bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Disease‐Specific and General Patient‐Reported Outcome Measures of Hearing Health
Authors: Mohan Suresh , Corrales C. Eduardo , Yueh Bevan , Shin Jennifer J.
Published: February 2018

Objective

To assess disease‐specific (Inner EAR) and general (Patient‐Reported Outcomes Measurement Information System [PROMIS]) health status in patients reporting hearing loss and whether there is enough correlation between scales such that the general instrument alone could suffice.

Study Design

Correlation analysis of prospective cohort data.

Setting

Tertiary care academic medical center.

Methods

Adults presenting with a chief complaint of hearing loss completed the Inner EAR scale and the PROMIS instrument. Summary statistics, including means, percentiles, and measures of variance, were calculated. The Spearman ρ statistic was used to test the null hypothesis that there were no correlations between the Inner EAR composite or global score and PROMIS scores.

Results

The mean Inner EAR composite score was 35.6, while the global item had a mean score of 4.8. Mean PROMIS‐10 scores were 16.0 for physical health and 15.3 for mental health. The global item and social item had mean scores of 3.6 and 3.8, respectively. Inner EAR composite scores were significantly correlated with the PROMIS mental health summary scores (Spearman ρ = 0.3, P =. 0066) and the PROMIS social item score (Spearman ρ = 0.4, P =. 0005). The Inner EAR global item was moderately correlated with the PROMIS social item score (Spearman ρ = 0.3, P =. 0118), while there was no significant correlation between the Inner EAR global item and the PROMIS physical health, mental health, or global item scores.

Conclusions

Inner EAR and a subset of PROMIS scores have weak to moderate correlations. Disease‐specific assessment still confers independent value.
Treatment Times in Salivary Gland Cancer: National Patterns and Association with Survival
Authors: Morse Elliot , Fujiwara Rance J. T. , Judson Benjamin , Mehra Saral
Published: February 2018

Objective

To characterize treatment times in salivary cancer; associate treatment times with patient, tumor, and treatment characteristics; and examine the association of treatment times and overall survival.

Study Design

Retrospective cohort.

Setting

Commission‐on‐Cancer Accredited Hospitals 2004‐2013.

Subjects and Methods

In total, 5953 patients with salivary cancer included in the National Cancer Database were identified. For each treatment interval, patients in the fourth quartile (“prolonged”) were compared to patients in the first and second quartiles (“not prolonged”). Patient, tumor, and treatment characteristics were associated with prolonged times via multivariable binary logistic regression. Prolongation of each interval was associated with overall survival via multivariable Cox proportional hazards regression, controlling for clinically relevant factors.

Results

Median durations for diagnosis‐to‐treatment initiation, surgery‐to‐radiation treatment (RT), RT duration, total treatment package, and diagnosis‐to‐treatment end were 31, 44, 47, 92, and 110 days, respectively. Race, insurance status, comorbidities, age, T and N stage, facility volume and location, and a facility care transition from diagnosis to initial treatment were associated with prolonged treatment time. Prolonged RT duration was associated with decreased overall survival (OS) (62% vs 75% 5‐year OS, HR = 1.26 [95% confidence interval (CI), 1.09‐1.47]; P =. 002), but prolonged diagnosis‐to‐treatment initiation, surgery‐to‐RT, total treatment package, and diagnosis‐to‐treatment end intervals were not (70% vs 67% 5‐year OS, HR = 1.11 [95% CI, 0.92‐1.34], P =. 284; 72% vs 68%, HR = 0.93 [95% CI, 0.79‐1.09], P =. 370; 70% vs 70%, HR = 1.00 [95% CI, 0.84‐1.20], P =. 974; 66% vs 71%, HR = 0.99 [95% CI, 0.84‐1.18], P =. 920, respectively).

Conclusion

The median durations identified here can serve as reference points. Radiation therapy duration is associated with overall survival in salivary cancer and could be considered a quality indicator.
Effect of Piecemeal vs En Bloc Approaches to the Lateral Temporal Bone on Survival Outcomes
Authors: Muelleman Thomas , Chowdhury Naweed I. , Killeen Daniel , Sykes Kevin , Kutz J. Walter , Isaacson Brandon , Staecker Hinrich , Lin James
Published: February 2018

Objectives

Lateral temporal bone resection (LTBR) has traditionally been performed en bloc in accordance with oncologic principles. Occasionally, this is not possible due to a low tegmen or lateralized vasculature. We sought to determine if outcomes of piecemeal and en bloc LTBR are comparable.

Study Design

Retrospective review.

Setting

Two academic medical centers.

Subjects and Methods

Multi‐institutional retrospective cohort study. Current Procedural Terminology codes were used to identify patients with T1 to T3 squamous cell carcinoma of the external auditory canal (EAC) who underwent LTBR from 2005 to 2015. Kaplan‐Meier curves were constructed to compare total survival between the 2 treatment approaches. Pairwise comparisons were performed using χ2 and Fisher exact tests (significance at P =. 05), as appropriate.

Results

Twenty‐five patients were identified. Ten patients underwent en bloc LTBR; 15 underwent piecemeal LTBR. Median follow‐up time was 11 months (range, 1‐60 months). There was not a significant difference in overall survival between en bloc (38.9 months; 95% confidence interval [CI], 22.7‐55.2) compared to piecemeal (37.5 months; 95% CI, 21.1‐53.9) procedures (P =. 519). Estimates of disease‐free survival also did not reveal statistically significant differences: estimated mean disease‐free survival was 48.1 months (95% CI, 33.7‐62.6) in en bloc patients and 32.5 months (95% CI, 17.1‐47.8) in piecemeal patients (P =. 246).

Conclusion

These data suggest that piecemeal resection can be considered for cases of squamous cell carcinoma involving the external auditory canal where anatomic constraints preclude a safe en bloc resection. Larger studies or studies with a longer follow‐up time may provide improved insight into survival comparisons.
Religion, Religious Heterogeneity, and Intimate Partner Violence Among Korean Immigrant Women
Authors: Kim Chunrye
Published: February 2018

This study examined the role of religious affiliations and frequency of religious service attendance—such as church, Bible studies, and temples—as well as religious heterogeneity between couples on intimate partner violence (IPV) among Korean immigrant women in the United States. Through a case-control design, this study compared 64 Korean immigrant IPV victims with 63 Korean immigrant non-IPV victims. This study’s findings reveal that for Korean immigrant women, a high frequency of religious service attendance was associated with higher IPV victimization, while their partners’ high religious service attendance was associated with lower IPV victimization. When women’s partners were religious compared with when they were not religious, they were less likely to perpetrate IPV even when the partners’ alcohol consumption frequency increased. Also, when there was a gap between couples regarding frequency of religious attendance, IPV victimization increased. This discussion concludes by suggesting some policy implications based on these findings.
Inductive Effect of a Ritonavir-Containing Hepatitis C Treatment Regimen on Warfarin in a Patient—A Case Report
Authors: Rosene Audrey C. , Gaspar Jaymee L.
Published: February 2018

The warfarin management strategy for a mechanical mitral valve patient initiated on a ritonavir-based hepatitis C treatment regimen is described. A 62-year-old male with a past medical history of hepatitis C genotype 1a and stable warfarin dose history was initiated on a concomitant Viekira Pak® (VP) regimen containing ritonavir. Prior to initiation of the VP for hepatitis C treatment, the patient was stable on a warfarin dose of 40 mg/wk for 5 months. During treatment with VP, the patient experienced a markedly decreased international normalized ratio (INR) and warfarin requirements ultimately increased 125% from baseline (90 mg/wk). Effective anticoagulation management throughout and surrounding the treatment period for hepatitis C involved frequent warfarin dose adjustments, including preemptive changes, close monitoring, and repeated use of enoxaparin to ensure adequate thrombotic prophylaxis. This is believed to be the first reported case describing the management of warfarin in a patient with hepatitis C who received VP and required a drastically increased weekly warfarin dose. The possible mechanisms suggestive of this interaction and similar case reports in the literature are discussed.
Hospital Ownership Type and Innovation: The Case of Electronic Medical Records Adoption
Authors: Freedman Seth , Lin Haizhen
Published: February 2018

Nonprofit and for-profit firms coexist in many industries, with the hospital sector being one of the most predominant examples. This article explores whether nonprofit hospitals are more likely to make expensive investments with uncertain returns and potential public good value. Specifically, we estimate differences in the adoption of electronic medical records (EMRs) by ownership structure. We find that nonprofit hospitals are 11 to 18 percentage points more likely to have installed advanced EMR systems than for-profit hospitals by 2012. Although we find little difference in the likelihood of meeting initial government requirements for the “meaningful use” of EMRs, we find that nonprofits are 12 percentage points more likely to reach more stringent meaningful use standards that began in 2014. That being said, nonprofit adoption rates decrease as for-profit market penetration rates increase, suggesting nonprofits are less likely to adopt an uncertain technology when facing more direct competition from for-profit hospitals.
The lupus patient with positive rheumatoid factor
Authors: Fedrigo A , dos Santos T A F G , Nisihara R , Skare T
Published: February 2018

Background

Patients with systemic lupus erythematosus (SLE) may form clusters with clinical manifestations and autoantibodies.

Objective

The objective of this report is to study whether SLE patients with positive rheumatoid factor (RF) have a special clinical and/or serological profile.

Methods

A retrospective study of 467 SLE patients seen at a single rheumatology unit was conducted. Epidemiological data (age, gender, age at disease onset, ethnic background and tobacco use), clinical data (malar rash, photosensitivity, oral ulcers, discoid lesions, serositis, glomerulonephritis, convulsions, psychosis, hemolytic anemia, leukopenia, lymphocytopenia, arthritis and hypothyroidism) and serological profile (anti-dsDNA, anti-Ro/SS-A, anti-La/SS-B, anti-RNP, anti-Sm, IgG aCL, IgM aCL, lupus anticoagulant, direct Coombs and RF) were collected. Patients with positive and negative RF were compared.

Results

RF was found in 24.9% of the sample. In univariate analysis, RF was positively associated with butterfly rash ( p = 0.04), anti-Ro ( p = 0.03), anti-Sm antibodies ( p = 0.01) and hypothyroidism ( p = 0.01) and negatively associated with glomerulonephritis ( p = 0.003). Logistic regression showed that only glomerulonephritis ( p = 0.03; OR = 0.45; 95% CI = 0.21–0.93) and anti-Ro ( p = 0.009; OR = 2.3; 95% CI = 1.24–4.57) were independent associations.

Conclusion

In our sample RF was associated with protection from glomerulonephritis and with higher prevalence of anti-Ro antibodies.
Modernizing the Military: Promoting a New ‘Brand Image’ of the British Army, Navy, and Air Force in the Post-National Service Era, 1957–63
Authors: Maartens Brendan
Published: February 2018

The 1957 Defence White Paper is widely regarded as a milestone in British military history, not least because it heralded the end of post-war conscription or National Service. The impact of the paper on the higher aspects of Britain’s defence policy, and on the nation’s place in Europe and the wider world, has been well documented. Yet little is known about how the armed forces responded to the reforms with a series of large-scale military recruitment campaigns to boost their annual intake of volunteers. The gradual phasing out of conscription placed new pressures on the Army, Navy, and Air Force, and this article explores how they sought to manage the transition from a partly conscripted to an all-professional system in 1957–63. Exploring a range of promotion carried in newspapers, films, newsreels, and broadcast media, it shows how recruiters drew on prevailing ideas of youth, modernity and affluence to try to entice a new generation of volunteers to the military.
Planning Telehealth for Older Adults With Atrial Fibrillation in Rural Communities: Understanding Stakeholder Perspectives
Authors: Rush Kathy L. , Hatt Linda , Gorman Nicole , Janicki Louann , Polasek Petr , Shay Matt
Published: February 2018

Older adults with atrial fibrillation (AF) in rural communities have less access to cardiac specialty care. Telehealth offers a viable approach to provide cardiac care, yet little is known about patients’ and providers’ views on telehealth’s potential to support rural patients with AF. This qualitative descriptive study examines patient and health providers’ perspectives, an important first step in planning a telehealth initiative. Eight patients with AF, along with one partner from rural communities, were recruited through an urban-based AF clinic. Five providers were recruited through professional practice leads in the health region. Semistructured telephone interviews were conducted with both stakeholder groups. The overriding theme was variability in patient and provider receptiveness to telehealth. Receptiveness reflected differences in past experience with telehealth, in perceived adequacy of rural health services, and in perceived gaps in AF care. These are important considerations in planning effective and sustainable telehealth in rural communities.
Active Presurgical Infant Orthopedics for Unilateral Cleft Lip and Palate
Authors: Kornbluth Michelle , Campbell Richard E. , Daskalogiannakis John , Ross Elizabeth J. , Glick Patricia H. , Russell Kathleen A. , Doucet Jean-Charles , Hathaway Ronald R. , Long Ross E. , Sitzman Thomas J.
Published: February 2018

Objective:

To compare dental arch relationship, craniofacial form, and nasolabial aesthetic outcomes among cleft centers using distinct methods of presurgical infant orthopedics (PSIO).

Design:

Retrospective cohort study.

Setting:

Four cleft centers in North America.

Patients:

One hundred ninety-one children with repaired complete unilateral cleft lip and palate (CUCLP).

Main Outcome Measures:

Dental arch relationship was assessed using the GOSLON Yardstick. Craniofacial form was assessed by 12 cephalometric measurements. Nasolabial aesthetics were assessed using the Asher-McDade system. Assessments were performed between 6 and 12 years of age.

Results:

The center that used no PSIO achieved the most favorable dental arch relationship and maxillomandibular relationship, with a median GOSLON score of 2.3 ( P < .01) and an ANB angle of 5.1° ( P < .05). The proportion of children assigned a GOSLON score of 4 or 5, predictive of the need for orthognathic surgery in adolescence, was 16% at the center that used no PSIO and no secondary surgery, compared to 76% at the centers that used the Latham appliance and early secondary lip and nose surgery ( P < .01). The center that used no PSIO and no secondary surgery achieved significantly less favorable nasolabial aesthetic outcomes than the centers using Latham appliance or nasoalveolar molding (NAM) ( P < .01).

Conclusions:

Effects of active PSIO are multifaceted and intertwined with use of revision surgery. In our study, centers using either the Latham appliance combined with early revision surgery or the NAM appliance without revision surgery achieved better nasolabial aesthetic outcomes but worse maxillary growth, compared to a center using no PSIO and secondary surgery.
Functional Outcomes of Symptomatic Implant Removal Following Ankle Fracture Open Reduction and Internal Fixation
Authors: Williams Benjamin R. , McCreary Dylan L. , Chau Michael , Cunningham Brian P. , Pena Fernando , Swiontkowski Marc F.
Published: February 2018

Background:

Orthopedic implant removal following open reduction internal fixation of a fracture is a common procedure, especially in the foot and ankle. The purpose of this study was to evaluate functional change after the removal of symptomatic implants following ankle fracture open reduction internal fixation (ORIF) using the Short Musculoskeletal Function Assessment (SMFA) outcome score. We hypothesized that implant removal after ankle fracture would result in improved functional outcomes.

Methods:

Retrospective review of prospectively collected data on patients with a closed ankle fracture between 2013 and 2016 was performed. Inclusion criteria were skeletal maturity, symptomatic ankle implants and completion of the SMFA questionnaire prior to and 6 months after removal. Exclusion criteria were development of a nonunion, prior or current infection, peripheral neuropathy or ongoing litigation surrounding the surgery. The primary outcome was change in SMFA score from baseline to follow-up using Wilcoxon signed-rank test. Additional logistic regression models evaluated the effects of age, sex, body mass index, smoking status, and patient American Society of Anesthesiologists scores.

Results:

The study population consisted of 43 patients. There was a statistically significant improvement in function, represented by a decrease in SMFA scores from baseline to the 6-month follow-up period (∆ = −4.1 [95% confidence interval, −7.0, −1.3]; P = .003). Secondary outcome measures of the bother index and daily activities domain also demonstrated significant improvements ( P = .005 and P = .002, respectively). Additional logistical regression models identified no significant effects by assessed covariates for change in SMFA scores.

Conclusion:

Patients with symptomatic implants following ankle fracture ORIF had a statistically significant improvement in function following implant removal. There appears to be value in removing implants from the ankle in patients who report discomfort during daily activities. Further investigation into the specific indications for implant removal and the impact of injury and fracture pattern on outcomes is warranted.

Level of Evidence:

Level IV, case series.
Gender Matters for Literacy Research Organizations
Authors: Wickens Corrine M.
Published: February 2018

Drawing from sociological and economic analyses of gender and work, this column explores issues of occupational gender segregation, privilege, and devaluation. Comparisons are made with increased female achievement at all levels in postsecondary education. The questions are then raised: If cultural devaluation of women and activities remains persistent and widespread, what might be the implications for literacy researchers and literacy research organizations that are comprised mostly of women? How might such research be received and perceived by policymakers? The column concludes by advocating for increased attention to cultural beliefs in gender essentialism and the ramifications thereof to make meaningful contributions to literacy practice.
Anatomical Pathology of the Umbilical Cord and Its Maternal and Fetal Clinical Associations in 434 Newborns
Authors: Olaya-C Mercedes , Gil Fabian , Salcedo Juan D , Salazar Ana J , Silva Jaime L , Bernal Jaime E
Published: February 2018

Introduction

Umbilical cord (UC) abnormalities and their clinical relations in 434 newborns were analyzed. We had previously reported on clinical associations of long and short UCs with any kind of malformation. This study focuses on other UC features (insertion, vessels, entanglements, coiling, and knots) and their associations with clinical characteristics and neonatal prognosis.

Methods

An observational analytic study was performed on placentas from consecutive deliveries. Ordered logistic regression with bivariate and multivariate analysis was performed to evaluate the relationship between variables of interest concerning UC abnormalities.

Results

A total of 434 placentas made up the study. UC abnormalities were abnormal insertion, 82 (18.86%); coiling (hypo and hypercoiled), 177 (40.78%); single umbilical artery (SUA), 4 (0.92%); entanglements, 8 (1.84%); true knots, 3 (0.69%); webs in UC base, 9 (2.07%); and right twist, 68 (15.67%). After analyzing maternal and fetal complications during pregnancy, multivariate analysis confirmed the recognized association between malformations and SUA and male gender; further confirmation was also made between hypertensive disorders of pregnancy and true knots.

Discussion

UC abnormalities associated with undesirable outcomes are varied and should be recognized and described. Clinical factors associated with anatomical UC abnormalities are not completely understood and justify forthcoming studies.
Graded negative Poisson’s ratio honeycomb structure design and application
Authors: Fang Guodong , Yuan Shenggang , Meng Songhe , Liang Jun
Published: February 2018

A sub-domain size optimization method is conducted to design degraded negative Poisson’s ratio honeycomb structures, which could fully utilize the material behavior, such as minimum weight, maximum stiffness and maximum strength etc. The flexural stiffness of negative Poisson’s ratio honeycomb structure is greatly associated with the geometry size, which are obtained by geometry size parameter analysis from the representative volume cell of negative Poisson’s ratio honeycomb sandwich structure. A three-point bending specimen is designed by sub-domain size optimization method, which is verified by bending experiments. The optimal three-point bending specimen with graded negative Poisson’s ratio honeycomb core have the largest bearing capacities and relatively lower weight. The variable thickness wing structure with graded negative Poisson’s ratio honeycomb core is also designed by using the sub-domain size optimization method.
A Comprehensive Study of De Novo Genome Assemblers: Current Challenges and Future Prospective
Authors: Khan Abdul Rafay , Pervez Muhammad Tariq , Babar Masroor Ellahi , Naveed Nasir , Shoaib Muhammad
Published: February 2018

Background:

Current advancements in next-generation sequencing technology have made possible to sequence whole genome but assembling a large number of short sequence reads is still a big challenge. In this article, we present the comparative study of seven assemblers, namely, ABySS, Velvet, Edena, SGA, Ray, SSAKE, and Perga, using prokaryotic and eukaryotic paired-end as well as single-end data sets from Illumina platform.

Results:

Results showed that in case of single-end data sets, Velvet and ABySS outperformed in all the seven assemblers with comparatively low assembling time and high genome fraction. Velvet consumed the least amount of memory than any other assembler. In case of paired-end data sets, Velvet consumed least amount of time and produced high genome fraction after ABySS and Ray. In terms of low memory usage, SGA and Edena outperformed in all the assemblers. Ray also showed good genome fraction; however, extremely high assembling time consumed by the Ray might make it prohibitively slow on larger data sets of single and paired-end data.

Conclusions:

Our comparison study will provide assistance to the scientists for selecting the suitable assembler according to their data sets and will also assist the developers to upgrade or develop a new assembler for de novo assembling.
Pain Management: Time to Minimize Variations in Practice
Authors: Bharadwaj Parag , Sheehan Brynn E , Dodani Sunita , von Gunten Charles F
Published: February 2018

There continue to be great variations in the management of pain in palliative care. Efforts need to be made within the field develop strategies to address this to avoid undue distress in patients.
Data Mining of Small RNA-Seq Suggests an Association Between Prostate Cancer and Altered Abundance of 5′ Transfer RNA Halves in Seminal Fluid and Prostatic Tissues
Authors: Dhahbi Joseph M , Atamna Hani , Selth Luke A
Published: February 2018

Extracellular RNAs are gaining clinical interest as biofluid-based noninvasive markers for diseases, especially cancer. In particular, derivatives of transfer RNA (tRNA) are emerging as a new class of small-noncoding RNAs with high biomarker potential. We and others previously reported alterations in serum levels of specific tRNA halves in disease states including cancer. Here, we explored seminal fluid for tRNA halves as potential markers of prostate cancer. We found that 5′ tRNA halves are abundant in seminal fluid and are elevated in prostate cancer relative to noncancer patients. Importantly, most of these tRNA halves are also detectable in prostatic tissues, and a subset were increased in malignant relative to adjacent normal tissue. These findings emphasize the potential of 5′ tRNA halves as noninvasive markers for prostate cancer screening and diagnosis and provide leads for future work to elucidate a putative role of the 5′ tRNA halves in carcinogenesis.
Cardiovascular Risk Factors and Atherogenic Indices in an Iranian Population: Birjand East of Iran
Authors: Kazemi Toba , Hajihosseini Morteza , Moossavi Maryam , Hemmati Mina , Ziaee Masood
Published: February 2018

Introduction: The alteration in serum lipid profile; increase in total cholesterol (TC), triacylglycerol (TAG), and low-density lipoprotein cholesterol (LDL-C); and reduction in high-density lipoprotein cholesterol (HDL-C) are key factors in cardiovascular disease progression. The high prevalence and severity of cardiovascular diseases require new screening tools for better evaluation. Atherogenic index (AI) (LDL-C/HDL-C) and coronary risk index (CRI) (TC/HDL-C) can be strong markers for predicting the risk of atherosclerosis and coronary heart disease and disclose the presence of LDL or TAG in the serum of related patients. To implement this strategy, the AIs and CRIs in our population were assessed. In this study, a total of 5207 subjects were recruited and AIs and CRIs were calculated for all of them. According to our data, age, body mass index, sex, as well as CRI and AI had affirmative correlation with TC, LDL-C, TAG, systolic blood pressure, and diastolic blood pressure. By increasing these factors, AIs and CRIs were augmented. Moreover, in situations where all atherogenic parameters are normal, these parameters may be the alternative screening tool.
Online memories of 1980s–2000s lifestyle and consumption politics in Greece during the current economic crisis (2009–2015)
Authors: Zestanakis Panagiotis
Published: February 2018

Lifestyle media very successfully promoted (conspicuous) consumption as a major referent in the social and cultural convergence between Greece and Western Europe between the mid-1980s and the late 2000s. Perceiving the Internet as a crucial component of the contemporary public sphere where testimonial cultures abound, this article explores how during the current economic crisis particular communities of web users dealt with the breakdown of previous consumer certainties, placing emphasis on the downfall of the lifestyle media industry and on how and why publisher Petros Kostopoulos is discussed as a metonym of this media field. Using comments published below articles about the collapse of lifestyle in popular media and posts in a popular men’s forum, the article examines the uses  of contemporary history in the construction of arguments about the origins of the current crisis and explores how the dismantlement of recent consumer utopias echoed questions of Europeanization and often carried traumatic loads.
The map is not the territory: Applying qualitative Geographic Information Systems in the practice of activist archaeology
Authors: O’Rourke Michael JE
Published: February 2018

In response to concerns regarding the social relevance of North American archaeology, it has been suggested that the tenets of ‘activist scholarship’ can provide a framework for a more publically engaged archaeological discipline. Maps have long been employed in the public dissemination of archaeological research results, but they can also play a role in enhancing public participation in heritage management initiatives. This article outlines how the goals of activist archaeology can be achieved through the mobilization of qualitative Geographic Information Systems practices, with an example of how ‘grounded visualization’ methods were employed in assessing the vulnerability of Inuvialuit cultural landscapes to the impacts of modern climate change.
Local Antibiotic Delivery Systems: Current and Future Applications for Diabetic Foot Infections
Authors: Markakis Konstantinos , Faris Alan Robert , Sharaf Hamed , Faris Barzo , Rees Sharon , Bowling Frank L.
Published: February 2018

Foot infections are common among diabetic patients with peripheral neuropathy and/or peripheral arterial disease, and it can be the pivotal event leading to a minor or major amputation of the lower extremity. Treatment of diabetic foot infections, especially deep-seated ones, remains challenging, in part because impaired blood perfusion and the presence of biofilms can impair the effectiveness of systemic antibiotics. The local application of antibiotics is an emerging field in the treatment of diabetic foot infections, with demonstrable advantages. These include delivery of high concentrations of antibiotics in the affected area, limited systemic absorption, and thus negligible side effects. Biodegradable vehicles, such as calcium sulfate beads, are the prototypical system, providing a good elution profile and the ability to be impregnated with a variety of antibiotics. These have largely superseded the nonbiodegradable vehicles, but the strongest evidence available is for calcium bead implantation for osteomyelitis management. Natural polymers, such as collagen sponge, are an emerging class of delivery systems, although thus far, data on diabetic foot infections are limited. There is recent interest in the novel antimicrobial peptide pexiganan in the form of cream, which is active against most of the microorganisms isolated in diabetic foot infections. These are promising developments, but randomized trials are required to ascertain the efficacy of these systems and to define the indications for their use. Currently, the role of topical antibiotic agents in treating diabetic foot infections is limited and outside of routine practice.
A New Needle Holder Design to Facilitate Intracorporeal Knot Tying
Authors: Sipahi Mesut , Arslan Ergin
Published: February 2018

Purpose. Intracorporeal knot tying in laparoscopic surgery continues to be a problem especially for beginners and inexperienced surgeons. A wide-angle needle holder was designed to make the knot maneuver easier while also ensuring that the knot does not come out of the needle holder. In this study, it was planned to compare the wide-angle needle holder with the classic needle holder in regard to knot tying time. Material and method. A total of 11 male volunteers were randomly selected from freshmen students of the faculty of medicine, who had no experience of surgery or laparoscopic surgery. After the required training and practice, candidates were asked to tie 3 knots each in the training box using a classic needle holder and a wide-angle needle holder. Their knot tying times were recorded. Results. Although the students had no experience, it was observed that they tied knots more easily and more comfortably using the wide-angle needle holder. It was found that the knot tying times with the wide-angle needle holder were quite short compared with the classic needle holder in all candidates. This difference was also statistically significant ( P = .01). Conclusion. We believe and claim that the use of a wide-angle needle holder during knot tying in laparoscopic surgery can facilitate knot tying and shorten the duration of the knotting, especially for inexperienced surgeons.
Cognitive Function in Cardiac Patients: Exploring the Occupational Therapy Role in Lifestyle Medicine
Authors: Norris Jennifer
Published: February 2018

Patients with cardiac dysfunction are at increased risk of mild cognitive impairment, which can affect their ability to successfully engage in daily activities important for home and community safety and in maintaining health and well-being. This risk increases in accordance with the number of cardiac conditions and cardiovascular risk factors or comorbidities. Occupational therapy has a role in chronic disease management in assessing and improving functional abilities affected by physical, emotional, and cognitive domains. With a holistic and client-centered approach, occupational therapy can complement lifestyle medicine principles through promotion and enablement of engagement in purposeful activity and self-management practices. It is suggested that the clinical management of patients with cardiac dysfunction expands beyond the traditional physical aspects of care to encompass cognitive considerations and incorporate occupational therapy in practice.
Cut stroke in half: Polypill for primary prevention in stroke
Authors: Brainin Michael , Feigin Valery , Martins Sheila , Matz Karl , Roy Jayanta , Sandercock Peter , Teuschl Yvonne , Tuomilehto Jaakko , Wiseman Anita
Published: February 2018

This review summarizes the potential for polypill therapies for stroke prevention. While a number of studies applying different approaches regarding polypill have been performed, none of them has had a focus on stroke as the main outcome. A combination pill containing drugs such as statins, diuretics, and other antihypertensives is currently available in various formats. Estimates focusing mostly on primary prevention show that using such a combination drug a reduction in the 5-year stroke incidence by 50% can be achieved – especially in low- and middle-income countries with a high prevalence of risk factors even among people at young ages. A combination of a large supporting population-wide program with a registry-based quality control is the most likely perspective and can be achieved within a reasonable time frame and potentially have significant influence in young stroke populations.
The Internet as a global good: UNESCO’s attempt to negotiate an international framework for universal access to cyberspace
Authors: Pohle Julia
Published: February 2018

The article analyzes one of the earliest intergovernmental initiatives regarding Internet constitutionalism. Based on an analytical framework that combines argumentative discourse analysis with elements from actor–network theory, it assesses the actors and discourses involved in the preparation of an international recommendation on universal access to the Internet, adopted by the United Nations Educational, Scientific, and Cultural Organization (UNESCO) in 2003. During the contentious negotiations, UNESCO had to find a balance between the divergent positions of its member states and to account for the different levels of technological development amongst them. By retracing the performative and discursive struggles that UNESCO had to face to reach consensus, the article contributes to the general understanding of ideas and practices behind Internet policy making in international settings.
Flexor tendon repair in the hand with the M-Tang technique (without peripheral sutures), pulley division, and early active motion
Authors: Giesen Thomas , Reissner Lisa , Besmens Inga , Politikou Olga , Calcagni Maurizio
Published: February 2018

We report outcomes in 29 patients with flexor tendon repairs in 32 digits (five thumbs and 27 fingers) with our modified protocols. We repaired the lacerated flexor digitorum profundus tendons with core suture repairs using the 6-strand M-Tang method and without circumferential sutures. We divided the pulleys as much as needed to allow excursion of the repaired tendons, including complete division of the A4 or A2 pulleys when necessary. In nine fingers, we repaired one slip of the flexor digitorum superficialis tendon and resected the other half. When the flexor digitorum profundus tendon would not glide under the A2 pulley, we excised the remaining slip of the flexor digitorum superficialis tendon. The wrist was splinted in mild extension post-surgery with early commencement of tenodesis exercises. No tendon repair ruptured. By the Strickland criteria, out of 27 fingers, 18 had excellent, six had good, two had fair, and one had poor results. We conclude that a strong core suture (such as the M-Tang repair) without peripheral sutures, and with division of pulleys as necessary is safe for early active motion and yields good outcomes.

Level of evidence: IV
A cyclic testing comparison of two flexor tendon repairs: asymmetric and modified Lim-Tsai techniques
Authors: Lim Rebecca Q. R. , Wong Yoke-Rung , Loke Austin M. K. , Tay Shian-Chao
Published: February 2018

This study compared the biomechanical performance of a novel 6-strand asymmetric flexor tendon repair with the modified Lim-Tsai technique using cyclic testing. Two groups of ten porcine tendons each were repaired and tested. Gap formation at every 100 cycles was measured. Survival was defined as maximum gap formation below 2 mm. All the repairs survived Stage I. With increased cyclic load in Stage II, the mean gap formation of modified Lim-Tsai repairs exceeded 2 mm at the 600th cycle and reached 4.2 mm (SD 1.93) at the end of Stage II, resulting in 0% survival. The mean gap formation of asymmetric repairs reached 2.0 mm (SD 1.43) at the 800th cycle and was 2.4 mm (SD 1.52) at the end of Stage II, with 60% survival. The asymmetric repair has better biomechanical performance under cyclic testing as compared with the modified Lim-Tsai repair.
New findings about the intrascaphoid arterial system
Authors: Xiao Zirun , Xiong Ge , Zhang Weiguang
Published: February 2018

We investigated the intraosseous arteries of six normal cadaveric scaphoids using red lead injection and three-dimensional reconstruction with micro-computed tomography. The arterial entrances were generally located around the dorsal ridge, the insertion of the scaphocapitate ligament and the radial part of the radioscaphocapitate ligament. Two to three trunk arteries entered the scaphoid on dorsal ridge at the level of the waist. The distal part of the scaphoid was mainly supplied by arteries from the waist. The blood supply of about 40% of proximal part of the scaphoid was poor. The blood supply from the scaphoid dorsal ridge plays an important role, not only for the proximal part of the scaphoid, but also for the waist and even the distal pole. The intrascaphoid arterial pattern may be contributory to nonunion, especially in proximal pole fractures.
Entry on “Accreditation” for Dictionnaire de sociologie clinique
Authors: Fleischer Michael S. , Winston Norma A.
Published: February 2018

This reprint presents a brief history and overview of the Commission on the Accreditation of Programs in Applied and Clinical Sociology (CAPACS), specifically in the context of global higher education accreditation; the increasing demand to accredit disciplinary and professional programs in the social and behavioral sciences as a process of external quality review; and the oversight of higher education accreditation commissions. Particular attention focuses on the creation of CAPACS in 1995 (originally known as the Commission on Applied and Clinical Sociology or CACS), as a joint initiative of the Society for Applied Sociology (SAS) and the Sociological Practice Association (SPA), which merged in 2006, to form the Association for Applied and Clinical Sociology (AACS); CAPACS accreditation standards; and the benefits of CAPACS Program accreditation in the discipline of Sociology and the profession of sociological practice. Reprint of “Accréditation,” in Vandevelde-Rougale Agnés & Pascal Fugier (eds.), Dictionnaire de sociologie clinique, Toulouse, ERES, to be published in 2018.
Comparison of the Ecological Value of Sacred and Nonsacred Community Forests in Kaboli, Togo
Authors: Lynch Lauren , Kokou Kouami , Todd Susan
Published: February 2018

Despite Togo's naturally low forest cover and high rates of deforestation, remnant forest patches play an important role in conserving biodiversity and ensuring the well-being of the country's human population. Many of these remnant forest patches are sacred forests, ecosystems that are increasingly threatened because of changes in belief systems which have accompanied westernization. This study compares the ecological value and level of degradation of two sacred forests with an otherwise similar control forest that does not contain a sacred site based on characteristics including tree cover, vegetation composition, biodiversity, and biomass. The sacred forests had a significantly higher percentage of tree cover, higher biodiversity, and a greater biomass than the forest that did not contain a sacred site. In addition, dominant species within the sacred forests were associated with deciduous dry forest ecosystems while dominant species within the forest not containing a sacred site were introduced plantation species and species associated with savanna ecosystems. These results indicate that sacred forests in Kaboli, Togo, have a higher ecological value and are less degraded than similar community forests that do not contain a sacred site. This important role of sacred sites in forest conservation suggests that feedback loops exist between social and ecological systems, and that both need to be considered together to achieve effective development of forest conservation strategies.
Influence of Land-Use Changes (1993 and 2013) in the Distribution of Wild Edible Fruits From Veracruz (Mexico)
Authors: Benítez-Badillo Griselda , Lascurain-Rangel Maite , Álvarez-Palacios José Luis , Gómez-Díaz Jorge Antonio , Avendaño-Reyes Sergio , Dávalos-Sotelo Raymundo , López-Acosta Juan Carlos
Published: February 2018

Wild edible fruits are a complement to the diet, generate income, and contain cultural values for local populations. In Mexico, their presence is threatened mainly by deforestation. The purpose of this work was to evaluate the distribution of 106 wild edible fruits from Veracruz state in several vegetation types and consider the effect of land-use changes on species distribution between 1993 and 2013. Seven species with the least number of herbarium specimens were chosen in order to estimate the current and potential distribution using Maxent models. The types of vegetation with the largest number of wild edible fruit species were the evergreen tropical rainforest with 64, deciduous tropical forest with 51, and the mountain cloud forest with 33. The largest loss between 1993 and 2013 was in secondary vegetation (0.19%) and evergreen tropical rainforest (0.11%). The main causes are the increment in human settlements and pasture, and grazing land (originally populated by tropical forests)—both factors that could put at risk, in the near future, most of the species studied. All of the species with restricted distribution in Veracruz showed a tendency to shrink in area, particularly the piñón ( Pinus cembroides) and nuez de castilla ( Juglans pyriformis), both of economic importance. In the face of land-use changes, conservation strategies must be designed in accordance with rational use and public policies that promote a sustainable management of wild edible fruits and the forests in which they grow.
Risk factors for fingolimod-induced lymphopenia in multiple sclerosis
Authors: Ohtani Ryohei , Mori Masahiro , Uchida Tomohiko , Uzawa Akiyuki , Masuda Hiroki , Liu Jia , Kuwabara Satoshi
Published: February 2018

Background

Lymphopenia is a well-known adverse event of fingolimod, a disease-modifying drug for multiple sclerosis (MS).

Objectives

The objective of this paper is to investigate risk factors for predicting fingolimod-induced lymphopenia in MS by frequent hematological monitoring.

Methods

We retrospectively reviewed data of fingolimod-treated MS patients. Data assessed were sex, age, disease duration, medication history, body mass index, all attacks, Kurtzke’s Expanded Disability Status Scale score, and absolute lymphocyte count (ALC) within two days before initiating fingolimod (baseline), on the day after first administration (day 2), and at least every other month after initiating fingolimod therapy.

Results

Of 41 MS patients, marked lymphopenia (ALC <200/µl) was confirmed in 12 patients (lymphopenia group) within one year. A significantly more frequent history of treatment with any interferon-beta and lower median baseline ALC was observed in the lymphopenia group than in the non-lymphopenia group ( n = 29) (91.7% vs. 44.8%; p = 0.006 and 1469/µl vs. 1879/µl; p = 0.005). An ALC of ≤952/μl on day 2 was the most responsible risk factor for predicting marked lymphopenia (sensitivity, 92%; specificity, 76%; area under the curve, 0.823; p < 0.001).

Conclusions

Low baseline ALC and treatment history with any interferon-beta were risk factors for fingolimod-induced lymphopenia, possibly predicted from ALC on day 2.
Advanced Metrics for Assessing Holistic Care: The “Epidaurus 2” Project
Authors: Foote Frederick O , Benson Herbert , Berger Ann , Berman Brian , DeLeo James , Deuster Patricia A. , Lary David J , Silverman Marni N. , Sternberg Esther M
Published: February 2018

In response to the challenge of military traumatic brain injury and posttraumatic stress disorder, the US military developed a wide range of holistic care modalities at the new Walter Reed National Military Medical Center, Bethesda, MD, from 2001 to 2017, guided by civilian expert consultation via the Epidaurus Project. These projects spanned a range from healing buildings to wellness initiatives and healing through nature, spirituality, and the arts. The next challenge was to develop whole-body metrics to guide the use of these therapies in clinical care. Under the “Epidaurus 2” Project, a national search produced 5 advanced metrics for measuring whole-body therapeutic effects: genomics, integrated stress biomarkers, language analysis, machine learning, and “Star Glyphs.” This article describes the metrics, their current use in guiding holistic care at Walter Reed, and their potential for operationalizing personalized care, patient self-management, and the improvement of public health. Development of these metrics allows the scientific integration of holistic therapies with organ-system-based care, expanding the powers of medicine.