bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Prednisone With Abiraterone Acetate in Metastatic Castration-Resistant Prostate Cancer
Authors: Auchus Richard J. , Yu Margaret K. , Nguyen Suzanne , Mundle Suneel D.
Published: November 2014

Abiraterone acetate, a prodrug of the CYP17A1 inhibitor abiraterone that blocks androgen biosynthesis, is approved for treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) in combination with prednisone or prednisolone 5 mg twice daily. This review evaluates the basis for the effects of prednisone on mineralocorticoid-related adverse events that arise because of CYP17A1 inhibition with abiraterone. Coadministration with the recommended dose of glucocorticoid compensates for abiraterone-induced reductions in serum cortisol and blocks the compensatory increase in adrenocorticotropic hormone seen with abiraterone. Consequently, 5 mg prednisone twice daily serves as a glucocorticoid replacement therapy when coadministered with abiraterone acetate, analogous to use of glucocorticoid replacement therapy for certain endocrine disorders. We searched PubMed to identify safety concerns regarding glucocorticoid use, placing a focus on longitudinal studies in autoimmune and inflammatory diseases and cancer. In general, glucocorticoid-related adverse events, including bone loss, immunosuppression, hyperglycemia, mood and cognitive alterations, and myopathy, appear dose related and tend to occur at doses and/or treatment durations greater than the low dose of glucocorticoid approved in combination with abiraterone acetate for the treatment of mCRPC. Although glucocorticoids are often used to manage tumor-related symptoms or to prevent treatment-related toxicity, available evidence suggests that prednisone and dexamethasone might also offer modest therapeutic benefit in mCRPC. Given recent improvements in survival achieved for mCRPC with novel agents in combination with prednisone, the risks of these recommended glucocorticoid doses must be balanced with the benefits shown for these regimens.
Stimuli responsive workability retention of cement paste containing polycarboxylate superplasticiser
Authors: Liang Qing , Sun Youyi , Chi Huijuan , Cai Wei , Liu Yaqing
Published: November 2014

Polycarboxylate superplasticisers (PCE) were synthesised and their structure was characterised by Fourier-transformed infrared spectroscopy. The simulated physiological environmental effects on the workability retention of cement paste containing PCE were studied; that is, stimuli response to sulfates by measuring the fluidity, water-reducing ratio, compressive strength and setting time. The fluidity and water-reducing ratio of cement paste containing PCE with a long chain weakly depended on the salt dosage, but properties of compressive strength and setting time were strongly influenced by the salt dosage. However, the fluidity, water-reducing ratio, compressive strength and setting time of cement containing PCE with both long and short chains were strongly influenced by alkaline sulfate. PCE with a long side chain has a good compatibility with cement paste. The ionic responsive properties are attributed to the change of the PCE adsorption ratio, which results directly in a variation of the dispersing force of superplasticiser.
CNC-loaded hydrogel particles generated from single- and double-emulsion drops
Authors: Ye Congwang , Kennedy Lauren , Shirk Kathryn , Córdova-Figueroa Ubaldo M. , Youngblood Jeffrey , Martinez Carlos J.
Published: November 2014

Cellulose nanocrystal (CNC) suspensions were processed for the first time in microcapillary microfluidic devices with the goal of fabricating CNC-loaded monodisperse hydrogel particles from single- and double-emulsion drops. CNC suspensions ranging from 2 to 12 wt% showed an increase in viscosity and shear thinning due to strong nanofiber interactions in solution. Despite their high viscosities, it was possible to generate monodisperse single-emulsion drops in polydimethylsiloxane oil with CNC concentrations up to 12 wt% and diameters ranging from 15 to 150 µm. CNC–poly(ethylene glycol) diacrylate (PEGDA) hydrogel particles with concentrations up to 10 wt% and sizes ranging from 50 to 80 µm were also generated from single-emulsion drops and survived cleaning, drying and re-hydration. CNC–PEGDA hydrogel particles with concentrations up to 61 wt% were obtained from double-emulsion drops. Overall, this study demonstrates a robust path for the fabrication of CNC-loaded hydrogel particles using microcapillary devices.
Modulus of elasticity of recycled aggregate concrete
Authors: Park Won-Jun , Noguchi Takafumi , Shin Sang-Heon , Oh Da-Young
Published: November 2014

Various empirical equations have previously been suggested for estimating the modulus of elasticity of concrete from its compressive strength. In addition, a considerable number of practical and universal equations have been proposed for predicting the modulus of elasticity when the product includes coarse aggregates and various types of mineral additions. However, such equations are not applicable to the whole data for recycled aggregate concrete because its mechanical properties depend greatly on both the type of aggregates recycled and the ratio of the mix proportions within such concrete. In this study, more than 1300 experimental data obtained from studies performed between 1980 and 2012 in Japan and Korea were used to statistically analyse the relationship between compressive strength and modulus of elasticity. The compressive strength of recycled aggregate concrete was found to range between 18 and 65 MPa, and therefore a prediction equation is proposed for recycled aggregate concrete that considers the ratio and types of recycled coarse aggregates used.
Heel Pain—Plantar Fasciitis: Revision 2014
Authors: Martin Robroy L. , Davenport Todd E. , Reischl Stephen F. , McPoil Thomas G. , Matheson James W. , Wukich Dane K. , McDonough Christine M. , Altman Roy D. , Beattie Paul , Cornwall Mark , Davis Irene , DeWitt John , Elliott James , Irrgang James J. , Kaplan Sandra , Paulseth Stephen , Torburn Leslie , Zachazewski James , Godges Joseph J.
Published: November 2014

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to nonarthritic heel pain.

J Orthop Sports Phys Ther 2014;44(11):A1–A23. doi:10.2519/jospt.2014.0303
Progression of a Lumbar Disc Extrusion
Authors: Crowell Michael S. , Alitz Curtis
Published: November 2014

The patient was a 34-year-old woman who was referred to a physical therapist for a chief complaint of progressively worsening right buttock pain with paresthesias of the right posterior thigh and calf. Prior magnetic resonance imaging of the patient's lumbar spine revealed a large left paracentral disc extrusion at L5–S1. Following physical therapist intervention, the patient reported a new onset of left posterior thigh pain, with paresthesias of the dorsolateral aspect of the left foot. Repeat magnetic resonance imaging of the patient's lumbar spine revealed an increase in the size of the disc extrusion at L5–S1. J Orthop Sports Phys Ther 2014;44(11):910. doi:10.2519/jospt.2014.0413
Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care
Authors: de Fátima Costa Oliveira Nubia , Oliveira Pena Costa Leonardo , Nelson Roger , Maher Chris G. , Beattie Paul F. , de Bie Rob , Oliveira WarleyMelo , Camara Azevedo Daniel , da Cunha Menezes Costa Luciola
Published: November 2014

Study Design

Clinical measurement study.

Objectives

To translate and cross-culturally adapt the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS) into Brazilian Portuguese and to test its measurement properties.

Background

To date, there is no standardized instrument for measuring patient satisfaction with physical therapy care in Brazil.

Methods

The MRPS was translated and cross-culturally adapted into Brazilian Portuguese. Patients completed the MRPS and a global change measure after 5 or more treatment visits. A subset of patients also completed the instrument a second time, 24 to 48 hours after the first assessment. We evaluated factorial validity, internal consistency, reproducibility, construct validity, and ceiling and floor effects.

Results

Three hundred three patients with different musculoskeletal conditions receiving physical therapy care in Brazil participated in this study. A 3-factor solution labeled as interpersonal, convenience and efficiency, and patient education provided the best factor loadings. Cronbach alpha coefficients ranged from .63 to .77, intraclass correlation coefficients ranged from 0.64 to 0.79, and standard errors of measurement ranged from 0.86 to 1.75 points. Thirteen items of the MRPS were moderately correlated with the global measure of change. A large ceiling effect was detected.

Conclusion

Although we did not fully achieve the measurement properties suggested by the guidelines, we believe that the MRPS can be used among Brazilian Portuguese-speaking patients. Some differences with regard to factor structure of the Brazilian Portuguese MPRS compared with the English version were observed. The reason for this is likely a combination of cultural aspects, differences in clinical settings, and patient expectation. J Orthop Sports Phys Ther 2014;44(11):879–889. doi:10.2519/jospt.2014.5150
Ultrasonography for neonatal brachial plexus palsy
Authors: Joseph Jacob Rahul , DiPietro Michael A. , Somashekar Deepak , Parmar Hemant A. , Yang Lynda J. S.
Published: November 2014

Ultrasonography has previously been reported for use in the evaluation of compressive or traumatic peripheral nerve pathology and for its utility in preoperative mapping. However, these studies were not performed in infants, and they were not focused on the brachial plexus. The authors report a case in which ultrasonography was used to improve operative management of neonatal brachial plexus palsy (NBPP). An infant boy was born at term, complicated by right-sided shoulder dystocia. Initial clinical evaluation revealed proximal arm weakness consistent with an upper trunk injury. Unlike MRI or CT myelography that focus on proximal nerve roots, ultrasonography of the brachial plexus in the supraclavicular fossa was able to demonstrate a small neuroma involving the upper trunk (C-5 and C-6) and no asymmetry in movement of the diaphragm or in the appearance of the rhomboid muscle when compared with the unaffected side. However, the supra- and infraspinatus muscles were significantly asymmetrical and atrophied on the affected side. Importantly, ultrasound examination of the shoulder revealed posterior glenohumeral laxity. Instead of pursuing the primary nerve reconstruction first, timely treatment of the shoulder subluxation prevented formation of joint dysplasia and formation of a false glenoid, which is a common sequela of this condition. Because the muscles innervated by proximal branches of the cervical nerve roots/trunks were radiographically normal, subsequent nerve transfers were performed and good functional results were achieved. The authors believe this to be the first report describing the utility of ultrasonography in the surgical treatment planning in a case of NBPP. Noninvasive imaging, in addition to thorough history and physical examination, reduces the intraoperative time required to determine the extent and severity of nerve injury by allowing improved preoperative planning of the surgical strategy. Inclusion of ultrasonography as a preoperative modality may yield improved outcomes for children with NBPP.
Prognostic value of newborn hearing screening in patients with myelomeningocele
Authors: Satzer David , Guillaume Daniel J.
Published: November 2014

Object

Brainstem dysfunction occurs in a minority of patients with myelomeningocele (MMC), most of whom have Chiari Type II malformation. Some surgeons advocate early identification of these patients for craniocervical decompression to avoid significant mortality. The auditory brainstem response has been found to be abnormal in most children with MMC. The present study examines whether failure of routine newborn hearing screening (NHS) predicts brainstem dysfunction in MMC patients.

Methods

The charts of 40 newborns with MMC and 50 newborns without MMC who stayed in the neonatal intensive care unit were reviewed. Results of NHS, brainstem symptoms, birth demographics, and surgical history were retrospectively examined. Differences in the presence and onset of brainstem symptoms by NHS result were assessed.

Results

Failure of NHS was more common among newborns with MMC who developed brainstem symptoms (31%, 4 of 13 patients) than among newborns without MMC (0%, 0 of 50 patients; p = 0.001). Among the 40 newborns with MMC, brainstem symptoms were more common in those who failed NHS (80%, 4 of 5 patients) than in those who passed (26%, 9 of 35 patients; p = 0.031). Respiratory symptom onset occurred later in patients who failed NHS (median 16 months) than among those who passed (median 0 months; p = 0.022). The positive and negative predictive values of NHS for brainstem dysfunction in MMC were 0.80 and 0.74, respectively.

Conclusions

Results of NHS may help predict future brainstem dysfunction in patients with MMC and may be useful to incorporate into prognostic assessment and surgical decision making.
Retroperitoneal oblique corridor to the L2–S1 intervertebral discs in the lateral position: an anatomic study
Authors: Davis Timothy T. , Hynes Richard A. , Fung Daniel A. , Spann Scott W. , MacMillan Michael , Kwon Brian , Liu John , Acosta Frank , Drochner Thomas E.
Published: November 2014

Object

Access to the intervertebral discs from L2–S1 in one surgical position can be challenging. The transpsoas minimally invasive surgical (MIS) approach is preferred by many surgeons, but this approach poses potential risk to neural structures of the lumbar plexus as they course through the psoas. The lumbar plexus and iliac crest often restrict the L4–5 disc access, and the L5–S1 level has not been a viable option from a direct lateral approach. The purpose of the present study was to investigate an MIS oblique corridor to the L2–S1 intervertebral disc space in cadaveric specimens while keeping the specimens in a lateral decubitus position with minimal disruption of the psoas and lumbar plexus.

Methods

Twenty fresh-frozen full-torso cadaveric specimens were dissected, and an oblique anatomical corridor to access the L2–S1 discs was examined. Measurements were taken in a static state and with mild retraction of the psoas. The access corridor was defined at L2–5 as the left lateral border of the aorta (or iliac artery) and the anterior medial border of the psoas. The L5–S1 corridor of access was defined transversely from the midsagittal line of the inferior endplate of L-5 to the medial border of the left common iliac vessel and vertically to the first vascular structure that crosses midline.

Results

The mean access corridor diameters in the static state and with mild psoas retraction, respectively, were as follows: at L2–3, 18.60 mm and 25.50 mm; at L3–4, 19.25 mm and 27.05 mm; and at L4–5, 15.00 mm and 24.45 mm. The L5–S1 corridor mean values were 14.75 mm transversely, from midline to the left common iliac vessel and 23.85 mm from the inferior endplate of L-5 cephalad to the first midline vessel.

Conclusions

The oblique corridor allows access to the L2–S1 discs while keeping the patient in a lateral decubitus position without a break in the table. Minimal psoas retraction without significant tendon disruption allowed for a generous corridor to the disc space. The L5–S1 disc space can be accessed from an oblique angle consistently with gentle retraction of the iliac vessels. This study supports the potential of an MIS oblique retroperitoneal approach to the L2–S1 discs.
Radiation-induced intradural malignant peripheral nerve sheath tumor of the cauda equina with diffuse leptomeningeal metastasis
Authors: Lau Darryl , Moon Dominic H. , Park Paul , Hervey-Jumper Shawn , McKeever Paul E. , Orringer Daniel A.
Published: November 2014

Malignant peripheral nerve sheath tumors (MPNSTs) are rare, affecting only a small portion of the general population. In many cases, MPNSTs occur in association with neurofibromatosis Type 1 and at times arise secondary to previous radiation therapy (RT). These tumors can be found essentially anywhere a peripheral nerve is present, but they rarely originate primarily from the spinal nerve or cauda equina and cause leptomeningeal spread. This report describes the treatment course of a 43-year-old man with a history of testicular seminoma treated with RT a decade before, who was found to have a large sacral MPNST. The patient underwent complete sacrectomy for gross-total resection. Despite this effort, he was eventually found to have metastatic lesions throughout the spine and brain, ultimately resulting in acute hydrocephalus and death. Biopsy results of these metastatic lesions proved to be characteristic of his original MPNST. The literature is also reviewed and the diagnostic modalities, management strategies, and prognosis of MPNST are discussed.
National treatment trends, complications, and predictors of in-hospital charges for the surgical management of craniopharyngiomas in adults from 2007 to 2011
Authors: Zaidi Hasan A. , Chapple Kristina , Little Andrew S.
Published: November 2014

Object

Treatment of craniopharyngiomas is one of the most demanding and controversial neurosurgical procedures performed. The authors sought to determine the factors associated with hospital charges and fees for craniopharyngioma treatment to identify possible opportunities for improving the health care economics of inpatient care.

Methods

The authors analyzed the hospital discharge database of the Nationwide Inpatient Sample (NIS) covering the period from 2007 through 2011 to examine national treatment trends for adults (that is, those older than 18 years) who had undergone surgery for craniopharyngioma. To predict the drivers of in-hospital charges, a multistep regression model was developed that accounted for patient demographics, acuity measures, comorbidities, hospital characteristics, and complications.

Results

The analysis included 606 patients who underwent resection of craniopharyngioma; 353 resections involved a transsphenoidal approach (58%) and 253 a transfrontal approach (42%). The mean age (± SD) of patients was 47.7 ± 16.3 years. The average hospital length of stay (LOS) was 7.6 ± 9 days. The mean hospital charge (± SD) was $92,300 ± $83,356. In total, 48% of the patients experienced postoperative diabetes insipidus or an electrolyte abnormality. A multivariate regression model demonstrated that LOS, hospital volume for the selected procedure, the surgical approach, postoperative complications, comorbidities, and year of surgery were all significant predictors of in-hospital charges. The statistical model accounted for 54% of the variance in in-hospital charge.

Conclusions

This analysis of inpatient hospital charges in patients undergoing craniopharyngioma surgery identified key drivers of charges in the perioperative period. Prospective studies designed to evaluate the long-term resource utilization in this complex patient population would be a useful future direction.
Neurosurgeons' responses to changing Medicare reimbursement
Authors: Rosenow Joshua M. , Orrico Katie O.
Published: November 2014

Object

Medicare reimbursement for physician services has been declining even as the number of Medicare enrollees has been increasing. The number of Medicare participants will only continue to grow as the American population ages and the Patient Protection and Affordable Care Act goes into effect. Efforts to increase reimbursement for physician services through Medicare are often met with data showing that most neurosurgeons continue to participate in the program despite these cutbacks. To better understand this dichotomy, practicing neurosurgeons were surveyed to gauge their response to cutbacks in the Medicare program beyond just their participation status.

Methods

An Internet-based survey invitation was emailed to 3469 practicing neurosurgeons. Reminder emails were sent at intervals over several weeks to help increase the response rate.

Results

Among respondents, an overwhelming percentage (96.8%) participated in Medicare. The neurosurgeons indicated that about one-third of their patient population was covered by Medicare. They also reported limiting the number of Medicare patients they see through a variety of mechanisms: only seeing Medicare patients with a specific diagnosis or from certain referring physicians or limiting the number of appointment slots for Medicare patients. Many respondents stated that further declines in Medicare reimbursement would lead to a reduction in their participation.

Conclusions

While most responding neurosurgeons do participate in the Medicare program, a substantial proportion modulates their participation through a variety of mechanisms. These barriers to care access for Medicare patients are only expected to become greater if further declines in reimbursement are implemented through the program.
Surgery is cost-effective treatment for young patients with vestibular schwannomas: decision tree modeling of surgery, radiation, and observation
Authors: Zygourakis Corinna C. , Oh Taemin , Sun Matthew Z. , Barani Igor , Kahn James G. , Parsa Andrew T.
Published: November 2014

Object

Vestibular schwannomas (VSs) are managed in 3 ways: observation (“wait and scan”); Gamma Knife surgery (GKS); or microsurgery. Whereas there is considerable literature regarding which management approach is superior, there are only a few studies addressing the cost of treating VSs, and there are no cost-utility analyses in the US to date.

Methods

In this study, the authors used the University of California at San Francisco medical record and hospital accounting databases to determine total hospital charges and costs for 33 patients who underwent open surgery, 42 patients who had GKS, and 12 patients who were observed between 2010 and 2013. The authors then performed decision-tree analysis to determine which treatment paradigm produces the highest quality-adjusted life years and to calculate the incremental cost-effectiveness ratio, depending on the patient's age at VS diagnosis.

Results

The average total hospital cost over a 3-year period for surgically treated patients was $80,074 (± $49,678) versus $9737 (± $5522) for patients receiving radiosurgery and $1746 (± $2792) for patients who were observed. When modeling the most debilitating symptoms and worst outcomes of VSs (vertigo and death) at different ages at diagnosis, radiation is dominant to observation at all ages up to 70 years. Surgery is cost-effective when compared with radiation (incremental cost-effectiveness ratio < $150,000) at younger ages at diagnosis (< 45 years old).

Conclusions

In this model, surgery is a cost-effective alternative to radiation when VS is diagnosed in patients at < 45 years. For patients ≥ 45 years, radiation is the most cost-effective treatment option.
Assessing the cost of contemporary pituitary care
Authors: McLaughlin Nancy , Martin Neil A. , Upadhyaya Pooja , Bari Ausaf A. , Buxey Farzad , Wang Marilene B. , Heaney Anthony P. , Bergsneider Marvin
Published: November 2014

Object

Knowledge of the costs incurred through the delivery of neurosurgical care has been lagging, making it challenging to design impactful cost-containment initiatives. In this report, the authors describe a detailed cost analysis for pituitary surgery episodes of care and demonstrate the importance of such analyses in helping to identify high-impact cost activities and drive value-based care.

Methods

This was a retrospective study of consecutively treated patients undergoing an endoscopic endonasal procedure for the resection of a pituitary adenoma after implementation and maturation of quality-improvement initiatives and the implementation of cost-containment initiatives.

Results

The cost data pertaining to 27 patients were reviewed. The 2 most expensive cost activities during the index hospitalization were the total operating room (OR) and total bed-assignment costs. Together, these activities represented more than 60% of the cost of hospitalization. Although value-improvement initiatives contributed to the reduction of variation in the total cost of hospitalization, specific cost activities remained relatively variable, namely the following: 1) OR charged supplies, 2) postoperative imaging, and 3) use of intraoperative neuromonitoring. These activities, however, each contributed to less than 10% of the cost of hospitalization. Bed assignment was the fourth most variable cost activity. Cost related to readmission/reoperation represented less than 5% of the total cost of the surgical episode of care.

Conclusions

After completing a detailed assessment of costs incurred throughout the management of patients undergoing pituitary surgery, high-yield opportunities for cost containment should be identified among the most expensive activities and/or those with the highest variation. Strategies for safely reducing the use of the targeted resources, and related costs incurred, should be developed by the multidisciplinary team providing care for this patient population.
A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes
Authors: James Whitney Sheen , Rughani Anand I. , Dumont Travis M.
Published: November 2014

Object

In the United States in recent years, a dramatic increase in the use of intraoperative neurophysiological monitoring (IONM) during spine surgeries has been suspected. Myriad reasons have been proposed, but no clear evidence confirming this trend has been available. In this study, the authors investigated the use of IONM during spine surgery, identified patterns of geographic variation, and analyzed the value of IONM for spine surgery cases.

Methods

In this retrospective analysis, the Nationwide Inpatient Sample was queried for all spine surgeries performed during 2007–2011. Use of IONM (International Classification of Diseases, Ninth Revision, code 00.94) was compared over time and between geographic regions, and its effect on patient independence at discharge and iatrogenic nerve injury was assessed.

Results

A total of 443,194 spine procedures were identified, of which 85% were elective and 15% were not elective. Use of IONM was recorded for 31,680 cases and increased each calendar year from 1% of all cases in 2007 to 12% of all cases in 2011. Regional use of IONM ranged widely, from 8% of cases in the Northeast to 21% of cases in the West in 2011. Iatrogenic nerve and spinal cord injury were rare; they occurred in less than 1% of patients and did not significantly decrease when IONM was used.

Conclusions

As costs of spine surgeries continue to rise, it becomes necessary to examine and justify use of different medical technologies, including IONM, during spine surgery.
Cerebrospinal fluid shunt placement in the pediatric population: a model of hospitalization cost
Authors: Lam Sandi K. , Srinivasan Visish M. , Luerssen Thomas G. , Pan I-Wen
Published: November 2014

Object

There have been no large-scale analyses on cost drivers in CSF shunt surgery for the treatment of pediatric hydrocephalus. The objective of this study was to develop a cost model for hospitalization costs in pediatric CSF shunt surgery and to examine risk factors for increased costs.

Methods

Data were extracted from the Kids' Inpatient Database (KID) of the Healthcare Cost and Utilization Project. Children with initial CSF shunt placement in the 2009 KID were examined. Patient charge was converted to cost using a cost-to-charge ratio. The factors associated with costs of CSF shunt hospitalizations were examined, including patient demographics, hospital characteristics, and clinical data. The natural log transformation of cost per inpatient day (CoPID) was analyzed. Three multivariate linear regression models were used to characterize the cost. Variance inflation factor was used to identify multicollinearity for each model.

Results

A total of 2519 patients met the inclusion criteria and were included in study. Average cost and length of stay (LOS) for initial shunt placement were $49,317 ± $74,483 (US) and 18.2 ± 28.5 days, respectively. Cost per inpatient day was $4249 ± $2837 (median $3397, range $80–$22,263). The average number of registered nurse (RN) full-time equivalents (FTEs) per 1000 adjusted inpatient days was 5.8 (range 1.6–10.8). The final model had the highest adjusted coefficient of determination (R2 = 0.32) and was determined to be the best among 3 models. The final model showed that child age, hydrocephalus etiology, weekend admission, number of chronic diseases, hospital type, number of RN FTEs per 1000 adjusted inpatient days, number of procedures, race, insurance type, income level, and hospital regions were associated with CoPID.

Conclusions

A patient's socioeconomic status, such as race, income level, and insurance, in addition to hospitalrelated factors such as number of hospital RN FTEs, hospital type, and US region, could affect the costs of initial CSF shunt placement, in addition to clinical factors such as hydrocephalus origin and LOS. To create a cost model of initial CSF shunt placement in the pediatric population, consideration of such nonclinical factors may be warranted.
Population viability of Pediocactus bradyi (Cactaceae) in a changing climate
Authors: Shryock Daniel F. , Esque Todd C. , Lee Hughes
Published: November 2014

• Premise of the study: A key question concerns the vulnerability of desert species adapted to harsh, variable climates to future climate change. Evaluating this requires coupling long‐term demographic models with information on past and projected future climates. We investigated climatic drivers of population growth using a 22‐yr demographic model for Pediocactus bradyi, an endangered cactus in northern Arizona.

• Methods: We used a matrix model to calculate stochastic population growth rates (λs) and the relative influences of life‐cycle transitions on population growth. Regression models linked population growth with climatic variability, while stochastic simulations were used to (1) understand how predicted increases in drought frequency and extreme precipitation would affect λs, and (2) quantify variability in λs based on temporal replication of data.

• Key results: Overall λs was below unity (0.961). Population growth was equally influenced by fecundity and survival and significantly correlated with increased annual precipitation and higher winter temperatures. Stochastic simulations increasing the probability of drought and extreme precipitation reduced λs, but less than simulations increasing the probability of drought alone. Simulations varying the temporal replication of data suggested 14 yr were required for accurate λs estimates.

• Conclusions: Pediocactus bradyi may be vulnerable to increases in the frequency and intensity of extreme climatic events, particularly drought. Biotic interactions resulting in low survival during drought years outweighed increased seedling establishment following heavy precipitation. Climatic extremes beyond historical ranges of variability may threaten rare desert species with low population growth rates and therefore high susceptibility to stochastic events.
The plastochron index: Still useful after nearly six decades
Authors: Meicenheimer Roger D.
Published: November 2014

The plastochron index (PI) introduced by Erickson and Michelini in 1957 provides a solution to a long‐standing problem, of how to measure time in growing plant populations, such that the occurrence of critical developmental events can be more readily detected, compared, and analyzed, than if chronologic time is used. The PI reduces the rather large variation associated with chronologic time in measuring such events by taking advantage of the growth characteristics of stem organs that repeat at regular intervals (the plastochron) and has found widespread application in botanical research. The original formulation and derivation of the PI and associated leaf plastochron index (LPI) is reviewed. Additional formulations that have been developed to overcome some of the limitations of the original PI formulation are examined. Major advancements that have been achieved in understanding the physiology, growth, and development of agriculturally important and current model plant species are reviewed to illustrate how various researchers have used the PI in such studies. Potential uses to which the PI and LPI might be applied in emerging frontiers of plant science are suggested. A searchable bibliography of most all the primary research studies that cite the original PI article is provided.
Annular floral nectary with oil‐producing trichomes in Salvia farinacea (Lamiaceae): Anatomy, histochemistry, ultrastructure, and significance
Authors: Zhang Xiaohui , Sawhney Vipen K. , Davis Arthur R.
Published: November 2014

• Premise of the study: Many angiosperms produce nectar that entices pollinator visits. Each floral nectary tends to embody a singular form, such as the receptacular ring arising beneath the ovary in mint flowers (Lamiaceae). Exceptionally, the annular floral nectary in Salvia farinacea possesses modified stomata plus secretory trichomes. This first study of nectary ultrastructure within the largest genus of Lamiaceae examined this unusual condition.

• Methods: Nectary anatomy, histochemistry, and ultrastructure were investigated from fresh and fixed material using light microscopy and scanning electron and transmission electron microscopy.

• Key results: The annular nectary encircled the ovary plus extended ventrally as a projection. Modified stomata occurred only in the projection's abaxial epidermis. Conversely, peltate trichomes with a basal cell, a stalk cell, and 4‐7 head cells were interspersed among the ovary lobes and covered the projection's adaxial surface. Phloem and xylem supplied the nectary interior, where parenchyma cells had numerous mitochondria and plastids with little starch, but few dictyosomes and little endoplasmic reticulum. Nectar accumulated as a drop opposite the projection's abaxial surface, escaping through stomatal pores and probably the cuticle. However, the annular nectary's glistening trichomes secreted a Sudan‐positive product largely retained below the distended cuticle, but not nectar.

• Conclusions: This first ultrastructural study of co‐occurring secretory trichomes and modified stomata on a mint nectary suggests multiple interactive functions for this atypical structure. These trichomes—possibly generating a substance informative to pollinators or as an ovarian defense against phytophagy—produced oil in an aqueous milieu, rather than contributing fluid to nectar.
Understanding Limitations in At-work Productivity in Patients with Active Ankylosing Spondylitis: The Role of Work-related Contextual Factors
Authors: Boonen Annelies , Boone Caroline , Albert Adelin , Mielants Herman
Published: November 2014

Objective.

To explore the effect of health-related and contextual factors on presenteeism, absenteeism, and overall work productivity loss in patients with active ankylosing spondylitis (AS).

Methods.

Consecutive patients with AS starting their first tumor necrosis factor inhibitor and in paid employment were eligible. Patients completed the Work Productivity and Activity Impairment (WPAI) questionnaire for AS to assess presenteeism, absenteeism, and overall work productivity loss in the previous 7 days. In addition, they answered questions about work characteristics (type, characteristics of workplace, satisfaction of contacts with colleagues, and importance of work in life) and health status [Bath AS Functional Index (BASFI), AS Disease Activity Score-C-reactive protein (ASDAS-CRP)]. Physicians assessed the Bath Ankylosing Spondylitis Metrology Index, presence of articular and extraarticular manifestations, comorbidities, and laboratory indicators of inflammation. Stepwise regression models were computed to determine which work-related and health-related factors contributed to WPAI outcomes.

Results.

The study included 80 patients. The WPAI presenteeism, absenteeism, and overall work productivity loss scores were 49.1%, 30.2%, and 53.1%, respectively. Presenteeism was associated with higher BASFI, female sex, and poor quality of contact with colleagues. Absenteeism was associated with increasing age, current smoking status, higher ASDAS-CRP, and low importance of work for life. Overall work productivity loss was associated with female sex, higher BASFI, past adaptation of job because of illness, number of working hours, and manual profession.

Conclusion.

Both health-related and contextual factors contribute to work limitations in patients with AS and suggest additional opportunities for improvement by addressing the working environment.
Etiopathogenic Role of Surfactant Protein D in the Clinical and Immunological Expression of Primary Sjögren Syndrome
Authors: Soto-Cárdenas María José , Gandía Myriam , Brito-Zerón Pilar , Arias Maria Teresa , Armiger Noelia , Bové Albert , Bosch Xavier , Retamozo Soledad , Akasbi Miriam , Pérez-De-Lis Marta , Gueitasi Hoda , Kostov Belchin , Pérez-Alvarez Roberto , Siso-Almirall Antoni , Lozano Francisco , Ramos-Casals Manuel
Published: November 2014

Objective.

To analyze the etiopathogenic role of genetic polymorphisms and serum levels of surfactant protein-D (SP-D) in primary Sjögren syndrome (pSS).

Methods.

We analyzed 210 consecutive patients with pSS.SFTPDgenotyping (M11T polymorphism rs721917) was analyzed by sequence-based typing and serum SP-D by ELISA.

Results.

Thirty-two patients (15%) had the Thr11/Thr11 genotype, 80 (38%) the Met11/Met11 genotype, and 96 (46%) the Met11/Thr11 genotype; 2 patients could not be genotyped. Patients carrying the Thr11/Thr11 genotype had a higher prevalence of renal involvement (13% vs 1% and 4% in comparison with patients carrying the other genotypes, p = 0.014). Serum SP-D levels were analyzed in 119 patients (mean 733.94 ± 49.88 ng/ml). No significant association was found between serum SP-D levels and the SP-D genotypes. Higher mean values of serum SP-D were observed in patients with severe scintigraphic involvement (851.10 ± 685.69 vs 636.07 ± 315.93 ng/ml, p = 0.038), interstitial pulmonary disease (1053.60 ± 852.03 vs 700.36 ± 479.33 ng/ml, p = 0.029), renal involvement (1880.64 ± 1842.79 vs 716.42 ± 488.01 ng/ml, p = 0.002), leukopenia (899.83 ± 661.71 vs 673.13 ± 465.88 ng/ml, p = 0.038), positive anti-Ro/SS-A (927.26 ± 731.29 vs 642.75 ± 377.23 ng/ml, p = 0.006), and positive anti-La/SS-B (933.28 ± 689.63 vs 650.41 ± 428.14 ng/ml, p = 0.007), while lower mean values of serum SP-D were observed in patients with bronchiectasis (489.49 vs 788.81 ng/ml, p = 0.019).

Conclusion.

In pSS, high SP-D levels were found in patients with severe glandular involvement, hypergammaglobulinemia, leukopenia, extraglandular manifestations, and positive anti-Ro/La antibodies. The specific association between SP-D levels and pulmonary and renal involvements may have pathophysiological implications.
Ultrasonographic Evaluation of the Anterior Chest Wall in Spondyloarthritis: A Prospective and Controlled Study
Authors: Verhoeven Frank , Guillot Xavier , Godfrin-Valnet Marie , Prati Clément , Wendling Daniel
Published: November 2014

Objective.

To determine the prevalence and type of ultrasonographic (US) lesions of the anterior chest wall (ACW) in cases of spondyloarthritis (SpA).

Methods.

This monocentric, prospective, and controlled study included patients consulting for SpA (Assessment of Spondyloarthritis International Society criteria) and control subjects. Clinical (pain and swelling) and US assessments (synovitis, joint effusion, erosion, ankylosis, margin narrowing, or Doppler signal) were performed on the sternoclavicular (SCJ) and the manubriosternal (MSJ) joints. The main characteristics of SpA were recorded [disease duration, biologic features, Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), radiographic and extraarticular involvement].

Results.

The study included 131 patients with SpA and 49 control subjects (same age and sex ratio). Clinical and US involvement of ACW were found in, respectively, 39% and 35.5% of SpA and in 12% and 14.3% of controls (p < 0.01). US highlighted erosions (34 vs 0), margin narrowing (12 vs 0), power Doppler activity (18 vs 2; p < 0.05), and ankylosis of the MSJ (24 vs 3). US involvement was associated with disease duration (14.9 vs 11.1 years; p = 0.04), age (45 vs 41 years; p = 0.004), radiographic change of sacroiliac joint (p = 0.05), and presence of inflammatory bowel disease (IBD; p = 0.03). No associations were found with HLA-B27, psoriasis, enthesitis, uveitis, or clinical involvement of ACW. Clinical involvement is associated with a higher BASDAI (47 vs 32; p = 0.0009) and ASDAS (2.9 vs 2.2; p = 0.006).

Conclusion.

US involvement of ACW is frequent in SpA (36.5%), mainly with erosion of SCJ and ankylosis of MSJ. It is associated with disease duration, radiographic sacroiliitis, and IBD.
Systematic Review of Treatment Effectiveness and Outcome Measures for Enthesitis in Psoriatic Arthritis
Authors: Orbai Ana-Maria , Weitz Joshua , Siegel Evan L. , Siebert Stefan , Savage Laura J. , Aydin Sibel Z. , Luime Jolanda J. , Elkayam Ori , Neerinckx Barbara , Urbancek Slavo , de Vlam Kurt , Ritchlin Christopher T. ,   the GRAPPA Enthesitis Working Group
Published: November 2014

Enthesitis is a characteristic feature of psoriatic arthritis (PsA) and is important in disease pathogenesis and classification. Use of clinical outcome measures for enthesitis is heterogeneous, and only 1 measure has been specifically developed and validated in PsA. Ultrasound and magnetic resonance imaging assessments of enthesitis may have advantages over clinical examination but are insufficiently studied. As part of an update of treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), we performed a systematic literature review and identified randomized controlled trials with enthesitis outcomes in PsA. For each treatment agent we calculated treatment effect sizes (where applicable) and graded the level of evidence.
Safety and Efficacy of Therapies for Skin Symptoms of Psoriasis in Patients with Psoriatic Arthritis: A Systematic Review
Authors: Boehncke Wolf-Henning , Alvarez Martinez David , Solomon James A. , Gottlieb Alice B.
Published: November 2014

Numerous guidelines and recommendations exist for the treatment of psoriasis in various populations. One important population is patients with psoriatic arthritis (PsA) who have symptoms of both joint and skin disease. In patients with both facets of psoriatic disease, skin and joints must be treated separately, but also simultaneously. As several systemic therapies are approved for either one or both, the concept of treating both facets with the same drug is feasible. This review summarizes evidence from studies in patients with PsA on the efficacy of these drugs on psoriatic skin disease in these patients.
Treatments for Nail Psoriasis: A Systematic Review by the GRAPPA Nail Psoriasis Work Group
Authors: Armstrong April W. , Tuong William , Love Thorvardur J. , Carneiro Sueli , Grynszpan Rachel , Lee Steve S. , Kavanaugh Arthur
Published: November 2014

Nail involvement in psoriatic diseases causes significant physical and functional disabilities. Evaluating, measuring, and treating nail involvement is important in improving the health outcomes and quality of life among patients with psoriasis and psoriatic arthritis (PsA). We performed a systematic analysis of the literature on nail psoriasis to help inform an update of treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).
Duplicated Pelvic Floor Musculature and Diastematomyelia in a Cloacal Exstrophy Patient
Authors: Inouye Brian Masao , Tourchi Ali , Massanyi Eric Z , Gearhart John P , Tekes Aylin
Published: November 2014

Cloacal exstrophy is the most severe and rare form of the exstrophy-epispadias complex, presenting with exposed bladder halves extruding through an abdominal wall defect and variable genitourinary, gastrointestinal, musculoskeletal, and neurological defects. The authors report magnetic resonance imaging findings of a neurologically-intact, 24-month-old female with cloacal exstrophy who presented with anterior spinal dysraphism and diastematomyelia and duplicate pelvic floor musculature. The constellation of defects suggests a common genetic, biochemical, and embryological origin for duplication of the bladder, spinal cord, and pelvic floor muscles occurring in the fourth week of gestation.
Bronchopulmonary sequestration in a 60 year old man
Authors: Naffaa Lena , Tank Jay , Ali Sara , Ong Cesar
Published: November 2014

We report a case of bronchopulmonary sequestration (BPS) in a 60 year old man with recurrent cough. After failed antibiotic therapy for presumed left lower lobe (LLL) pneumonia seen on chest radiographs, bronchoscopy was performed revealing cryptogenic organizing pneumonia. Further work-up with thoracic imaging demonstrates a feeding artery from the thoracic aorta to the LLL consolidation indicating the presence of BPS. A brief review of the clinical and radiological features and management options of BPS are listed, with particular emphasis on the various imaging modalities and techniques in the diagnosis and pre-surgical planning of intralobar sequestration.
La Aurora Patriótica Mallorquina (1812-1813) y el clero regular. Dos maneras contrapuestas de entender el patriotismo, la religión y la política
Authors: Rodríguez Morín Felipe
Published: November 2014

Malgré la modération des postulats du périodique libéral Aurora Patriótica Mallorquina (fondé en juin 1812), en ce qui concerne sa vision des ordres réguliers et la nécessité de leur modernisation et réforme afin qu'ils se consacrent à des tâches plus utiles et solidaires, cette publication et ses rédacteurs furent dénigré par les absolutistes qui les traitèrent, sans la moindre preuve, d'apostats et de mécréants, ce qui dans leur esprit équivalait à la condition de mauvais espagnols. En fait, la nouvelle vision de la religion et la conception de l'Etat prônées par les libéraux et donc par la Aurora Patriótica Mallorquina commençaient à se superposer ou plutôt à se juxtaposer à l'ancienne qui avait toujours régné en Espagne. Aussi les réactionnaires, dont les prédicateurs étaient les principaux porte-paroles, ne pouvaient en aucun cas autoriser des changements aussi importants, en particulier quand ils entraînaient la perte de privilèges ancestraux.
Un modelo de mujer en la prensa del Trienio Liberal: análisis a través del Periódico de las Damas
Authors: Crespo Sánchez Francisco Javier
Published: November 2014

Il s'agira dans cet article d'appréhender les changements et les continuités dans le discours sur le rôle que les femmes doivent jouer dans la société à travers l'étude d'un journal consacré aux femmes, le Periódico de las Damas (1822). Nous analyserons le modèle féminin proposé : ce que devrait être la relation de la femme avec l'homme, sa préparation au mariage, si l’on a continué à mettre l'accent sur la maternité, quels ont été les éléments jugés nécessaires pour son éducation et quelles devaient être ses valeurs. Il s’agit donc de déterminer si se dessine ou pas ou pas une nouvelle conception de la femme.