bluuebunny/crossref_metadata_2025 huggingface dataset:
Dizziness on Airplane
Authors: Pitman Justin T.
Published: December 2018

There is a broad differential for dizziness in any environment. Assessing a thorough history, concurrent medical problems, and careful physical examination can often narrow the possible causes significantly. In the setting of ear pain and recent altitude or pressure change, barotrauma should be suspected. Although most care is supportive, including the use of nonsteroidal anti-inflammatory drugs, the Frenzel maneuver and decongestants can help equilibrate inner ear and atmospheric pressures. This chapter examines the case of a woman who presents to the emergency room with ear pain following a recent airplane trip and addresses the patient history, details of the physical exam, diagnosis, and treatment plan.
Out of Hospital Cardiac Arrest
Authors: Rueckmann Erik
Published: December 2018

The management of out-of-hospital, atraumatic cardiac arrest has changed over the past decade. This case details the evidence-based changes in care that optimize the chance of neurologically intact survival. The key factors include immediate, continuous, high-quality cardiopulmonary resuscitation with minimal interruptions, early defibrillation, and the use of capnography to assess resuscitative efforts. The orchestration of resuscitative efforts is a bundle of care that must all be met to provide the patient the best chance of survival. Furthermore, this case illustrates the key points of postarrest care and touches on termination of resuscitation. This chapter examines the case of emergency medical services call for an unresponsive patient in cardiac arrest on arrival.
Cat Bite
Authors: Casey Martin
Published: December 2018

This case reviews the basics in caring for patients with animal bites. Specifically, the chapter will demonstrate a case of flexor tenosynovitis, a severe hand infection that may be the result of common animal bites. Critical steps will be reviewed including identifying the severity of injury and when consultation for invasive management, such as surgery, may be indicated. Wound closure, antibiotic choice, and indications for rabies prophylaxis are discussed as well. The chapter focuses on a case of a cat bite. The patient presents to the emergency room with a 1-day prior cat bite. The chapter reviews her symptoms, such as swelling, pain, and erythema.
Dyspnea
Authors: Joyce Michael
Published: December 2018

The case covers the diagnosis and treatment of a rare but potentially life-threatening complication of surgery: pulmonary embolism. Despite prophylaxis, the diagnosis of pulmonary embolism should be considered in any patient who has acute decompensation postoperatively. Initiation of therapy once the diagnosis is thought to be likely is imperative to prevent further clot formation. Common clinical presentation, diagnostic tests, and therapy options are discussed, as well as the use of bedside echocardiogram to assist in the diagnosis. The best treatment option for postoperative patients is shorter acting and potentially reversible unfractionated heparin. Thrombolytic therapy should be considered for patients who have evidence of hemodynamic compromise.
Anemia
Authors: Li Kathleen
Published: December 2018

This case highlights the identification and management of acute blood loss anemia in the intensive care unit setting. It reviews common presentations of anemia and pertinent history and exam findings in cases of suspected anemia. Key management points include recognizing common risk factors for bleeding, identifying potential sources of bleeding, obtaining appropriate lab testing (including complete blood count, coagulation factors, and type and cross), assessing the need for blood transfusion, and initiating timely consultation with appropriate services such as gastroenterology to address the source of bleeding. In addition, this case provides an overview of indications for blood transfusion, commonly accepted transfusion thresholds, and risks associated with blood product transfusion.
Focal Weakness
Authors: Tozer Jordan
Published: December 2018

The case illustrates how to approach the management of intracranial hemorrhage related to severe hypertension. Early recognition is the key initial step, which will mediate downstream management and help distinguish this entity from mimics such as ischemic cerebrovascular accident, encephalopathy, and hypoglycemia. Management of intracranial hypertensive hemorrhage is predicated upon tight blood pressure control, reducing intracranial pressure, and possible neurosurgical intervention. Prognosis is uniformly poor, even when recognized early. Key management issues include the consideration of hypoglycemia in the differential diagnosis, obtaining an emergent noncontrast head computer tomography scan in a patient with stroke-like symptoms, and rapid blood pressure management.
Abdominal Pain
Authors: Blackman Rachelle
Published: December 2018

Splanchnic vein thrombosis (SVT) is an uncommon presentation of acute thrombosis; however, it can have serious complications, including bowel or splenic ischemia, portal hypertension, and bleeding. Clinical features can vary from asymptomatic to nausea, vomiting, and/or severe abdominal pain out of keeping with physical examination. This chapter illustrates the presentation of acute SVT in the setting of inflammatory bowel disease (IBD). Risk factors for SVT include IBD, malignancy, intra-abdominal sepsis or surgery, intra-abdominal inflammatory states, thrombophillic conditions, and liver disease. The ideal imaging modality is abdominal computed tomography (CT). Anticoagulation is the primary treatment of choice in most cases of SVT.
Blistering Rash
Authors: Sutherland Ashley
Published: December 2018

This case reviews an eruption of herpes zoster (shingles) in an inpatient. It examines the clinical presentation, pathophysiology, and treatment of this condition. Herpes zoster is an acute, painful vesiculobullous eruption that is seen most commonly in older adults in the setting of previous exposure to varicella zoster virus. Classic features include painful vesicles on well-defined erythema, typically confined to a single dermatome. Initiation of antiviral therapy within 72 hours of the onset of skin lesions is given to reduce the duration of the eruption and decrease the incidence of postherpetic neuralgia. This case will also review how herpes zoster differs from other cutaneous eruptions that may look similar, such as herpes simplex or Stevens Johnson syndrome.
Crying Infant
Authors: Black Caroline
Published: December 2018

This chapter reviews the most common pediatric arrhythmia, supraventricular tachycardia (SVT). SVT often presents as fussiness in infants as well as other symptoms concerning for congenital heart failure, sepsis, gastrointestinal obstruction, or physical conditions such as hair tourniquets. It also reviews recognition of tachycardia with associated electrocardiogram waveform abnormalities (narrow QRS complex, absent P waves) consistent with SVT. It examines key aspects in the evaluation of hemodynamic status (perfusion and mental status) and its importance in the recognition and classification of stable versus unstable SVT. It discusses the guidance of management strategy following hemodynamic assessment with use of vagal maneuvers or adenosine in stable SVT and emergent cardioversion in unstable SVT.
Fever in a Child
Authors: Drohan Shannon
Published: December 2018

Acute otitis media (AOM) is a common cause of fever especially in the first two years of life. This condition can be easily diagnosed in a child with an acute illness by presence of middle ear effusion on exam in addition to signs of inflammation revealed by intense erythema or report of otalgia. Recent guidelines recommend a “watchful waiting” approach to treatment in certain patients to help reduce antibiotic usage as most cases of AOM resolve spontaneously. This strategy can be used in children >6 months old with non-severe symptoms, as long as follow-up is ensured to provide a rescue antibiotic if symptoms do not improve within 48-72 hours.
Cervical Fracture Dislocation
Authors: Liounakos Jason , Brusko G. Damian , Wang Michael Y.
Published: December 2018

Cervical spine fractures resulting in a dislocation often occur with a high-energy trauma. Prompt and accurate diagnosis of a fracture can be obtained with a CT scan. Controversy exists as to whether closed reduction should be performed prior to obtaining an MRI due to concerns of traumatic disc herniation. Closed reduction of a fracture with a traumatic disc herniation can potentially worsen a neurologic deficit by creating more severe cord compression. Open or closed reduction of a cervical fracture should be followed by internal fixation. Anterior, posterior, or circumferential fixation should be instituted on a case-by-case basis. Postoperative care in an intensive care unit includes maintaining adequate mean arterial pressure for spinal cord perfusion, and monitoring for signs of neurogenic shock.
Atlantoaxial Instability
Authors: Parish Jonathan M. , Coric Domagoj
Published: December 2018

There are a number of different imaging modalities that can be used to confirm atlantoaxial instability. Plain film radiographs of the cervical spine can be used to assess the atlantodental interval (ADI). Cervical CT is necessary to assess the atlantoaxial bony anatomy as well as to assess the foramen transversarium at C1 and C2. In particular, CT scan should be used to estimate screw length, medial/lateral and cranial/caudal screw trajectory. MRI can also evaluate the extent of cervical cord compression or cord injury that has occurred due to atlantoaxial instability.
Cervical Radiculopathy Due to Central Disc
Authors: Turel Mazda K. , Traynelis Vincent C.
Published: December 2018

Cervical radiculopathy is one of the most common conditions treated by a spine surgeon. Disc herniation usually occurs in patients with mild to moderate degenerative changes.
The initial evaluation includes a careful history, which is important for distinguishing between vascular, infectious, neoplastic, and traumatic etiologies of the symptoms.
In this chapter, with the help of a case illustration, the authors discus the clinical features, radiology management issues, decision-making process, operative options, and postoperative care in a young patient with a cervical disc prolapse. This will serve as an important guide to resident and young neurosurgeons in the optimal management of similar cases.
Lumbar Degenerative Scoliosis
Authors: LaBagnara Michael , Sure Durga R. , Shaffrey Christopher I. , Smith Justin S.
Published: December 2018

Degenerative scoliosis is the most common form of adult scoliosis encountered in clinical practice. The prevalence of this pathology continues to increase in many developed countries as demographics shift to an older population. In contrast to adolescent scoliosis, patients with degenerative scoliosis characteristically present with pain and disability. In the absence of significant or progressive neurological deficits, nonoperative modalities should be considered as first-line treatments. Surgical treatment for degenerative scoliosis may be considered for patients who fail to sufficiently respond to nonoperative treatments, but the decision of whether to pursue surgery should include a detailed discussion of risks versus benefits since these procedures are typically substantial and are associated with relatively high rates of complications. This chapter illustrates the clinical and radiographic assessment as well as management of a typical patient presenting with symptomatic degenerative scoliosis.
Physiological Activity and Artefacts in Epileptic Brain in Subdural EEG
Authors: Diehl Beate , Scott Catherine A.
Published: December 2018

‘Physiological activity and artefacts in epileptic brain in subdural EEG’ reviews intracranial appearances of physiological brain rhythms in each brain region, many of which are also seen on scalp EEG. The alpha rhythm has been described as originating from multiple occipital and extra-occipital cortical generators variously overlapping and influencing each other, probably under the relative control of a central pacemaker. Another more focal pattern has been described in intracranial EEG recordings in the calcarine region, with a third rhythm arising in midtemporal regions, not detectable in scalp EEG, with a frequency in the alpha or theta range. Lambda waves, sleep structures, and mu rhythms over motor cortex can also be detected on subdural electrodes. On a region-by-region basis, intracranial EEG appearances are summarized, including brain oscillations in hippocampus and motor cortex and their modifiers, as well as ongoing rhythms in cingulum. Common sources of physiological and non-physiological artefacts are reviewed.
The Irritative Zone and Seizure Onset Zone in Subdural EEG
Authors: Bauer Sebastian , Rosenow Felix
Published: December 2018

Subdural EEG has a high sensitivity for detecting interictal spikes. The irritative zone is usually more extended than the seizure onset zone. Removal of the entire irritative zone improves outcome in extratemporal as well as neocortical and tumour-related temporal lobe epilepsy, but not in mesial TLE. Quantification of spike features like amplitude, frequency, or latency may help differentiate the localizing and prognostic value of different spike populations. Although EEG patterns are not aetiology, some pathologies such as focal cortical dysplasias are frequently associated with typical EEG patterns, in which case intraoperative electrocorticography should be applied to tailor resections. Presence of a focal seizure onset zone and slow propagation are associated with good surgical outcome. Definition of a sound hypothesis about location of the seizure onset zone from pre-invasive findings is a crucial prerequisite for the success of subdural recordings. Concordance of interictal and ictal recordings is highly predictive of outcomes.
Invasive EEG and Hippocampal Sclerosis
Authors: Engel Jerome , Staba Richard , Fried Itzhak
Published: December 2018

Hippocampal sclerosis is the most common lesion associated with pharmacoresistant epilepsy, and anterior temporal lobe resection for hippocampal sclerosis remains the most common surgical treatment for epilepsy in adults. There are several different types of hippocampal sclerosis. Although the predominant causes of this condition are unknown, much is understood concerning the pathophysiology and anatomy of the neuronal networks most often constituting the epileptogenic region, the resection of which is necessary and sufficient to eliminate spontaneous epileptic seizures. Advances in neuroimaging, clinical neurophysiology, neurocognitive testing, and other diagnostic procedures now permit successful surgical treatment of intractable seizures with a standardized anteromesial temporal resection in most patients. Invasive monitoring is necessary in a minority of patients and is based on the known anatomy and pathophysiology of mesial temporal lobe epilepsy. A seizure-free outcome can be expected in 70–85% of patients.
Invasive EEG in Tuberous Sclerosis
Authors: Simon Harvey A.
Published: December 2018

This chapter reviews the application of intracranial EEG monitoring and cortical stimulation in the surgical treatment of tuberous sclerosis (TS) patients with uncontrolled epilepsy. It begins with a review of issues related to seizure localization and determination of epileptogenic tubers, followed by a review of surgical series in which intraoperative electrocorticography (ECoG) or extraoperative EEG monitoring with subdural or depth electrodes was utilized. Specific interictal and ictal EEG patterns suggesting intrinsic epileptogenicity of tubers are described, and similarities with focal cortical dysplasia are emphasized. The discussion is illustrated with examples of invasive EEG findings in patients with TS, and their relationship to the centre and rims of epileptogenic and non-epileptogenic tubers, and to perituberal and remote cortex. The chapter provides a comprehensive resource that will help epileptologists and neurophysiologists to decide on the need for invasive EEG, and the significance of findings, in TS patients with uncontrolled epilepsy.
Invasive EEG in Grey Matter Heterotopia
Authors: Mai Roberto , Tassi Laura
Published: December 2018

Grey matter heterotopias (GMH) are in the malformations of cortical development group of disorders, comprising an entity of abnormal neuronal migration, triggering patterns of cortical and neuronal disarrangement. Normal but misplaced tissue within the original organ characterizes heterotopias. They share the same signal intensity as adjacent cortical grey matter, are bilateral or unilateral, diffuse or localized, with subependymal, subcortical, or transmantle localization. Genetic causes are common, particularly in bilateral cases. Drug-resistant epilepsy is the main symptom; surgery should be planned early. Invasive recordings are considered mandatory, and stereo-EEG is the most suitable exploration methodology. Both GMH and surrounding cortices may originate discharges. Surgery demonstrates good results, especially when a lesionectomy (even when incomplete) is associated with a corticectomy. Recently, thermocoagulation of the GMH and cortices encompassed within the epileptogenic zone has provided a therapeutic approach in selected, even bilateral, cases. Laser interstitial thermal therapy needs further evaluation in these patients.
Depth EEG in Sensorimotor Cortex Epilepsy
Authors: Devaux Bertrand , Chassoux Francine , Landré Elisabeth , Turak Baris
Published: December 2018

Surgery for intractable seizures originating from the sensorimotor cortex is associated with a risk of permanent deficit and a risk of incomplete epileptogenic tissue removal. Depth electrode implantation in the sensorimotor region has been performed over several decades with acceptable morbidity. Motor, sensory, premotor, supplementary motor area, and connected areas (parietal lobe, cingulate gyrus, and insular cortex) are explored with orthogonal and oblique electrodes. Implantation strategy is guided by ictal semiology and by the type of epileptogenic lesion identified on imaging. SEEG may identify (1) an MRI-negative focal cortical dysplasia, frequently localized in the sensorimotor region, (2) the epileptogenic part of a heterotopia or a polymicrogyria, (3) the extent of cortex resection in infantile hemiplegia, as an alternative to hemispherotomy, and may guide stereotactic radiofrequency thermocoagulations of a focal lesion as an alternative to surgical resection.
Case 4.26
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

78-year-old man with a history of renal cell carcinoma

Axial fat-suppressed FRFSE T2-weighted images (Figure 4.26.1) reveal multiple mildly hyperintense lesions in the pancreatic body and head. Arterial phase (Figure 4.26.2) and venous phase (Figure 4.26.3) postgadolinium 3D SPGR images also demonstrate multiple hypervascular pancreatic lesions. Notice also the absent left kidney (from a nephrectomy) and multiple solid enhancing lesions in the right kidney....
Rapid and robust identification of clinical isolates of Talaromyces marneffei based on MALDI-TOF mass spectrometry or dimorphism in Galleria mellonella
Authors: Borman Andrew M , Fraser Mark , Szekely Adrien , Johnson Elizabeth M
Published: December 2018

Talaromyces marneffei is a thermally dimorphic fungal pathogen that causes serious infections particularly in patients with human immunodeficiency virus (HIV). Although the mould form typically produces a characteristic red-diffusing pigment, and conidia from penicillate heads, several nonpathogenic Talaromyces/Penicillium species are morphologically and phenotypically similar. While those other species do not exhibit thermal dimorphism, conversion of T. marneffei to the distinctive fission yeast form in vitro is arduous and frequently incomplete. Here we show that T. marneffei can be rapidly and unambiguously discriminated from related nonpathogenic Talaromyces/Penicillium spp., either by matrix-assisted laser desorption ionisation time-of-flight (MALDI-TOF) mass spectrometry or conversion to fission yeast after introduction into Galleria mellonella. Conversion of T. marneffei conidia to the fission yeast form in G. mellonella larvae occurred as early as 24 h post inoculation at 37oC. Identification by MALDI-TOF was possible after supplementation of the commercial Bruker database with in-house mass spectral profiles created from either the yeast or mycelial phase of T. marneffei. In addition, we show that in-house generated mass spectral profiles could be successfully used to identify T. marneffei with a recently published on-line MALDI-TOF database, circumventing the need to create extensive in-house additional databases for rarely encountered fungal pathogens.
A3-A3 Bypass Surgery for Aneurysm: Technical Nuances
Authors: Grigore Florina-Nicoleta , Amin-Hanjani Sepideh
Published: December 2018

BACKGROUND

Cerebral bypass remains important for the treatment of complex cerebral aneurysms including dissecting, giant, and fusiform aneurysms not amenable to endovascular treatment or simple clip ligation. For such aneurysms involving the anterior communicating artery complex or its branches, distal anterior cerebral artery (ACA) A3-A3 side-to-side bypass represents a valuable treatment option. Distal ACA in situ anastomosis is recognized to be technically demanding mainly due to the relative depth and narrowness of the interhemispheric surgical corridor and type of anastomosis.

OBJECTIVE

To demonstrate technical nuances of A3-A3 side-to-side in situ bypass surgery through case illustrations and operative videos.

METHODS

Elements of the procedure relating to positioning, approach, and anastomosis which have evolved in the operative technique of the senior author were collated based on review of clinical case material, imaging and video recordings of ACA aneurysms treated with side-to-side in situ A3-A3 bypass procedure. Technical elements were contrasted with relevant literature.

RESULTS

Nuances relative to patient positioning, selection of craniotomy variants, adjunctive intraoperative tools and microsurgical nuances of the side-to-side bypass procedure are reviewed. Three illustrative operative video cases, along with illustrations, are provided to complement the description of the nuances.

CONCLUSION

In the light of the inherent technical difficulty, as well as the rather limited case volumes, the technical tips provided may contribute to bringing additional refinement and simplicity to the A3-A3 bypass procedure.
Enunciations of Transnational Citizenship
Authors: Félix Adrián
Published: December 2018

Chapter 2 examines how Mexican migrants enunciate transnational citizenship as they navigate the naturalization process in the United States. This chapter treats naturalization—the so-called political baptism of migrants—as the first stage of the migrant political life cycle insofar as this is the moment where migrants contest state scripts of singular loyalty. Drawing on a political ethnography of the naturalization process and the citizenship classroom, this chapter captures Mexican migrants’ mythologies of citizenship as they collectively expose the central contradictions of U.S. citizenship and constitutionalism. The bureaucratic arbitrariness and institutional discrimination that Mexican migrants perceive throughout the naturalization process infuse their mythologies of citizenship and inform their alternative enunciations of transnational political membership and belonging. When naturalization is sought in response to an antimigrant context, the so-called political baptism of Mexican migrants may in effect mark the political birth of transnational citizens.
Underappreciated Utility of the Purse-String Suture in Head and Neck Skin Cancer Defect Reconstruction
Authors: Collett Tolbin , Smith Andrea , Liu Yuan F. , Bradford Benjamin , Yang Jin , Ardeshirpour Farhad , Inman Jared C.
Published: December 2018

BACKGROUND

The purse-string suture (PSS) is a simple, reversible method for reconstructing skin cancer defects. Its utility may be underappreciated in head and neck reconstructive surgery.

OBJECTIVE

To evaluate the utility of the PSS as an adjunct to the reconstructive ladder when reconstructing head and neck skin cancer defects.

MATERIALS AND METHODS

This prospective nonrandomized cohort included 109 consecutive adult patients with head and neck defects resulting from skin cancer resection. The PSS was placed in every patient after resection. Patients were evaluated before and after suture placement, and final reconstructive methods were recorded.

RESULTS

The PSS resulted in a mean defect area reduction of 77.1% (p < .001) and was used in the final reconstruction in 79 (72.5%) patients. The PSS reduced the number of patients requiring adjacent tissue transfer (11), regional tissue transfer (3), and free tissue transfer (1) by 69.4%, 70%, and 80%, respectively. Fifty patients underwent reconstruction in the operating room. After intraoperative placement of the PSS, it was determined that 22 (44.0%) of these defects could have been reconstructed in the clinic (p = .003).

CONCLUSION

The PSS dramatically reduces defect size, simplifies reconstructive techniques, and often permits reconstruction to be performed in the clinic rather than the operating room.
Postoperative Endophthalmitis Before and After Preferred Utilization of Prophylactic Intracameral Antibiotics for Phacoemulsification Cataract Surgeries at Cole Eye Institute
Authors: Li Ang , Shao Jack , Gans Richard , Bena James , Goshe Jeffrey
Published: December 2018

Purpose:

To compare the rate of endophthalmitis of intracameral versus topical antibiotic prophylaxis for patients undergoing phacoemulsification at a single-centered, multispecialty ophthalmological institute.

Methods:

A retrospective analysis of the rate of endophthalmitis by coding search within 90 days of cataract surgery in periods before (May 15, 2012–May 15, 2014) and after (April 30, 2015–April 30, 2017) intracameral antibiotics became the institution's preferred practice pattern for phacoemulsification. Clinical data were collected for each endophthalmitis case, including timing of onset, presenting symptoms and signs, culture results, treatment performed, and visual acuity outcome.

Results:

The rate of postphacoemulsification endophthalmitis decreased from 0.18% (29 eyes among 16,201 cataract surgeries) to 0.07% (11 eyes among 16,325 surgeries) when the preferred method was changed from topical to intracameral antibiotics (P=0.004) with an odds ratio of 0.32. Endophthalmitis cases in the 2 groups had comparable visual acuity at initial presentation and at 3 months (P=0.86). The most commonly isolated organism in culture-proven cases of endophthalmitis in both groups was coagulase-negative staphylococcus. The rate of gram-positive endophthalmitis decreased from 0.08% to 0.02% with an odds ratio of 0.23 (P=0.012) while the rate of gram-negative cases remained similar.

Conclusions:

The use of intracameral antibiotics during cataract surgery was associated with a statistically significant reduction of postoperative endophthalmitis.
Crystalline Keratopathy in Post-LASIK Ectasia: A Case Report
Authors: Modabber Milad , Darvish-Zargar Mahshad , Breton Léo , Chung Doug D. , Duong Huong , Aldave Anthony J. , Choremis Johanna
Published: December 2018

Purpose:

To report an unusual case of bilateral crystalline keratopathy presenting several years after a laser in situ keratomileusis (LASIK) procedure.

Methods:

Case report and review of the literature.

Results:

A healthy 42-year-old woman with post-LASIK ectasia, treated with long-term corneoscleral contact lenses, developed new-onset crystalline keratopathy in both eyes. Anterior segment optical coherence tomography demonstrated bilaterally symmetric paracentral rings of hyperreflectivity, involving the LASIK corneal flaps. There was good clearance of the corneoscleral contact lenses with no corneal–lens touch in all quadrants. There was no evidence of infectious or systemic etiologies. Genetic testing for the UBIAD1 gene for Schnyder corneal dystrophy was negative. Continued clinical observations have exhibited progressive corneal crystalline deposition, yet the patient has remained visually asymptomatic.

Conclusions:

This is the first known reported case of significantly delayed progressive noninfectious crystalline keratopathy in post-LASIK ectasia. The pathophysiology of this condition remains elusive to date and highlights the challenges of noninvasive diagnostic techniques and yet the utility of molecular genetic analysis in elucidating the etiology of this unique clinical presentation.
The Effects of Patient Care Results of Applied Nursing Intervention to Individuals With Stoma According to the Health Belief Model
Authors: Cengiz Burcu , Bahar Zuhal , Canda Aras Emre
Published: December 2018

Background

Individuals who have undergone stoma surgery take time to adjust to the stoma, and their quality of life is decreasing.

Objective

The aim of this study was to examine the effects of home-based nursing interventions informed by the Health Belief Model on patient care outcomes for individuals having a stoma.

Methods

This pretest, posttest, and semiexperimental design with a control group included adults who underwent a stoma operation in the previous 3 months. In total, 30 were assigned to the experimental group and 31 to the control group. Study forms included a sociodemographic questionnaire, the Stoma Quality of Life Scale, the Ostomy Adjustment Inventory, and the Pittman Complication Severity Index.

Results

After home nursing interventions, there was a significant difference between the compliance rates of the individuals in the experimental group and the complication rates and cost averages (P < .05) with individuals in the control group; no significant difference in quality-of-life scores was found between the 2 groups.

Conclusion

In order to effectively support postoperative individuals following stoma surgery when they are released from the hospital, postdischarge follow-up care informed by the Health Belief Model components should be offered.

Implications for Practice

We recommend creating hospital-based, home care teams that follow individuals with a stoma for at least 6 months after discharge.
Traumatic Brain Injury in the General Population
Authors: Hale Andrew C. , Bohnert Kipling M. , Grekin Rebecca , Sripada Rebecca K.
Published: December 2018

Traumatic brain injury (TBI) is a relatively prevalent and burdensome condition with significant public health cost; however, epidemiological studies of TBI in the United States have rarely used nationally representative samples or included measures of functioning. Data were obtained from the third wave of the National Epidemiological Survey on Alcohol and Related Conditions. Of the 36,309 individuals surveyed, 193 (0.53% weighted) reported a past-year TBI. Results from weighted logistic regression modeling indicated that prior active duty military status, mood disorders, posttraumatic stress disorder, and nicotine use disorders were associated with greater odds of TBI. Annual household income greater than $20,000 was associated with lower odds of TBI. Regarding functioning, TBI was associated with greater impairment on SF-12 scales measuring mental and physical health and the organization subscale of the Executive Function Index. Results suggest that many individuals in the US population experience TBI each year and that such injuries are associated with impairment across multiple domains.
Relationships Between Meaning in Life, Dispositional Mindfulness, Perceived Stress, and Psychological Symptoms Among Chinese Patients With Gastrointestinal Cancer
Authors: Zhong Mengyu , Zhang Qian , Bao Junyi , Xu Wei
Published: December 2018

This research examined the degree to which meaning in life explained the association between dispositional mindfulness and psychological symptoms. This was a survey research study with 292 patients with gastrointestinal cancer. Meaning in Life, dispositional mindfulness, psychological symptoms, and perceived stress were assessed. Results showed that consistent with theory and prior research, greater dispositional mindfulness was associated with less psychological symptoms and perceived stress. In addition, the results of the structural equation model verify that meaning in life mediates the association between dispositional mindfulness and perceived stress and psychological symptoms. Findings are consistent with logotheory and suggest that psychological symptoms may be reduced by addressing the impact of meaning in life.
Effect of Orthokeratology on Axial Length Elongation in Anisomyopic Children
Authors: Zhang Yu , Chen Yueguo
Published: December 2018

SIGNIFICANCE

Anisomyopia is a natural experimental paradigm that compares dose response between fellow eyes. This study is the first to explore whether orthokeratology (ortho-k) has a dose-response effect on axial length growth and reduces the interocular difference in axial length in anisomyopic children.

PURPOSE

The purpose of this study was to compare the effect of ortho-k on axial length elongation between the fellow eyes of anisomyopic children.

METHODS

In this retrospective study, 49 anisomyopic children who wore ortho-k lenses were assigned to the anisomyopic ortho-k group. Based on the one-to-one match principle (same age and proximate spherical equivalent), high-isomyopic and low-isomyopic groups each enrolled 49 isomyopic children who wore ortho-k lenses with spherical equivalent similar to that of the more myopic eye and the less myopic eye in the anisomyopic ortho-k group, respectively. Forty-nine anisomyopic children who wore spectacles were enrolled in the anisomyopic spectacle group. At baseline and at 1- and 2-year visits, axial length was measured. Axial length elongation and interocular difference in axial length were compared.

RESULTS

In the anisomyopic ortho-k group, the less myopic eyes exhibited more axial length elongation than did the more myopic eyes during 1- and 2-year treatment periods (P < .01). However, there was no significant difference in axial length elongation between the fellow eyes in the isomyopic groups and anisomyopic spectacle group. At the 2-year visit, the interocular difference in axial length of children in the anisomyopic ortho-k group significantly decreased from 0.72 ± 0.34 to 0.56 ± 0.38 mm (P < .05). In contrast, ortho-k lens–wearing isomyopic children or spectacle-wearing anisomyopic children did not show a significant change in interocular difference in axial length.

CONCLUSIONS

Orthokeratology could reduce the amount of anisomyopia in children primarily through stronger myopia control in the more myopic eye.
Theoretical Study of Refraction Effects of Plano Ophthalmic Prisms
Authors: Atchison David A. , Suheimat Marwan
Published: December 2018

SIGNIFICANCE

Nominally plano prisms can have appreciable refractive errors that exceed the usual prescribing step of 0.25 D, particularly when an eye rotates to view off-axis objects.

PURPOSE

The purpose of this study was to determine theoretically the refractive power effects of nominally plano-refracting power prisms.

METHODS

Plano prisms with zero refraction were designed for the as-worn condition. A basic method was developed to determine refractive effects in the presence of pantoscopic tilt. A refined method was developed that considers the eye rotating behind the lens, and this and the basic method were compared with accurate raytracing.

RESULTS

Plano prisms of 4 and 8 Δ were designed with astigmatic back surfaces to compensate for oblique incidence, and tangential and sagittal image vergence errors were investigated for base-up (BU) and base-down (BD) directions, 0 and −3.33 D object vergences, and pantoscopic tilts up to 10°. Basic and refined results did not differ from accurate results by more than 0.04 and 0.08 D, respectively. Errors for 8 Δ prisms were approximately twice those for 4 Δ prisms. Errors were approximately proportional to tilt. With 10° tilt, the errors ranged between −0.65 D/−0.23 D (8 Δ BD, −3.33 D object vergence) and +0.36 D/+0.15 D (8 Δ BU, 0 D object vergence). Sagittal errors were generally about one third of corresponding tangential errors. In the presence of tilt, BU prisms had positive errors, and BD prisms had similar, but negative, errors for distance objects. At −3.33 D object vergence with tilt, negative errors for BD were greater than positive errors for BU. When the eye rotates to look at objects at different positions, errors can increase beyond those occurring on-axis.

CONCLUSIONS

When designed for nontilted conditions, but then subjected to tilt or to viewing off-axis objects, plano prisms can have errors exceeding the usual prescribing step of 0.25 D.
Sex differences in the relationship between social difficulties and executive dysfunction in children and adolescents with autism spectrum disorder
Authors: Torske Tonje , Nærland Terje , Quintana Daniel S. , Hypher Ruth Elizabeth , Kaale Anett , Høyland Anne Lise , Hope Sigrun , Johannessen Jarle , Øie Merete G , Andreassen Ole A
Published: December 2018

The prevalence of autism spectrum disorder (ASD) in boys is nearly four times higher than in girls, and the causes of this sex difference are not fully known. Difficulties in executive function may be involved in development of autistic symptomatology. Here we investigated sex differences in the relationship between executive function in everyday life and social dysfunction symptoms in a sample of 116 children (25 girls) aged 5-19 years with IQ above 70 and with a diagnosis of ASD. They were assessed with the Behavior Rating Inventory of Executive Function (BRIEF) and the Autism Diagnostic Interview Revised (ADI-R). We found no significant differences in BRIEF or ADI-R scores between girls and boys after correcting for multiple testing. Nested linear regression models revealed significant sex differences in the relationship between executive function and both reciprocal social interaction (p<0.001) and communication (p=0.001) over and above the main effects of age, sex, IQ and comorbid attention deficit/hyperactivity disorder diagnosis. We did not find sex differences in the relationship between executive dysfunction and restricted and repetitive behaviors. Altogether, our results provide a greater understanding of the sex-specific characteristics of ASD and may suggest that boys and girls can benefit from different intervention strategies.
Midfrontal theta phase coordinates behaviorally relevant brain computations during cognitive control
Authors: Duprez Joan , Gulbinaite Rasa , Cohen Michael X
Published: December 2018

Neural oscillations are thought to provide a cyclic time frame for orchestrating brain computations. Following this assumption, midfrontal theta oscillations have recently been proposed to temporally organize brain computations during conflict processing. Using a multivariate analysis approach, we show that brain-behavior relationships during conflict tasks are modulated according to the phase of ongoing endogenous midfrontal theta oscillations recorded by scalp EEG. We found reproducible results in two independent datasets, using two different conflict tasks: brain-behavior relationships (correlation between reaction time and theta power) were theta phase-dependent in a subject-specific manner, and these “behaviorally optimal” theta phases were also associated with fronto-parietal cross-frequency dynamics emerging as theta phase-locked beta power bursts. These effects were present regardless of the strength of conflict. Thus, these results provide empirical evidence that midfrontal theta oscillations are involved in cyclically orchestrating brain computations likely related to response execution during the tasks rather than purely related to conflict processing. More generally, this study supports the hypothesis that phase-based computation is an important mechanism giving rise to cognitive processing.
One-dimensional parallax-free position-sensitive detector for diffraction measurements based on a home-made thin THGEM
Authors: Chen Shi , Liu Hongbang , Liu Qian , Zheng Yangheng , Wang Binglong , Huang Wenqian , Dong Yang , Rong Yu , Jiao Xinda , Guan Yu , Wang Jing , Li Min , Liu Jizhou , Zhang Mengmeng
Published: December 2018

A large parallax-free gas diffraction meter based on a thinner-THGEM (thick gaseous electron multiplier) has been developed at the Beijing Synchrotron Radiation Facility (BSRF). A thinner-THGEM of thickness 200 µm is adopted, which can be shaped into a curve to eliminate parallax-error effects. The detector is designed to have a 48° open angle positioned 20 cm from the powder samples. A front-end electronics board with 128 channels direct-current mode was adapted for the 8 keV BSRF beamline with 0.2 ns/100 ns stable duty cycle. Two powder samples, TiO2 and SnO2, were tested separately. The measured spectra with an angular resolution of 0.148 ± 0.081° are consistent with the data from the powder diffraction file. Combining the gas gain of the thinner-THGEM with the electronic circuit dynamic range, a very broad dynamic range of about 107 could be obtained.
The X-ray crystal structure of human endothelin 1, a polypeptide hormone regulator of blood pressure
Authors: McPherson Alexander , Larson Steven B.
Published: December 2018

Human endothelin is a 21-amino-acid polypeptide, constrained by two intra-chain disulfide bridges, that is made by endothelial cells. It is the most potent vasoconstrictor in the body and is crucially important in the regulation of blood pressure. It plays a major role in a host of medical conditions, including hypertension, diabetes, stroke and cancer. Endothelin was crystallized 28 years ago in the putative space group P6122, but the structure was never successfully solved by X-ray diffraction. Using X-ray diffraction data from 1992, the structure has now been solved. Assuming a unit cell belonging to space group P61 and a twin fraction of 0.28, a solution emerged with two, almost identical, closely associated molecules in the asymmetric unit. Although the data extended to beyond 1.8 Å resolution, a model containing 25 waters was refined to 1.85 Å resolution with an R of 0.216 and an R
free of 0.284. The disulfide-constrained `core' of the molecule, amino-acid residues 1–15, has a main-chain conformation that is essentially the same as endothelin when bound to its receptor, but many side-chain rotamers are different. The carboxy-terminal `tail' comprising amino-acid residues 16–21 is extended as when receptor-bound, but it exhibits a different conformation with respect to the `core'. The dimer that comprises the asymmetric unit is maintained almost exclusively by hydrophobic interactions and may be stable in an aqueous medium.
AtNPR4 from Arabidopsis thaliana: expression, purification, crystallization and crystallographic analysis
Authors: Yang Qingzhan , Zhang Mengze , Zheng Jimin , Jia Zongchao
Published: December 2018

Salicylic acid (SA) is an important phytohormone that is involved in the regulation of plant defence, growth and development. A large number of proteins have been shown to have the ability to interact with SA, and NPR4 has been demonstrated to be a receptor of SA that plays significant roles in the innate immune response of plants. In this study, Spodoptera frugiperda (Sf9) cells were used to express full-length AtNPR4 from Arabidopsis thaliana. To facilitate crystallization, T4 lysozyme (T4L) was added to the N-terminus of the AtNPR4 protein. The recombinant T4L-AtNPR4 protein was expressed, purified and crystallized using the sitting-drop and hanging-drop vapour-diffusion methods. The T4L-AtNPR4 crystals have symmetry consistent with space group C2, with unit-cell parameters a = 93.7, b = 85.8, c = 88.2 Å, β = 90° and one molecule per asymmetric unit. The best crystal diffracted to a resolution of 2.75 Å. Structure determination is in progress.
Lifecycle-oriented framing of value at the front end of infrastructure projects
Authors: Martinsuo Miia Maarit , Vuorinen Lauri , Killen Catherine
Published: December 2018

Purpose

Infrastructure projects are expected to deliver value to their stakeholders long after completion. Project value is multi-dimensional and subjective and evolves over the project lifecycle. How stakeholders frame the expected value is central to the public debate about proposed infrastructure projects and influences the financing decisions; however, this framing is inadequately understood. The purpose of this paper is to develop new knowledge for shaping infrastructure projects by identifying the ways in which stakeholders frame project value at the project front end.

Design/methodology/approach

Three transport infrastructure projects are compared in a qualitative, document-based study. The authors map the dimensions of value at the project front end and identify stakeholders’ approaches to lifecycle-oriented framing of value.

Findings

Financial, social and comparative values are dominant in the project front end. The authors frame value into positive and negative dimensions and identify four themes in the lifecycle-oriented framing of value, including uncertainties, timing of cost and benefit realization, project relations and external sponsorship.

Research limitations/implications

The research is limited through the focus on transport infrastructure projects and project front end only, the selection of cases from a single country and the use of document-based data. The systematic analysis approach has yielded novel analytical frameworks that will be useful for further research.

Practical implications

This study identifies value dimensions that are specific to transport infrastructure projects and proposes a framework to assist stakeholders and project managers to better assess and negotiate value when designing their projects.

Originality/value

Regional and comparative values are revealed as novel aspects of value specific to infrastructure projects. The alternative lifecycle-oriented frames offer a new way to understand and structure the co-creation of value and shape negotiation for investment decisions in the project. A portfolio perspective to investment decision making is proposed.
Prevalence and Associations Between Related Factors and Defining Characteristics of the Nursing Diagnosis Sedentary Lifestyle in Patients with Acute Coronary Syndrome
Authors: da Silva Costa Laís , de Lima Lopes Juliana , Takáo Lopes Camila , Batista Santos Vinicius , Lúcia Bottura Leite de Barros Alba
Published: December 2018

PURPOSE

To identify the prevalence of Sedentary Lifestyle (SL) and associations between its defining characteristics (DC) and related factors (RF) in patients with acute coronary syndrome (ACS).

DATA SOURCES

123 patients with ACS were assessed for SL through the International Physical Activity Questionnaire. Associations between DC and RF was investigated by Pearson's Chi square and Fisher's exact test.

DATA SYNTHESIS

56.1% had SL. Insufficient motivation and Insufficient resources for physical activity were associated with two DC.

CONCLUSION

SL was frequent and there were associations between RF and DC.

IMPLICATIONS FOR NURSING PRACTICE

Multi‐professional interventions should aim at motivating patients to adopt physical activities.