bluuebunny/crossref_metadata_2025 huggingface dataset:
American Studies
Authors: Rubens Amy
Published: August 2019

American Studies is an interdisciplinary field that has ties to literary studies and other disciplines, notably history, anthropology, sociology, and religious studies. Health humanists use American Studies methods to explore how representations of illness, health, and healthcare construct and are constructed by notions of nation, national character, and citizenship, not only as they relate to the US nation-state, but also to other conceptions of America. For this reason, health humanist projects guided by American Studies can identify the processes through which embodied selves exert or are subject to power. While American Studies methods encourage intervention in matters of social injustice, they also may reduce the individual, subjective experience of embodiment to a means to an interpretive end.
Mixed Methods Program Evaluation
Authors: Gowda Deepthiman , Curran Tayla , Balmer Dorene F.
Published: August 2019

Program evaluations explore the effectiveness and feasibility of new programs. An evaluation method using a mixed methods approach combines qualitative and quantitative data; this approach enables triangulation of data to provide more comprehensive understanding of a program and increase the trustworthiness of evaluation findings. Mixed methods evaluation can be resource intensive and requires expertise in both qualitative and quantitative methods. Program evaluation questions should be informed by program stakeholders and by the concerns of the field. In this chapter, the authors describe how to conduct a mixed methods program evaluation and explore its benefits and limitations. The authors draw on their experience of using a mixed methods approach to evaluate a year-long narrative medicine program in primary care clinics. Though not appropriate for all health humanities program evaluation, a mixed methods evaluation offers rich, multidimensional understandings of programs.
Evidence Synthesis Methods
Authors: Springs Stacey , Baruch Jay
Published: August 2019

Despite the many studies that are published every day by research teams across the globe, decisions in healthcare policy, practice, and programming are often made in the absence of quality, relevant evidence. This evidence gap between research and practice highlights the need to improve translation of what is known into what is done. Evidence synthesis employs rigorous and replicable techniques to bridge this gap, to better understand the quality and quantity of relevant evidence that informs decision making. In this chapter, the authors provide an overview of evidence synthesis in health humanities and describe the necessary process steps to conduct evidence synthesis projects in a rigorous and reproducible manner. This chapter intends to provide readers with the requisite knowledge to become informed consumers of evidence synthesis products and familiar with the basic steps necessary to complete an evidence review.
Preoperative Physical Conditioning
Authors: McAnally Heath B.
Published: August 2019

Physical fitness is increasingly recognized as a crucial and unfortunately diminishing component and contributor to overall biopsychosocial-spiritual well-being. Morbidity and mortality are closely linked to physical inactivity (PI), as are many chronic pain states; furthermore, there are complex and confounding relationships between PI and obesity, sleep disorders, depression, and anxiety, which all mediate chronic pain and other morbidity and mortality in their own right. Physical inactivity is also associated with worsened postoperative outcomes, and a growing body of evidence supports both rationale and effectiveness of improving physical fitness levels prior to surgery for optimal patient and overall system/economic outcomes. Recent evidence indicates that as little as four weeks of mild to moderate but regular physical activity can improve surgical outcomes. As with many if not all lifestyle issues, PI is at its root a biopsychosocial-spiritual issue, and adequate understanding and accommodation of underlying motivational deficits, obstacles and competing factors, and habit factors are essential to supporting patients in improving their fitness for surgery.
Preoperative Management of Tobacco
Authors: McAnally Heath B.
Published: August 2019

Despite significant reductions in prevalence in the United States over the past half-century, smoking (and the use of other tobacco products) continues to constitute the most common chemical dependency (aside from caffeine, perhaps) and the leading preventable cause of morbidity and mortality in the developed world. It is well documented that the use of tobacco products increases overall health risks and, in the context of this work, perioperative complications. Less well recognized but also supported by the literature is an independent association with chronic pain in general after adjusting for common comorbid health risks, and also with worsened postoperative pain control. Conversely, there is evidence that preoperative tobacco cessation results in substantial improvements in outcomes. This chapter briefly reviews basic and clinical science underpinning these phenomena, the descriptive epidemiology and available outcomes data pertinent to the issue, and what the current literature has to say about preoperative tobacco cessation and support, both biologic/pharmacologic and behavioral. Recognizing the complex issues surrounding tobacco use, the chapter highlights the importance of both motivational enhancement and habit alteration.
Preoperative Management of Chronic Opioid Therapy
Authors: McAnally Heath B. , Darnall Beth
Published: August 2019

The literature increasingly supports an association between
Putting It All Together
Authors: McAnally Heath B. , Freeman Lyn , Darnall Beth
Published: August 2019

Joint behavioral health and medical care is required for optimal success in preoperative optimization of the chronic pain patient. This effort basically comprises lifestyle modification issues, and habit breaking and replacement do not come easily. Physical and psychological dependence on tobacco, alcohol, and opioids adds to the complexity and requires skilled and individualized intervention. Nonetheless, some basic principles, goals and a template/plan for multidimensional “baby steps” can be implemented in every case. Given that many of these variables (e.g., sleep, exercise, diet, kinesiophobia, etc.) are interdependent, such a multidimensional approach is preferred in terms of efficacy. Correspondingly, current forward-thinking charters such as the US National Pain Strategy recognize that the mainstream passivity-inducing and frequently opioid-reliant chronic pain management culture with its failure to encourage biopsychosocial-spiritual health and proactive solutions fosters dependence on reactive efforts. It is no wonder patients suffering with chronic pain in this country should pursue stronger drugs, more procedures and surgery, which in the absence of improved baseline mind-body health status all too often results in worsening of their pain syndrome and opioid dependence. The individual patient and the system at large require recalibration, focusing on what our forebears called “fitness for surgery.”
Communication
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

The concept of communication encompasses speech and language alongside our ability to understand non-verbal communication. While communication appears effortless in normal circumstances, large amounts of unconscious processing are required from widely distributed brain regions. Non-verbal communication incorporates additional neurological systems including visual pathways, occipital lobe, mirror neurons, and so on. These observations mean that language function can be impaired from a much wider range of brain injuries than the relatively focal lesions that were traditionally considered. This chapter discusses acquired speech and language disorders (dysphasia/aphasia, fluent dysphasias, non-fluent dysphasia, global dysphasia, dysarthria, apraxia of speech, and neurogenic stuttering) and their assessment. Different therapies are defined, including impairment and communication-based therapies, and their appropriate applications depending on the underlying cause of the disorder.
Skin problems
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

This chapter includes some of the common skin-related problems encountered in rehabilitation settings, including pressure ulcers, chronic venous ulcers, ischaemic ulcers, and osteomyelitis. A pressure ulcer is an area of localized damage to the skin and underlying tissue caused by pressure, shear, and friction, either individually or in combination. The definition, features, and grades of pressure ulcers are discussed, followed by prevention and management strategies. The prevalence of leg ulcers ranges from 1 to 3 per 1000 population and can rise to 8.5% in those aged more than 65 years. The commonest causes of chronic ulcers are venous ulcers (60–70%), mixed ulcers (15–20%), arterial (10%), and systemic diseases and unusual causes (5%). The causes and management of leg ulcers are also discussed.
Rehabilitation in critical illness
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

This chapter focuses on those situations where the effects of a critical illness can produce additional morbidity with the potential to affect later rehabilitation. In the context of critical illness, much of this additional morbidity takes the form of readily predictable complications resulting from the disease process or the consequences of its early management. In this sense, rehabilitation principles should be an essential and integrated part of management in the intensive care unit (ICU) setting. Even though it is occurring in ICU, the goals of rehabilitation are unchanged—to maximize the potential for the person to maximize their short- and long-term functional capacity and quality of life. This chapter also describes rehabilitation in specific critical illnesses.
Traumatic brain injury
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

Traumatic brain injury (TBI) is a subset of acquired brain injuries, a larger grouping that includes acute-onset diseases such as stroke as well as degenerative conditions such as the dementing illnesses. TBI is often considered separately to other acquired brain injuries due to differences in its presentation and how treatment is approached. TBI occurs over an extremely broad range of severities, from concussion through to profound and life-threatening damage. As the injury becomes more severe, the affected individual has an increasing risk of experiencing lifelong and complex physical, behavioural, emotional, cognitive and social problems. This chapter describes mechanisms, severity, consequences, related conditions, and stages of rehabilitation.
Stroke
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

The World Health Organization defines stroke as: ‘Rapidly developing signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin’. This definition may be a little outdated with modern imaging techniques commonly diagnosing pathology at a very early stage or diagnosing old ‘silent’ infarcts. This chapter describes the epidemiology and different types of stroke and the diagnosis, prognosis, and secondary prevention of stroke are discussed. Stroke rehabilitation settings are then described, as well as the initial multidisciplinary team assessment, principles of stroke rehabilitation, and predictors of poorer functional prognosis. Rehabilitation for impairment of different functions are covered, describing upper and lower limb impairment, dysphagia and nutrition, speech impairments, visual impairments, and unilateral spatial neglect. The final section is on discharge planning.
Disorders of the peripheral nerves
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

Accurate diagnosis is important for the rehabilitation of people with disorders of the peripheral nerves. There are a small but increasing number of disorders that are now specifically treatable. Even in those disorders of peripheral nerves that do not currently have a specific treatment, accurate diagnosis remains important in order to determine natural history and prognosis. This will help to determine the rehabilitation strategy. Some conditions may recover spontaneously—such as Guillain–Barré syndrome—while others are progressive—such as the hereditary motor and sensory neuropathies. Some may require surgical intervention (e.g. the brachial plexus injuries). Disorders of peripheral nerves usually consist of several symptoms, and this chapter covers a range of disorders to indicate the range and extent of these disorders.
Common musculoskeletal conditions
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

The Global Burden of Disease study identified musculoskeletal (MSK) conditions as the largest single cause of years lived with disability. MSK medicine and rehabilitation services worldwide are heterogeneous in nature in terms of patient pathway and involvement of various healthcare professionals. The service can be led by consultants in different medical specialties; in primary care by General Practitioners with a special interest in MSK disorders and in secondary care by rheumatologists, orthopaedic surgeons, neurosurgeons, pain specialists, rehabilitation and MSK physicians. Allied health professionals such as physiotherapists and extended scope practitioners now have a far greater role in managing MSK conditions in some countries such as the UK.
Burns rehabilitation
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

A burn injury is an unexpected and dramatic event in a person’s life, with a strong likelihood of persistent physical and psychological impacts. Overall, the incidence of burns is relatively low; however, it is higher in developing countries, in lower socioeconomic and disadvantaged groups, in children under 2 years of age, and in the workplace. How well a person copes following a burn injury depends on multiple factors including those relating to the burns themselves (e.g. area, depth, and type), secondary issues relating to treatment (e.g. efficacy of pain management and multiple operations), associated long-term implications (e.g. contractures, cosmesis, and psychology), along with personality, family, and societal influences. As with all rehabilitation, the goal is to maximize quality of life by minimizing adverse outcomes, maximizing adaptation, and encouraging positive psychological coping mechanisms.
Reward Processing in Adolescents with Depression
Authors: O’Callaghan Georgia , Stringaris Argyris
Published: August 2019

The role of aberrant neural processing of rewards in the development of depression has long been proposed. This commentary reviews the reward literature in adolescent depression across imaging modalities such as functional magnetic resonance imaging and electroencephalography methodologies. When integrating findings across studies, consistent neural abnormalities emerge, expressed as reduced striatal blood oxygen level-dependent responses to anticipation and feedback outcome phases of reward tasks, altered frontostriatal connectivity, and blunted feedback-related negativity potentials. These are observed in current depression but, more importantly, have been found to be predictive of the onset of depression in longitudinal studies with community-based adolescent samples. The evidence for the specificity of these findings to depression is discussed, in addition to a review of intervention work probing this mechanism as it relates to decreases in depressive symptomatology. The chapter makes recommendations for future work that may continue to elucidate this relationship, a greater understanding of which may lead to more targeted and efficacious treatments for depression in adolescence.
Cognition-Related Brain Networks Underpin Cognitive, Emotional, and Somatic Symptom Dimensions of Depression
Authors: Rayner Genevieve
Published: August 2019

The latest functional neuroimaging evidence suggests that the abnormal activation and connectivity of cognition-related brain networks may account for different symptom dimensions of unipolar depression. In particular, abnormal functioning of the autobiographic memory network (AMN) and cognitive control network (CCN) is central to the emotional, somatic, and cognitive symptomatology of depression. Chronic hyperactivity of the self-focused AMN is linked to pathological introspection; namely, brooding, self-blame, and rumination. In parallel, underengagement of the CCN is associated with indecisiveness, negative thoughts, poor concentration, and distorted cognitive processing. Downstream effects include dysregulation of networks linked to the somatic and emotional symptoms of depression, namely the cortico–subcortical affective network and salience network. AMN–CCN dynamics can change between individuals and over time, plausibly accounting for both the pleomorphic presentation of depression and its fluctuating course. Framing depression as a disorder of neurocognitive networks directly links clinical features to neurobiology, in line with gold standard psychiatric research guidelines.
Bone disease
Authors: Breeze Johno , Parmer Sat , McLeod Niall
Published: August 2019

This chapter contains eight clinical vivas on the subject of maxillofacial bone disease. This will provide candidates sitting the vivas component of the Oral and Maxillofacial Surgery FRCS examination with practical knowledge in the assessment and treatment of conditions such as keratocystic odontogenic tumours, ameloblastoma as well as osteonecrosis derived from medications or iatrogenic radiotherapy. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery, in how to engage in a debate with a senior clinician in the contemporary management of such complex cases.
Oral medicine and pathology
Authors: Breeze Johno , Parmer Sat , McLeod Niall
Published: August 2019

This chapter contains eight clinical vivas on the subject of oral medicine and pathology. This will provide candidates sitting the vivas component of the Oral and Maxillofacial Surgery FRCS examination with practical knowledge in the assessment and treatment of pathological conditions affecting the oral mucosa including ulceration, lichen planus, leukoplakia, as well as pemphigoid and pemphigus. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery, in how to engage in a debate with a senior clinician in the contemporary management of such complex cases.
Probing inhomogeneity in the helium ionizing UV background
Authors: Morrison Sean , Pieri Matthew M , Syphers David , Kim Tae-Sun
Published: August 2019

We present an analysis combining the simultaneous measurement of intergalactic absorption by hydrogen (${\rm {H\,\small {I}}}$), helium (${\rm {He\,\small {II}}}$), and oxygen (${\rm {O\,\small {VI}}}$) in UV and optical quasar spectra. The combination of the ${\rm {H\,\small {I}}}$ and ${\rm {He\,\small {II}}}$ Lyman-alpha forests through η (the ratio of column densities of singly ionized helium to neutral hydrogen) is thought to be sensitive to large-scale inhomogeneities in the extragalactic UV background. We test this assertion by measuring associated five-times-ionized oxygen (${\rm {O\,\small {VI}}}$) absorption, which is also sensitive to the UV background. We apply the pixel optical depth technique to ${\rm {O\,\small {VI}}}$ absorption in high and low η samples filtered on various scales. This filtering scale is intended to represent the scale of any coherent oxygen excess/deficit. We find a 2σ detection of an ${\rm {O\,\small {VI}}}$ opacity excess in the low η sample on scales of ∼10 cMpc for HE 2347-4342 at $\bar{z}\approx 2.6$, consistent with a large-scale excess in hard UV photons. However, for HS 1700 + 6416 at $\bar{z}\approx 2.5$ we find that the measured ${\rm {O\,\small {VI}}}$ absorption is not sensitive to differences in η. HS 1700 + 6416 also shows a relative absence of ${\rm {O\,\small {VI}}}$ overall, which is 6σ inconsistent with that of HE 2347-4342. This implies UV background inhomogeneities on ≳200 cMpc scales, hard UV regions having internal ionization structure on ∼10 cMpc scales, and soft UV regions showing no such structure. Furthermore, we perform the pixel optical depth search for oxygen on the ${\rm {He\,\small {II}}}$ Gunn-Peterson trough of HE 2347-4342 and find results consistent with post-${\rm {He\,\small {II}}}$-reionization conditions.
EZOA – a catalogue of EBHIS H i-detected galaxies in the northern Zone of Avoidance
Authors: Schröder A C , Flöer L , Winkel B , Kerp J
Published: August 2019

We present a catalogue of galaxies in the northern Zone of Avoidance (ZoA), extracted from the shallow version of the blind H i survey with the Effelsberg 100 m radio telescope, EBHIS, that has a sensitivity of 23 mJy beam−1 at 10.24 km s−1 velocity resolution. The catalogue comprises 170 detections in the region δ ≥ −5° and |b| < 6°. About a third of the detections (N = 67) have not been previously recorded in H i. While 29 detections have no discernible counterpart at any wavelength other than H i, 48 detections (28 per cent) have a counterpart visible on optical or near-infrared images but are not recorded as such in the literature. New H i detections were found as close as 7.5 Mpc (EZOA J2120+45), and at the edge of the Local Volume, at 10.1 Mpc, we have found two previously unknown dwarf galaxies (EZOA J0506+31 and EZOA J0301+56). Existing large-scale structures crossing the northern ZoA have been established more firmly by the new detections, with the possibility of new filaments. We conclude that the high rate of 39 per cent new H i detections in the northern ZoA, which has been extensively surveyed with targeted observations in the past, proves the power of blind H i surveys. The full EBHIS survey, which will cover the full northern sky with a sensitivity comparable to the HIPASS survey of the southern sky, is expected to add many new detections and uncover new structures in the northern ZoA.
Mapping the missing branch on the neogastropod tree of life: molecular phylogeny of marginelliform gastropods
Authors: Fedosov Alexander E , Caballer Gutierrez Manuel , Buge Barbara , Sorokin Pavel V , Puillandre Nicolas , Bouchet Philippe
Published: August 2019

Marginelliform gastropods are a heterogeneous and diverse group of molluscs encompassing over 1,600 living species, among which are the smallest known neogastropods. The relationships of marginelliform gastropods within the order Neogastropoda are controversial, and the monophyly of the two marginelliform families the Marginellidae J. Fleming, 1828 and the Cystiscidae Stimpson, 1865, remains unconfirmed. DNA sequence data have never been used to assess the relationships of the marginelliform gastropods, making this group the only major branch missing in our current understanding of the neogastropod tree of life. Here we report results of the first multilocus phylogenetic analysis of marginelliform gastropods, which is based on a dataset comprising 63 species (20 genera) of Marginellidae and Cystiscidae, and a wide range of neogastropod lineages. The Marginellidae and Cystiscidae form a moderately supported clade that is sister to the family Volutidae. Marginellona gigas appears to be sister to all other marginelliforms. The subfamily Marginellinae was recovered as a well-supported clade, and good resolution of this part of the tree makes it possible to propose amendments to the family-level classification of the group. The relationship between Granulina and other marginelliforms could not be resolved and requires further study. Due to poor resolution of basal relationships within the Marginellidae–Cystiscidae clade, the monophyly of the Cystiscidae was neither confirmed nor convincingly rejected. The shell morphology of most marginellid and cystiscid genera is taxonomically not very informative but, nevertheless, of the traditionally recognized genera only Gibberula and Dentimargo were shown to be polyphyletic. Although a comprehensive systematic revision of the group requires more extensive taxonomic sampling (e.g. with better representation of the type species of nominal genus-group names), our results support the superfamily Volutoidea, comprising four families (Volutidae, Cystiscidae, Marginellidae and Marginellonidae), with the placement of the Granulinidae uncertain for the time being.
Homelessness in Adults With Invasive Pneumococcal Disease in Calgary, Canada
Authors: Lemay Julie-Anne , Ricketson Leah J , Zwicker Lauren , Kellner James D
Published: August 2019

Background

Homelessness is uncommon but is frequently a characteristic in adults with invasive pneumococcal disease (IPD). In Calgary, homeless persons comprise approximately 0.2% of the population. We evaluated the relationship of homelessness and IPD in Calgary.

Methods

Demographic, clinical, and microbiologic data were collected by the Calgary Streptococcus pneumoniae Epidemiology Research (CASPER) team through prospective, population-based surveillance of all IPD cases. Here, we report on cases in adults (≥18 years) from 2000 to 2016.

Results

Of 1729 IPD cases, 321 (18.8%) occurred in homeless persons. Compared with nonhomeless persons, homeless persons were younger, more often male, smokers, alcohol abusers, illegal drug users, and had a primary diagnosis of pneumonia. In multivariable models of outcomes, homeless persons had lower odds of being admitted to the ICU (odds ratio [OR], 0.7; P = .02) and lower odds of death (OR, 0.6; P = .146). IPD caused by serotypes 4, 5, or 8, which have caused outbreaks in Calgary, was more common in homeless persons (54.4% vs 21.0%; P < .001). In addition, regardless of homeless status, persons with IPD caused by serotypes 4, 5, or 8 had lower odds of ICU admission and mortality (OR, 0.7; P = .017; and OR, 0.4; P = .004; respectively).

Conclusions

Homelessness is overrepresented in IPD cases in Calgary, despite most homeless persons having fewer risk factors than the overall population of persons with IPD. Most cases are caused by serotypes in both the 23-valent polysaccharide vaccine and the 13-valent conjugate vaccine. Thus, enhanced efforts are needed to deliver both vaccines to this vulnerable population.
Oral Fluoroquinolone or Trimethoprim-Sulfamethoxazole vs ß-Lactams as Step-Down Therapy for Enterobacteriaceae Bacteremia: Systematic Review and Meta-analysis
Authors: Punjabi Chitra , Tien Vivian , Meng Lina , Deresinski Stan , Holubar Marisa
Published: August 2019

Background

Using published data, we sought to compare outcomes in patients transitioned to either oral fluoroquinolones (FQs) or trimethoprim-sulfamethoxazole (TMP-SMX) vs ß-lactams (BLs) after an initial intravenous (IV) course for gram-negative rod (GNR) bacteremia.

Methods

We conducted a systematic review of PubMed and EMBASE and published IDWeek abstracts. We included studies that reported all-cause mortality and/or infection recurrence in patients transitioned to oral FQ/TMP-SMX and BLs.

Results

Eight retrospective studies met inclusion criteria with data for 2289 patients, of whom 65% were transitioned to oral FQs, 7.7% to TMP-SMX, and 27.2% to BLs. Follow-up periods ranged from 21 to 90 days. All-cause mortality was not significantly different between patients transitioned to either FQ/TMP-SMX or BLs (odds ratio [OR], 1.13; 95% confidence interval [CI], 0.69–1.87). Overall recurrence of infection, either bacteremia or the primary site, occurred more frequently in patients transitioned to oral BLs vs FQs (OR, 2.05; 95% CI, 1.17–3.61). Analysis limited to recurrent bacteremia was similarly suggestive, although limited by small numbers (OR, 2.15; 95% CI, 0.93–4.99). However, based on known pharmacokinetics/pharmacodynamics, prescribed ß-lactam dosing regimens were frequently suboptimal.

Conclusions

In the step-down IV to oral treatment of GNR bacteremia, we found insufficient data regarding outcomes after oral TMP-SMX; however, selection of an FQ over commonly utilized ß-lactam regimens may reduce chances of infection recurrence. Although this may be a class effect, it may simply be the result of inadequate dosing of ß-lactams. Additional investigations are warranted to determine outcomes with TMP-SMX and optimized oral ß-lactam dosing regimens.
HIV-Associated Vacuolar Encephalomyelopathy
Authors: Madden Gregory R , Fleece Molly E , Gupta Akriti , Lopes M Beatriz S , Heysell Scott K , Arnold Christopher J , Wispelwey Brian
Published: August 2019

We report a case of HIV-associated vacuolar encephalomyelopathy with progressive central nervous system dysfunction and corresponding vacuolar degeneration of the spinal cord, cranial nerves, and brain, the anatomic extent of which has not previously been described. Vacuolar myelopathy classically presents as a spinal syndrome with progressive, painless gait disturbance in the setting of advanced HIV and AIDS. Vacuolar involvement of the brain and cranial nerves, as illustrated in this case report, is a newly described variant of this condition that we term vacuolar encephalomyelopathy.
Transpalpebral Approach “Eyelid Incision” for Surgical Treatment of Intracerebral Aneurysms: Lessons Learned During a 10-Year Experience
Authors: Mao Gordon , Gigliotti Michael , Aziz Khaled , Aziz Khaled
Published: August 2019

BACKGROUND

The classic pterional, pretemporal, and orbitozygomatic approaches achieve large areas of exposure with easy maneuverability. In select cases (eg, some anterior circulation aneurysms), the minimally invasive fronto-orbital craniotomy can yield adequate exposure that must be balanced with its risk of frontalis injury.

OBJECTIVE

To detail a 10-yr experience using the transpalpebral approach, characterized by an incision whose camouflage is the natural eyelid crease, notably the effectiveness and outcomes of this exposure for anterior circulation aneurysms.

METHODS

In this retrospective review, 82 patients with 88 aneurysms underwent a supraorbital frontal minicraniotomy via the eyelid incision performed by a single neurosurgeon and closure by an oculoplastic surgeon (2007-2016). Incision of the orbiculi oculi developed a plane between the muscle and orbital septum superiorly. Outcomes recorded included aneurysm occlusion or residual, treatment modality (clipping/wrapping), postoperative hemorrhage or stroke, postoperative wound healing, and overall cosmesis.

RESULTS

Of 85 (97%) aneurysms treated by clipping, postoperative and follow-up imaging showed complete obliteration in 81 (95%) aneurysms and residuals in 4 (5%). Cosmetic outcomes for the eyelid incision were excellent: 81 (99%) patients noted excellent wound healing at follow-up and no scarring; 1 patient developed significant temporalis wasting and upper eyelid scarring after posterior communicating artery aneurysm clipping. Overall, 13 minor and 8 major complications affected 19 patients.

CONCLUSION

Our findings confirm the versatility of the eyelid supraorbital frontal minicraniotomy for common anterior circulation aneurysms. This large series found that postoperative complication risks were similar to traditional techniques and cosmetic results were excellent.
Population and Conflict
Authors: Acemoglu Daron , Fergusson Leopoldo , Johnson Simon
Published: August 2019

Medical innovations during the 1940s quickly resulted in significant health improvements around the world. Countries with initially higher mortality from infectious diseases experienced larger increases in life expectancy, population, and subsequent social conflict. This cross-country result is robust across alternative measures of conflict and is not driven by differential trends between countries with varying baseline characteristics. A similar effect is also present within Mexico. Initial suitability conditions for malaria varied across municipalities, and anti-malaria campaigns had differential effects on population growth and social conflict. Both across countries and within Mexico, increased conflict over scarce resources predominates and this effect is more pronounced during times of economic hardship (specifically, in countries with a poor growth record and in drought-stricken areas in Mexico). At least during this time period, a larger increase in population made social conflict more likely.
Real Option Exercise: Empirical Evidence
Authors: Décaire Paul H , Gilje Erik P , Taillard Jérôme P
Published: August 2019

We study when and why firms exercise real options. Using detailed project-level investment data, we find that the likelihood that a firm exercises a real option is strongly related to peer exercise behavior. Peer exercise decisions are as important in explaining exercise behavior as variables commonly associated with standard real option theories, such as volatility. We identify peer effects using localized exogenous variation in peer project exercise decisions and find evidence consistent with information externalities being important for exercise behavior. (JEL G30, G31, G32)
Association between immunosuppressive therapy and course of mild interstitial lung disease in systemic sclerosis
Authors: Hoa Sabrina , Bernatsky Sasha , Steele Russell J , Baron Murray , Hudson Marie ,   for the Canadian Scleroderma Research Group
Published: August 2019

Objective

Interstitial lung disease (ILD) is a leading cause of mortality in SSc. Little is known about the benefits of immunosuppressive drugs in mild ILD. Our aim was to determine whether use of CYC or MMF was associated with an improved ILD course in patients with normal or mildly impaired lung function.

Methods

A retrospective cohort of SSc subjects with ILD, disease duration below seven years and no exposure to CYC or MMF prior to the baseline visit was constructed from the Canadian Scleroderma Research Group registry. Subjects were categorized as having mild ILD if baseline forced vital capacity (FVC % predicted) was >85%. The primary exposure was any use of CYC or MMF at the baseline visit. FVC at one year was compared between exposed and unexposed subjects, using multivariate linear regression.

Results

Out of 294 eligible SSc-ILD subjects, 116 met criteria for mild ILD. In this subgroup, mean (s.d.) disease duration was 3.7 (2.0) years. Thirteen (11.2%) subjects were exposed to CYC or MMF at baseline. The one-year FVC was higher in exposed subjects compared with unexposed subjects, by a difference of 8.49% (95% CI: 0.01–16.98%). None of the exposed subjects experienced clinically meaningful progression over two years, whereas 24.6% of unexposed subjects did.

Conclusion

In this real-world setting, CYC/MMF exposure at baseline was associated with higher FVC values and a lower risk of progression among subjects with mild ILD. These data suggest a window of opportunity to preserve lung function in SSc-ILD.
OCCUPATIONAL DOSE AND RADIATION PROTECTION PRACTICE IN UAE: A RETROSPECTIVE CROSS-SECTIONAL COHORT STUDY (2002–2016)
Authors: Elshami Wiam , Abuzaid Mohamed , Piersson Albert D , Mira Ola , AbdelHamid Mohamed , Zheng Xiaoming , Kawooya M G
Published: August 2019

A two-phased retrospective cross-sectional study analysed the occupational dose and radiation protection practice among medical workers in two hospitals in the UAE. Phase 1 evaluated radiation protection practice using a questionnaire, whereas phase 2 assessed the occupational dose. Readings of 952 thermoluminescence dosimeters were analyzed. The result showed 52% of medical workers have a good level of radiation protection practice. Readings of 952 thermoluminescence dosimeters were analyzedAverage annual effective dose per worker ranged from 0.39 to 0.83 mSv. Cardiologists and nurses displayed a higher average of occupational radiation dose compared to other workers. There were no significant correlations between radiation protection practice and hospital, occupation or department. Finally, the occupational dose was within the international and national limits, but the reduction of radiation dose to cardiologist and nurses is essential. Moreover, training is essential to promote radiation safe practice among medical workers.
RAMESIS PROJECT: COLLABORATION WITH SCHOOLS AND INSTITUTIONS ON THE BUILDING OF A CITIZEN MONITORING NETWORK
Authors: Fojtíková Ivana , Helebrant Jan , Kuča Petr
Published: August 2019

In a radiation emergency situation, including its post-emergency recovery phase, substantial needs for radiation measurements can be expected. In such situations, responsible authorities might not be able to satisfy all requirements for measurement. Therefore, involvement of local communities is desirable. Citizen radiation monitoring networks, established in advance as citizen science structures, can serve as a knowledge basis for later participation in self-help protective actions. The article describes the progress of citizen radiation monitoring networks being established in the Czech Republic in the frame of Radiation Monitoring Network for Institutions and Schools project. During the project launch, it has been shown that conducting radiation measurements and results processing have educational effect on students and enhance awareness among interested groups in the field of radiation protection and radiation in general. This article describes the socially oriented part of the project.
PREPARATION OF WOOD, CHARCOAL AND BONE COLLAGEN MICRO SAMPLES USING AUTOMAT FOR AMS RADIOCARBON DATING
Authors: Simek Pavel , Megisová Natálie , Bemš Július
Published: August 2019

For the pretreatment of wood, charcoal and collagen from bone micro samples using the Acid–Base–Acid (ABA) method, we have assembled an automated computer-controlled unit in our laboratory CRL. The sample is placed in a glass single-necked cuvette. The machine consists of prepared solutions which are guided through capillaries, switching valve and peristaltic pump into the cuvette with the sample according to the currently selected program. The automat can be used for the pretreatment of charcoal, wood and also collagen from bones.
The physiological phenotype of obstructive sleep apnea differs between Caucasian and Chinese patients
Authors: O’Driscoll Denise M , Landry Shane A , Pham Jonathan , Young Alan , Sands Scott A , Hamilton Garun S , Edwards Bradley A
Published: August 2019

Study Objectives

The mechanisms responsible for the development of obstructive sleep apnea (phenotypic “traits”) are known to differ between individuals and may differ across ethnicities. We aimed to examine whether loop gain, arousal threshold, pharyngeal collapsibility and muscle compensation differ between Chinese and Caucasian individuals with OSA.

Methods

We noninvasively determined the relative contribution of loop gain, arousal threshold, pharyngeal collapsibility, and muscle compensation from the ventilatory flow pattern recorded during a standard clinical polysomnography in a cohort of age and AHI matched Caucasian and Chinese patients with moderate-severe OSA (n = 90).

Results

Chinese participants had significantly more collapsible pharyngeal airways as indicated by a lower Vpassive (68.9 [51.5–75.2] vs. 74.0 [65.1–80.4] %Veupnea, U = 703, p = 0.012), but less ventilatory control instability as indicated by a lower loop gain (0.60 [0.50–0.67] vs. 0.63 [0.57–0.81], U = 762, p = 0.043) compared with Caucasian participants. Further, multiple logistic regression analyses demonstrated that the combined pharyngeal collapsibility (Vpassive) and loop gain traits help to better explain the differences between the groups beyond upper-airway collapsibility alone. No statistically significant group differences were found in muscle compensation or arousal threshold traits between groups.

Conclusion

Individuals of Chinese descent appear to have OSA that is driven much more by the relative contribution of their anatomical predisposition and to a lesser extent nonanatomical causes compared with Caucasians. Future research should focus on determining if Chinese versus Caucasian ethnicity is an important contributing factor to clinical outcomes and therapeutic responses in OSA.
Clinical autonomic dysfunction in narcolepsy type 1
Authors: Barateau Lucie , Chenini Sofiene , Evangelista Elisa , Jaussent Isabelle , Lopez Regis , Dauvilliers Yves
Published: August 2019

Study Objectives

(1) To compare the presence of autonomic symptoms using the validated SCOPA-AUT questionnaire in untreated patients with narcolepsy type 1 (NT1) to healthy controls, (2) to study the determinants of a high total SCOPA-AUT score in NT1, and (3) to evaluate the effect of drug intake on SCOPA-AUT results in NT1.

Methods

The SCOPA-AUT questionnaire that evaluates gastrointestinal, urinary, cardiovascular, thermoregulatory, pupillomotor, and sexual dysfunction was completed by 92 consecutive drug-free adult NT1 patients (59 men, 39.1 ± 15.6 years old) and 109 healthy controls (63 men, 42.6 ± 18.2 years old). A subgroup of 59 NT1 patients completed the questionnaire a second time, under medication (delay between two evaluations: 1.28 ± 1.14 years).

Results

Compared to controls, NT1 patients were more frequently obese, had more dyslipidemia, with no difference for age and gender. The SCOPA-AUT score of NT1 was higher than in controls in crude and adjusted models. Patients experienced more problems than controls in all subdomains. A higher score in NT1 was associated with older age, longer disease duration, altered quality of life and more depressive symptoms, but not with orexin levels and disease severity. Among patients evaluated twice, the SCOPA-AUT score total did not differ according to treatment status, neither did each subdomain.

Conclusion

We captured a frequent and large spectrum of clinical autonomic dysfunction in NT1, with impairment in all SCOPA-AUT domains, without key impact of medication intake. This assessment may allow physicians to screen and treat various symptoms, often not spontaneously reported but associated with poor quality of life.
Genetic disruption of the putative binding site for Homer on DmGluRA reduces sleep inDrosophila
Authors: Ly Sarah , Strus Ewa , Naidoo Nirinjini
Published: August 2019

Homer proteins mediate plasticity and signaling at the postsynaptic density of neurons and are necessary for sleep and synaptic remodeling during sleep. The goal of this study was to investigate the mechanisms of sleep regulation by Homer signaling. Using the Drosophila animal model, we demonstrate that knockdown of Homer specifically in the brain reduces sleep and that Drosophila Homer binds to the sole Drosophila mGluR, known as DmGluRA. This is the first evidence that DmGluRA, which bears greatest homology to group II mammalian metabotropic glutamate receptors (mGluRs), shares functional homology with group I mGluRs which couple to Homer proteins in mammals. As sleep is associated with the physical dissociation of Homer and mGluRs proteins at the synapse, we sought to determine the functional necessity of Homer × DmGluRA interaction in sleep regulation. Using the CRISPR/Cas9 gene editing system, we generated a targeted amino acid replacement of the putative binding site for Homer on DmGluRA to prevent Homer and DmGluRA protein binding. We found that loss of the conserved proline-rich PPXXF sequence on DmGluRA reduces Homer/DmGluRA associations and significantly reduces sleep amount. Thus, we identify a conserved mechanism of synaptic plasticity in Drosophila and demonstrate that the interaction of Homer with DmGluRA is necessary to promote sleep.
Economic aspects of insomnia medication treatment among Medicare beneficiaries
Authors: Wickwire Emerson M , Vadlamani Aparna , Tom Sarah E , Johnson Abree M , Scharf Steven M , Albrecht Jennifer S
Published: August 2019

Study Objectives

To examine economic aspects of insomnia and insomnia medication treatment among a nationally representative sample of older adult Medicare beneficiaries.

Methods

Using a random 5% sample of Medicare administrative data (2006–2013), insomnia was defined using International Classification of Disease, Version 9, Clinical Modification diagnostic codes. Treatment was operationalized as one or more prescription fills for an US Food and Drug Administration (FDA)-approved insomnia medication following diagnosis, in previously untreated individuals. To evaluate the economic impact of insomnia treatment on healthcare utilization (HCU) and costs in the year following insomnia diagnosis, a difference-in-differences approach was implemented using generalized linear models.

Results

A total of 23 079 beneficiaries with insomnia (M age = 71.7 years) were included. Of these, 5154 (22%) received one or more fills for an FDA-approved insomnia medication following insomnia diagnosis. For both treated and untreated individuals, HCU and costs increased during the 12 months prior to diagnosis. Insomnia treatment was associated with significantly increased emergency department visits and prescription fills in the year following insomnia diagnosis. After accounting for pre-diagnosis differences between groups, no significant differences in pre- to post-diagnosis costs were observed between treated and untreated individuals.

Conclusions

These results advance previous research into economics of insomnia disorder by evaluating the impact of medication treatment and highlighting important differences between treated and untreated individuals. Future studies should seek to understand why some individuals diagnosed with insomnia receive treatment but others do not, to identify clinically meaningful clusters of older adults with insomnia, and to explore the economic impact of insomnia and insomnia treatment among subgroups of individuals with insomnia, such as those with cardiovascular diseases, mood disorders, and neurodegenerative disease.
A General and Efficient Algorithm for the Likelihood of Diversification and Discrete-Trait Evolutionary Models
Authors: Louca Stilianos , Pennell Matthew W
Published: August 2019

As the size of phylogenetic trees and comparative data continue to grow and more complex models are developed to investigate the processes that gave rise to them, macroevolutionary analyses are becoming increasingly limited by computational requirements. Here, we introduce a novel algorithm, based on the “flow” of the differential equations that describe likelihoods along tree edges in backward time, to reduce redundancy in calculations and efficiently compute the likelihood of various macroevolutionary models. Our algorithm applies to several diversification models, including birth–death models and models that account for state- or time-dependent rates, as well as many commonly used models of discrete-trait evolution, and provides an alternative way to describe macroevolutionary model likelihoods. As a demonstration of our algorithm’s utility, we implemented it for a popular class of state-dependent diversification models—BiSSE, MuSSE, and their extensions to hidden-states. Our implementation is available through the R package $\texttt{castor}$. We show that, for these models, our algorithm is one or more orders of magnitude faster than existing implementations when applied to large phylogenies. Our algorithm thus enables the fitting of state-dependent diversification models to modern massive phylogenies with millions of tips and may lead to potentially similar computational improvements for many other macroevolutionary models.