bluuebunny/crossref_metadata_2025 huggingface dataset:
Home Oxygen Therapy for Bronchiolitis: An Evaluation of the Primary Care Providers’ Experience at Sea Level
Authors: Dunbar Erin E. , Macy Michelle L. , Cranford James A. , Sroufe Nicole , Lozon Marie , Louie Marisa C.
Published: May 2018

Despite 90% of primary care providers at altitude reporting experience with home oxygen therapy for hypoxemic, otherwise well infants, its use at sea level is not well described. Our objective was to understand experience with home oxygen at sea level and determine potential barriers and benefits of its use. We surveyed all pediatricians and family medicine providers within a 30-mile radius of our pediatric hospital from May 2016 to December 2016. Forty-three percent of providers responded. Few (8%) had any experience with home oxygen therapy for bronchiolitis. When all responders were asked about potential benefits and barriers, they reported less disruption of family routines and reduced cost as the largest potential benefits, and lack of parental comfort the largest barrier. Despite their concerns, 53% of providers felt that home oxygen use would not substantially affect their practice. Our results identify a need for education before using this alternative to admission in our center.
Warfarin-Induced Skin Necrosis in the Presence of Acute Hepatic Injury and May-Thurner Syndrome
Authors: Tilton Carrie , Livengood Spencer , Hodges Jeremy , Marshall Jessica
Published: May 2018

Purpose: The purpose of the report is to describe a patient with warfarin-induced skin necrosis in the presence of acute hepatic injury and significant risk factors for venous thromboembolism, including protein C deficiency and May-Thurner syndrome. Summary: A 44-year-old female with multiple comorbidities presented to the emergency department with a significantly elevated international normalized ratio (INR > 15.9) rapidly reversed with vitamin K and fresh frozen plasma. Due to the findings of bilateral acute on chronic deep vein thromboses (DVTs) and suspected warfarin-induced skin necrosis, a heparin infusion was initiated but later discontinued due to endogenous partial thromboplastin times (PTT) elevations despite dose reductions. Although the necrosis encompassed large areas of the fatty tissue, the depth of necrosis remained mostly superficial. Supportive care and wound management were provided following warfarin reversal; no skin grafts or amputations were performed. Conclusion: A 44-year-old female developed a complicated probable warfarin-induced skin necrosis in the setting of acute liver failure, septic shock, May-Thurner syndrome, previously failed anticoagulation, and acute deep vein thrombosis.
Respondent Processing of Images in Web Surveys
Authors: Charoenruk Nuttirudee , Stange Mathew
Published: May 2018

Most research on images in surveys has examined how images affect answers to questions, which are known as visual context effects. Less frequently studied is how respondents process images in surveys and how variation in processing impacts observing visual context effects. Using data from two eye-tracking studies, we found that less than half of the respondents looked at the images in our surveys and that rates of looking at the images and time spent processing them significantly differed by gender. Additionally, we found that those who looked at the images for at least 60 milliseconds had their responses influenced by the images. The visual context effects did not occur for respondents who did not fixate on the images. Our findings suggest researchers must be cautious when placing images in surveys, given the possibility of visual context effects and variation of these effects by whether respondents fixate on the images, which could vary among subgroups.
Recasting Participation in Drug Policy
Authors: Lancaster Kari , Ritter Alison , Diprose Rosalyn
Published: May 2018

Calls for “evidence-based policy” and greater community “participation” are often heard in the drug policy field. Both movements are in different ways concerned with the same questions about how “drug problems” ought to be governed and the place of “expertise” and “engagement” in democratic societies. However, these calls rely on the assumption that knowledges, publics, expertise, and issues of concern are fixed and stable, waiting to be addressed or called to action, thus obscuring ontological questions about what “participation” (be that lay or expert) may do or produce. There has been limited research in the drugs field that has taken “participation” as an object of study in itself and through critical examination attempted to open up new possibilities for its remaking. In this article, we draw on science and technology studies scholarship that has sought to illuminate the relations between public deliberation and government decision-making in public affairs involving technical claims and the generative capacity of such engagement (including for democracy itself). We describe various rationales for participation and examples of experiments that have sought to remake participatory processes in other policy domains. This literature provides fruitful ground for a reengagement with (and possibly a reconfiguration of) “evidence-based policy” or community “participation” in drug policy. Through this exploration, we hope to recast and more sensitively articulate the concept of “participation” in deliberations about public affairs involving technical claims in drug policy, thus opening up possibilities for experiments and practices that redistribute expertise, “slow down” reasoning, attend to emergent publics, and disrupt consensual claims as to “what counts” and what does not.
America’s apocalyptic literature of the radical right
Authors: Kaplan Jeffrey
Published: May 2018

This article examines the American radical right’s fascination with apocalyptic millenarianism through the apocalyptic literature the movement has either generated or, as with The Protocols of the Learned Elders of Zion, adopted as its own. These works are not all of a kind however; there are distinct categories into which they fall. These are: (1) Literature of the Crossroads in which the apocalypse can be averted if the nation follows a prescribed path; and (2) post-apocalyptic literature which sees no alternative to the End, and therefore embraces the inevitable cataclysm in the faith that the millennial future will bring at long last perfect peace and terrestrial perfection. Moreover, there are two distinct courses of action which this body of literature prescribes: (1) revolution now; or (2) a quietist withdrawal to an enclave where the White Race can safely sit out the apocalypse to come.
Epidemiology of Elbow Ulnar Collateral Ligament Injuries Among Baseball Players: National Collegiate Athletic Association Injury Surveillance Program, 2009-2010 Through 2013-2014
Authors: DeFroda Steven F. , Goodman Avi D. , Gil Joseph A. , Owens Brett D.
Published: May 2018

Background:

Injuries to the ulnar collateral ligament (UCL) of the elbow are of major concern in baseball; however, the epidemiology of these injuries among National Collegiate Athletic Association (NCAA) athletes is poorly described.

Purpose:

To determine the incidence of UCL injuries in NCAA baseball and investigate the risk factors involved.

Study Design:

Descriptive epidemiology study.

Methods:

All UCL injuries for academic years 2009-2010 through 2013-2014 were extracted from the NCAA Injury Surveillance Program database. The incidence was calculated for different positions, activity, time in game, competition status, and injury characteristics and compared via injury risk ratios to determine risk factors for injury occurrence. The NCAA provides sampling weights based on division and year. For all other injury characteristic analysis, unweighted data were used.

Results:

Over the course of the 2009-2010 to 2013-2014, 20 UCL injuries were reported in the NCAA Injury Surveillance Program over 177,992 athletic exposures (AEs) for an overall incidence of 1.12 per 10,000 AEs (95% CI, 0.63-1.62). Eighty-five percent occurred during throwing, and 100% were new injuries. Of the injuries sustained during games, 28.6% occurred early (warm-up through third inning) and 71.4% late (fourth inning or later), with a risk ratio of 1.3 for late-game injuries (95% CI, 0.24-6.44). Of those injured, 45.0% were able to return to play by the next season, while the remainder were out for at least 7 days. Injury was season ending for 15% of athletes (0.17 per 10,000 AEs), and 15% of athletes required surgery.

Conclusion:

UCL injury is a potentially season-ending, even career-ending, injury among NCAA baseball players. Additionally, while more injuries occurred later in games, the current study revealed no significant difference in injury rates with respect to time in game. Last, the authors found a higher reported rate of extensive time away from sport after UCL injury than previously published studies on this patient population.
Tinfolec: A New French Web-Based Test for Reading Assessment in Primary School
Authors: Beauvais Lucie , Bouchafa Houria , Beauvais Caroline , Kleinsz Nina , Magnan Annie , Ecalle Jean
Published: May 2018

The goal of the experiment was to examine the relevance of a new French web-based assessment, Tinfolec (Test INFOrmatisé d’évaluation de la LECture), the aim of which is to evaluate the reading abilities of children in primary grades. The participants were 1,016 children from Grades 2 to 5. They completed the five tasks of Tinfolec designed to assess the efficiency of the two procedures used to identify written words (the nonlexical route and the lexical orthographic route). We tested the reliability and validity of the new tool in a subsection of this sample. Correlational analyses provided evidence of the reliability and validity of Tinfolec. The results are consistent with the conventionally observed effect of lexical factors (length, consistency, and frequency) on written word processing. The results confirm the relevance of the proposed tasks. The study produced promising results and would allow practitioners to perform online assessments of reading skills.
Youth digital participation: Measuring social impact
Authors: Pawluczuk Alicja , Hall Hazel , Webster Gemma , Smith Colin
Published: May 2018

Current scholarly debate around digital participatory youth projects and approaches to their evaluation are examined in this article. The analysis of the literature presented here reveals (1) an over-reliance on traditional evaluation techniques for such initiatives, and (2) a scarcity of models for the assessment of the social impact of digital participatory youth projects. It is concluded that the challenges and limitations of social impact evaluation practice in digital participatory youth projects should be addressed through the adoption of alternative, participant-centred approaches. These issues are discussed in reference to a current ongoing study that seeks to identify solutions for enhancing social impact evaluations of participatory digital initiatives by young people.
Armageddon: Political Elites and Their Visions of a General European War before 1914
Authors: Mulligan William
Published: May 2018

Expectations of a general European war before 1914 remain a contentious area of historiographical debate. This article discusses how one particular group, political and diplomatic elites, imagined a future war before 1914. In contrast to the ‘short-war myth’, this article argues that political elites understood that war would bring in its wake revolution, chaos, and impoverishment. This article analyses the varieties of understandings of catastrophe among European political elites before 1914, the sources of their knowledge about the consequences of war, and the implications these visions of catastrophic warfare had for the conduct of international politics.
Behavioral Pain Intervention for Hospice and Palliative Care Patients: An Integrative Review
Authors: Mayahara Masako , Wilbur JoEllen , Fogg Louis , Breitenstein Susan M.
Published: May 2018

Despite the advances in pain management, achieving optimal pain control in hospice and palliative care is challenging. Patient/caregiver’s lack of pain management knowledge, poor pain reporting, and poor adherence to pain management regimens are all associated with inadequate pain control. The purpose of this integrated review is to examine behavioral interventions designed for patients and caregivers to improve pain control in hospice and palliative care settings. Ten studies were identified through a database search. Seven of the 10 studies found significant improvement in at least 1 pain marker. Of the 7 studies that looked at changes in pain knowledge, 5 had significant improvements in at least 1 knowledge subscale. The 2 studies that looked at adherence to pain management found significant improvements. One limitation of the reviewed studies was that the delivery of them would not be efficient across all health-care settings, and, as a consequence, more technologically sophisticated delivery methods are needed. Therefore, while it is clear from the review that effective pain management interventions have been developed for hospice and palliative care patients, it is also clear that future research needs to focus on providing these same interventions through a more technologically sophisticated delivery method.
Development of a Management Algorithm for the Diagnosis of Cellular Fibroepithelial Lesions From Core Needle Biopsies
Authors: Jung Jaehag , Kang Eunyoung , Chae Su Min , Kim Hyojin , Park So Yeon , Yun Bo La , Kim Sun Mi , Jang Mijung , Kim Sung-Won , Kim Eun-Kyu
Published: May 2018

Purpose. Surgical excision is recommended for complete evaluation of cellular fibroepithelial lesions identified from core needle biopsy. The purpose of this study was to determine factors associated with phyllodes tumor among cellular fibroepithelial lesions from core biopsies and develop a scoring system to predict the risk of phyllodes tumor. Methods. We retrospectively reviewed clinical data of 169 breast lesions that were diagnosed as cellular fibroepithelial lesions from core needle biopsy at the Seoul National University Bundang Hospital between March 2005 and January 2013. The clinical, histopathologic, and radiologic characteristics were compared between phyllodes tumors and fibroadenomas during the final diagnosis after surgical excision. Results. Of the 169 lesions, 17 were observed and 152 were surgically removed. After excision, final pathology revealed 60 (39.5%) fibroadenomas and 92 (60.5%) phyllodes tumors. Multivariate analysis demonstrated that age (≥40 years), stromal overgrowth, and stromal cellularity were independent factors associated with phyllodes tumors. A scoring system was developed based on a multivariate logistic regression model, and the area under the receiver operating characteristic curve was 0.828 (95% confidence interval = 0.763-0.893). Conclusion. The scoring system will help clinicians make appropriate treatment for patients with cellular fibroepithelial lesions on core needle biopsy.
Outcomes of Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity in Older Patients
Authors: Conti Matthew S. , Jones Mackenzie T. , Savenkov Oleksandr , Deland Jonathan T. , Ellis Scott J.
Published: May 2018

Background:

Reconstruction of the stage II adult-acquired flatfoot deformity (AAFD) often requires the use of multiple osteotomies and soft tissue procedures that may not heal well in older patients. The purpose of our study was to determine whether patients older than 65 years with stage II AAFD had inferior clinical outcomes or an increased number of subsequent surgical procedures after flatfoot reconstruction when compared with younger patients.

Methods:

One-hundred forty consecutive feet (70 right, 70 left) with stage II AAFD in 137 patients were divided into 3 groups based on age: younger than 45 years (young; n = 21), 45 to 65 years (middle-aged; n = 87), and 65 years and older (older; n = 32). Preoperative and postoperative Foot and Ankle Outcome Scores (FAOSs) at a minimum of 2 years were compared. Hospital records were reviewed to determine if patients underwent a subsequent procedure postoperatively.

Results:

Patients in the older group did not demonstrate any differences in changes in FAOS subscales compared with patients in the young and middle-aged groups (all P > .15). The older group had significant preoperative to postoperative improvements in all the FAOS subgroups ( P < .01). In addition, patients in the older group were not more likely to undergo a subsequent surgery than were the younger patients (all P > .10).

Conclusions:

Our study found that patients older than 65 years with stage II AAFD have improvements in patient-reported outcomes and rates of revision surgery after surgical reconstruction that were not significantly different than those of younger patients.

Level of Evidence:

Therapeutic Level III, comparative series.
Time to Diagnosis and Treatment of Surgical Site Infections in Foot and Ankle Surgery
Authors: Baranek Eric S. , Tantigate Direk , Jang Eugene , Greisberg Justin K. , Vosseller J. Turner
Published: May 2018

Background:

The time at which patients typically present with surgical site infections (SSI) following foot and ankle surgery has not been characterized. The primary aim of this study was to quantify the time to definitive treatment of SSIs.

Methods:

We performed a retrospective review of 1933 foot and ankle procedures in 1632 patients from 2011 through 2015. Demographic and surgical data were collected. Time to presentation in cases diagnosed with postoperative wound complications or SSIs was analyzed. Wound complications were defined as any case with concerning wound appearance that subsequently resolved with antibiotic therapy alone. SSIs were defined as cases requiring operative irrigation and debridement (I&D) for successful definitive management.

Results:

A total of 1569 procedures met inclusion criteria, with 17 SSIs (1.1%) and 63 wound complications (4.0%). Time between surgery and definitive treatment in the SSI group was significantly greater than in the wound complication group (28.2 ± 9.1 vs 13.4 ± 4.7 days, P < .00001). Eleven (64.7%) cases in the SSI group failed a trial of antibiotics prior to I&D, and 6 (35.3%) cases did not receive antibiotics prior to I&D. Antibiotic treatment prior to I&D did not significantly decrease the yield of intraoperative wound cultures (70% vs 100%, P = .51).

Conclusion:

In our cohort of patients, the time to diagnosis and treatment of SSIs was longer than that of wound complications. SSIs requiring operative intervention did not present until an average of 4 weeks after surgery. These data are of some benefit in trying to define and understand SSI.

Level of Evidence:

Level III, retrospective cohort study.
Evaluation of Articular Cartilage Injury Using Computed Tomography With Axial Traction in the Ankle Joint
Authors: Nakasa Tomoyuki , Ikuta Yasunari , Sawa Mikiya , Yoshikawa Masahiro , Tsuyuguchi Yusuke , Ota Yuki , Kanemitsu Munekazu , Adachi Nobuo
Published: May 2018

Background:

Although chondral or osteochondral injuries are usually assessed by magnetic resonance imaging, its accuracy can be low, presumably related to the relatively thin cartilage layer and the close apposition of the cartilage of the talus and tibial plafond. We hypothesized that axial traction could provide a contrast between the articular cartilage and joint cavity, and it enabled the simultaneous evaluation of cartilage and subchondral bone. The purpose of this study was to assess the feasibility of using computed tomography (CT) imaging with axial traction for the diagnosis of articular cartilage injuries.

Methods:

Chondral lesions in 18 ankles were evaluated by CT with axial traction using a tensioning device and ankle strap for enlargement of the joint space of the ankle. CT was done in 3-mm slices and programmed for gray scale, and then CT images were allocated colors to make it easier to evaluate the cartilage layer. The International Cartilage Repair Society (ICRS) grades on CT were compared with those on arthroscopic findings.

Results:

The respective sensitivity and specificity of CT imaging with traction using ICRS grading were 74.4%, and 96.3%. The level of agreement of the ICRS grading between CT images and arthroscopic findings was moderate (kappa coefficient, 0.547). Adding axial traction to CT increased the delineation of the cartilage surface, including chondral thinning, chondral defect, and cartilage separation.

Conclusions:

CT with axial traction produced acceptable levels of sensitivity and specificity for the evaluation of articular cartilage injuries, in addition to the assessment of subchondral bone.

Level of Evidence:

Level III, comparative case series.
Surgical Considerations in Interrupted Aortic Arch
Authors: LaPar Damien J. , Baird Christopher W.
Published: May 2018

Interrupted aortic arch (IAA) is a rare congenital anomaly with several anatomical variants and is often associated with other intracardiac and/or extracardiac congenital anomalies. Historically, associated with high early mortality, outcomes for this anomaly have improved in recent eras with advances in perioperative and anesthesia management and refinements in surgical technique. This review provides a description of surgical anatomy, anatomical classifications, and associated congenital lesions as well as an examination of the perioperative and surgical management of IAA in the contemporary surgical era.
Critical complicity: The feel of difference at work in home and field
Authors: Ashcraft Karen Lee
Published: May 2018

This provocation to debate begins with the observation that critical management and organization scholars exhibit powerful capacity for critiquing, weaker capacity for changing, and atrophied capacity for feeling relations of power at work. Following developments in affect theory, I propose that we foster a critical practice of inhabiting, discerning, and cultivating relations of difference in our own work world as we also study power elsewhere. The argument unfolds in three turns, claiming that (1) difference at work is a constitutive sensate activity, (2) our “senses” of difference at home haunt our studies of power in other fields, and (3) we could be better change agents if we tuned in to the relation of home and field (i.e. how we are already doing what we seek to know about). Ultimately, I suggest that efforts in so-called critical performativity must also include critical vulnerability, whereby we begin to grapple with our complicity and integrate it into critical practice.
CSF inflammatory biomarkers responsive to treatment in progressive multiple sclerosis capture residual inflammation associated with axonal damage
Authors: Romme Christensen Jeppe , Komori Mika , von Essen Marina Rode , Ratzer Rikke , Börnsen Lars , Bielekova Bibi , Sellebjerg Finn
Published: May 2018

Background:

Development of treatments for progressive multiple sclerosis (MS) is challenged by the lack of sensitive and treatment-responsive biomarkers of intrathecal inflammation.

Objective:

To validate the responsiveness of cerebrospinal fluid (CSF) inflammatory biomarkers to treatment with natalizumab and methylprednisolone in progressive MS and to examine the relationship between CSF inflammatory and tissue damage biomarkers.

Methods:

CSF samples from two open-label phase II trials of natalizumab and methylprednisolone in primary and secondary progressive MS. CSF concentrations of 20 inflammatory biomarkers and CSF biomarkers of axonal damage (neurofilament light chain (NFL)) and demyelination were analysed using electrochemiluminescent assay and enzyme-linked immunosorbent assay (ELISA).

Results:

In all, 17 natalizumab- and 23 methylprednisolone-treated patients had paired CSF samples. CSF sCD27 displayed superior standardised response means and highly significant decreases during both natalizumab and methylprednisolone treatment; however, post-treatment levels remained above healthy donor reference levels. Correlation analyses of CSF inflammatory biomarkers and NFL before, during and after treatment demonstrated that CSF sCD27 consistently correlates with NFL.

Conclusion:

These findings validate CSF sCD27 as a responsive and sensitive biomarker of intrathecal inflammation in progressive MS, capturing residual inflammation after treatment. Importantly, CSF sCD27 correlates with NFL, consistent with residual inflammation after anti-inflammatory treatment being associated with axonal damage.
Aging and lymphocyte changes by immunomodulatory therapies impact PML risk in multiple sclerosis patients
Authors: Mills Elizabeth A , Mao-Draayer Yang
Published: May 2018

New potent immunomodulatory therapies for multiple sclerosis (MS) are associated with increased risk for progressive multifocal leukoencephalopathy (PML). It is unclear why a subset of treated patients develops PML, but patient age has emerged as an important risk factor. PML is caused by the JC virus and aging is associated with immune senescence, which increases susceptibility to infection. With the goal of improving PML risk stratification, we here describe the lymphocyte changes that occur with disease-modifying therapies (DMTs) associated with high or moderate risk toward PML in MS patients, how these changes compare to immune aging, and which measures best correlate with risk. We reviewed studies examining how these therapies alter patient immune profiles, which revealed the induction of changes to lymphocyte number and/or function that resemble immunosenescence. Therefore, the immunosuppressive activity of these MS DMTs may be enhanced in the context of an immune system that is already exhibiting features of senescence.
Multiple underwater target positioning with optimally placed acoustic surface sensor networks
Authors: Moreno-Salinas David , Pascoal Antonio Manuel , Aranda Joaquín
Published: May 2018

In an increasing number of scientific and commercial mission scenarios at sea, it is required to simultaneously localize a group of underwater targets. The latter may include moored systems, autonomous vehicles, and even human divers. For reasons that have to do with the unavailability of Global Positioning System underwater, cost reduction, and simplicity of operation, there is currently a surge of interest in the development of range-based multiple target localization systems that rely on the computation of the distances between the targets and a number of sensor nodes deployed at the ocean surface, equipped with acoustic range measuring devices. In the case of a single target, there is a wealth of literature on the problem of optimal acoustic sensor placement to maximize the information available for target localization using trilateration methods. In the case of multiple targets, however, the literature is scarce. Motivated by these considerations, we address the problem of optimal sensor placement for multiple underwater target positioning. In this setup, we are naturally led to a multiple objective optimization problem, the solution of which allows for the analysis of the trade-offs involved in the localization of the targets simultaneously. To this end, we resort to tools from estimation theory and multi-objective optimization. For each target, the function to be minimized (by proper choice of the sensor configuration) is related to the determinant of the corresponding Fisher information matrix, which yields information on the minimum possible covariance of the error with which the position of the target can be estimated using any non-biased estimator. To deal with the fact that more than one target is involved, we exploit the concept of multiple objective Pareto-optimal solutions to characterize the best possible accuracy with which each of the targets can be positioned, given constraints on the desired positioning accuracy of the other targets. Simulation examples illustrate how, for a three-sensor network and two targets, it is possible to define an optimal sensor configuration that yields large positioning accuracy for both targets simultaneously, using convex optimization tools. When more than two targets are involved, however, more than three sensors are required to exploit an adequate trade-off of the accuracy with which each target can be positioned by resorting to non-convex and Pareto-optimization tools. We show how in this case the optimal sensor configurations depend on the Pareto weights assigned to each of the targets, as well as on the number of sensors, the number of targets, and the uncertainty with which the positions of the targets are known a priori.
Repatriation of Academics: A Study on Sri Lankan University Lecturers
Authors: James Robinson
Published: May 2018

Although repatriation adjustment is a matter for all re-entry groups, it is not clear if it is an issue for returning academics. The article aims to investigate whether the repatriation adjustment is a matter for academic repatriates. The study was conducted with 63 Sri Lankan academic repatriates who had been attached to a foreign university or academic institution for more than 1 year, had been involved in academic activities and, at the survey date, had returned within the past 2 years. One sample t-test, independent sample t-test and regression analysis were employed to test the proposed hypotheses. The article provides empirical evidence to show that repatriation adjustment is a matter for academic repatriates too. Academics who return to their home university experience less fit to their organization compared to their fit with their home organization before they had left. The article highlights that universities need to take necessary steps to develop policies and procedures to capitalize the knowledge and international experience of returning academics. The findings extend the current scope of literature on repatriation adjustment by identifying a new group of repatriates who are experiencing repatriation adjustment issues.
Trichobezoar-Induced Heartburn in a Teenage Girl: A Case Report
Authors: Akbar Shahrazad , Akbar Lujayn , Akbar Nuralhuda , Nawras Ali
Published: May 2018

One of the most commonly encountered medical problems affecting all age groups in health care is abdominal pain. There are many surgical and medical causes behind this symptom; however, a rare cause of abdominal pain and other unspecific abdominal complaints are gastric bezoars. Gastric bezoars are defined as the accumulation of undigested or partially digested foreign materials in the stomach. They are typically found incidentally during upper endoscopy. Patients may present with abnormal behavior or eating disorders such as pica. Therefore, proper history taking and establishing a good rapport with the patient play a key role in diagnosis. We present a case of trichobezoar-induced heartburn in an 18-year-old female. In this article, we will discuss the types, risk factors, clinical picture, diagnosis, and treatment of this condition.
Rates and causes of 30-day readmission and emergency room utilization following head and neck surgery
Authors: Wu Vincent , Hall Stephen F.
Published: May 2018

Background

Unplanned returns to hospital are common, costly, and potentially avoidable. We aimed to investigate and characterize reasons for all-cause readmissions to hospital as in-patients (IPs) and visits to the Emergency Department (ED) within 30-days following patient discharge post head and neck surgery (HNS).

Methods

Retrospective case series with chart review. All patients within the Department of Otolaryngology – Head and Neck Surgery who underwent HNS for benign and malignant disease from January 1, 2010 to May 31, 2015 were identified. The electronic medical records of readmitted patients were reviewed for reasons of readmission, demographic data, and comorbidities.

Results

Following 1281 surgical cases, there were 41 (3.20%) IP readmissions and 109 (8.43%) ED visits within 30-days after discharge for HNS. For IP readmissions, most common causes included infection (26.8%), respiratory symptoms (17.1%), and pain (17.1%). Most common reasons for ED visits were for pain (31.5%), bleeding (17.6%), and infection (14.8%). Readmitted IPs had significantly higher health burden at pre-operative baseline as compared to patients who visited the ED when assessed with the American Society of Anesthesiology scores ( p = 0.002) and the Cumulative Illness Rating Scale ( p = 0.004).

Conclusion

Rate of 30-day IP readmission and ED utilization was 3.20 and 8.43%, respectively. Pain and infection were common causes for returns to hospital. Discharge planning may be improved to target common causes for post-surgical hospital visits in order to decrease readmission rates.
Integrated X-ray fluorescence and diffuse visible-to-near-infrared reflectance scanner for standoff elemental and molecular spectroscopic imaging of paints and works on paper
Authors: Delaney John K. , Conover Damon M. , Dooley Kathryn A. , Glinsman Lisha , Janssens Koen , Loew Murray
Published: May 2018

Prior studies have shown the improved ability to identify artists’ pigments by combining results from X-ray fluorescence (XRF), which provides elemental information, with reflectance spectroscopy in the visible to near infrared (400–1000 nm) that provides information on electronic transitions. Extending the spectral range of reflectance spectroscopy into the UV, 350–400 nm, allows identification of several white pigments since their electronic transitions occur in this region (e.g., zinc white and rutile and anatase forms of titanium white). Extending the range further into the infrared, out to 2500 nm, provides information on vibrational transitions of various functional groups, such as hydroxyl, carbonate, and methyl groups. This allows better identification of mineral-based pigments and some paint binders. The combination of elemental information with electronic and vibrational transitions provides a more robust method to identify artists’ materials in situ. The collection of both sets of spectral information across works of art, such as paintings and works on paper, allows generating a more complete map of artists’ materials. Here, we describe a 2-D scanner that simultaneously collects XRF spectra and reflectance spectra from 350 to 2500 nm across the surfaces of works of art. The scanner consists of a stationary, single pixel XRF spectrometer and fiber optic reflectance spectrometer along with a 2-D position-controlled easel that moves the artwork in front of the two detection systems. The dual-mode scanner has been tested on a variety of works of art from illuminated manuscripts (0.1 × 0.1 m2) to paintings as large as 1.7 × 1.9 m2. The scanner is described and two sets of results are presented. The first is the XRF scanning of a large warped panel painting by Andrea del Sarto titled Charity. The second is a combined XRF and reflectance scan of Georges Seurat’s painting titled Haymakers at Montfermeil. The XRF was collected at 1 mm spatial sampling and the reflectance spectral data at 3 mm. Combining the results from the data sets was found to enhance the identification of pigments as well as yield distribution maps, in spite of the relatively low reflectance spatial sampling. The elemental and reflectance maps allowed the identification and mapping of lead white, cobalt blue, viridian, ochres, and likely chrome yellow. The maps also provide information on the mixing of pigments. While the reflectance image cube has 10–20× larger spatial samples than desired, the elimination of having to use two hyperspectral cameras to cover the range from 400 to 2500 nm makes for a low cost dual modality scanner.
Effectiveness of Prenatal Vitamin D Deficiency Screening and Treatment Program: A Stratified Randomized Field Trial
Authors: Rostami Maryam , Tehrani Fahimeh Ramezani , Simbar Masoumeh , Bidhendi Yarandi Razieh , Minooee Sonia , Hollis Bruce W , Hosseinpanah Farhad
Published: May 2018

Context

Despite evidence on the association between hypovitaminosis D and adverse pregnancy outcomes and the positive impact of vitamin D supplementation, no evidence exists supporting a universal screening program in pregnancy as part of routine prenatal care.

Objective

We sought to determine the effectiveness of a prenatal screening program on optimizing 25-hydroxyvitamin D [25(OH)D] levels and preventing pregnancy complications. Also, to identify a safe regimen, we compared several regimens in a subgroup of vitamin D–deficient pregnant women.

Design

Two cities of Masjed-Soleyman and Shushtar from Khuzestan province, Iran, were selected as the screening and nonscreening arms, respectively. Within the screening arm, a randomized controlled trial was conducted on 800 pregnant women.

Setting

Health centers of Masjed-Soleyman and Shushtar cities.

Patients or Participants

Pregnant women aged 18 to 40 years.

Intervention

Women with moderate [25(OH)D, 10 to 20 ng/mL] and severe [25(OH)D, <10 ng/mL] deficiency were randomly divided into four subgroups and received vitamin D3 (D3) until delivery.

Main Outcome Measure

Maternal concentration of 25(OH)D at delivery and rate of pregnancy complications

Results

After supplementation, only 2% of the women in the nonscreening site met the sufficiency level (>20 ng/mL) vs 53% of the women in the screening site. Adverse pregnancy outcomes, including preeclampsia, gestational diabetes mellitus, and preterm delivery, were decreased by 60%, 50%, and 40%, respectively, in the screening site. A D3 injection in addition to monthly 50,000 IU maintenance therapy contributed the most to achievement of sufficient levels at delivery.

Conclusions

A prenatal vitamin D screening and treatment program is an effective approach in detecting deficient women, improving 25(OH)D levels, and decreasing pregnancy adverse outcomes.
Mechanical stability of the cell nucleus – roles played by the cytoskeleton in nuclear deformation and strain recovery
Authors: Wang Xian , Liu Haijiao , Zhu Min , Cao Changhong , Xu Zhensong , Tsatskis Yonit , Lau Kimberly , Kuok Chikin , Filleter Tobin , McNeill Helen , Simmons Craig A. , Hopyan Sevan , Sun Yu
Published: May 2018

Extracellular forces transmitted through the cytoskeleton can deform the cell nucleus. Large nuclear deformations increase the risk of disrupting the integrity of the nuclear envelope and causing DNA damage. The mechanical stability of the nucleus defines its capability to maintain nuclear shape by minimizing nuclear deformation and allowing strain to be minimized when deformed. Understanding the deformation and recovery behavior of the nucleus requires characterization of nuclear viscoelastic properties. Here, we quantified the decoupled viscoelastic parameters of the cell membrane, cytoskeleton, and the nucleus. The results indicate that the cytoskeleton enhances nuclear mechanical stability by lowering the effective deformability of the nucleus while maintaining nuclear sensitivity to mechanical stimuli. Additionally, the cytoskeleton decreases the strain energy release rate of the nucleus and might thus prevent shape change-induced structural damage to chromatin.
Effects of chronic exposure to 12‰ saltwater on the endocrine physiology of juvenile American alligator (Alligator mississippiensis)
Authors: Faulkner P. C. , Burleson M. L. , Simonitis L. , Marshall C. , Hala D. , Petersen L. H.
Published: May 2018

American alligator (Alligator mississippiensis, Linnaeus) habitats are prone to saltwater intrusion following major storms, hurricanes or droughts. Anthropogenic impacts affecting hydrology of freshwater systems may exacerbate saltwater intrusion into freshwater habitats. The endocrine system of alligators is susceptible to changes in the environment but it is currently not known how the crocodilian physiological system responds to environmental stressors such as salinity. Juvenile alligators were exposed to 12‰ saltwater for 5 weeks to determine effects of chronic exposure to saline environments. Following 5 weeks, plasma levels of hormones (e.g., progesterone, testosterone, estradiol, corticosterone, aldosterone, angiotensin II) were quantified using LC-MS/MS. Compared to freshwater kept subjects, saltwater exposed alligators had significantly elevated plasma levels of corticosterone, 11-deoxycortisol, 17α-hydroxyprogesterone, testosterone, 17β-estradiol, estrone and estriol while pregnenolone and angiotensin II (ANG II) were significantly depressed and aldosterone (ALDO) levels were unchanged (slightly depressed). However, saltwater exposure did not affect gene expression of renal mineralo- and glucorticoid (MR, GR) and angiotensin type 1 (AT-1) receptors or morphology of lingual glands. On the other hand, saltwater exposure significantly reduced plasma glucose concentrations whereas parameters diagnostic of perturbed liver function (enzymes AST, ALT) and kidney function (creatinine, creatine kinase) were significantly elevated. Except for plasma potassium levels (K+), plasma ions Na+ and Cl− were significantly elevated in saltwater alligators. Overall, this study demonstrated significant endocrine and physiological effects in juvenile alligators chronically exposed to a saline environment. Results provide novel insights into the effects of a natural environmental stressor (salinity) on renin-angiotensin-aldosterone system and steroidogenesis of alligators.
Exercise Periodization over the Year Improves Metabolic Syndrome and Medication Use
Authors: MORALES-PALOMO FELIX , RAMIREZ-JIMENEZ MIGUEL , ORTEGA JUAN FERNANDO , MORA-RODRIGUEZ RICARDO
Published: May 2018

Purpose

We aimed to determine if yearly repeated exercise training reduces metabolic syndrome (MetS) and the use of medicines to control MetS components.

Methods

Fifty-five MetS individuals were randomized into a TRAIN group that underwent two yearly programs of 16-wk high-intensity interval training or a nonexercising CONT group. We measured the evolution of all five MetS components, cardiorespiratory fitness (assessed by V˙O2PEAK) and medicine use, at baseline (0 months), mid (12 months), and end-point (24 months). Testing took place 8 months after the last training session to assess the chronic effects of training.

Results

Daily physical activity (wristband activity monitors) and calorie intake (3-d nutritional diary) remained similar to baseline at 1 and 2 yr in each group and were not different between groups. Blood triglycerides and glucose concentrations did not significantly vary in any group. However, waist circumference increased only in CONT after 2 yr (107 ± 2 cm to 111 ± 3 cm; P = 0.004). Mean arterial pressure decreased in TRAIN (101 ± 2 mm Hg to 94 ± 2 mm Hg; P = 0.002), whereas it remained unchanged in CONT (98 ± 2 mm Hg to 99 ± 2 mm Hg; P = 1.000) after 2 yr. Starting from similar levels at baseline, after 2 yr V˙O2PEAK was higher (2.32 ± 0.14 L·min−1 vs 1.98 ± 0.11 L·min−1; P = 0.049) and medicine use lower (1.27 ± 0.22 vs 2.23 ± 0.43; P = 0.043) in TRAIN than CONT. The reduction in MAP in TRAIN commanded a parallel reduction in MetS Z-score from baseline to 2 yr (0.30 ± 0.1 to 0.07 ± 0.1; P = 0.013).

Conclusions

Two yearly 16-wk high-intensity interval training programs are enough exercise to chronically lower MetS while preventing the reductions in cardiorespiratory fitness associated to aging. Of clinical relevance, yearly exercise training halts the increase in medicine use that occurs in non-exercising MetS individuals.
La ISO 9001 y la Administración de la Calidad Total en las Empresas Peruanas
Authors: Benzaquen de las Casas Jorge
Published: May 2018

El presente estudio muestra el impacto de tener un Sistema de Gestión de Calidad (SGC) con la certificación ISO 9001:2008 en las empresas en Perú en base a los nueve factores de éxito utilizados para medir la implementación de la Administración de la Calidad Total (TQM). En el año 2017 se analizaron 211 empresas al realizar una comparación entre las empresas que poseen dicha certificación y aquellas que no la tienen. Asimismo, se propone que la metodología utilizada en este estudio se aplique en otros países latinoamericanos.
Branch-and-Price-and-Cut for the Truck-and-Trailer Routing Problem with Time Windows
Authors: Rothenbächer Ann-Kathrin , Drexl Michael , Irnich Stefan
Published: May 2018

In this paper, we present a new branch-and-price-and-cut algorithm to solve the truck-and-trailer routing problem with time windows (TTRPTW) and two real-world extensions. In all TTRPTW variants, the fleet consists of one or more trucks that may attach a trailer. Some customers are not accessible with a truck-and-trailer combination, but can however be serviced by one if the trailer is previously detached and parked at a suitable location. In the first extension, the planning horizon comprises two days and customers may be visited either on both days or only once, in which case twice the daily supply must be collected. The second extension incorporates load transfer times depending on the quantity moved from a truck to its trailer. The exact branch-and-price-and-cut algorithm for the standard variant and the two new extensions is based on a set-partitioning formulation in which columns are routes describing the movement of a truck and its associated trailer. Linear relaxations of this formulation are solved by column generation where new routes are generated with a dynamic programming labeling algorithm. The effectiveness of this pricing procedure can be attributed to the adaptation of techniques such as bidirectional labeling, the ng-neighborhood, and heuristic pricing using dynamically reduced networks and relaxed dominance. The cutting component of the branch-and-price-and-cut adds violated subset-row inequalities to strengthen the linear relaxation. Computational studies show that our algorithm outperforms existing approaches on TTRP and TTRPTW benchmark instances used in the literature.

The online appendix is available at https://doi.org/10.1287/trsc.2017.0765 .
Leveraging Customer Flexibility for Car-Sharing Fleet Optimization
Authors: Ströhle Philipp , Flath Christoph M. , Gärttner Johannes
Published: May 2018

Car-sharing is a precursor to the emerging class of “mobility services” leveraging modern technology to enable access to car-based mobility without the consumer owning the physical asset. Consequently, it plays an increasingly important role for urban mobility. Two-way station-based systems, where the customer picks up and returns a car at a single designated station, are the most common type of car-sharing solution. While these systems are most common in practice, they have attracted limited research activity from the optimization community. This paper addresses this gap by exploring the potentials of spatial and temporal customer flexibility to achieve better supply-demand alignment. To this end, we assess both the value and the cost of customer flexibility. Using a real-world data set with over 50,000 car-sharing reservations from a midsized German city, we assess the potential benefits of customer flexibility under offline and online optimization. The offline results indicate that temporal flexibility has only very limited potentials for fleet size reductions (4% reduction at four hours’ flexibility). At the same time, spatial flexibility is highly valuable—customer flexibility of 1 kilometer facilitates a fleet reduction of 12%. Furthermore, we find that spatial and temporal flexibility are highly complementary, with 750 meters and 3 hours yielding reduction potentials of almost 20%. The viability of the potentials is confirmed in the online setting with this reduced fleet. To assess customer willingness to provide flexibility, we conducted a basic discrete choice experiment with 1,529 car-sharing customers. We find that several customers are likely to offer flexibility in time or space for relatively little compensation. These estimates are then used as an input to an expanded fleet optimization problem. These results provide novel insights into the benefits and costs of leveraging consumer flexibility in car-sharing schemes. They are of particular relevance for car-sharing service providers and communities that aim to efficiently bridge the gap between individual and public transportation, and to inform urban transportation policy.

The online appendix is available at https://doi.org/10.1287/trsc.2017.0813 .