's baseline walking speed.

Methods:

Seventy-six participants with chronic stroke and able to walk without therapist assistance participated in 2 visits to record overground self-selected comfortable gait speed (CGS) and fast gait speed (FGS). Based on the CGS at visit 1, participants were assigned to 1 of 3 speed groups: low (<0.4 m/s; n = 32), moderate (0.4-0.8 m/s; n = 29), and high functioning group (>0.8 m/s; n = 15). Participants were then reclassified using updated gait speed cutoffs of 0.49 and 0.93 m/s. For each group, we determined test-retest reliability between visits, and the MDC for CGS and FGS.

Results:

Gait speed significantly increased from visit 1 to visit 2 for each group (P < 0.001). The reliability for CGS declined with increasing gait speed, and MDC95 values increased with increasing gait speed (low: 0.10 m/s; moderate: 0.15 m/s; and high: 0.18 m/s). Similar findings were observed for FGS, and when participants were recoded using alternative thresholds.

Discussion and Conclusions:

Slower walkers demonstrated greater consistency in walking speed from day to day, which contributed to a smaller MDC95 than faster walkers. These data will help researchers and clinicians adjust their expectations and goals when working with individuals with chronic stroke. Expectations for changing gait speed should be based on baseline gait speed, and will allow for more appropriate assessments of intervention outcomes.

available

for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A253).
Trunk Exercises Improve Balance in Parkinson Disease: A Phase II Randomized Controlled Trial
Authors: Hubble Ryan P. , Silburn Peter A. , Naughton Geraldine A. , Cole Michael H.
Published: March 2019

Background and Purpose:

Trunk control is important for maintaining balance; hence, deficient trunk control may contribute to balance problems in people with Parkinson disease (PD). Unfortunately, this deficit is poorly managed with pharmacological therapies, emphasizing the need for alternative therapies for these patients. This randomized controlled trial sought to examine the effects of a 12-week trunk-specific exercise-based intervention on balance in people with PD.

Methods:

Twenty-four people with PD and with a history of falls completed assessments of motor symptom severity, balance confidence, mobility, quality of life, and quiet-standing balance. Participants were then randomized to receive either 12 weeks of exercise or education and reassessed after 12 and 24 weeks.

Results:

Linear mixed-models analyses showed no significant changes in clinical outcomes following the intervention. However, during quiet standing, sway area on a foam surface without vision was reduced for the exercise group at 12 (−6.9 ± 3.1 cm; 95% confidence interval [CI] = −13.1 to −0.7; P = 0.029; d = 0.66) and 24 weeks (−7.9 ± 3.1 cm; 95% CI = −14.1 to −1.7; P = 0.013; d = 0.76). Furthermore, the exercise group demonstrated reduced sway variability at 12 (−0.2 ± 0.1 cm; 95% CI = −0.4 to 0.0; P = 0.042; d = 0.62) and 24 weeks in the medial-lateral direction (−0.2 ± 0.1 cm; 95% CI = −0.4 to 0.0; P = 0.043; d = 0.62). No changes in quiet standing balance were recorded for the education group.

Discussion and Conclusions:

The results of this study suggest that exercise-based interventions targeting trunk strength, endurance, and mobility may be effective for improving quiet-standing balance in people with PD. However, additional research is needed to determine whether these improvements are sufficient to reduce falls risk.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A254).
Vestibular Physical Therapy in Individuals With Cognitive Impairment: A Theoretical Framework
Authors: Klatt Brooke N. , Ries Julie D. , Dunlap Pamela M. , Whitney Susan L. , Agrawal Yuri
Published: March 2019

Falls are a major health care concern in individuals with Alzheimer disease (AD) and their caregivers. Vestibular impairment is a known risk factor for falls, and individuals with AD have been shown to have an increased prevalence of vestibular loss compared with age-matched controls. Vestibular physical therapy (VPT) is effective in improving balance and reducing fall risk in cognitively-intact persons with vestibular impairment. However, the effectiveness of VPT in improving balance and reducing falls in individuals with AD who have vestibular loss has never been explored.

Summary of Key Points:

In this article, we apply prevailing ideas about rehabilitation and motor learning in individuals with cognitive impairment (IwCI) to VPT.

Recommendations for Clinical Practice:

We propose a modification of current evidence-based VPT protocols for IwCI using the strength-based theoretical framework that emphasizes the motor learning abilities of IwCI. In addition, we highlight the importance of establishing an excellent rapport with IwCI, and present key strategies for optimizing the therapeutic relationship. In ongoing work, we are assessing the efficacy of this modified VPT protocol in IwCI to improve balance and reduce falls.
Incremental Vestibulo-ocular Reflex Adaptation Training Dynamically Tailored for Each Individual
Authors: Todd Christopher J. , Schubert Michael C. , Figtree William V. C. , Migliaccio Americo Aniello
Published: March 2019

Background and Purpose:

Unilateral incremental vestibulo-ocular reflex (VOR) adaptation (IVA) increases the VOR gain (= eye/head velocity) for head rotations to one side by ∼10%. Prior IVA studies involved setting the initial VOR training gain demand at the subject's starting value (= 1 in a healthy subject), with the gain preset to increment by 0.1 every 90 seconds over 15 minutes, defined as Static IVA. We determined whether a dynamically calculated gain demand (= “actual gain” + 0.1) would result in greater adaptation, defined as Dynamic IVA.

Methods:

Using a hybrid video-oculography and StableEyes training system, we measured the active (self-generated head impulse) and passive (imposed, unpredictable head impulse) VOR gain in 8 healthy subjects before and after 15 minutes of Static (ie, preset) and Dynamic IVA training consisting of active, leftward and rightward, horizontal head impulses (peak amplitude 15°, peak velocity 150°/s, and peak acceleration 3000°/s2). We also measured the active VOR gain during training.

Results:

The VOR gain increase toward the adapting side was ∼5% larger after Dynamic compared with Static IVA training (Dynamic: 13.9% ± 5.2%, Static: 9.4% ± 7.3%; P < 0.05).

Discussion and Conclusions:

Our data suggest that 17°/s retinal image slip (due to the 0.1 gain difference between demand and actual gain) is sufficient to drive robust VOR adaptation. The implications for vestibular rehabilitation are that Dynamic IVA training not only produces better VOR adaptation but also allows more flexible training, for example, training can be spread over several smaller time blocks, without undoing prior adaptation.
Ocular Misalignment in Dizzy Patients—Something's A-Skew
Authors: Gold Daniel R. , Schubert Michael C.
Published: March 2019

Background and Purpose:

Both central (eg, brain stem, cerebellum) and peripheral (eg, vestibular, fourth cranial nerve palsy) etiologies can cause a vertical misalignment between the eyes with a resultant vertical diplopia. A vertical binocular misalignment may be due to a skew deviation, which is a nonparalytic vertical ocular misalignment due to roll plane imbalance in the graviceptive pathways. A skew deviation may be 1 component of the ocular tilt reaction. The purposes of this article are (1) to understand the pathophysiology of a skew deviation/ocular tilt reaction and (2) to be familiar with the examination techniques used to diagnose a skew and to differentiate it from mimics such as a fourth cranial nerve palsy.

Summary of Key Points:

The presence of a skew deviation usually indicates a brain stem or cerebellar localization. Vertical ocular misalignment is easily missed when observing the resting eye position alone.

Recommendations for Clinical Practice:

Physical therapists treating patients with vestibular pathology from central or peripheral causes should screen for vertical binocular disorders.