bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease
Authors: De Kock Isabelle , Delrue Louke , Lecluyse Clarisse , Hindryckx Pieter , De Vos Martine , Villeirs Geert
Published: September 2018

Background

Assessment of Crohn’s disease (CD) activity is important to identify patients with active inflammation for therapy management. Quantitative analysis can provide objective measurement of disease presence.

Purpose

To evaluate the feasibility of quantitative analysis of contrast-enhanced dual-energy computed tomography (DECT) data in detection of small bowel inflammation in patients with CD with an emphasis on iodine quantification.

Material and Methods

DECT enterography was prospectively performed in 20 patients with active CD and in 20 healthy individuals, as the control group. Iodine overlay images were created. Wall thickness, attenuation, absolute iodine density, relative iodine density, and fat fraction were measured in the terminal ileum of all patients by two radiologists. Intraclass correlation coefficients were calculated to assess inter-rater agreement. Parameters were compared between patient groups using mixed model analysis. Receiver operating characteristic (ROC) analysis was performed.

Results

Both absolute and relative iodine density were significantly higher in active disease than in normal small bowel (all P < 0.001). In contrast, measurement of fat fraction was not significantly different in affected terminal ileal loops compared to normal terminal ileum ( P = 0.075). ROC analysis demonstrated a similar excellent diagnostic accuracy of wall thickness, attenuation, and absolute and relative iodine density with area under the ROC curve (AUC) values in the range of 0.96 for attenuation to 1 for relative iodine density.

Conclusion

DECT with iodine quantification can be used in distinguishing normal small bowel from active inflammatory CD. Further research should investigate the value of iodine quantification in grading CD activity and in monitoring therapeutic response.
Arterial blood gas changes during cardiac arrest and cardiopulmonary resuscitation combined with passive oxygenation/ventilation: a METI HPS study
Authors: Strnad Matej , Lešnik Damjan , Križmarić Miljenko
Published: September 2018

Objective

High-fidelity simulators can simulate physiological responses to medical interventions. The dynamics of the partial arterial pressure of oxygen (PaO2), partial arterial pressure of carbon dioxide (PaCO2), and oxygen pulse saturation (SpO2) during simulated cardiopulmonary resuscitation (CPR) were observed and compared with the results from the literature.

Methods

Three periods of cardiac arrest were simulated using the METI Human Patient Simulator™ (Medical Education Technologies, Inc., Sarasota, FL, USA): cardiac arrest, chest compression-only CPR, and chest compression-only CPR with continuous flow insufflation of oxygen (CFIO).

Results

In the first period, the observed values remained constant. In the second period, PaCO2 started to rise and peaked at 63.5 mmHg. In the CFIO period, PaCO2 slightly fell. PaO2 and SpO2 declined only in the second period, reaching their lowest values of 44 mmHg and 70%, respectively. In the CFIO period, PaO2 began to rise and peaked at 614 mmHg. SpO2 exceeded 94% after 2 minutes of CFIO.

Conclusions

The METI Human Patient Simulator™ accurately simulated the dynamics of changes in PaCO2. Use of this METI oxygenation model has some limitations because the simulated levels of PaO2 and SpO2 during cardiac arrest correlate poorly with the results from published studies.
Extensive intraperitoneal lavage to eliminate intraperitoneal tumor cells in gastrectomy with D2 lymphadenectomy for gastric cancer
Authors: Ronellenfitsch Ulrich , Ernst Kristina , Mertens Christina , Trunk Marcus J. , Ströbel Philipp , Marx Alexander , Kienle Peter , Post Stefan , Nowak Kai
Published: September 2018

Introduction:

Survival in gastric cancer is often limited by peritoneal carcinomatosis, which supposedly develops from serosal tumor infiltration or tumor cell spread during gastrectomy with lymphadenectomy. To eliminate peritoneal tumor cells, extensive intraperitoneal lavage (EIPL) has been suggested. Impressive results have been achieved in Japanese trials. In this trial, we assessed EIPL in Western patients.

Methods:

This prospective trial included patients with non-metastatic gastric adenocarcinoma undergoing gastrectomy with D2 lymphadenectomy. Peritoneal fluid samples at laparotomy, after lymphadenectomy, and after EIPL were analyzed for tumor cells using cytology and EpCAM antibodies. The primary endpoint was peritoneal conversion rate (PCR; proportion of patients in whom EIPL eliminated tumor cells after lymphadenectomy). Secondary endpoints were peritoneal release rate (PRR; proportion of patients with peritoneal tumor cells after gastrectomy/lymphadenectomy among all patients without cells before gastrectomy/lymphadenectomy) and prevalence of peritoneal tumor cells before resection. EIPL was considered ineffective if PCR ⩽ 0.2 and warranted further exploration if PCR ⩾ 0.5. Clinicaltrials.gov identifier is NCT01476553.

Results:

The trial was stopped early because tumor cells after gastrectomy/lymphadenectomy were detected in only 3/27 (11.1%) patients. In none of these did EIPL eliminate tumor cells (PCR 0, 95% confidence interval [CI] 0%–12.5%). In 8/27 (29.6%) patients, tumor cells were detected after EIPL. PRR was 11.1% (95% CI 2.4%–29.2%). There were no perioperative complications higher than Clavien-Dindo grade 3a.

Conclusions:

In Western patients, free peritoneal tumor cells after gastrectomy with D2 lymphadenectomy for gastric cancer were detected only sporadically. Although based on few cases, the findings suggest that EIPL spreads tumor cells into the peritoneal cavity, thus being potentially harmful. Therefore, EIPL cannot be generally recommended.
Lisbon in the sixteenth century: decoding the Chafariz d’el Rei
Authors: Halikowski Smith Stefan
Published: September 2018

An anonymous sixteenth-century painting of the King’s Fountain in the Lisbon Alfama, Chafariz d’el Rei, recently the subject of speculation over its provenance and date, has also been of interest because of its depiction of so many black and white figures together, from all social strata and walks of life and in many (often water-related) trades in a public square. It very obviously suggests that black residents of Lisbon at that time, if originating from the trade in slaves, had been able to make their way as freedmen and women into Portuguese society. With careful reading of the figures in the painting against other written and painted portrayals from the time, the author attempts to deduce if this was an accurate depiction of Lisbon in the 1500s, or whether the painter might have distorted reality to render Lisbon as a ludic or exotic space – or indeed to disparage it. The painter himself might well have come from northern Europe.
Dielectric relaxation behavior of three-phase MWCNTs-PANI polystyrene nanocomposites
Authors: Farrag Emad AM
Published: September 2018

Polymer nanocomposites consisting of multiwalled carbon nanotubes (MWCNTs), polyaniline (PANI), and polystyrene (PS) were prepared at different MWCNT weight ratios and fixed amount of PANI (0.2 wt%). Impedance, dielectric constant, dielectric loss, and electrical conductivity for these composites were investigated as a function of applied field and MWCNTs content at room temperature. Obtained results indicated that adding 0.2 wt% PANI polymer to MWCNTs-PS system will enhance electrical conductivity and polar character while reduce the percolation threshold from 0.8% to 0.2% MWCNTs of nanocomposites. Relaxation behavior of prepared nanocomposites showed interesting results. In general, impedance results showed that all samples contain capacitor and resistor elements. Increasing of MWCNTs amount will reduce the distance between CNTs–CNTs in the CNTs–polymer network, and the resistor element become more pronounced. Moreover, at high level of MWCNTs content the relaxation behavior is mostly due to conductivity relaxation with single value of relaxation time. The addition of PANI (0.2% PANI) to CNT–polymer or CNT–CNT networks will introduce easy pathway for carriers to transfer through network leading to increase the electrical conduction for composites. Relaxation results indicated that the relaxation behavior of prepared nanocomposite is mostly due to conductivity relaxation above 0.2 wt% nanocomposite.
Children’s reconstruction of psychological knowledge: An ethnographic study of life skills education programmes in India
Authors: Maithreyi R
Published: September 2018

Despite calls for examining children’s lives relationally, dominant accounts view childhood as biologically, culturally or economically determined. Based on ethnographic observations of children’s life skills education programmes in Bangalore, this article shows how poor and marginalised children reposition themselves as ‘better educated’ and successful compared to peers, while a global network of professionals position them as ‘at-risk’, seeking to intervene in their lives. This article draws attention to how children can be seen as ‘strategically opportunising actors’, who creatively seek to make meaning of their lives despite structural and discursive constraints placed upon them.
Women’s Experiences Following Mastectomy: Loss, Grief, and Meaning-Reconstruction
Authors: Gershfeld-Litvin Avital
Published: September 2018

The purpose of the study is to explore women’s experiences following mastectomy, from a perspective of loss and grief. Eighteen women (age 26–80 years) who had undergone mastectomies were interviewed. Half of the participants choose immediate breast reconstruction. The interviews were thematically analyzed based on Denzin’s interpretive interactionism approach. The findings show that the women’s experiences can be divided into three central themes: diagnosis, mastectomy, and living without breasts. Mastectomy was perceived as a lifesaving procedure in light of their cancer diagnoses, making it difficult for women to acknowledge the loss of their breasts and to allow themselves to feel grief. They used meaning-reconstruction processes to reduce the importance that they attributed to their breasts, or placed them in a negative context in order to minimize the significance of their loss and avoid postmastectomy grief. Women who choose immediate reconstruction did so in an attempt to escape the loss, and any feelings of postmastectomy grief were reconstructed as depression. The study highlights meaning-reconstruction processes in light of social constructs, as women attempt to reconstruct their bodies and their identities. Breast loss following mastectomy is experienced as disenfranchised grief because the loss is ambiguous, especially for women who had breast reconstructions. Implications for psychosocial providers is as follows: Acknowledging loss is essential in order to experience grief and should be the focus of therapy and counseling for women coping with breast cancer.
The Lived Experiences of Adolescents With Cancer: A Phenomenological Study
Authors: Chien Ching-Hui , Chang Yung-Ying , Huang Xuan-Yi
Published: September 2018

This descriptive phenomenological study was conducted to explore the lived experiences of adolescents with cancer. Purposive sampling was used to recruit participants. In-depth, nonstructured interviews were conducted to collect data, and narratives were analyzed using Colaizzi’s seven-step method. Data saturation was achieved after interviewing 16 participants. The study was divided into three main themes and 16 subthemes: suffering (caused by symptoms, therapy, cancer recurrence, the feeling of being trapped in hospital, the burden of food therapy, delayed education, the absence of peer relationships, and limited activities), emotional reactions (fear, worry, sadness, anger, and loneliness), and rebalancing (strong family relationships, optimistic thinking, and healthy lifestyles). While adolescents with cancer experience changes in lifestyle, and physical, psychological, and social burden, they also have positive life experiences. Building appropriate learning systems, improving communication skill, and providing appropriate food therapy may alleviate the psychological burden experienced by young patients.
Emotionally Focused Therapy in the Context of Addictions
Authors: Fletcher Kara , MacIntosh Heather
Published: September 2018

Substance addictions represent a serious social problem in North America, negatively impacting family relationships and couple functioning. Research is increasingly considering the potential for couple therapy as a model within this context. Issues presented by an addiction can be exacerbated by other issues present in a couple relationship. Using a case study design, this research study explored a proposed theoretical extension of emotionally focused couple therapy (EFT) in the context of substance addictions. Four couples were recruited, and an analysis of the therapeutic process and their experiences is presented. Comparisons between the normative EFT treatment model and the theoretical extension are made and recommendations are provided for further adaptations to the model. Results from this study indicate the important place of couple therapy in addiction treatment.
Effective Low-Intensity Strategies to Enhance School Success: What Every Educator Needs to Know
Authors: Lane Kathleen Lynne , Menzies Holly M. , Ennis Robin Parks , Oakes Wendy Peia
Published: September 2018

We developed this special issue, Effective Low-Intensity Strategies to Enhance School Success: What Every Educator Needs to Know, for Beyond Behavior as a resource for educators and parents. Each article provides easy-to-access resources for readers to learn about effective, efficient, low-intensity strategies to support student engagement and limit challenging behavior. In this introductory article, we provide a rationale for focusing on these low-intensity strategies and an overview of the features of each article to follow.
Thiotepa-induced cutaneous toxicity in pediatric patients: Case report and implementation of preventive care guidelines
Authors: Van Schandevyl Guy , Bauters Tiene
Published: September 2018

Thiotepa, a highly lipophilic, alkylating agent, and/or its active metabolites may be excreted in part via skin in patients receiving high-dose therapy. We present a case of cutaneous toxicity observed in a 4.5-year-old girl patient with medulloblastoma treated with a high-dose thiotepa conditioning regimen before autologous stem cell transplantation. Skin lesions, as well as their pattern and locations, were evocative of thiotepa toxidermia. After the case herein described, preventive care guidelines were implemented in our unit as from 2014. A retrospective follow-up of 26 pediatric patients receiving thiotepa prior to stem cell transplantation was performed until March 2018. In this series of patients, only one patient experienced cutaneous toxicity as reported herein. Thereafter, only mild cutaneous toxicity was observed, even with double or triple transplantation protocols with high-dose thiotepa. Clear preventive care instructions should be detailed in the Summary of Product Characteristics in order to minimize the cutaneous toxicity of thiotepa.
Transparent, Translucent, Opaque: Exploring the Dimensions of Power in Culturally Responsive Evaluation Contexts
Authors: Stickl Haugen Jaimie , Chouinard Jill Anne
Published: September 2018

The concept of power is a complex and often intangible aspect of the evaluation process that is frequently a focal topic among the conceptual evaluation literature concerning collaborative or culturally responsive evaluation (CRE) contexts. Unfortunately, there remains a significant theory to practice gap as power is often rarely addressed or specifically identified in empirical practice. In the current article, the authors provide a comprehensive review of the empirical literature on CREs, with an emphasis on the manifestation of power in practice. The analysis of the literature selected for review leads to the development of a conceptual framework, which identifies intersecting power dynamics across the relational, political, discursive, and historical/temporal dimensions. The authors conclude with a research synthesis and implications for practice, including a discussion of practical ways that evaluators can begin with considerations of power rather than reflecting on the concept retrospectively.
Generally cylindrical orthotropic constitutive modeling of matrix-filled carbon nanotubes: Transverse mechanical properties and responses
Authors: Askari Davood , Ghasemi-Nejhad Mehrdad N.
Published: September 2018

The main objective of this article is to introduce exact analytical closed-form solutions for the prediction of effective transverse Young’s modulus and Poisson ratio of a matrix-filled nanotube (i.e., a representative element of nanotube-based nanocomposites), as well as its mechanical behavior, when subjected to external loads. In this work, both the nanotube and its filler were considered to be generally cylindrical orthotropic. To ensure no loss of generality, the no plane strain condition was used, and the axial strain was taken into consideration to obtain a more precise set of solutions. Analytical formulae were developed based on the well-established principles of linear elasticity and continuum mechanics, considering effective orthotropic properties for both constituents as continuum tubes. To validate and verify the accuracy of the closed-form solutions obtained from the analytical approach, a three-dimensional finite element analysis was performed, and results were compared to those obtained from the analytical exact solutions. Excellent agreement was achieved, and the analytically obtained solutions were verified.
The Pediatric Personal Care Allocation Model for Home Care (PCAM): A Personal Care Case-Mix Model for Children Facing Special Health Care Challenges
Authors: Phillips Charles D
Published: September 2018

Background:

State Medicaid programs in the United States provide services to children with special health care challenges through the Early Prevention, Screening, Diagnostic, and Treatment program. One element of the services provided is Medicaid Personal Care Services (PCS), which are intended to correct or ameliorate any functional impairments faced by a child or youth (C/Y) in the community. Previous research indicates that considerable variation in the allocation of PCS depends on the assessor. A case-mix model is developed that might make the distribution of such services more uniform and equitable.

Data:

The sample in this research includes 2708 C/Y aged 4 to 20 who were receiving PCS in Texas in 2008.

Results:

A case-mix model was developed that groups sample members into 33 categories based on the number of hours of PCS authorized by an assessor. The Pediatric Personal Care Allocation Model (PCAM) explains 27% of the variance in the allocation of PCS hours.

Discussion:

The implementation of the PCAM should provide guidance to assist in ensuring that C/Y facing similar functional challenges receive similar levels of PCS. However, implementation of any case-mix model is only a first step in moving to a prospective payment system for PCS.
Wound Closure after Thyroid and Parathyroid Surgery: A Meta-Analysis of Randomized Controlled Trials
Authors: Huang Y.-H. , Chen C. , Lee C.-H. , Loh E.-W. , Tam K.-W.
Published: September 2018

Aims:

Wound closure after thyroidectomy and parathyroidectomy is associated with patients’ satisfaction, perception of cosmetic appearance, and experience of postoperative pain. Subcutaneous sutures, clips, and tissue adhesive are the three major methods of wound closure. In this study, we conducted a meta-analysis of randomized controlled trials to evaluate the outcomes of these methods.

Methods:

Relevant studies published before December 2017 were identified from PubMed, Embase, Cochrane Library, Scopus, and the ClinicalTrials.gov registry. Individual effect sizes were standardized, and a meta-analysis was conducted to calculate the pooled effect size by using random-effect models. The primary outcome was the cosmetic appearance, which was evaluated 4 weeks, 6 weeks, and 6 months after surgery. The secondary outcomes were patient satisfaction, postoperative pain, and complications.

Results:

A total of nine trials with 612 patients were reviewed. No significant difference was observed in patient satisfaction, postoperative pain, and complications among the wound closure methods. However, according to surgeon assessment, the subcutaneous suture method resulted in a significantly more favorable cosmetic appearance than the clip method (mean difference: −1.47, 95% confidence interval: −2.72 to −0.23).

Conclusion:

In the current study, no differences were found in patient satisfaction and postoperative pain among the subcutaneous suture, clip, and tissue adhesive wound closure methods. However, surgeons provided a more favorable appraisal for the subcutaneous suture method because of the improved cosmetic appearance. The choice of the closure method should be based on surgeon’s preference and cost.
Functional Outcome After Lower Extremity Soft Tissue Sarcoma Treatment: A Pilot Study Based on Translated and Culturally Adapted Measures
Authors: Kask G. , Barner-Rasmussen I. , Repo J. , Blomqvist C. , Tukiainen E.
Published: September 2018

Background and Aims:

The present standard of care in treating lower extremity soft tissue sarcomas is function-sparing, limb-preserving resection and reconstruction with or without oncological therapy. The aim of this pilot study was to test the suitability and adequacy of the Finnish translations of two functional outcome questionnaires (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society score) and to perform a preliminary investigation of functional outcomes of Finnish lower-limb soft tissue sarcoma patients after operative treatment.

Materials and Methods:

Between June 2015 and December 2015, consecutive surgically treated outpatients were asked to participate in the study. Demographic, clinical, surgical, and oncological outcome data were collected. Two functional outcome questionnaires were used (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores). A comparative analysis is presented.

Results:

A total of 19 lower-limb soft tissue sarcoma patients with a mean follow-up time of 2 years and 10 months were included. All (n = 19) invited patients participated in the study. Mean age was 62.3 years. In total, 13 had high-grade sarcomas. Eight wounds were closed directly, four used skin grafts, and five required flap reconstructions. One patient required a tumor prosthesis, and one required a rotationplasty. A total of 14 patients received oncological therapy. No problems or difficulties were reported in using and completing the Finnish versions of the Toronto Extremity Salvage Score or Musculoskeletal Tumor Society questionnaires. The overall Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores were 88 and 76, respectively.

Conclusion:

This pilot study suggests that the Finnish versions of the Toronto Extremity Salvage Score and Musculoskeletal Tumor Society questionnaires are suitable for measuring functional outcome after lower extremity soft tissue sarcomas treatment. Functional outcomes vary from moderate to excellent.
Conceptually confused, but on a field level? A method for conceptual analysis and its application
Authors: Tähtinen Jaana , Havila Virpi
Published: September 2018

This article develops and applies a conceptual analysis method (CAM). The CAM is a critical reflection on multiple definitions and descriptions of concepts and terms all used to refer to a phenomenon or the experiences of it. The method particularly helps researchers working in emerging research fields to discover any conceptual confusion and elucidate multiple terms and concepts. We demonstrate the utility of the CAM by discovering conceptual confusion on an example field: business relationship uncoupling, and elucidating its terms and concepts. This article adds to the discussion on the importance of conscious conceptual language for theory development, on the level of a research field.
Marketing’s metaphors have expired: An argument for a new dominant metaphor
Authors: Delbaere Marjorie , Slobodzian Adam D.
Published: September 2018

The discipline of marketing uses many metaphors. Historically, the dominant metaphors in marketing strategy have been adapted from warfare and military science. The purpose of this conceptual article is to analyze and evaluate commonly used warfare metaphors in marketing strategy. A cross-domain comparison of these metaphors and conceptualizations of war are assessed to determine whether they are still appropriate in light of the advancements in both military science and marketing theory. The analysis found that there are many fundamental and questionable differences between these two domains; therefore, a new conceptual metaphor for marketing strategy is proposed.
The Demand for English Premier League Soccer Betting
Authors: Deutscher Christian , Ötting Marius , Schneemann Sandra , Scholten Hendrik
Published: September 2018

Betting markets have grown considerably lately. Despite their impact on the economic importance of professional sports, they just received academic interest recently. This article determines factors affecting the amount of money bet as well as the number of matched bets placed on the largest European soccer league, namely, the English Premier League between 2009-2010 and 2015-2016. Data from the betting exchange Betfair suggest season progress, weekday, number of substitutes, both teams market values, as well as uncertainty of outcome to determine market transactions and, hence, the economic importance.
Basilar Thumb Arthritis: The Utility of Suture-Button Suspensionplasty
Authors: DeGeorge Brent R. , Chawla Sagar S. , Elhassan Bassem T. , Kakar Sanjeev
Published: September 2018

Background: We sought to compare the functional outcomes, radiographic outcomes, and complications of trapeziectomy and flexor carpi radialis (FCR) to abductor pollicis longus (APL) side-to-side tendon transfer with or without suture-button suspensionplasty for thumb basilar joint arthritis. Methods: Patients treated with and without suture-button suspensionplasty were compared over a 6-year period. Data were reviewed for complications and functional outcomes, including grip and pinch strength, range of motion, and visual analog scale (VAS) pain scores. Plain radiographs were independently reviewed at initial presentation and at final follow-up, including proximal phalanx length, trapezial space height, and trapezial height ratio. Results: Seventy thumb arthroplasties were performed in 70 patients. Trapeziectomy with FCR-APL side-to-side tendon transfer was performed in 39 patients, and trapeziectomy with FCR-APL side-to-side tendon transfer with suture-button suspensionplasty was performed in 31 patients. Mean length of follow-up was 28.4 ± 3.9 and 23.8 ± 2.6 months, respectively. Postoperative grip, oppositional and appositional pinch strength, and VAS pain scores improved compared with preoperative values, but were not significantly different based on suture-button suspensionplasty. Percentage decline in trapezial space ratio was significantly different between groups at 36.7% and 20.4% for procedures with and without suture-button suspensionplasty, respectively indicating that the trapezial space was better maintained within the suture suspension cohort. The incidence of postoperative complications, including surgical site infection, paresthesias, reoperation, complex regional pain syndrome, and symptomatic subsidence, was not significantly different between groups. Conclusions: Trapeziectomy with FCR to APL side-to-side tendon transfer with and without suture-button suspensionplasty results in comparable improvement in pain, grip strength, and functional parameters. Suture-button suspensionplasty results in significantly greater preservation of trapezial space.
Impact of Casting and Splinting Manipulations on Below-Dressing Pressures: An Experimental Model
Authors: Adapa Nikhil , Goyal Kanu S.
Published: September 2018

Background: We tested how different applications of casts and splints affect underlying below-dressing pressures and how these dressings respond to swelling. Methods: A 3-in polyvinyl chloride pipe with an attached 100 mL saline bag to the outer surface was used to simulate a human forearm. A pressure transducer was attached to the bag and connected to a monitor providing continuous pressure measurements. Either a circumferential fiberglass cast or single-sided plaster splint was applied around the bag. To simulate the dressing’s compliance to soft tissue swelling, change in pressure was measured after 25 mL of saline was injected into the bag. Compliance was determined by calculating change in volume over change in pressure as volume was added. Results: In our 150 mL model, cast bivalving reduced pressure up to 28%, and splitting the cotton padding of a splint reduced pressures up to 33%. The mean compliance (ability to accommodate swelling) across all volume intervals was 182% greater in a bivalved cast versus a cast and 21% greater in a cotton-split splint versus a splint. Below-dressing pressure of a tightly wrapped elastic bandage was up to 2.76× greater than a medium tension bandage and up to 6.44× greater than a loosely applied bandage. A splint with real cotton padding had a 28% greater pressure than a splint with synthetic soft-roll padding. Conclusions: Splitting a dressing, utilizing synthetic cotton padding, and applying an elastic bandage cautiously can help reduce surface pressures and allow the construct to be more accommodating to soft tissue swelling.
A decoupling algorithm with first-order asymptotic integration for reliability-based design optimization
Authors: Huang Zhiliang , Yang Tongguang , Li Fangyi
Published: September 2018

Conventional decoupling approaches usually employ first-order reliability method to deal with probabilistic constraints in a reliability-based design optimization problem. In first-order reliability method, constraint functions are transformed into a standard normal space. Extra non-linearity introduced by the non-normal-to-normal transformation may increase the error in reliability analysis and then result in the reliability-based design optimization analysis with insufficient accuracy. In this article, a decoupling approach is proposed to provide an alternative tool for the reliability-based design optimization problems. To improve accuracy, the reliability analysis is performed by first-order asymptotic integration method without any extra non-linearity transformation. To achieve high efficiency, an approximate technique of reliability analysis is given to avoid calculating time-consuming performance function. Two numerical examples and an application of practical laptop structural design are presented to validate the effectiveness of the proposed approach.
A systematic review of obesity interventions targeting anthropometric changes in youth with intellectual disabilities
Authors: Conrad Eric , Knowlden Adam P
Published: September 2018

Due to the increased prevalence of obesity and disparity experienced by youth with intellectual disabilities, efforts to synthesize existing knowledge of interventions to attenuate obesity within this marginalized population is imperative. The purpose of this investigation is to systematically analyze interventions targeting anthropometric changes in youth with intellectual disabilities. A search of Cumulative Index of Nursing and Allied Health Literature, Educational Resources Information Center, Medical Literature Analysis and Retrieval System Online, and Psychological Information Database was conducted for the time frame of January 2006 to October 2016. Data extraction resulted in a total of 10 interventions that met inclusion criteria. Included studies mainly comprised participants having mild-to-moderate intellectual disability with diverse comorbidities. Five studies indicated significant positive outcomes in at least one anthropometric measure. The majority of programs utilized physical activity targeting individual-level change as the primary intervention modality. Weaknesses of the reviewed studies and inconclusive evidence indicate the need for additional research to gauge the effectiveness of interventions to treat obesity among youth with intellectual disabilities.
Factors that may contribute to poor outcome despite good reperfusion after acute endovascular stroke therapy
Authors: Rabinstein Alejandro A , Albers Gregory W , Brinjikji Waleed , Koch Sebastian
Published: September 2018

Endovascular therapy with mechanical thrombectomy is a formidable treatment for severe acute ischemic stroke caused by occlusion of a proximal intracranial artery. Its strong beneficial effect is explained by the high rates of very good and excellent reperfusion achieved with current endovascular techniques. However, there is a sizable proportion of patients who do not experience clinical improvement despite successful recanalization of the occluded artery and reperfusion of the ischemic territory. Factors such as baseline reserve, collateral flow, anesthesia and systemic factors have been identified as potential culprits for lack of improvement in the setting of timely and successful revascularization. Older age, baseline disability and perhaps radiological markers of chronic brain injury can affect the prognosis of patients treated with endovascular therapy. Collateral flow is a major determinant of outcome after endovascular therapy and it is manifested by the size of the core in relation to the volume of the salvageable tissue. Parenchymal and vascular imaging can help assess the quality of collateral flow, but the optimal radiological strategy for daily practice (i.e. the optimal combination of rapid availability and diagnostic precision) has not been established. A sizable body of observational evidence indicates that acute hypertension, hyperglycemia and fever are associated with worse outcomes after a stroke even after optimal reperfusion with endovascular therapy. Lastly, current randomized controlled trials in anesthesia for stroke demonstrate similar rates of good functional outcome between general anesthesia and conscious sedation suggesting equipoise exists.
The Actress-Manager and the Movies: Resolving the Double Life of Sarah Bernhardt
Authors: Duckett Victoria
Published: September 2018

Sarah Bernhardt is one of the most globally celebrated actress-managers of the late nineteenth century. Bernhardt’s fame, however, is rarely associated with silent film. This article explores the coincidence between Sarah Bernhardt’s role as a theatrical manager in the late nineteenth and early twentieth century and her pioneering work in the nascent film industry. I argue that Bernhardt was not only a performer and manager in the theatre, but a creative agent in modern media industries. Questions about the relationship between Bernhardt and early film allow us to discuss the formation of female business experience in the theatre and its subsequent movement into a cinematographic culture that would dominate and define twentieth-century culture and commerce. Even if Bernhardt is regarded as a ‘lone entrepreneur’ and therefore extraneous to broader national discussions of theatrical industrialisation, it is important to understand the impact she has as a media celebrity who used film in order to expand her own twentieth-century global marketability.
Optimizing the Composition of Irrigation Fluid to Reduce the Potency of Staphylococcus aureus α-Toxin: Potential Role in the Treatment of Septic Arthritis
Authors: Liu Cheryl L. S. , Hall Andrew C.
Published: September 2018

Objective

Septic arthritis is commonly caused by Staphylococcus aureus and is a medical emergency requiring antibiotics and joint irrigation. The bacteria produce α-toxin causing rapid cartilage cell ( chondrocyte) death. Saline (0.9%NaCl) lavage is normally used to remove bacteria and toxins, however, its composition might be suboptimal to suppress the lethal effects of α-toxin. We utilized rabbit erythrocyte hemolysis as a sensitive, biologically relevant assay of α-toxin levels to determine if changes to osmolarity, temperature, pH, and divalent cation (Mg2+, Ca2+) concentration were protective.

Design

Erythrocytes were incubated in the various conditions and then exposed to α-toxin (“chronic” challenge) or incubated with α-toxin and then exposed to experimental conditions (“acute” challenge).

Results

Raising osmolarity from 300 mOsm (0.9%NaCl) to 400, 600, or 900 mOsm (sucrose addition) when applied chronically, significantly reduced hemolysis linearly. As an acute challenge, osmotic protection was significant and similar over 400 to 900 mOsm. Reducing temperature chronically from 37°C to 25°C and 4°C significantly reduced hemolysis, however, when applied as an acute challenge although significant, was less marked. Divalent cations (Mg2+, Ca2+ at 5mM) reduced hemolysis. Varying pH (6.5, 7.2, 8.0) applied chronically marginally reduced hemolysis. The optimized saline (0.9% NaCl; 900 mOsm with sucrose, 5 mM MgCl2 (37°C)) rapidly and significantly reduced hemolysis compared with saline and Hank’s buffered saline solution applied either chronically or acutely.

Conclusions

These results on the effect of S. aureus α-toxin on erythrocytes showed that optimizing saline could markedly reduce the potency of S. aureus α-toxin. Such modifications to saline could be of benefit during joint irrigation for septic arthritis.
Safety and efficacy of aerobic exercise commenced early after cardiac surgery: A systematic review and meta-analysis
Authors: Doyle Mathew P , Indraratna Praveen , Tardo Daniel T , Peeceeyen Sheen CS , Peoples Gregory E
Published: September 2018

Background

Aerobic exercise is a critical component of cardiac rehabilitation following cardiac surgery. Aerobic exercise is traditionally commenced 2–6 weeks following hospital discharge and most commonly includes stationary cycling or treadmill walking. The initiation of aerobic exercise within this early postoperative period not only introduces the benefits associated with aerobic activity sooner, but also ameliorates the negative effects of immobilization associated with the early postoperative period.

Methods

A systematic review identified all studies reporting safety and efficacy outcomes of aerobic exercise commenced within two weeks of cardiac surgery. A meta-analysis was performed comparing functional, aerobic and safety outcomes in patients receiving early postoperative aerobic exercise compared with usual postoperative care.

Results

Six-minute walk test distance at hospital discharge was 419 ± 88 m in early aerobic exercise patients versus 341 ± 81 m in those receiving usual care (mean difference 69.5 m, 95% confidence interval (CI) 39.2–99.7 m, p < 0.00001). Peak aerobic power was 18.6 ± 3.8 ml·kg–1·min–1 in those receiving early exercise versus 15.0 ± 2.1 ml·kg–1·min–1 in usual care (mean difference 3.20 ml·kg–1·min–1, 95% CI 1.45–4.95, p = 0.0003). There was no significant difference in adverse events rates between the two groups (odds ratio 0.41, 95% CI 0.12–1.42, p = 0.16).

Conclusion

Aerobic exercise commenced early after cardiac surgery significantly improves functional and aerobic capacity following cardiac surgery. While adverse event rates did not differ significantly, patients included were very low risk. Further studies are required to adequately assess safety outcomes of aerobic exercise commenced early after cardiac surgery.
Shoulder Instability: Interobserver and Intraobserver Agreement in the Assessment of Labral Tears
Authors: Wolf Brian R. , Uribe Bastian , Hettrich Carolyn M. , Gao Yubo , Johnson Morgan ,   MOON Shoulder Group, Kuhn John E. , Cox Charles L. , Feely Brian T. , Bishop Julie , Jones Grant , Brophy Robert H. , Smith Matthew V. , Baumgarten Keith M. , Spencer Edwin E.
Published: September 2018

Background:

The glenohumeral joint combines large range of motion and insufficient bony stabilization, making it susceptible to instability and dislocations. Arthroscopic surgery is routinely used as a diagnostic tool and has been considered the gold standard for the diagnosis of shoulder lesions. However, several studies have demonstrated variability in intraobserver and interobserver agreement.

Purpose:

To evaluate interobserver and intraobserver agreement in the assessment of intra-articular lesions associated with shoulder instability among fellowship-trained shoulder surgeons.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

A total of 24 arthroscopic videos from patients treated for recurrent shoulder instability were shown to a group of 10 fellowship-trained shoulder surgeons who are members of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group. They were presented to the surgeons on 2 different occasions at least 2 months apart. They were asked to classify labral tears by their position, type, extension, other intra-articular abnormality, and preferred treatment. No patient history or physical examination data were provided. The primary outcome was the median overall percentage of agreement for the surgeons performing a video review, measured for each variable evaluated. Intraclass correlation coefficients were used to evaluate continuous variables, and kappa values were used for categorical items.

Results:

Interobserver agreement was good for anterior labral lesions; good for Hill-Sachs lesions; and moderate for lesions of the superior labrum, posterior labrum, anterior sublabral foramen, and position and extension of the tear. Intraobserver agreement was either good or very good for all variables evaluated, except for being poor for inferior labral lesions and moderate for lesions of the meniscoid superior labrum.

Conclusion:

Interobserver and intraobserver reliability for the arthroscopic assessment of labral tears in patients with recurrent shoulder instability were good to moderate for the majority of anatomic structures assessed. There was relatively good agreement between shoulder instability surgeons on assessing and documenting shoulder instability–associated abnormalities. These findings are important when interpreting collaborative clinical cohort studies with numerous surgeons involved in the research.
Using Vividness Interventions to Improve Financial Decision Making
Authors: Hershfield Hal E. , John Elicia M. , Reiff Joseph S.
Published: September 2018

Prior policy work has effectively eased some financial problems that Americans face: Automatic enrollment in retirement saving accounts has drastically increased the number of workers who participate in defined contribution retirement plans. Yet, such choice architecture interventions cannot always be implemented, and even when they can, they are beholden to whatever decisions the choice architect made and, in any case, may not go far enough in helping maximize financial well-being over time. Additional interventions thus need to complement already successful choice architecture ones. Namely, because many financial decisions involve trade-offs between present and future selves, with the present self often being prioritized, this review highlights interventions that make the future self more vivid to decision makers. We discuss the theoretical background underlying such interventions, the factors that may make vividness interventions more or less effective in policy contexts, and possible future directions for researchers and policy makers.
Measurable residual disease monitoring by NGS before allogeneic hematopoietic cell transplantation in AML
Authors: Thol Felicitas , Gabdoulline Razif , Liebich Alessandro , Klement Piroska , Schiller Johannes , Kandziora Christian , Hambach Lothar , Stadler Michael , Koenecke Christian , Flintrop Madita , Pankratz Mira , Wichmann Martin , Neziri Blerina , Büttner Konstantin , Heida Bennet , Klesse Sabrina , Chaturvedi Anuhar , Kloos Arnold , Göhring Gudrun , Schlegelberger Brigitte , Gaidzik Verena I. , Bullinger Lars , Fiedler Walter , Heim Albert , Hamwi Iyas , Eder Matthias , Krauter Jürgen , Schlenk Richard F. , Paschka Peter , Döhner Konstanze , Döhner Hartmut , Ganser Arnold , Heuser Michael
Published: September 2018

Molecular measurable residual disease (MRD) assessment is not established in approximately 60% of acute myeloid leukemia (AML) patients because of the lack of suitable markers for quantitative real-time polymerase chain reaction. To overcome this limitation, we established an error-corrected next-generation sequencing (NGS) MRD approach that can be applied to any somatic gene mutation. The clinical significance of this approach was evaluated in 116 AML patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) in complete morphologic remission (CR). Targeted resequencing at the time of diagnosis identified a suitable mutation in 93% of the patients, covering 24 different genes. MRD was measured in CR samples from peripheral blood or bone marrow before alloHCT and identified 12 patients with persistence of an ancestral clone (variant allele frequency [VAF] >5%). The remaining 96 patients formed the final cohort of which 45% were MRD+ (median VAF, 0.33%; range, 0.016%-4.91%). In competing risk analysis, cumulative incidence of relapse (CIR) was higher in MRD+ than in MRD− patients (hazard ratio [HR], 5.58; P < .001; 5-year CIR, 66% vs 17%), whereas nonrelapse mortality was not significantly different (HR, 0.60; P = .47). In multivariate analysis, MRD positivity was an independent negative predictor of CIR (HR, 5.68; P < .001), in addition to FLT3-ITD and NPM1 mutation status at the time of diagnosis, and of overall survival (HR, 3.0; P = .004), in addition to conditioning regimen and TP53 and KRAS mutation status. In conclusion, NGS-based MRD is widely applicable to AML patients, is highly predictive of relapse and survival, and may help refine transplantation and posttransplantation management in AML patients.
SPLUNC1 degradation by the cystic fibrosis mucosal environment drives airway surface liquid dehydration
Authors: Webster Megan J. , Reidel Boris , Tan Chong D. , Ghosh Arunava , Alexis Neil E. , Donaldson Scott H. , Kesimer Mehmet , Ribeiro Carla M.P. , Tarran Robert
Published: September 2018

The multi-organ disease cystic fibrosis (CF) is caused by mutations in the cystic fibrosis transmembrane regulator gene (CFTR) that lead to diminished transepithelial anion transport. CF lungs are characterised by airway surface liquid (ASL) dehydration, chronic infection/inflammation and neutrophilia. Dysfunctional CFTR may upregulate the epithelial Na+channel (ENaC), further exacerbating dehydration. We previously demonstrated that short palate lung and nasal epithelial clone 1 (SPLUNC1) negatively regulates ENaC in normal airway epithelia.

Here, we used pulmonary tissue samples, sputum and human bronchial epithelial cells (HBECs) to determine whether SPLUNC1 could regulate ENaC in a CF-like environment.

We found reduced endogenous SPLUNC1 in CF secretions, and rapid degradation of recombinant SPLUNC1 (rSPLUNC1) by CF secretions. Normal sputum, containing SPLUNC1 and SPLUNC1-derived peptides, inhibited ENaC in both normal and CF HBECs. Conversely, CF sputum activated ENaC, and rSPLUNC1 could not reverse this phenomenon. Additionally, we observed upregulation of ENaC protein levels in human CF bronchi. Unlike SPLUNC1, the novel SPLUNC1-derived peptide SPX-101 resisted protease degradation, bound apically to HBECs, inhibited ENaC and prevented ASL dehydration following extended pre-incubation with CF sputum.

Our data indicate that CF mucosal secretions drive ASL hyperabsorption and that protease-resistant peptides,e.g.SPX-101, can reverse this effect to rehydrate CF ASL.