bluuebunny/crossref_metadata_2025 huggingface dataset:
Extended Stability of Epinephrine Hydrochloride Injection in Polyvinyl Chloride Bags Stored in Amber Ultraviolet Light–Blocking Bags
Authors: Van Matre Edward T. , Ho Kang C. , Lyda Clark , Fullmer Beth A. , Oldland Alan R. , Kiser Tyree H.
Published: October 2017

Objective: The objective of this study was to evaluate the stability of epinephrine hydrochloride in 0.9% sodium chloride in polyvinyl chloride bags for up to 60 days. Methods: Dilutions of epinephrine hydrochloride to concentrations of 16 and 64 µg/mL were performed under aseptic conditions. The bags were then placed into ultraviolet light–blocking bags and stored at room temperature (23°C-25°C) or under refrigeration (3°C-5°C). Three samples of each preparation and storage environment were analyzed on days 0, 30, 45, and 60. Physical stability was performed by visual examination. The pH was assessed at baseline and upon final degradation evaluation. Sterility of the samples was not assessed. Chemical stability of epinephrine hydrochloride was evaluated using high-performance liquid chromatography. To determine the stability-indicating nature of the assay, degradation 12 months following preparation was evaluated. Samples were considered stable if there was less than 10% degradation of the initial concentration. Results: Epinephrine hydrochloride diluted to 16 and 64 µg/mL with 0.9% sodium chloride injection and stored in amber ultraviolet light–blocking bags was physically stable throughout the study. No precipitation was observed. At days 30 and 45, all bags had less than 10% degradation. At day 60, all refrigerated bags had less than 10% degradation. Overall, the mean concentration of all measurements demonstrated less than 10% degradation at 60 days at room temperature and under refrigeration. Conclusion: Epinephrine hydrochloride diluted to 16 and 64 µg/mL with 0.9% sodium chloride injection in polyvinyl chloride bags stored in amber ultraviolet light–blocking bags was stable up to 45 days at room temperature and up to 60 days under refrigeration.
Chimeric Antigen Receptor T-Cell Therapy for Lymphomas
Authors: Jolley Benjamin , Walker Scot
Published: October 2017

It is estimated that 2.1% of the population of the United States will develop non-Hodgkin lymphoma (NHL) in a lifetime. With treatment, 71% of patients with NHL live to 5 years. Because current drugs used for treatment do not cure all patients and cause serious adverse effects, new strategies have been studied to treat lymphoma. One new pharmacologic strategy is to use chimeric antigen receptor T-cell (CAR T-cell) therapy. CAR T-cell therapies are very potent. As a class, the CAR T-cell therapies have induced complete remission in 50% to 80% of patients. Most patients using CAR T-cell therapies develop cytokine release syndrome, with about 1 in 3 having a severe form of the syndrome. This article will briefly review CAR T-cell therapies in development.
Simulation of thermal cycle aging process on fiber-reinforced polymers by extended finite element method
Authors: González Sergio , Laera Gianluca , Koussios Sotiris , Domínguez Jaime , Lasagni Fernando A
Published: October 2017

The simulation of long life behavior and environmental aging effects on composite materials are subjects of investigation for future aerospace applications (i.e. supersonic commercial aircrafts). Temperature variation in addition to matrix oxidation involves material degradation and loss of mechanical properties. Crack initiation and growth is the main damage mechanism. In this paper, an extended finite element analysis is proposed to simulate damage on carbon fiber reinforced polymer as a consequence of thermal fatigue between −50℃ and 150℃ under atmospheres with different oxygen content. The interphase effect on the degradation process is analyzed at a microscale level. Finally, results are correlated with the experimental data in terms of material stiffness and, hence, the most suitable model parameters are selected.
Cultural Adaptation and Psychometric Properties of the Shirom–Melamed Vigor Measure (SMVM) With Workers in Spain
Authors: Pulido-Martos Manuel , Meléndez-Domínguez Montserrat , Lopez-Zafra Esther
Published: October 2017

Shirom’s proposal about engagement focuses on vigor. Under this approach, vigor is considered an affect that mediates the relationship between resources, behaviors, and attitudes related to psychological functioning and health. It is important for occupational health professionals to have adequate measures of this construct. The Shirom–Melamed vigor measure (SMVM) was developed to capture this sense of energy comprising three components (physical strength, emotional energy, and cognitive liveliness). In the absence of a Spanish version of the SMVM, our aim is to perform a cultural adaptation and to further analyze its psychometric properties. In Study 1, we culturally adapt the SMVM in Spanish samples. It incorporates a careful development of a three-step procedure according to the International Test Commission and qualitative analyses to ensure a consensus version. Twenty-six individuals were involved. In Study 2, the responses of 203 workers from different organizations show the validity and reliability of the instrument. Confirmatory factor analyses yield a model with three interrelated dimensions showing good fit indices. Furthermore, concurrent validity is demonstrated. Finally, we discuss the usefulness of the SMVM for occupational health professionals.
Masters of the universe
Authors: Derickson Kate
Published: October 2017

Feminist scholars, urban and otherwise, have painstakingly illustrated the way in which how we know is intimately related to what we can know, and that these knoweldges are always socially, institutionally, and geographically situated. The making and traveling of these knowledges is itself political, as are the vantage points purported to be achieved in various epistemological frameworks. The emergence of the planetary urbanization thesis takes on a particular and interesting valence when read against this body of feminist work and scholarship. In this commentary, I argue that the planetary urbanization thesis inverts the feminist intervention, coopting feminist conceptions of relationality and hybridity while evacuating them of their political – and, crucially, their epistemological – force.
How to Initiate Dementia Care Networks? Processes, Barriers, and Facilitators During the Development Process of a Practice-Oriented Website Toolkit Out of Research Results
Authors: Heinrich Steffen , Sommerfeld Ulrike , Michalowsky Bernhard , Hoffmann Wolfgang , Thyrian Jochen René , Wolf-Ostermann Karin , Roes Martina
Published: October 2017

Background:

Despite its high relevance, scientific evidence often fails to be disseminated into practice. Information websites can be a successful information dissemination tool, but very little is known about the processes involved in the interdisciplinary development of such websites. This article aims to demonstrate the processes, barriers, and facilitators during the development and publication of a practice-friendly information website grounded in scientifically based research findings about dementia care networks obtained by the DemNet-D study.

Method:

The qualitative data of this article are based on a work progress protocol and a recorded interview with the project’s science journalist. The interview was transcribed, analyzed, and coded based on structured content analysis. Quantitative data were extracted to display the website usage rate. Results: The results indicate that interdisciplinary teamwork is an essential factor for successful website development. Furthermore, the use of a formalized model can help to organize the development structure. To transform scientific content, a specialized expert in the field is needed. Continuous evaluations and marketing strategies are vital for the success of a website. The final website had a high access rate 1 month after launch.

Conclusion:

Crucial processes, barriers, and facilitators during the development of a practice-related information website about dementia care networks are presented and discussed. These findings can help people who aim to disseminate research findings to other practitioner-associated priority groups as well as public health-related groups.
Can We Hasten Development? Effects of Treatment on Psychosocial Maturity
Authors: Riggs Romaine Christina L. , Kemp Kathleen , Giallella Christy L. , Goldstein Naomi E. S. , Serico Jennifer , Kelley Sharon
Published: October 2017

Research continues to highlight factors associated with developmental immaturity, including persistent delinquency. This article examines whether aspects of developmental immaturity, psychosocial maturity, and emotion regulation are responsive to therapeutic intervention. Fifty-seven female youth in secure residential juvenile justice facilities participated in a randomized controlled trial of the Juvenile Justice Anger Management (JJAM) Treatment for Girls, an intervention that targets skills relevant to psychosocial maturity, including problem-solving, coping, and emotion regulation. Participants in JJAM showed increases in temperance, providing evidence that intervention might stimulate psychosocial development. Implications for treatment, evaluation, and measurement of psychosocial maturity are discussed.
They go to the city, and sometimes they come back: Conceptualising rural and urban spaces through experiences of circular migration in Paraguay
Authors: Finnis Elizabeth
Published: October 2017

In this paper, I examine what people’s reasons for migrating from, and subsequently returning to, a rural community can tell us about the inter-related ways that rural and urban spaces are conceptualised. Drawing on research in a small, agricultural community in Paraguay, I explore two illustrations of women who are circular migrants, in order to demonstrate some of the potential circumstances, aspirations, and experiences that can shape decisions to migrate for work and then eventually return to rural spaces. My discussion demonstrates the importance of migration in the construction of a rural present and future, in which movements between rural and urban spaces help to support rural life and aspirations.
Velocity control algorithm in glass polishing based on the cubic NURBS curve
Authors: Han Junzhao , Chen Wenhua
Published: October 2017

To limit velocity fluctuations and to achieve a controllable jerk value in a glass polishing process, a new velocity control algorithm is proposed based on nonuniform rational B-splines (NURBS). The key of this algorithm is replacing the traditional linear acceleration–deceleration with flexible NURBS acceleration–deceleration. Based on the linear acceleration–deceleration algorithm, the control points of the NURBS curve are confirmed, and the final velocity of the polishing wheel center is solved using the Preston equation. With jerk continuity and limitations of the servo system, nonlinear equations are constructed, and the weighting factors corresponding to the control points are obtained. Cubic velocity control equations can be derived from the obtained feature parameters, which include the final velocity, control points, weighting factors and knot vectors. Based on the proposed NURBS acceleration–deceleration algorithm, a fourth-order Runge–Kutta formula was used to obtain the initial points, and the Milne–Hamming equation was used to predict and correct the next point. The predictor-corrector interpolation algorithm for parametric trajectory was implemented during the polishing process. The experimental results indicate that the proposed approach guarantees limited fluctuations of the relative velocity at contact points and ensure smoother velocity changes at dangerous points.
Going across Europe for an apprenticeship? A factorial survey experiment on employers’ hiring preferences in Germany
Authors: Protsch Paula , Solga Heike
Published: October 2017

Owing to the recent recession, the German apprenticeship model is once again praised for smoothing out school-to-work transitions. In line with the social policy shift of favouring education as a key means to combat youth unemployment, European Union (EU) recommendations and German national policies encourage young Southern and Eastern EU citizens to apply for apprenticeship training abroad. Yet, young people wanting to go abroad are not only mobile young people but also immigrants. Given the prevalence of ethnic disparities in the German apprenticeship system, the question arises whether employers would be willing to hire these newcomers. Using a factorial survey experiment, we investigate how employers rate applications from Spanish newcomers compared to those from young immigrant descendants of Spanish origin. The results indicate that newcomers are substantially less preferred than immigrant descendants born in Germany. Employers’ expectations about newcomers’ language skills and employers’ interest in training for their own skilled labour force are key barriers to policies promoting apprenticeships abroad.
Exports Cause Outward Foreign Direct Investment in Indian Pharmaceutical Industry?
Authors: Suri F. K. , Banerji A.
Published: October 2017

This article discusses the relationship among exports, outward FDI and total sales of Indian pharmaceutical industry. Aim is to analyze a two-way causal relationship among exports and outward FDI from Indian pharmaceutical market to understand whether exports and outward FDI are supplementary or complementary in nature. The article also aims to analyze how exports and outward FDI are affected by the lagged year’s values. The article illustrates the trend of exports and outward FDI from Indian pharmaceutical sector to draw an eclectic paradigm to study the impact of exports on outward FDI. A vector auto regression (VAR) model has been developed on exports and outward FDI, keeping total sales as exogenous variable using a lag of one and two years. The VAR model-substituted coefficients suggest that pharmaceutical exports are directly affected by last year Pharma OFDI. It was found that in context of Indian pharmaceutical sector, exports cause outward FDI and in turn previous year’s outward FDI has a direct impact on current year’s exports.
Screening of Chronic Alcoholics for Cognitive Impairment Using Montreal Cognitive Assessment—Occupational Therapy Perspective
Authors: Sawant Parag , Gokhale Preetee , Ferzandi Zarine
Published: October 2017

Rationale:

Chronic alcoholics suffer from cognitive impairment, thereby affecting their ADL and work performance.

Objectives:

The objective was to screen chronic alcoholics for cognitive impairment and assessing affectations in various components of MoCA. Early screening to help them from further deterioration in ADL and work.

Materials and Methodology:

In this case control study, 50 chronic alcoholics, males, age group 30–50 years, abstaining for more than two months, referred to outpatient De-addiction Occupational Therapy department of K. E. M. Hospital, Mumbai were screened using MoCA (Hindi) and compared with their age matched control group.

Results:

All patients showed mild cognitive impairment (MCI) on MoCA, irrespective of pattern and frequency of drinking. Their average mean score in MoCA test and control group was 21.02 and 26.03, respectively. The domains more affected were language, abstraction and memory, thus affecting their performance in ADL and work. Results were analyzed using unpaired ‘ t’-test and were statistically significant at the level of p < 0.05 and 95 per cent confidence level.

Conclusion:

Screening of chronic alcoholics using MoCA showed MCI with varying degree of affectations in the sub-components of the test.
Colder environments are associated with a greater cancer incidence in the female population of the United States
Authors: Sharma Ankit , Sharma Tanu , Panwar Mahaveer S , Sharma Devesh , Bundel Rashmi , Hamilton Ryan T , Radosevich James A , Mandal Chandi C
Published: October 2017

Cancer incidence and/or mortality among individuals varies with diet, socio-culture, ethnicity, race, gender, and age. Similarly, environmental temperature modulates many biological functions. To study the effect of environment temperature on cancer incidence, the US population was selected. Because, county-wise cancer incidence rate data of various anatomical site–specific cancers and different races/ethnicities for both males and females are available. Moreover, the differences amongst the aforementioned factors among individuals are much less, as compared to the world population. Statistical analysis showed a negative correlation between the average annual temperature and cancer incidence rate at all anatomical sites and individually for 13 types (out of 16 types) of anatomical site–specific cancer incidence rates (e.g. uterine, bladder, thyroid, breast, esophagus, ovary, melanoma, non-Hodgkin lymphoma, leukemia, brain, pancreas, etc.) for females. Further analysis found a similar inverse trend in all races/ethnicities of the female population but not in all male races/ethnicities or anatomical site–specific cancers. Moreover, the majority of the counties having the top-most cancer incidence rate in females are located above the latitude 36.5°N. These findings indicate that living in a cold county in the United States might have a higher risk of cancer irrespective of cancer type (except cervical and liver) and races/ethnicities for females but not in all such cases for the male population.
A review of charge methods for driving piezoelectric actuators
Authors: Bazghaleh Mohsen , Grainger Steven , Mohammadzaheri Morteza
Published: October 2017

Piezoelectric actuators are the most commonly used actuators in nanopositioning. They provide excellent operating bandwidth and precision. These actuators are normally driven by voltage amplifiers; however, the relationship of the applied voltage on the actuator and its position is nonlinear and complex due to phenomena such as hysteresis. This adversely influences actuator’s position control which is the core component of nanopositioning. However, the electrical charge applied on a piezoelectric actuator has a significantly less complex relationship with its position. As a result, driving piezoelectric actuators with charge amplifiers has attracted significant attention. In this article, charge driving methods are classified, and their advantages, major issues and the solutions to these issues are critically reviewed.
Amy and Drew: Two Children Who Helped Determine What Free Appropriate Public Education Means
Authors: Hammel Alice M.
Published: October 2017

Two Supreme Court cases have served to frame our legal rights and responsibilities regarding a Free Appropriate Public Education for students in our music classrooms and ensembles. This article serves as record of the two cases and their merits, according to the Supreme Court, as well as the actions recommended based on the court decisions.
Hepatitis C infection and chemotherapy toxicity
Authors: Ly Amy , Cheng Heather H , Alwan Laura
Published: October 2017

There exists little guidance on chemotherapy toxicity management in patients with a history of or active hepatitis C viral infection. We report four cases of patients with solid organ tumors and hepatitis C viral infection, who have experienced severe or unexpected toxicities with chemotherapy. Based on the four case reports, we recommend increased laboratory monitoring for toxicities, initial dose reductions for chemotherapy given with palliative intent, or pre-emptive use of growth factor support, even if the patient presents with normal liver function tests. In this patient population, we also recommend treating active hepatitis C viral infection prior to chemotherapy treatment when possible.
Instantly Converting Atrial Fibrillation into Sinus Rhythm by a Digital Rectal Exam on a 29-year-Old Male
Authors: Ruan Cheng-Huai
Published: October 2017

Vagal maneuvers cause increase in vagal tone, which has been shown to slow many types supraventricular tachycardia, such as atrial fibrillation (AF). However, the conversion of AF to sinus rhythm is usually not associated with vagal manuvers. Thus, AF is classically treated with medication and electrical cardioversion. Here, we present a 29-year-old male with no cardiovascular history and a low atherosclerotic risk profile who developed AF which converted into sinus rhythm immediately after a digital rectal exam. The patient remained asymptomatic after a 3-month follow-up. This implies that the digital rectal exam can be considered as an additional attempt to convert AF to sinus rhythm in AF patients.
The ambivalence of coworking: On the politics of an emerging work practice
Authors: de Peuter Greig , Cohen Nicole S , Saraco Francesca
Published: October 2017

Self-employed media and cultural workers are key users of co-working spaces, where a growing number of independent workers share desks and office amenities, escape the isolation of working from home and seek contacts for paid work. Informed by interviews with coworking space operators and members, this article assesses coworking as a response to precarity. We argue that social and political ambivalence is intrinsic to the culture of coworking. First, we situate coworking in a political–economic context, claiming that coworking emerged as a worker-developed response to changing economic conditions but, in its current form, is increasingly commodified and ultimately reinforces labour flexibilization. Second, we survey meanings attached to coworking, highlighting tensions between coworking’s counter-corporate identity and its recapitulation of neoliberal norms. Third, we address subjectivity formation, proposing that coworking spaces are a stage for the performance of network sociality. We conclude by considering coworking’s political potential as a platform for collective action. This article forms part of the Special Issue ‘On the Move’, which marks the twentieth anniversary of European Journal of Cultural Studies.
Reappraising and Redirecting Research on the Victim–Offender Overlap
Authors: Berg Mark T. , Mulford Carrie F.
Published: October 2017

The strong positive association between offending and victimization, or the victim–offender overlap, has received considerable amount of research attention in recent years. Empirical research has made important strides in unpacking the sources of the phenomenon, but important questions remain unanswered. Ambiguity surrounds the utility of certain theoretical explanations for the overlap, the nature of the phenomenon, and the methodological tools used to examine its etiology. Owing to these knowledge gaps, the scientific meaning of the victim–offender overlap is unclear. Moreover, a number of potentially important theoretical arguments are rarely subject to empirical testing in this line of research. The purpose of this article is to use a narrative review methodology to provide a critical reappraisal of the theoretical, empirical, and methodological research on the victim–offender overlap and offer directions for ways forward to develop a more comprehensive understanding of the phenomenon. This review includes critical analysis of 78 academic publications, along with a table that summarizes the key findings and conclusions from 18 critical empirical studies that have contributed to our understanding of the victim–offender overlap. We offer recommendations for the continued development of theoretical and methodological tools to better understand this complex phenomenon.
Preferences in Sleep Position Correlate With Nighttime Paresthesias in Healthy People Without Carpal Tunnel Syndrome
Authors: Roth Bettlach Carrie L. , Hasak Jessica M. , Krauss Emily M. , Yu Jenny L. , Skolnick Gary B. , Bodway Greta N. , Kahn Lorna C. , Mackinnon Susan E.
Published: October 2017

Background: Carpal tunnel syndrome has been associated with sleep position preferences. The aim of this study is to assess self-reported nocturnal paresthesias and sleeping position in participants with and without carpal tunnel syndrome diagnosis to further clinical knowledge for preventive and therapeutic interventions. Methods: A cross-sectional survey study of 396 participants was performed in young adults, healthy volunteers, and a patient population. Participants were surveyed on risk factors for carpal tunnel syndrome, nocturnal paresthesias, and sleep preferences. Binary logistic regression analysis was performed comparing participants with rare and frequent nocturnal paresthesias. Subanalyses for participants without carpal tunnel syndrome under and over 21 years of age were performed on all factors significantly associated with subclinical compression neuropathy in the overall population. Results: Thirty-three percent of the study population experienced nocturnal paresthesias at least weekly. Increased body mass index ( P < .001) and sleeping with the wrist flexed ( P = .030) were associated with a higher frequency of nocturnal paresthesias. Side sleeping was associated with less frequent nocturnal symptoms ( P = .003). In participants without carpal tunnel syndrome, subgroup analysis illustrated a relationship between nocturnal paresthesias and wrist position. In participants with carpal tunnel syndrome, sleeping on the side had a significantly reduced frequency of nocturnal paresthesias. Conclusion: This study illustrates nocturnal paresthesias in people without history of carpal tunnel syndrome including people younger than previously reported. In healthy patients with upper extremity subclinical compression neuropathy, sleep position modification may be a useful intervention to reduce the frequency of nocturnal symptoms prior to developing carpal tunnel syndrome.
A solution-focused approach to understanding patient motivation in diabetes self-management: Gender differences and implications for primary care
Authors: Bhaloo Tajudaullah , Juma Michael , Criscuolo-Higgins Christine
Published: October 2017

Objective

Healthcare providers often neglect to recognize the role they play in motivating patients with diabetes to perform self-management. Our aims were to understand what motivates patients with diabetes to implement recommended self-management practices and understand the role of the primary care team in patient motivation.

Methods

We use a solution-focused qualitative approach, supplemented with a quantitative scale. We used a purposive sampling strategy to invite patients with uncontrolled diabetes. Semi-structured telephone interviews were conducted and analyzed using content and thematic analysis.

Results

Key motivators were strong support systems that included family and friends, the physician’s communication style and message, fear of deterioration, and other intrinsic factors. Female family members were described as supportive; not all married women felt supported by their husbands. Women were more influenced by empathy and concern from their doctor, compared to men who were motivated by improved health literacy. Women with few family or friends were more disadvantaged, regardless of race/ethnicity.

Discussion

While physicians play a vital role in motivating their patients, female patients may depend on this empathy more than males. The interdisciplinary care team can play an important role in helping patients create a support network where it may not exist.
TOUGH: The Measure of Merit in Psychological Science
Authors: Lubart Todd , Mouchiroud Christophe
Published: October 2017

Scientific careers depend largely on the evaluation of one’s merit. Yet scientists agree that the measurement of merit is quite a complex endeavor. Some indicators exist, such as Hirsch’s well-known h index, but none can fully capture the complexity of the notion of merit. We propose that the h factor should be complemented with additional useful measurements: the t, o, u, and g indexes.
Native paraneurial tissue and paraneurial adhesions alter nerve strain distribution in rat sciatic nerves
Authors: Foran Ian M. , Hussey Vincent , Patel Rushil A. , Sung Jaemyoung , Shah Sameer B.
Published: October 2017

Paraneurial adhesions have been implicated in the pathological progression of entrapment neuropathies. Surgical decompression of adhesions is often performed, with the intent of restoring nerve kinematics. The normal counterpart of adhesions, native paraneurium, is also thought to influence nerve deformation and mobility. However, influences of native or abnormal paraneurial structures on nerve kinematics have not been investigated. We measured regional strains in rat sciatic nerves before and immediately after decompression of native paraneurial tissue, and before and after decompression of abnormal paraneurial adhesions, which formed within 6 weeks of the initial decompression. Strain was significantly higher in the distal-femoral than in the mid-femoral region of the nerve before either decompression. Decompression of native and abnormal paraneurial tissue removed this regional strain difference. Paraneurial tissues appear to play a major role in distributing peripheral nerve strain. Normal nerve strain distributions may be reconstituted following decompression, even in the presence of paraneurial adhesions.
Fragmentation of Forest Ecosystems and Connectivity Between Sacred Groves and Forest Reserves in Southeastern Benin, West Africa
Authors: Alohou E. C. , Gbemavo D. S. J. C. , Mensah Sylvanus , Ouinsavi C.
Published: October 2017

An old yet appealing fact in conservation biology is the potential of sacred groves (SGs) and forest reserves (FRs) to harbor considerable biodiversity. Although fragmentation effects have been extensively investigated in several studies, the specific context pertaining to SG has rarely been discussed. Using data from two sites (Kétou and Pobè) in South Benin, we studied the similarities and connectivity between SG and FR, and the effects of fragmentation on forest ecosystems. Nonmetric multidimensional scaling and Moran index-based correlogram were used to analyze species-based similarities, distribution, and spatial autocorrelation. Fragmentation effects on characteristic species and forest structures were also tested. Results showed slightly greater similarity between SG and FR for Kétou SG–FR group compared with that of Pobè. Spatial association between SG and FR was also site specific and stronger in Pobè SG–FR group. The weak spatial dependence between SG and FR for the Kétou group reflects the state of degradation in the FR. Species richness and structural parameters were higher in SG than in FR for both sites. The results indicate that these forests emanated from fragmentation of primary forests and that the fragmentation effects were more pronounced in FR. The indicator species analysis further revealed some fragmentation effects on woody species composition, suggesting that forest isolation is potential threat for conservation of biological and structural diversity. In sum, this study shows that despite their limited spatial extent, SGs are key landscape features that play a vital role in local biodiversity conservation.
‘Missed’ oesophageal adenocarcinoma and high‐grade dysplasia in Barrett's oesophagus patients: A large population‐based study
Authors: van Putten Margreet , Johnston Brian T , Murray Liam J , Gavin Anna T , McManus Damian T , Bhat Shivaram , Turkington Richard C , Coleman Helen G
Published: October 2017

Background

A systematic review suggests that 25% of oesophageal adenocarcinomas (OAC) are ‘missed’ at index endoscopy for Barrett's oesophagus (BO); however, this included few population‐based studies and may be an overestimate.

Objective

The objective of this article is to quantify the ‘missed’ rates of high‐grade dysplasia (HGD) and OAC at index BO endoscopy.

Methods

Patients from the Northern Ireland BO register diagnosed between 1993 and 2010 (n = 13,159) were linked to the Northern Ireland Cancer Registry to identify patients who developed OAC or HGD. Logistic regression analysis compared characteristics of ‘missed’ vs ‘incident’ HGD/OAC, defined as diagnoses within 3–12 months vs >1 year after incident BO, respectively.

Results

A total of 267 patients were diagnosed with HGD/OAC ≥3 months after BO diagnosis, of whom 34 (12.7%) were potentially ‘missed’. The proportion of ‘missed’ HGD/OAC was 25% among BO patients with low‐grade dysplasia (LGD) and 9% among non‐dysplastic BO patients. Older age and BO‐LGD carried a higher risk of ‘missed’ HGD/OAC. Non‐dysplastic BO patients were more often diagnosed with a ‘missed’ OAC (rather than HGD; 89%), compared with BO‐LGD patients (40%).

Conclusions

Approximately one in 10 HGD/OAC cases are ‘missed’ at incident BO diagnosis, which is significant but lower than previous reports. However, ‘missed’ HGD/OAC cases represent only 0.26% of all BO patients.
Review of cutaneous penile lesions
Authors: Fortier Edouard , Cerruti Arnaud , Clec’h Christian LE , Bigot Pierre
Published: October 2017

Introduction:

Penile lesions often go undiagnosed and are difficult to identify for general practitioners and specialists, yet the stakes could be high. Indeed, the condition is highly varied and includes physiological variants, specific skin entities, genital dermatoses, genital ulcers, balanitis, premalignant lesions, and, finally, cancerous lesions. Knowledge of these entities can help to prevent overlooking potentially progressive lesions and diagnose cancerous lesions early so that patients can be offered conservative treatment, improving chances of survival. We review here these different lesions.

Materials and methods and authors personal experience:

A literature review was carried out in December 2016 using the Medline/Pubmed database, without any restrictions regarding the time period but limiting the review to studies in English or French. The main keywords used were “penile lesion”, “penile cancer”, “balanitis” and “premalignant lesion”. A specific review was performed for each type. All the pictures and cases came from our personal practice in our specific uro-dermatological consultation. All the patients gave us their informed consent for the utilization of their pictures.

Results:

We studied 66 references covering the field of benign and malignant lesions and their respective treatment. It is essential to take a medical history and perform a clinical examination, despite the fact that some lesions are not specific. A biopsy must be performed systematically in the case of all suspicious lesions.

Conclusion:

Lesions on genital organs in men are very diverse. Some are difficult to diagnose and treat, with the main challenge being early diagnosis of lesions with a high progressive potential in order to prevent dissemination and the need for mutilating surgery.
Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population
Authors: Jensen Andrew R. , Cha Peter S. , Devana Sai K. , Ishmael Chad , Di Pauli von Treuheim Theo , D’Oro Anthony , Wang Jeffrey C. , McAllister David R. , Petrigliano Frank A.
Published: October 2017

Background:

Medicare insures the largest population of patients at risk for rotator cuff tears in the United States.

Purpose:

To evaluate the trends in incidence, concomitant procedures, and complications with open and arthroscopic rotator cuff repairs in Medicare patients.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

All Medicare patients who had undergone open or arthroscopic rotator cuff repair from 2005 through 2011 were identified with a claims database. Annual incidence, concomitant procedures, and postoperative complications were compared between these 2 groups.

Results:

In total, 372,109 rotator cuff repairs were analyzed. The incidence of open repairs decreased (from 6.0 to 4.3 per 10,000 patients, P < .001) while the incidence of arthroscopic repairs increased (from 4.5 to 7.8 per 10,000 patients, P < .001) during the study period. Patients in the arthroscopic group were more likely to have undergone concomitant subacromial decompression than those in the open group (87% vs 35%, P < .001), and the annual incidence of concomitant biceps tenodesis increased for both groups (from 3.8% to 11% for open and 2.2% to 16% for arthroscopic, P < .001). While postoperative complications were infrequent, patients in the open group were more likely to be diagnosed with infection within 6 months (0.86% vs 0.37%, P < .001) but no more likely to undergo operative debridement (0.43% vs 0.26%, P = .08). Additionally, patients in the open group were more likely to undergo intervention for shoulder stiffness within 1 year (1.4% vs 1.1%, P = .01).

Conclusion:

In the Medicare population, arthroscopic rotator cuff repairs have increased in incidence and now represent the majority of rotator cuff repair surgery. Among concomitant procedures, subacromial decompression was most commonly performed despite evidence suggesting a lack of efficacy. Infections and stiffness were rare complications that were slightly but significantly more frequent in open rotator cuff repairs.
Deletion of BMP6 worsens the phenotype of HJV-deficient mice and attenuates hepcidin levels reached after LPS challenge
Authors: Latour Chloé , Besson-Fournier Céline , Gourbeyre Ophélie , Meynard Delphine , Roth Marie-Paule , Coppin Hélène
Published: October 2017

Key Points

Loss of Bmp6 further represses hepcidin expression in the liver of Hjv knockout mice and markedly worsens the iron phenotype of females. Induction of hepcidin by LPS is not prevented by lack of Bmp6 and/or Hjv but its level poststimulation is blunted compared with controls.
Potential impact of complement regulator deficiencies on hemolytic reactions due to minor ABO-mismatched transfusions
Authors: Pandey Priyanka , Anani Waseem Q. , Gottschall Jerome L. , Denomme Gregory A.
Published: October 2017

Key Points

An in vitro model shows that hemolysis could be due to the presence of a subclinical PNH clone causing a negative C3b/d DAT. Changes to decay-accelerating factor and membrane inhibitor of reactive lysis may lead to overt hemolysis after minor mismatched transfusions.
The integration of a Podiatrist into an orthopaedic department: a cost‐consequences analysis
Authors: Walsh Tom P. , Ferris Linda R. , Cullen Nancy C. , Brown Christopher H. , Loughry Cathy J. , McCaffrey Nikki M.
Published: October 2017

Background

The aim of this study was to evaluate the cost‐consequences of a podiatry‐led triage clinic provided in an orthopaedic department relative to usual care for non‐urgent foot and ankle complaints in an Australian tertiary care hospital.

Methods

All new, non‐urgent foot and ankle patients seen in an outpatient orthopaedic department were included in this study. The patients seen between 2014 and 2015 by Orthopaedic Surgeons were considered ‘usual care’, the patients seen between 2015 and 2016 by a Podiatrist were considered the ‘Podiatry Triage Clinic’. Data on new and review patient appointments; the number of new patients / session; the number of appointments / patient; the number of patients discharged; the surgical conversion rate; staff time; and imaging use were collected. A cost‐consequences analysis, undertaken from a healthcare provider perspective (hospital) estimated the incremental resource use, costs and effects of the Podiatry Triage Clinic relative to usual care over a 12‐month period.

Results

The Orthopaedic Surgeons and Podiatrist consulted with 72 and 212 new patients during the usual care and triage periods, respectively. The Podiatrist consulted with more new patients / session, mean (SD) of 3.6 (1.0) versus 0.7 (0.8), p < 0.001 and utilised less appointments / patient than the Orthopaedic Surgeons, mean (SD) of 1.3 (0.6) versus 1.9 (1.1), p < 0.001. The percentage of patients discharged without surgery was similar in the Podiatry Triage Clinic and usual care, 80.3% and 87.5% p = 0.135, respectively, but the surgical conversion rate was higher in the Podiatry Triage Clinic, 76.1% versus 12.5% p < 0.001. The total integrated appointment cost for the 12‐month usual care period was $32,744, which represented a cost of $454.78 / patient. The total appointment and imaging cost during the triage period was $19,999, representing $94.34 / patient. Further analysis, suggests that the projected annual saving of integrating a Podiatry Triage Clinic versus an orthopaedic clinic alone is $50,441.

Conclusions

The integration of a Podiatrist into an orthopaedic department significantly increases the number of patients seen, is cost‐effective, improves the surgical conversion rate and improves the utilisation of Orthopaedic Surgeons.
Cost-Effectiveness Analysis of Monthly Zoledronic Acid, Zoledronic Acid Every 3 Months, and Monthly Denosumab in Women With Breast Cancer and Skeletal Metastases: CALGB 70604 (Alliance)
Authors: Shapiro Charles L. , Moriarty James P. , Dusetzina Stacie , Himelstein Andrew L. , Foster Jared C. , Grubbs Stephen S. , Novotny Paul J. , Borah Bijan J.
Published: October 2017

Purpose

Skeletal-related events (SREs) such as pathologic fracture, spinal cord compression, or the necessity for radiation or surgery to bone metastasis cause considerable morbidity, decrements in quality of life, and costs to the health care system. The results of a recent large randomized trial (Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology [CALGB/Alliance 70604]) showed that zoledronic acid (ZA) every 3 months was noninferior to monthly ZA in reducing the risks of SREs. We sought to determine the cost-effectiveness (CE) of monthly ZA, ZA every 3 months, and monthly denosumab in women with breast cancer and skeletal metastases.

Methods

Using a Markov model, costs per SRE avoided were calculated for the three treatments. Sensitivity analyses were performed where denosumab SRE probabilities were assumed to be 50%, 75%, and 90% lower than the ZA SRE probabilities. Quality-adjusted life-years were also calculated. The analysis was from the US payer perspective.

Results

The mean costs of the denosumab treatment strategy are nine-fold higher than generic ZA every 3 months. Quality-adjusted life-years were virtually identical in all the three treatment arms; hence, the optimal treatment would be ZA every 3 months because it was the least costly treatment. The sensitivity analyses showed that relative to ZA every 3 months, the incremental costs per mean SRE avoided for denosumab ranged from $162,918 to $347,655.

Conclusion

ZA every 3 months was more CE in reducing the risks of SRE than monthly denosumab. This analysis was one of the first to incorporate the costs of generic ZA and one of the first independent CE analyses not sponsored by either Novartis or Amgen, the makers of ZA and denosumab, respectively. ZA every 3 months is the more CE option and more reasonable alternative to monthly denosumab.
Nurse prescribing: An essential requirement or an expensive luxury for school nurses?
Authors: Taylor Cathy , Bailey Victoria
Published: October 2017

This small study sought to gain an understanding of the views and experiences of Specialist Community Public Health Nurses (SCPHN) School Nurse (SN) prescribers within two health boards in Wales.

Aim and objectives:

to explore the experiences of SN prescribers within Wales. The objectives (1) to conduct a review of the literature using a systematic approach to identify evidence where nurses have achieved or improved positive health outcomes through nurse prescribing (2) to identify whether SNs are currently prescribing at local level; (3) to identify the perceived benefits of nurse prescribing for the school nursing service (4) to identify possible barriers that may hinder SNs from prescribing.

Research design:

A predominantly qualitative approach was used to explore SNs views and experiences of prescribing in clinical practice.

Findings:

SN’s within this study are not using their nurse prescribing qualification, with many not feeling able to prescribe. Despite recognition of public health benefits, many felt uncertain about their role as nurse prescribers suggesting that additional organisational support was required if they were to remain competent within this role following qualification.

Conclusions:

A change in culture is required if SNs are to feel empowered to use their nurse prescribing qualification to improve outcomes for children and young people for the future.
Looking at how we can support pupils with low self-esteem
Authors: Thornton Stephanie
Published: October 2017

Low self-esteem can result in children being withdrawn and isolated, and can lead to depression. Stephanie Thornton looks at strategies to help pupils overcome these feelings.
Human Chorionic Gonadotropin Assays for Testicular Tumors: Closing the Gap between Clinical and Laboratory Practice
Authors: Ferraro Simona , Trevisiol Chiara , Gion Massimo , Panteghini Mauro
Published: October 2017

BACKGROUND

Clinical practice guidelines recommend the measurement of human chorionic gonadotropin (hCG) and/or hCGβ in serum for management of testicular germ cell tumors (GCTs). These guidelines, however, disregard relevant biochemical information on hCG variants to be detected for oncological application. We set out to provide a critical review of the clinical evidence together with a characterization of the selectivity of currently marketed hCG immunoassays, identifying assays suitable for management of GCTs.

CONTENT

Evidence sources in the available literature were critically appraised. Most instances of misdiagnosis and mismanagement of testicular GCTs have been associated with hCG results. According to the clinical evidence, 36% of patients with seminoma show an exclusive hCGβ increase, and 71% of patients with nonseminomatous GCTs (NSGCTs) show an increase of intact hCG and/or hCG + hCGβ, whereas the hCGβ increase in NSGCTs is variable according to the tumor stage and histology.

hCG + hCGβ assays that display an equimolar recognition of hCG and hCGβ, or at least do not overtly underestimate hCGβ, may be employed for management of testicular GCTs. Assays that underestimate hCGβ are not recommended for oncological application. In addition to the hCG + hCGβ assay in service, an additional assay with broader selectivity for other hCG variants should be considered when false-negative or false-positive results are suspected on the basis of clinical data.
Cerebrospinal Fluid Total Protein Reference Intervals Derived from 20 Years of Patient Data
Authors: McCudden Christopher R , Brooks John , Figurado Priya , Bourque Pierre R
Published: October 2017

BACKGROUND

Reference intervals are vital for interpretation of laboratory results. Many existing reference intervals for cerebrospinal fluid total protein (CSF-TP) are derived from old literature because of the invasive nature of sampling. The objective of this study was to determine reference intervals for CSF-TP using available patient data.

METHODS

Twenty years of hospital database information was mined for previously reported CSF-TP results. Associated demographic, laboratory, and clinical diagnosis (International Classification of Diseases 9/10 codes) details were extracted. CSF-TP results included 3 different analytical platforms: the Siemens Vista 1500, Beckman Lx20, and Roche Hitachi 917. From an initial data set of 19591 samples, the following exclusion criteria were applied: incomplete data, white blood cells (WBCs) >5 × 106/L, red blood cells (RBCs) >50 × 106/L, and glucose <2.5 mmol/L. Patient charts were reviewed in detail to exclude 60 different conditions for which increases in CSF-TP would be expected. A total of 6068 samples were included; 63% of the samples were from females. Continuous reference intervals were determined using quantile regression. Age- and sex-partitioned intervals were established using the quantile regression equation and splitting age-groups into 5-year bins.

RESULTS

CSF-TP showed a marked age dependence, and males had significantly higher CSF-TP than females across all ages. CSF-TP results from the 3 different instruments and manufacturers showed small (approximately 0.04 g/L), but statistically significant, differences. CSF-TP showed weak, but again statistically significant, correlation with WBC and RBC but was independent of serum total protein and creatinine.

CONCLUSIONS

The age dependence of CSF-TP supports that age-partitioned reference intervals will be more accurate than a single cutoff, particularly in patients with advancing age.