bluuebunny/crossref_metadata_2025 huggingface dataset:
Education and Qualifications as Skills
Authors: Dalziel Paul
Published: March 2017

The chapter begins with an introduction of the basic Mincer, Shultz and Becker human capital model. Section 2 discusses two theories that question the model’s link between education and labour market skills. The first theory argues that the education is a device to signal to potential employers that the individual has high natural abilities that are unobservable to the employer while the second argues that education sorts workers into different labour markets that are segmented by wider socio-economic forces. Section 3 considers two more recent developments. The first involves sequential analysis in which the decision-maker learns more about his or her abilities and opportunities as a result of participating in education or training, while the second uses a ‘skill ecosystem’ metaphor to express how educational institutions, students, employers and policy makers can combine to sustain a high-skills, high-wage equilibrium or reinforce a low-skills, low-wage equilibrium.
Trade, Commerce, and Employment
Authors: Dau-Schmidt Kenneth G.
Published: March 2017

The technology of production shapes the employment relationship and important issues in its regulation. The new information technology has transformed the organization of production replacing large vertically organized firms governed by the internal labour market with horizontally organized firms governed by a global labour market. These changes require policymakers to broaden the definitions of ‘employee’, ‘employer’, and ‘appropriate bargaining unit’ in the regulation of employment and find ways to incorporate the new information technology into that regulation. As profound as these changes have been, the speedy evolution of information technology and the development of artificial intelligence promise even greater changes in the future. Future regulation will require not only a more expanded notion of the employment relationship, but also increased education and retraining programmes, benefit programmes tied to citizenship rather than employment, increased regulation, subsidy of retirement programmes, and perhaps even a basic income programme.
The Common Good
Authors: Dickenson Donna
Published: March 2017

In conventional thinking, the promise of scientific progress gives automatic and unquestioned legitimacy to any new development in biotechnology. It is the nearest thing we have in a morally relativistic society to the concept of the common good. This chapter begins by examining a recent case study, so-called ‘mitochondrial transfer’ or three-person IVF, in which policymakers appeared to accept that this new technology should be effectively deregulated because that would serve UK national scientific progress and the national interest, despite serious unanswered concerns about its effectiveness and safety. The historical and philosophical underpinnings of the concept of the common good should make us more sceptical of the manner in which the concept can be perverted by particular interests. But there are also hopeful signs that the common good and the biomedical commons are being taken seriously in new models for governance of genomics and biotechnology more generally.
Early Physics
Authors: Beeley Philip
Published: March 2017

This chapter discusses Leibniz’s earliest work on physical questions. It begins with how his discovery of contemporary publications on the laws of motion prompted him to investigate the topic for himself, leading him to make a fundamental distinction between pure theory and natural phenomena. From this distinction emerged his two tracts Theoria motus abstracti and Hypothesis physica nova, the latter of which played an important role in his admission to the fellowship of the Royal Society in 1673. Salient parts of these two tracts are outlined, as are some of the more important physical ideas Leibniz developed from them during his stay in Paris.
Aphasia Syndromes: Introduction and Value in Clinical Practice
Authors: Raymer Anastasia M. , Gonzalez Rothi Leslie J.
Published: March 2017

Neurologic damage affecting the left cerebral hemisphere leads to impairments in comprehension and expression of language in the verbal modality (aphasia) and in the written modality (dyslexia and dysgraphia). Impairment patterns take various forms, differing in the fluency/nonfluency of verbal output and integrity of auditory comprehension, repetition, and word retrieval abilities. The divergent classifications of aphasia allow reflection on neural and psychological correlates of specific aspects of language processing in verbal and written modalities. Neurologic damage affecting the right cerebral hemisphere can lead to changes in social and prosodic communication, speaking to the role of the right hemisphere in language processing. Patterns of language breakdown following neurologic injury have implications for assessment and intervention for affected individuals. Whereas perspectives vary on interpretation of the language breakdown across disciplines, this volume’s purpose is to facilitate interactions across disciplines to improve the lives of those with aphasia and related communication disorders.
Incomplete Understanding of Concepts
Authors: Wikforss Åsa
Published: March 2017

This article discusses the thesis that a subject can have a concept, think thoughts containing it, that she incompletely understands. The central question concerns how to construe the distinction between having a concept and understanding it. Two important versions of the thesis are distinguished: a metasemantic version and an epistemic version. According to the first, the subject may have concept C without being a fully competent user, in virtue of deference to other speakers or to the world. According to the second, the subject may have a concept without being able to provide a proper explication of it. It is argued that whereas the epistemic version is plausible, the metasemantic version faces some challenges. First, it needs to be explained precisely how deference enables a speaker to have C. Second, metasemantic incomplete understanding is in tension with the idea that concepts serve to capture the subject’s cognitive perspective.
Identifying malnutrition
Authors: Tyler Renay D. , Guenter Peggi
Published: March 2017

Nutrition assessment and intervention significantly contribute to the well-being of patients. NPs should advocate that patients be appropriately evaluated and implement recommendations as part of a comprehensive care plan to avoid malnutrition in patients while they are in the hospital and when they return home.
Vaginal Progesterone as Maintenance Treatment After an Episode of Preterm Labour (PROMISE) Study: A Multicentre, Double-blind, Randomised, Placebo-Controlled Trial
Authors: Palacio Montse , Cobo Teresa , Antolín Eugenia , Ramirez M. , Cabrera Francisco , Mozo de Rosales Francisco , Bartha José Luis , Juan Miquel , Martí Anna , Oros Daniel , Rodríguez A. , Scazzocchio E. , Olivares José María , Varea Sara , Ríos J. , Gratacós Eduard
Published: March 2017

(Abstracted from BJOG 2016;123:1990–1999)

A large proportion of both short-term neonatal morbidity and mortality and long-term disability is associated with preterm birth. Women with previous preterm delivery, a short cervical length at midgestation, a twin pregnancy, and an episode of preterm labor arrested with tocolytic medication all have an increased risk of preterm delivery.
Nivolumab Causing a Polymyalgia Rheumatica in a Patient With a Squamous Non–Small Cell Lung Cancer
Authors: Bernier Marjorie , Guillaume Cyril , Leon Nathalie , Alexandre Joachim , Hamel-Senecal Lea , Chretien Basile , Lecaignec Florian , Humbert Xavier , Fedrizzi Sophie , Madelaine Jeannick , Sassier Marion
Published: March 2017

The anti-programmed cell-death-1 antibody, nivolumab, has been recently approved for the treatment of advanced non–small cell lung cancer. Although, today, immune-related adverse effects such as dermatologic, digestive, hepatic, and endocrine toxicities are well-known with immune checkpoint inhibitors, rheumatic diseases are less well described. Herein, we report the case of a patient without a history of arthritis who developed polymyalgia rheumatica after 13 cycles of nivolumab used for the treatment of advanced non–small cell lung cancer. Laboratory evidence of inflammatory syndrome, articular echography, and clinical presentation with classical symptoms and also distal manifestations were suggestive of this chronic inflammatory disorder. Because of a relevant pain, clinicians were forced to suspend immunotherapy. Nevertheless, due to glucocorticoid therapy, the patient’s symptoms have decreased progressively. Moreover, nivolumab was reintroduced 8 weeks later, whereas prednisone (10 mg) was continued, without any recurrence symptoms. To conclude, our case suggests that polymyalgia rheumatica might be a very disabling anti-programmed cell-death-1 immune-related adverse effect.
Regenerating the Anal Sphincter: Cytokines, Stem Cells, or Both?
Authors: Sun Li , Xie Zhuojun , Kuang Mei , Penn Marc , Damaser Margot S. , Zutshi Massarat
Published: March 2017

BACKGROUND:

Healing of an anal sphincter defect at a time distant from injury is a challenge.

OBJECTIVE:

We aimed to investigate whether re-establishing stem cell homing at the site of an anal sphincter defect when cytokine expression has declined using a plasmid engineered to express stromal derived factor 1 with or without mesenchymal stem cells can improve anatomic and functional outcome.

DESIGN:

This was a randomized animal study.

SETTINGS:

Thirty-two female age- and weight-matched Sprague Dawley rats underwent 50% excision of the anal sphincter complex. Three weeks after injury, 4 interventions were randomly allocated (n = 8), including no intervention, 100-μg plasmid, plasmid and 800,000 cells, and plasmid with a gelatin scaffold mixed with cells.

MAIN OUTCOME MEASURES:

The differences in anal sphincter resting pressures just before and 4 weeks after intervention were used for functional analysis. Histology was analyzed using Masson staining. One-way ANOVA followed by the Tukey post hoc test was used for pressure and histological analysis.

RESULTS:

All 3 of the intervention groups had a significantly greater change in resting pressure (plasmid p = 0.009; plasmid + cells p = 0.047; plasmid + cells in scaffold p = 0.009) compared with the control group. The plasmid-with-cells group showed increased organization of muscle architecture and increased muscle percentage, whereas the control group showed disorganized architecture at the site of the defect. Histological quantification revealed significantly more muscle at the site of defect in the plasmid-plus-cells group compared with the control group, which had the least muscle. Quantification of connective tissue revealed significantly less fibrosis at the site of defect in the plasmid and plasmid-plus-cells groups compared with the control group.

LIMITATIONS:

Midterm evaluation and muscle morphology were not defined.

CONCLUSIONS:

At this midterm follow-up, local delivery of a stromal derived factor 1 plasmid with or without local mesenchymal stem cells enhanced anal sphincter muscle regeneration long after an anal sphincter injury, thereby improving functional outcome. See Video Abstract at http://links.lww.com/DCR/A324.
Systemic Metronidazole May Not Reduce Posthemorrhoidectomy Pain: A Meta-Analysis of Randomized Controlled Trials
Authors: Wanis Kerollos Nashat , Emmerton-Coughlin Heather M. , Coughlin Shaun , Foley Norine , Vinden Christopher
Published: March 2017

BACKGROUND:

Hemorrhoidectomy is associated with significant postoperative pain. Oral metronidazole has been recommended as an adjunct to improve posthemorrhoidectomy analgesia.

OBJECTIVE:

This study aimed to evaluate the impact of oral metronidazole on patient-reported pain following hemorrhoidectomy.

DATA SOURCES:

We conducted a systematic search in the MEDLINE, EMBASE, ISI Web of Science, and Cochrane Central Register of Controlled Trials databases.

STUDY SELECTION:

Randomized controlled trials examining adults who underwent surgical hemorrhoidectomy were included. Participants in an active intervention group received oral metronidazole postoperatively, and those in a control group received placebo or usual care. Postoperative pain was assessed for at least 3 days postoperatively.

INTERVENTION:

A random-effects model was used.

MAIN OUTCOMES MEASURES:

The primary outcome was pain during the first 2 postoperative weeks, measured on a visual analogue scale. The secondary outcome was time to return to normal activities.

RESULTS:

Patients who received oral metronidazole had significantly lower reported pain scores on postoperative day 1 (standardized mean difference, –0.87 ± 0.44; 95% CI, –1.73 to –0.015; p = 0.046; n = 4) and day 4 (standardized mean difference, –1.43 ± 0.71; 95% CI, –2.83 to –0.037; p = 0.044; n = 3). Metronidazole use was associated with a significantly shorter time to return to normal activities (standardized mean difference, –0.76 ± 0.34; 95% CI, –1.43 to –0.088, p = 0.027). The improvements disappeared in a sensitivity analysis excluding the largest trial with a high risk of bias, and no significance was observed during the remaining postoperative days.

LIMITATIONS:

The meta-analysis was limited by lack of double blinding, absence of a placebo, and unclear or high risk of bias in a proportion of the included trials.

CONCLUSIONS:

Although a favorable adverse effect profile supports consideration of oral metronidazole to reduce posthemorrhoidectomy pain, pooled analysis reveals inconsistent results with no pain reduction on most postoperative days. The current recommendation for routine prescription of oral metronidazole should be reevaluated in the absence of additional well-designed trials.
Preimplantation embryonic mosaicism: origin, consequences and the reliability of comprehensive chromosome screening
Authors: Marin Diego , Scott Richard T. , Treff Nathan R.
Published: March 2017

Purpose of review

Embryonic mosaicism represents an ongoing challenge for contemporary comprehensive chromosome screening platforms due to the unknown reproductive potential of mosaic embryos and technical difficulties of its detection from a single embryo biopsy.

Recent findings

Mosaicism in preimplantation embryos is a product of mitotic errors arising primarily from anaphase lag and chromosome nondisjunction. To date, there is high variability among estimations of prevalence of mosaicism in blastocysts, the most recent ranging from 3.3 to 83%. It has been reported that alleged mosaic embryos can develop into healthy babies, although the proper study evaluating this question remains to be completed. Technical artefacts from comprehensive chromosome screening platforms may also hinder correct classification of embryos as genuine mosaics.

Although complex, embryonic mosaicism is a phenomenon that deserves further investigation. Many embryos classified as mosaic may have actual reproductive potential. The predictive value of intermediate chromosome copy number assignments for the remaining embryo and for ongoing reproductive potential needs more careful consideration. In addition, recent advancements in extended embryo culture raise the possibility of investigating whether preferential segregation, selective advantage of normal cells or surveillance of abnormal chromosome numbers occur at postimplantation stages.
CHOROIDAL THICKNESS IN DIABETIC PATIENTS WITHOUT DIABETIC RETINOPATHY
Authors: Tavares Ferreira Joana , Vicente André , Proença Rita , Santos Bruno O. , Cunha João P. , Alves Marta , Papoila Ana L. , Abegão Pinto Luís
Published: March 2017

Purpose:

To compare choroidal thickness (CT) between diabetic patients without diabetic retinopathy and a nondiabetic group. To explore how CT relates to disease duration, mean arterial pressure, glycemia, glycosylated hemoglobin, intraocular pressure, and ocular pulse amplitude.

Methods:

Choroidal thickness was assessed using a spectral-domain optical coherence tomography and enhanced depth mode at 13 locations (subfoveal and 3 measurements 500 μm apart in 4 directions—nasal, temporal, superior, and inferior). Linear regression models were used.

Results:

One hundred seventy-five patients were recruited (125 diabetic patients without diabetic retinopathy and 50 nondiabetic patients). In diabetic patients, although without statistical significance, CT showed a trend to be thicker in all locations (6.16–24.27 μm). Choroidal thickness was negatively associated with age (P < 0.001) in both groups, but only in the diabetic group, it was positively associated to ocular pulse amplitude (with a mean increase between 8.5 μm and 11.6 μm for each millimeter of mercury increase in ocular pulse amplitude). Diabetic patients' CT seems to stabilize after 150 months of diabetes, increase with higher glycemia levels (>160 mg/dL) while showing no fluctuation with glycosylated hemoglobin and mean arterial pressure.

Conclusion:

There seems to be a thickening of the choroid in diabetic patients without diabetic retinopathy. Moreover, this tissue may be functionally different in diabetes, as the pattern of associations seems to differ between groups.
The prevalence and characteristics of chronic ocular itch: a cross-sectional survey
Authors: Stull Carolyn , Valdes-Rodriguez Rodrigo , Shafer Brian M. , Shevchenko Alina , Nattkemper Leigh A. , Chan Yiong-Huak , Tabaac Sydney , Schardt Martin J. , Najjar Dany M. , Foster William J. , Yosipovitch Gil
Published: March 2017

Introduction:

In this cross-sectional study, we aimed to determine the prevalence and characteristics of chronic ocular itch in an outpatient ophthalmology and optometry clinic.

Methods:

Four hundred patients from an outpatient ophthalmology and optometry clinic were enrolled. The presence and characteristics of chronic ocular itch were assessed by a questionnaire. Data regarding ophthalmologic, dermatologic, and systemic conditions as well as current medications were extracted from medical records.

Results:

Chronic ocular itch was present in 118 (29.5%) of 400 participants. Chronic ocular pruritus was significantly more prevalent in females [P=0.015; odds ratio (OR)=1.8; 95% confidence interval (CI), 1.1–2.8] and was significantly associated with the presence of allergic conjunctivitis [51.8% (n=45); P<0.001; OR=5.0; 95% CI, 3.0–8.3], dry eye syndrome [40.1% (75); P<0.001; OR=2.6; 95% CI, 1.7–4.1], blepharitis [43.8% (n=21); P=0.021; OR=2.0; 95% CI, 1.1–3.8], and atopic dermatitis [50.0% (n=10); P=0.023; OR=2.6; 95% CI, 1.1–5.8]. Chronic ocular itch was not significantly associated with systemic conditions, or the use of prescribed ophthalmologic medications.

Discussion:

Chronic ocular itch is common and may be related to ophthalmologic or dermatologic pathologies. The present findings highlight the importance of identifying and managing this uncomfortable symptom that may negatively impact the quality of life and sleep of affected patients.
Pain and pharmacologic pain management in long-stay nursing home residents
Authors: Hunnicutt Jacob N. , Ulbricht Christine M. , Tjia Jennifer , Lapane Kate L.
Published: March 2017

Previous studies estimate that >40% of long-stay nursing home (NH) residents experience persistent pain, with 20% of residents in pain receiving no analgesics. Strengthened NH surveyor guidance and improved pain measures on the Minimum Data Set 3.0 were introduced in March 2009 and October 2010, respectively. This study aimed to provide estimates after the important initiatives of (1) prevalence and correlates of persistent pain; and (2) prevalence and correlates of untreated or undertreated persistent pain. We identified 1,387,405 long-stay residents in U.S. NHs between 2011 and 2012 with 2 Minimum Data Set assessments 90 days apart. Pain was categorized as persistent (pain on both assessments), intermittent (pain on either assessment), or none. Pharmacologic pain management was classified as untreated pain (no scheduled or as needed medications received) or potentially undertreated (no scheduled received). Modified Poisson models adjusting for resident clustering within NHs provided adjusted prevalence ratios (APRs) estimates and 95% confidence intervals (CIs). The prevalence of persistent and intermittent pain was 19.5% and 19.2%, respectively, but varied substantially by age, sex, race and ethnicity, cognitive impairment, and cancer. Of residents in persistent pain, 6.4% and 32.0% were untreated and undertreated, respectively. Racial and ethnic minorities (non-Hispanic blacks vs whites, APR = 1.19, 95% CI: 1.13-1.25) and severely cognitively impaired residents (severe vs no/mild APR = 1.51, 95% CI: 1.44-1.57) had an increased prevalence of untreated and undertreated pain. One in 5 NH residents has persistent pain. Although this estimate is greatly improved, many residents may be undertreated. The disturbing disparities in untreated and undertreated pain need to be addressed.
Allodynia in cluster headache
Authors: Wilbrink Leopoldine A. , Louter Mark A. , Teernstra Onno P.M. , van Zwet Erik W. , Huygen Frank J.P.M. , Haan Joost , Ferrari Michel D. , Terwindt Gisela M.
Published: March 2017

Cutaneous allodynia is an established marker for central sensitization in migraine. There is debate whether cutaneous allodynia may also occur in cluster headache, another episodic headache disorder. Here, we examined the presence and severity of allodynia in a large well-defined nationwide population of people with cluster headache. Using validated questionnaires we assessed, cross-sectionally, ictal allodynia and comorbid depression and migraine in the nationwide “Leiden University Cluster headache neuro-Analysis” (LUCA) study. Participants with cluster headache were diagnosed according to the International Classification of Headache Disorders criteria. Multivariate regression models were used, with correction for demographic factors and cluster headache subtype (chronic vs episodic; recent attacks <1 month vs no recent attacks). In total, 606/798 (75.9%) participants with cluster headache responded; of whom, 218/606 (36%) had allodynia during attacks. Female gender (odds ratio [OR] 2.05, 95% confidence interval [95% CI] 1.28-3.29), low age at onset (OR 0.98, 95% CI 0.96-0.99), lifetime depression (OR 1.63, 95% CI 1.06-2.50), comorbid migraine (OR 1.96, 95% CI 1.02-3.79), and having recent attacks (OR 1.80, 95% CI 1.13-2.86), but not duration of attacks and chronic cluster headache, were independent risk factors for allodynia. The high prevalence of cutaneous allodynia with similar risk factors for allodynia as found for migraine suggests that central sensitization, like in migraine, also occurs in cluster headache. In clinical practice, awareness that people with cluster headache may suffer from allodynia can in the future be an important feature in treatment options.
Polysubstance use and misuse or abuse of prescription opioid analgesics: a multi-level analysis of international data
Authors: Morley Katherine I. , Ferris Jason A. , Winstock Adam R. , Lynskey Michael T.
Published: March 2017

Increasing mortality and morbidity associated with opioid analgesics has led to concerns about their misuse and abuse, even when obtained through a prescription. These concerns have been most pronounced in the United States, but limited data make it difficult to determine whether it is a problem in other countries. We investigated opioid analgesic misuse and abuse in participants from the Global Drug Survey 2015 resident in the United States (N = 1334), United Kingdom (N = 1199), France (N = 1258), Germany (N = 866), and Australia (N = 1013) who had used at least 1 prescription opioid analgesic medication in the past year. We also investigated the relationship with polysubstance use, one of the most consistent predictors of problematic opioid analgesic use. Data included misuse and abuse of codeine, hydrocodone, oxycodone, and tramadol; ability to obtain a prescription; different sources for obtaining drugs; and past-year use of benzodiazepines and illicit drugs. In multilevel models, country of residence accounted for less than 3% of the variance in opioid analgesic misuse or abuse. Adjusting for country of residence and sociodemographic factors, use of illicit drugs and benzodiazepines was associated with 4-fold greater odds of misuse (odds ratio 4.36, 95% confidence interval 3.29-5.93) and 6-fold greater odds of abuse compared with not using either drug (odds ratio 6.49, 95% confidence interval 4.0-10.48), although the strength of the association with abuse varied by country. Misuse and abuse by those prescribed opioid analgesics seem to be a problem that is not limited to the United States and warrant attention on an international scale.
Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth
Authors: Zhong Changqing , Qu Changmin , Wang Baoyan , Liang Shuwen , Zeng Bolun
Published: March 2017

The present study conducted a meta-analysis and systematic review of current evidence to assess the efficacy of probiotics in preventing or treating small intestinal bacterial overgrowth (SIBO). Relevant studies from PubMed, Embase, and the Cochrane Central Register of Controlled Trials, until May 2016, were assimilated. The prevention efficacy was assessed by the incidence of SIBO in the probiotic group, and the treatment efficacy by the SIBO decontamination rate, reduction in H2 concentration, and symptom improvement. The relative risk (RR) and weighted mean difference (WMD) were used as effect measures and the random-effects model used for meta-analysis. A total of 14 full-text articles and 8 abstracts were included for the systematic review, and 18 studies were eligible for data synthesis. Patients on probiotic usage showed an insignificant trend toward low SIBO incidence [RR=0.54; 95% confidence intervals (CI), 0.19-1.52; P=0.24]. The pooled SIBO decontamination rate was 62.8% (51.5% to 72.8%). The probiotics group showed a significantly higher SIBO decontamination rate than the nonprobiotic group (RR=1.61; 95% CI, 1.19-2.17; P<0.05). Also, the H2 concentration was significantly reduced among probiotic users (WMD=−36.35 ppm; 95% CI, −44.23 to −28.47 ppm; P<0.05). Although probiotics produced a marked decrease in the abdominal pain scores (WMD=−1.17; 95% CI, −2.30 to −0.04; P<0.05), it did not significantly reduce the daily stool frequency (WMD=−0.09; 95% CI, −0.47 to 0.29). Therefore, the present findings indicated that probiotics supplementation could effectively decontaminate SIBO, decrease H2 concentration, and relieve abdominal pain, but were ineffective in preventing SIBO.
Resumption of Warfarin After Hospitalization for Lower Gastrointestinal Bleeding and Mortality Benefits
Authors: Patel Parita , Nigam Neha , Sengupta Neil
Published: March 2017

Goals:

To evaluate whether resumption of warfarin after hospitalization for lower gastrointestinal bleeding (LGIB) is associated with improved 90-day and 6-month survival.

Background:

LGIB is a common complication for patients on warfarin. There is limited data to guide clinicians on the optimal management of warfarin following hospitalization for LGIB.

Study:

We identified patients hospitalized with LGIB while on warfarin using a validated, machine-learning algorithm. Patients were classified as those who had warfarin resumed at discharge and those who did not. Univariate and multivariate Cox proportional hazards were used to determine whether resuming warfarin was associated with improved 90-day and 6-month mortality.

Results:

In total, 607 patients were admitted with warfarin-associated LGIB. A total of 403 (66.4%) patients had warfarin held at discharge. Discontinuation of warfarin was associated with an increased 90-day and 6-month mortality on univariate analysis [hazard ratio (HR), 2.07, 95% confidence interval (CI), 1.04-4.58, P=0.04; HR, 1.78, 95% CI, 1.02-3.27, P=0.04]. On multivariate regression adjusting for age, comorbidities, and transfusion requirement, only a higher Charlson Index was associated with increased 90-day mortality (HR, 1.18, 95% CI, 1.07-1.29, P=<0.001). At 6 months, only older age was associated with an increased mortality on multivariate regression (HR, 1.02, 95% CI, 1.00-1.05, P=0.02), with no significantly increased mortality risk with holding warfarin (HR, 1.48, 95% CI, 0.84-2.78, P=0.18)

Conclusions:

There was no association between resumption of warfarin at discharge following hospitalization for LGIB and either 90-day or 6-month mortality on multivariate analysis. Mortality in LGIB was largely driven by age and comorbidities.
Chorioamnionitis: time for a new approach
Authors: Randis Tara M. , Polin Richard A. , Saade George
Published: March 2017

Purpose of review

The association between maternal chorioamnionitis and early-onset sepsis in the newborn has long been recognized, and established guidelines recommend treating all exposed infants with broad-spectrum antibiotics until infection can be ruled out. However, recent data suggest that close observation of well appearing term and late-preterm newborns may be a preferable alternative. The present review addresses the evidence in favor of newly proposed changes to the diagnosis and management of women and newborns following a maternal diagnosis of chorioamnionitis. Potential implications of these new practice guidelines will also be discussed.

Recent findings

A panel of experts assembled in 2015 to provide updated, evidence-based guidelines for the diagnosis and management of women and newborns following a maternal diagnosis of chorioamnionitis. Revised terminology and diagnostic criteria were proposed as well as changes in the management of newborns of mothers with suspected intrauterine infection, most notably a recommendation to observe (rather than treat) well appearing term and late-preterm newborns.

A management strategy consisting of close observation of well appearing term and late-preterm infants exposed to suspected intrauterine infection is preferable to empiric antimicrobial therapy. Large prospective epidemiologic studies will be needed to ascertain the impact of these new practice guidelines on the outcomes of infants exposed to intrauterine infection and/or inflammation. Improved precision in the clinical diagnosis of intrauterine infection should improve both the quality and reproducibility of data generated from future studies.
Association of Maternal Gestational Weight Gain With the Infant Fecal Microbiota
Authors: Robinson Alyssa , Fiechtner Lauren , Roche Brianna , Ajami Nadim J. , Petrosino Joseph F. , Camargo Carlos A. , Taveras Elsie M. , Hasegawa Kohei
Published: March 2017

Objectives:

Pregnancy characteristics may influence the infant fecal microbiota during early life. We aimed to examine associations of maternal gestational weight gain with infant fecal microbiota composition, bacterial community richness, and Shannon diversity index.

Methods:

We analyzed data from a prospective cohort study of healthy infants. We collected prenatal data, including report of mother's gestational weight gain, and infant fecal samples from 84 infant‐mother dyads. By applying 16S rRNA gene sequencing and an unbiased clustering by partitioning around medoids using Bray‐Curtis distances, we identified 4 fecal microbiota profiles, and examined the associations of maternal gestational weight gain with the 4 fecal microbiota profiles, bacterial community richness, and Shannon diversity index.

Results:

Overall, the median age of infants was 4.0 months and 43% were girls. The mothers of the 84 infants gained a mean of 14.2 kg (standard deviation, 5.4 kg) during pregnancy. We identified 4 distinct microbiota profiles: Bifidobacterium‐dominant (42%), Enterobacter/Veillonella‐dominant (23%), Bacteroides‐dominant (19%), and Escherichia‐dominant (17%). Infants whose mothers had higher gestational weight gain were less likely to have a Bacteroides‐dominant profile, corresponding to a relative risk ratio of 0.83 (95% confidence interval, 0.71–0.96; P = 0.01) per 1 kg increase in weight. In addition, higher gestational weight gain was also associated with lower bacterial community richness and Shannon diversity index (P < 0.05).

Conclusions:

In this prospective cohort study of healthy infants, maternal gestational weight gain was associated with the infant fecal microbiota profiles, bacterial community richness, and Shannon diversity index.
Medulloblastoma With Extensive Nodularity:Tailored Therapy in a Low-resource Setting
Authors: Aristizabal Paula , Burns Luke , Rivera-Gomez Rebeca , Levy Michael L. , Roberts William , Crawford John R.
Published: March 2017

Treatment for medulloblastoma carries significant risks, particularly in resource-constrained settings. We report a case of a Mexican infant with desmoplastic/nodular medulloblastoma. Given the nature of her tumor, we developed a tailored regimen following subtotal resection to avoid both radiation therapy and the high-dose cisplatin therapy offered at most centers in the United States. The patient is in remission 4 years after the initial diagnosis. This case suggests an alternative treatment plan for this particular tumor variant that accommodates the limited resources of many centers around the world and avoids the risks associated with radiation therapy at a young age.
Monocyte Chemoattractant Protein-1 (MCP-1) as a Potential Therapeutic Target and a Noninvasive Biomarker of Liver Fibrosis Associated With Transient Myeloproliferative Disorder in Down Syndrome
Authors: Kobayashi Kenichiro , Yoshioka Takako , Miyauchi Jun , Nakazawa Atsuko , Yamazaki Shigeaki , Ono Hiromi , Tatsuno Michiko , Iijima Kenta , Takahashi Chiaki , Okada Yoko , Teranishi Kenji , Matsunaga Takaaki , Matsushima Chieko , Inagaki Mayo , Suehiro Minoru , Suehiro Saori , Nishitani Masahiko , Kubota Hirohito , Iio Jun , Nishida Yoshinobu , Katayama Tetsuo , Takada Narito , Watanabe Kentaro , Yamamoto Tetsuro , Yasumizu Ryoji , Matsuoka Kentaro , Ohki Kentaro , Kiyokawa Nobutaka , Maihara Toshiro , Usami Ikuya
Published: March 2017

Liver fibrosis is one of the common complications of transient myeloproliferative disorder (TMD) in Down syndrome (DS), but the exact molecular pathogenesis is largely unknown. We herein report a neonate of DS with liver fibrosis associated with TMD, in which we performed the serial profibrogenic cytokines analyses. We found the active monocyte chemoattractant protein-1 expression in the affected liver tissue and also found that both serum and urinary monocyte chemoattractant protein-1 concentrations are noninvasive biomarkers of liver fibrosis. We also showed a prospective of the future anticytokine therapy with herbal medicine for the liver fibrosis associated with TMD in DS.
Pantoea Species Bacteremia in a Child With Sickle Cell Disease: Looking for a Culprit
Authors: Oliveira Marisa I. , Batalha Sara , Gouveia Catarina , Maia Raquel , Kjöllerstrom Paula
Published: March 2017

Pantoea agglomerans has been classically associated with cellulitis or synovitis secondary to penetrating trauma by vegetation. It is an infrequent cause of systemic infections. We describe the case of a 5-year-old girl with sickle cell disease with P. agglomerans bacteremia and review its potential causes.
Diagnosis and Management of Congenital Uterine Anomalies in Pregnancy
Authors: Vaz Sharon A. , Dotters-Katz Sarah K. , Kuller Jeffrey A.
Published: March 2017

Importance

Congenital uterine anomalies (CUAs) are strongly associated with adverse fertility and pregnancy outcomes. Health care providers must be able to diagnose these anomalies, understand their impact, and counsel women on interventions that might improve rates of pregnancy and live birth.

Objectives

The aims of this study were to characterize CUAs and their effects on adverse fertility and pregnancy outcomes, to describe the best imaging modalities to diagnose specific uterine anomalies, and to learn about interventions that may improve the reproductive outcomes of infertile and pregnant women.

Evidence Acquisition

A search of the PubMed database revealed 56 relevant studies, 49 of which were referenced in this comprehensive summary of the literature.

Results

Congenital uterine anomalies are strongly associated with recurrent pregnancy loss, low birth weight, preterm birth, hypertensive disorders of pregnancy, malpresentation, and cesarean delivery. Transvaginal 3-dimensional ultrasonography appears to be the best initial test for uterine anomaly evaluation. Prior to conception, women who undergo hysteroscopic metroplasty may have better fertility and pregnancy outcomes.

Conclusions and Relevance

Congenital uterine anomalies, although rare in the general population, pose significant challenges to women and their clinicians with regard to fertility and pregnancy management. Accurate diagnosis, preconception counseling and metroplasty, and antenatal monitoring may improve reproductive outcomes for women with CUAs.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to (1) characterize congenital uterine anomalies and their potential effects on adverse fertility and pregnancy outcomes, (2) determine the best imaging modalities to diagnose specific uterine anomalies, and (3) counsel both infertile and pregnant patients about interventions that may improve their reproductive outcomes.
Asphyxia in Motor Vehicle Crashes
Authors: Storvik Steven G. , Campbell Julius Q. , Wheeler Jeffrey B.
Published: March 2017

Rates of death because of asphyxia in motor vehicle crashes have been previously estimated using county and statewide data sets, but national estimates have not been reported. The literature regarding asphyxia in motor vehicle crashes primarily involves discussions about clinical findings, and crash-related variables have been sparsely reported. The current study calculated a nationwide fatality rate for asphyxia in motor vehicle crashes of 1.4%. Seventeen case studies of asphyxia were also reported providing crash-, vehicle-, and occupant-related variables. These included type of accident, crash severity, seat belt use, containment status, extent of occupant compartment intrusion, height, weight, and injury pattern. The data presented can be used to better understand the injury mechanism, identify risk factors, develop possible protective countermeasures, and create situational awareness for emergency responders and investigators.
Influence of opioid-related side effects on disability, mood, and opioid misuse risk among patients with chronic pain in primary care
Authors: Jamison Robert N. , Dorado Kathleen , Mei Anna , Edwards Robert R. , Martel Marc O.
Published: March 2017

Background:

There is increasing concern among primary care practitioners about the use of opioids for chronic pain, including their adverse effects, but little attention has been given to how reports of side effects from prescription medication can contribute to outcomes among patients with chronic pain. The aim of this study was to investigate the impact of frequently reported side effects on mood, disability, and opioid misuse in patients with chronic pain prescribed opioids within primary care.

Methods:

Two hundred (N = 200) patients with chronic pain taking opioids for pain were recruited into the study. All patients completed baseline measures and a monthly side effects checklist once a month for 6 months. Patients were divided evenly based on a median split of the number of endorsed side effects over 6 months. The subjects repeated the baseline measures at the end of the study period.

Results:

Over time, reports of medication side effects tended to decrease, but differences in frequency of reported side effects from baseline to follow-up (6-month time) were not significant, and the order of the frequency of the reported side effects remained similar. Patients who reported significant medication-related adverse effects reported significantly greater activity interference, negative affect, and catastrophizing compared with those with fewer side effects (P < 0.01). In addition, those patients with pain who reported more side effects showed significantly higher scores on opioid misuse risk (P < 0.001).

Discussion:

This study demonstrates the important role of monitoring medication-related side effects among patients with chronic pain who are prescribed opioid medication for pain within primary care.
Preoperative Computed Tomographic Angiogram Measurement of Abdominal Muscles Is a Valuable Risk Assessment for Bulge Formation after Microsurgical Abdominal Free Flap Breast Reconstruction
Authors: Kappos Elisabeth A. , Jaskolka Jeff , Butler Kate , O’Neill Anne C. , Hofer Stefan O. P. , Zhong Toni
Published: March 2017

Background:

A major shortcoming associated with abdominal tissue breast reconstruction is long-term abdominal wall morbidity. Although abdominal muscle size on computed tomographic angiography has been correlated with morbidity following many abdominal operations, it has not been studied for breast reconstruction. Therefore, the authors evaluated the association between preoperative computed tomography angiography–derived measurements of abdominal core muscles and postoperative abdominal wall morbidity after abdominal tissue breast reconstruction.

Methods:

In this retrospective matched case-control study of women who underwent microsurgical abdominal flap breast reconstruction at one institution between January 2011 and June 2015, the authors evaluated all cases of postoperative bulge/hernia, matched by type of abdominal flap and body mass index in a ratio of 1:2 to controls without bulge/hernia. The authors obtained morphometric measurements of abdominal core muscles on preoperative computed tomographic angiographs. Using univariable and multivariable logistic regressions, the authors examined the effects of clinical risk factors and computed tomographic angiography morphometric measurements on postoperative bulge/hernia formation.

Results:

Of the 589 patients who underwent abdominal free flap breast reconstruction, symptomatic bulges/hernias were identified in 35 patients (5.9 percent). When compared to the 70 matched controls, multivariable analysis showed that decreased area of rectus abdominis muscle (OR, 0.18; p < 0.01) and increased inter-rectus abdominis distance (OR, 1.14; p < 0.01) on computed tomographic angiography were significant risk factors associated with postoperative bulge/hernia.

Conclusion:

Preoperative computed tomographic angiography allows objective measurements of the patient’s abdominal muscle anatomy that provide valuable prognostic information on the risk of bulge/hernia formation following abdominally based microsurgical breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Impact of Primary Tumor Location on Postoperative Recurrence and Subsequent Prognosis in Nonmetastatic Colon Cancers
Authors: Ishihara Soichiro , Murono Koji , Sasaki Kazuhito , Yasuda Koji , Otani Kensuke , Nishikawa Takeshi , Tanaka Toshiaki , Kiyomatsu Tomomichi , Kawai Kazushige , Hata Keisuke , Nozawa Hioaki , Sugihara Kenichi , Watanabe Toshiaki
Published: March 2017

Objective:

We aimed to clarify the prognostic impact of primary tumor location on recurrence after curative surgery and subsequent survival in patients with nonmetastatic colon cancer.

Summary of Background Data:

Right and left colon cancers are suggested to be oncologically different; however, their prognostic differences have been conflictingly reported.

Methods:

A total of 5664 patients with curatively resected stage II-III colon cancer were reviewed, retrospectively. Relapse-free survival (RFS) after primary surgery and cancer-specific survival (CSS) after recurrence were compared between patients with right and left colon cancer. Patients’ backgrounds were matched using propensity scores.

Results:

Although patients with right colon cancer had more advanced disease, their 5-year RFS rate was significantly superior compared with that in those with left colon cancer (83.9% vs 81.1%, P = 0.019). However, the 5-year CSS after recurrence rate was significantly inferior in patients with right colon cancer compared with that in those with left colon cancer (30.6% vs 43.6%, P = 0.016).

Conclusions:

The primary tumor location of nonmetastatic colon cancer might have different prognostic implications for the rates of recurrence after curative resection and cancer-specific mortality after recurrence.
Introduction Wind farms in complex terrains: an introduction
Authors: Alfredsson P. H. , Segalini A.
Published: March 2017

Wind energy is one of the fastest growing sources of sustainable energy production. As more wind turbines are coming into operation, the best locations are already becoming occupied by turbines, and wind-farm developers have to look for new and still available areas—locations that may not be ideal such as complex terrain landscapes. In these locations, turbulence and wind shear are higher, and in general wind conditions are harder to predict. Also, the modelling of the wakes behind the turbines is more complicated, which makes energy-yield estimates more uncertain than under ideal conditions. This theme issue includes 10 research papers devoted to various fluid-mechanics aspects of using wind energy in complex terrains and illustrates recent progress and future developments in this important field.

This article is part of the themed issue ‘Wind energy in complex terrains’.
Reduced representation optical methylation mapping (R2OM2)
Authors: Grunwald Assaf , Sharim Hila , Gabrieli Tslil , Michaeli Yael , Torchinsky Dmitry , Juhasz Matyas , Wagner Kathryn R , Pevsner Jonathan , Reifenberger Jeff , Hastie Alex R , Cao Han , Weinhold Elmar , Ebenstein Yuval
Published: March 2017

Reduced representation methylation profiling is a method of analysis in which a subset of CpGs is used to report the overall methylation status of the probed genomic regions. This approach has been widely adopted for genome-scale bisulfite sequencing since it requires fewer sequencing reads and uses significantly less starting material than whole-genome analysis. Consequently, this method is suitable for profiling medical samples and single cells at high throughput and reduced costs. Here, we use this concept in order to create a pattern of fluorescent optical methylation profiles along individual DNA molecules. Reduced representation optical methylation mapping (R2OM2) in combination with Bionano Genomics next generation genome mapping (NGM) technology provides a hybrid genetic/epigenetic genome map of individual chromosome segments spanning hundreds of kilobase pairs (kbp). These long reads, along with the single-molecule resolution, allow for epigenetic variation calling and methylation analysis of large structural aberrations such as pathogenic macrosatellite arrays not accessible to single-cell next generation sequencing (NGS). We apply this method to facioscapulohumeral dystrophy (FSHD) showing both structural variation and hypomethylation status of a disease-associated, highly repetitive locus on chromosome 4q.