bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior centre-edge angle on sagittal CT: a comparison of normal hips to dysplastic hips
Authors: Monazzam Shafagh , Williams Karly Ann , Shelton Trevor J , Calafi Arash , Haus Brian M
Published: May 2018

Purpose:

The anterior centre-edge angle (ACEA) describes anterior acetabular coverage on false profile radiographs. Variability associated with pelvic tilt, radiographic projection, and identifying the true anterior edge, causes discrepancies in measuring an accurate ACEA. Computed tomography (CT) has the potential of improving the accuracy of ACEA. However, because the ACEA on sagittal CT has been shown to not be equivalent to ACEA on false profile radiographs, the normal range of ACEA on CT currently remains unknown and cannot reliably be used to determine over/under coverage. We therefore asked: what is the normal variation of ACEA corrected for pelvic tilt on sagittal CT and how does this compare to dysplastic hips?

Material and Methods:

A retrospective review was conducted on patients 10–35 who underwent CT for non-orthopedic related issues and patients with known hip dysplasia. The ACEA was measured on a sagittal slice corresponding to the centre of the femoral head on the axial slice and adjusted for pelvic tilt. A statistical comparison was then performed.

Results:

A total of 320 normal patients and 22 patients with hip dysplasia were reviewed. The mean ACEA for all ages was 50° ± 8°, (range: 23–81º), with a larger mean ACEA for males (51°) than females (49°). The ACEA mean for dysplastic hips was 30° ± 11° with a statistically significant difference in mean from the normal hip group ( p < 0.0001).

Conclusion:

The ACEA can be reliably measured on sagittal CT and significantly differs from dysplastic hips. ACEA measurements above 66° or below 34° may represent anterior over and under coverage.
Cutaneous Nontuberculous Mycobacterial Infections in Alberta, Canada: An Epidemiologic Study and Review
Authors: Sander Megan A. , Isaac-Renton Judith L. , Tyrrell Gregory J.
Published: May 2018

Background:

Cutaneous infections caused by nontuberculous mycobacteria (NTM) occur infrequently. Nonetheless, the incidence of NTM infections is reported to be increasing. In Canada, cutaneous NTM infections have not been well described.

Objectives:

A database review from 2006 to 2016 was done to assess species frequency, incidence, and trends of the most common cutaneous NTMs in the province of Alberta, Canada. We also reviewed major diagnostic and epidemiologic aspects of NTM cutaneous infections with a focus on Mycobacterium marinum.

Results:

A database search identified 244 cases of NTM infections. Mycobacterium avium-intracellulare complex had the highest incidence, causing 64% of cases. Rapid growers ( Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium fortuitum) caused 23% and M marinum 13%. Information on infection site was available for 117 cases. There was no difference noted in sex distribution; however, differences in age groups between species were noted.

Conclusions:

The incidence of NTM cutaneous infections in Alberta, Canada, was reported for the first time and the incidence of M marinum was found to be similar to that reported in the worldwide literature. Patients’ age groups were different between species. Knowledge of the unique microbiological features of NTMs and the role of the diagnostic laboratory are important.
High neurofilament levels are associated with clinically definite multiple sclerosis in children and adults with clinically isolated syndrome
Authors: van der Vuurst de Vries Roos M , Wong Yu Yi M , Mescheriakova Julia Y , van Pelt E Daniëlle , Runia Tessel F , Jafari Naghmeh , Siepman Theodora AM , Melief Marie-José , Wierenga-Wolf Annet F , van Luijn Marvin M , Samijn Johnny P , Neuteboom Rinze F , Hintzen Rogier Q
Published: May 2018

Background:

A promising biomarker for axonal damage early in the disease course of multiple sclerosis (MS) is neurofilament light chain (NfL). It is unknown whether NfL has the same predictive value for MS diagnosis in children as in adults.

Objective:

To explore the predictive value of NfL levels in cerebrospinal fluid (CSF) for MS diagnosis in paediatric and adult clinically isolated syndrome (CIS) patients.

Methods:

A total of 88 adult and 65 paediatric patients with a first attack of demyelination were included and followed (mean follow up-time in adults: 62.8 months (standard deviation (SD) ±38.7 months) and 43.8 months (SD ±27.1 months) in children). Thirty control patients were also included. Lumbar puncture was done within 6 months after onset of symptoms. NfL was determined in CSF using enzyme-linked immunosorbent assay (ELISA). COX regression analyses were used to calculate hazard ratios (HR) for clinically definite multiple sclerosis (CDMS) diagnosis.

Results:

After adjustments for age, oligoclonal bands (OCB), and asymptomatic T2 lesions on baseline magnetic resonance imaging (MRI), increased NfL levels in both paediatric and adult CIS patients were associated with a shorter time to CDMS diagnosis (children HR = 3.7; p = 0.007, adults HR = 2.1; p = 0.032). For CIS patients with a future CDMS diagnosis, children showed higher NfL levels than adults (geometric mean 4888 vs 2156 pg/mL; p = 0.007).

Conclusion:

CSF NfL levels are associated with CDMS diagnosis in children and adults with CIS. This makes NfL a promising predictive marker for disease course with potential value in clinical practice.
Phishing holidays
Authors: Butler David J
Published: May 2018

A recent book by Nobel laureates Akerlof and Shiller, Phishing for Phools, has drawn attention to the ‘dark side’ of the nudge. This article presents the timeshare market as an exemplar; a number of features of this market make it uniquely suitable for this purpose. I highlight the manner in which developers leverage consumer biases and cognitive limitations to secure sales. I then draw comparisons with the timeshare resale market to estimate the loss to consumers. I finish with some possible recommendations for reform.
Adjusted linguistic validation and psychometric properties of the Colombian version of KIDSCREEN-52
Authors: Jaimes-Valencia Mary Luz , Perpiñá-Galvañ Juana , Cabañero-Martínez Maria José , Cabrero-García Julio , Richart-Martínez Miguel
Published: May 2018

In health and clinical studies, health-related quality of life is often assessed using the well-established KIDSCREEN-52 questionnaires as well as the Vécu et Santé Perçue de l’Adolescent (VSP-A). The purpose of this study was twofold: to perform an adjusted linguistic validation of the Colombian version of the KIDSCREEN-52 and to assess its psychometric properties in children and adolescents. A total of 146 children and adolescents completed the KIDSCREEN-52, adolescents ( n = 48) additionally completed the VSP-A. Psychometric analyses focused on the internal consistency as well as the convergent and discriminant validity of the KIDSCREEN-52 Colombian version. Syntactic and semantic modifications were made to 19 items in the adapted version of the KIDSCREEN-52. Cronbach’s α ranged from .74 to .89 for eight dimensions, while α < .70 was obtained for self-perception and social acceptance. We found evidence of good convergent validity with the VSP-A dimensions. Regarding known-groups validity, children aged between 8 and 10=years, male, with a high socioeconomic level and no chronic health condition obtained higher scores compared to the other categories. The developed Colombian version of the KIDSCREEN-52 showed acceptable reliability and validity. This study provides a cultural adaptation of the Spanish version of the KIDSCREEN-52 for Colombian children and adolescents.
Access to care among children with disabilities enrolled in the MassHealth CommonHealth Buy-In program
Authors: Hirschi Melissa , Walter Angela Wangari , Wilson Kasey , Jankovsky Kate , Dworetzky Beth , Comeau Meg , Bachman Sara S
Published: May 2018

Children with disabilities utilize more health-care services and incur higher costs than other children do. Medicaid Buy-In programs for children with disabilities have the potential to increase access to benefits while reducing out-of-pocket costs for families whose income exceeds Medicaid eligibility. This study sought to understand how parents and caregivers of Massachusetts children with disabilities perceive access to care under CommonHealth, Massachusetts’s Medicaid Buy-In program. Parents and caregivers ( n = 615) whose children were enrolled in CommonHealth participated in a survey assessing the impact of the program. Qualitative data were coded across five access domains—availability, accessibility, accommodation, affordability, and acceptability. Data suggest that CommonHealth improves access to care for children with disabilities by providing the benefits that were limited in scope or unavailable through other insurance before enrollment and by making available services more affordable. Policy and administrative changes could improve the program and further increase access to care for children with complex, costly conditions. Adopting a Medicaid Buy-In program may be an effective way for states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/or whose families incur high out-of-pocket costs for their care.
‘The Pope’s own hand outstretched’: Holy See diplomacy as a hybrid mode of diplomatic agency
Authors: Troy Jodok
Published: May 2018

The unconventional nature of Holy See diplomats rests in the composite character of their ecclesiastical role as the Pope’s representatives and their legal diplomatic status and commencement to ordinary diplomatic practice. Holy See diplomacy is a form of conduct created by a set of mixed secular and religious standards in which agents are guided by practices. I locate this argument within a classical English School and a conventional understanding of practice, diplomacy, and agency while incorporating understandings of the diplomat as a stranger. The article situates a Holy See diplomat’s mode of agency as a hybrid one by nature, located at the intersections of political and religious modes of agency and substantial and relational conceptions of international politics. I probe this conceptual framework of hybrid agency by analysing episodes involving papal diplomats in turmoil-ridden historical episodes, and correspondence with informed agents.
An assessment of the UK inpatient care for heart failure patients with diabetes
Authors: Wu Lihua , Cleator Jackie , Mamas Mamas , Deaton Christi
Published: May 2018

Background:

Diabetes is a common co-morbidity for patients with heart failure. Diabetes as a co-morbidity means that inpatient care should focus on both conditions to maximize the treatment regimen. However, this pressing issue is not widely researched and so it is unclear whether the acute care management needs of these patients are being met.

Aims:

(1) To assess the differences in the number of hospital readmissions between patients with heart failure and patients with heart failure–diabetes; (2) to assess the use of integrated care approach for patients with heart failure–diabetes during the index heart failure-related admission; (3) to explore patient experiences of admissions.

Methods:

A mixed methods design was used: we identified heart failure-related admissions between 1 April 2011 and 31 March 2012 in two hospitals, then reviewed medical records and interviewed 14 patients.

Results:

Over a 12 month period patients with heart failure–diabetes ( n=172) had more heart failure-related Accident and Emergency attendance episodes (incident rate ratio 1.24, p<0.01) and hospital readmissions (incident rate ratio 1.23, p=0.01) than patients with heart failure ( n=370). We reviewed 72 medical records which met inclusion criteria (adults with heart failure–diabetes, ejection fraction <45%): during admission most of them were reviewed by heart failure specialists but less than one-third were reviewed by diabetes specialists. The interview respondents addressed the need for better integration and co-ordination of care.

Conclusions:

This is one of the first UK studies to assess the integration of inpatient care for those with heart failure and multi-morbidities. The findings suggest that maximal care management during admission should be explored as a way of reducing the frequent readmissions and improving patient outcomes.
Bruised and Battered: Reinforcing Intimate Partner Violence in Comic Books
Authors: Garland Tammy S. , Policastro Christina , Branch Kathryn A. , Henderson Brandy B.
Published: May 2018

Previous studies have examined intimate partner violence (IPV) in popular culture; however, little attention has been given to the presence of domestic violence myths in comic books. Using a convenience sample taken from popular comic book series, this content analysis examines the prevalence of IPV and the myths used to justify such portrayals. Findings indicate that the reinforcement of IPV through myths is clearly evident within mainstream comic books. Discussion of the negative impact of the acceptance and reinforcement of IPV myths is addressed.
The Notion of Manhood Embedment in the Practice of Traditional Male Circumcision in Ngove Village, Limpopo, South Africa
Authors: Siweya Tryphosa , Sodi Tholene , Douglas Mbuyiselo
Published: May 2018

Traditional male circumcision (TMC) is a cultural ritual that involves the removal of the penile foreskin of a male person undertaken as part of a rite of passage from childhood into adulthood. The aim of the study was to determine the notions of manhood in TMC by African adolescent boys in Ngove Village, Limpopo Province. This was a qualitative study that sampled a total of 20 adolescent boys through purposive sampling. Data were collected using semistructured interviews and analyzed through interpretive phenomenological analysis (IPA). Five main themes emerged from this study, namely: (a) TMC as a passage to manhood, (b) the role of TMC in role modeling, (C) fearlessness and aggressiveness as qualities of manhood in TMC, (d) TMC as indicating readiness for heterosexual relationships, and (e) the decline in the practice of TMC. The study concludes with discussion and recommendation of integration of both traditional male circumcision and medical male circumcision (MMC) with specific tactfulness and respect of the notion of manhood value embedment in the process to gain cooperation of the local community members affected.
A Physician’s Guide to Recommending Yoga
Authors: Smith Sarah , Frates Beth
Published: May 2018

The popularity of yoga in the United States and across the globe has been steadily increasing over the past several decades. The interest in yoga as a therapeutic lifestyle tool has also grown within the medical community during this time. However, the wide range of styles available to the public can make it difficult for patients and physicians alike to choose the one that will offer the most benefit. This guide was created to assist physicians in making informed recommendations for patients practicing yoga in the community. When the most suitable style is selected, yoga can be an extremely useful lifestyle tool for patients seeking to improve fitness and develop a mindfulness-based practice.
Not for the World of Theorizing But for the Need of Knowledge in the Nursing Discipline
Authors: Jensen Annesofie L. , Handberg Charlotte , Thomsen Thora Grothe , Kjerholt Mette , Soelver Lisbeth , Hølge-Hazelton B.
Published: May 2018

Research networks have significant value and are essential for conducting high-quality applied health research. In this article, we describe the establishment, content, and contribution of a Danish national qualitative interpretive description (ID) network. There are only a few examples of clinical research networks and in most qualitative research methodology is not highly prioritized. Still, a number of nurses and allied health professionals work with qualitative methods and applied health research. This may call for different kinds of networks depending on the geographical context, management support, background, and goal of the network. In this article, we share our knowledge of different kinds of networks and in particular our experiences with an ID knowledge-creating network. The network has provided us with results in the form of stimulating professional conversations and discussions. It has also strengthened the methodological depth of our research and the epistemological standpoints.
Design and modeling of motion-decoupling mechanism for cable-driven joints
Authors: Jiang Surong , Hua Daren , Wang Yaoyao , Ju Feng , Yin Liang , Chen Bai
Published: May 2018

With the advantages of simple structure, low power consumption, high ratio of load to self-weight, and good flexibility, the cable-driven robots are especially suitable for medical instruments and home service. Due to the alignment of cables, there is a problem of motion coupling between the manipulator joints, leading to the degradation of control accuracy. Moreover, the hysteresis and the dead zone of the cable driving unit make it difficult to control the joint accurately. To effectively solve above-mentioned motion-coupling problem, a novel motion-decoupling mechanism is proposed and investigated. An experimental setup is established to verify the kinematic decoupling characteristics. Based on the “static friction + Coulomb friction” model, the friction model is established and verified. Thus, studies on the friction model have provided theoretical basis for the accurate force coordinated control of the cable-driven system.
Adaptive human-in-the-loop multi-target recognition improved by learning
Authors: Wu Xuesong , Wang Chang , Niu Yifeng , Hu Xiaoping , Fan Chen
Published: May 2018

Machine learning algorithms have been designed to address the challenge of multi-target recognition in dynamic and complex environments. However, sufficient high-quality samples are not always available for training an accurate multi-target recognition classifier. In this article, we propose a generic human-in-the-loop multi-target recognition framework that has four collaborative autonomy levels, and it allows adaptive autonomy level adjustment based on the recognition task complexity as well as the human operator’s performance. The human operator can intervene to relabel the collected data and guarantee the recognition accuracy when the trained classifier is not good enough. Meanwhile, the relabeled data are used for online learning which further improves the performance of the classifier. Experiments have been carried out to validate the proposed approach.
Current trends and future perspectives in pelvic reconstructive surgery
Authors: Aubé Mélanie , Tu Le Mai
Published: May 2018

Pelvic organ prolapse is a prevalent disorder with a high lifetime incidence of surgical repair. Pelvic organ prolapse surgery has greatly evolved over the past years, and pelvic floor reconstructive surgeons are faced with a vast array of treatment options for their patients. Our review article illustrates the current trends and future perspectives for the surgical treatment of pelvic organ prolapse.
Does Addition of Tobramycin Powder Reduce Infection Rates After Spine Surgery?
Authors: Lee Yu-Po , Farhan Saifal-Deen , Pendi Arif , Cunningham Torin J. , Kiester P. Douglas , Hahn Peter , Rosen Charles D. , Bhatia Nitin
Published: May 2018

Study Design:

Retrospective chart review.

Objectives:

To evaluate the efficacy of tobramycin and vancomycin powder in reducing surgical site infections in posterior lumbar instrumented fusion.

Methods:

A multicenter, electronic database search was conducted for all patients who underwent posterior instrumented lumbar fusions.

Results:

The addition of vancomycin powder decreased postoperative infections from an incidence of 5.7% down to a rate of 2.0%. This difference was statistically significant ( P = .018). The addition of tobramycin powder to the wound in addition to vancomycin further decreased the infection rate down to 1.8%. The postoperative infection rate was statistically significant ( P = .041) when compared with the no-powder group. However, the difference was not statistically significant ( P = 1.00) when compared with vancomycin alone. There was also a trend toward gram-negative organisms with the addition of more antibiotic powder. In the control group, for example, the organisms cultured were 66% methicillin-sensitive Staphylococcus aureus and 33% gram-negative organisms. In the vancomycin group, 30% of the organisms cultured were Staphylococcus aureus and 60% gram-negative organisms. In the vancomycin and tobramycin powder group, 100% of the organisms cultured were gram-negative.

Conclusions:

There is a reduction in surgical site infections with addition of antibiotic powder to the wound prior to closure. However, the reduction in the infection rate was not as great with the addition of tobramycin powder to vancomycin alone and there was a noticeable change in the spectrum of organism cultured with this addition. Clinicians should consider the risk-to-benefit ratio in each case when deciding to use antibiotic powder.
Thyroid Storm Presenting as Psychosis
Authors: Desai Dimpi , Zahedpour Anaraki Sara , Reddy Neetha , Epstein Eric , Tabatabaie Vafa
Published: May 2018

Thyroid storm is a life-threatening endocrine emergency with an incidence rate of 1% to 2%. It is a systemic condition of excessive thyroid hormone production and release leading to thermoregulatory, adrenergic, neuropsychiatric, cardiovascular, and abdominal manifestations. Although it is a rare condition, it carries a significant mortality rate. Hence, knowing the common and uncommon presentations of thyroid storm is important for its prompt diagnosis and treatment. In this article, we present an unusual case of a young woman who presented with psychosis as the manifesting symptom of thyroid storm. She did not respond adequately to conventional medical treatment, requiring plasmapheresis and a definitive thyroidectomy, which ultimately led to the return of patient’s baseline mental status and a dramatic recovery.
Self-reported Mental Disorders Negatively Influence Surgical Outcomes After Arthroscopic Treatment of Femoroacetabular Impingement
Authors: Lansdown Drew A. , Ukwuani Gift , Kuhns Benjamin , Harris Joshua D. , Nho Shane J.
Published: May 2018

Background:

Femoroacetabular impingement (FAI) is responsible for hip pain and dysfunction, and surgical outcomes depend on multiple factors. The presence of mental disorders negatively influences outcomes of multiple orthopaedic conditions, although the impact on FAI surgery is unclear.

Hypothesis:

The authors hypothesized that a preoperative self-reported history of mental disorders would negatively influence patient-reported outcome measures after FAI surgery.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A matched-cohort study was performed by reviewing a prospectively collected database of cases of arthroscopic management of FAI with a single surgeon over a 2-year period. Demographics and radiographic parameters were recorded for all patients. Patients completed the Hip Outcome Score–Activity of Daily Living Subscale (HOS-ADL), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and modified Harris Hip Score (mHHS) prior to surgery and 2 years after surgery. Unpaired and paired t tests were used to compare results between and within cohorts at baseline and follow-up. Statistical significance was defined as P < .05.

Results:

The cohort included 301 patients, with 75 and 226 patients reporting and not reporting a history of mental disorders, respectively. Before treatment, all patient-reported outcome measures were significantly lower among patients reporting a history of mental disorders ( P < .01 for HOS-ADL, HOS-SSS, and mHHS). Patients in both groups demonstrated significant improvements ( P < .0001) in HOS-ADL, HOS-SSS, and mHHS when preoperative outcome measures were compared with follow-up. Patients with reported mental disorders had significantly lower scores after surgery as compared with patients without mental disorders ( P < .0001 for HOS-ADL, HOS-SSS, and mHHS).

Conclusion:

The presence of a reported mental disorder is associated with lower patient-reported outcomes before and after surgical management of FAI. Statistically significant and clinically relevant improvements were observed for patients who reported mental disorders. The magnitude of these improvements was not as large as that for an age- and sex-matched control group without a self-reported mental disorder.
Evaluation of a Community-Based Program That Integrates Joyful Movement Into Fall Prevention for Older Adults
Authors: Carlucci Celeste , Kardachi Julie , Bradley Sara M. , Prager Jason , Wyka Katarzyna , Jayasinghe Nimali
Published: May 2018

Background: Despite the development of evidence-based fall-prevention programs, there remains a need for programming that will engage older adults in real-world settings. Objective: This study aimed to evaluate a community-based group program that integrates joyful movement into fall prevention. The curriculum emphasizes a positive experience of movement, cultivating a healthy body image, and retraining of biomechanics. Design: Program evaluation was conducted using a one-group pre–post test study design. Key outcomes were functional balance and confidence. Qualitative feedback was gathered at the final class sessions. Results: Two hundred fifteen older adults enrolled at four sites over the period from 2010 to 2014. Among 86 participants who provided feedback, most credited the program for an increased sense of optimism and/or confidence (70%), and better walking ability (50%). Among 102 participants who completed both initial and final assessments, there was evidence of significant improvements on the Functional Reach Test ( d = .60, p < .001) and Modified Falls Efficacy Scale ( d = .17, p < .001). Conclusion: A joyful movement curriculum is acceptable to older participants, and they show improvements in functional balance and confidence. Future research should examine whether the positive changes encouraged by joyful movement lead to lasting reductions in fall risk and additional health benefits.
Trends in Geriatrics Graduate Medical Education Programs and Positions, 2001 to 2018
Authors: Petriceks Aldis H. , Olivas John C. , Srivastava Sakti
Published: May 2018

It is no secret that the average age of the U.S. population is increasing, and this has special significance for the U.S. health care system. The number of individuals above 65 years old is predicted to increase 55% by 2030, and all the while, there is a looming physician shortage, one especially relevant for Geriatricians. Therefore, current Geriatricians must have objective information to assess the past, present, and future state of this important specialty. However, little literature exists regarding the recent changes in Geriatrics-related graduate medical education programs. In the present study, we use data from the Accreditation Council of Graduate Medical Education, to characterize quantitative trends in Geriatrics graduate medical education between academic years 2001-2002 and 2017-2018. We find that, when Hospice/Palliative Care is excluded, Geriatrics-related graduate medical education programs have grown by just 1.1% when adjusting for population growth. There are 58 fewer total filled Geriatrics and Geriatric Psychiatry positions in 2017-2018 than there were in 2001-2002, a population-adjusted decline of 23.3%. Our results confirm the growing notion that the Geriatrics specialty may need to alter its approach toward professional supply, if it is to meet the growing health care demands of an aging U.S. population.
The Effects of Boswellia serrata Gum Resin on the Blood Glucose and Lipid Profile of Diabetic Patients: A Double-Blind Randomized Placebo-Controlled Clinical Trial
Authors: Mehrzadi Saeed , Tavakolifar Bahreh , Huseini Hasan Fallah , Mosavat Seyed Hamdollah , Heydari Mojtaba
Published: May 2018

Regarding preclinical evidence for antidiabetic effects of Boswellia serrata, we evaluated antihyperglycemic and lipid-lowering effects of Boswellia serrata gum resin in type 2 diabetic patients. Fifty-six diabetic patients were randomly allocated to 2 groups to receive 250 mg of the Boswellia serrata gum resin or placebo twice daily for 8 weeks in addition to their routine antidiabetic treatments. Although there was a considerable reduction after the intervention in the field of fasting blood sugar, glycosylated hemoglobin, and triglyceride in the Boswellia serrata gum resin group, no significant difference was observed in all outcome measures between the 2 groups at the end of the study. The current study showed that 8 weeks of complementary use of Boswellia serrata gum resin with a daily dose of 500 mg had no better glucose and lipid-lowering effect than placebo in diabetic patients.
Advance care planning in life-threatening pulmonary disease: a focus group study
Authors: Hjorth Nina Elisabeth , Haugen Dagny Faksvåg , Schaufel Margrethe Aase
Published: May 2018

Advance care planning (ACP) is a communication process for mapping a patient's wishes and priorities for end-of-life care. In preparation for the introduction of ACP in Norway, we wanted to explore the views of Norwegian pulmonary patients on ACP.

We conducted four focus group interviews in a Norwegian teaching hospital, with a sample of 13 patients suffering from chronic obstructive pulmonary disease, lung cancer or lung fibrosis. Analysis was by systematic text condensation.

Participants' primary need facing end-of-life communication was “the comforting safety”, implying support, information and transparency, with four underlying themes: 1) provide good team players; 2) offer conversations with basic information; 3) seize the turning point; and 4) balance transparency. Good team players were skilled communicators knowledgeable about treatment and the last phase of life. Patients preferred dialogues at the time of diagnosis and at different “turning points” in the disease trajectory and being asked carefully about their needs for communication and planning. Transparency was important, but difficult to balance.

ACP for patients with life-threatening pulmonary disease should rest upon an established patient–doctor/nurse relationship and awareness of turning points in the patient's disease progression. Individually requested and tailored information can support and empower patients and their relatives.
Dynamic hyperinflation during the 6-min walk test in severely asthmatic subjects
Authors: Benfante Alida , Di Marco Fabiano , Terraneo Silvia , Centanni Stefano , Scichilone Nicola
Published: May 2018

We tested the hypothesis that dynamic hyperinflation develops in severe asthmatic subjects during exercise. Changes in inspiratory capacity (IC) were measured during the 6-min walk test (6MWT) in severe asthmatic subjects compared with chronic obstructive pulmonary disease (COPD) subjects with a similar degree of bronchial obstruction. We assessed whether changes in IC were associated with changes in dyspnoea perception.

27 severe asthmatic subjects (10 males and 17 females) and 43 COPD subjects (35 males and eight females) were recruited. The two groups performed similarly in the 6MWT (p=0.90). At the end of the test, the Borg score increased significantly in both groups (mean difference: for asthmatic subjects 1.7±1.6; p<0.0001; for COPD subjects 3.1±1.9; p<0.0001). IC measured at the beginning of 6MWT was not different between groups (2.25±0.47 L in asthmatic subjectsversus2.38±0.60 L in COPD subjects; p=0.32) and decreased in both groups (mean difference: for asthmatic subjects 0.160 L; p=0.02; for COPD subjects 0.164 L; p<0.0001). However, changes in IC were significantly associated with changes in the Borg score in the COPD group (r2=0.17; p=0.006), but not in the asthma group (r2=0.06; p=0.20).

In severe asthmatic subjects, IC significantly drops during the 6MWT to the same extent as COPD subjects with a similar degree of lung impairment, indicating the development of dynamic hyperinflation. Contrary to COPD, in asthmatic subjects the occurrence of dynamic hyperinflation was not associated with changes in dyspnoea perception.
Systematic Review of the Impact of Cancer Survivorship Care Plans on Health Outcomes and Health Care Delivery
Authors: Jacobsen Paul B. , DeRosa Antonio P. , Henderson Tara O. , Mayer Deborah K. , Moskowitz Chaya S. , Paskett Electra D. , Rowland Julia H.
Published: May 2018

Purpose

Numerous organizations recommend that patients with cancer receive a survivorship care plan (SCP) comprising a treatment summary and follow-up care plans. Among current barriers to implementation are providers’ concerns about the strength of evidence that SCPs improve outcomes. This systematic review evaluates whether delivery of SCPs has a positive impact on health outcomes and health care delivery for cancer survivors.

Methods

Randomized and nonrandomized studies evaluating patient-reported outcomes, health care use, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Data extracted by independent raters were summarized on the basis of qualitative synthesis.

Results

Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer types, SCP delivery timing and method, SCP recipients and content, SCP-related counseling, and outcomes assessed. Nonrandomized study findings yielded descriptive information on satisfaction with care and reactions to SCPs. Randomized study findings were generally negative for the most commonly assessed outcomes (ie, physical, functional, and psychological well-being); findings were positive in single studies for other outcomes, including amount of information received, satisfaction with care, and physician implementation of recommended care.

Conclusion

Existing research provides little evidence that SCPs improve health outcomes and health care delivery. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal outcomes. Findings are limited but more positive for proximal outcomes (eg, information received) and for care delivery, particularly when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. Recommendations for future research include focusing to a greater extent on evaluating ways to ensure SCP recommendations are subsequently acted on as part of ongoing care.
Disease Burden and Outcome in Children and Young Adults With Concurrent Graves Disease and Differentiated Thyroid Carcinoma
Authors: MacFarland Suzanne P , Bauer Andrew J , Adzick N Scott , Surrey Lea F , Noyes Jessica , Kazahaya Ken , Mostoufi-Moab Sogol
Published: May 2018

Context

Adults with differentiated thyroid cancer (DTC) and Graves disease (GD) demonstrate a greater reported disease burden and aggressive DTC behavior. To date, no studies have examined the impact and long-term outcome of concurrent GD and DTC (GD-DTC) in children and young adults.

Design

Single institution, retrospective longitudinal cohort study between 1997 and 2016.

Participants

One hundred thirty-nine children and young adults with DTC, diagnosed at median age 15 (range, 5 to 23) years, compared with 12 patients with GD-DTC, median age 18 (range, 12 to 20) years.

Major Outcome Measures

Patient demographics, preoperative imaging, fine needle aspiration (FNA) cytology, operative and pathological reports, laboratory studies, treatment, and subsequent 2-year outcomes.

Results

Compared with DTC, patients with GD-DTC were significantly older at the time of DTC diagnosis (P < 0.01). Patients with GD-DTC were more likely to exhibit microcarcinoma (P < 0.01), and 2 of 12 (17%) demonstrated tall cell variant papillary thyroid cancer (PTC) vs 2 of 139 (2%) in patients who had DTC alone (P = 0.03). Although patients with DTC showed greater lymphovascular invasion (60% vs 25%; P = 0.03), no group differences were noted in extrathyroidal extension, regional lymph node, and distant or lung metastasis. There were no group differences in the 2-year outcome for remission, persistent disease, or recurrence.

Conclusions

Concurrent DTC in pediatric patients with GD is not associated with a greater disease burden at presentation and shows no significant difference in 2-year outcomes compared with DTC alone. Similar to adults, microcarcinoma and tall cell variant PTC is prevalent in pediatric patients with GD-DTC. For patients who have GD-DTC with an identified nodule on ultrasound imaging prior to definitive therapy, FNA biopsy is recommended to guide definitive treatment.
Reproductive Hormones and Subclinical Cardiovascular Disease in Midlife Women
Authors: Thurston Rebecca C , Bhasin Shalender , Chang Yuefang , Barinas-Mitchell Emma , Matthews Karen A , Jasuja Ravi , Santoro Nanette
Published: May 2018

Context

Reproductive hormones are important to the pathophysiology of cardiovascular disease (CVD) in women. However, standard estradiol (E2) and testosterone (T) assays lack sensitivity at the levels of postmenopausal women.

Objective

Investigate relations of mass spectrometry–assessed estrone (E1), E2, and T and SHBG and subclinical CVD in women.

Design, Setting, and Participants

Three hundred and four perimenopausal and postmenopausal women aged 40 to 60 years underwent subclinical CVD measurements. E1, E2, and T were assayed using liquid chromatography–tandem mass spectrometry; free T (FT) was estimated using ensemble allostery models. Regression models were adjusted for CVD risk factors.

Main Outcome Measures

Carotid artery intima media thickness, interadventitial diameter (IAD), and plaque; brachial flow mediated dilation (FMD).

Results

Higher E1 was related to higher FMD [β(SE) = 0.77 (0.37), P = 0.04], indicating better endothelial function. Higher E2 was related to lower IAD [β(SE) = −0.07 (0.02), P = 0.004], indicating less carotid remodeling. Higher SHBG was related to higher FMD [β(SE) = 1.31 (0.40), P = 0.001], yet higher IAD [β(SE) = 0.15 (0.06), P = 0.02] and plaque [OR (95% CI) = 1.84 (1.16 to 2.91), P = 0.009]; FT showed a similar yet inverse pattern of relations as SHBG. Thus, higher SHBG and lower FT were associated with better endothelial function, yet greater carotid remodeling and plaque.

Conclusions

Endogenous E1 levels were related to endothelial function and E2 to vascular remodeling, suggesting distinct roles of these estrogens. SHBG and FT have complex roles depending on the vessel under study.
Visual field shape and foraging ecology in diurnal raptors
Authors: Potier Simon , Duriez Olivier , Cunningham Gregory B. , Bonhomme Vincent , O'Rourke Colleen , Fernández-Juricic Esteban , Bonadonna Francesco
Published: May 2018

Birds, particularly raptors, are believed to forage primarily using visual cues. However, raptor foraging tactics are highly diverse — from chasing mobile prey to scavenging — which may reflect adaptations of their visual systems. To investigate this, we studied the visual field configuration of 15 species of diurnal Accipitriformes that differ in such tactics, first focusing on the binocular field and blind area by using a single traits approach, and then exploring the shape of the binocular field with morphometric approaches. While the maximum binocular field width did not differ in species of different foraging tactics, the overall shape of their binocular fields did. In particular, raptors chasing terrestrial prey (ground predators) had a more protruding binocular field and a wider blind area above the head than did raptors chasing aerial or aquatic prey and obligate scavengers. Ground predators that forage on mammals from above have a wide but short bill — which increases ingestion rate — and large suborbital ridge to avoid sun glare. This may explain the protruding binocular field and the wide blind area above the head. By contrast, species from the two other groups have long but narrow bills used to pluck, flake or tear food and may need large visual coverage (and reduced suborbital ridges) to increase their foraging efficiency (e.g. using large visual coverage to follow the escaping prey in three dimensions or detect conspecifics). We propose that binocular field shape is associated with bill and suborbital ridge shape and, ultimately, foraging strategies.
First demonstration of olfactory learning and long term memory in honey bee queens
Authors: Gong Zhiwen , Tan Ken , Nieh James C.
Published: May 2018

As the primary source of colony reproduction, social insect queens play a vital role. However, the cognitive abilities of queens are not well understood, although queen learning and memory are essential in multiple species such as honey bees, in which virgin queens must leave the nest and then successful learn to navigate back over repeated nuptial flights. Honey bee queen learning has never been previously demonstrated. We therefore tested olfactory learning in queens and workers and examined the role of DNA methylation, which plays a key role in long term memory formation. We provide the first evidence that honey bee queens have excellent learning and memory. The proportion of honey bee queens that exhibited learning was 5-fold higher than workers at every tested age and, for memory, 4-fold higher than workers at a very young age. DNA methylation may play a key role in this queen memory because queens exhibiting remote memory had a more consistent elevation in Dnmt3 gene expression as compared to workers. Both castes also showed excellent remote memory (7 day memory), which was reduced by 14-20% by the DNA methylation inhibitor, zebularine. Given that queens live about 10-fold longer than workers, these results suggest that queens can serve as an excellently long-term reservoir of colony memory.
The first 3D printed multiple sclerosis brain: Towards a 3D era in medicine
Authors: Avasarala Jagannadha , Pietila Todd
Published: May 2018

Conventional magnetic resonance imaging (MRI) studies depict disease of the human brain in 2D but the reconstruction of a patient’s brain stricken with multiple sclerosis (MS) in 3D using 2D images has not been attempted. 

Using 3D reconstruction algorithms, we built a 3D printed patient-specific brain model to scale. It is a first of its kind model that depicts the total white matter lesion (WML) load using T2 FLAIR images in an MS patient. The patient’s images in Digital Imaging and Communications in Medicine (DICOM) format were imported into Mimics inPrint 2.0 (Materialise NV, Leuven, Belgium) a dedicated medical image processing software designed for the purposes of image segmentation and 3D modeling.  The imported axial images were automatically formatted to display coronal and sagittal slices within the software. The imaging data were then segmented into regions and surface rendering was done to achieve 3D virtual printable files of the desired structures of interest.

Rendering brain tumor(s) in 3D has been attempted with the specific intent of extending the options available to a surgeon but no study to our knowledge has attempted to quantify brain disease in MS that has, for all practical purposes, no surgical options. The purpose of our study was to demonstrate that 3D depiction of chronic neurological diseases is possible in a printable model while serving a fundamental need for patient education. Medical teaching is moored in 2D graphics and it is time to evolve into 3D models that can be life-like and deliver instant impact.
Recent advances in transfusions in neonates/infants
Authors: Goel Ruchika , Josephson Cassandra D.
Published: May 2018

Transfusions of red blood cells (RBCs), platelets, and plasma are critical therapies for infants and neonates (particularly preterm neonates) in the neonatal intensive care unit, who are the most frequently transfused subpopulation across all ages. Although traditionally a significant gap has existed between the blood utilization and the evidence base essential to adequately guide transfusion practices in infants and neonates, pediatric transfusion medicine is evolving from infancy and gradually coming of age. It is entering an exciting era with recognition as an independent discipline, a new and evolving high-quality evidence base for transfusion practices, novel technologies and therapeutics, and national/international collaborative research, educational, and clinical efforts. Triggers and thresholds for red cell transfusion are accumulating evidence with current phase III clinical trials. Ongoing trials and studies of platelet and plasma transfusions in neonates are anticipated to provide high-quality evidence in years to come. This article aims to summarize the most current evidence-based practices regarding blood component therapy in neonates. Data on the use of specific components (RBCs, plasma, and platelets) are provided. We attempt to define thresholds for anemia, thrombocytopenia, and abnormal coagulation profile in neonates to highlight the difficulties in having a specific cutoff value in neonates and preterm infants. Indications for transfusion of specific products, transfusion thresholds, and current practices and guidelines are provided, and possible adverse outcomes and complications are discussed. Finally, the critical research knowledge gaps in these practices as well as ongoing and future research areas are discussed. In an era of personalized medicine, neonatal transfusion decisions guided by a strong evidence base must be the overarching goal, and this underlies all of the strategic initiatives in pediatric and neonatal transfusion research highlighted in this article.
Value Encounter Modeling—Formalization and Application
Authors: Weigand Hans , Johannesson Paul , Andersson Birger
Published: May 2018

The concept of cocreation of value has been widely accepted in the management literature and service science. Value modeling approaches such as e3value focus on the exchange of value rather than cocreation. In this paper, a new value modeling approach is proposed that builds on e3value but highlights the notion of a “value encounter.” Value encounters are defined as interaction spaces where a group of actors meet and derive value by each one bringing in some of its own resources. The paper provides a formal value encounter ontology. It is shown that this ontology captures the concept of value cocreation and offers a useful instrument for open innovation projects. A case study is provided in which the approach has been applied in the development of a “green” hospital.
Effect of Thermal Shock on Bending Strength of Composites Made from Fly Ash and Glass Waste
Authors: Waziz Wildan Jamasri, Muhammad , Kusnanto Kusnanto.
Published: May 2018

The bending strength of composite made from fly ash and glass waste can be improved by controlling chemical composition of the raw materials and sintering temperatures. In this study, the composites made from mixture of various weight fractions between fly ash (FA) and glass waste (GL). Each mixture was uni-axially pressed with various compacting pressures to produce green body. The formed green body was then sintered at various temperatures from 900 °C to 1100°C for 2h. From the experimental result, it shows that the bending strength of composite fly ash and glass waste is highly varied based on the weight fraction of glass waste content, sintering temperatures and compacting pressures. The highest bending strength value is 44.53 MPa obtained from specimen that contains 50 (% wt.) of glass waste with sintering temperature of 1050 °C and compacting pressure of 130 MPa. A thermal shock test was performed on the specimen composites of 50FA-50GL by heating up to various temperatures and followed by quenching (rapid cooling) to water media. Bending test was then done on the thermal shocked specimen. The bending strength of specimen decreases sharply around 80.93 % from its original strength when subjected to temperature gradient (ΔT) of 285 °C.