bluuebunny/crossref_metadata_2025 huggingface dataset:
International Relations before Critical Theory
Authors: Devetak Richard
Published: August 2018

The chapter elaborates the post-war disciplinary context from which critical international theory emerged. While most accounts start with the so-called ‘third debate’, this chapter situates its emergence in the longer story of the rise in theory’s prestige in the social sciences. It tells the story of a series of disputes over method (Methodenstreit) that paved the way not just for higher levels of theoretical abstraction, and a never vanquished humanist challenge to the scientific outlook. It was during the 1950s that the persona of the theorist was first established in international relations. In the following decades, personae of the international relations theorist evolved through academic institutionalization of certain epistemic practices and technical capabilities modelled on behaviouralist and philosophy-of-science standards. The stage was thus set for a rival, namely, critical intellectual persona to emerge in opposition to both the humanist and scientific outlooks, but in continuity with the ever-higher orders of abstraction.
Influence of the ICCPR in the Middle East
Authors: Çali Başak
Published: August 2018

This chapter surveys the legal influence of the International Covenant on Civil and Political Rights (ICCPR) on the domestic laws of States in the Middle East region. It analyses ratification, reservation, and reporting practices, the domestic legal status of the ICCPR, and State responses to the Human Rights Committee’s concluding observations. The chapter argues that the ICCPR’s legal influence in the region is structurally hampered due to its lack of authoritative legal status and the dominance of defensive domestic legalism. A significant gap remains between the HRC’s vision of civil and political rights protection grounded in the entrenchment of liberal, democratic, and multicultural laws and the region’s authoritarian or majoritarian political structures that foreground security and treat non-majority identities as threats. The influence of the ICCPR on domestic laws in the Middle East remains a long-term battle, whereby small gains under limited legal opportunity structures remain the overarching norm.
The Last Warning
Authors: Como David R.
Published: August 2018

This chapter analyzes the content and context of The Last Warning To all the Inhabitants Of London of March 1646. The Last Warning was the first openly republican tract published during England’s crisis. The chapter analyzes the distribution of the pamphlet—which was produced by the secret press of Richard Overton—and charts the intensive investigation that ensued. The Last Warning furnishes an interpretative window, allowing for observation of shifts in the ideological ambience at the conclusion of the civil war, and revealing England’s future path towards regicide and revolution.
Gravity Reframed
Authors: Wittman David M.
Published: August 2018

The effects of gravity disappear in freely falling laboratories.Within such a laboratory, a freely falling particle appears to have no forces on it—it is an inertial particle following the rules of special relativity. We therefore expect it to follow a worldline of maximum proper time. This chapter develops thinking tools for identifying paths of maximum proper time in the presence of gravity, where clocks have altitudedependent tick rates; these include graphical tools as well as a qualitative description of the geodesic equation. The reward: we find that altitude‐dependent time by itself explains all the trajectories we associate with everyday gravity. Gravity is not a force at all, it is a differential flow of time. This explains why freely falling particles feel no force. It also abolishes the need to explain how “the force of gravity” manages to accelerate all particles equally, regardless of their mass or other properties.
Conclusion
Authors: Plutynski Anya
Published: August 2018

This conclusion provides an overview of some of the central themes and arguments presented in the previous chapters, and then turns to the question of whether we are winning the “war on cancer.” I argue that there have been both successes and limitations. I close with a discussion of how cancer can and should be an important subject of inquiry for philosophers, drawing their attention to the ways in which science and values intertwine.
Environmental health in Australia: overlooked and underrated
Authors: Whiley H , Willis E , Smith J , Ross K
Published: August 2018

Improvements in environmental health have had the most significant impact on health status. In Australia, life expectancy has significantly increased through provision of vaccination, safe food and drinking water, appropriate sewage disposal and other environmental health measures. Yet the profession that is instrumental in delivering environmental health services at the local community level is overlooked. Rarely featuring in mainstream media, the successes of Environmental Health Officers (EHOs) are invisible to the general public. As a consequence, students entering university are unaware of the profession and its significant role in society. This has resulted in there being too few EHOs to meet the current regulatory requirements, much less deal with the emerging environmental health issues arising as a consequence of changing global conditions including climate change. To futureproof Australian society and public health this workforce issue, and the associated oversight of environmental health must be addressed now.
Reduced myocyte complex N‐glycosylation causes dilated cardiomyopathy
Authors: Ednie Andrew R. , Deng Wei , Yip Kay-Pong , Bennett Eric S.
Published: August 2018

Protein glycosylation is an essential posttranslational modification that affects a myriad of physiologic processes. Humans with genetic defects in glycosylation, which result in truncated glycans, often present with significant cardiac deficits. Acquired heart diseases and their associated risk factors were also linked to aberrant glycosylation, highlighting its importance in human cardiac disease. In both cases, the link between causation and corollary remains enigmatic. The glycosyltransferase gene, mannosyl (α‐1,3‐)‐glycoprotein β‐1,2‐N‐acetylglucosaminyltransferase (Mgat1), whose product, N‐acetylglucosaminyltransferase 1 (GlcNAcT1) is necessary for the formation of hybrid and complex N‐glycan structures in the medial Golgi, was shown to be at reduced levels in human end‐stage cardiomyopathy, thus making Mgat1 an attractive target for investigating the role of hybrid/complex N‐glycosylation in cardiac pathogenesis. Here, we created a cardiomyocyte‐specific Mgatl knockout (KO) mouse to establish a model useful in exploring the relationship between hybrid/complex N‐glycosylation and cardiac function and disease. Biochemical and glycomic analyses showed that Mgat1KO cardiomyocytes produce predominately truncated N‐glycan structures. All Mgat1KO mice died significantly younger than control mice and demonstrated chamber dilation and systolic dysfunction resembling human dilated cardiomyopathy (DCM). Data also indicate that a cardiomyocyte L‐type voltage‐gated Ca2+ channel (Cav) subunit (α281) is a GlcNAcT1 target, and Mgat1KO Cav activity is shifted to more‐depolarized membrane potentials. Consistently, Mgat1KO cardiomyocyte Ca2+ handling is altered and contraction is dyssynchronous compared with controls. The data demonstrate that reduced hybrid/complex N‐glycosylation contributes to aberrant cardiac function at whole‐heart and myocyte levels drawing a direct link between altered glycosylation and heart disease. Thus, the Mgat1KO provides a model for investigating the relationship between systemic reductions in glycosylation and cardiac disease, showing that clinically relevant changes in cardiomyocyte hybrid/complex N‐glycosylation are sufficient to cause DCM and early death.—Ednie, A. R., Deng, W., Yip, K.‐P., Bennett, E. S. Reduced myocyte complex N‐glycosylation causes dilated cardiomyopathy. FASEB J. 33, 1248–1261 (2019). www.fasebj.org
The Diabetic Foot Amputation Decision-Making Process
Authors: Wang Shou-Yu , Liu Ju-Fen , Huang Yu-Ping , Chang Ying-Ying
Published: August 2018

OBJECTIVE:

Diabetes has been the fourth leading cause of death in Taiwan since 2002 and is one of the top four most prevalent chronic diseases worldwide. Patients who have diabetic foot, as well as their families, are faced with the burden of possible limb amputation. The aim of this study was to explore the amputation decision-making process with patients with diabetic foot and their families.

METHODS:

Grounded theory was used in this study. Data from 16 participants at a regional hospital in Taiwan were collected using purposive sampling. The data analysis was conducted through open coding, axial coding, selective coding, and memo writing.

RESULTS:

The study revealed that the core factor in the decision-making process was “amputation in order to survive.” Patients and families additionally considered “the devastation of experiencing multiple diseases,” “treatment of poorly healing wounds,” and “facing the decision of whether to undergo amputation.”

CONCLUSIONS:

After understanding the patients’ decision-making process regarding amputation, healthcare providers should be encouraged to empathize with such patients. Further, providers should respect the patients’ and families’ decision and provide them with necessary care. Future research should explore professional perspective and family members’ care process for amputees to understand the decision-making process of patients who require amputation.
A Wolf in Sheep’s Clothing: An Unusual Presentation of Diabetic Myonecrosis
Authors: Boinpally Harika , Howell Raelina S. , Mazzie Joseph , Slone Eric , Woods Jon S. , Gillette Brian M. , Castellano Michael , Gorenstein Scott
Published: August 2018

Diabetic myonecrosis is a rare complication of poorly controlled diabetes mellitus that presents similarly to many common conditions such as cellulitis, abscess, and fasciitis. Therefore, a high index of suspicion is required for diagnosis. Magnetic resonance imaging is the investigative test of choice. Treatment includes antiplatelet therapy, nonsteroidal anti-inflammatory agents, and glycemic control.

GENERAL PURPOSE:

To provide information about the diagnosis and treatment of diabetic myonecrosis (DMN).

TARGET AUDIENCE:

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES:

After participating in this educational activity, the participant should be better able to:

1. Cite the incidence and symptomatology of diabetic myonecrosis.

2. Identify the diagnostic tests associated with DMN.

3. Summarize the evidence-based treatments for DMN.
Diagnosis and primary care management of focal segmental glomerulosclerosis in children
Authors: Wong Angela Y. , John Rita Marie
Published: August 2018

Focal segmental glomerulosclerosis (FSGS) is a pattern of kidney damage that can occur in individuals at any age, including children. Pediatric patients with FSGS require medication monitoring, growth, and psychological health. This article discusses the NP's role in the clinical presentation, diagnostic workup, and treatment of FSGS in pediatric patients.
The ABCs of RSV
Authors: Krause Christine I.
Published: August 2018

Respiratory syncytial virus (RSV) is a common viral infection affecting many children in the United States. This seasonal virus is the leading cause of hospitalization of infants and neonates. This article reviews the current recommendations for diagnostic testing, treatment options, and prevention of RSV.
Managing lupus nephritis
Authors: Cadet Myriam Jean , Tucker Lorna
Published: August 2018

Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus, an autoimmune disease that results in multiple organ injuries. LN is challenging to manage because it mimics the clinical presentations of other diseases. This article highlights recommendations for the management of lupus erythematosus to improve quality of life. In addition, it provides NPs with evidence-based guidelines for managing patients with LN for positive health outcomes.
Evaluation of Liquid From the Papanicolaou Test and Other Liquid Biopsies for the Detection of Endometrial and Ovarian Cancers
Authors: Wang Yuxuan , Li Lu , Douville Christopher , Cohen Joshua D. , Yen Ting-Tai , Kinde Isaac , Sundfelt Karin , Kjær Susanne K. , Hruban Ralph H. , Shih Ie-Ming , Wang Tian-Li , Kurman Robert J. , Springer Simeon , Ptak Janine , Popoli Maria , Schaefer Joy , Silliman Natalie , Dobbyn Lisa , Tanner Edward J. , Angarita Ana , Lycke Maria , Jochumsen Kirsten , Afsari Bahman , Danilova Ludmila , Levine Douglas A. , Jardon Kris , Zeng Xing , Arseneau Jocelyne , Fu Lili , Diaz Luis A. , Karchin Rachel , Tomasetti Cristian , Kinzler Kenneth W. , Vogelstein Bert , Fader Amanda N. , Gilbert Lucy , Papadopoulos Nickolas
Published: August 2018

(Abstracted from Sci Transl Med 2018;10:eaap8793)

Although the Papanicolaou (Pap) test has dramatically decreased mortality from cervical cancer in the screened population, the test generally is unable to detect endometrial or ovarian cancers. These 2 cancers are usually diagnosed at an advanced stage when the prognosis is poor and treatment does not increase relative survival.
Ibuprofen Is Deleterious for the Development of First-Trimester Human Fetal Ovary Ex Vivo
Authors: Leverrier-Penna S. , Mitchell R. T. , Becker E. , Lecante L. , Ben Maamar M. , Homer N. , Lavoué V. , Kristensen D. M. , Dejucq-Rainsford N. , Jégou B. , Mazaud-Guittot S.
Published: August 2018

(Abstracted from Hum Reprod 2018;33(3):482–493)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used over-the-counter medications for treatment of pain, inflammation, and fever. In 2013, up to 28.3% of pregnant women reported the use of ibuprofen at some stage during their pregnancy.
Clinical Updates in Women’s Health Care Summary: The Role of Physical Therapy in Obstetric–Gynecologic Practice
Authors: Butler Rachel
Published: August 2018

This monograph addresses the diagnosis and management of many neuromusculoskeletal conditions that both obstetrician–gynecologists and physical therapists encounter in their practices. Collaborative care initiated by the physician through consultation with a physical therapist can considerably enhance women’s health outcomes associated with these conditions. Physical therapy techniques are described to enhance physician understanding of the scope of this treatment option. Information is presented in the chronological sequence of a woman’s reproductive life cycle, although some information is universal and affects multiple stages of a woman’s life. Separate sections are devoted to problems of the pelvic floor muscles, pregnancy and postpartum care, and conditions common in older women.
Objective Comparison of the Quality and Reliability of Auditory Brainstem Response Features Elicited by Click and Speech Sounds
Authors: Novis Kimberley , Bell Steven
Published: August 2018

Objectives:

Auditory brainstem responses (ABRs) are commonly generated using simple, transient stimuli (e.g., clicks or tone bursts). While resulting waveforms are undeniably valuable clinical tools, they are unlikely to be representative of responses to more complex, behaviorally relevant sounds such as speech. There has been interest in the use of more complex stimuli to elicit the ABR, with considerable work focusing on the use of synthetically generated consonant–vowel (CV) stimuli. Such responses may be sensitive to a range of clinical conditions and to the effects of auditory training. Several ABR features have been documented in response to CV stimuli; however, an important issue is how robust such features are. In the current research, we use time- and frequency-domain objective measures of quality to compare the reliability of Wave V of the click-evoked ABR to that of waves elicited by the CV stimulus /da/.

Design:

Stimuli were presented to 16 subjects at 70 dB nHL in quiet for 6000 epochs. The presence and quality of response features across subjects were examined using F
sp and a Bootstrap analysis method, which was used to assign p values to ABR features for individual recordings in both time and frequency domains.

Results:

All consistent peaks identified within the /da/-evoked response had significantly lower amplitude than Wave V of the ABR. The morphology of speech-evoked waveforms varied across subjects. Mean F
sp values for several waves of the speech-evoked ABR were below 3, suggesting low quality. The most robust response to the /da/ stimulus appeared to be an offset response. Only click-evoked Wave V showed 100% wave presence. Responses to the /da/ stimulus showed lower wave detectability. Frequency-domain analysis showed stronger and more consistent activity evoked by clicks than by /da/. Only the click ABR had consistent time–frequency domain features across all subjects.

Conclusions:

Based on the objective analysis used within this investigation, it appears that the quality of speech-evoked ABR is generally less than that of click-evoked responses, although the quality of responses may be improved by increasing the number of epochs or the stimulation level. This may have implications for the clinical use of speech-evoked ABR.
Risk Factors for Knee Stiffness Surgery After Tibial Plateau Fracture Fixation
Authors: Reahl G. Bradley , Marinos Dimitrius , O'Hara Nathan N. , Howe Andrea , Degani Yasmin , Wise Brent , Maceroli Michael , O'Toole Robert V.
Published: August 2018

Objective:

To determine the risk factors for knee stiffness surgery after tibial plateau fixation.

Design:

Retrospective observational cohort study.

Setting:

Academic Level I trauma center.

Patients/Participants:

A study group of 110 patients who underwent knee stiffness surgery (manipulation while under anesthesia, arthroscopic lysis of adhesion, or quadricepsplasty) at a time remote from open reduction and internal fixation of tibial plateau fractures and a control group of 319 patients with tibial plateau fractures treated with open reduction and internal fixation who did not undergo knee stiffness surgery and who had either a minimum of 1 year of follow-up or clearly documented range of motion ≥110 degrees with a minimum of 90 days of follow-up.

Intervention:

Each case was assessed from the time of index admission through study event, end of minimum follow-up, or achievement of ≥110 degrees range of motion.

Main Outcome Measurements:

Knee stiffness surgery.

Results:

Total number of weeks in an external fixator (odds ratio, 1.5 per week; 95% confidence interval, 1.3–1.7; P < 0.001) and the presence of bilateral tibial plateau fractures (odds ratio, 3.3; 95% confidence interval, 1.2–9.1; P = 0.02) were significant predictors of knee stiffness intervention.

Conclusion:

Clinicians should be aware that the time spent in external fixation and the presence of bilateral tibial plateau injuries are strong risk factors for requiring subsequent surgery to treat knee stiffness.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Patient-Reported Outcomes Measurement Information System Outcome Measures and Mental Health in Orthopaedic Trauma Patients During Early Recovery
Authors: Vincent Heather K. , Hagen Jennifer E. , Zdziarski-Horodyski Laura A. , Patrick Matthew , Sadasivan Kalia K. , Guenther Robert , Vasilopoulos Terrie , Sharififar Sharareh , Horodyski MaryBeth
Published: August 2018

Objectives:

This study explored the relationships between negative affective states (depression and anxiety), physical/functional status, and emotional well-being during early treatment and later in recovery after orthopaedic trauma injury.

Design:

This was a secondary observational analysis from a randomized controlled study performed at a Level-1 trauma center.

Patients:

Patients with orthopaedic trauma (N = 101; 43.5 ± 16.4 years, 40.6% women) were followed from acute care to week 12 postdischarge.

Main Outcome Measures:

Patient-reported outcomes measurement information system measures of Physical Function, Psychosocial Illness Impact—Positive and Satisfaction with Social Roles and Activities and the Beck Depression Inventory-II and the State-Trait Anxiety Inventory were administered during acute care and at weeks 2, 6, and 12. Secondary measures included hospital length of stay, adverse readmissions, injury severity, and surgery number.

Results:

At week 12, 20.9% and 35.3% of patients reported moderate-to-severe depression (Beck Depression Inventory-II score ≥20 points) and anxiety (State-Anxiety score ≥40 points), respectively. Depressed patients had greater length of stay, complex injuries, and more readmissions than those without. The study sample improved patient-reported outcomes measurement information system T-scores for Physical Function and Satisfaction with Social Roles and Activities by 40% and 22.8%, respectively (P < 0.0001), by week 12. Anxiety attenuated improvements in physical function. Both anxiety and depression were associated with lower Psychosocial Illness Impact—Positive scores by week 12.

Conclusions:

Although significant improvements in patient-reported physical function and satisfaction scores occurred in all patients, patients with depression or anxiety likely require additional psychosocial support and resources during acute care to improve overall physical and emotional recovery after trauma.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
An Innovative Technique for Craniocaudal Pedicle Screw Guidance: A Technical Note
Authors: Yadav Sanjay , Singh Saurabh
Published: August 2018

In spine surgery, pedicle screw instrumentation is being used very commonly. However, putting pedicle screws in the right place and direction needs the use of image intensifier in 2 orthogonal planes. This consumes valuable time while moving the image intensifier and operating table multiple times during the surgery and also excess radiation exposure. Here, we present a simple technique to apply surgical pearl to angulate the pedicle screws in cephalocaudal direction using simple instrument available on table. This may help in reducing the usage of image intensifier and expedite the procedure.
Improvements in Depressive Symptoms and Affect During Cardiac Rehabilitation
Authors: Gathright Emily C. , Busch Andrew M. , Buckley Maria L. , Stabile Loren , DeAngelis Julianne , Whited Matthew C. , Wu Wen‑Chih
Published: August 2018

Purpose:

Depression is indicative of poor prognosis in cardiac patients. Reductions in depression have been observed following cardiac rehabilitation (CR). Whether similar improvements in positive and negative affect occur is unknown. Greater understanding of depressive symptom and affect change is needed to enhance facilitators of emotional improvement after a cardiac event.

Methods:

Cardiac rehabilitation attendees (n = 637) completed measures of depressive symptoms, affect, health status, and social support at CR intake and discharge. Body mass index, metabolic equivalents, and blood pressure were also measured. Relationships between changes in psychosocial and physical health indicators and depressive symptoms, positive affect, and negative affect were examined.

Results:

From intake to discharge, depressive symptoms (d = 0.40, P < .001) and negative affect (d = 0.26, P < .001) decreased. Positive affect increased (d = 0.34, P < .001). In multivariate regression, predictors of depressive symptom reduction were increased vitality (β = −.26) and decreased bodily pain (β = −.08). Predictors of positive affect increase were increased vitality (β = .25), social support (β = .16), and physical role functioning (β = .09). Predictors of negative affect reduction were increased vitality (β = −.23) and social support (β = −.10). Changes in indicators of physical health were not related to depressive symptom or affect change.

Conclusions:

Depressive symptom and affect improvements following CR were observed and most strongly associated with improvements in vitality and social support. Future research should explore how enhancement of these mechanisms may further improve depressive symptom and affect during CR.
PRESUMED FOVEAL BACILLARY LAYER DETACHMENT IN A PATIENT WITH TOXOPLASMOSIS CHORIORETINITIS AND PACHYCHOROID DISEASE
Authors: Mehta Nitish , Chong Jillian , Tsui Edmund , Duncan Jacque L. , Curcio Christine A. , Freund K. Bailey , Modi Yasha
Published: August 2018

Purpose:

To report a detachment that apparently separated photoreceptor inner segment myoids from inner segment ellipsoids as a manifestation of toxoplasmosis chorioretinitis in a patient with pachychoroid spectrum disease.

Methods:

Multimodal imaging including fundus photography, spectral domain and enhanced-depth imaging optical coherence tomography (OCT), indocyanine green angiography, and OCT angiography.

Results:

A 33-year-old man with a history of toxoplasmosis chorioretinitis reported 1 week of decreased vision to 20/200 in his right eye. Examination of the right eye demonstrated mild vitritis with recurrent chorioretinitis inferior to the fovea and adjacent to a chorioretinal scar. A dome-shaped, foveal photoreceptor layer-splitting detachment was noted on OCT. Because degenerating cone photoreceptors are capable of shedding their inner segments, we inferred the location of the detachment at the level of the inner segment myoid and provided a histological example of such from an unrelated donor case. In addition, multimodal imaging revealed dilated choroidal veins (pachyvessels) with attenuation of the inner choroid in both eyes and asymptomatic findings of central serous chorioretinopathy in the left eye. After 1 month of antibiotic and steroid therapy, the chorioretinitis resolved, as did the detachment. Hyperreflective foci on the vitreoretinal interface were appreciated with en face OCT that appeared to aggregate throughout the course of therapy, induce inner retinal striae, and resolve without inducing epiretinal membrane formation.

Conclusion:

Patients with preexisting pachychoroid spectrum disease may manifest a more significant retinal fluid accumulation in the setting of superimposed chorioretinal inflammation. In this case of macular toxoplasmosis chorioretinitis, inflammation manifested as a retinal detachment at the level of photoreceptor inner segment myoids that we named as a bacillary layer detachment. In this case, inflammatory sequelae of toxoplasmosis reactivation responded well to oral and intravitreal therapy.
Intravenous Acetaminophen Improves Outcomes after Transapical Transcatheter Aortic Valve Replacement
Authors: Allen Keith B. , Michael Borkon A. , Cohen David J. , Chhatriwalla Adnan K. , Aggarwal Sanjeev , Saxon John , Russell Davis J. , Kennedy Kevin F.
Published: August 2018

Objective

Complications with opioid-based postoperative pain management have led to guideline recommendations for a multimodal analgesia strategy incorporating nonopioid agents. We evaluated the opioid-sparing effect of intravenous acetaminophen in patients undergoing transapical transcatheter aortic valve replacement.

Methods

A multimodal pain management strategy that incorporated intravenous acetaminophen was retrospectively evaluated in 43 patients undergoing transapical transcatheter aortic valve replacement between November 2012 and March 2014. Before intravenous acetaminophen formulary availability, 23 patients received standard postoperative pain management interventions including intravenous narcotics and oral narcotics/acetaminophen. After intravenous acetaminophen availability, 20 patients received intravenous acetaminophen (4 g/d, ≥4 doses) and supplemental intravenous and nonacetaminophen oral narcotics. Daily narcotic dose (standardized to morphine equivalents), drug cost, and hospital length of stay were compared between groups.

Results

Baseline characteristics were similar between intravenous acetaminophen (n = 20) and nonintravenous acetaminophen (n = 23) patients including the Society of Thoracic Surgery mortality risk (10.5% vs 9.0%, P = 0.3). The median number of intravenous acetaminophen doses was 6.5 (interquartile range = 4.0–18.5), with a median cost per patient of US $221 (interquartile range = $136–$629). Patients who received intravenous acetaminophen used significantly fewer morphine equivalents on postoperative day 0 compared with patients not receiving intravenous acetaminophen (22.5 vs 45.0 morphine equivalents, P = 0.03) and had a shorter median length of stay (5.0 vs 7.0 days, P = 0.007). After adjusting for the Society of Thoracic Surgery risk, intravenous acetaminophen continued to be associated with a reduction in median postoperative length of stay [−1.9 days (95% confidence interval = −0.9 to −8.2 days), P = 0.049].

Conclusions

In patients undergoing transapical transcatheter aortic valve replacement, a multimodal pain management strategy incorporating intravenous acetaminophen was associated with reductions in narcotic use on the day of surgery and overall length of stay.
Effectiveness of Initiating Deep Vein Thrombosis Prophylaxis in Patients With Stroke: An Integrative Review
Authors: Dizon Mark Angel M. , De Leon Josephine M.
Published: August 2018

Venous thromboembolism (VTE) is a frequent and potentially fatal complication of immobility caused by cerebrovascular disease. This review examines the efficiency of deep vein thrombosis (DVT) prophylaxis methods. Patients with stroke initiated on DVT prophylaxis were compared with those who did not have any prophylaxis. Integrative review research design was used and included articles from 2010 to 2016. Search terms such as “DVT prophylaxis” and “stroke” were used to identify scientific publications. Of 173 studies identified, 12 articles were included and rated using the Canadian Medical Association and Center for Evidence-Based Medicine Level of Evidence ranking system. Of DVT prophylaxis methods identified, intermittent pneumatic compression device was superior to antiembolic stockings. Current data showed that the stockings were insufficient in preventing VTE. Heparin and low–molecular-weight heparin were efficient chemoprophylaxis in reducing the incidence of VTE. The combination of chemical and mechanical DVT prevention is recommended.
Factors Affecting the Adherence to Disease-Modifying Therapy in Patients With Multiple Sclerosis
Authors: Erbay Öznur , Usta Yeşilbalkan Öznur , Yüceyar Nur
Published: August 2018

Background: Adherence to medication treatment in patients with multiple sclerosis (MS) is important to increase its effectiveness, reduce patient disability, prevent attacks, and increase the quality of life. Aim: This study investigated factors that influence adherence to disease-modifying therapy in patients with MS. Methods: This descriptive study was conducted with 198 patients with MS who met the inclusion criteria and agreed to participate between July 2016 and February 2017. Data were collected using an Individual Identification Form that included sociodemographic characteristics, the Multiple Sclerosis Treatment Adherence Questionnaire, the Fatigue Severity Scale, the Self-Efficacy Scale, and the Brief COPE. Results: We found that 59.6% of the patients were adherent to therapy. Patients were significantly more adherent to Avonex than other treatments, and “memory problems” was the most common reason for missing or forgetting medication in nonadherent patients. There was a significant difference between medication adherence and some sociodemographic characteristics and disease characteristics (P < .05). There was no significant difference between coping attitudes, fatigue, and self-efficacy level and medication adherence (P > .05). Conclusion: Patients’ adherence to medication treatment was low and may be associated with social, physical, and cognitive measures.
Effect of Educational Intervention on Self-Sampling Acceptability and Follow-Up Paps in Border Dwelling Hispanic Females
Authors: Molokwu Jennifer C. , Penaranda Eribeth , Dwivedi Alok , Mallawaarachchi Indika , Shokar Navkiran
Published: August 2018

Objective

The aims of the study were to evaluate the effect of a community outreach worker (promotora)-led high-intensity educational intervention compared with control without promotora-led intervention on cervical cancer screening preference (Pap smear vs self-sampling) and to determine the effect of this preference on subsequent screening completion.

Materials and Methods

This randomized controlled trial compared the effect of educational intervention on women's preferences for self-sampling for human papillomavirus. Inclusion criteria were women aged 30 to 65 years and no cervical cancer screening in 3 years or more. Community-based study with intervention group receiving culturally tailored education by promotora vs control group who received written education pamphlet. We evaluated participants' test preference, knowledge, and Pap completion at 12-months postintervention.

Results

Two hundred one predominantly Hispanic women were randomly assigned to high-intensity (n = 100) education vs low-intensity education (n = 101). The mean age was 46.4 years (SD = 8.2 years). There was no difference in test preference between high- and low-intensity groups (49% vs 41%, both tests equally; 28.6% vs 35.1%, self-sampling; and 22% vs 23%, Pap, p = .536). High-intensity intervention resulted in a significantly higher self-sampling acceptability score (25.02 vs 24.06, p = .039).Testing preference did not significantly affect Pap completion (Pap vs self-sampling vs unsure/both equally, 60.0% vs 43.6% vs 48.9%, p = 0.24). Human papillomavirus knowledge was found to be significantly associated with completion of Pap at 12 months. Human papillomavirus–positive result on self-sampling trended toward increased likelihood of screening completion (16.3% vs 7.8%, p = .058).

Conclusions

We found a high level of acceptability of self-sampling regardless of intensity of education in a largely Hispanic female population living on the US-Mexico border and a trend toward increased Pap smear follow-up in participants who tested positive.
No difference between direct-acting antivirals for hepatitis C in hepatocellular carcinoma risk
Authors: Mun Elijah J. , Green Pamela , Berry Kristin , Ioannou George N.
Published: August 2018

Background and aims

It is unclear whether there are differences between direct-acting antivirals (DAAs) for hepatitis C virus in risk of hepatocellular carcinoma (HCC) after antiviral therapy. We aimed to compare different DAA regimens with respect to risk of de novo HCC following antiviral therapy.

Patients and methods

We identified 33 137 patients who initiated hepatitis C virus antiviral treatment in the Veterans Affair healthcare system between 6 December 2013 and 31 December 2015 with one of four DAA-only regimens (± ribavirin): paritaprevir/ritonavir/ombitasvir/dasabuvir (n=6289), sofosbuvir (n=4356), sofosbuvir+simeprevir (n=3210), and ledipasvir/sofosbuvir (n=19 282). We retrospectively followed patients until 15 June 2017 to identify incident (de novo) cases of HCC. We used propensity score-adjusted Cox proportional hazards regression to compare different DAA regimens with respect to HCC risk.

Results

During a mean follow-up of 1.52 years, 741 new cases of HCC were diagnosed after antiviral treatment (annual incidence=1.47%). Patients treated with sofosbuvir+simeprevir had the highest annual HCC incidence (2.47%), followed by sofosbuvir (1.91%), ledipasvir/sofosbuvir (1.26%), and paritaprevir/ritonavir/ombitasvir/dasabuvir (0.95%). However, there were great differences between DAA-treated patients in the prevalence of cirrhosis, markers of advanced fibrosis, thrombocytopenia, and other HCC risk factors. After adjustment for baseline characteristics associated with HCC, there were no significant differences in HCC risk between the four DAA regimens.

Conclusion

There are no significant differences between DAA regimens in HCC risk after antiviral treatment. This suggests that DAAs do not have direct carcinogenic effects as it would be unlikely that different DAAs would have identical carcinogenic effects.
To transfuse or not transfuse: an intensive appraisal of red blood cell transfusions in the ICU
Authors: Hayes Margaret M. , Uhl Lynne
Published: August 2018

Purpose of review

This review is a critical appraisal of the current data comparing restrictive vs. liberal transfusion strategies for patients who are critically ill in ICUs. We focus on four subsets of critically ill patients: pediatric patients, patients with gastrointestinal bleeds, septic patients and patients undergoing cardiac surgery.

Recent findings

Almost a decade after the TRICC trial, a randomized trial showing the safety of a restrictive transfusion threshold in critically ill patients, four large randomized controlled trials have shown that a restrictive transfusion strategy is safe in pediatric critically ill patients, patients with acute upper gastrointestinal bleeds, patients with septic shock and patients undergoing cardiac surgery. A large multicenter randomized trial is underway to determine the safety of a restrictive strategy in myocardial infarction.

A restrictive transfusion threshold is recommended in nearly all critically ill patients. This is at least noninferior to more liberal transfusion practice; in addition, a restrictive threshold has shown improved outcomes in some patients and decreased chances of adverse events in patients. Judicious use of red cells improves patient outcome and protects the blood supply, a limited resource. More data are needed to determine appropriate transfusion threshold recommendations for patients with traumatic brain injury and acute coronary syndrome.
Next-generation sequencing-based minimal residual disease monitoring in patients receiving allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia or myelodysplastic syndrome
Authors: Shapiro Roman M. , Kim Dennis Dong Hwan
Published: August 2018

Purpose of review

The monitoring of minimal residual disease (MRD) has important clinical implications in both the pre and postallogeneic stem cell transplant (SCT) setting in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Next-generation sequencing (NGS) is a rapidly improving technology whose application to the monitoring of MRD is an active area of research. We aim to describe existing methods of MRD in AML and MDS, with a focus on the utility of NGS in patients undergoing SCT.

Recent findings

Flow cytometry and quantitative PCR have been recommended by the European Leukemia Net as the preferred methods of MRD in AML and MDS, but these methods have limitations in cases without a disease-defining phenotype and genotype. Clinical trials are currently ongoing to assess the use of NGS in the setting of SCT for MDS and AML. Few studies have so far assessed the optimal method of MRD monitoring in the posttransplant setting.

The optimal method for the monitoring of MRD in AML and MDS both pre and post transplant may require more than one technology. NGS holds great promise for the monitoring of MRD, with prospective trials currently ongoing to evaluate its efficacy in this regard.
The role of genomics in transfusion medicine
Authors: Wheeler Marsha M. , Johnsen Jill M.
Published: August 2018

Purpose of review

To summarize recent advances in red blood cell (RBC) blood group genotyping, with an emphasis on advances in the use of NGS next generation sequencing (NGS) to detect clinically relevant blood group gene variation.

Recent findings

Genetic information is useful in predicting RBC blood group antigen expression in several clinical contexts, particularly, for patients at high-risk for allosensitization, such as multiple transfused patients. Blood group antigen expression is directed by DNA variants affecting multiply genes. With over 300 known antigens, NGS offers the attractive prospect of comprehensive blood group genotyping. Recent studies from several groups show that NGS reliably detects blood group gene single nucleotide variants (SNVs) with good correlation with other genetic methods and serology. Additionally, new custom NGS methods accurately detect complex DNA variants, including hybrid RH alleles. Thus, recent work shows that NGS detects known and novel blood group gene variants in patients, solves challenging clinical cases, and detects relevant blood group variation in donors.

New work shows that NGS is particularly robust in identifying SNVs in blood group genes, whereas custom genomic tools can be used to identify known and novel complex structural variants, including in the RH system.
Current status and future direction of uterus transplantation
Authors: Brännström Mats
Published: August 2018

Purpose of review

The current review gives an updated synopsis of all cases of uterus transplantation (UTx) that has been published and technical details about surgery. The live births that so far have been reported are described regarding pregnancy and outcome. In addition, the review highlights some specific areas of live donor UTx, deceased donor UTx and UTx in general that need further research for clarification/optimization. It is predicted that the clinical field of UTx will expand rapidly and recommendations for a scientific development of the UTx field are presented.

Recent findings

The first successful UTx was performed in Sweden in February 2013, with the proof of success being the first UTx live birth (September 2014). This proof-of-concept of UTx as a treatment of absolute uterine factor infertility has been followed by several more births in Sweden, USA and Brazil. Live births have occurred both after live donor UTx and deceased donor UTx.

UTx is still at the experimental stage and new UTx cases should be within registered trials and with data accumulated in an international registry, to collect data and results to further optimize the procedure concerning efficiency and safety.
An Interview With Dr Karen Cox
Authors: Reid-Ponte Patricia
Published: August 2018

In this column, Dr Reid-Ponte interviews Dr Karen Cox, current president of the American Academy of Nursing and chief operating officer for Children's Mercy Hospital in Kansas City. Dr Cox discusses her leadership trajectory and lessons learned.
Involving Clinical Nurses in Evaluation of a Professional Practice Model
Authors: Cobb Susan , Wolf Kathleen , Shine Christa , Jadwin Anne
Published: August 2018

As part of the Magnet® application process, chief nurse executives (CNEs) are challenged to support the development, implementation, and evaluation of a Professional Practice Model (PPM) and include clinical nurses in this process. A focus group approach is a way to meet dual goals of evaluating the PPM and involving clinical nurses in the research process. The article describes how a focus group approach can be used effectively to identify themes and highlight the role of the CNE. In addition, the PPM resulted in revisions based on clinical nurse input.
Minimal Clinically Important Difference of the 6-Minute Walk Test in People With Stroke
Authors: Fulk George D. , He Ying
Published: August 2018

Background and Purpose:

The 6-minute walk test (6MWT) is commonly used in people with stroke. The purpose of this study was to estimate the minimal clinically important difference (MCID) of the 6MWT 2 months poststroke.

Methods:

We performed a secondary analysis of data from a rehabilitation trial. Participants underwent physical therapy between 2 and 6 months poststroke and the 6MWT was measured before and after. Two anchors of important change were used: the modified Rankin Scale (mRS) and the Stroke Impact Scale (SIS). The MCID for the 6MWT was estimated using receiver operating characteristic curves for the entire sample and for 2 subgroups: initial gait speed (IGS) <0.40 m/s and ≥0.40 m/s.

Results:

For the entire sample, the estimated MCID of the 6MWT was 71 m with the mRS as the anchor (area under the curve [AUC] = 0.66) and 65 m with the SIS as the anchor (AUC = 0.59). For participants with IGS <0.40 m/s, the estimated MCID was 44 m with the mRS as the anchor (AUC = 0.72) and 34 m with the SIS as the anchor (AUC = 0.62). For participants with IGS ≥0.40 m/s, the estimated MCID was 71 m with the mRS as the anchor (AUC = 0.59) and 130 m with the SIS as the anchor (AUC = 0.56).

Discussion and Conclusions:

Between 2 and 6 months poststroke, people whose IGS is <0.40 m/s and experience a 44-m improvement in the 6MWT may exhibit meaningful improvement in disability. However, we were not able to estimate an accurate MCID for the 6MWT in people whose IGS was ≥0.40 m/s. MCID values should be estimated across different levels of function and anchors of importance.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A232).
Aspirin for the Prevention of Preterm and Term Preeclampsia: Systematic Review and Meta-analysis
Authors: Roberge Stephanie , Bujold Emmanuel , Nicolaides Kypros H.
Published: August 2018

(Abstracted from Am J Obstet Gynecol 2018;218:287–293.e1)

Several randomized studies have found contradictory results while examining the possibility of preventing preeclampsia with a prophylactic daily dose of aspirin. Preeclampsia is a major cause of morbidity and mortality in mothers and their newborns, and it can have particularly adverse consequences if associated with preterm birth.
Pediatric Neurocritical Care: Evolution of a New Clinical Service in PICUs Across the United States
Authors: LaRovere Kerri L. , Murphy Sarah A. , Horak Robin , Vittner Patrick , Kapur Kush , Proctor Mark , Tasker Robert C.
Published: August 2018

Objectives:

Pediatric neurocritical care as a conceptual service is relatively new, and implementation of such specialized services may improve outcomes for children with disorders of the brain or spinal cord. How many pediatric neurocritical care services currently exist in the United States, and attitudes about such a service are unknown.

Design:

Web-based survey, distributed by e-mail.

Setting:

Survey was sent to PICU Medical Directors and Program Directors of Pediatric Neurosurgery fellowship and Child Neurology residency programs.

Patients:

None.

Interventions:

None.

Measurements and Main Results:

A total of 378 surveys were distributed; 161 respondents representing 128 distinct hospitals completed the survey (43% response rate). Thirty-five percent (45/128) reported having a pediatric neurocritical care service. The most common type of service used a consultation model (82%; 32/39 responses). Other types of services were intensivist-led teams in the PICU (five hospitals) and dedicated PICU beds (two hospitals). Hospital characteristics associated with availability of pediatric neurocritical care services were level 1 trauma status (p = 0.017), greater numbers of PICU beds (χ2 [6, n = 128] = 136.84; p < 0.01), and greater volume of children with pediatric neurocritical care conditions (χ2 [3, n = 128] = 20.16; p < 0.01). The most common reasons for not having a pediatric neurocritical care service were low patient volume (34/119 responses), lack of subspecialists (30/119 responses), and lack of interest by PICU faculty (25/119 responses). The positive impacts of a pediatric neurocritical care service were improved interdisciplinary education/training (16/45 responses), dedicated expertise (13/45 responses), improved interservice communication (9/45 responses), and development/implementation of guidelines and protocols (9/45 responses). The negative impacts of a pediatric neurocritical care service were disagreement among consultants (2/45 responses) and splitting of the PICU population (2/45 responses).

Conclusions:

At least 45 specialized pediatric neurocritical care services exist in the United States. Eighty percent of these services are a consultation service to the PICU. Hospitals with level 1 trauma status, greater numbers of PICU beds, and greater numbers of patients with pediatric neurocritical care conditions were associated with the existence of pediatric neurocritical care as a clinical service.