bluuebunny/crossref_metadata_2025 huggingface dataset:
Why urban environments matter for refugee mental health
Authors: Schofield Peter
Published: June 2019

Refugees are at increased risk of mental disorders. This is increasingly attributed to the post-migration context in which they live, typically socio-economically deprived urban areas. In general, neighbourhood factors are relevant to mental health outcomes. There is now research showing that neighbourhood ethnic density is related to the incidence of psychosis and other mental disorders for ethnic minorities. One consequence of dispersal policies is that refugees are often placed in urban areas far from others from their country of origin, which is likely to affect their mental health. Refugees are more likely to be exposed to other neighbourhood factors shown to have adverse mental health consequences, e.g. high levels of social deprivation and low levels of social cohesion. The extent to which these factors might explain the elevated risk of mental disorders among refugees is still unknown and further research is needed.
Sex in the city
Authors: Bhugra Dinesh , Ventriglio Antonio
Published: June 2019

Sexual acts form the basis of human life. In urban areas, both male and female sex workers and their mental health have been studied. The risks of resulting sexually transmitted diseases are higher and, consequently, physical and psychiatric comorbidity may be higher. The theory of sex markets focuses on sexual partnering and emphasizes that it is fundamentally a local process, meaning that the two people must live within reasonable geographical proximity to initiate and develop a sexual relationship that is physical. Of course, often people do indulge in cybersex, for which adequate electronic and WiFi facilities have to be available. Economic needs and perspectives may play a major role in transient sexual partnering.
Gender and sexual minorities
Authors: Bradlow Richard , Singh Neha , Beloskar Suraj , Kalra Gurvinder
Published: June 2019

A person’s living environment can have substantial impact on his/her mental health due to a range of factors related to the environment. It has often been argued that urban settings are a hotpot of sociocultural evolutions that attract individuals from the gender and sexual minority (GSM) groups. This has led to migration from rural to urban areas and also from one urban area to another urban area. Various push and pull factors in both the rural and urban areas help GSM individuals decide in which direction to move. While rural areas present with challenges such as social isolation within a homophobic/transphobic environment, urban areas also have their own unique set of challenges for the GSM population. In this chapter, we focus on various factors in both rural and urban settings that impact on the mental health of GSM population.
A tale of two cities: urban mental health in Vancouver and New York City
Authors: Jang Kerry L. , Krausz Michael , Song Michael Jae
Published: June 2019

Urbanization and mental health are inter-linked. With the expansion of cities, pressures on services are increasing. The constraints for providing healthcare services are tremendous and financial resources can be demanding. In this chapter, service provision in Vancouver and New York are compared. It is well recognized that in most countries, there exist three levels of government: the national or federal, state or provincial assemblies, and city or municipal councils. In theory, each order is relatively independent. Local or municipal governments typically derive their powers from state or provincial law. This is notable because it places statutory limitations on what cities are responsible for, and restrictions on how, and where, the municipality may raise and spend monies. Health care policies may be developed at federal or national levels and, paradoxically, their delivery is expected at local levels, raising specific issues and pressures on local authorities.
Urban design for mental health in Tokyo
Authors: McCay Layla , Suzuki Emily , Chang Anna
Published: June 2019

Tokyo is one of the most populous urban areas in the world, with a city population of over 13 million people and a metropolitan area extending to 36 million people. Urban planning has not traditionally focused on mental health in Tokyo. A policy review alongside interviews with urban practitioners examined how Tokyo applies the key principles of urban planning and design for population mental health, and extracts lessons. Tokyo could further leverage the urban environment to improve mental health by increasing awareness among architects and planners; removing barriers to commuting by bicycle; developing waterways and station pavilions for green space, physical activity and positive social interactions; and optimizing the workplace for mental health. Other cities could learn from Tokyo’s empowering of residents to green their neighbourhoods, and its largely pedestrianized roads that prioritize greenery, walkability, bikeability, and social activities. Thinking is growing around interior placemaking, from shopping malls to offices.
Urban mental health strategies
Authors: Litman Todd
Published: June 2019

Urban living can impose mental health risks, such as concentrated poverty, loneliness and alienation, crowding and reduced privacy, fear of crime, reduced physical activity, economic stress, transport conditions, and inadequate interaction with nature. Research helps experts understand and respond to these risks. Urban healthcare professionals can use this information to protect and enhance their own mental health, to better address their patients’ mental health problems, and to guide policymakers and urban planners to enhance mental health in communities. By understanding these effects, health professionals can help inoculate their cities against mental health risks the same way they support strategies that reduce physical health risks. This chapter examines mental health risks associated with urban living, the degree that they are associated with or caused by urban conditions, and ways for individuals and communities to reduce these risks and enhance urban mental health. These issues are important in developed and developing countries.
The EDGE-CALIFA survey: exploring the star formation law through variable selection
Authors: Dey Biprateep , Rosolowsky Erik , Cao Yixian , Bolatto Alberto , Sanchez Sebastian F , Utomo Dyas , Colombo Dario , Kalinova Veselina , Wong Tony , Blitz Leo , Vogel Stuart , Loeppky Jason , García-Benito Rubén
Published: June 2019

We present a multilinear analysis to determine the significant predictors of star formation in galaxies using the combined EDGE-CALIFA sample of galaxies. We analyse 1845 kpc-scale lines of sight across 39 galaxies with molecular line emission measurements from EDGE combined with optical IFU data drawn from CALIFA. We use the Least Absolute Shrinkage and Selection Operator (LASSO) to identify significant factors in predicting star formation rates. We find that the local star formation rate surface density is increased by higher molecular gas surface densities and stellar surface densities. In contrast, we see lower star formation rates in systems with older stellar populations, higher gas- and stellar-phase metallicities and larger galaxy masses. We also find a significant increase in star formation rate with galactocentric radius normalized by the disc scale length, which suggests additional parameters regulating star formation rate not explored in this study.
Overcast on Osiris: 3D radiative-hydrodynamical simulations of a cloudy hot Jupiter using the parametrized, phase-equilibrium cloud formation code EddySed
Authors: Lines S , Mayne N J , Manners J , Boutle I A , Drummond B , Mikal-Evans T , Kohary K , Sing D K
Published: June 2019

We present results from 3D radiative-hydrodynamical simulations of HD 209458b with a fully coupled treatment of clouds using the EddySed code, critically, including cloud radiative feedback via absorption and scattering. We demonstrate that the thermal and optical structure of the simulated atmosphere is markedly different, for the majority of our simulations, when including cloud radiative effects, suggesting this important mechanism cannot be neglected. Additionally, we further demonstrate that the cloud structure is sensitive to not only the cloud sedimentation efficiency (termed fsed in EddySed), but also the temperature–pressure profile of the deeper atmosphere. We briefly discuss the large difference between the resolved cloud structures of this work, adopting a phase-equilibrium and parametrized cloud model, and our previous work incorporating a cloud microphysical model, although a fairer comparison where, for example, the same list of constituent condensates is included in both treatments is reserved for a future work. Our results underline the importance of further study into the potential condensate size distributions and vertical structures, as both strongly influence the radiative impact of clouds on the atmosphere. Finally, we present synthetic observations from our simulations reporting an improved match, over our previous cloud-free simulations, to the observed transmission, HST WFC3 emission, and 4.5 μm Spitzer phase curve of HD 209458b. Additionally, we find all our cloudy simulations have an apparent albedo consistent with observations.
Statistical detection of a tidal stream associated with the globular cluster M68 using Gaia data
Authors: Palau Carles G , Miralda-Escudé Jordi
Published: June 2019

A method to search for tidal streams and to fit their orbits based on maximum likelihood is presented and applied to the Gaia data. Tests of the method are performed showing how a simulated stream produced by tidal stripping of a star cluster is recovered when added to a simulation of the Gaia catalogue. The method can be applied to search for streams associated with known progenitors or to do blind searches in a general catalogue. As the first example, we apply the method to the globular cluster M68 and detect its clear tidal stream stretching over the whole North Galactic hemisphere, and passing within 5 kpc of the Sun. This is one of the closest tidal streams to us detected so far, and is highly promising to provide new constraints on the Milky Way gravitational potential, for which we present preliminary fits finding a slightly oblate dark halo consistent with other observations. We identify the M68 tidal stream with the previously discovered Fjörm stream by Ibata et al. The tidal stream is confirmed to contain stars that are consistent with the HR-diagram of M68. We provide a list of 115 stars that are most likely to be stream members, and should be prime targets for follow-up spectroscopic studies.
Evolution of cosmic ray electron spectra in magnetohydrodynamical simulations
Authors: Winner Georg , Pfrommer Christoph , Girichidis Philipp , Pakmor Rüdiger
Published: June 2019

Cosmic ray (CR) electrons reveal key insights into the non-thermal physics of the interstellar medium (ISM), galaxies, galaxy clusters, and active galactic nuclei by means of their inverse Compton (IC) γ-ray emission and synchrotron emission in magnetic fields. While magnetohydrodynamical (MHD) simulations with CR protons capture their dynamical impact on these systems, only few computational studies include CR electron physics because of the short cooling time-scales and complex hysteresis effects, which require a numerically expensive, high-resolution spectral treatment. Since CR electrons produce important non-thermal observational signatures, such a spectral CR electron treatment is important to link MHD simulations to observations. We present an efficient post-processing code for Cosmic Ray Electron Spectra that are evolved in Time (crest) on Lagrangian tracer particles. The CR electron spectra are very accurately evolved on comparably large MHD time-steps owing to an innovative hybrid numerical-analytical scheme. crest is coupled to the cosmological MHD code arepo and treats all important aspects of spectral CR electron evolution such as adiabatic expansion and compression, Coulomb losses, radiative losses in form of IC, bremsstrahlung and synchrotron processes, diffusive shock acceleration and reacceleration, Fermi-II reacceleration, and secondary electron injection. After showing various code validations of idealized one-zone simulations, we study the coupling of crest to MHD simulations. We demonstrate that the CR electron spectra are efficiently and accurately evolved in shock-tube and Sedov–Taylor blast wave simulations. This opens up the possibility to produce self-consistent synthetic observables of non-thermal emission processes in various astrophysical environments.
Unified lensing and kinematic analysis for any elliptical mass profile
Authors: Shajib Anowar J
Published: June 2019

We demonstrate an efficient method to compute the strong-gravitational-lensing deflection angle and magnification for any elliptical surface density profile. This method solves a numerical hurdle in lens modelling that has lacked a general solution for nearly three decades. The hurdle emerges because it is prohibitive to derive analytic expressions of the lensing quantities for most elliptical mass profiles. In our method, we first decompose an elliptical mass profile into concentric Gaussian components. We introduce an integral transform that provides us with a fast and accurate algorithm for this Gaussian decomposition. We derive analytic expressions of the lensing quantities for a Gaussian component. As a result, we can compute these quantities for the total mass profile by adding up the contributions from the individual components. This lensing analysis self-consistently completes the kinematic description in terms of Gaussian components presented by Cappellari (2008). Our method is general without extra computational burden unlike other methods currently in use.
Zscan4c activates endogenous retrovirus MERVL and cleavage embryo genes
Authors: Zhang Weiyu , Chen Fuquan , Chen Ruiqing , Xie Dan , Yang Jiao , Zhao Xin , Guo Renpeng , Zhang Yongwang , Shen Yang , Göke Jonathan , Liu Lin , Lu Xinyi
Published: June 2019

Endogenous retroviruses (ERVs) contribute to ∼10 percent of the mouse genome. They are often silenced in differentiated somatic cells but differentially expressed at various embryonic developmental stages. A minority of mouse embryonic stem cells (ESCs), like 2-cell cleavage embryos, highly express ERV MERVL. However, the role of ERVs and mechanism of their activation in these cells are still poorly understood. In this study, we investigated the regulation and function of the stage-specific expressed ERVs, with a particular focus on the totipotency marker MT2/MERVL. We show that the transcription factor Zscan4c functions as an activator of MT2/MERVL and 2-cell/4-cell embryo genes. Zinc finger domains of Zscan4c play an important role in this process. In addition, Zscan4c interacts with MT2 and regulates MT2-nearby 2-cell/4-cell genes through promoting enhancer activity of MT2. Furthermore, MT2 activation is accompanied by enhanced H3K4me1, H3K27ac, and H3K14ac deposition on MT2. Zscan4c also interacts with GBAF chromatin remodelling complex through SCAN domain to further activate MT2 enhancer activity. Taken together, we delineate a previously unrecognized regulatory axis that Zscan4c interacts with and activates MT2/MERVL loci and their nearby genes through epigenetic regulation.
Spinal Cord Stimulation vs Conventional Therapies for the Treatment of Chronic Low Back and Leg Pain: A Systematic Review of Health Care Resource Utilization and Outcomes in the Last Decade
Authors: Odonkor Charles A , Orman Sebastian , Orhurhu Vwaire , Stone Martha E , Ahmed Shihab
Published: June 2019

Objective

The purpose of this review is to critically appraise the literature for evidence supporting the health care resource utilization and cost-effectiveness of spinal cord stimulation (SCS) compared with conventional therapies (CTs) for chronic low back and leg pain.

Methods

The PubMed, MEDLINE, Embase, CINAHL, and Rehabilitation & Sports Medicine databases were searched for studies published from January 2008 through October 2018, using the following MeSH terms: “spinal cord stimulation,” “chronic pain,” “back pain,” “patient readmission,” “economics,” and “costs and cost analysis.” Additional sources were added based on bibliographies and consultation with experts. The following data were extracted and analyzed: demographic information, study design, objectives, sample sizes, outcome measures, SCS indications, complications, costs, readmissions, and resource utilization data.

Results

Of 204 studies screened, 11 studies met inclusion criteria, representing 31,439 SCS patients and 299,182 CT patients. The mean age was 53.5 years for SCS and 55.6 years for CT. In eight of 11 studies, SCS was associated with favorable outcomes and found to be more cost-effective than CT for chronic low back pain. Compared with CT, SCS resulted in shorter hospital stays and lower complication rates and health care costs at 90 days. SCS was associated with significant improvement in health-related quality of life, health status, and quality-adjusted life-years.

Conclusions

For the treatment of chronic low back and leg pain, the majority of studies are of fair quality, with level 3 or 4 evidence in support of SCS as potentially more cost-effective than CT, with less resource expenditure but higher complication rates. SCS therapy may yet play a role in mitigating the financial burden associated with chronic low back and leg pain.
ROSETTA-informed design of structurally stabilized cyclic anti-amyloid peptides
Authors: Est Chandler B , Mangrolia Parth , Murphy Regina M
Published: June 2019

β-amyloid oligomers are thought to be the most toxic species formed en route to fibril deposition in Alzheimer’s disease. Transthyretin is a natural sequestering agent of β-amyloid oligomers: the binding site to β-amyloid has been traced to strands G/H of the inner β-sheet of transthyretin. A linear peptide, with the same primary sequence as the β-amyloid binding domain on transthyretin, was moderately effective at inhibiting β-amyloid fibril growth. Insertion of a β-turn template and cyclization greatly increased stability against proteolysis and improved efficacy as an amyloid inhibitor. However, the cyclic peptide still contained a significant amount of disorder. Using the Simple Cyclic Peptide Application within ROSETTA as an in silico predictor of cyclic peptide conformation and stability, we investigated putative structural enhancements, including stabilization by disulfide linkages and insertion of a second β-turn template. Several candidates were synthesized and tested for secondary structure and ability to inhibit β-amyloid aggregation. The results demonstrate that cyclization, β-sheet structure and conformational homogeneity are all preferable design features, whereas disulfide bond formation across the two β-strands is not preferable.
Insider–outsider representation and social democratic labor market policy
Authors: Bürgisser Reto , Kurer Thomas
Published: June 2019

Postindustrialization and occupational change considerably complicate partisan politics of the welfare state. This article asks about the determinants of contemporary social democratic labor market policy. We argue that the composition of their support base is a critical constraint and empirically demonstrate that the actual electoral clout of different voter segments decisively affects policy outcomes under left government. We calculate the electoral relevance of two crucial subgroups of the social democratic coalition, labor market insiders and outsiders, in 19 European democracies and combine these indicators with original data capturing the specific content of labor market reforms. The analysis reveals considerable levels of responsiveness and demonstrates that relative electoral relevance is consistently related to policy outcomes. Social democratic governments with a stronger support base among the atypically employed push labor market reforms on their behalf—and vice versa. Our findings have important implications for our understanding of policy-making in postindustrial societies.
Hell’s Grannies and Crazy Ladies—Challenging the Precarization of Older Women
Authors: Hudson Christine
Published: June 2019

Older women are often portrayed as particularly vulnerable and in need of protection, producing processes of ageist “othering” that deny agency, foster “appropriate” behaviors, and work to exclude them from everyday life. While not denying many women face a precarious situation in later life, some older women resist their subjectivation as vulnerable. Drawing on a concept of precarity as governmentality, older women’s acceptance and resistance to being characterized as “vulnerable” and in need of protection are explored in relation to focus group interviews with female pensioners in four Swedish municipalities.
A Statewide Study of School-Based Victimization, Discriminatory Bullying, and Weapon Victimization by Student Homelessness Status
Authors: Moore Hadass , Astor Ron Avi , Benbenishty Rami
Published: June 2019

Youths who experience homelessness are at high risk of victimization, yet little is known about school violence in the context of students experiencing homelessness. Specifically, limited research has considered different subgroups of students experiencing homelessness according to the McKinney–Vento Homeless Assistance Act (nonsheltered, sheltered, doubled up) in comparison with nonhomeless students. Using a representative sample ofCalifornia public high school students (N = 390,028), authors applied bivariate and multivariate analyses to examine differences among nonsheltered, sheltered, and doubled-up students experiencing homelessness regarding levels of discriminatory bullying, behavioral victimization, and weapon victimization at school. Findings show that students experiencing homelessness across all subgroups are at high risk of experiencing school violence. The severity of findings and differences among subgroups emphasize the need to develop school-based responses for each subgroup. Providers serving youths experiencing homelessness are encouraged to consider schools as a site for prevention and intervention for this population.
Inhibition of Human Liver Carboxylesterase (hCE1) by Organophosphate Ester Flame Retardants and Plasticizers: Implications for Pharmacotherapy
Authors: Phillips Allison L , Stapleton Heather M
Published: June 2019

Organophosphate ester (OPE) flame retardants and plasticizers, consumer product additives with widespread human exposure, were evaluated for their effect on the activity of purified human liver carboxylesterase (hCE1). Four of the 15 OPEs tested had IC50 values lower than 100 nM, including triphenyl phosphate (TPHP), 2-ethylhexyl diphenyl phosphate (EHDPHP), 4-isopropylphenyl diphenyl phosphate (4IPPDPP), and 4-tert-butylphenyl diphenyl phosphate (4tBPDPP), as did 4 of the commercial flame retardant mixtures tested. Because hCE1 is critical for the activation of imidapril, an angiotensin-converting enzyme-inhibitor prodrug prescribed to treat hypertension, the most potent inhibitors, TPHP and 4tBPDPP, and an environmentally relevant mixture (house dust) were further evaluated for their effect on imidapril bioactivation in vitro. TPHP and 4tBPDPP were potent inhibitors of hCE1-mediated imidapril activation (Ki = 49.0 and 17.9 nM, respectively). House dust extracts (100 µg/ml) also caused significant reductions (up to 33%) in imidapril activation. Combined, these data suggest that exposure to OPEs may affect pharmacotherapy.
Atropselective Oxidation of 2,2′,3,3′,4,6′-Hexachlorobiphenyl (PCB 132) to Hydroxylated Metabolites by Human Liver Microsomes and Its Implications for PCB 132 Neurotoxicity
Authors: Uwimana Eric , Cagle Brianna , Yeung Coby , Li Xueshu , Patterson Eric V , Doorn Jonathan A , Lehmler Hans-Joachim
Published: June 2019

Polychlorinated biphenyls (PCBs) have been associated with neurodevelopmental disorders. Several neurotoxic congeners display axial chirality and atropselectively affect cellular targets implicated in PCB neurotoxicity. Only limited information is available regarding the atropselective metabolism of these congeners in humans and their atropselective effects on neurotoxic outcomes. Here we investigate the hypothesis that the oxidation of 2,2′,3,3′,4,6′-hexachlorobiphenyl (PCB 132) by human liver microsomes (HLMs) and their effects on dopaminergic cells in culture are atropselective. Racemic PCB 132 was incubated with pooled or single donor HLMs, and levels and enantiomeric fractions of PCB 132 and its metabolites were determined gas chromatographically. The major metabolite was either 2,2′,3,4,4′,6′-hexachlorobiphenyl-3′-ol (3′-140), a 1,2-shift product, or 2,2′,3,3′,4,6′-hexachlorobiphenyl-5′-ol (5′-132). The PCB 132 metabolite profiles displayed interindividual differences and depended on the PCB 132 atropisomer. Computational studies suggested that 3′-140 is formed via a 3,4-arene oxide intermediate. The second eluting atropisomer of PCB 132, first eluting atropisomer of 3′-140, and second eluting atropisomer of 5′-132 were enriched in all HLM incubations. Enantiomeric fractions of the PCB 132 metabolites differed only slightly between the single donor HLM preparations investigated. Reactive oxygen species and levels of dopamine and its metabolites were not significantly altered after a 24 h exposure of dopaminergic cells to pure PCB 132 atropisomers. These findings suggest that there are interindividual differences in the atropselective biotransformation of PCB 132 to its metabolites in humans; however, the resulting atropisomeric enrichment of PCB 132 is unlikely to affect neurotoxic outcomes associated with the endpoints investigated in the study.
Real-Time PCR and LAMP Assays for the Detection of Spores of Alternaria solani and Sporangia of Phytophthora infestans to Inform Disease Risk Forecasting
Authors: Lees A. K. , Roberts D. M. , Lynott J. , Sullivan L. , Brierley J. L.
Published: June 2019

Real-time loop-mediated isothermal amplification (LAMP) assays for the detection of sporangia of the causal pathogen of late blight, Phytophthora infestans, and spores of the main causal pathogen of early blight, Alternaria solani, were developed to facilitate the in-field detection of airborne inoculum to improve disease forecasting. These assays were compared with an existing real-time PCR assay for P. infestans and a newly developed real-time PCR assay for A. solani. Primers were designed for real-time LAMP of P. infestans and A. solani. The specificity of the P. infestans real-time LAMP assay was similar to that of an existing real-time PCR assay: DNA of P. infestans was consistently amplified as was DNA of the taxonomically closely related species Phytophthora mirabilis, Phytophthora phaseoli, and Phytophthora ipomoea; no amplification of DNA from the potato pathogens Phytophthora erythroseptica or Phytophthora nicotianae occurred. Real-time LAMP and PCR assays were developed for A. solani, and the specificity was compared with an existing conventional PCR assay. Importantly, the A. solani real-time LAMP and PCR assays did not amplify the species Alternaria alternata. However, cross-reactivity with Alternaria dauci was observed with the real-time PCR assay and Alternaria brassicae with the real-time LAMP assay. The sensitivity of all assays for the detection of DNA extracted from sporangia/spores of the target pathogens was evaluated. The P. infestans real-time LAMP assay reliably detected 5 pg of DNA, equivalent to ∼1 sporangia per reaction. By comparison, 20 fg of DNA was detectable with the existing real-time PCR assay. In the case of A. solani, real-time LAMP detected 4.4 pg of DNA, equivalent to ∼1 spore per reaction, and real-time PCR detected 200 fg of DNA. In-field air samplers were deployed in two trial plots planted with potato: one infected with P. infestans, and the other infected with A. solani. Four additional samplers were located in commercial potato fields. Air samples were taken through the season, and detection of airborne inoculum of P. infestans and A. solani with both real-time PCR and LAMP was assessed.
Mastocytosis presenting as insect anaphylaxis: gender differences and natural history
Authors: Alvarez-Twose Iván , Matito Almudena
Published: June 2019

Purpose of review

Currently, there is strong evidence about an association between hymenoptera venom anaphylaxis (HVA) and mastocytosis. This review is focused on the most relevant clinical and biological features of systemic mastocytosis associated with HVA.

Recent findings

HVA is a relatively common complication that modifies the natural course of patients with mastocytosis, particularly men with indolent systemic mastocytosis without skin lesions (ISMs−) in whom HVA can be the presenting symptom in up to around one-half of the cases. Patients with ISMs− associated with HVA are typically males with cardiovascular symptoms in the absence of itching, urticaria, and angioedema during anaphylaxis. Noteworthy, ISMs− is characterized by a low bone marrow mast cell load and a low risk for disease progression. Early and more recent studies support that specific venom immunotherapy (VIT) is a well-tolerated and effective treatment in patients with mastocytosis.

VIT should be given life-long to all patients with mastocytosis and proven immunoglobulin E (IgE)-mediated HVA. In patients with negative venom skin test and undetectable IgE antibodies, additional studies such as component-based allergy testing might contribute to confirm an IgE-mediated mechanism of anaphylaxis in some cases, thus providing the indication of VIT.
Reducing the Syndesmosis Under Direct Vision: Where Should I Look?
Authors: Tornetta Paul , Yakavonis Mark , Veltre David , Shah Anjan
Published: June 2019

Objectives:

To compare the quality of syndesmotic reduction obtained using the incisura versus the ankle articular surface as the visual cue. Secondarily, we evaluated the difference in the anterior to posterior depth of the fibula to the tibia at the joint level and the fibula to the incisura 1 cm above the joint.

Methods:

Seven surgeons reduced disrupted syndesmoses of 10 cadaveric ankles using either the anterolateral articular surface of the distal tibia to the anteromedial fibular articular surface or the location of the fibula within the incisura as a visual reference. Malreductions in translation were measured in millimeter from the anatomical position of the fibula. The anterior to posterior distances of the tibia and fibula were also measured at both levels to determine the differences in their depths.

Results:

The translational reduction was within 2 mm in 93% (0.7 ± 0.7 mm) of reductions using the articular surface as a reference compared with 80% (1.2 ± 1.0 mm) using the incisura as a reference (P = 0.0001). All surgeons' reductions were better using the joint articular surface as the visual reference. The difference in the fibular and the tibial depth was smaller at the level of the articular surface versus the incisura (2.1 mm vs. 5.9 mm; P = 0.0002).

Conclusions:

The articular surface is a significantly more accurate visual landmark for translational reduction of the syndesmosis. This is potentially explained by the larger differences in the fibula and tibial depth at the incisura versus the articular surface.
External Radiation Dose, Obesity, and Risk of Childhood Thyroid Cancer After the Fukushima Daiichi Nuclear Power Plant Accident: The Fukushima Health Management Survey
Authors: Ohira Tetsuya , Ohtsuru Akira , Midorikawa Sanae , Takahashi Hideto , Yasumura Seiji , Suzuki Satoru , Matsuzuka Takashi , Shimura Hiroki , Ishikawa Tetsuo , Sakai Akira , Suzuki Shinichi , Yamashita Shunichi , Yokoya Susumu , Tanigawa Koichi , Ohto Hitoshi , Kamiya Kenji
Published: June 2019

Background:

The 2011 Great East Japan Earthquake led to a nuclear accident at Fukushima Daiichi Nuclear Power Plant. This study examines the associations of radiation dose and lifestyle factors with incidence of thyroid cancer in Fukushima.

Methods:

We designed a prospective study with 300,473 participants aged 18 years or younger, who underwent thyroid examinations from October 2011. Follow-up surveys were conducted through June 2017, and 245,530 participants (123,480 men and 122,050 women, 82% follow-up) received follow-up examinations. Fukushima Prefecture was divided into five areas based on individual external radiation dose. We calculated relative risks and 95% confidence intervals (CIs) for thyroid cancer in each area, with area of lowest dose as reference, using age-adjusted Poisson regression models. We also calculated risks associated with overweight and obesity.

Results:

The incidence per 100,000 for Groups A (highest dose), B, C, D, and E (lowest dose) were 13.5, 19.2, 17.3, 9.0, and 8.3, respectively. Compared with Group E, the age-adjusted risks (95% CIs) were 1.62 (0.59, 4.47) for group A, 2.32 (0.86, 6.24) for group B, 2.21 (0.82, 5.94) for group C, and 1.02 (0.36, 2.86) for group D. Obesity was positively associated with thyroid cancer incidence; the multivariable-adjusted risk of thyroid cancer was 2.23 (1.01, 4.90) for obese individuals compared with nonobese individuals.

Conclusion:

Regional differences in radiation dose were not associated with increased risk of thyroid cancer among children in Fukushima within 4 to 6 years after the nuclear power plant accident. Obesity may be an important factor for further follow-up in Fukushima.
Artificial intelligence and augmented reality in gynecology
Authors: Moawad Gaby , Tyan Paul , Louie Michelle
Published: June 2019

Purpose of review

Artificial intelligence and augmented reality have been progressively incorporated into our daily life. Technological advancements have resulted in the permeation of similar systems into medical practice.

Recent findings

Both artificial intelligence and augmented reality are being increasingly incorporated into the practice of modern medicine to optimize decision making and ultimately improve patient outcomes.

Artificial intelligence has already been incorporated into many areas of medical practice but has been slow to catch on in clinical gynecology. However, several applications of augmented reality are currently in use in gynecologic surgery. We present an overview of artificial intelligence and augmented reality and current use in medical practice with a focus on gynecology.
Risk Management in Obstetrics and Gynecology
Authors: KLEIN VICTOR R.
Published: June 2019

This article will review the basic principles of risk management, the role of the risk manager, and the importance of risk management in the patient safety movement as it pertains to obstetrics and gynecology. Several tools that are used by risk managers including risk assessments and root cause analyses will be used to illustrate positive patient safety measures that can be initiated to decrease adverse outcomes and reduced risk to an organization. The dramatic reduction in adverse outcomes and claims after the introduction of patient safety initiatives in a major obstetrical service will be reviewed.
Five-Year Outcomes of Ultrathin Descemet Stripping Automated Endothelial Keratoplasty
Authors: Madi Silvana , Leon Pia , Nahum Yoav , D'Angelo Sergio , Giannaccare Giuseppe , Beltz Jacqueline , Busin Massimo
Published: June 2019

Purpose:

To report 5-year outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) with a central graft thickness intended to be <100 μm.

Methods:

This retrospective, consecutive, interventional case series included 354 eyes with endothelial decompensation due to various causes (Fuchs endothelial dystrophy, pseudophakic or aphakic bullous keratopathy, failed previous graft, herpetic endothelitis, or buphthalmos). Donor tissue was prepared using the microkeratome-assisted double-pass technique aiming at a graft thickness <100 μm. The Descemet membrane was stripped under air. The graft was delivered into the anterior chamber using the pull-through technique through a 3.2-mm clear corneal incision using a modified Busin glide. The best spectacle-corrected visual acuity (BSCVA), endothelial cell loss, graft survival rates, and immunologic rejection rates were evaluated.

Results:

Follow-up data at 1, 2, 3, and 5 years after UT-DSAEK were collected from 214, 172, 147, and 105 eyes, respectively. After excluding eyes with comorbidities, BSCVA better than or equal to  20/20 was recorded in 36.3%, 37.4%, 46.4%, and 53.4% of eyes, respectively, whereas BSCVA better than or equal to 20/40 was documented in 95.5%, 95.3%, 96.0%, and 96.6% of eyes, respectively. The mean endothelial cell loss was 35.4%, 42.3%, 43.3%, and 52.3%; Kaplan–Meier graft survival probability was 99.1%, 96.2%, 94.2%, and 94.2%, and Kaplan–Meier cumulative probability of a rejection episode was 3.4%, 4.3%, 5%, and 6.9% at 1, 2, 3, and 5 years, respectively.

Conclusions:

UT-DSAEK grafts allow excellent 5-year outcomes, including BSCVA, endothelial cell density, and survival rates comparable with those recorded post-Descemet membrane endothelial keratoplasty, but with a higher immunologic rejection rate.
Analysis of Intrasession Repeatability of Ocular Aberrometric Measurements and Validation of Keratometry Provided by a New Integrated System in Mild to Moderate Keratoconus
Authors: Piñero David P. , Soto-Negro Roberto , Ruiz-Fortes Pedro , Pérez-Cambrodí Rafael J. , Fukumitsu Hideki
Published: June 2019

Purpose:

To evaluate the intrasession repeatability and validity of corneal curvature measurements provided by a new multifunctional device and to assess the intrasession repeatability of its ocular aberrometric measures.

Methods:

This prospective study comprises 37 mild to moderate keratoconus eyes of 37 patients. In all cases, 3 repeated measures of corneal topography and ocular aberrometry were performed with the iDesign 2 system (iD2; Johnson & Johnson Vision Care Inc, Jacksonville, FL) and one keratometric measurement was performed with the intraocular lens-(IOL) Master 500 (Carl Zeiss Meditec Inc, Dublin, CA) and Sirius (CSO) (SIR) systems.

Results:

The within-subject SD (Sw) was <0.50 D for all iD2 keratometric measurements, with intraclass correlation coefficient (ICC) >0.980. Sw and ICC for the keratometric axis were 2.60 degrees and 0.992, respectively. Concerning aberrations, all Sw values for high-order Zernike terms were ≤0.11 μm (ICC > 0.900), and all Sw values for refraction data were <0.75 D (ICC > 0.95), except for J45. No statistically significant differences were found between the devices in any keratometric parameter evaluated (P ≥ 0.222), but the limits of agreement between the devices were clinically relevant. The magnitude of K readings and astigmatism correlated significantly with the difference in these parameters between iD2 and SIR (0.432 ≤ r ≤ 0.489, P ≤ 0.041).

Conclusions:

The iD2 system provides consistent measures of keratometry and ocular aberrometry in eyes with mild to moderate keratoconus. Keratometric data obtained with this system in these eyes cannot be considered as interchangeable with data provided by intraocular lens-Master 500 and SIR.
Gonioscopy-assisted Transluminal Trabeculotomy (GATT) is An Effective Procedure for Steroid-induced Glaucoma
Authors: Boese Erin A. , Shah Manjool
Published: June 2019

Precis:

Gonioscopy-assisted transluminal trabeculotomy (GATT) is a novel technique that lowers intraocular pressure (IOP) by fracturing the trabecular meshwork. In this retrospective chart review, GATT was found to be effective at lowering the intraocular pressure for steroid-induced glaucoma (SIG).

Purpose:

GATT is a novel microinvasive glaucoma surgery that builds on traditional trabeculotomy techniques to decrease the proximal resistance of conventional outflow, and it is proposed to be an effective surgical treatment for SIG. The purpose of this study is to evaluate the efficacy of GATT for lowering the IOP in SIG.

Methods and Patients:

A retrospective chart review was performed of all GATT procedures performed on patients with a predominant diagnosis of steroid-induced glaucoma between March 1, 2016 and March 30,2018 at the University of Michigan. Primary outcome measures include IOP, the number of IOP-lowering medications prescribed, and the topical steroid dosing over the duration of follow-up.

Results:

A total of 13 patients with steroid-induced glaucoma underwent the GATT procedure. There was a significant reduction in the mean IOP at all postoperative visits. The average IOP decreased by 16.4 (55%) to 19.5 mm Hg (63%) between 3 and 24 months postoperatively. By 24 months, all patients had a reduction in IOP of >20%. The number of glaucoma medications also decreased significantly from an average of 3.1 medications preoperatively to an average of 0.8 medications at last follow-up. The majority of patients (>67%) required continued use of steroids at all postoperative visits. The most common postoperative complication was a transient hyphema (38%). No patients required a repeat glaucoma surgery or anterior chamber washout.

Conclusions:

This small case series suggests that GATT is an effective and safe surgical technique to decrease IOP and decrease medication burden in patients with predominantly steroid-induced glaucoma. To our knowledge, this is the first study looking specifically at the efficacy of GATT for predominantly SIG.
A systematic review of questionnaires on itch by the Special Interest Group “Questionnaires” of the International Forum for the Study of Itch (IFSI)
Authors: Dominick Friederike , van Laarhoven Antoinette I.M. , Evers Andrea W.M. , Weisshaar Elke
Published: June 2019

Introduction:

Itch can be perceived differently across patients and it can affect daily life in various ways. It is essential to assess those aspects that are relevant for the individual patient’s needs to improve treatment of patients suffering from acute or chronic itch. The International Forum for the Study on Itch (IFSI) Special Interest Group on “Questionnaires” aims to propose tools to assess different dimensions of itch and improve patient care. As a first step, this study aimed at a systematically reviewing existing patients’ self-report questionnaires on itch.

Materials and methods:

The databases PubMed, PsycINFO, and CINAHL were systematically searched for any scientific publication describing patients’ self-report questionnaires that assess itch-related information (≥2 items). Information about the publication was extracted by 2 experts as well as which of the 14 predefined dimensions of itch (by the IFSI Special Interest Group) were assessed within the questionnaire, for instance, duration of itch, itch aggravating or relieving factors, and effects on quality of life.

Results:

From a total of 5282 records, 58 articles were derived describing 62 questionnaires. Over half of the questionnaires were developed for dermatological conditions, and the vast majority targeted at adults. Most questionnaires address itch-related disability and itch intensity. Affective qualities of itch, coping with itch, response to current itch treatment, and the opinion on the origin of itch are infrequently asked for.

Discussion:

The number and content of the items within a dimension vary greatly. Measurement properties of the questionnaires were not systematically addressed, as these were often not reported in the original publication. Future research should focus on selecting adequate and reliable (sub)scales to develop a modular questionnaire system in order to uniformly assess the individual patient’s demands and improve care.
Efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE) combined with radiofrequency ablation versus DEB-TACE alone in Chinese hepatocellular carcinoma patients
Authors: Zhu Dedong , Yuan Denggao , Wang Zhe , Chen Sihan
Published: June 2019

To compare the efficacy of drug-eluting bead transarterial chemoembolization combined with radiofrequency ablation (DEB-TACE+RFA) versus DEB-TACE alone in Chinese hepatocellular carcinoma (HCC) patients.

The 28 patients receiving DEB-TACE+RFA and 74 HCC patients receiving DEB-TACE were recruited in this study. Treatment responses, progression-free survival (PFS), and overall survival (OS) were evaluated.

One to 3 months after treatments, the proportion of patients achieving complete response (CR) (78.6% vs 33.8%, P <.001) and objective response rate (ORR) (92.9% vs 78.4%, P =.010) were elevated in DEB-TACE+RFA group compared with DEB-TACE group. Multivariate logistic regression displayed that DEB-TACE+RFA was an independently predicting factor for better CR (P = .006). Subgroup analysis of CR achievement illuminated that DEB-TACE+RFA disclosed better CR achievement in patients with history of cirrhosis (P <.001), tumor located in right liver (P = .003), bilobar disease (P = .013), tumor size <3.3 cm (P = .001), no portal vein invasion (P = .001), no hepatic vein invasion (P <.001), Child-pugh stage A (P <.001), Barcelona Clinic Liver Cancer (BCLC) stage 0, A-B (P <.001), abnormal alpha-fetoprotein (AFP) (P = .001) and normal AFP (P = .016). The PFSs were similar between 2 groups (P = .112), however, the OS was more prolonged in DEB-TACE+RFA group (P = .025) compared with DEB-TACE group. And subgroup analysis displayed that PFS of patients with largest nodule size >3.3 cm (P = .025) was longer and patients with unilobar disease (P = .009), and patients with no hepatic invasion (P = .019) and Child-pugh stage A (P = .037) had more favorable OS in DEB-TACE+RFA group compared with DEB-TACE group.

DEB-TACE+RFA achieved better treatment responses and OS compared with DEB-TACE alone in Chinese HCC patients.
Cobra-PLA provides higher oropharyngeal leak pressure than LMA-Classic and LMA-Unique
Authors: Tan Yuan , Duan Guangyou , Chen Qin , Chen Feng , Li Hong
Published: June 2019

Cobra Perilaryngeal Airway (Cobra-PLA) is a relatively new single-use supraglottic device employed during general anesthesia. This meta-analysis includes randomized controlled trials (RCTs) yielding extensive comparison results among Cobra-PLA, Laryngeal Mask Airway (LMA)-Classic, and LMA-Unique.

Two authors performed searches in EMBASE, CENTRAL, PubMed, and ScienceDirect to identify RCTs that compared Cobra-PLA with LMA-Classic and with LMA-Unique in patients undergoing general anesthesia. Both random- and fixed-effects models were used. Begg's funnel plot was used to evaluate publication bias.

Twenty-two RCTs with a total of 1845 patients were included. Cobra-PLA offered significantly higher oropharyngeal leak pressure than LMA-Classic [mean difference (MD) = 3.56 (1.56, 5.55), P = .0005] and LMA-Unique [MD = 4.44 (2.12, 6.76), P = .0002]. First-insertion success rate, ease of insertion, insertion time, and reported complications among Cobra-PLA, LMA-Classic, and LMA-Unique were similar.

Compared with the commonly used LMA-Classic and LMA-Unique, Cobra-PLA provides superior airway sealing.