bluuebunny/crossref_metadata_2025 huggingface dataset:
Distinct Autistic Traits Are Differentially Associated With the Width of the Multisensory Temporal Binding Window
Authors: Yaguchi Ayako , Hidaka Souta
Published: December 2017

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and interaction, and restricted interests and behavior patterns. These characteristics are considered as a continuous distribution in the general population. People with ASD show atypical temporal processing in multisensory integration. Regarding the flash–beep illusion, which refers to how a single flash can be illusorily perceived as multiple flashes when multiple auditory beeps are concurrently presented, some studies reported that people with ASD have a wider temporal binding window and greater integration than typically developed people; others found the opposite or inconsistent tendencies. Here, we investigated the relationships between the manner of the flash–beep illusion and the various dimensions of ASD traits by estimating the degree of typically developed participants’ ASD traits including five subscales using the Autism-Spectrum Quotient. We found that stronger ASD traits of communication and social skill were associated with a wider and narrower temporal binding window respectively. These results suggest that specific ASD traits are differently involved in the particular temporal binding processes of audiovisual integration.
The Rubber Hand Illusion in Healthy Younger and Older Adults
Authors: Campos Jennifer L. , El-Khechen Richandi Graziella , Taati Babak , Keshavarz Behrang
Published: December 2017

Percepts about our body’s position in space and about body ownership are informed by multisensory feedback from visual, proprioceptive, and tactile inputs. The Rubber Hand Illusion (RHI) is a multisensory illusion that is induced when an observer sees a rubber hand being stroked while they feel their own, spatially displaced, and obstructed hand being stroked. When temporally synchronous, the visual–tactile interactions can create the illusion that the rubber hand belongs to the observer and that the observer’s real hand is shifted in position towards the rubber hand. Importantly, little is understood about whether these multisensory perceptions of the body change with older age. Thus, in this study we implemented a classic RHI protocol (synchronous versus asynchronous stroking) with healthy younger (18–35) and older (65+) adults and measured the magnitude of proprioceptive drift and the subjective experience of body ownership. As an adjunctive objective measure, skin temperature was recorded to evaluate whether decreases in skin temperature were associated with illusory percepts, as has been shown previously. The RHI was observed for both age groups with respect to increased drift and higher ratings of ownership following synchronous compared to asynchronous stroking. Importantly, no effects of age and no interactions between age and condition were observed for either of these outcome measures. No effects were observed for skin temperature. Overall, these results contribute to an emerging field of research investigating the conditions under which age-related differences in multisensory integration are observed by providing insights into the role of visual, proprioceptive, and tactile inputs on bodily percepts.
Ain’t Nobody Got Time for That: Anti-Black Girl Violence in the Era of #SayHerName
Authors: Lindsey Treva B.
Published: January 2018

In the era of #BlackLivesMatter, anti-Black state violence is a primary focus. From police brutality to the Flint Water Crisis, organizers within the Movement for Black Lives draw important connections between various sites of racial injustice as experienced by people of African descent in the United States. One of the many sites where anti-Black violence and victimization occurs is in our classrooms. This article explores the classroom as a site of racial–gender terror for Black girls. The classroom is far too often an anti-Black girl space.
Gender and education policy in India: Twists, turns and trims of transnational policy transfers
Authors: Nakray Keerty
Published: December 2017

Gender-based exclusion remains a vexing problem in the Indian education system. Drawing on feminist and intersectionality perspectives, this article examines the constraints of Indian education policies in addressing issues pertaining to the education of girls from marginalised communities. The article examines the knowledge transfers from developed countries to developing countries based on notions of ideational power and the ‘epistemic imagery’ of modernisation. Focusing on a plethora of conditional cash transfers, programmes that were initiated by the Indian state governments to address gender inequalities in the education system, the article concludes that such knowledge transfers are inevitable in the current mode of epistemic governance and emanate from the power imbalance between rich and poor countries. When juxtaposed against the institutional discrimination widely prevalent in the Indian education system, political rhetoric fails on the dual goals of educational policy, to achieve economic efficiency and social justice.
Unintended consequences of job formalisation: Precarious work in Brazil’s sugarcane plantations
Authors: Queiroz Allan S , Vanderstraeten Raf
Published: December 2017

This article focuses on the shift from informal to formal employment in the sugarcane plantations of Alagoas, Northeast Brazil, and its unintended consequences. Drawing on the employment experiences of sugarcane cutters, the authors stress the main mechanisms that produce precarity within formal employment structures. Precarity is forged by means of employers’ hiring practices, which turn formal employment contracts into insecure and temporary ones, disciplinary techniques used to control workers’ daily productivity within this labour-intensive production process, and the parasitic uses of the unemployment insurance system. While job formalisation has given access to more social protection, it has also created a permanently temporary workforce, which is rehired discontinuously by the plantations. The authors’ analysis of the link between formal employment, precarity and state protection more particularly leads to a reconsideration of Ulrich Beck’s ‘Brazilianization thesis’.
Trends in Contemporary Holistic Nursing Research: 2010-2015
Authors: Delaney Colleen , McCaffrey Ruth G. , Barrere Cynthia , Kenefick Moore Amy , Dunn Dorothy J. , Miller Robin J. , Molony Sheila L. , Thomas Debra , Twomey Teresa C. , (Susan) Zhu Xiaoyuan
Published: January 2018

Purpose: The purpose of this study was to describe and summarize the characteristics of contemporary holistic nursing research (HNR) published nationally. Design: A descriptive research design was used for this study. Method: Data for this study came from a consecutive sample of 579 studies published in six journals determined as most consistent with the scope of holistic nursing from 2010 to 2015. The Johns Hopkins level of evidence was used to identify evidence generated, and two criteria—power analysis for quantitative research and trustworthiness for qualitative research—were used to describe overall quality of HNR. Findings: Of the studies, 275 were considered HNR and included in the analysis. Caring, energy therapies, knowledge and attitudes, and spirituality were the most common foci, and caring/healing, symptom management, quality of life, and depression were the outcomes most often examined. Of the studies, 56% were quantitative, 39% qualitative, and 5% mixed-methods designs. Only 32% of studies were funded. Level III evidence (nonexperimental, qualitative) was the most common level of evidence generated. Conclusions: Findings from this study suggest ways in which holistic nurse researchers can strengthen study designs and thus improve the quality of scientific evidence available for application into practice and improve health outcomes.
Militarism and its limits: Sociological insights on security assemblages in the Sahel
Authors: Frowd Philippe M , Sandor Adam J
Published: January 2018

This article assesses the concepts of militarism and militarization in relation to contemporary security interventions in the Sahel, a region increasingly understood through the prisms of violence, cross-border illicit flows, and limited statehood. This region is subject to security interventions that include French military action, EU-funded projects to prevent drug trafficking, and both bilateral and multilateral efforts against irregular migration. To many observers, it is experiencing an ongoing militarization. We argue that while the inextricable concepts of militarism and militarization go some way towards explaining interventions’ occasional use of military violence, they are limited in their grasp of the non-martial and symbolic violence in security practices. We instead propose a focus on assemblages of (in)security to show the heterogeneous mix of global and local actors, and often contradictory rationalities and practices that shape the logics of symbolic and martial violence in the region. Throughout, the article draws on the authors’ fieldwork in Mauritania, Senegal, and Niger, and includes two case studies on efforts against the Sahel’s ‘crime–terror nexus’ and to control irregular migration through the region. The article’s contribution is to better situate debates about militarism and militarization in relation to (in)security and to provide a more granular understanding of the Sahel’s security politics.
Discursive (in)securities and postcolonial anxiety: Enabling excessive militarism in India
Authors: Parashar Swati
Published: January 2018

This article queries the intimate relationship between militarism and the state, which is seen as the by-product of ‘postcolonial anxiety’ (Krishna, 1999) related to the survival of the nation-state in the Third World. This anxiety enables militarism at various levels of governance and state interventions in the everyday lives of the citizenry. The article engages with the historical trajectory of the Indian state to argue that its ‘postcolonial anxiety’ engenders militarism not in the immediate aftermath of independence from colonial rule, as in other postcolonial states, but as an anomaly since the end of the Cold War and the advent of globalization. The Indian state rejected militarism immediately after independence, but subsequently used it sporadically to deal with armed insurgencies in the 1970s and 1980s. The popular endorsement of militarism in India coincides with the globalized world order of the 1990s, the move to democratize ‘security’ in discourse and practice, and the adoption of neoliberal developmentalism to ‘catch up’ with the ‘modern’ trajectory of the European nation-states. I argue that this has led to ‘excessive militarism’ that thrives on the shared consensus between the state and citizens that security is a collective enterprise in which the material and affective labour of militarism must be performed by both sides. Citizens embrace military logics and military ethos, both to contest the state’s violence and to confer legitimacy on the state and secure development benefits. The article concludes that militarism opens up new spaces for understanding the complex statebuilding processes of postcolonial societies, the fraught and textured relationship between the state and citizens, and the constant tensions and negotiations between civilian lives and military culture.
Integrating Occupational Complexity Levels to Interest Assessments in Social and Enterprising Areas: Development of the Vertical Social Interest Scale
Authors: Açıkgöz Yalçın , Toker Yonca
Published: January 2018

With the goal of improving assessment of interests toward social and enterprising areas, we developed the Vertical Social Interest Scale (VSIS) by incorporating vertical differentiation between occupations in terms of authority and communication. Social and enterprising occupations, their complexity levels, and work activities were identified using the information in the Dictionary of Occupational Titles and Occupational Information Network. Three studies ( N = 515 total), two of which utilized students and one a working adult sample, were conducted to assess the factor structure and validity of VSIS. Construct validity was demonstrated using factor analyses and based on associations with traditional interest assessments and extraversion. Criterion-related validity was demonstrated based on associations with satisfaction with academic domain for the student sample and affective occupational commitment for the adult sample. Results support the validity of VSIS in predicting relevant vocational outcomes.
Newcomers’ Trait Positive Affectivity and Social Assimilation in Organizations: Testing the Mediating Role of Proactive Relationship Building Behaviors
Authors: Li Hairong , Fan Jinyan , Yao Xiang , Zheng Lu
Published: January 2018

Becoming assimilated into the social environment at an organization is critical and challenging to newcomers. The present study examined whether newcomers’ trait positive affectivity (PA) could predict social assimilation through proactive relationship building behaviors including general socializing, relationship building with boss, and networking. Participants in this three-wave survey study were 323 new employees in three organizations in China. Results based on structural equation modeling showed that newcomers’ trait PA at T1 (within 2 weeks postentry) was positively related to all three dimensions of relationship building behaviors at T2 (8 weeks postentry); however, only general socialization was found to mediate the relationships between PA and two social assimilation outcomes at T3 (14 weeks postentry), that is, social integration and affective organizational commitment. Theoretical and practical implications were discussed.
Viral justice? Online justice-seeking, intimate partner violence and affective contagion
Authors: Wood Mark , Rose Evelyn , Thompson Chrissy
Published: January 2018

What has been termed the survivor selfie is a recent and growing phenomenon whereby survivors of intimate partner violence or their close supporters upload graphic photos and accounts of their injuries and suffering to social media. In this article, we examine how the like economy of Facebook can lead to the rapid circulation of survivor selfies to large audiences, and in doing so, generate what we term viral justice: the outcome of a victim’s online justice-seeking post ‘going viral’ and quickly being viewed and shared-on by thousands of social media users. Through examining the trajectory and impact of one particular case—Ashlee Savins’s viral survivor selfie—we identify the technological preconditions of viral justice and three of its key dimensions: affective contagion; swarm sociality; and movement power. Through discussing the speed, sociality and contagion of viral justice, we critically consider some of its implications for online justice-seeking, and responding to intimate partner violence.
Transforming Learning Identities in Literacy Programmes
Authors: Tett Lyn
Published: January 2018

This article draws on the theories of Mezirow, Foucault, and Holland and colleagues to investigate how students were positioned in relation to their own experiences, what opportunities they had to overcome their negative positioning in relation to the power structures that inform the worlds in which they move, and how their changed practices impacted on their positional and figured worlds. Data from community- and prison-based participants in Scottish adult literacy projects are used to interrogate the factors that contributed to overcoming the negative discourses that students had been embedded in. This article concludes that by the end of their programs, the students had experienced transformative changes in their learning identities, and these changes encompassed cognitive, emotional, and social dimensions.
Use of a Smartphone Application to Reduce Hypoglycemia in Type 1 Diabetes: A Pilot Study
Authors: Feuerstein-Simon Carly , Bzdick Suzan , Padmanabhuni Amitha , Bains Puneetpal , Roe Cheryl , Weinstock Ruth S.
Published: January 2018

Background:

Hypoglycemia and hypoglycemia unawareness are common in long-standing type 1 diabetes (T1D). This pilot study examined the real-world use of a smartphone application (app), which receives meter readings and logs hypoglycemic symptoms, causes, and treatments to reduce hypoglycemia.

Methods:

Adults with T1D and recent hypoglycemia synchronized their glucose meter to their smartphone and used the Joslin HypoMap™ app powered by Glooko to track hypoglycemic events. At baseline, and after 6 and 12 weeks of using the app, a blinded continuous glucose monitor (CGM; Dexcom G4) was used for 2 weeks and surveys administered.

Results:

Participants (n = 22) at baseline had mean (SD) age 43 (14) years, duration of diabetes 26 (13) years, A1c 8.0% (0.87) and 21/22 had reduced hypoglycemia awareness per Clarke Hypoglycemia Unawareness survey scores; 13 (59%) were “CGM completers” (CGM data available at baseline and follow-up). Most noncompletion related to time required/difficulties using the mobile app. After 6 weeks, 8/13 completers (62% of CGM completers, 36% of total participants) had reduced daytime minutes with glucose <54 mg/dL (mean ↓331 minutes) and 10/13 (77% of CGM completers; 45% of total participants) had reduced time ≤ 70 mg/dL (mean ↓449 minutes). This was not sustained at 12 weeks, at which time half of the completers had less time (“improved”). Five participants reported improved hypoglycemia awareness; 9 stated the app helped them better recognize hypoglycemia.

Conclusions:

Use of this phone app has the potential to help reduce daytime hypoglycemia in a subset of T1D adults with reduce hypoglycemia awareness; larger studies are needed.
Outcomes After Dermal Allograft Reconstruction of Chronic or Subacute Pectoralis Major Tendon Ruptures
Authors: Neumann Julie A. , Klein Christopher M. , van Eck Carola F. , Rahmi Hithem , Itamura John M.
Published: January 2018

Background:

Avoiding delay in the surgical management of pectoralis major (PM) ruptures optimizes outcomes. However, this is not always possible, and when a tear becomes chronic or when a subacute tear has poor tissue quality, a graft can facilitate reconstruction.

Purpose:

The primary aim was to evaluate the clinical outcomes of PM reconstruction with dermal allograft augmentation for chronic tears or for subacute tears with poor tissue quality. A second aim was to determine patient and surgical factors affecting outcome.

Study Design:

Case series; Level of evidence, 4.

Methods:

Nineteen consecutive patients (19 PM ruptures) with a mean ± SD age of 39.1 ± 8.4 years were retrospectively reviewed at 26.4 ± 16.0 months following PM tendon reconstruction with dermal allograft. Surgery was performed at 19.2 ± 41.2 months after injury (median, 7.6 months; range, 1.1-185.4 months). Several outcome scores were recorded pre- and postoperatively, including Disabilities of the Arm, Shoulder, and Hand (DASH), as well as visual analog scale (VAS) (range, 0-10; 0 = no pain) and Single Assessment Numeric Evaluation (SANE). Range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and complications/reoperations were recorded postoperatively.

Results:

Scores improved significantly for the DASH (preoperative, 34.9; postoperative, 8.0; P < .001) and VAS (preoperative, 5.0; postoperative, 1.5; P = .011). There was a trend toward improved SANE scores (preoperative, 15.0; postoperative, 80.0; P = .097), but the difference was not statistically significant, likely because of the small number of patients having preoperative SANE scores for review. Increased age was associated with higher VAS scores ( r = 0.628, P = .016) and less forward flexion ( r = –0.502, P = .048) and external rotation ( r = –0.654, P = .006). Patients with workers’ compensation had lower scores for 3 measures: SANE (75.8 vs 88.4, P = .040), Constant (86.7 vs 93.4, P = .019), and ASES (81.9 vs 97.4, P = .016). Operating on the dominant extremity resulted in lower Constant scores (87.8 vs 95.4, P = .012). A 2-head tendon tear (107.5° vs 123.3°, P = .033) and the use of >1 graft (105.0° vs 121.3°, P = .040) resulted in decreased abduction.

Conclusion:

This was the first large series to observe patients with chronic or subacute PM tendon tears treated with dermal allograft reconstruction. PM tendon reconstruction with dermal allografts resulted in good objective and subjective patient-reported outcomes.
Axillary Temperature, as Recorded by the iThermonitor WT701, Well Represents Core Temperature in Adults Having Noncardiac Surgery
Authors: Pei Lijian , Huang Yuguang , Mao Guangmei , Sessler Daniel I.
Published: December 2017

BACKGROUND:

Core temperature can be accurately measured from the esophagus or nasopharynx during general anesthesia, but neither site is suitable for neuraxial anesthesia. We therefore determined the precision and accuracy of a novel wireless axillary thermometer, the iThermonitor, to determine its suitability for use during neuraxial anesthesia and in other patients who are not intubated.

METHODS:

We enrolled 80 adults having upper abdominal surgery with endotracheal intubation. Intraoperative core temperature was measured in distal esophagus and was estimated at the axilla with a wireless iThermonitor WT701 (Raiing Medical, Boston MA) at 5-minute intervals. Pairs of axillary and reference distal esophageal temperatures were compared and summarized using linear regression and repeated-measured Bland–Altman methods. We a priori determined that the iThermonitor would have clinically acceptable accuracy if most estimates were within ±0.5°C of the esophageal reference, and suitable precision if the limits of agreement were within ±0.5°C.

RESULTS:

There were 3339 sets of paired temperatures. Axillary and esophageal temperatures were similar, with a mean difference (esophageal minus axillary) of only 0.14°C ± 0.26°C (standard deviation). The Bland–Altman 95% limits of agreement were reasonably narrow, with the estimated upper limit at 0.66°C and the lower limit at −0.38°C, thus ±0.52°C, indicating good agreement across the range of mean temperatures from 34.9°C to 38.1°C. The absolute difference was within 0.5°C in 91% of the measurements (95% confidence interval, 88%–93%).

CONCLUSIONS:

Axillary temperature, as recorded by the iThermonitor WT701, well represents core temperature in adults having noncardiac surgery and thus appears suitable for clinical use.
Comparison of DNA Damage and Oxidative Stress in Patients Anesthetized With Desflurane Associated or Not With Nitrous Oxide: A Prospective Randomized Clinical Trial
Authors: Nogueira Flávia R. , Braz Leandro G. , Souza Kátina M. , Aun Aline G. , Arruda Nayara M. , Carvalho Lídia R. , Chen Chung-Yen O. , Braz José Reinaldo C. , Braz Mariana G.
Published: December 2017

BACKGROUND:

Little is known about the effects of desflurane associated or not with nitrous oxide (N2O) on oxidative stress and patient genetic material. The aim of this study was to compare the effects of anesthesia maintained with desflurane associated or not with N2O on DNA damage (as a primary outcome) and oxidative stress (as a secondary outcome) in patients who underwent an elective minimally invasive surgery.

METHODS:

This prospective randomized clinical trial analyzed 40 patients of both sexes with an American Society of Anesthesiologists physical status I who were 18–50 years of age and scheduled for septoplasty. The patients were randomly allocated into 2 groups according to anesthesia maintenance as follows: desflurane (n = 20) or desflurane/N2O (n = 20). Blood samples were collected before anesthesia (T1 = baseline), 1.5 hours after anesthesia induction (T2), and on the morning of the postoperative first day (T3). Basal and oxidative DNA damage (determined using formamidopyrimidine DNA glycosylase to detect oxidized purines and endonuclease III to detect oxidized pyrimidines) were evaluated using the comet assay. Oxidative stress markers were evaluated based on lipid peroxidation (by assessing 4-hydroxynonenal and 8-iso-prostaglandin F2α [8-isoprostane] using enzyme linked immunosorbent immunoassay), protein carbonyls (assessed by enzyme linked immunosorbent immunoassay), and antioxidant defense (ferric-reducing antioxidant power by spectrophotometry). The effect size was expressed as the mean differences between groups and the corresponding 95% confidence interval (CI).

RESULTS:

There was no significant mean difference between groups in relation to DNA damage (−1.7 [95% CI, −7.0 to 3.5]), oxidized DNA pyrimidines (−1.8 [95% CI, −12.5 to 8.9]) and purines (−1.9 [95% CI, −13.9 to 10.1]), 4-hydroxynonenal (−0.2 [95% CI, −2.8 to 2.4]), 8-isoprostane (549 [95% CI, −2378 to 3476]), protein carbonyls (0.2 [95% CI, −2.1 to 2.3]), or ferric-reducing antioxidant power (24 [95% CI, −52.0 to 117.2]).

CONCLUSIONS:

The coadministration of 60% N2O with desflurane did not seem to impair the effects on DNA or the redox status compared with desflurane anesthesia, suggesting that both studied anesthetic techniques can be suitable options for healthy individuals who undergo minimally invasive surgery lasting at least 1.5 hours. However, due to the low power of the study, more research is necessary to confirm our findings.
Anesthesia for Cesarean Delivery: A Cross-Sectional Survey of Provincial, District, and Mission Hospitals in Zimbabwe
Authors: Lonnée Herman A. , Madzimbamuto Farai , Erlandsen Ole R. M. , Vassenden Astrid , Chikumba Edson , Dimba Rutenda , Myhre Arne K. , Ray Sunanda
Published: December 2017

BACKGROUND:

Cesarean delivery is the most common surgical procedure in low- and middle-income countries, so provision of anesthesia services can be measured in relation to it. This study aimed to assess the type of anesthesia used for cesarean delivery, the level of training of anesthesia providers, and to document the availability of essential anesthetic drugs and equipment in provincial, district, and mission hospitals in Zimbabwe.

METHODS:

In this cross-sectional survey of 8 provincial, 21 district, and 13 mission hospitals, anesthetic providers were interviewed on site using a structured questionnaire adapted from standard instruments developed by the World Federation of Societies of Anaesthesiologists and the World Health Organization.

RESULTS:

The anesthetic workforce for the hospitals in this survey constituted 22% who were medical officers and 77% nurse anesthetists (NAs); 55% of NAs were recognized independent anesthetic providers, while 26% were qualified as assistants to anesthetic providers and 19% had no formal training in anesthesia. The only specialist physician anesthetist was part time in a provincial hospital. Spinal anesthesia was the most commonly used method for cesarean delivery (81%) in the 3 months before interview, with 19% general anesthesia of which 4% was ketamine without airway intubation. The mean institutional cesarean delivery rate was 13.6% of live births, although 5 district hospitals were <5%. The estimated institutional maternal mortality ratio was 573 (provincial), 251 (district), and 211 (mission hospitals) per 100,000 live births. Basic monitoring equipment (oximeters, electrocardiograms, sphygmomanometers) was reported available in theatres. Several unsafe practices continue: general anesthesia without a secure airway, shortage of essential drugs for spinal anesthesia, inconsistent use of recovery area or use of table tilt or wedge, and insufficient blood supplies. Postoperative analgesia management was reported inadequate.

CONCLUSIONS:

This study identified areas where anesthetic provision and care could be improved. Provincial hospitals, where district/mission hospitals refer difficult cases, did not have the higher level anesthesia expertise required to manage these cases. More intensive mentorship and supervision from senior clinicians is essential to address the shortcomings identified in this survey, such as the implementation of evidence-based safe practices, supply chain failures, high maternal morbidity, and mortality. Training of medical officers and NAs should be strengthened in leadership, team work, and management of complications.
American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery
Authors: Hedrick Traci L. , McEvoy Matthew D. , Mythen Michael (Monty) G. , Bergamaschi Roberto , Gupta Ruchir , Holubar Stefan D. , Senagore Anthony J. , Gan Tong Joo , Shaw Andrew D. , Thacker Julie K. M. , Miller Timothy E.
Published: December 2017

The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but this has been shown to be false in the modern era owing to the proliferation of enhanced recovery protocols. However, impaired GI function is still common after colorectal surgery, and the current literature is ambiguous with regard to the definition of postoperative GI dysfunction (POGD), or what is typically referred to as ileus. This persistent ambiguity has impeded the ability to ascertain the true incidence of the condition and study it properly within a research setting. Furthermore, a rational and standardized approach to prevention and treatment of POGD is needed. The second Perioperative Quality Initiative brought together a group of international experts to review the published literature and provide consensus recommendations on this important topic with the goal to (1) develop a rational definition for POGD that can serve as a framework for clinical and research efforts; (2) critically review the evidence behind current prevention strategies and provide consensus recommendations; and (3) develop rational treatment strategies that take into account the wide spectrum of impaired GI function in the postoperative period.
Airway Management by Laryngeal Mask Airways for Cervical Tracheal Resection and Reconstruction: A Single-Center Retrospective Analysis
Authors: Schieren Mark , Egyed Enikö , Hartmann Burkhard , Aleksanyan Armen , Stoelben Erich , Wappler Frank , Defosse Jerome M.
Published: December 2017

BACKGROUND:

Supraglottic airway devices (SADs) may have advantages over endotracheal intubation for tracheal resection and reconstruction in cases of severe and proximally located subglottic stenosis. This retrospective case series examines the feasibility of using SADs as a novel approach to airway management in tracheal resections.

METHODS:

All patients who were managed with SADs for cervical tracheal resection and reconstruction during the study period (2010–2015) in our university hospital were included.

To examine the feasibility of airway management with SADs for tracheal resection, medical records were obtained from our institution’s electronic database and reviewed.

RESULTS:

SADs were used in 10 patients who had extensive tracheal stenosis and a high prevalence of severe comorbidities. SAD insertion and subsequent positive pressure ventilation were successful in all patients, although 1 patient with preoperative respiratory failure had persistent hypercarbia. During the phase of resection and reconstruction, high-frequency jet ventilation was used to ensure adequate oxygenation. There were no intraoperative complications related to anesthetic management, apart from transient hypercarbia during and after jet ventilation. Most patients (n = 6; 60%) had an uneventful postoperative course. In this high-risk cohort, postoperative complications (ie, vocal cord edema, postoperative hemorrhage, pneumonia) occurred in 4 patients (40%).

CONCLUSIONS:

This retrospective case series demonstrates the feasibility of using supraglottic airways alongside high-frequency jet ventilation for airway management in at least some cases of cervical tracheal resection and reconstruction. However, the small number of cases examined limits conclusions regarding indications, contraindications, and periprocedural safety.
American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway
Authors: Abola Ramon E. , Bennett-Guerrero Elliott , Kent Michael L. , Feldman Liane S. , Fiore Julio F. , Shaw Andrew D. , Thacker Julie K. M. , Gan Tong J. , Miller Timothy E.
Published: December 2017

Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2–3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using the Quality of Recovery-15 score. After discharge at 30 and 90 days, we recommend the use of the World Health Organization Disability Assessment Scale 2.0, or a tailored use of the Patient-Reported Outcomes Measurement Information System. (4) Future study that consistently applies PROMs in an ERP will define the role these measures will have evaluating quality and guiding clinical care. Consensus guidelines regarding the incorporation of PRO measures in an ERP were created by the POQI workgroup. The inclusion of PROMs with traditional measures of health care quality after surgery provides an opportunity to improve clinical care.
Dexmedetomidine for Improved Quality of Emergence From General Anesthesia: A Dose-Finding Study
Authors: Aouad Marie T. , Zeeni Carine , Al Nawwar Rony , Siddik-Sayyid Sahar M. , Barakat Hanane B. , Elias Sandra , Yazbeck Karam Vanda G.
Published: December 2017

BACKGROUND:

Dexmedetomidine provides smooth and hemodynamically stable emergence at the expense of hypotension, delayed recovery, and sedation. We investigated the optimal dose of dexmedetomidine for prevention of cough, agitation, hypertension, tachycardia, and shivering, with minimal side effects.

METHODS:

In this prospective, randomized, double-blind trial, 216 adult patients were randomly assigned to dexmedetomidine 1 µg/kg (D 1), 0.5 µg/kg (D 0.5), 0.25 µg/kg (D 0.25), or control (C). During emergence, cough, agitation, hemodynamic parameters, shivering, time to extubation, and sedation scores were recorded.

RESULTS:

A total of 190 patients were analyzed. The respective incidences for the groups D 1, D 0.5, and D 0.25 versus group C were 48%, 64%, and 64% vs 84% for cough—corrected P < .003 between groups D 1 and C; 33%, 34%, and 33% vs 72% for agitation—corrected P < .003 between group C and each of the study groups; and 4%, 2%, and 7% vs 22% for shivering—corrected P = .03 and corrected P = .009 between groups D 1 and D 0.5 versus group C, respectively. The percent increase from baseline blood pressure on extubation for the 3 treatment groups was significantly lower than group C. Percent increase in heart rate was lower than control in groups D 1 and D 0.5 but not in group D 0.25. Time to extubation and sedation scores were comparable. However, more hypotension was recorded during the emergence phase in the 3 treatment groups versus group C.

CONCLUSIONS:

D 1 at the end of surgery provides the best quality of emergence from general anesthesia including the control of cough, agitation, hypertension, tachycardia, and shivering. D 0.5 also controls emergence phenomena but is less effective in controlling cough. The 3 doses do not delay extubation. However, they cause dose-dependent hypotension.
Characteristics of Desaturation and Respiratory Rate in Postoperative Patients Breathing Room Air Versus Supplemental Oxygen: Are They Different?
Authors: Taenzer Andreas H. , Perreard Irina M. , MacKenzie Todd , McGrath Susan P.
Published: December 2017

BACKGROUND:

Routine monitoring of postoperative patients with pulse oximetry–based surveillance monitoring has been shown to reduce adverse events. However, there is some concern that pulse oximetry is limited in its ability to detect deterioration quickly enough to allow for intervention in patients receiving supplemental oxygen. To address such concerns, this study expands on the current limited knowledge of differences in desaturation and respiratory rate characteristics between patients breathing room air and those receiving supplemental oxygen.

METHODS:

Pulse oximetry–derived data and patient characteristics were used to examine overnight desaturation patterns of 67 postoperative patients who were receiving either supplemental oxygen or breathing room air. The 2 modalities with respect to the speed of desaturation, in addition to magnitude and duration of desaturation events, are compared. Night-time pulse rate, oxygen saturation, respiratory rate, and the transition times from normal oxygen saturation levels to desaturated states are also compared. The behavior of respiratory rate in proximity to desaturation events is described. Statistical methods included multivariable regression and inverse probability of treatment weighted to adjust for any imbalance in patient characteristics between the oxygen and room air patients and linear mixed effect models to account for clustering by patient.

RESULTS:

The study included 33 patients on room air and 34 receiving supplemental oxygen. The speed of desaturation was not different for room air versus oxygen for 2 types of desaturation (adjusted % difference, 95% confidence interval [CI]: type I; 22.4%, −51.5% to 209%; P = .67, type II; −17.3%, −53.8% to 47.6%; P = .52). Patients receiving supplemental oxygen had a higher mean oxygen saturation (adjusted difference, 95% CI, 2.4 [0.7–4.0]; P = .006). No differences were found for the average overnight respiratory or pulse rate, or proportion of time in desaturation states between the 2 groups.

The time to transition from a normal oxygen saturation (92%) to 88% or below was not longer for supplemental oxygen patients (P = .42, adjusted difference 26.1%: 95% CI, −28.1% to 121%). Respiratory rates did not differ between the overall mean and desaturation or recovery phases or between the oxygen and room air group.

CONCLUSIONS:

In this study, desaturation characteristics did not differ between patients receiving supplemental oxygen and breathing room air with regard to speed, depth, or duration of desaturation. Transition time for desaturations to reach low oxygen saturation alarms was not different, while respiratory rate remained in the normal range during these events. These findings suggest that pulse oximetry–based surveillance monitoring for deterioration detection can be used equally effectively for patients on supplemental oxygen and for those on room air.
Prophylactic Platelet Transfusions for Critically Ill Patients With Thrombocytopenia: A Single-Institution Propensity-Matched Cohort Study
Authors: Warner Matthew A. , Chandran Arun , Frank Ryan D. , Kor Daryl J.
Published: December 2017

BACKGROUND:

Thrombocytopenia is frequently encountered in critically ill patients, often resulting in prophylactic transfusion of platelets for the prevention of bleeding complications. However, the efficacy of this practice remains unclear. The objective of this study was to determine the relationship between prophylactic platelet transfusion and bleeding complications in critically ill patients.

METHODS:

This is a retrospective cohort study of adults admitted to surgical, medical, or combined medical-surgical intensive care units (ICUs) at a single academic institution between January 1, 2009, and December 31, 2013. Inclusion criteria included age ≥18 years and a platelet count measured during ICU admission. Propensity-matched analyses were used to evaluate associations between prophylactic platelet transfusions and the outcomes of interest with a primary outcome of red blood cell transfusion in the ensuing 24 hours and secondary outcomes of ICU and hospital-free days and changes in sequential organ failure assessment scores.

RESULTS:

A total of 40,693 patients were included in the investigation with 3227 (7.9%) receiving a platelet transfusion and 1065 (33.0%) for which platelet transfusion was prophylactic in nature. In propensity-matched analyses, 994 patients with prophylactic platelet transfusion were matched to those without a transfusion. Patients receiving prophylactic platelets had significantly higher red blood cell transfusion rates (odds ratio 7.5 [5.9–9.5]; P < .001), fewer ICU-free days (mean [standard deviation] 20.8 [9.1] vs 22.7 [8.3] days; P = .004), fewer hospital-free days (13.0 [9.7] vs 15.8 [9.4] days; P < .001), and less improvement in sequential organ failure assessment scores (mean decrease of 0.2 [3.6] vs 1.8 [3.3]; P < .001) in the subsequent 24 hours. These findings appeared robust, persisting in multiple predefined sensitivity analyses.

CONCLUSIONS:

Prophylactic administration of platelets in the critically ill was not associated with improved clinical outcomes, though residual confounding may exist. Further investigation of platelet transfusion strategies in this population is warranted.
Can Functional Movement Assessment Predict Football Head Impact Biomechanics?
Authors: FORD JULIA M. , CAMPBELL KODY R. , FORD CASSIE B. , BOYD KENNETH E. , PADUA DARIN A. , MIHALIK JASON P.
Published: December 2017

Purpose

The purposes of this study was to determine functional movement assessments’ ability to predict head impact biomechanics in college football players and to determine whether head impact biomechanics could explain preseason to postseason changes in functional movement performance.

Methods

Participants (N = 44; mass, 109.0 ± 20.8 kg; age, 20.0 ± 1.3 yr) underwent two preseason and postseason functional movement assessment screenings: 1) Fusionetics Movement Efficiency Test and 2) Landing Error Scoring System (LESS). Fusionetics is scored 0 to 100, and participants were categorized into the following movement quality groups as previously published: good (≥75), moderate (50–75), and poor (<50). The LESS is scored 0 to 17, and participants were categorized into the following previously published movement quality groups: good (≤5 errors), moderate (6–7 errors), and poor (>7 errors). The Head Impact Telemetry (HIT) System measured head impact frequency and magnitude (linear acceleration and rotational acceleration). An encoder with six single-axis accelerometers was inserted between the padding of a commercially available Riddell football helmet. We used random intercepts general linear-mixed models to analyze our data.

Results

There were no effects of preseason movement assessment group on the two Head Impact Telemetry System impact outcomes: linear acceleration and rotational acceleration. Head impact frequency did not significantly predict preseason to postseason score changes obtained from the Fusionetics (F
1,36 = 0.22, P = 0.643, R
2 = 0.006) or the LESS (F
1,36 < 0.01, P = 0.988, R
2 < 0.001) assessments.

Conclusions

Previous research has demonstrated an association between concussion and musculoskeletal injury, as well as functional movement assessment performance and musculoskeletal injury. The functional movement assessments chosen may not be sensitive enough to detect neurological and neuromuscular differences within the sample and subtle changes after sustaining head impacts.
The Design and Price of Information
Authors: Bergemann Dirk , Bonatti Alessandro , Smolin Alex
Published: January 2018

A data buyer faces a decision problem under uncertainty. He can augment his initial private information with supplemental data from a data seller. His willingness to pay for supplemental data is determined by the quality of his initial private information. The data seller optimally offers a menu of statistical experiments. We establish the properties that any revenue-maximizing menu of experiments must satisfy. Every experiment is a non-dispersed stochastic matrix, and every menu contains a fully informative experiment. In the cases of binary states and actions, or binary types, we provide an explicit construction of the optimal menu of experiments. (JEL D42, D81, D82, D83)
The rise and fall of machine learning methods in biomedical research
Authors: Koohy Hashem
Published: January 2018

In the era of explosion in biological data, machine learning techniques are becoming more popular in life sciences, including biology and medicine. This research note examines the rise and fall of the most commonly used machine learning techniques in life sciences over the past three decades.
A semiótica greimasiana sob aspectos fenomenológicos: uma relação de sentido
Authors: Vasconcelos Suani De Almeida
Published: December 2017

O presente trabalho apresenta considerações que envolvem a relação entre a fenomenologia com os estudos em linguagem, mais especificamente no campo da significação, focalizando o trabalho do lingüista Algirdas-Julien Greimas – Semiótica Textual. Para tal, fez-se um breve retrospecto teórico, a partir da filosofia platônica (séc. V a.C), chegando até os filósofos contemporâneos no campo da Filosofia da Linguagem, os quais serviram de base para o arranjo lógico-semiótico e fenomenológico moderno, desembocando na teoria greimasiana sobre a significação e o processo interpretativo. Palavras-chaves: Linguagem. Filosofia da Linguagem. Semiótica Textual