bluuebunny/crossref_metadata_2025 huggingface dataset:
Aspirin plus Clopidogrel as Secondary Prevention after Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis
Authors: Zhang Qinghua , Wang Chao , Zheng Maoyong , Li Yanxia , Li Jincun , Zhang Liping , Shang Xiao , Yan Chuanzhu
Published: April 2017

Background: Antiplatelet agents are the mainstay for secondary prevention of non-cardioembolic stroke. This systematic review examined the safety and efficacy of short-, middle-, and long-term aspirin in combination with clopidogrel as secondary prevention of stroke or transient ischemic attack (TIA) of presumed arterial origin. Methods: PubMed, EmBase, and CENTRAL were searched up to May 2014. Randomized controlled trials (RCTs) that compared aspirin plus clopidogrel versus aspirin or clopidogrel as secondary prevention of stroke or TIA of arterial origin were included. The analyses were stratified into short-term (≤3 months), middle-term (>3 months and <1 year), and long-term (≥1 year). Outcomes were compared using risk ratio (RR) and 95% confidence interval (95% CI). Results: Eight RCTs (20,728 patients) were included in the overall analysis. Compared with aspirin or clopidogrel alone, the complete analysis of all the data indicated that the combination therapy significantly reduced the risk of stroke recurrence (RR, 0.82; 95% CI 0.70-0.96, p = 0.01) and major vascular events (RR, 0.84; 95% CI 0.73-0.96, p < 0.01). But the risk of hemorrhagic stroke (RR, 1.59; 95% CI 1.08-2.33, p = 0.02) and major bleeding (RR, 1.83; 95% CI 1.37-2.45, p < 0.01) was increased. No RCT studied middle-term combination therapy. The analyses were therefore stratified into only two subgroups, short- and long-term treatment. Stratified analysis of short-term treatment showed that relative to monotherapy, the drug combination reduced the risk of stroke recurrence (RR, 0.69; 95% CI 0.59-0.81, p < 0.01) and did not increase the risk of hemorrhagic stroke (RR, 1.23; 95% CI 0.50-3.04, p = 0.65) and major bleeding events (RR, 2.17; 95% CI 0.18-25.71, p = 0.54). Short-term combination therapy was associated with a significantly lower risk of major vascular events (RR, 0.70; 95% CI 0.69 to 0.82, p < 0.01). Stratified analysis of long-term treatment revealed that the combination treatment did not decrease the risk of stroke recurrence (RR, 0.92; 95% CI 0.83-1.03, p = 0.15), but was associated with a significantly higher risk of hemorrhagic stroke (RR, 1.67; 95% CI 1.10-2.56, p = 0.02) and major bleeding events (RR, 1.90; 95% CI 1.46-2.48, p < 0.01). Long-term combination therapy failed to reduce the risk of major vascular events (RR, 0.92; 95% CI 0.84-1.03, p = 0.09). Conclusions: Compared with monotherapy, short-term aspirin in combination with clopidogrel is more effective as secondary prevention of stroke or TIA without increasing the risk of hemorrhagic stroke and major bleeding events. Long-term combination therapy does not reduce the risk of stroke recurrence, and is associated with increased major bleeding events. The clinical applicability of the findings of this systematic review, however, needs to be confirmed in future clinical trials.
Administration of Ferric Citrate Hydrate Decreases Circulating FGF23 Levels Independently of Serum Phosphate Levels in Hemodialysis Patients with Iron Deficiency
Authors: Iguchi Akira , Kazama Junichiro J. , Yamamoto Suguru , Yoshita Kazuhiro , Watanabe Yasuo , Iino Noriaki , Narita Ichiei
Published: April 2017

Background/Aim: Dietary phosphate intake and vitamin D receptor activator (VDRA) regulate fibroblast growth factor 23 (FGF23); iron may modulate FGF23 metabolism. We aimed to determine whether oral iron supplementation influences serum FGF23 concentration in hemodialysis (HD) patients, while excluding the effect of dietary phosphate intake. Methods: This prospective study enrolled 27 maintenance HD patients with iron deficiency and hyperphosphatemia treated with sevelamer-HCl. The phosphate binder was changed from sevelamer-HCl to ferric citrate hydrate (FCH) to maintain constant phosphate levels. VDRA, other phosphate binders, and cinacalcet HCl were not changed. Serum intact FGF23, C-terminal FGF23 (C-term FGF23), intact parathyroid hormone (PTH), 1,25(OH)2D and other parameters were monitored for 12 weeks. Results: Serum phosphate levels (5.89 ± 1.45 mg/dl at baseline, 5.54 ± 1.35 mg/dl at 12 weeks) and 1,25(OH)2D levels were unchanged. Serum ferritin levels increased from 25.6 ± 24.3 ng/ml at baseline to 55.8 ± 33.5 ng/ml at 12 weeks with FCH administration. Serum intact FGF23 and C-term FGF23 levels significantly decreased at 12 weeks compared with baseline (2,000 (1,300.0-3,471.4) to 1,771.4 (1,142.9-2,342.9) pg/ml, p = 0.01, and 1,608.7 (634.8-2,308.7) to 1,165.2 (626.1-1,547.8) RU/ml, p = 0.007, respectively); serum intact PTH levels significantly increased (96 (65-125) to 173 (114-283) pg/ml, p < 0.001). Conclusions: Oral FCH administration decreased serum intact FGF23 and C-term FGF23 levels and increased intact PTH levels; phosphate and 1,25(OH)2D levels were unchanged. Oral FCH administration to treat iron deficiency is a possible strategy for reducing serum FGF23 levels independent of phosphate and VDRA.
Measuring Global Brain Atrophy with the Brain Volume/Cerebrospinal Fluid Index: Normative Values, Cut-Offs and Clinical Associations
Authors: Orellana Camila , Ferreira Daniel , Muehlboeck J.-Sebastian , Mecocci Patrizia , Vellas Bruno , Tsolaki Magda , Kłoszewska Iwona , Soininen Hilkka , Lovestone Simon , Simmons Andrew , Wahlund Lars-Olof , Westman Eric ,   for the AddNeuronMed consortium and for the Alzheimer's Disease Neuroimaging Initiative
Published: April 2017

Background: Global brain atrophy is present in normal aging and different neurodegenerative disorders such as Alzheimer's disease (AD) and is becoming widely used to monitor disease progression. Summary: The brain volume/cerebrospinal fluid index (BV/CSF index) is validated in this study as a measurement of global brain atrophy. We tested the ability of the BV/CSF index to detect global brain atrophy, investigated the influence of confounders, provided normative values and cut-offs for mild, moderate and severe brain atrophy, and studied associations with different outcome variables. A total of 1,009 individuals were included [324 healthy controls, 408 patients with mild cognitive impairment (MCI) and 277 patients with AD]. Magnetic resonance images were segmented using FreeSurfer, and the BV/CSF index was calculated and studied both cross-sectionally and longitudinally (1-year follow-up). Both AD patients and MCI patients who progressed to AD showed greater global brain atrophy compared to stable MCI patients and controls. Atrophy was associated with older age, larger intracranial volume, less education and presence of the ApoE ε4 allele. Significant correlations were found with clinical variables, CSF biomarkers and several cognitive tests. Key Messages: The BV/CSF index may be useful for staging individuals according to the degree of global brain atrophy, and for monitoring disease progression. It also shows potential for predicting clinical changes and for being used in the clinical routine.
Effect of Melatonin and Resveratrol against Memory Impairment and Hippocampal Damage in a Rat Model of Vascular Dementia
Authors: Shen Dongfang , Tian Xiaoyan , Sang Wenxu , Song Rongrong
Published: April 2017

Objectives: This study was intended to investigate whether treatment with resveratrol and melatonin alone or in combination can exert neurorestorative effects in a rat model of vascular dementia. Methods: Briefly, male Wistar rats were subjected to permanent bilateral common carotid artery occlusion (BCCAO) by surgery. After 4 weeks, the cognitive deficits were assessed using the Morris water maze and novel object recognition tests. The biochemical parameters of oxidative stress and inflammation were also assessed. Results: Rats in the BCCAO group showed cognitive deficits, accompanied by oxidonitrosative stress, neuroinflammation, and a reduction in brain-derived neurotrophic factor (BDNF) in the hippocampus region. Moreover, the acetylcholinesterase activity in the hippocampus was found to be increased in the BCCAO group compared to the sham group. The 4-week treatment with melatonin (10 mg/kg) and resveratrol (20 mg/kg) alone and in combination (melatonin 5 mg/kg and reseveratrol 10 mg/kg) caused a significant improvement in the cognitive deficits induced by BCCAO, accompanied by a reversal of oxidonitrosative stress, neuroinflammation, and BDNF depletion in the hippocampus region. Additionally, the treatment with melatonin and resveratrol significantly decreased acetylcholinesterase activity compared to in the BCCAO group. Melatonin and resveratrol ameliorated the BDNF expression of hippocampal protein. Conclusion: These results emphasize that coadministration of melatonin and resveratrol can be beneficial in BCCAO-induced vascular dementia through changes in BDNF expressions.
Accessory Spleen in the Greater Omentum: Embryology and Revisited Prevalence Rates
Authors: Gill Nikita , Nasir Areeba , Douglin Jennifer , Pretterklieber Bettina , Steinke Hanno , Pretterklieber Michael , Cotofana Sebastian
Published: April 2017

Purpose: To investigate in a large sample the prevalence rates of accessory spleens located in the greater omentum and to explain the embryological background and the vascular supply of this rare congenital disorder. Methods: Evaluation of the presence of accessory spleens located in the greater omentum was performed in 5 different international anatomical centers investigating a total of 1,045 body donors. Arterial and venous blood supply and the precise location of the respective vasculature within the splenic ligaments are described based on dissection of this rare condition in a male specimen. Results: The reported prevalence rates from 5 different centers were: 0.5% (out of 380 body donors), 0% (out of 230 donors), 0% (out of 200 donors), 2% (out of 200 donors), and 0% (out of 35 donors). The cumulative prevalence rate obtained from 1,045 anatomical dissections was 0.6%. The identified accessory spleen measured 3 × 3 × 2.5 cm and was located in the left upper abdominal quadrant. A vascular stag 7.5 cm in length was identified within the gastro-splenic ligament, containing an artery and a vein piercing the greater omentum from posterior. Conclusion: An accessory spleen located in the greater omentum is a rare congenital disorder. Physicians should be aware of the fact that in patients without any representative symptom history a nodular mass located within the greater omentum could be an accessory spleen.
Two-Year Complete Remission of Diffuse Large B-Cell Lymphoma in an Immunological Nonresponder HIV-Infected Patient: Case Report
Authors: Vrbic Miodrag , Petkovic Ivan , Vrbic Svetislav , Jovanovic Maja , Rankovic Aleksandar , Popovic-Dragonjic Lidija , Djordjevic-Spasic Marina
Published: April 2017

Introduction: HIV-infected patients are affected significantly more frequently by all types of lymphoma, with diffuse large B-cell lymphoma (DLBCL) as the most prevalent histological type. Since the introduction of combination antiretroviral therapy (cART) morbidity and mortality of DLBCL has been markedly reduced, which is primarily interpreted as a result of the drug-mediated immune reconstitution. Case Report: We present a previously healthy, 44-year-old HIV-infected man with DLBCL of the oral cavity, treated with immunochemotherapy and cART. During HIV-directed treatment, despite the successful virologic response, a satisfactory immunological response was not achieved. However, the patient had a 2-year complete remission after first-line treatment of DLBCL. Conclusion: Response to cART strongly predicts outcome in patients with DLBCL. Close monitoring of HIV-directed therapy efficacy, especially as to achievement of successful virologic response, independently associated with prolonged survival, is essential for estimating future DLBCL treatment strategies.
Nicotinamide N-Methyltransferase Suppression Participates in Nickel-Induced Histone H3 Lysine9 Dimethylation in BEAS-2B Cells
Authors: Li Qian , He Min-Di , Mao Lin , Wang Xue , Jiang Yu-Lin , Li Min , Lu Yong-Hui  , Yu Zheng-Ping , Zhou Zhou
Published: April 2017

Background: Nickel compounds are well-established human carcinogens with weak mutagenic activity. Histone methylation has been proposed to play an important role in nickel-induced carcinogenesis. Nicotinamide N-methyltransferase (NNMT) decreases histone methylation in several cancer cells by altering the cellular ratio of S-adenosylmethionine (SAM) to S-adenosylhomocysteine (SAH). However, the role of NNMT in nickel-induced histone methylation remains unclear. Methods: BEAS-2B cells were exposed to different concentrations of nickel chloride (NiCl2) for 72 h or 200 μM NiCl2 for different time periods. Histone H3 on lysine 9 (H3K9) mono-, di-, and trimethylation and NNMT protein levels were measured by western blot analysis. Expressions of NNMT mRNA and the H3k9me2-associated genes, mitogen-activated protein kinase 3 (MAP2K3) and dickkopf1 (DKK1), were determined by qPCR analysis. The cellular ratio of nicotinamide adenine dinucleotide (NAD+) to reduced NAD (NADH) and SAM/SAH ratio were determined. Results: Exposure of BEAS-2B cells to nickel increased H3K9 dimethylation (H3K9me2), suppressed the expressions of H3K9me2-associated genes (MAP2K3 and DKK1), and induced NNMT repression at both the protein and mRNA levels. Furthermore, over-expression of NNMT inhibited nickel-induced H3K9me2 and altered the cellular SAM/SAH ratio. Additionally, the NADH oxidant phenazine methosulfate (PMS) not only reversed the nickel-induced reduction in NAD+/NADH but also inhibited the increase in H3K9me2. Conclusions: These findings indicate that the repression of NNMT may underlie nickel-induced H3K9 dimethylation by altering the cellular SAM/SAH ratio.
Crisis and Revolt in Spain
Authors: Berglund Oscar
Published: April 2017

In this review ofThe Limits to Capital in Spainby Greig Charnock, Thomas Purcell and Ramon Ribera-Fumaz andFin de Cicloby Isidro López and Emmanuel Rodríguez, I discuss how the two books advance our understanding of the Spanish crisis and the forms of resistance that have arisen since it began in 2008.
Jesus Nazarenus Legislator
Authors: Quatrini Francesco
Published: April 2017

This article examines the manuscript, entitled Jesus Nazarenus Legislator, written by Adam Boreel against the De Tribus Impostoribus. The analysis focuses on three main aspects of the manuscript. First, I give some information about De Tribus Impostoribus. Second, I trace the history of the writing of Boreel’s book. To this end, I will mainly take into consideration the correspondences of Henry Oldenburg and John Worthington. Last, I show that Boreel postulates a rational Christian religion and that he places emphasis on the practical aspects of this religion. For this reason, all humankind can accept it. In conclusion, I will sum up the results obtained from my analysis of the Jesus Nazarenus Legislator; I will also suggest that Boreel’s ideas could be read in light of the discussion on adiaphora in the Christian religion.
A new Cernosvitoviella species (Clitellata: Enchytraeidae) and its comparison with other Cernosvitoviella species from Sphagnum mires in Hungary
Authors: DÓZSA-FARKAS KLÁRA , CSITÁRI BIANKA , FELFÖLDI TAMÁS
Published: April 2017

Results of a comparative investigation on five Cernosvitoviella species from Hungarian Sphagnum mires including their distribution and the description of a new species, Cernosvitoviella farkasi sp. n., are presented in this paper. Cernosvitoviella atrata, C. aggtelekiensis, C. crassoductus and C. farkasi sp. n. could be easily distinguished from each other based on both morphological and molecular taxonomic analyses. However, C. minor seems to be a species complex on the basis of these investigations, so it was referred as C. minor sensu lato. The status of the C. minor variants requires further studies.
A Stochastic Dynamical Model of Arctic Sea Ice
Authors: Moon Woosok , Wettlaufer J. S.
Published: April 2017

The noise forcing underlying the variability in the Arctic ice cover has a wide range of principally unknown origins. For this reason, the analytical and numerical solutions of a stochastic Arctic sea ice model are analyzed with both additive and multiplicative noise over a wide range of external heat fluxes Δ F0, corresponding to greenhouse gas forcing. The stochastic variability fundamentally influences the nature of the deterministic steady-state solutions corresponding to perennial and seasonal ice and ice-free states. Thus, the results are particularly relevant for the interpretation of the state of the system as the ice cover thins with Δ F0, allowing a thorough examination of the differing effects of additive versus multiplicative noise. In the perennial ice regime, the principal stochastic moments are calculated and compared to those determined from a stochastic perturbation theory described previously. As Δ F0increases, the competing contributions to the variability of the destabilizing sea ice–albedo feedback and the stabilizing longwave radiative loss are examined in detail. At the end of summer the variability of the stochastic paths shows a clear maximum, which is due to the combination of the increasing influence of the albedo feedback and an associated “memory effect,” in which fluctuations accumulate from early spring to late summer. This is counterbalanced by the stabilization of the ice cover resulting from the longwave loss of energy from the ice surface, which is enhanced during winter, thereby focusing the stochastic paths and decreasing the variability. Finally, common examples in stochastic dynamics with multiplicative noise are discussed wherein the choice of the stochastic calculus (Itô or Stratonovich) is not necessarily determinable a priori from observations alone, which is why both calculi are treated on equal footing herein.
Internal Intraseasonal Variability of the West African Monsoon in WRF
Authors: Alaka Ghassan J. , Maloney Eric D.
Published: April 2017

The West African monsoon (WAM) and its landmark features, which include African easterly waves (AEWs) and the African easterly jet (AEJ), exhibit significant intraseasonal variability in boreal summer. However, the degree to which this variability is modulated by external large-scale phenomena, such as the Madden–Julian oscillation (MJO), remains unclear. The Weather Research and Forecasting (WRF) Model is employed to diagnose the importance of the MJO and other external influences for the intraseasonal variability of the WAM and associated AEW energetics by removing 30–90-day signals from initial and lateral boundary conditions in sensitivity tests. The WAM produces similar intraseasonal variability in the absence of external influences, indicating that the MJO is not critical to produce WAM variability. In control and sensitivity experiments, AEW precursor signals are similar near the AEJ entrance in East Africa. For example, an eastward extension of the AEJ increases barotropic and baroclinic energy conversions in East Africa prior to a 30–90-day maximum of perturbation kinetic energy in West Africa. The WAM appears to prefer a faster oscillation when MJO forcing is removed, suggesting that the MJO may serve as a pacemaker for intraseasonal oscillations in the WAM. WRF results show that eastward propagating intraseasonal signals (e.g., Kelvin wave fronts) are responsible for this pacing, while the role of westward propagating intraseasonal signals (e.g., MJO-induced Rossby waves) appears to be limited. Mean state biases across the simulations complicate the interpretation of results.
Longitudinal changes in the antecedent and early manifest course of bipolar disorder—A narrative review of prospective studies
Authors: Pfennig Andrea , Leopold Karolina , Ritter Philipp , Böhme Anne , Severus Emanuel , Bauer Michael
Published: April 2017

Objective:

Prospective study designs ideally allow patients to be followed from the first manifestations of the illness or even from an at-risk stage. It can thus provide data on the predictive value of changes in clinical symptomatology, cognition or further biological markers to broaden our understanding of the etiopathology and symptomatic trajectory of bipolar disorders. The scope of this narrative review is to summarize evidence from prospectively collected data on psychopathological and other clinical and biological changes in the early developmental course of bipolar disorders.

Methods:

The narrative review was based on a literature search conducted in February 2016 within the PubMed library for prospective study data of persons in antecedent and early manifest stages of manifest bipolar disorder published within the last 15 years.

Results:

A total of 19 prospective studies were included. Regarding psychopathological features; personality, temperament and character traits as well as changes in sleep and circadian rhythm, the evidence suggests that risk factors for the development of bipolar disorder can already be described and should be studied further to understand their interaction, mediation with other factors and timing in the developmental process of bipolar disorder. Apart from the positive family history, childhood anxiety, sleep problems, subthreshold (hypo)manic symptoms and certain character traits/emotionality should be identified and monitored already in clinical practice as their presence likely increases risk of bipolar disorder. Up to date no substantiated evidence was found from prospective studies addressing cognitive features, life events, immunological parameters and morphological central nervous system changes as potential risk factors for bipolar disorder.

Conclusion:

For an improved understanding of episodic disorders, longitudinal data collection is essential. Since the etiology of bipolar disorders is complex, a number of potential risk factors have been proposed. Prospective studies addressing this spectrum and resilience factors are critical and will be best conducted within multi-site research networks or initiatives.
Investigation on the flexural response of multiscale anisogrid composite panels reinforced with carbon fibers and multi-walled carbon nanotubes
Authors: Eslami-Farsani Reza , Shahrabi-Farahani Alireza
Published: April 2017

Grid stiffened composite structures have been maturely developed in aircraft and automobile industries due to their excellence properties such as high specific strength, high specific stiffness, excellent energy absorption capability and corrosion resistance. In the current investigation, the effect of multi-walled carbon nanotubes addition in various weight percentages (0, 0.1, 0.25 and 0.4) on the flexural response of anisogrid composite panels was evaluated. For fabrication of the composite specimens, hand lay-up method was used where plain weave E-glass fibers and unidirectional carbon fibers impregnated to the epoxy resin that modified with multi-walled carbon nanotubes were used in the skin and rib parts, respectively. Experimental results from three-point bending test showed that with the addition of 0.4 wt.% of multi-walled carbon nanotubes, the maximum flexural load, flexural stiffness and energy absorption of anisogrid composite panels increased by 24%, 35% and 25%, respectively. Microscopic analyses revealed that the improvement in the flexural properties of anisogrid composite panels with the addition of multi-walled carbon nanotubes was due to improvement in the interfacial properties of matrix and fibers.
Global Finance, Labor Politics, and the Political Economy of Housing Prices
Authors: Johnston Alison , Regan Aidan
Published: April 2017

International political economy identifies declining nominal interest rates, securitization, and financial liberalization as drivers of rising housing prices. Despite witnessing these common credit shocks, however, developed economies experienced divergent trends in housing inflation since the 1980s. We offer a comparative political economy explanation of variation in house prices, arguing that by restraining household incomes, wage-setting institutions can blunt financial liberalization’s inflationary impact on housing markets. Employing quantitative analysis and a comparative study of Ireland and the Netherlands, we uncover two findings. First, countries where political coalitions in the export sector held veto powers over those in the nontraded sector in national wage setting realized lower housing inflation. Second, the impact of sectoral coalitions on housing prices in OECD countries is similar to that of financial variables. Our results suggest that the organization of labor politics continues to play an important role in mitigating the destabilizing effects of global finance on developed economies.
Rethinking Coup Risk
Authors: Rabinowitz Beth , Jargowsky Paul
Published: April 2017

Military interventions continue to be prevalent in Africa. In the 21st century alone, 14 coups have been successfully staged. Whereas most studies of coup risk examine how militaries are organized or what structural conditions are associated with coups, we take a novel approach. We explore how coalition politics relate to coup risk. It has long been observed that regimes try to hold power by buying off urban consumers. We argue that focusing on urban consumers actually makes regimes more prone to military intervention. Instead, leaders who ally with established rural elites are more effective at thwarting coups. To test our hypothesis, we develop a unique data set of rural political strategies, coding regimes in 44 sub-Saharan countries from 1960 to 2000. Using a continuous-time Cox proportional hazards regression model, we find a robust correlation between policies supportive of rural elites and lower coup risk.
Tracheostomy for Severe Pediatric Obstructive Sleep Apnea: Indications and Outcomes
Authors: Rizzi Christopher J. , Amin Julian D. , Isaiah Amal , Valdez Tulio A. , Jeyakumar Anita , Smart Suzanne E. , Pereira Kevin D.
Published: April 2017

Objectives

(1) To describe characteristics of pediatric patients undergoing tracheostomy for obstructive sleep apnea (OSA). (2) To highlight perioperative events and outcomes of the procedure.

Study Design

Case series with chart review.

Setting

Four tertiary care academic children’s hospitals.

Subjects and Methods

Twenty‐nine children aged <18 years from January 1, 2010, to December 31, 2015, who underwent tracheostomy for severe OSA, defined as an apnea‐hypopnea index (AHI) >10, were included in the study. Data on patient characteristics, polysomnographic findings, comorbidities, and perioperative events and outcomes were collected and analyzed.

Results

Twenty‐nine patients were included. Mean age at tracheostomy was 2.0 years (95% CI, −2.2 to 6.2). Mean body mass index z score was −1.2 (95% CI, −4.9 to −2.5). Mean preoperative AHI was 60.2 (95% CI, −15.7 to 136.1). Mean postoperative intensive care unit stay was 23.2 days (95% CI, 1.44‐45.0). One procedure was complicated by bronchospasm. Thirteen patients had craniofacial abnormalities; 10 had a neurologic disorder resulting in hypotonia; and 5 had a diagnosis of laryngomalacia. Mean follow‐up was 30.6 months (95% CI, −10.4 to 71.6). Six patients were decannulated, with a mean time to decannulation of 40.8 months (95% CI, 7.9‐73.7). Five patients underwent capped sleep study prior to decannulation with a mean AHI of 6.6 (95% CI, −9.9 to 23.1) and a mean oxygen nadir of 90.0% (95% CI, 80%‐100%).

Conclusion

OSA is an uncommon indication for tracheostomy in children. Patients who require the procedure usually have an associated syndromic diagnosis resulting in upper airway obstruction. The majority of children who undergo tracheostomy for OSA will remain dependent at 24 months.
Resident Involvement in Professional Otolaryngology Organizations: Current Trends in the United States
Authors: Wong Kevin , Jang Minyoung , Gilad Amir , Levi Jessica R.
Published: April 2017

Involvement by residents in professional medical organizations can enrich their training, but little data exist regarding the number and types of involvement opportunities available to otolaryngology residents. We sought to fill this gap in knowledge by quantifying the extent to which major otolaryngology‐related organizations in the United States provide involvement opportunities to otolaryngology residents. Our analysis included 23 organizations and subspecialty societies. Results showed that many opportunities exist for residents to attend conferences and present research; however, fewer involvement and funding opportunities existed in any other leadership, health policy, or service‐learning experiences. These findings were consistent across general and subspecialty societies. Given the many purported benefits of resident involvement in otolaryngology outside of the standard training environment, future efforts may be warranted to increase the number and type of involvement opportunities currently available in professional societies.
Do Clinical Practice Guidelines Improve Quality?
Authors: Baldassari Cristina M.
Published: April 2017

Controversy exists surrounding how to best define and assess quality in the health care setting. Clinical practice guidelines (CPGs) have been developed to improve the quality of medical care by highlighting key clinical recommendations based on recent evidence. However, data linking CPGs to improvements in outcomes in otolaryngology are lacking. Numerous barriers contribute to difficulties in translating CPGs to improvements in quality. Future initiatives are needed to improve CPG adherence and define the impact of CPG recommendations on the quality of otolaryngologic care provided to our patients.
Otolaryngology Residency Program Research Resources and Scholarly Productivity
Authors: Villwock Jennifer A. , Hamill Chelsea S. , Nicholas Brian D. , Ryan Jesse T.
Published: April 2017

Objective

To delineate research resources available to otolaryngology residents and their impact on scholarly productivity.

Study Design

Survey of current otolaryngology program directors.

Setting

Otolaryngology residency programs.

Subjects and Methods

An anonymous web‐based survey was sent to 98 allopathic otolaryngology training program directors. Fisher exact tests and nonparametric correlations were used to determine statistically significant differences among various strata of programs.

Results

Thirty‐nine percent (n = 38) of queried programs responded. Fourteen (37%) programs had 11 to 15 full‐time, academic faculty associated with the residency program. Twenty (53%) programs have a dedicated research coordinator. Basic science lab space and financial resources for statistical work were present at 22 programs (58%). Funding is uniformly provided for presentation of research at conferences; a minority of programs (13%) only funded podium presentations. Twenty‐four (63%) have resident research requirements beyond the Accreditation Council for Graduate Medical Education (ACGME) mandate of preparing a “manuscript suitable for publication” prior to graduation. Twenty‐five (67%) programs have residents with 2 to 3 active research projects at any given time. None of the investigated resources were significantly associated with increased scholarly output. There was no uniformity to research curricula.

Conclusions

Otolaryngology residency programs value research, evidenced by financial support provided and requirements beyond the ACGME minimum. Additional resources were not statistically related to an increase in resident research productivity, although they may contribute positively to the overall research experience during training. Potential future areas to examine include research curricula best practices, how to develop meaningful mentorship and resource allocation that inspires continued research interest, and intellectual stimulation.
Toward a multiscale modeling framework for understanding serotonergic function
Authors: Wong-Lin KongFatt , Wang Da-Hui , Moustafa Ahmed A , Cohen Jeremiah Y , Nakamura Kae
Published: April 2017

Despite its importance in regulating emotion and mental wellbeing, the complex structure and function of the serotonergic system present formidable challenges toward understanding its mechanisms. In this paper, we review studies investigating the interactions between serotonergic and related brain systems and their behavior at multiple scales, with a focus on biologically-based computational modeling. We first discuss serotonergic intracellular signaling and neuronal excitability, followed by neuronal circuit and systems levels. At each level of organization, we will discuss the experimental work accompanied by related computational modeling work. We then suggest that a multiscale modeling approach that integrates the various levels of neurobiological organization could potentially transform the way we understand the complex functions associated with serotonin.
Modified laparoscopic cholecystectomy technique for treatment of situs inversus totalis: A case report
Authors: Ren Jian-jun , Li Shu-dong , Geng Ya-jun , Xiao Rui
Published: April 2017

Laparoscopic cholecystectomy is a broadly used technique for gallbladder treatment. However, situs inversus, a rare anomaly, is reportedly difficult to treat by conventional laparoscopic cholecystectomy. A 36-year-old woman with chronic cholecystitis and multiple gallstones was found to have dextrocardia on a chest X-ray. Magnetic resonance imaging demonstrated situs inversus, cholecystitis, and cholelithiasis. We successfully performed laparoscopic cholecystectomy using our modified technique, which mainly involved a left-handed operation and adjustment of the port positions. This case will be very instructive for right-handed surgeons in the management of cholelithiasis by laparoscopic cholecystectomy in patients with situs inversus.
The Relationship of Static Tibial Tubercle–Trochlear Groove Measurement and Dynamic Patellar Tracking
Authors: Carlson Victor R. , Sheehan Frances T. , Shen Aricia , Yao Lawrence , Jackson Jennifer N. , Boden Barry P.
Published: April 2017

Background:

The tibial tubercle to trochlear groove (TT-TG) distance is used for screening patients with a variety of patellofemoral joint disorders to determine who may benefit from patellar medialization using a tibial tubercle osteotomy. Clinically, the TT-TG distance is predominately based on static imaging with the knee in full extension; however, the predictive ability of this measure for dynamic patellar tracking patterns is unknown.

Purpose:

To determine whether the static TT-TG distance can predict dynamic lateral displacement of the patella.

Study Design:

Cohort study (Diagnosis); Level of evidence, 2.

Methods:

The static TT-TG distance was measured at full extension for 70 skeletally mature subjects with (n = 32) and without (n = 38) patellofemoral pain. The dynamic patellar tracking patterns were assessed from approximately 45° to 0° of knee flexion by use of dynamic cine-phase contrast magnetic resonance imaging. For each subject, the value of dynamic lateral tracking corresponding to the exact knee angle measured in the static images for that subject was identified. Linear regression analysis determined the predictive ability of static TT-TG distance for dynamic patellar lateral displacement for each cohort.

Results:

The static TT-TG distance measured with the knee in full extension cannot accurately predict dynamic lateral displacement of the patella. There was weak predictive ability among subjects with patellofemoral pain ( r2 = 0.18, P = .02) and no predictive capability among controls. Among subjects with patellofemoral pain and static TT-TG distances 15 mm or more, 8 of 13 subjects (62%) demonstrated neutral or medial patellar tracking patterns.

Conclusion:

The static TT-TG distance cannot accurately predict dynamic lateral displacement of the patella. A large percentage of patients with patellofemoral pain and pathologically large TT-TG distances may have neutral to medial maltracking patterns.
Augmentation of Distal Biceps Repair With an Acellular Dermal Graft Restores Native Biomechanical Properties in a Tendon-Deficient Model
Authors: Conroy Christine , Sethi Paul , Macken Craig , Wei David , Kowalsky Marc , Mirzayan Raffy , Pauzenberger Leo , Dyrna Felix , Obopilwe Elifho , Mazzocca Augustus D.
Published: April 2017

Background:

The majority of distal biceps tendon injuries can be repaired in a single procedure. In contrast, complete chronic tears with severe tendon substance deficiency and retraction often require tendon graft augmentation. In cases with extensive partial tears of the distal biceps, a human dermal allograft may be used as an alternative to restore tendon thickness and biomechanical integrity.

Hypothesis:

Dermal graft augmentation will improve load to failure compared with nonaugmented repair in a tendon-deficient model.

Study Design:

Controlled laboratory study.

Methods:

Thirty-six matched specimens were organized into 1 of 4 groups: native tendon, native tendon with dermal graft augmentation, tendon with an attritional defect, and tendon with an attritional defect repaired with a graft. To mimic a chronic attritional biceps lesion, a defect was created by a complete tear, leaving 30% of the tendon’s width intact. The repair technique in all groups consisted of cortical button and interference screw fixation. All specimens underwent cyclical loading for 3000 cycles and were then tested to failure; gap formation and peak load at failure were documented.

Results:

The mean (±SD) load to failure (320.9 ± 49.1 N vs 348.8 ± 77.6 N, respectively; P = .38) and gap formation (displacement) (1.8 ± 1.4 mm vs 1.6 ± 1.1 mm, respectively; P = .38) did not differ between the native tendon groups with and without graft augmentation. In the tendon-deficient model, the mean load to failure was significantly improved with graft augmentation compared with no graft augmentation (282.1 ± 83.8 N vs 199.7 ± 45.5 N, respectively; P = .04), while the mean gap formation was significantly reduced (1.2 ± 1.0 mm vs 2.7 ± 1.4 mm, respectively; P = .04). The mean load to failure of the deficient tendon with graft augmentation (282.1 N) compared with the native tendon (348.8 N) was not significantly different ( P = .12). This indicates that the native tendon did not perform differently from the grafted deficient tendon.

Conclusion:

In a tendon-deficient, complete distal biceps rupture model, acellular dermal allograft augmentation restored the native tendon’s biomechanical properties at time zero. The grafted tissue-deficient model demonstrated no significant differences in the load to failure and gap formation compared with the native tendon. As expected, dermal augmentation of attritional tendon repair increased the load to failure and stiffness as well as decreased displacement compared with the ungrafted tissue-deficient model. Tendons with their native width showed no statistical difference or negative biomechanical consequences of dermal augmentation.

Clinical Relevance:

Dermal augmentation of the distal biceps is a biomechanically feasible option for patients with an attritionally thinned-out tendon.
Use of steroids in baseball primarily sports story
Authors: Kozman Claudia
Published: April 2017

A content analysis of U.S. newspapers over 10 years revealed that the issue of steroids in baseball was the result of accidental events slightly more than routine ones. While both news and sports reporters covered accidental events, the news reporters’ attention faded without government officials to adopt the issue and routinize the story.
Florida political reporters interact rarely online
Authors: Parmelee John H. , Deeley David
Published: April 2017

A content analysis of the tweets of political reporters at Florida newspapers examines the degree to which local and regional journalists interact with the public on Twitter. Twitter activity focused primarily on feedback, with journalists tweeting links, photos or hashtags as one-way communication. Findings indicate little of genuine interactivity on Twitter between journalists and citizens.
Citizen journalism practice increases civic participation
Authors: Nah Seungahn , Namkoong Kang , Record Rachael , Van Stee Stephanie K.
Published: April 2017

Drawing on the theory of reasoned action, this study examines direct and indirect effects of citizen journalism on civic participation. Through a quasi-experimental design, analyses show that citizen journalism practice has a direct effect on civic participation and enhances attitudes toward nonprofi t and voluntary organizations leading to volunteering and donating behavioral intentions.
The Importance of Being Patriotic: Enregistered Connections in Croatian Minority Activism
Authors: Hodges Andrew
Published: April 2017

Drawing on ethnographic fieldwork conducted in a school in a village in Vojvodina, Serbia, where teaching in Croatian has been introduced, this article analyses relationships maintained between Croatian minority activists, the teaching staff at the school, and representatives from Croatian state institutions who visited. This minority context is especially sensitive as, following the wars that accompanied the break-up of the Socialist Yugoslav state into primarily nationally defined states, Serbo-Croatian split into two mutually intelligible standards, Serbian and Croatian. The article examines the contexts of such visits, with a focus on what was at stake in the encounters and how different participants in minority politics manage various connections ( veze) with Croatian state institutions. In particular, it describes how a hegemonic register consisting of tropes, or ideologemes, relating to domoljublje (patriotism) and caring for/preserving Croatian national identity featured in these interactions. This article makes the ethnographic argument that some activists primarily used this patriotic register non-referentially, its use indexing the pursuit of connections with Croatian state institutions, whilst other activists used the patriotic register referentially. Nevertheless, it is argued that when disputes occurred, “pro-national” activists used the enregistered tropes referentially, in so doing disrupting the networks of activists who used them in a primarily non-referential sense. Finally, the consequences and wider implications of this are explored.
Fabrication and characterisation of anisotropic magnetorheological elastomer with 45° iron particle alignment at various silicone oil concentrations
Authors: Tian Tongfei , Nakano Masami
Published: April 2017

In this study, anisotropic magnetorheological elastomers with 0% and 15% weight fractions of silicone oil were fabricated under a magnetic field that was rotated with a 45° angle so that the iron particle alignment inside the magnetorheological elastomer was 45° to the direction of flat magnetorheological elastomer. Scanning electron microscopic images confirmed the aligned structure of iron particles and showed that the sample with 15% silicone oil contribution resulted in a less volume fraction of iron particles. The magnetorheological elastomers were then tested in an oscillatory pure shear mode at different shear strain amplitudes under different magnetic flux densities to measure their dynamic viscoelastic properties. The testing results showed that the magnetorheological elastomer with 15% silicone oil had lower zero-field storage and loss moduli and also had higher maximum magnetorheological effect than the magnetorheological elastomer with 0% silicone oil. Because of the 45° iron particle alignment, the storage modulus of the magnetorheological elastomers had a higher value in a particular direction than its contrary direction. These unique properties made the magnetorheological elastomers with 45° iron particle alignment to be potentially used in industry where extra support is needed in a particular direction.
Teaching Phenomenological Research and Writing
Authors: Adams Catherine , van Manen Michael Anders
Published: April 2017

In this article, we describe our approach and philosophical methodology of teaching and doing phenomenology. The human science seminar that we offer involves participants in the primary phenomenological literature as well as in a variety of carefully engaged writing exercises. Each seminar participant selects a personal phenomenological project that aims at producing a publishable research paper. We show how the qualitative methodology of hermeneutic phenomenology requires of its practitioner a sensitivity and attitudinal disposition that has to be internalized and that cannot be captured in a procedural or step-by-step program. Our experience is that seminar participants become highly motivated and committed to their phenomenological project while involved in the rather intense progression of lectures, workshop activities, readings, and discussions.
Optimization of flutter boundaries of cantilevered trapezoidal functionally graded sandwich plates
Authors: Torabi Keivan , Afshari Hasan
Published: April 2017

As a useful tool for designing wings and tail fins of aircrafts, this paper presents an optimization for flutter characteristics of cantilevered functionally graded sandwich plates. The plate is composed of an isotropic homogeneous core and two functionally graded face sheets. The plate is modeled based on the first-order shear deformation theory. The aerodynamic pressure is estimated using supersonic piston theory and using Hamilton's principle, the set of governing equations and boundary conditions are then derived. Applying a transformation of coordinates, governing equations and boundary conditions are converted and solved numerically by differential quadrature method. Natural frequencies, damping ratio, corresponding mode shapes, critical aerodynamic pressure, and flutter frequency are calculated. In order to achieve an optimum design, particle swarm optimization is employed to find the best values of aspect ratio, thickness of the plate, thickness of the core, power law index, and angles of the plate which increase critical aerodynamic pressure. Some constrains on the angles of the plate and its mass and area (lift force) are also considered.
Risk Factors of Pesticide Poisoning and Pesticide Users’ Cholinesterase Levels in Cotton Production Areas: Glazoué and Savè Townships, in Central Republic of Benin
Authors: Vikkey Hinson Antoine , Fidel Dossou , Pazou Elisabeth Yehouenou , Hilaire Hountikpo , Hervé Lawin , Badirou Aguèmon , Alain Koudafoke , Parfait Houngbégnon , Fabien Gounongbé , Benjamin Fayomi
Published: April 2017

Objective:

To assess the degree of poisoning in farmers using the erythrocyte acetylcholinesterase (AChE) test before and after the exposure to pesticides in townships in central Benin (Glazoué and Savè) and to identify the associated risk factors.

Methods:

Using a cross-sectional study design, we recruited 264 farm pesticide sprayers, who have been working for at least 5 years. They completed a questionnaire and underwent the AChE test using the Test-mate Model 400 device (EQM Research Inc.) with a photometric sensor, based on the works of Ellman.

Results:

Organophosphate/pyrethroids were the most common pesticides used by at least 72.96% of the farmworkers. We observed an inhibition of AChE between pre-exposure and post-exposure ( P = .002) for 60.61% of the farmworkers. Among them, 11.88% displayed more than 20% AChE inhibition.

Conclusions:

Pesticide poisoning is a reality, and AChE monitoring is urgently needed for farmworker surveillance.