bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Trial of a Rice-Powder Oral Rehydration Beverage
Authors: Martínez Homero , Habicht Jean-Pierre , Garza Cutberto , Mota Felipe
Published: November 2018

A clinical trial was conducted to assess the efficacy of a rice-based gruel as a rehydration solution, identified in a previous study to be widely used by mothers during diarrhoeal episodes in their children. Seventy children under five years of age, admitted to a paediatric hospital with clinical dehydration secondary to acute diarrhoea, were randomly assigned to receive rice-based gruel (n = 37) or oral rehydration salts (ORS) (n = 33). The hydration status was measured on admission and hourly until discharge, for a maximum of 8 hours, after which treatment was considered to have failed in children who had not been rehydrated Successful rehydration was achieved in 92% of the patients receiving rice-based gruel and 91% of those receiving ORS. Over 50% of all patients were rehydrated 4 to 5 hours after treatment was initiated; at these times the faecal output was statistically significantly lower in patients receiving rice-based gruel than in those receiving ORS. More patients were discharged from the study with hypernatraemia in the group receiving ORS than in the group receiving rice-based gruel, whereas the number of patients with hyponatraemia on discharge was similar in both groups. Faecal sodium concentrations were similar on admission in both groups but were statistically significantly lower at discharge in the group receiving rice-based gruel. We concluded that rice-based gruel could be safely used as an oral rehydration solution at the community level.
Human Protein Requirements: A Brief Update
Authors: Scrimshaw Nevin S.
Published: November 2018

In the 1950s and 1960s the risk of protein deficiency in the diets of most developing country populations, both in absolute terms and relative to calories, was considered to be high. An FAO/WHO expert committee that met in 1971 proposed a protein allowance value 20% lower than that previously recommended. Nutritionists and economists accepted this new value, recalculated the risk from dietary intake data, and concluded that protein deficiency was not a problem. This conclusion was reinforced by the concurrent virtual disappearance of the severe form of protein deficiency, kwashiorkor, as developing country conditions improved. However, metabolic studies coordinated by UNU in 16 countries soon showed that the protein required for sustained normal functioning was one-third more than that proposed in the report of the 1971 committee. This higher value was accepted in the 1985 FAO/WHO/UNU expert consultation report on energy and protein requirements. In addition, infections, highly prevalent under conditions of poverty, increase protein losses and often decrease protein absorption. Although it is true that when people can consume enough of their traditional diet to meet energy needs, protein needs are also usually met, problems arise when, because of poverty or illness, people cannot consume their traditional diets. New data on protein digestibility and on protein quality are recognized in a 1991 FAO/WHO expert consultation and a 1994 International Dietary Energy Consultative Croup (IDECG) workshop. Protein requirements are re-evaluated in this paper on the basis of these considerations.
Human Amino Acid Requirements: A Re-Evaluation
Authors: Young Vernon R. , El-Khoury Antoine E.
Published: November 2018

The most recent internationally stated estimates of the amino acid requirements in adult humans are those given in the 1985 report of the Joint FAO/WHO/UNU Expert Consultation on Energy and Protein Requirements. In this review we present, in brief a number of scientific concerns and problems that lead us to conclude that these current recommendations for amino acid requirements are not valid and that the appropriate values are likely to be considerably higher. Following a short review of the C-labelled amino acid tracer studies carried out at the Massachusetts of Technology (MIT) and designed to reassess the requirements for specific indispensable amino acids, we focus particular attention on the lysine requirement in adults. When various criteria and methods are used to estimate this requirement, it appears that a cohesive body of data indicates the mean requirement value for lysine in healthy adults to be about 30 mg/kg/day or 50 mg/g protein. Although this value contrasts with the FAO/WHO/UNU value of 12 mg/kg/day or 16 ma/g protein, this new, tentative requirement value is consistent with findings from studies carried out earlier at MIT on the nutritional quality of wheat proteins. We propose that it would be prudent to apply the MIT amino acid requirement pattern (see Food and Nutrition Bulletin 1990;12:298–300), rather than the 1985 FAO/WHO/UNU adult amino acid requirement pattern, in the design and implementation of sound nutrition policies and programmes that include considerations of the amount and quality of the protein component of national and regional diets.
Salt Iodine Variation within an Extended Guatemalan Community: The Failure of Intuitive Assumptions
Authors: Stewart Christopher , Solomons Noel , Mendoza Ivan , May Sandy , Maberly Glen
Published: November 2018

Guatemalan law mandates an iodine concentration from 30 to 700 parts per million (ppm) in all table salt offered in local commerce. Forty-four specimens of salt were collected in urban and rural sectors of a county on the outskirts of the capital of Guatemala and analysed for their iodine content by an iodate titration method. The concentrations ranged from 1 to 117 ppm, (mean ± SD 26.6 ± 21.7 ppm, median 24 ppm). Salt samples with iodine in both the adequate and the inadequate ranges were found in each of five subjurisdictions (township and four hamlets), and the median concentration was equivalent at all sites, without an urban-to-rural gradient. Similarly, the mandated iodine concentration was no more likely to be found in salt packaged under a brand name with a commercial label than in salt in a plain, unlabelled package. The findings place in relief the continuing difficulties in Guatemala in the effort to provide a universally protective level of iodine in table salt.
Can Africa Meet the Goal of Eliminating Iodine-Deficiency Disorders by the Year 2000?
Authors: Kavishe Festo P.
Published: November 2018

The story of the control of iodine-deficiency disorders in Africa is one of success and provides the best example of how Africa can make rapid progress in the area of health and nutrition. It shows that Africa is moving rapidly towards the elimination of iodine-deficiency disorders by the year 2000 largely because of the availability of affordable, cost-effective technology and an unprecedented alliance among governments, the private sector, and international agencies. Following the impetus created by the 7987 regional meeting sponsored by WHO/UNICEF/International Council for the Control of Iodine-Deficiency Disorders (ICCIDD) and attended by 22 countries, and particularly after the 1990 World Summit for Children and the 1992 International Conference on Nutrition in which the elimination of iodine-deficiency disorders by the year 2000 was adopted as a feasible goal, progress towards universal salt iodation in Africa has been spectacular. By the end of 1995, there were iodine-deficiency disorder control programmes, using iodated salt as the long-term strategy, in almost all of the 50 countries in Africa where WHO estimates that iodine-deficiency disorder is a problem of public health significance. As of February 1996, it was estimated that more than 50% of the salt consumed in Africa was iodated, and that if the present efforts towards provision of iodation machinery and regulatory mechanisms are carried out to their logical conclusion, the mid-decade goal of universal salt iodation might be achieved by the end of 1996. The elimination of iodine-deficiency disorders in Africa may be a reality by the beginning of the next millennium. Major challenges to complete and sustained universal salt iodation still remain and require sustained advocacy, resource mobilization and monitoring, and evaluation.
Problems of Establishing Lactation
Authors: Woolridge Michael W.
Published: November 2018

The problems associated with the establishment of lactation can be viewed primarily from the mother's perspective but should also be viewed from that of the caregiver supporting her and the maternity facility providing her with care.
Demographic Effects of Breastfeeding: Fertility, Mortality, and Population Growth
Authors: Menken Jane , Kuhn Randall
Published: November 2018

This article reviews the demographic effects of breastfeeding on fertility and child survival and, ultimately, on population growth. Extended breastfeeding both reduces fertility by prolonging birth intervals and increases child survival through improved nutrition, especially where adequate substitutes are not available. The results presented show, however, that although breastfeeding is a major determinant of fertility in the absence of other means of fertility control, prolonged breastfeeding alone cannot reduce fertility to levels consonant with slow or zero population growth. The benefits, at least for the first year of life, demonstrate the need for policies that promote breastfeeding and encourage compatibility between breastfeeding and other aspects of women's fives. In particular, policies are needed that permit women to breastfeed their children while, at the same time, improving their socio-economic circumstances through participation in the labour force.
Effects of Breastfeeding on Maternal Health and Well-Being
Authors: Rasmussen Kathleen M. , McGuire Michelle K.
Published: November 2018

Lactation occurs as part of a reproductive and may have different effects on maternal nutritional status, depending on its duration and intensity. Thus, its effect on maternal health will differ with cultural setting and level of development. Lactation helps women to maintain a healthy body weight. Among well-nour-shed women, it may help to prevent obesity. Among poorly pour/shed women, breastfeeding also leads to weight loss, but with adequate birth spacing brought about by lactational anovulation, maternal depletion can be avoided. Lactation is probably not responsible for osteoporosis. Current evidence suggests that breastfeeding helps to prevent pre-menopausal breast cancer and is not associated with post-menopausal disease Furthermore, breastfeeding may also help reduce ovarian cancer. Positive effects of breastfeeding occur at all levels of development and are most likely when biological, political, and sociocultural conditions interact to support its initiation and continuation.
Infection and Disease: The Impact of Early Weaning
Authors: Victora Cesar G.
Published: November 2018

Although the protective effect of breastfeeding against infectious diseases has been long suspected, it has only recently been adequately quantified This article reviews the available epidemiologic evidence. Breastfeeding provides marked protection against diarrhoeal morbidity and severity (as measured by its duration, level of dehydration, or case-fatality rate), and mortality. This is true for acute watery diarrhoea as well as for dysentery and persistent diarrhoea. A dose-response pattern is observed: the risk level for children receiving both breastmilk and artificial milk is between that of exclusively breasfed children and that of completely weaned children. Even the introduction of water or herbal teas to a previously exclusively breasfed infant increases the risk of morbidity and mortality. The protection is greatest for young infants, and the period immediately after weaning seems to carry the highest risk. Although breastfeeding does not seem to have an appreciable effect on the incidence of acute respiratory infections as a whole, there is evidence of an effect on the incidence of pneumonia, on the incidence of hospitalization for pneumonia, and on mortality from respiratory infections. The level of protection against pneumonia, however, is lower than that against diarrhoea. Breastfeeding also protects against onus media and other infections, including neonatal sepsis, meningitis, and bacteraemia, although the number of relevant studies is small. A simulation exercise shows that a 40% reduction in the prevalence of nonbreastfeeding would prevent up to 15% of diarrhoea deaths and 7% of pneumonia deaths occurring in regions with a short breastfeeding duration, such as urban Latin America. In regions where breastfeeding durations are longer, the emphasis should be on maintaining these high rates and increasing the proportion of young infants who are exclusively breastfed. The present review confirms that breastfeeding promotion is an essential child survival strategy.
The Role of Education in Breastfeeding Success
Authors: Valdés Veronica , Schooley Janine
Published: November 2018

Many of the factors that have contributed to the decline in breastfeeding around the world can be overcome by education and support. Examples of successful approaches to education at different levels (mother, health professional, institution) that impact breastfeeding are discussed. For example, because breastfeeding is a learned behaviour for both mother and baby, providing the mother with information, skills, and support for the breastfeeding process is integral to her ability to breastfeed successfully. In addition, because the health professional plays a pivotal role in the success or failure of breastfeeding it is essential I that education and training of health professionals be adequately addressed. By using an approach to healthprofessional education that builds on a highly trained core and spreads to all levels through a built-in multiplier effect, improvement of breastfeeding practices can be assured. In order to sustain these results, however, health-professional school curricula must include adequate information on the science of lactation and the clinical management of breastfeeding The experience of Chile's National Breastfeeding Programme is used to illustrate the power of education at each of these levels in influencing the success of breastfeeding and the feasibility of using education of both mothers and health professionals as a way of preserving this incredible natural resource.
Anthropometric Reference Data for International Use: Recommendations from a who Expert Committee
Authors: de Onis Mercedes , Habicht Jean-Pierre
Published: November 2018

The World Health Organization (WHO) convened an Expert Committee to re-evaluate the use of anthropometry at different ages for assessing health, nutrition, and social well-being. The Committee's task included identifying reference data for anthropometric indices when appropriate, and providing guidelines on how the data should be used. For foetal growth, the Committee recommended an existing sex-specific multiracial reference. In view of the significant technical drawbacks of the current National Center for Health Statistics (NCHS)/WHO reference and its inadequacy for assessing the growth of breastfed infants, the Committee recommended the development of a new reference concerning weight and length/height for infants and children, which will be a complex and costly undertaking. Proper interpretation of mid-upper-arm circumference for pre-schoolers requires age-specific reference data. To evaluate adolescent height-for-age, the Committee recommended the current NCHS/WHO reference. Use of the NCHS body mass index (BMI) data, with their upper percentile elevations and skewness, is undesirable for setting health goals; however, these data were provisionally recommended for defining obesity based on a combination of elevated BMI and high subcutaneous fat. The NCHS values were provisionally recommended as reference data for subscapular and triceps skinfold thicknesses. Guidelines were also provided for adjusting adolescent anthropometric comparisons for maturational status. Currently, there is no need for adult reference data for BMI; interpretation should be based on pragmatic BMI cut-offs. Finally, the Committee noted that few normative anthropometric data exist for the elderly, especially for those over 80 years of age. Proper definitions of health status, function, and biologic age remain to be developed for this group.
Child Malnutrition and Feeding Practices in Malawi
Authors: Madise Nyovani Janet , Mpoma Mabel
Published: November 2018

The 1992 Malawi and Demographic Health Survey data are used to assess the association between breast-feeding practices, socio-economic and morbidity variables, and the nutritional status of children under the age of five years using multilevel models. About 27% of under-five children in Malawi are underweight, and nearly 50% are stunted. The results of this study suggest that socio-economicfactors, morbidity, and inappropriate feeding practices are some of the factors associated with malnutrition in Malawi. High socio-economic status, as measured by urban residence, the presence of modern amenities, and some maternal education, is associated with better nutritional status, whereas morbidity within two weeks before the survey is associated with low weight-for-age Z scores. Breast-feeding is almost universal and is carried on for about 21 months, but the introduction of complementary food starts much too early; only 3% of Malawian children under the age of 4 months are exclusively breastfed. Children aged 12 months or older who were still breastfeeding at the time of the survey were of lower nutritional status than those who had stopped breastfeeding. The analysis also showed a significant intra-family correlation of weight-for-age Z scores of children of the same family of about 39%.
Improved Retinol, Carotene, Ferritin, and Folate Status in Nuxalk Teenagers and Adults after a Health Promotion Programme
Authors: Kuhnlein Harriet V. , Burgess Sandy
Published: November 2018

Plasma retinol and carotene, erythrocyte folate, serum ferritin, and haemoglobin were determined in native people living on the west coast of British Columbia before and after a three-year intervention programme of nutrition education and health promotion emphasizing local cultural food. One hundred ninety-nine persons participated before (T1) and 267 after (T2) the programme, with 107 persons participating in both periods. Overall T2 mean ± SEM adult (20–60 years) retinol increased (p <.05) over T1 from 23.8 ± 0.5 to 42.4 ± 17.3 μg/dl, carotene increased from 37.4 ± 1.2 to 54.1 ± 1.6 μg/dl, and erythrocyte folate increased from 226 ± 8 to 264 ± 8 ng/ml. T2 mean ± SEM adult ferritin and haemoglobin for all ages/sexes combined did not change; however, haemoglobin for older women 41 to 60 years of age increased (p <.05) from 12.4 ± 0.4 to 13.2 ± 0.2 g/dl, and the percentage of teenagers at risk for low ferritin levels was reduced for females from 85% to 17% and for males from 50% to 11%. It was concluded that the intervention programme improved vitamin A and folate status for the overall community and iron status for teenagers.
“Public Nutrition”: The Need for Cross-Disciplinary Breadth in the Education of Applied Nutrition Professionals
Authors: Rogers Beatrice , Schlossman Nina
Published: November 2018

A study supported by the Pew Charitable Trusts investigated whether the nutrition situation in Central America and Mexico would be improved by professional training in applied, operationally oriented nutrition. The results reported here are based on interviews conducted with nutrition professionals in the United States and abroad and a survey of graduates of US graduate programmes. The respondents agreed that appropriate training of nutrition professionals could improve the nutrition situation of the region, recognizing that social and economic factors are critical determinants of nutrition. This field was seen as a social science discipline. The name “public nutrition” is proposed for the field. Critical elements of training include reaching a critical mass of persons at multiple levels; obtaining institutional commitment to allow newly trained professionals the resources and responsibility to apply what they have learned in their jobs; building in follow-up through networking, information exchange, and reunions of participants and faculty; and combining the skills and knowledge of public nutrition with a strong disciplinary base in a recognized field. The substance of the training programme would consist of applied research skills; communication and advocacy skills; programme management and administration; nutrition science; nutrition programmes and policies; social science concepts of economic and political economy; and fieldwork, internships, or practical. The usefulness of each of these fields is assessed by employed graduates of US programmes. Effective professionals also need personal qualities of leadership, dedication, motivation, and an entrepreneurial spirit. Immediate returns to short-term training of front-line programme managers should not result in ignoring the long-term benefit of higher-level professional education of senior administrators, policy makers, and researchers needed to advance the field of nutrition.
Advanced Training in Food and Nutrition: Disciplinary, Interdisciplinary, and Problem-Oriented Approaches
Authors: Pelletier David L.
Published: November 2018

The development of effective and sustainable solutions to food and nutrition problems is known to require knowledge from many disciplines and the involvement of multiple sectors within a country. For this reason, interdisciplinary knowledge and intersectoral action have come to be recognized as important strategies. Disciplinary and interdisciplinary knowledge is essential for characterizing the prevalence, distribution, causes, and consequences of food and nutrition problems, and for developing and testing potential interventions. However, this paper maintains that disciplinary and interdisciplinary knowledge is insufficient for generating effective and sustainable solutions. The paper identifies four limitations inherent in this approach (pragmatic, epistemological, instrumental, and normative) and argues that a problem-oriented, participatory approach is required to overcome these limitations at all administrative levels from community through national policy. This approach draws upon knowledge from diverse disciplines in the search for solutions, but also integrates it with situation-specific knowledge concerning causes, feasibility, and distributional consequences of alternative solutions, and social interests and values held by the interested and affected parties. Although these are amenable to analysis through well-established methods of planning and social sciences, these methods are still subject to the four limitations noted above. This perspective is used in the second half of this paper to identify the key characteristics of effective practitioners and the key elements of advanced training programmes.
Developing a National Training Pyramid
Authors: Solon Florentino S.
Published: November 2018

The training pyramid is a system with designated levels corresponding to types of training needed for personnel in a national nutrition programme. Each proportional level refers to the type, purpose, and content of training and the category of individuals to be trained. Level III, the upper part of the pyramid, is intended for a few professionals with master's or doctoral degrees who deal with macronutrition issues and the solution of nationwide nutrition problems through policies, programmes, macroplanning, and legislative action. Short-term training periods provide skills in studying and formulating national policies to solve malnutrition problems and translate research results into policies for the benefit of the population. Training at level II is intended to develop the research capability of professionals to undertake studies for use in formulating national policies, plans, and programmes. This level of training provides knowledge and skills in research design, information technology, statistics, identifying research needs, developing research proposals, planning and managing research activities, and comprehensively communicating technical information and results to policy makers, legislators, macroplanners, programme planners, managers, and implementers. Short courses on laboratory procedures, new methods, and use of the latest equipment should be included. Level I, the base of the pyramid, is for training professionals to translate national policies and macroplans, including research findings, into community-based programmes and projects appropriate to the existing political, economic, and socio-cultural situation. This level of training focuses on efficient and effective programme implementation and management.
Anxiety detection and training task adaptation in robot-assisted active stroke rehabilitation
Authors: Xu Guozheng , Gao Xiang , Pan Lizheng , Chen Sheng , Wang Qiang , Zhu Bo , Li Jinfei
Published: November 2018

In the therapist-centered rehabilitation program, the experienced therapists can observe emotional changes of stroke patients and make corresponding decisions on their intervention strategies. Likewise, robotic-assisted stroke rehabilitation systems will be more appreciated if they can also perceive emotional states of the stroke patients and enhance their engagements by exploring emotion-based dynamic difficulty adjustments. Nevertheless, few research have addressed this issue. A two-phase pilot study with anxiety as the target emotion state was conducted in this article. In phase I, the motor performances and the physiological responses to the stroke subject’s anxiety with high, medium, and low intensities were statistically analyzed, and anxiety models with three intensities were offline developed using support vector machine–based classifiers. In phase II, anxiety-based closed-loop robot-aided training task adaptation and its impacts on patient–robot interaction engagements were explored. As a comparison, a performance-based robotic behavior adaptation was also implemented. Experimental results with 12 recruited stroke patients conducted on the Barrett WAMTM manipulator verified that the rehabilitation robot can implicitly recognize the anxiety intensities of the stroke survivors and the anxiety-based real-time robotic behavior adaptation shows more engagements in the human–robot interactions.
Constituent power of the multitude
Authors: Lorey Isabell
Published: November 2018

How might we understand a constituent power that is thought not as constitutively juridical but nevertheless as a political power, one that issues from the heterogeneous multitude and develops its collective potentia not by its number but rather in its polyvocality? Such an alternative conception would need to leave gendered connotations, the idea of a masculinist bourgeois subject, and questions of belonging behind. It would need to issue radically from the mutual connectedness of singularities and, against the backdrop of queer-feminist and postcolonial considerations, place the necessity of care and reproduction at its center. Initial prompts for thinking a constituent power that is not constitutively juridical can be found in the work of Antonio Negri. The article further develops Negri’s approach and connects it with the municipalist movements in Spain as examples of new forms of constituent and constituted power.
Building Bridges Through Collaboration and Consensus: Expanding Awareness and Use of Peer Support and Peer Support Communities Among People With Diabetes, Caregivers, and Health Care Providers
Authors: Warshaw Hope , Edelman David
Published: November 2018

Diabetes, regardless of type, is a complex disease. Successful management to achieve both short- and long-term health goals and outcomes is highly dependent on learning, mastery, and regular implementation and execution of self-care behaviors. The importance of a positive mental outlook and minimization of psychosocial barriers to care is increasingly identified as important in managing the whole person with diabetes and, as appropriate, the caregivers. Ongoing support from HCP and increasingly ongoing support from peers are critical elements of quality diabetes care. With the availability of virtually accessible technologies for social media and networking, the volume of peer support among people with diabetes and their caregivers has increased exponentially and will likely continue to do so. With the value of ongoing peer support recognized as an important element in diabetes health, a growing number of peer support communities and increasing engagement in these communities among some diabetes educators, the American Association of Diabetes Educators (AADE) embarked on an initiative to more formally work with diabetes peer support communities and their leaders. To initiate this effort AADE held and supported a consensus meeting in 2017. This article reviews the history and goals of this effort and details the meeting outcomes. It also discusses the collaborations completed since the initial meeting along with plans for the near future. This collaboration is unique and presents a model for similar endeavors in diabetes or other chronic diseases.
Does Posterior Scoliosis Correction Improve Respiratory Function in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis
Authors: Kato So , Murray Jean-Christophe , Ganau Mario , Tan Yongyao , Oshima Yasushi , Tanaka Sakae
Published: November 2018

Study Design:

A systematic review and meta-analysis.

Objectives:

Pulmonary dysfunction is often advocated among the indications for surgical correction of adolescent idiopathic scoliosis (AIS). Previous studies have discussed the effect of scoliosis correction on respiratory function without reaching a definitive conclusion: Some showed that the respiratory function can improve after scoliosis surgery without defining the precise role of anterior, posterior, and combined approaches on this improvement; furthermore, the majority of these studies did not take normal growth into account. As a result, the role of surgery remains to be clarified. The object of the present study was to synthesize the current knowledge regarding changes in respiratory function after posterior corrective surgery for AIS.

Methods:

A comprehensive systematic search was performed to identify all relevant studies in the following electronic databases: MEDLINE, EMBASE, CINAHL (EBSCO). We focused on the studies (1) that discussed posterior fusion surgery for AIS without thoracoplasty, (2) that discussed comparisons of pre- and postoperative percent-predicted values of forced vital capacity (%FVC) or forced expiratory volume (%FEV), and (3) with minimum 2-year follow-up. Forest plots were depicted and Z value was calculated as a test for overall effect.

Results:

Ten studies (6 prospective and 4 retrospective studies) met our inclusion criteria. The overall effect showed that there was no significant difference in %FVC or %FEV between pre- and postoperative measurements (very low evidence).

Conclusions:

Posterior correction surgery for mild to moderate AIS patients showed no significant improvement of postoperative respiratory function measured by relative, percent-predicted values at minimum 2-year follow-up.
Endoscopic Brow Lift Fixation With Mitek Suture Anchors: A 9-Year Experience of a New “Ideal” Technique
Authors: Adetayo Oluwaseun A. , Wong Wendy W. , Motakef Saba , Frew Tyler G. , Campwala Insiyah , Gupta Subhas C.
Published: November 2018

Purpose:

In recent years, the endoscopic technique has emerged as a minimally invasive approach to forehead rejuvenation, although the specific need for and mode of brow fixation for endoscopic brow lifts remain under considerable debate. An ideal fixation device should provide non-palpable long-lasting fixation and allow retention of the device post-operatively without the need for removal. It should also allow precise intraoperative adjustment for symmetry and correction of brow ptosis.

Methods:

The authors describe an endoscopic brow lift technique using an absorbable bone anchor, Mitek Microfix. A retrospective chart review was conducted in patients who underwent endoscopic brow lift procedures utilizing this fixation method at an academic practice. Outcomes evaluated included operative times, reoperation rates, palpability, fixation device permanence, incremental costs comparisons to conventional methods, efficacy, and technical learning curve. Complication rates were evaluated and the economic, incremental cost analysis of current fixation methods was reviewed.

Results:

Eighty-two patients underwent single-procedure endoscopic brow fixation using the Mitek anchor over a 9-year period (2005-2014). The mean operative time was 100 minutes. There were no cases of implant palpability, alopecia, or other postoperative complications. Two patients underwent revision secondary lifts after an average of 5.5 months for temporal ptosis.

Conclusion:

The Mitek Microfix QuickAnchor provides durable, long-lasting fixation without device palpability. Its technical ease of use is demonstrated by the reasonable mean operative time achieved with the active involvement of resident surgeons. This device is operator-friendly, easy to use, fully indwelling, and provides lasting fixation without the development of palpability or alopecia.
10-Year Epidemiology of Ankle Injuries in Men’s and Women’s Collegiate Basketball
Authors: Tummala Sailesh V. , Hartigan David E. , Makovicka Justin L. , Patel Karan A. , Chhabra Anikar
Published: November 2018

Background:

Ankle injury is the most common injury in men’s and women’s basketball, regardless of the level of competition.

Purpose:

To use the National Collegiate Athletic Association (NCAA) Injury Surveillance Program/System (ISP/ISS) to review the 10-year epidemiology of ankle injuries in men’s and women’s collegiate basketball players.

Study Design:

Descriptive epidemiology study.

Methods:

The NCAA ISP was queried for men’s and women’s collegiate basketball ankle injury data from the 2004 through 2014 academic years. Ankle injury rates were calculated based on injuries per athlete-exposure (AE). Injury proportion ratios (IPRs) were determined by comparing variables between sexes. Activity and position of injury were also studied.

Results:

Over the 10-year study period, most ankle injuries in collegiate basketball occurred in the preseason (female, 1.45/1000 AEs; male, 2.00/1000 AEs), were contact related (female, 50.4%; male, 57.6%), were treated conservatively (female, 98.5%; male, 99.3%), and were new injuries (female, 78.0%; male, 78.9%), resulting in a time loss of less than 7 days (female, 62.7%; male, 65.2%). The most common injury types were lateral ligament complex tears (female, 83.5%; male, 80.0%), deltoid ligament tears (female, 5.6%; male, 7.2%), and high ankle sprains (female, 7.1%; male, 7.0%). Guards experienced the highest rate of ankle injuries in competition (female, 50.1%; male, 43.3%), and rebounding was found to be the most common activity during an injury (female, 30.3%; male, 34.4%). The rate of ankle injuries was significantly lower in women than in men (IPR, 0.81 [95% CI, 0.75-0.88]).

Conclusion:

This study found that most ankle injuries in collegiate basketball occurred during the preseason, were contact related, were treated conservatively, and were new injuries that resulted in a time loss of less than 7 days.
Millennials’ Views and Expectations Regarding the Communicative and Relational Behaviors of Leaders: Exploring Young Adults’ Talk About Work
Authors: Omilion-Hodges Leah M. , Sugg Christine E.
Published: November 2018

While research has started to debunk some millennial stereotypes, a gap between this cohort and their predecessors persists. In response, two studies were conducted with matriculating millennials to reveal the expectations they hold regarding typical leader behavior and leader-member relationships. The studies establish millennials’ views and communicative and relational expectations of leaders and also help to answer which leader communication behaviors are likely to be valued and potentially most effective with this cohort. This research puts millennial self-report data in conversation with extant research to offer new insight. Suggestions for instructors and managers are included.
Safety evaluation of Bifidobacterium breve MCC1274 via oral toxicity tests in rats
Authors: Arai Satoshi , Minami Jun-ichi , Muto Masamichi , Iwabuchi Noriyuki , Yamauchi Koji , Xiao Jin-zhong , Abe Fumiaki
Published: November 2018

In this study, the safety of Bifidobacterium breve MCC1274, a probiotic bifidobacterial strain, was assessed by single-dose and 90-day repeated-dose oral toxicity studies. In the single-dose oral toxicity assay using 6000 mg/kg of B. breve MCC1274 corresponding to 8.4 × 1011 colony-forming unit (CFU)/kg, mortality and adverse effects were not observed. Furthermore, the administration of 1000 mg/kg of B. breve MCC1274 by oral gavage in saline for 90 days did not induce any signs of toxicity, such as changes in clinical signs, body weight (BW), food consumption, ophthalmoscopy, urinalysis, hematology, blood chemistry, organ weight, gross pathology, and histopathology compared to the control group given cornstarch in saline (10/sex/group). The no-observed-adverse-effect-level of B. breve MCC1274 in the 90-day repeated-dose toxicity study was greater than 1000 mg/kg corresponding to 1.3 × 1011 CFU/kg. Based on the findings of this study, the acceptable daily intake of B. breve MCC1274 was calculated to be 1.3 × 109 CFU/kg BW/day.
Heterotopic Ossification of the Brachial Plexus After Reverse Total Shoulder Arthroplasty
Authors: Riggle Patrick K , Brazier Brett G , Wilcox C Luke
Published: November 2018

In the following report, we present the case of a patient who presented with a proximal humerus fracture dislocation and an associated brachial plexopathy. After undergoing a reverse total shoulder arthroplasty, the brachial plexopathy showed signs of improvement plateaued until the patient started having increased pain in the involved extremity and the brachial plexopathy began to worsen. At that time, it was discovered that the patient had heterotopic ossification (HO) encasing the brachial plexus and axillary artery. To our knowledge, this is the first reported case of HO involving the brachial plexus and axillary artery.
Subscapularis Management in Total Shoulder Arthroplasty: Current Evidence Comparing Peel, Osteotomy, and Tenotomy
Authors: Bornes Troy D , Rollins Meaghan D , Lapner Peter LC , Bouliane Martin J
Published: November 2018

The optimal approach to management of the subscapularis in total shoulder arthroplasty (TSA) is controversial. Options include the subscapularis tenotomy, lesser tuberosity osteotomy (LTO), and peel. This review provides a summary of subscapularis anatomy and function, outcomes associated with subscapularis management options in TSA, and postoperative subscapularis deficiency. Based on the available literature, LTO appears to result in improved function and subscapularis integrity relative to tenotomy, while peel and LTO have generally led to equivalent outcomes. The highest level of evidence to date is derived from a randomized controlled trial that demonstrated that outcomes following peel and LTO were not significantly different. There is currently a paucity of high-quality evidence as most studies have consisted of small retrospective series with varying outcome measures. Furthermore, the optimal approach to establishing the diagnosis of subscapularis deficiency following TSA is unclear.
In Vivo Modulation of Rat Liver Microsomal Cytochrome P450 Activity by Antimalarial, Anti-HIV, and Antituberculosis Plant Medicines
Authors: Appiah-Opong Regina , Tuffour Isaac , Ofori-Attah Ebenezer , Aning Abigail , Atchoglo Philip , Danso Eunice Ampem , Ahedor Believe , Adjei Samuel , Nyarko Alexander K.
Published: November 2018

Drug interactions are key reasons for adverse drug reactions and attrition from market. Major infectious diseases causing morbidity/mortality in Ghana are malaria, tuberculosis, and HIV/AIDS. In this study, plant medicines commonly used to treat/manage these diseases in Ghana were investigated for their potential to modulate rat cytochrome P450 enzyme activities. Fluorescence and high-performance liquid chromatography–based assays were used to assess effects of antimalarial plant medicines, Fever (FEV), Mal-TF (MAL), and Kantinka terric (KT); anti-TB medicines, Chestico (CHES), CA + ST Pains + HWNT (TF), and Kantinka herbatic (KHB); and anti-HIV/AIDS medicines, Wabco (WAB), AD + T/AD (LIV) and Kantinka BA (KBA) on rat liver microsomal cytochrome P450 enzyme activities. Effects of medicines on rat biochemical and hematological parameters were also assessed. Generally, the medicines altered microsomal CYP1A1/1A2, CYP2B1/2B2, CYP2C9, and CYP2D6 activities. Only KBA elicited an increase (80%) in CYP1A1/1A2 activity. FEV, MAL, CHES, WAB, and LIV strongly inhibited the enzyme activity. All the medicines significantly inhibited CYP2C9 (24%-80%) activity. CYP2D6 activity increased after treatment with MAL, KBA, LIV, and TF. Also, MAL, WAB, LIV, KHB, and CHES increased CYP2B1/2B2 activity, while KT decrease the activity. Generally, the medicines altered liver function in the rats. Cholesterol levels declined after KBA treatment only. White and red blood cell counts, hemoglobin and hematocrit levels were significantly reduced in KT- and KBA-treated rats. Our results suggest that use of the medicines could have implications for drug interactions and safety, particularly if the medicines are administered over prolonged periods. Further investigations are imperative to establish clinical relevance of these results.
Recombinant factor VIII Fc fusion protein drives regulatory macrophage polarization
Authors: Kis-Toth Katalin , Rajani Gaurav Manohar , Simpson Allison , Henry Kate L. , Dumont Jennifer , Peters Robert T. , Salas Joe , Loh Christine
Published: November 2018

The main complication of replacement therapy with factor in hemophilia A (HemA) is the formation of inhibitors (neutralizing anti–factor VIII [FVIII] antibodies) in ∼30% of severe HemA patients. Because these inhibitors render replacement FVIII treatment essentially ineffective, preventing or eliminating them is of top priority in disease management. The extended half-life recombinant FVIII Fc fusion protein (rFVIIIFc) is an approved therapy for HemA patients. In addition, it has been reported that rFVIIIFc may induce tolerance to FVIII more readily than FVIII alone in HemA patients that have developed inhibitors. Given that the immunoglobulin G1 Fc region has the potential to interact with immune cells expressing Fc receptors (FcRs) and thereby affect the immune response to rFVIII, we investigated how human macrophages, expressing both FcRs and receptors reported to bind FVIII, respond to rFVIIIFc. We show herein that rFVIIIFc, but not rFVIII, uniquely skews macrophages toward an alternatively activated regulatory phenotype. rFVIIIFc initiates signaling events that result in morphological changes, as well as a specific gene expression and metabolic profile that is characteristic of the regulatory type Mox/M2-like macrophages. Further, these changes are dependent on rFVIIIFc-FcR interactions. Our findings elucidate mechanisms of potential immunomodulatory properties of rFVIIIFc.
30-day mortality after the start of systemic anticancer therapy for lung cancer: is it really a useful performance indicator?
Authors: Burgers Jacobus Adrianus , Damhuis Ronald Alphons
Published: November 2018

Systemic treatment is the standard treatment for unresectable stage III and IV lung cancer. Nevertheless, a 5–10% death rate has been described within 30 days after the last systemic treatment, suggesting that these patient did not benefit. We analysed the 30-day mortality after start of systemic therapy.

Data were retrieved from the Netherlands National Cancer Registry. From 2010 to 2015, 26 277 patients were included. 56% were men. The median age was 65 years and 31% of patients were aged ≥70 years. 27% involved small cell lung cancer and 73% nonsmall cell lung cancer. Overall mortality within 30 days after the start of systemic treatment was 6.2%. Multivariable analysis established the prognostic influence of age, histology, number of metastatic sites and type of systemic treatment. Chemotherapy was administered in 77 hospitals, treating each 15–161 lung cancer patients with systemic therapy annually. None of the hospitals had a significantly higher 30-day mortality according to hierarchical multivariable analysis, controlling for case-mix.

In the Netherlands, the 30-day mortality rate after start of systemic therapy for lung cancer patients was comparable with earlier reports. Hospital volume did not influence the 30-day mortality rate. 30-day mortality rate is not a meaningful indicator to monitor quality of care.
Work-related variables associated with perceptions of recovery-oriented care among Quebec mental health professionals
Authors: Fleury Marie-Josée , Sabetti Judith , Grenier Guy , Bamvita Jean-Marie , Vallée Catherine , Cao Zhirong
Published: November 2018

Background

Provider working conditions are important in mental health service delivery.

Aims

To identify variables associated with perceived recovery-oriented care among mental health professionals.

Method

A total of 315 mental health professionals and 41 managers across four Quebec service networks completed questionnaires. Univariate and multilevel mixed-effects linear regressions for bivariate and multivariate analyses were performed using independent variables from the input–mediator–output–input model and recovery-oriented care.

Results

Recovery-oriented care related to: working in primary care or out-patient mental health services, team support, team interdependence, prevalence of individuals with suicide ideation, knowledge-sharing, team reflexivity, trust, vision (a subset of team climate), belief in multidisciplinary collaboration and frequency of interaction with other organisations.

Conclusions

Optimising team processes (for example knowledge-sharing) and emergent states (for example trust) may enhance recovery-oriented care. Adequate financial and other resources, stable team composition, training on recovery best practices and use of standardised assessment tools should be promoted, while strengthening primary care and interactions with other organisations.

Declaration of interest

None.
Autoimmune Thyroid Disease in Islet Transplant Recipients Discontinuing Immunosuppression Late After Lymphodepletion
Authors: Dunn Alanna , Lam Anna , Hidalgo Luis , Shapiro A M James , Senior Peter A
Published: November 2018

Context

Clinical islet transplantation (CIT) is an innovative strategy to treat highly selected individuals with type 1 diabetes mellitus (T1DM). Lymphodepletion with alemtuzumab or thymoglobulin is often used for induction therapy in CIT. Alemtuzumab was recently licensed as a treatment of relapsing remitting multiple sclerosis (RRMS). In RRMS, autoimmune thyroid disease (AITD) has developed in up to 40% of individuals treated with alemtuzumab. The appearance of AITD after CIT is not well described. We herein explore factors associated with AITD developing after CIT and any relationship with exposure to lymphodepleting antibodies (alemtuzumab or thymoglobulin).

Case Description

Five cases of AITD developing after CIT for T1DM are described. All were female. Four cases had received alemtuzumab (20 to 40 mg) prior to at least one islet infusion, and one received thymoglobulin induction. The presentation with AITD was 18 to 135 months after first transplant and 11 to 18 months after withdrawal of all maintenance immunosuppression (IS). Four cases presented with clinical and biochemical evidence of hyperthyroidism from Graves disease. One case presented with biochemical evidence of hypothyroidism and positive TSH receptor antibodies. All were treated with conventional therapies for AITD.

Conclusions

Despite routine use of alemtuzumab, clinical presentations of AITD seem to be uncommon in patients with CIT receiving IS. However, AITD can develop after withdrawal of IS, highlighting the need for careful thyroid surveillance in this population.