bluuebunny/crossref_metadata_2025 huggingface dataset:
Enfermagem em ventilação mecânica: cuidados na prevenção de pneumonia
Authors: Assunção Ribeiro Kaiomakx Renato , Anjos Eliana Gervásio dos , Oliveira Elizangela Macedo de
Published: April 2017

A causa mais frequente de internação unidade de terapia intensiva é a insuficiência respiratória aguda, sendo a ventilação mecânica invasiva os métodos mais eficazes para o seu tratamento. Esses pacientes permanecem na UTI em ventilação mecânica e necessitam de cuidados especializados da equipe de saúde dentre eles a enfermagem. Diante disso esse estudo objetivou verificar por meio da literatura os cuidados que favorecem a prevenção de pneumonias em pacientes sob ventilação mecânica (PAV). O estudo se caracteriza como uma revisão de literatura do tipo narrativa sobre a temática “cuidados preventivos de PAV”. Os dados foram obtidos por meio de pesquisa na Biblioteca Virtual de Saúde. Foram incluídos 25 artigos que estavam disponíveis na integra eletronicamente. Deve se estimular a educação continuada da equipe de saúde, sobretudo da enfermagem para que possam utilizar as evidências cientificas disponíveis com o intuito de prevenir as complicações associadas a ventilação mecânica
O papel do enfermeiro no manejo da monitorização hemodinâmica em unidade de terapia intensiva
Authors: Venturi Viviane , Pereira Viana Cidicléia , Maia Luiz Faustino dos Santos , Basílio Maria Jesuela , Oliveira Andréia Avelino , Sobrinho Josiane Carlos , Silva Ferreira de Melo Roberto da
Published: April 2017

Mostrar a importância do enfermeiro frente a monitorização hemodinâmica em unidade de terapia intensiva. Trata-se de um trabalho de revisão bibliográfica, através de artigos encontrados nas bases de dados do SCIELO e Biblioteca Virtual de Saúde, onde foram encontrados 30 artigos, dos quais foram selecionados 13 artigos para o desenvolvimento do presente trabalho. Observou-se a importância do papel do enfermeiro no manejo da monitorização hemodinâmica, ressaltando que é um cuidado que deve ser rigorosamente executado para prestar um cuidado de enfermagem apropriado, resultando assim na melhora do estado do paciente.
Novas tecnologias no tratamento quimioterápico por enfermeiros em um hospital
Authors: Soares de Souza Ruth , Lopes Carvalho Sandra Suely , Nascimento Matos Diana Oliveira do , Rodrigues da Silva Márcia Helena
Published: April 2017

Nas últimas décadas tem se observado um acelerado avanço no tratamento do câncer, no qual a tecnologia tem se apresentado cada dia mais como aliada na prevenção e no tratamento. O objetivo deste trabalho é descrever a adesão do enfermeiro às novas tecnologias no tratamento da quimioterapia antineoplásica e identificar as dificuldades apresentadas por estes profissionais em aderir tais tecnologias. Trata-se de um estudo de campo com abordagem descritiva e qualitativa, realizado em um hospital geral, privado e com filantropia oncológica, localizado em Teresina-PI. Foram entrevistados 10 enfermeiros que trabalhavam na oncologia há mais de 2 anos e que consentiram participar da pesquisa por meio de entrevista semiestruturada e foram criadas categorias analíticas através dos objetivos e dados obtidos. Pelos resultados colhidos torna-se claro todo o processo inerente à enfermagem para a adesão às novas tecnologias, possibilitando intervenções através da identificação das dificuldades existentes, para uma assistência eficaz.
A atuação do enfermeiro do trabalho na prevenção de riscos ergonômicos
Authors: Oliveira Pedrosa Islayne , Araújo Sobral Wglaison Paulo de , Espíndula Brasileiro Marislei
Published: April 2017

Descrever a atuação do enfermeiro do trabalho na prevenção de riscos ergonômicos. É um estudo bibliográfico, exploratório e descritivo, com análise integrativa da literatura disponível nas bases de dados virtuais em saúde, Biblioteca Virtual de Saúde - Bireme e SciELO - Scientific Electronic Library Online. Foram selecionados  8 artigos científicos, durante os anos de 2010 e 2013, onde concordam que a atuação do enfermeiro do trabalho é essencial para a prevenção de riscos ergonômicos tais como: avaliar a comunidade, planejar as suas ações, suprir a falta de informações e condições de trabalho, ampliar seu papel, ampliar a saúde do trabalhador, ajudar na sua reabilitação em seu retorno ao trabalho reassumindo sua autonomia, atuando por uma coletividade, segurança, bem estar, e a qualidade de vida para todos, dentro ou fora das organizações, conscientizando da necessidade dos equipamentos de proteção individuais - EPI’s, atuar na prevenção primária com o intuito de evitar danos à saúde, adequação ergonômica, prevenindo dores posturais, principalmente as musculoesqueléticas, complicações físicas e mentais, fadigas e acidentes, adequadas condições de trabalho, conhecimento e avaliação de riscos ergonômicos, melhorar o conforto, melhor qualidade de vida e desempenho produtivo. Conclui-se que o enfermeiro do trabalho por meio de seus cuidados, é um profissional que faz a prevenção, redução e/ou eliminação dos riscos ergonômicos.
As complicações causadas pelo consumo de drogas lícitas e ilícitas durante a gestação: um desafio para a equipe de enfermagem
Authors: Menezes Ferreira Brenda Rayane , Silva Miranda Jamilly Karoliny da
Published: April 2017

A identificação de dependência química durante a gravidez é bastante difícil, pois a gestante usuária de drogas geralmente não relata o fato ao profissional de saúde, o que contribui para uma assistência pré-natal aquém de suas necessidades mais complexas relacionadas com a referida dependência. Este trabalho objetiva fazer uma revisão da literatura para conhecer quais as complicações causadas pelo consumo de drogas lícitas e ilícitas durante a gestação. O estudo buscou referências nas bases de dados: Biblioteca virtual em saúde (BVS), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), e Scientific Electronic Library Online (SciELO). Utilizou-se os seguintes artigos científicos dos anos de 2007 a 2016: Revista Cientifica de Enfermagem (RECIEN); Revista de Enfermagem; Revista Cientifica da Faculdade de Educação e Meio Ambiente (FAEMA); Revista Eletrônica Saúde Mental Álcool e Drogas e Escola de Enfermagem Anna Nery (EEAN).
Sexualidade no enfrentamento do câncer de mama: estratégias de superação
Authors: Sebold Natália , Laverde Ana Gabriela , Martins da Rosa Luciana , Anders Jane Cristina , Hoffmann Priscila , Radün Vera
Published: April 2017

Identificar as estratégias adotadas por mulheres com câncer de mama para minimizar os danos que as terapêuticas utilizadas para o controle da doença causam sobre a sexualidade, sensualidade e vida sexual. Pesquisa descritiva com abordagem qualitativa que incluiu dez mulheres submetidas à mastectomia ou quandrantectomia, com ou sem linfadenectomia axilar, em remissão da doença ou realizando hormonioterapia. Os dados foram coletados por entrevistas realizadas entre março e maio de 2014 e foram submetidos à análise de conteúdo. As categorias temáticas estabelecidas foram: Cuidados com a estética corporal; Intervenção dos profissionais da saúde; Inovação no relacionamento amoroso/sexual; Aceitação da doença e Cumplicidade com o parceiro. As estratégias encontradas são exemplos de escolhas de cuidados que devem ser divulgados e estimulados por enfermeiros e equipe multiprofissional.
A educação ambiental na formação do enfermeiro: uma revisão
Authors: Aquino Horta Diego , Gargia Eça Marcela
Published: April 2017

A ecologia trouxe o ensejo do desenvolvimento econômico e sustentável com o pensamento principal que o ambiente está diretamente ligado à forma como o homem se apropria dos recursos. A enfermagem tem como alicerce o cuidado e o bem-estar do indivíduo buscando o equilíbrio na promoção da saúde e no educar. Este projeto tem o objetivo de identificar, em literatura, a forma como o pensamento ecológico evoluiu e vem sendo abordado pela enfermagem no ensino da educação ambiental nas escolas.  A metodologia científica adotada baseia-se na pesquisa bibliográfica do tipo revisão literária com recorte temporal de vinte anos - 1996 a 2016. Após a leitura criteriosa, duas categorias foram compostas: "Educação da Ecologia na Enfermagem" - evidenciando a formação do profissional de enfermagem no pensamento prático associando a saúde - e o "Meio Ambiente, e Ecologia na Pratica de Enfermagem" - que exibe o desenvolvimento da enfermagem na conscientização ao manejo de substâncias que possam agredir o ambiente. Diante do exposto, hiperativa-se o questionamento referente ao meio ambiente e ao desenvolvimento do pensamento crítico-reflexivo nos profissionais de enfermagem para a responsabilidade ambiental, propiciando mudanças sociais transformadoras e inserção do enfermeiro no entrelaçamento do cuidado do meio ambiente e do homem, interligando-os em uma harmonia mútua.
Tecnologias do cuidado e humanização do pré-natal na atenção básica
Authors: Miranda dos Santos Rachael , Souza Aparecida Helena de , Santos Silva Kelly dos , Torres Karla Dala Paula , Chaves de Sá Selma Petra
Published: April 2017

A gravidez e o parto são eventos fisiológicos na vida das mulheres. No entanto, trazem repercussões físicas e emocionais, que requerem cuidados a mulher e sua família por parte dos profissionais de saúde responsáveis pela assistência pré-natal. Diante desse contexto esse estudo tem como objetivos: realizar um levantamento bibliográfico sobre humanização da atenção ao pré-natal e puerpério na rede de atenção primária; Identificar as tecnologias do cuidado voltadas à humanização da atenção ao pré-natal e puerpério utilizadas pelos profissionais da atenção básica; e Verificar a presença de citações da recente Rede Cegonha nos estudos levantados. Realizou-se uma revisão de literatura, contudo 12 fizeram parte da amostra. Concluiu-se que embora existam estudos que abordem a humanização, são necessários mais estudos que explorem as práticas efetivas realizadas no pré-natal na atenção básica, ou seja, as tecnologias, utilizadas para humanizar a assistência.
Assistência de enfermagem ao adulto com agravos respiratórios
Authors: Maia Luiz Faustino dos Santos , Laís dos Santos Barbara , Pereira Clene Maria de Jesus , Moura Santos Marcilene , Pereira Rodrigues Ediana , Conceição dos Santos Magda da
Published: April 2017

O objetivo deste trabalho é descrever as principais ações de assistência de enfermagem diante de pacientes adultos com agravos respiratórios.  Realizou-se um levantamento da produção científica relacionada à prática de enfermagem diante dos agravos respiratórios na base de dados eletrônicos SciELO e LILACS.  Constatou-se que a pneumonia, a asma e gripe são os tipos de agravos respiratórios que acometem um grande número de indivíduos sendo consideradas entre as principais causas de internações. Neste contexto o profissional de enfermagem se depara frequentemente com pacientes com algum tipo de agravo respiratório. O estudo apontou que ele executa deste o apoio do paciente nos limites hospitalares e o desenvolvimento do diagnóstico de enfermagem e aplicação de prescrições de enfermagem até a realização de educação em saúde visando orientar a população a respeito da identificação de fatores agravantes e desencadeantes, dos sintomas característicos e melhorar-se aderência as diferentes formas de tratamento e controle.
Percepção dos enfermeiros referente a utilização das diretrizes curriculares nacionais
Authors: Leocadio Amanda Carolina , Rogério Biondo Deybson , Siqueira Júnior Antônio Carlos , Karan Barbosa Pedro Marco
Published: April 2017

Avaliar a utilização das competências descritas nas Diretrizes Curriculares Nacionais, para o desenvolvimento da prática dos enfermeiros. Pesquisa de caráter quantitativo, transversal e analítico. A amostra foi composta por 40 enfermeiros. Para a coleta de dados utilizamos um questionário que contém uma escala de Likert, onde empregamos a análise da frequência de utilização das competências e as assertivas quanto as mesmas serem classificadas em gerais ou específicas. A análise estatística foi realizada por meio do programa (Epi Info versão 3.5.2). Obtivemos a média de utilização das competências gerais conforme a escala de Likert, como se segue: mais ou menos, 10,19 pessoas (25,41%) e bastante, 18,5 (46,25%), para as competências específicas as médias de frequências mais relevantes foram: mais ou menos 10,61 pessoas (26,80%) e bastante 20,87 (50,41%). Em relação as competências serem classificadas em gerais ou específicas, a média de assertivas foi de respectivamente, 19,66 pessoas (49,16%) e 22,12 (54,19%). Podemos verificar que ainda há necessidade dos enfermeiros compreenderem melhor o significado de competência, bem como sua utilização para uma qualificação do atendimento e desenvolvimento profissional.
O cuidador de paciente com insuficiência cardíaca: desafios no cuidar
Authors: Gomes de Oliveira Liliane , Assis Souto Thais de , Ferreira Vitorio Aline Mirema
Published: April 2017

O estudo objetivou identificar e analisar as pesquisas relacionadas à temática cuidadores de pacientes com Insuficiência Cardíaca (IC). Trata-se de revisão integrativa no qual os artigos estavam disponíveis nas bases de dados CINAHL e Medline e LILACS via portal Biblioteca Virtual de Saúde (BVS) publicados entre 2010 e 2015 com os descritores Insuficiência Cardíaca e Cuidador dentre outros. Nove estudos foram analisados. Quanto a metodologia dos estudos selecionados, 7 foram pesquisas descritivas de abordagem qualitativa, uma pesquisa metodológica e um estudo de caso qualitativo. Mudanças nas rotinas dos cuidadores em função do cuidado ao paciente, o sofrimento com a falta de suporte social dos familiares e dos profissionais de saúde em relação ao cuidado foram assuntos prevalentes abordados nos artigos. Recomenda-se oferecer aos cuidadores de paciente com IC uma rede de suporte; e a realização de estudos que avaliem a qualidade de vida destes indivíduos.
2016 JOSPT Awards: Additive Effects and Biological Mechanisms of Interventions Offer Important Insights
Authors: Abbott J. Haxby
Published: April 2017

During the American Physical Therapy Association's Combined Sections Meeting in San Antonio, TX in February 2017, JOSPT recognized the authors of the most outstanding research and clinical practice manuscripts published in JOSPT during 2016. The 2016 JOSPT Excellence in Research Award was presented to Carol A. Courtney, Alana D. Steffen, César Fernández-de-las-Peñas, John Kim, and Samuel J. Chmell, MD, for their March 2016 article “Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee.” The 2016 George J. Davies-James A. Gould Excellence in Clinical Inquiry Award was presented to Seyda Toprak Celenay, Turkan Akbayrak, and Derya Ozer Kaya for their February 2016 article “A Comparison of the Effects of Stabilization Exercises Plus Manual Therapy to Those of Stabilization Exercises Alone in Patients With Nonspecific Mechanical Neck Pain: A Randomized Clinical Trial.”

J Orthop Sports Phys Ther 2017;47(4):225–227. doi:10.2519/jospt.2017.0104
Challenging Colonial Norms and Attending to Presencing in Stories of Missing and Murdered Indigenous Women
Authors: Savarese Josephine L.
Published: April 2017

Scholarship related to missing and murdered Indigenous women in Canada has highlighted community resistance in response to traumatic losses. While sympathetic to other scholarship, I offer a different approach. I take on the challenging task of documenting resistance by missing and murdered women during and beyond their physical lifetimes. I attempt to engage in the delicate work of tracking what Leanne Simpson called “presencing” in her 2011 publication, Dancing on Our Turtle's Back: Stories of Nishnaabeg Re-creation, Resurgence and a New Emergence, in two fatalities. This is accomplished through a close examination of the death in 2013 of Kinew James, an Indigenous woman held in federal custody, and the homicide of twenty-year-old Alberta resident, Amber Tuccaro, in August 2010. In her qualitative studies on Indigenous girlhood, Sandrina de Finney encourages scholars to take up presencing to illuminate ways in which Indigenous girls' are actively engaged in anti-oppressive strategies. With her scholarship in mind, I examine news articles that report on Amber Tuccaro's and Kinew James' last words and actions to pinpoint their resistant strategies. Finally, I draw from the work of socio-legal scholars to explore presencing as a pathway to more transformative legal inquiry.
La traite des femmes dans le contexte des grands évènements sportifs : quel plan de match ?
Authors: Plouffe-Malette Kristine , Langlois Léa Lemay
Published: April 2017

À chaque évènement sportif d'envergure internationale, Jeux olympiques, Coupe du monde, Super Bowls ou Grands Prix de Formule 1 confondus, l'hypothèse selon laquelle l'exploitation sexuelle, la prostitution et la traite des femmes augmentent refait surface. Si l'existence de ces phénomènes n'est plus à démontrer, leur augmentation lors de la tenue de grands évènements sportifs fait toujours l'objet de débats, et ce, essentiellement en raison d'une confusion sémantique. Cet article avance qu'il est impossible de conclure à une augmentation de la traite lors de ces évènements en raison, d'une part, des problèmes d'interprétation de la notion de traite des femmes, internationalement définie et trop souvent confondue avec celle de prostitution, lesquelles reposent sur des systèmes normatifs distincts. D'autre part, ces méconnaissances interprétatives entraînent des impairs méthodologiques illustrés par une revue des campagnes de lutte contre l'exploitation sexuelle lors des grands évènements sportifs. En conséquence, différents acteurs instrumentalisent le « mythe » de l'augmentation de la traite des femmes afin de faire avancer leurs agendas respectifs lors de ces évènements, et ce, au détriment de la protection des victimes de traite. Il s'agit ainsi d'analyser l'impact du droit, international et accessoirement national canadien, en matière de prostitution et de traite des femmes, en temps d'évènements sportifs d'envergure.
Living alongside military PTSD: a qualitative study of female partners’ experiences with UK Veterans
Authors: Murphy Dominic , Palmer Emily , Hill Kate , Ashwick Rachel , Busuttil Walter
Published: April 2017

Introduction: An increased risk of emotional burden in partners of military Veterans with mental health difficulties has been observed. This study aimed to explore the experiences and needs of female partners of Veterans seeking help. Methods: Our sample of eight female partners was drawn from a population of help-seeking Veterans who had received treatment for PTSD. Qualitative data were collected using a semi-structured interview schedule. Results: Super-ordinate themes of challenges faced, desired type of support, and barriers to support were each described by a set of sub-themes. Challenges faced were described with the themes of inequality in relationship, loss of congruence with own identity, volatile environment, and emotional distress and isolation. Desired type of support was described by the themes of practical focus on improving, sharing with fellow experts, and support tailored to the partner. Barriers to support were described by the themes feeling restricted by practical barriers and ambivalence about the involvement of others. Discussion: Interventions to support partners of Veterans with mental health difficulties need to address their individual needs, focus on practical techniques, and consider practical limitations.
Evaluating the Quality of Veterinary Students' Experiences of Learning in Clinics
Authors: Matthew Susan M. , Ellis Robert A. , Taylor Rosanne M.
Published: April 2017

Educators seeking to evaluate the quality of students' experiences of clinic-based learning (CBL) face a challenging task. CBL programs provide multiple opportunities for learning and aim to develop a wide range of skills, knowledge, and capacities. While direct observation of learners provides important information about students' proficiency in performing various clinical tasks, more comprehensive measures are required to unpack and identify factors relating to practice readiness as a whole. This study identified variables that have a logical and statistically significant association with learning outcomes across the broad range of attributes expected of new graduate veterinarians. The research revealed that the extent of final-year veterinary students' practice readiness, as assessed by placement supervisors against criteria relevant to new graduate practice, is related to the quality of their conceptions of and approaches to CBL. Students' conceptions of and approaches to CBL were evaluated using quantitative survey instruments, with a 93% response rate (N=100) obtained for the two questionnaires. Descriptive and exploratory statistics were used to link qualitative differences in students' conceptions of and approaches to CBL with performance against criteria relevant to new graduate practice. Students who reported poorer-quality conceptions of and approaches to CBL (n=38) attained lower levels of achievement than students who reported better-quality conceptions of and approaches to CBL (n=55). Evaluation of students' conceptions of and approaches to CBL can be used by educators seeking to evaluate and improve the extent to which CBL programs are achieving their desired goals.
Enhancing Safety Risk Management with Quantitative Measures
Authors: Claros Boris , Sun Carlos , Edara Praveen
Published: April 2017

At the airfield in hub airports, many activities occur that involve a range of participants, including various-size aircraft, ground vehicles, and workers. The safety management system is FAA's approach for systematically managing aviation safety. A major component of the safety management system is safety risk management (SRM), which entails analysis, assessment, and control of safety risks, including risks on the airfield. Current SRM has few specific safety models to estimate the likelihood or frequency of risks. This paper presents an example for development and incorporation of safety models into SRM. Specifically, it discusses safety models for runway incursion that use the following variables: total and general aviation operations, length of runway by type, number of taxiway intersections, snowfall, precipitation, number of hot spots, and construction activity. Categorization and processing of data were significant because each variable used could take on multiple forms, and some types of data involved review of airfield diagrams. The data used were from 137 U.S. hub airports for 2009 through 2014. For modeling, the negative multinomial distribution was used because it proved suitable for representing overdispersed data such as runway incursion frequency. Performance of the models was assessed through the goodness-of-fit measures of log likelihood, overdispersion, and cumulative residual plots. Models were developed for five severity categories of runway incursions and three types of surface events. The safety modeling approach presented here can serve as a foundation for development of other safety models that can be integrated into SRM to enable quantitative analysis of safety risks.
Vessel wall signal enhancement on 3-T MRI in acute stroke patients after stent retriever thrombectomy
Authors: Abraham Peter , Scott Pannell J. , Santiago-Dieppa David R. , Cheung Vincent , Steinberg Jeffrey , Wali Arvin , Gupta Mihir , Rennert Robert C. , Lee Roland R. , Khalessi Alexander A.
Published: April 2017

OBJECTIVE

In vivo and in vitro studies have demonstrated histological evidence of iatrogenic endothelial injury after stent retriever thrombectomy. However, noncontrast vessel wall (VW)–MRI is insufficient to demonstrate vessel injury. Authors of this study prospectively evaluated iatrogenic endothelial damage after stent retriever thrombectomy in humans by utilizing high-resolution contrast-enhanced VW-MRI. Characterization of VW-MRI changes in vessels subject to mechanical injury from thrombectomy may allow better understanding of the biological effects of this intervention.

METHODS

The authors prospectively recruited 11 patients for this study. The treatment group included 6 postthrombectomy patients and the control group included 5 subjects undergoing MRI for nonvascular indications. All subjects were evaluated on a Signa HD× 3.0-T MRI scanner with an 8-channel head coil. Both pre- and postcontrast T1-weighted Cube VW images as well as MR angiograms were acquired. Sequences obtained for evaluation of the brain parenchyma included diffusion-weighted, gradient echo, and T2-FLAIR imaging. Two independent neuroradiologists, who were blinded to the treatment status of each patient, determined the presence of VW enhancement. Patient age, National Institutes of Health Stroke Scale score on presentation, location of occlusion, stroke etiology, type of device used, number of device deployments, Thrombolysis in Cerebral Infarction (TICI) reperfusion score, stroke volume, and 90-day modified Rankin Scale score were also noted.

RESULTS

Postcontrast T1-weighted VW enhancement was detected in the M2 segment in 100% of the thrombectomy patients, in the M1 segment in 83%, and in the internal carotid artery in 50%. One patient also demonstrated A1 segment enhancement, which was attributable to thrombectomy treatment of that vessel segment during the same procedure. None of the control patients demonstrated VW enhancement of their intracranial vasculature on T1-weighted images.

CONCLUSIONS

The study findings suggest that VW injury incurred during stent retriever thrombectomy can be reliably detected utilizing contrast-enhanced 3-T VW-MRI. The results further demonstrate that endothelial injury is associated with oversizing of stent retrievers relative to the treated vessel. Further studies are needed to evaluate the clinical significance of endothelial injury and to characterize the differential effects of various devices.
Initial experience with a multiple parallel guidewire support system for complex tortuous aortic arch navigation and great vessel catheterization: technical note
Authors: Rangel-Castilla Leonardo , Shakir Hakeem J. , Siddiqui Adnan H.
Published: April 2017

The ability to traverse an anatomically challenging and complex arch is paramount to the success of any neuroendovascular procedure. With age, the aortic arch becomes elongated, calcified, and less compliant. The authors present the initial experience with a multiple parallel guidewire system (ZigiWire Mode 3) for catheterization through a complex tortuous aortic arch to access extracranial vessels. The ZigiWire is an organized guidewire system that uses consecutive delivery of 3 small-diameter (0.014-inch) guidewires that are progressively advanced in parallel to secure support-wire access. The authors have found it useful in situations in which traditional methods for great-vessel access have failed. Moreover, the progressive construction of a large wire from smaller wires prevents “kickback” force from a single larger guidewire, allowing stable distal access. The authors have been able to advance different diagnostic and guide catheters over the ZigiWire. This guidewire has allowed them to successfully complete neuroendovascular procedures in patients who were previously considered unsuitable for the procedure because of tortuous vascular access.
Management of acute ischemic stroke due to tandem occlusion: should endovascular recanalization of the extracranial or intracranial occlusive lesion be done first?
Authors: Rangel-Castilla Leonardo , Rajah Gary B. , Shakir Hakeem J. , Shallwani Hussain , Gandhi Sirin , Davies Jason M. , Snyder Kenneth V. , Levy Elad I. , Siddiqui Adnan H.
Published: April 2017

OBJECTIVE

Acute tandem occlusions of the cervical internal carotid artery and an intracranial large vessel present treatment challenges. Controversy exists regarding which lesion should be addressed first. The authors sought to evaluate the endovascular approach for revascularization of these lesions at Gates Vascular Institute.

METHODS

The authors performed a retrospective review of a prospectively maintained, single-institution database. They analyzed demographic, procedural, radiological, and clinical outcome data for patients who underwent endovascular treatment for tandem occlusions. A modified Rankin Scale (mRS) score ≤ 2 was defined as a favorable clinical outcome.

RESULTS

Forty-five patients were identified for inclusion in the study. The average age of these patients was 64 years; the mean National Institutes of Health Stroke Scale score at presentation was 14.4. Fifteen patients received intravenous thrombolysis before undergoing endovascular treatment. Thirty-seven (82%) of the 45 proximal cervical internal carotid artery occlusions were atherothrombotic in nature. Thirty-eight patients underwent a proximal-to-distal approach with carotid artery stenting first, followed by intracranial thrombectomy, whereas 7 patients underwent a distal-to-proximal approach (that is, intracranial thrombectomy was performed first). Thirty-seven (82%) procedures were completed with local anesthesia. For intracranial thrombectomy procedures, aspiration alone was used in 15 cases, stent retrieval alone was used in 5, and a combination of aspiration and stent-retriever thrombectomy was used in the remaining 25. The average time to revascularization was 81 minutes. Successful recanalization (thrombolysis in cerebral infarction Grade 2b/3) was achieved in 39 (87%) patients. Mean National Institutes of Health Stroke Scale scores were 9.3 immediately postprocedure (p < 0.05) (n = 31), 5.1 at discharge (p < 0.05) (n = 31), and 3.6 at 3 months (p < 0.05) (n = 30). There were 5 in-hospital deaths (11%); and 2 patients (4.4%) had symptomatic intracranial hemorrhage within 24 hours postprocedure. Favorable outcomes (mRS score ≤ 2) were achieved at 3 months in 22 (73.3%) of 30 patients available for follow-up, with an mRS score of 3 for 7 of 30 (23%) patients.

CONCLUSIONS

Tandem occlusions present treatment challenges, but high recanalization rates were possible in the present series using acute carotid artery stenting and mechanical thrombectomy concurrently. Proximal-to-distal and aspiration approaches were most commonly used because they were safe, efficacious, and feasible. Further study in the setting of a randomized controlled trial is needed to determine the best sequence for the treatment approach and the best technology for tandem occlusion.
Advanced imaging in acute ischemic stroke
Authors: Kilburg Craig , Scott McNally J. , de Havenon Adam , Taussky Philipp , Kalani M. Yashar S. , Park Min S.
Published: April 2017

The evaluation and management of acute ischemic stroke has primarily relied on the use of conventional CT and MRI techniques as well as lumen imaging sequences such as CT angiography (CTA) and MR angiography (MRA). Several newer or less-established imaging modalities, including vessel wall MRI, transcranial Doppler ultrasonography, and 4D CTA and MRA, are being developed to complement conventional CT and MRI techniques. Vessel wall MRI provides high-resolution analysis of both extracranial and intracranial vasculature to help identify previously occult lesions or characteristics of lesions that may portend a worse natural history. Transcranial Doppler ultrasonography can be used in the acute setting as a minimally invasive way of identifying large vessel occlusions or monitoring the response to stroke treatment. It can also be used to assist in the workup for cryptogenic stroke or to diagnose a patent foramen ovale. Four-dimensional CTA and MRA provide a less invasive alternative to digital subtraction angiography to determine the extent of the clot burden and the degree of collateral blood flow in large vessel occlusions. Along with technological advances, these new imaging modalities are improving the diagnosis, workup, and management of acute ischemic stroke— roles that will continue to expand in the future.
Utility of a Y-configured stentriever technique as a rescue method of thrombectomy for an intractable rooted thrombus located on the middle cerebral artery bifurcation: technical note
Authors: Okada Hideo , Matsuda Yoshikazu , Chung Joonho , Crowley R. Webster , Lopes Demetrius K.
Published: April 2017

Mechanical thrombectomy with stentriever and/or aspiration is the new gold standard for the treatment of acute strokes with large-vessel occlusion. As many as 20% of cases remain refractory to current stentriever and/or aspiration devices. “Saddle clots” obstructing a bifurcation may be a particular challenge for recanalization with conventional techniques and devices. The authors describe an alternative technique to bifurcation occlusions resistant to the conventional mechanical thrombectomy approach in which they simultaneously deployed 2 stentrievers into both branches of an occluded bifurcation. This stentriever Y-configuration was very effective in managing a challenging intracranial bifurcation occlusion.
Neuroprotective delivery platforms as an adjunct to mechanical thrombectomy
Authors: Babadjouni Robin M. , Walcott Brian P. , Liu Qinghai , Tenser Matthew S. , Amar Arun P. , Mack William J.
Published: April 2017

Despite the success of numerous neuroprotective strategies in animal and preclinical stroke models, none have effectively translated to clinical medicine. A multitude of influences are likely responsible. Two such factors are inefficient recanalization strategies for large vessel occlusions and suboptimal delivery methods/platforms for neuroprotective agents. The recent endovascular stroke trials have established a new paradigm for large vessel stroke treatment. The associated advent of advanced mechanical revascularization devices and new stroke technologies help address each of these existing gaps. A strategy combining effective endovascular revascularization with administration of neuroprotective therapies is now practical and could have additive, if not synergistic, effects. This review outlines past and current neuroprotective strategies assessed in acute stroke trials. The discussion focuses on delivery platforms and their potential applicability to endovascular stoke treatment.
Novel and emerging technologies for endovascular thrombectomy
Authors: Chartrain Alexander G. , Awad Ahmed J. , Mascitelli Justin R. , Shoirah Hazem , Oxley Thomas J. , Feng Rui , Gallitto Matthew , De Leacy Reade , Fifi Johanna T. , Kellner Christopher P.
Published: April 2017

Endovascular thrombectomy device improvements in recent years have served a pivotal role in improving the success and safety of the thrombectomy procedure. As the intervention gains widespread use, developers have focused on maximizing the reperfusion rates and reducing procedural complications associated with these devices. This has led to a boom in device development. This review will cover novel and emerging technologies developed for endovascular thrombectomy.
Application of emerging technologies to improve access to ischemic stroke care
Authors: Vuong Shawn M. , Carroll Christopher P. , Tackla Ryan D. , Jeong William J. , Ringer Andrew J.
Published: April 2017

During the past 20 years, the traditional supportive treatment for stroke has been radically transformed by advances in catheter technologies and a cohort of prominent randomized controlled trials that unequivocally demonstrated significant improvement in stroke outcomes with timely endovascular intervention. However, substantial limitations to treatment remain, among the most important being timely access to care. Nonetheless, stroke care has continued its evolution by incorporating technological advances from various fields that can further reduce patients' morbidity and mortality. In this paper the authors discuss the importance of emerging technologies—mobile stroke treatment units, telemedicine, and robotically assisted angiography—as future tools for expanding access to the diagnosis and treatment of acute ischemic stroke.
Neuroprotective strategies and the underlying molecular basis of cerebrovascular stroke
Authors: Karsy Michael , Brock Andrea , Guan Jian , Taussky Phillip , Kalani M. Yashar S. , Park Min S.
Published: April 2017

Stroke is a leading cause of disability in the US. Although there has been significant progress in the area of medical and surgical thrombolytic technologies, neuroprotective agents to prevent secondary cerebral injury and to minimize disability remain limited. Only limited success has been reported in preclinical and clinical trials evaluating a variety of compounds. In this review, the authors discuss the most up-to-date information regarding the underlying molecular biology of stroke as well as strategies that aim to mitigate this complex signaling cascade. Results of historical research trials involving N-methyl-d-aspartate and α-amino-3-hydroxy-5-methyl-4-isoxazole propionate receptor antagonists, clomethiazole, antioxidants, citicoline, nitric oxide, and immune regulators have laid the groundwork for current progress. In addition, more recent studies involving therapeutic hypothermia, magnesium, albumin, glyburide, uric acid, and a variety of other treatments have provided more options. The use of neuroprotective agents in combination or with existing thrombolytic treatments may be one of many exciting areas of further development. Although past trials of neuroprotective agents in ischemic stroke have been limited, significant insights into mechanisms of stroke, animal models, and trial design have incrementally improved approaches for future therapies.
Transradial approach for mechanical thrombectomy in anterior circulation large-vessel occlusion
Authors: Sur Samir , Snelling Brian , Khandelwal Priyank , Caplan Justin M. , Peterson Eric C. , Starke Robert M. , Yavagal Dileep R.
Published: April 2017

OBJECTIVE

The goals of this study were to describe the authors' recent institutional experience with the transradial approach to anterior circulation large-vessel occlusions (LVOs) in acute ischemic stroke patients and to report its technical feasibility.

METHODS

The authors reviewed their institutional database to identify patients who underwent mechanical thrombectomy via a transradial approach over the 2 previous years, encompassing their experience using modern techniques including stent retrievers.

RESULTS

Eleven patients were identified. In 8 (72%) of these patients the right radial artery was chosen as the primary access site. In the remaining patients, transfemoral access was initially attempted. Revascularization (modified Treatment in Cerebral Ischemia [mTICI] score ≥ 2b) was achieved in 10 (91%) of 11 cases. The average time to first pass with the stent retriever was 64 minutes. No access-related complications occurred.

CONCLUSIONS

Transradial access for mechanical thrombectomy in anterior circulation LVOs is safe and feasible. Further comparative studies are needed to determine criteria for selecting the transradial approach in this setting.
Introduction to Deep Brain Stimulation
Authors: Lozano Andres M. , Gross Robert E.
Published: April 2017

It is estimated that over 160,000 patients worldwide have received deep brain stimulation (DBS) to date predominantly for Parkinson's disease and other movement disorders. With the success of this therapy, a greater appreciation of the clinical benefits and adverse effects is being realized. Neurosurgeons are increasingly paying attention to the technical details of these procedures and optimizing targeting, surgical techniques, and programming to improve outcomes.

In this issue, the nuances of surgical techniques for DBS are covered by Dr. House. Dr. Toda et al. and Mr. Chartrain et al. tackle the approach to treating tremors, either essential tremor or Holmes tremor, using either a single target or, in cases of difficult-to-treat tremors, using more than one target and interleaving the stimulation. These abstracts and videos will be appreciated by both those who are being initiated to DBS and the more seasoned practitioners who are looking for helpful hints to tackle challenging cases.
Coaxial interleaved stimulation of the thalamus and subthalamus for treatment of Holmes tremor
Authors: Toda Hiroki , Nishida Namiko , Iwasaki Koichi
Published: April 2017

Holmes tremor is often treated with multiple deep brain stimulation (DBS) electrodes. The authors describe a novel technique to suppress the tremors by effectively utilizing a single electrode.

A 16-year-old boy presented with severe right arm tremor following a midbrain injury. A DBS electrode was implanted into the ventral oralis nucleus of the thalamus (VO) and the subthalamic region. While individual stimulation of each target was ineffective, an interleaved dual stimulation of both targets has been effective for 6 years.

Coaxial interleaved stimulation of the VO and the subthalamic region is useful for treating Holmes tremor.

The video can be found here: https://youtu.be/tSwGh3vy68c.
Deep brain stimulation of the ventralis intermedius nucleus for the treatment of essential tremor
Authors: Chartrain Alexander G. , Awad Ahmed J. , Rasouli Jonathan J. , Rothrock Robert J. , Kopell Brian H.
Published: April 2017

A 59-year-old woman with a 30-year history of essential tremor refractory to medical therapy underwent staged deep brain stimulation of the ventralis intermedius nucleus of the thalamus (VIM). Left-sided lead placement was performed first. Once in the operating room, microelectrode recording (MER) was performed to confirm the appropriate trajectory and identify the VIM border with the ventralis caudalis nucleus. MER was repeated after repositioning 2 mm anteriorly to reduce the likelihood of stimulation-induced paresthesias. Physical examination prior to permanent lead placement demonstrated micro-lesion effect, suggesting optimal trajectory. After implantation of the permanent lead, physical examination showed excellent results.

The video can be found here: https://youtu.be/nn3KRdmRCZ4.
Technical nuances to minimize common complications of deep brain stimulation
Authors: House Paul
Published: April 2017

The implantation of deep brain stimulator electrodes is associated with infrequent complications. These complications are consistent across prospective trials and include infection, skin erosion, hemorrhage, and lead misplacement. Nuances of surgical technique can be used to minimize the risk of these commonly noted complications. Several of these technical nuances are highlighted in this video submission.

The video can be found here: https://youtu.be/GL09W9p013g.
Self-Organized Nanoscale Roughness Engineering for Broadband Light Trapping in Thin Film Solar Cells
Authors: Mennucci Carlo , Martella Christian , Mercaldo Lucia V. , Usatii Iurie , Veneri Paola Delli , Mongeot Francesco Buatier de
Published: April 2017

We present a self-organized method based on defocused ion beam sputtering for nanostructuring glass substrates which feature antireflective and light trapping effects. By irradiating the substrate, capped with a thin gold (Au) film, a self-organized Au nanowire stencil mask is firstly created. The morphology of the mask is then transferred to the glass surface by further irradiating the substrate, finally producing high aspect ratio, uniaxial ripple-like nanostructures whose morphological parameters can be tailored by varying the ion fluence. The effect of a Ti adhesion layer, interposed between glass and Au with the role of inhibiting nanowire dewetting, has also been investigated in order to achieve an improved morphological tunability of the templates. Morphological and optical characterization have been carried out, revealing remarkable light trapping performance for the largest ion fluences. The photon harvesting capability of the nanostructured glass has been tested for different preparation conditions by fabricating thin film amorphous Si solar cells. The comparison of devices grown on textured and flat substrates reveals a relative increase of the short circuit current up to 25%. However, a detrimental impact on the electrical performance is observed with the rougher morphologies endowed with steep v-shaped grooves. We finally demonstrate that post-growth ion beam restructuring of the glass template represents a viable approach toward improved electrical performance.
Perspectives on Technology-Assisted Relaxation Approaches to Support Mind-Body Skills Practice in Children and Teens: Clinical Experience and Commentary
Authors: Culbert Timothy
Published: April 2017

It has been well-established that a variety of mind-body (MB) techniques, including yoga, mental imagery, hypnosis, biofeedback, and meditation, are effective at addressing symptoms such as pain, anxiety, nausea, and insomnia, as well as helping with a wide variety of medical, emotional, and behavioral issues in pediatric populations. In addition, MB skills can also be health promoting in the long-term, and with regular practice, could potentially contribute to longer attention spans, social skills, emotional regulation, and enhanced immune system functioning. Importantly, the benefits accrued from MB skills are largely dose dependent, meaning that individuals who practice with some consistency tend to benefit the most, both in the short- and long-term. However, clinical experience suggests that for busy patients, the regular practice of MB skills can be challenging and treatment adherence commonly becomes an issue. This commentary reviews the concept of technology assisted relaxation as an engaging and effective option to enhance treatment adherence (i.e., daily practice) for pediatric patients, for whom MB skills have been recommended to address physical and mental health challenges.
Analysis of Low Frequency Oscillation Using the Multi-Interval Parameter Estimation Method on a Rolling Blackout in the KEPCO System
Authors: Shim Kwan-Shik , Ahn Seon-Ju , Yun Sang-Yun , Choi Joon-Ho
Published: April 2017

This paper describes a multiple time interval (“multi-interval”) parameter estimation method. The multi-interval parameter estimation method estimates a parameter from a new multi-interval prediction error polynomial that can simultaneously consider multiple time intervals. The root of the multi-interval prediction error polynomial includes the effect on each time interval, and the important mode can be estimated by solving one polynomial for multiple time intervals or signals. The algorithm of the multi-interval parameter estimation method proposed in this paper is applied to the test function and the data measured from a PMU (phasor measurement unit) installed in the KEPCO (Korea Electric Power Corporation) system. The results confirm that the proposed multi-interval parameter estimation method accurately and reliably estimates important parameters.
A Decoupled Design Parameter Analysis for Free-Piston Engine Generators
Authors: Jia Boru , Zuo Zhengxing , Smallbone Andrew , Feng Huihua , Roskilly Anthony
Published: April 2017

The free-piston engine generator (FPEG) is a novel power generation device with an estimated brake efficiency (energy contained in the fuel that is transformed into useful work) of up to 46%, compared to the 25–35% reported in conventional reciprocating engines. This paper seeks to address a major challenge in the development of new and complex technologies—how do we effectively communicate and understand the influence of key design parameters on its operating performance? In this paper, the FPEG is described using a simple numerical model, a model which is reduced to a forced mass-spring vibration system under external excitation, enabling all the major input parameters to be decoupled. It proved that the engine piston position as a function of time and output power could be predicted directly from the input parameters with acceptable accuracy. The influence of the key FPEG design parameters on the piston oscillation characteristics and electric power output can be characterised with respect to one another and summarised. Key design parameters include piston mass, compression stroke length, piston cross sectional area, and electric load. Compared with previous and more complex numerical models, the presented methods can be used to simply describe the sensitivity of key design parameters on the FPEG performance. It will provide useful general guidance for the FPEG hardware design process.