bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of the Etiology of Central Serous Chorioretinopathy Using En-Face Optical Coherence Tomography and Indocyanine Green Angiography
Authors: Shinojima Ari , Fujita Kyoko , Mori Ryusaburo , Kawamura Akiyuki , Yuzawa Mitsuko , Yasukawa Tsutomu
Published: August 2016

Purpose: To identify locations of hypofluorescent lesions on late-phase indocyanine green angiography (ICGA) in patients with central serous chorioretinopathy (CSC) using en-face optical coherence tomography (OCT). Procedures: We retrospectively studied 25 consecutive untreated CSC patients, using swept-source OCT and ICGA. En-face swept-source OCT images were automatically segmented and flattened with Bruch's membrane (BrM). We compared the sizes of hyperreflective areas in the 25 CSC and 25 contralateral eyes on en-face images and hypofluorescent areas on ICGA after 30 min. Results: All 25 CSC eyes and 13 contralateral eyes showed abnormal hypofluorescent areas on late-phase ICGA and hyperreflective areas on en-face OCT from BrM to the choriocapillaris, and these findings correlated with the abnormal areas (r = 0.9988; p < 0.001). Conclusions: In CSC patients, we detected abnormal hypofluorescence on ICGA in the late phase, which corresponded to abnormal hyperreflective areas from BrM to the choriocapillaris level in en-face images.
Somatic Mosaicism in Bulls Estimated from Genome-Wide CNV Array and TSPY Gene Copy Numbers
Authors: Oluwole Olutobi A. , Revay Tamas , Mahboubi Kiana , Favetta Laura A. , King W. Allan
Published: August 2016

Somatic mosaicism has become a focus in human research due to the implications of individual genetic variability in disease. Here, we assessed somatic copy number variations (CNVs) in Holstein bulls in 2 respects. We estimated genome-wide CNVs and assayed CNVs of the TSPY gene, the most variable bovine gene from the Y chromosome. Somatic tissues (blood, lung, heart, muscle, testis, and brain) of 4 bulls were arrayed on the Illumina Bovine SNP50k chip and qPCR tested for TSPY copy numbers. Our results showed extensive copy number divergence in tissues within the same animal as well as significant copy number alterations of TSPY. We detected a mean of 31 CNVs per animal among which 14 were of germline origin, as they were constantly present in all investigated tissues of the animal, while 18 were specific to 1 tissue. Thus, 57% of the total number of detected CNVs was the result of de novo somatic events. Further, TSPY copy number was found to vary significantly among tissues as well as among the same tissue type from different animals in a wide range from 7 to 224% of the calibrator. Our study shows significant autosomal and Y-chromosomal de novo somatic CNV in bulls.
Maximizing Benefits from Maintenance Pemetrexed with Stereotactic Ablative Radiotherapy in Oligoprogressive Non-Squamous Non-Small Cell Lung Cancer
Authors: Lu Shao-Lun , Hsu Feng-Ming , Chen Kuan-Yu , Ho Chao-Chi , Yang James Chih-Hsin  , Cheng Jason Chia-Hsien
Published: August 2016

Maintenance pemetrexed offers survival benefit with well-tolerated toxicities for advanced non-squamous non-small cell lung cancer (NSCLC). We present 3 consecutively enrolled patients with advanced non-squamous NSCLC, receiving stereotactic ablative radiotherapy (SABR) for oligoprogressive disease during maintenance pemetrexed. All of them had sustained local control of thoracic oligoprogression after the SABR, while maintenance pemetrexed were kept for additionally long progression-free interval. SABR targeting oligoprogression with continued pemetrexed is an effective and safe approach to extend exposure of maintenance pemetrexed, thus maximizing the benefit from it.
Severe White Matter Hyperintensity Is Associated with Early Neurological Deterioration in Patients with Isolated Pontine Infarction
Authors: Nam Ki-Woong , Lim Jae-Sung , Kang Dong-Wan , Lee Yong-Seok , Han Moon-Ku , Kwon Hyung-Min
Published: August 2016

Objective: Pontine infarction is a common type of brain stem infarction and early neurological deterioration (END). We evaluated the possibility of severe white matter hyperintensity (WMH) as a predictor of END in isolated pontine infarction. Methods: We recruited 2 types of patients with isolated pontine infarction within 24 h from symptom onset. END was defined as an increase of ≥1 point on the motor National Institutes of Health Stroke Scale (NIHSS) or ≥2 points on the total NIHSS score within 72 h from admission. We graded WMH using Fazekas scale, which is dichotomized into mild (grades 0-1) and moderate to severe (grades 2-3) on fluid-attenuated inversion recovery images. Results: A total of 82 patients with an isolated pontine infarction were selected. END was detected in 23 patients (28%). Severe periventricular and subcortical WMH (PVWMH and SCWMH, respectively) were more frequent in deteriorating patients (p = 0.001 and p = 0.019, respectively). A logistic regression analysis revealed that both severe PVWMH (OR 6.17; 95% CI 1.93-19.75, p = 0.002) and SCWMH (OR 3.19; 95% CI 1.10-9.23, p = 0.032) remained independent predictors of END. Conclusions: Both severe PVWMH and SCWMH were useful to predict END in patients with isolated pontine infarction.
Radiotherapy of Cervical Cancer
Authors: Vordermark Dirk
Published: August 2016

Curative-intent radical radiotherapy of cervical cancer consists of external-beam radiotherapy, brachytherapy, and concomitant chemotherapy with cisplatin. For each element, new developments aim to improve tumor control rates or treatment tolerance. Intensity-modulated radiotherapy (IMRT) has been shown to reduce gastrointestinal toxicity and can be used to selectively increase the radiotherapy dose. Individualized, image-guided brachytherapy enables better adaptation of high-dose volumes to the tumor extension. Intensification of concomitant or sequential systemic therapy is under evaluation.
Aspectos sociodemográficos dos usuários de crack assistidos pela rede de atenção psicossocial
Authors: Andrade Aline Teles de , Rimes Halita Soares , Costa Lourdes Suelen Pontes , Jorge Maria Salete Bessa , Quinderé Paulo Henrique Dias
Published: August 2016

Objetivou-se analisar o perfil sociodemográfico de um grupo de usuários de crack assistidos pelos serviços de saúde e rede social de apoio. Estudo exploratório descritivo com abordagem quantitativa, realizado na cidade de Fortaleza-CE. Os resultados apontam para 92,5% de idivíduos do sexo masculino, com idade entre 30 e 39 anos (50%), que residem com familiares (59%), ensino médio completo (37,5%). Possibilitou-se desconstruir estereótipos estabelecidos socialmente sobre a perspectiva de vida desses sujeitos. Concepções errôneas sobre usuários de crack podem levar a intervenções equivocadas, necessitando aprofundamento de estudos sobre os mesmos.
Teorias e práticas de retorno e permanência no trabalho: elementos para a atuação dos terapeutas ocupacionais
Authors: Lancman Selma , Barros Juliana De Oliveira , Jardim Tatiana De Andrade
Published: August 2016

O trabalho é um dos aspectos determinantes dos processos saúde e doença, além de constituir-se como elemento central na construção da saúde e da identidade dos indivíduos. Dessa forma, tanto seus aspectos objetivos, como as condições de trabalho, tanto os subjetivos e relacionais, ligados à organização do trabalho constituem-se como pontos importantes de ancoragem para construção de programas de retorno ao trabalho que sejam realmente efetivos e aliem a necessidade da produção de bens e serviços à construção da saúde dos trabalhadores. A partir de um diálogo com a literatura nacional e internacional busca-se nesse artigo contribuir com o debate acerca dos aspectos relacionados ao retorno e a permanecia no trabalho e criar elementos de reflexão para as práticas e teorias da Terapia Ocupacional nesse campo de atuação.
Contribuições da análise da atividade do trabalho no processo de retorno do trabalhador afastado por LER/DORT
Authors: Silva Elaine Cristina , Camarotto João Alberto
Published: August 2016

O aumento do número de trabalhadores afastados por LER/DORT tem constrangido a sociedade brasileira a lidar com esse problema, visto que a importância de suasmanifestações pode ser considerada um grave problema de saúde pública. Os trabalhadores afastados têm encontrado várias dificuldades ao retornar ao trabalho, uma vez que, além das limitações funcionais, também enfrentam obstáculos no trabalho. Além disso, a reabilitação profissional do INSS, não garante as melhorias necessárias para um efetivo retorno às atividades laborais. Frente a esta realidade, o objetivo deste artigo é proporcionar o entendimento de como a análise da atividade de trabalho contribui para o processo de retorno de trabalhadores afastados por LER/DORT. O modelo proposto no fluxograma para a análise do processo de retorno ao trabalho, após afastamento por LER/DORT, é explicado e associado aos pressupostos da Ergonomia da Atividade. A análise da atividade de trabalho permite a compreensão dos aspectos intrínsecos das ações dos trabalhadores e os respectivos constrangimentos, o que permite aproximar a necessidade da empresa com as potencialidades dos trabalhadores.
Validade e reprodutibilidade do Questionário de Hábitos relacionados ao Trabalho (QHT) para trabalhadores do SAMU 192
Authors: Chaise Fabiana Oliveira , Kasten Ana Paula , Furlanetto Tássia Silveira , Pasa Jorge , Candotti Cláudia Tarragô
Published: August 2016

O estudo teve objetivo de desenvolver um questionário sobre hábitos relacionados ao trabalho (QHT) e verificar sua validade e reprodutibilidade. As etapas do QHT foram: observação de campo e revisão teórica sobre hábitos relacionados ao trabalho de profissionais da área da saúde; descrição e conteúdo; validade de conteúdo e reprodutibilidade. Para análise dos dados foi utilizado estatística descritiva (validade de conteúdo) e percentual de concordância(%C) e a medida de concordância Kappa (reprodutibilidade). Seis especialistas avaliaram a maior parte do instrumento como excelente, considerando-o válido em seu conteúdo. Os valores de Kappa mostraram concordância moderadas a excelentes entre as respostas(%C>80%), indicando ser o QHT um instrumento reprodutível. Apesar das limitações do QHT tais como ausência de questões sobre etilismo e desequilíbrio entre demanda de trabalho e disponibilidade de recursos humanos, o alcance prático do instrumento está na suafacilidade em obtenção de informações para conhecer o perfil e alguns importantes aspectos de rotina de trabalho dos trabalhadores da saúde, útil para avaliação na área da Terapia Ocupacional.
RBM20 Regulates Circular RNA Production From the Titin Gene
Authors: Khan Mohsin A.F. , Reckman Yolan J. , Aufiero Simona , van den Hoogenhof Maarten M.G. , van der Made Ingeborg , Beqqali Abdelaziz , Koolbergen Dave R. , Rasmussen Torsten B. , van der Velden Jolanda , Creemers Esther E. , Pinto Yigal M.
Published: August 2016

Rationale:

RNA-binding motif protein 20 (RBM20) is essential for normal splicing of many cardiac genes, and loss of RBM20 causes dilated cardiomyopathy. Given its role in splicing, we hypothesized an important role for RBM20 in forming circular RNAs (circRNAs), a novel class of noncoding RNA molecules.

Objective:

To establish the role of RBM20 in the formation of circRNAs in the heart.

Methods and Results:

Here, we performed circRNA profiling on ribosomal depleted RNA from human hearts and identified the expression of thousands of circRNAs, with some of them regulated in disease. Interestingly, we identified 80 circRNAs to be expressed from the titin gene, a gene that is known to undergo highly complex alternative splicing. We show that some of these circRNAs are dynamically regulated in dilated cardiomyopathy but not in hypertrophic cardiomyopathy. We generated RBM20-null mice and show that they completely lack these titin circRNAs. In addition, in a cardiac sample from an
RBM20
mutation carrier, titin circRNA production was severely altered. Interestingly, the loss of RBM20 caused only a specific subset of titin circRNAs to be lost. These circRNAs originated from the RBM20-regulated I-band region of the titin transcript.

Conclusions:

We show that RBM20 is crucial for the formation of a subset of circRNAs that originate from the I-band of the titin gene. We propose that RBM20, by excluding specific exons from the pre-mRNA, provides the substrate to form this class of RBM20-dependent circRNAs.
Une défense de la langue arabe dialev ctale dans un journal de l’Association des Oulémas algériens en 1936 : démontrer l’unicité de la langue arabe par la richesse de ses parlers
Authors: Courreye Charlotte
Published: August 2016

Whereas the Algerian Ulama are usually perceived as an elite, giving value only to fuṣḥā Arabic and despising the local dialects, an article promoting the vernacular Arabic language (ʿāmmiyya) and enhancing its use was published in one of their newspapers in February 1936. This original argumentation leads us to question their link to the Arabic language, conceived as a comprehensive entity composed by a founding language and its various branches. In colonial context, the priority was in fact to preserve this language from foreign influences to struggle against acculturation.

Alors qu’il est communément admis que les Oulémas algériens, par élitisme, ne prêtaient de valeur qu’à l’arabe éloquent (fuṣḥā) et méprisaient les parlers locaux, un journal de l’Association des Oulémas Musulmans Algériens publia en février 1936 un article qui défendait l’usage et l’intérêt de la langue arabe dialectale (ʿāmmiyya). Cette argumentation originale nous permet d’interroger leur rapport à la langue arabe, conçue comme un tout cohérent composé d’une langue-mère aux différentes branches. En contexte colonial, la priorité était en fait de préserver cette langue des influences étrangères, pour lutter contre l’acculturation.

This article is in French.
A molecular analysis reveals hidden species diversity within the current concept of Russula maculata (Russulaceae, Basidiomycota)
Authors: ADAMČÍK SLAVOMÍR , CABOŇ MIROSLAV , EBERHARDT URSULA , SABA MALKA , HAMPE FELIX , SLOVÁK MAREK , KLEINE JESKO , MARXMÜLLER HELGA , JANČOVIČOVÁ SOŇA , PFISTER DONALD H. , KHALID ABDUL N. , KOLAŘÍK MIROSLAV , MARHOLD KAROL , VERBEKEN ANNEMIEKE
Published: August 2016

The current generally accepted concept of Russula maculata defines the species by yellow-brownish spots on the basidiomata, an acrid taste, a yellow spore print and a red pileus. This concept was tested using collections originating from various geographical areas mainly in Europe. Analyses of the ITS region suggested that there were three species within this broad concept. One of them, R. maculata, was identified based on the sequence from the epitype. Two other species, R. nympharum and R. sp., are described here as newly identified species. The European species R. maculata and R. nympharum grow in deciduous forests, are similar in their field aspect and are distinctly different in micro-morphological characteristics of spores, pleurocystidia and pileipellis. An Asian species, R. sp., is associated with pine and has smaller basidiomata and spores. These three species form the R. maculata complex and represent the sister clade to the R. globispora complex. This clade consists of species also characterized by a yellow-brownish context discolouration but with a different type of spore ornamentation. All of the other tested species had an acrid taste and yellow spore print but did not have a conspicuous yellow-brownish context discolouration and were placed in various unrelated clades.
Discovery of a new species of Caloptilia (Lepidoptera: Gracillariidae) from east and central Africa with its suggested associated host (Gentianales: Rubiaceae) and natural enemies (Hymenoptera: Eulophidae)
Authors: PRINS JURATE DE , GUMOVSKY ALEX , CONINCK ELIANE DE
Published: August 2016

A new species of the leaf-mining moth genus Caloptilia (Gracillariidae), C. mwamba sp. nov., suggested to be associated with Cremaspora triflora (Thonn.) K.Schum. (Rubiaceae) is described from east and central Africa. The taxonomic relationships of the new species with its congeners from the Oriental and the Palaearctic regions are discussed. Newly obtained taxonomic and biological data are linked with the DNA barcode workbench in BOLD, providing the molecular, machine-readable identification tag of the new species. New distribution and morphological data for two parasitoid species, Afrotroppopsis risbeci Gumovsky, 2007 and Zaommomentedon newbyi (Kerrich, 1969) (Eulophidae), which were found to be associated with C. mwamba sp. nov., are presented.
A review of the cicada genus Haphsa Distant from China (Hemiptera: Cicadidae)
Authors: WANG XU , YANG MINGSHENG , WEI CONG
Published: August 2016

The cicada genus Haphsa Distant from China was reviewed based on the description of a new species (Haphsa lueta sp. n.) and redescriptions of other three known species which are reported from China for the first time. A key to all known species of Haphsa worldwide is provided. The geographical distribution of the Haphsa species and the availability of Haphsa dianensis Chou, Lei, Li, Lu & Yao, 1997 are discussed.
Synonymy of Cryptopsocus Li with Trichadenotecnum Enderlein (Insecta: Psocodea: 'Psocoptera': Psocidae) and description of three new species
Authors: YOSHIZAWA KAZUNORI , LIENHARD CHARLES
Published: August 2016

The genus Cryptopsocus Li, 2002 is synonymized with Trichadenotecnum Enderlein, 1909. The type species of Crypto-psocus, T. cynostigmus (Li, 2002) n. comb., is considered to be a close relative of T. marginatum New & Thornton, 1976. These species cannot be assigned to any species group previously established in Trichadenotecnum so that the marginatum species group is here proposed for them. Three new species belonging to this species group are described: T. tigrinum and T. sharkeyi from Thailand and T. sabahense from Sabah, Malaysia. The phylogenetic position of the marginatum group is discussed using morphological data.
What The Heck Are We Doing in Ottumwa, Anyway? Presidential Candidate Visits and Their Political Consequence
Authors: Wood Thomas
Published: August 2016

This article investigates the purpose and effects of presidential campaign visits. I recount common strategic rationales for rallies, town hall meetings, impromptu conversations, and the like, and then show how candidate visits are geographically assigned. I also investigate the impact of campaign visits, finding that while state-level political factors influence the location of visits, the visits themselves have little effect on local media markets. Finally, a bespoke survey is used to measure visits’ influence on visited and unvisited respondents in the closing stages of the 2012 presidential election: respondents are shown to have little knowledge about candidate visits, and the visits themselves have only a small and evanescent effect on voter intentions.
Ideological Factions in the Republican and Democratic Parties
Authors: Noel Hans
Published: August 2016

Both the Republican and Democratic parties are internally divided. Each contains a party regular wing, which is interested in winning office and in the compromises necessary to govern. And each contains an ideological wing, which is interested in close adherence to the core coalition of the party. But the nature of the cleavage is very different within the parties. Among Democrats, the cleavage is mild, with most members belonging to the party regular camp, to the chagrin of ideologues, who are for the most part Bernie Sanders supporters. The cleavage among Republicans, though, is so deep that the party could not find a way to bridge it in the so-called invisible primary for 2016, creating an opening for Donald Trump, who is from neither camp.
Back to the Future? What the Politics of the Late Nineteenth Century Can Tell Us about the 2016 Election
Authors: Azari Julia , Hetherington Marc J.
Published: August 2016

The politics and party system of the late Civil War era are strikingly similar to what we have in the present day. Elections were consistently close; race, culture, immigration, and populism were salient issues; and states almost always voted for the same party in election after election. The states that supported Democrats then, however, mostly support Republicans now, and vice versa. In 1896, though, a new party system began to emerge. In this article, we evaluate bygone elections alongside contemporary ones to assess whether 2016 might be the beginning of something new in American electoral politics. Are national politics likely to follow the familiar pattern of the last four presidential races, or are Americans going to be presented altogether different choices? Our analysis suggests that race and populism are guideposts for potential change in 2016: if the concerns of race continue to define political conflict, the electoral map should change little, but if economic populism eclipses race as it did in 1896, a new political era may be ushered in in America.
On the Origins and Spread of Pan-Indian Spirituality in Canada
Authors: Fonda Marc
Published: August 2016

Since the 1960s, often in an urban setting and alongside the Friendship Centre movement, emerged a form of pan-Indian spirituality often used to connect urban Aboriginal people living far from their home communities and provide a safe cultural meeting place, a harbour for political protest, and an opportunity to embark on healing journeys. This paper will provide an introduction into some of the characteristics of pan-Indian spirituality mainly as expressed through the Healing Movement in particular, the social contexts in which it is emerging, and its national and international reach. The example of the Healing Movement, I argue, demonstrates the complexities of pan-Indian Spirituality, since it is developing through an interplay with localized Indigenous traditions and increasing levels of cross-tribal cultural and spiritual sharing, the encounter of Anglo-European and Indigenous cultures in the development of an ideology of pan-Indian spirituality, and the opportunities and challenges of the significant urbanized nature of Canadian First Nations’ lives.
Who Wants Long-Term Care Insurance? A Stated Preference Survey of Attitudes, Beliefs, and Characteristics
Authors: Allaire Benjamin T. , Brown Derek S. , Wiener Joshua M.
Published: August 2016

Approximately half of people turning 65 years between 2015 and 2019 are projected to need long-term support and services. Yet the long-term care insurance (LTCI) market is depressed, with only 7.4 million people owning policies. The objective of this study was to provide an analysis of potential LTCI purchasers. We investigate (1) who wants to purchase LTCI, (2) what are the attitudes and beliefs among those who have a preference for LTCI, and (3) who would prefer a law mandating the purchase of LTCI and how that view relates to willingness to purchase LTC. We combine a discrete choice experiment with a survey on attitudes toward LTCI. We estimate odds ratio for choosing a plan based on sociodemographic characteristics, attitudes, and beliefs. Our sample consists of a population of 12 936 people who completed an Internet panel survey. Female respondents were substantially less likely to choose an LTCI plan (OR = 0.74). Income and assets over $100 000 were strong predictors of LTCI uptake (OR = 1.27 and OR = 1.48, respectively). Having adult children live close by was not associated with preference for LTCI. People who support almost any government intervention are more likely to purchase private insurance (OR = 1.12-1.33). Minorities expressed a preference for mandatory enrollment relative to whites. There is a relationship between attitudes toward long-term care financing reform and preference for LTCI, but it is not limited to supporters of private sector initiatives. While support for mandatory LTCI is low overall, it is strongest among racial/ethnic minorities and people with health problems, who potentially have the most to gain.
Preferences for Simultaneous Polydrug Use
Authors: Østergaard Jeanette , Østergaard Stine V. , Fletcher Adam
Published: August 2016

Cross-national surveys of young adults’ simultaneous polydrug use (SPU) are rare, as measuring polydrug use requires multiple questions capturing the timing, sequence, and dosage of mixing drugs. This study proposes a new way of measuring SPU by examining how preferences for simultaneous polydrug use (PSPU) vary among club/bar-goers in two European countries, Denmark and England, typically cited as exemplars of the normalization of illegal drug use. The study considers the utility of the normalization thesis for understanding preferences for polydrug use in the European nighttime economy. An in situ survey of 1,298 young adults (18–35 years) conducted in 50 bars, pubs, and nightclubs in England and Denmark assessed sociodemographics, substance use patterns, and personal preference(s) for mixing alcohol and drug use. Multinomial regression analyses examined the relative risk of PSPU categories among those reporting drug use, according to sociodemographics, alcohol intake, frequency of intoxication, and smoking. Illicit drug use was more prevalent among young adults in England than Denmark. The difference was smallest for cannabis use: Lifetime cannabis use is 66% in England and 58% in Denmark. Lifetime cocaine use was 38% in England and 17% in Denmark. In England, young adults with drug experience preferred to mix alcohol with cocaine (65%). In Denmark, young adults with drug experience preferred to mix alcohol with cannabis (78%). In multinominal regression, Danish young adults’ educational level was associated with PSPU, whereas in England legal substance use was associated with PSPU. This study calls for a more differentiated understanding of normalization. Preferences for mixing alcohol and drug use varied significantly cross nationally (alcohol/cocaine, England; alcohol/cannabis, Denmark). Different factors are associated with PSPU in each country. In England, not Denmark, drinking behaviors appear to shape preferences for mixing alcohol with cocaine, suggesting caution should be taken when replicating harm reduction interventions.
Prognostic Utility of the Braden Scale and the Morse Fall Scale in Hospitalized Patients With Heart Failure
Authors: Carazo Matthew , Sadarangani Tina , Natarajan Sundar , Katz Stuart D. , Blaum Caroline , Dickson Victoria Vaughan
Published: August 2016

Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study ( N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and all-cause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.
Exploring the Impact of Age, Race, and Stereotypes on Perceptions of Language Performance and Patronizing Speech
Authors: Atkinson Jaye L. , Sloan Robin G.
Published: August 2016

Two experiments tested whether age and racial stereotypes influence communication. Specifically, both studies sought to understand if older African American targets would experience a communicative double jeopardy. In the first experiment, participants assessed targets’ language performance and beliefs about their own speech style (i.e., patronizing speech style). Age (participant and target) interacted with stereotype to influence ratings of language competence, and an interaction of target race, stereotype, and participant age influenced the elicitation of patronizing speech. In the second experiment, participants assessed communication competence and patronizing speech. Age groups of the targets and the participants, rather than racial groups, significantly influenced perceptions of both ratings of communication competence and the adoption of a patronizing speech style. Implications for the Age Stereotype in Interaction Model of intergenerational communication and future research on intersectionality are discussed.
Influence of Opportunity to Learn Indices and Education Status on Students’ Mathematics Achievement Growth
Authors: Elliott Stephen N. , Kurz Alexander , Tindal Gerald , Yel Nedim
Published: August 2016

We examined instructional processes in classrooms where students with and without disabilities received mathematics instruction to understand the relationship among key instructional process variables and achievement as measured by interim and end-of-year summative assessments. Teachers ( N = 78) completed instructional logs daily and administered easyCBM probes quarterly to 162 students with disabilities and 165 students without disabilities. Examination of instructional data indicated both groups of students had nearly equal opportunities to learn (OTLs) the same mathematics content, yet there were significant differences in these students’ mathematics achievement on interim and summative tests. Special education status and instructional practices were found to be significant predictors of achievement growth. Furthermore, grade level and special education status, along with OTL scores, accounted for significant variance in end-of-year mathematics scores. Discussion of results focuses on instructional practice implications and the role these practices play in achievement gaps.
Lateral Browlift Using Temporal (Pretrichial) Subcutaneous Approach Under Local Anesthesia
Authors: Taban Mehryar Ray
Published: August 2016

Lateral brow ptosis is a common aging phenomenon, contributing to the lateral upper eyelid hooding, in addition to dermatochalasis. Lateral brow lift complements upper blepharoplasty in achieving a youthful periorbital appearance. In this study, the author reports his experience in utilizing a temporal (pretrichial) subcutaneous lateral brow lift technique under local anesthesia. A retrospective analysis of all patients undergoing the proposed technique by one surgeon from 2009 to 2016 was conducted. Additional procedures were recorded. Preoperative and postoperative photographs at the longest follow-up visit were used for analysis. Operation was performed under local anesthesia. The surgical technique included a temporal (pretrichial) incision with subcutaneous dissection toward the lateral brow, with superolateral lift and closure. Total of 45 patients (44 females, 1 male; mean age: 58 years) underwent the temporal (pretrichial) subcutaneous lateral brow lift technique under local anesthesia in office setting. The procedure was unilateral in 4 cases. Additional procedures included upper blepharoplasty (38), ptosis surgery (16), and lower blepharoplasty (24). Average follow-up time was 1 year (range, 6 months to 5 years). All patients were satisfied with the eyebrow contour and scar appearance. One patient required additional brow lift on one side for asymmetry. There were no cases of frontal nerve paralysis. In conclusion, the temporal (pretrichial) subcutaneous approach is an effective, safe technique for lateral brow lift/contouring, which can be performed under local anesthesia. It is ideal for women. Additional advantages include ease of operation, cost, and shortening the hairline (if necessary).
Intravenous Fat Emulsion Formulations for the Adult and Pediatric Patient
Authors: Anez‐Bustillos Lorenzo , Dao Duy T. , Baker Meredith A. , Fell Gillian L. , Puder Mark , Gura Kathleen M.
Published: August 2016

Intravenous fat emulsions (IVFEs) provide essential fatty acids (EFAs) and are a dense source of energy in parenteral nutrition (PN). Parenterally administered lipid was introduced in the 17th century but plagued with side effects. The formulation of IVFEs later on made it a relatively safe component for administration to patients. Many ingredients are common to all IVFEs, yet the oil source(s) and its (their) percentage(s) makes them different from each other. The oil used dictates how IVFEs are metabolized and cleared from the body. The fatty acids (FAs) present in each type of oil provide unique beneficial and detrimental properties. This review provides an overview of IVFEs and discusses factors that would help clinicians choose the optimal product for their patients.
Home Parenteral Nutrition
Authors: Mundi Manpreet S. , Salonen Bradley R. , Bonnes Sara
Published: August 2016

Since the first intravenous nutrition support attempt with olive oil in the 17th century, intravenous fat emulsions (IVFEs) have evolved to become an integral component in the management of patients receiving home parenteral nutrition (HPN). IVFEs serve as a calorie source and provide essential fatty acids (linoleic acid and α‐linolenic acid) in patients unable to achieve adequate intake of these fatty acids through alternative means. However, IVFE use is also associated with multiple complications, including increased infection risk, liver disease, and systemic proinflammatory states. In the United States, most IVFEs are composed of 100% soybean oil; internationally multiple alternative IVFEs (using fish oil, olive oil, and long‐ and medium‐chain triglycerides) are available or being developed. The hope is that these IVFEs will prevent, or decrease the risk of, some of the HPN‐associated complications. The goal of this article is to review how IVFEs came into use, their composition and metabolism, options for IVFE delivery in HPN, benefits and risks of IVFE use, and strategies to minimize the risks associated with IVFE use in HPN patients.
Noninvasive Ventilation in the Critically Ill Patient With Obesity Hypoventilation Syndrome: A Review
Authors: Sequeira Telma C. A. , BaHammam Ahmed S. , Esquinas Antonio M.
Published: August 2016

Obesity is a global epidemic that adversely affects respiratory physiology. Sleep-disordered breathing and obesity hypoventilation syndrome (OHS) are among the most common pulmonary complications related to obesity class III. Patients with OHS may present with acute hypercapnic respiratory failure (AHRF) that necessitates immediate noninvasive ventilation (NIV) or invasive ventilation and intensive care unit (ICU) monitoring. The OHS is underrecognized as a cause of AHRF. The management of mechanical ventilation in obese ICU patients is one of the most challenging problems facing respirologists, intensivists, and anesthesiologists. The treatment of AHRF in patients with OHS should aim to improve alveolar ventilation with better alveolar gas exchange, as well as maintaining a patent upper airway, which is ideally achieved through NIV. Treatment with NIV is associated with improvement in blood gases and lung mechanics and may reduce hospital admissions and morbidity. In this review, we will address 3 main issues: (1) NIV of critically ill patients with acute respiratory failure and OHS; (2) the indications for postoperative application of NIV in patients with OHS; and (3) the impact of OHS on weaning and postextubation respiratory failure. Additionally, the authors propose an algorithm for the management of obese patients with AHRF.
A severe hypersensitivity reaction to abacavir following re-challenge
Authors: Todd SEJ , Emerson CR
Published: August 2016

We report this case to highlight the possibility of a severe hypersensitivity reaction as an important potential consequence of couples, living with HIV, sharing anti-retroviral treatment. An HIV-1 positive and carrier of HLA-B*57:01 allele, treatment experienced man was commenced one pill Regimen Stribild (tenofovir, emtricitabine, elvitegravir and cobicistat) in July 2015. On running short of medication, he admitted to sharing his partner’s treatment (Triumeq; abacavir, lamivudine and dolutegravir). On the second occasion, re-introduction resulted in whole body rash 4 h post dose and was associated with fever, respiratory symptoms, headache and vomiting. On examination, he was pyrexic, tachyponeic, tachycardiac and hypotensive. Hypersensitivity to abacavir can cause significant morbidity. Re-challenge can result in a more rapid, severe and potentially life-threatening reaction. This potentially could become an increasing problem with more couples, living with HIV, sharing medication.
Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists in Cardiac Disorders
Authors: Wroge Jamie , Williams Nancy Toedter
Published: August 2016

Objective: To evaluate the literature about the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in the treatment of cardiac disorders, specifically myocardial infarction (MI) and heart failure (HF). Data Sources: Searches were conducted in MEDLINE (1946-May 2016) and Excerpta Medica (1980-May 2016) using EMBASE with the search terms glucagon-like peptide 1, exenatide, albiglutide, liraglutide, dulaglutide, myocardial infarction, heart failure, and cardiovascular. The references of relevant articles were reviewed to identify additional citations. Study Selection and Data Extraction: Clinical trials were limited to the English language and human trials. In all, 18 trials explored the use of GLP-1 RAs in the treatment of cardiac disorders in patients with and without diabetes mellitus. Data Synthesis: Of the 18 trials reviewed, 11 trials studied the impact of GLP-1 RAs in MI. All showed a significant beneficial effect on various cardiac parameters. Favorable outcome improvements included myocardial blood flow, left ventricular (LV) function, and MI size. Seven trials reviewed the use of GLP-1 RAs in the treatment of HF. Three trials showed significant improvements in LV ejection fraction, cardiac index, and peak oxygen consumption. Conclusions: Limited data suggest that GLP-1 RAs may be effective for the treatment of cardiac disorders in patients with and without diabetes mellitus. These studies suggest that GLP-1 RAs may have potential pleiotropic beneficial effects in patients with cardiovascular disease beyond their role in managing diabetes. These medications may be cardioprotective after a MI but are less promising in HF.
Solving the Value Equation: Assessing Surgeon Performance Using Risk-Adjusted Quality-Cost Diagrams and Surgical Outcomes
Authors: Knechtle William S. , Perez Sebastian D. , Raval Mehul V. , Sullivan Patrick S. , Duwayri Yazan M. , Fernandez Felix , Sharma Joe , Sweeney John F.
Published: August 2016

Quality-cost diagrams have been used previously to assess interventions and their cost-effectiveness. This study explores the use of risk-adjusted quality-cost diagrams to compare the value provided by surgeons by presenting cost and outcomes simultaneously. Colectomy cases from a single institution captured in the National Surgical Quality Improvement Program database were linked to hospital cost-accounting data to determine costs per encounter. Risk adjustment models were developed and observed average cost and complication rates per surgeon were compared to expected cost and complication rates using the diagrams. Surgeons were surveyed to determine if the diagrams could provide information that would result in practice adjustment. Of 55 surgeons surveyed on the utility of the diagrams, 92% of respondents believed the diagrams were useful. The diagrams seemed intuitive to interpret, and making risk-adjusted comparisons accounted for patient differences in the evaluation.
A Coding System for Reoperations Following Total Ankle Replacement and Ankle Arthrodesis
Authors: Younger Alastair S. E. , Glazebrook Mark , Veljkovic Andrea , Goplen Gordon , Daniels Timothy R. , Penner Murray , Wing Kevin J. , Dryden Peter J. , Wong Hubert , Lalonde Karl-André
Published: August 2016

Background:

Repeated surgery can be a measure of failure of the primary surgery. Future reoperations might be avoided if the cause is recognized and procedures or devices modified accordingly. Reoperations result in costs to both patient and the health care system. This paper proposes a new classification system for reoperations in end-stage ankle arthritis, and analyzes reoperation rates for ankle joint replacement and arthrodesis surgeries from a multicenter database.

Methods:

A total of 213 ankle arthrodeses and 474 total ankle replacements were prospectively followed from 2002 to 2010. Reoperations were identified as part of the prospective cohort study. Operating reports were reviewed, and each reoperation was coded. To verify inter- and intraobserver reliability of this new coding system, 6 surgeons experienced in foot and ankle surgery were asked to assign a specific code to 62 blinded reoperations, on 2 separate occasions. Reliability was determined using intraclass correlation coefficients (ICCs) and proportions of agreement.

Results:

Of a total of 687 procedures, 74.8% (514/687) required no reoperation (Code 1). By surgery type, 14.1% (30/213) of ankle arthrodesis procedures and 30.2% (143/474) of ankle replacement procedures required reoperation. The rate for reoperations surrounding the ankle joint (ie, Codes 2 and 3) was 9.9% (21/213) for ankle arthrodesis versus 5.9% for ankle replacement (28/474). Reoperation rates within the ankle joint (ie, Codes 4 to 10) were 4.7% (10/213) for ankle arthrodesis and 26.1% (124/474) for ankle replacement. Overall, 0.9% (2/213) of arthrodesis procedures required reoperation outside the initial operative site (Code 3), versus 4.6% (22/474) for total ankle replacement. The rate of reoperation due to deep infection (Code 7) was 0.9% (2/213) for arthrodesis versus 2.3% (11/474) for ankle replacement. Interobserver reliability testing produced a mean ICC of 0.89 on the first read. The mean ICC for intraobserver reliability was 0.92. For interobserver, there was 87.9% agreement (804/915) on the first read, and 87.5% agreement (801/915) on the second. For the intra observer readings, 88.5% (324/366) were in agreement.

Conclusions:

The new coding system presented here was reliable and may provide a more standardized, clinically useful framework for assessing reoperation rates and resource utilization than prior complication- and diagnosis-based classification systems, such as modifications of the Clavien Dindo System. Analyzing reoperations at the primary site may enable a better understanding of reasons for failure, and may therefore improve the outcomes of surgery in the future.

Level of Evidence:

Level III, retrospective comparative cohort study based on prospectively collected data.
Value of 3D Reconstructions of CT Scans for Calcaneal Fracture Assessment
Authors: Roll Christina , Schirmbeck Johanna , Müller Franz , Neumann Carsten , Kinner Bernd
Published: August 2016

Background:

The interpretation of CT scans for the evaluation of calcaneal fractures is difficult. Three-dimensional (3D) reconstruction (volume rendering technique [VRT]) has been valuable in the evaluation of irregularly shaped bones. However, their value for the analysis of calcaneal fractures is still debated. Therefore, the objective of this study was to assess the effect of additional use of 3D CTs in calcaneal fractures.

Methods:

In a prospective multicenter study, the CT data set of 5 different fractures was presented to 57 evaluators. First, the participating surgeons were asked to assess the fractures on the basis of axial, coronal, and sagittal reconstructions using a multiple-choice questionnaire. Second, 3D reconstructions (VRT) were presented. The CT scans were validated by the intraoperative findings and the results were compared to the model solution of 3 foot and ankle surgeons. Intra- and interrater reliabilities were calculated.

Results:

The proportion of intraobserver agreement was 82%, with Cohen kappa of κ = 0.748 ( P < .001). Interrater agreement varied between 0.772 ( P = .006) for the assessment of concomitant fractures and 0.987 ( P < .001) for the suggested approach. The evaluation of several items improved after presentation of the 3D CTs (Cochrane Q test, P < .001). The benefit of 3D imaging was higher in inexperienced surgeons and complex fractures (Friedman test P < .001).

Conclusion:

The evaluation of CT scans of calcaneal fractures was improved by the additional use of 3D images (VRT).

Level of Evidence:

Level II, prospective comparative study.
Early Experience of Financial Performance and Solvency of Medicaid-Focused Insurers Under ACA Expansion
Authors: McCue Michael J.
Published: August 2016

To allow for greater coverage of the uninsured, the Affordable Care Act expanded Medicaid coverage in 2014. Accessing financial data of state health insurers from the National Association of Insurance Commissioners, this data trend study compares the financial performance and solvency of Medicaid-focused health insurers prior to and after the first year expansion of Medicaid coverage. After the first year of Medicaid expansion, there was a significant increase in operating profit margin ratio for Medicaid-focused health insurers within expansion states. Lower medical loss ratio as well as no change in administrative costs contributed to this profitable position. The risk-based capital ratio for solvency increased significantly for health insurers in nonexpansion states while there was no change in this ratio for health insurers in expansion states. Conversely, the other important solvency ratio of cash flow margin increased significantly for health insurers in expansion states but not for insurers in nonexpansion states.