bluuebunny/crossref_metadata_2025 huggingface dataset:
Perspective from the United Kingdom on Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
Authors: Mercer Nigel S G
Published: February 2019

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare disease known to be associated with textured breast implants. The most up-to-date incidence in the United Kingdom is 1:24,000 and 45 confirmed cases have been reported since the first UK case was reported in 2012 and there has been one confirmed death as a result of BIA-ALCL. How the regulatory framework in the United Kingdom works and shapes the information, which must be given by surgeons to patients contemplating breast augmentation, for any reason, is discussed. In addition, the approach to informing patients with breast implants in situ is discussed. It is surgeons’ duty to inform all prospective patients that there is a risk of BIA-ALCL. Not to do so in the United Kingdom would be likely to leave surgeons open to legal action by patients who develop the disease.
The Protective Effect of Breast Implants in Penetrating Trauma
Authors: Pannucci Christopher J , Kurnik Nicole M , Brzezienski Mark , Higdon K Kye , Rebecca Alanna M
Published: February 2019

Breast implants are typically placed for cosmetic or reconstructive purposes, and are recognized to have a substantial impact on aesthetics and quality of life. In addition, the presence of a breast implant on the chest wall has a potential benefit of force diffusion or force absorption in traumatic injury. This article reports a series of three patients with preexisting breast implants who suffered penetrating chest trauma. In each case, the presence of a breast implant was potentially lifesaving. We describe the cases in detail, provide a conceptual discussion, and discuss directions for future research.

Level of Evidence: 5
Stepwise En Bloc Resection of Breast Implant-Associated Anaplastic Large Cell Lymphoma with Oncologic Considerations
Authors: Tevis Sarah E , Hunt Kelly K , Clemens Mark W
Published: February 2019

Guidelines published by the National Comprehensive Cancer Network state that standard of care treatment for the majority of patients with breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is surgical resection. This cancer is generally indolent, and if confined to the capsule, curative treatment is usually surgery alone. An en bloc resection involves a total capsulectomy, explantation, complete excision of associated masses, and excision of any involved lymph node(s). Patients with surgical control of disease have favorable long-term overall and event-free survival. Oncologic principles should be applied when resecting BIA-ALCL, and a complete oncologic resection is essential to cure patients of the disease. Incomplete resections, partial capsulectomies, and positive margins are all associated with high rates of disease recurrence and have potential for progression of the disease. Routine sentinel lymph node biopsy is unnecessary and full axillary lymph node dissection is rarely indicated except in cases of proven involvement of multiple nodes. Lymphoma oncology consultation and disease staging by imaging is performed prior to surgery. Importantly, en bloc resection is indicated only for an established diagnosis of BIA-ALCL, and is not recommended for merely suspicious or prophylactic surgeries. The purpose of this article was to demonstrate a stepwise approach to surgical ablation of BIA-ALCL with an emphasis on oncologic considerations critical to disease prognosis.
Prepectoral Direct-to-Implant Breast Reconstruction: Early Outcomes and Analysis of Postoperative Pain
Authors: Fredman Rafi , Wu Cindy , Rapolti Mihaela , Luckett Daniel , Fine Jason , McGuire Kandace , Gallagher Kristalyn , Roughton Michelle
Published: February 2019

Background

Direct-to-implant (DTI) breast reconstruction provides high-quality aesthetic results in appropriate candidates. Most commonly, implants are placed in the subpectoral space which can lead to pain and breast animation. Surgical and technological advances have allowed for successful prepectoral implant placement which may eliminate these trade-offs.

Objectives

Here we present early outcomes from 153 reconstructions in 94 patients who underwent prepectoral DTI. We sought to determine whether these patients have less postoperative pain and narcotic use than subpectoral implant or expander placement.

Methods

A retrospective review was performed for all prepectoral DTI reconstructions at our institution from 2015 to 2016. Data were collected on postoperative pain and narcotic use while in hospital.

Results

The average follow-up time was 8.5 months (range, 3–17 months) and the overall complication rate was 27% (n = 41) with the most common complications being skin necrosis (9%, n = 13) and infection (7%, n = 11). No statistically significant difference in complications was found in patients who underwent postmastectomy radiation therapy. Patients who underwent prepectoral DTI reconstruction did not have a statistically significant difference in postoperative pain and narcotic use while in-hospital compared with other techniques.

Conclusion

Prepectoral DTI reconstruction provides good results with similar complication rates to subpectoral techniques. Prepectoral DTI eliminates the problem of breast animation. Although our series did not reach statistical significance in pain scores or requirement for postoperative narcotics, we believe that it is an important preliminary result and with larger numbers we anticipate a more definitive conclusion.

Level of Evidence: 4
Validation strategies for target prediction methods
Authors: Mathai Neann , Chen Ya , Kirchmair Johannes
Published: February 2019

Computational methods for target prediction, based on molecular similarity and network-based approaches, machine learning, docking and others, have evolved as valuable and powerful tools to aid the challenging task of mode of action identification for bioactive small molecules such as drugs and drug-like compounds. Critical to discerning the scope and limitations of a target prediction method is understanding how its performance was evaluated and reported. Ideally, large-scale prospective experiments are conducted to validate the performance of a model; however, this expensive and time-consuming endeavor is often not feasible. Therefore, to estimate the predictive power of a method, statistical validation based on retrospective knowledge is commonly used. There are multiple statistical validation techniques that vary in rigor. In this review we discuss the validation strategies employed, highlighting the usefulness and constraints of the validation schemes and metrics that are employed to measure and describe performance. We address the limitations of measuring only generalized performance, given that the underlying bioactivity and structural data are biased towards certain small-molecule scaffolds and target families, and suggest additional aspects of performance to consider in order to produce more detailed and realistic estimates of predictive power. Finally, we describe the validation strategies that were employed by some of the most thoroughly validated and accessible target prediction methods.
Activating community workers in governing conduct: tensions in the practices to empower others
Authors: Nunn Angela
Published: February 2019

This paper presents findings from a historical study of community renewal, as it was articulated and operationalized in NSW, Australia in the period 1999–2006 to improve conditions on public housing estates. The key argument is that community practitioners need to pay closer attention to the power relations involved in actual interventions that claim to empower others. Further, it is argued that such an analysis is a crucial aspect of developing critical, reflexive and innovative forms of practice which have the potential to reconfigure power relations and open possibilities for new understandings of community. Case examples of the implementation of community renewal are included to show the tensions involved when practitioners engage in empowerment practices that are coercive in that they include the exercise of regulatory and disciplinary power. It is incumbent upon community work practitioners and those who educate aspiring practitioners to understand that policies and programmes utilizing community as a solution to social problems are not benign, nor are they necessarily solely politically expedient, although the dangers lay in conceiving and enacting them as such.
Simultaneous Fault Models for the Generation and Location of Efficient Error Detection Mechanisms
Authors: Leeke Matthew
Published: February 2019

The application of machine learning to software fault injection data has been shown to be an effective approach for the generation of efficient error detection mechanisms (EDMs). However, such approaches to the design of EDMs have invariably adopted a fault model with a single-fault assumption, limiting the relevance of the detectors and their evaluation. Software containing more than a single fault is commonplace, with safety standards recognizing that critical failures are often the result of unlikely or unforeseen combinations of faults. This paper addresses this shortcoming, demonstrating that it is possible to generate efficient EDMs under simultaneous fault models. In particular, it is shown that (i) efficient EDMs can be designed using fault injection data collected under models accounting for the occurrence of simultaneous faults, (ii) exhaustive fault injection under a simultaneous bit flip model can yield improved EDM efficiency, (iii) exhaustive fault injection under a simultaneous bit flip model can be made non-exhaustive and (iv) EDMs can be relocated within a software system using program slicing, reducing the resource costs of experimentation to practicable levels without sacrificing EDM efficiency.
A Retrospective Analysis of Selected Opioids in Hair of Workplace Drug Testing Subjects
Authors: Stowe G Neil , Paulsen Ryan B , Hill Virginia A , Schaffer Michael I
Published: February 2019

Opioids, both naturally occurring and semisynthetic, are effective pain management medications, but also possess the potential for abuse. Analyses of over 37,000 head and body hair samples containing codeine, morphine, hydrocodone, hydromorphone, oxycodone or oxymorphone provide a view of use habits of workplace-testing subjects that cannot be obtained from fluid matrices results. Testing was performed using FDA cleared immunoassays using either 2 ng morphine or oxycodone per 10 mg hair as calibrators. Non-negative screening samples were washed with an extended aqueous wash procedure followed by LC–MS-MS confirmation at a cutoff concentration of 2 ng opioid per 10 mg hair. The LC–MS-MS method measured codeine, morphine, 6-acetylmorphine, hydrocodone, hydromorphone, oxycodone and oxymorphone with an administratively established LOQ of 0.50 ng opioid per 10 mg hair. The linear range was 0.50–100 ng morphine per 10 mg hair, and 0.50–150 ng opioid per 10 mg hair for all other measured analytes. For all analytes, within run precision was ≤5.4%, and between-run precision was ≤6.4%. Analysis of samples containing metabolites found that, among codeine positive samples, 97% contained less than 10% morphine metabolite and 88% less than 20% hydrocodone metabolite, among hydrocodone positive samples, 97% contained less than 10% hydromorphone metabolite and 95% of oxycodone positive samples contained less than 10% oxymorphone metabolite. Our analysis of opioid-positive samples may provide guidelines for interpretation of hair opioid levels typically observed in workplace testing.
False-Positive Serum Cocaine Screening Results in Patients Undergoing Evaluation for Renal Transplant
Authors: Snozek Christine L H , Corey Rebecca L , Buras Matthew R , Johnson-Davis Kamisha L
Published: February 2019

Drug screening during pre-transplant evaluations can have major implications for patient care, particularly because drug abuse has been associated with poor transplant outcomes. Although urine drug screening is usually preferred, serum testing is available for situations such as anuria due to end stage renal disease. However, there are few studies evaluating serum drug screening in specific populations such as patients undergoing kidney transplant evaluation. All serum drug screens ordered between January 2015 and November 2017 on patients being evaluated for renal transplant were compared against a large population of serum drug screens ordered from other institutions. Cocaine screening and confirmation results were evaluated to determine false positives. Cocaine screens were positive in 23 of 537 (4.3%) pre-transplant samples, and 211 of 5,115 (4.1%) comparison samples. Confirmation testing demonstrated that 14 (60.9%) pre-transplant samples were false positives, which was significantly (P < 0.01) higher than the rate of false positives in the comparison group (47/211, 22.3%). No common medication or other cross-reacting substance could be identified in the pre-transplant cohort to explain the false-positive results. Although serum cocaine screening had a low overall false-positive rate, the proportion of false positives was significantly higher in pre-transplant patients. Given the poor transplant outcomes associated with drug abuse, failure to properly interpret screening results as being false positives could negatively affect patient care. All members of the transplant team should recognize the importance of confirmation testing in this setting, to avoid unintended consequences due to false-positive screening results.
Effects of Cantharidin and Norcantharidin on Larval Feeding and Adult Oviposition Preferences of the Diamondback Moth (Lepidoptera: Plutellidae)
Authors: Li Yi-fan , Sun Hong , Xi Na , Zhang Yalin
Published: February 2019

The diamondback moth, Plutella xylostella (L.) (Lepidoptera: Plutellidae), is a destructive insect pest of cruciferous plants that has developed resistance to almost every listed commercial insecticide. Cantharidin as an animal-derived biopesticide is a natural defensive compound produced by Meloidae insects with toxicity to many insects including P. xylostella. Norcantharidin is an important substitute of cantharidin and has similar insecticidal activities to cantharidin. Although the toxicity of cantharidin and norcantharidin to P. xylostella has been reported, little research has focused on the effects of cantharidin or norcantharidin on the behavior of P. xylostella. In this study, we investigated the feeding behavior of third-instar larvae and the oviposition preference of adult P. xylostella in order to explore the effects of different concentrations of cantharidin and norcantharidin. Results show that cantharidin and norcantharidin have antifeedant effect on P. xylostella larvae. The values for AFC50 were 13.0228 and 149.4210 mg/ml, respectively. Furthermore, the oviposition deterrence rate of cantharidin on P. xylostella ranged from 49.37 to 58.24% and that of norcantharidin was from 20.88 to 33.33%. These results suggest cantharidin and norcantharidin may have repellent and antifeedant effect on P. xylostella, which could contribute toward using biopesticides to manage P. xylostella and may provide a new strategy for integrated pest management.
Integrated Management of Tomato Yellow Leaf Curl Virus and its Whitefly Vector in Tomato
Authors: Riley David G , Srinivasan Rajagopalbabu
Published: February 2019

Whitefly-transmitted Tomato yellow leaf curl virus (Family Geminiviridae; Genus Begomovirus) severely restricts tomato production in the Southeastern United States. Whitefly and tomato yellow leaf curl virus management studies typically investigate control tactics individually, but successful management of this pest complex more often relies on a combination of tactics. This study examined the individual and combined effects of tomato yellow leaf curl virus-resistant cultivars, insecticides, and metallic reflective mulch on whiteflies, tomato yellow leaf curl virus disease incidence, and marketable tomato yields using split-split plot trials over 3 yr. Reflective mulch significantly reduced whitefly adults and nymphs and tomato yellow leaf curl virus symptom severity in all 3 yr of the study. Reflective mulch treatments also provided greater marketable tomato yield in 2 out of 3 yr. Imidacloprid and cyantraniliprole treatments reduced whitefly adults and nymphs’ establishment and marginally increased yields, but there was no significant insecticide effect on tomato yellow leaf curl virus incidence/symptom severity compared with the non-treated check. Virus-resistant tomato cultivars did not influence whitefly populations, but provided consistent reduction in virus disease incidence. Interactions between host plant resistance and insecticide treatments ranged from strongly additive in the standard white plastic mulch treatment to only marginally additive in the reflective mulch treatments in terms of enhancing tomato yields. tomato yellow leaf curl virus-resistant tomato cultivars and reflective mulch provided the bulk of the protection against tomato yellow leaf curl virus disease incidence. However, it was the combination of all the best tactics (reflective mulch, cyantraniliprole, ‘Security’ hyb. tomato yellow leaf curl virus-resistant) that provided the maximum increase in marketable tomato yield (2.8-fold) over the least effective combination (white mulch, no whitefly insecticide, ‘FL47’ hyb. tomato yellow leaf curl virus-susceptible).
Effect of Pesticides on Biological Control Potential of Neoscona theisi (Araneae: Araneidae)
Authors: Tahir Hafiz Muhammad , Basheer Tayyba , Ali Shaukat , Yaqoob Rabia , Naseem Sajida , Khan Shafaat Yar
Published: February 2019

The present study was designed to record the effect of λ-cyhalothrin, Bifenthrin, and Glyphosate on the mortality, avoidance behavior, foraging activity, and activity of Acetylcholine esterase (AChE) and Carboxylesterase (CarE) in Neoscona theisi (Walckenaer, 1841). Highest mortality (70%) in N. theisi was recorded against λ-cyhalothrin. However, Glyphosate was found to be least toxic. Spider spent less time on insecticides/herbicide-treated surfaces. Insecticides/herbicide-treated N. theisi consumed less prey than untreated control spiders. Similarly, when N. theisi were offered insecticide/herbicide-treated prey, they consumed significantly less. Increased AChE and CarE activities were recorded in insecticides/herbicide-treated spiders as compared to control group. Total protein contents were less in insecticides/herbicide-treated spiders than control group. The results revealed that λ-cyhalothrin is more harmful to spiders as compared to Bifenthrin and Glyphosate. It is suggested that the effect of all pesticides used in agro-ecosystem on beneficial insects should be evaluated before using them in the fields.
Susceptibility Profile of Aedes aegypti L. (Diptera: Culicidae) from Montclair, California, to Commonly Used Pesticides, With Note on Resistance to Pyriproxyfen
Authors: Su Tianyun , Thieme Jennifer , Lura Taylor , Cheng Min-Lee , Brown Michelle Q
Published: February 2019

The peridomestic anthropophilic Aedes aegypti L. (Diptera: Culicidae) is originated from the wild zoophilic subspecies Aedes aegypti formosus in sub-Saharan Africa, and currently has a broad distribution in human-modified environments of the tropics and subtropics worldwide. In California, breeding populations were initially detected in 2013 in the cities of Fresno, Madera, and San Mateo, and now can be found in 188 cities of 12 counties in the state. Recent genetic studies suggest that this species invaded California on multiple occasions from several regions of the United States and northern Mexico prior to initial detection. As an invasive species and vector for numerous arboviruses, Ae. aegypti is a primary target of surveillance and control in California. In southern California city of Montclair, a population was identified in September 2015, from which a short-term colony was established in an insectary. The susceptibility of this field population to commonly used pesticides with various modes of action, including 15 formulations against larvae and four against adults, was determined, in reference to a susceptible laboratory colony of the same species. No resistance was shown to most pesticides tested. However, tolerance or reduced susceptibility to spinosad, spinetoram, diflubezuron, and fipronil was detected, and modest levels of resistance to pyriproxyfen (resistance ratio = 38.7-fold at IE50 and 81.5-fold at IE90) was observed. Results are discussed based on the field usage and modes of action of the pesticides tested. Strategic selection and application of pesticides against this population of Ae. aegypti in the urban environments should be taken into consideration.
The evolution of nitric oxide signalling diverges between animal and green lineages
Authors: Astier Jeremy , Mounier Arnaud , Santolini Jérôme , Jeandroz Sylvain , Wendehenne David
Published: February 2019

Nitric oxide (NO) is a ubiquitous signalling molecule with widespread distribution in prokaryotes and eukaryotes where it is involved in countless physiological processes. While the mechanisms governing nitric oxide (NO) synthesis and signalling are well established in animals, the situation is less clear in the green lineage. Recent investigations have shown that NO synthase, the major enzymatic source for NO in animals, is absent in land plants but present in a limited number of algae. The first detailed analysis highlighted that these new NO synthases are functional but display specific structural features and probably original catalytic activities. Completing this picture, analyses were undertaken in order to investigate whether major components of the prototypic NO/cyclic GMP signalling cascades mediating many physiological effects of NO in animals were also present in plants. Only a few homologues of soluble guanylate cyclases, cGMP-dependent protein kinases, cyclic nucleotide-gated channels, and cGMP-regulated phosphodiesterases were identified in some algal species and their presence did not correlate with that of NO synthases. In contrast, S-nitrosoglutathione reductase, a critical regulator of S-nitrosothiols, was recurrently found. Overall, these findings highlight that plants do not mediate NO signalling through the classical NO/cGMP signalling module and support the concept that S-nitrosation is a ubiquitous NO-dependent signalling mechanism.
Epidemiology and Etiology of Kidney Disease
Authors: Couchoud Cécile , Bayat Sahar
Published: February 2019

More than 30% of the world population will develop chronic kidney disease (CKD) during their life. More than 10% of the world population live with CKD and, therefore, are at higher risk of cardiovascular events, acute kidney injury episodes, progression to end-stage renal disease, and death. Risk factors of kidney disease occurrence may be intrinsic in a “patient at risk” or be related to a “situation at risk.” Primary prevention among the identified risk groups must be organized to decrease the risk of kidney disease appearance. Moreover, many risk factors also contribute to kidney damage progression in patients with CKD, and, therefore, they also are the target of secondary prevention. Because of restricted funding, the issue of unequal access to treatment, in particular to renal replacement therapy, explain most of the geographical differences observed.
Meaning in Illness
Authors: Borneman Tami , Brown-Saltzman Katherine
Published: February 2019

This chapter explores both the challenges and opportunities presented to patients at the end of life as they search to create meaning of their illness. The dying experience may mean suffering beyond physical symptoms, and nurses often find it difficult to address the anticipatory grief, existential despair, and the depression that arises as one faces death. Identifying these concerns and introducing concepts of how the search for meaning may impart the possibilities of hope, resolution, growth, spiritual discovery, reframing, and coming to peace about the essence of one’s life are addressed. Finally, this chapter describes how care of the dying that integrates these elements becomes a gift for the healthcare professional, offering the possibility to develop resiliency and strength for the future.
Palliative Care in the Community
Authors: Robertson Nancy , Sutton Barbara
Published: February 2019

Palliative care, as its own specialty, has grown exponentially within the hospital setting and is now flowing over into the communities where seriously ill people and their loved ones live. But how to deliver this approach is as uncertain as the socioeconomic and political influences currently at play. What is not unclear is the huge opportunity presented for nursing’s impact on this field. Palliative care is nursing at its core. Along with nursing’s long history of serving in the community, the nursing discipline stands to contribute greatly to the success of this specialty. This chapter reviews the current state of community-based palliative care. It looks at the efficacy of the community-based palliative care interventions, the various models being utilized to deliver these services, and the structure as it exists of the interdisciplinary teams providing this care, as well as the reimbursement challenges currently faced. Rules and regulations along with standards governing palliative care nursing practice will be reviewed, and the future of nursing in this arena is discussed.
Important Legal Concerns Faced by Informal Cancer Caregivers
Authors: Wolf Debra , Pejoves Gorman Cristina
Published: February 2019

This chapter examines various laws that may affect cancer caregivers. Informal caregivers, whether family or friends, often face emotional and financial challenges when taking on caregiving responsibilities for their loved ones. Common concerns may include job security and the financial implications of time off, as well as family conflicts regarding caregiving decisions. As a result, caregivers may experience an increase in stress and obstacles that can interfere with their ability to carry out caregiving responsibilities. This chapter reviews the laws that may be of interest to informal cancer caregivers, including legal protections for caregivers who may need to take time off from work and possible avenues for compensation. The chapter also explores the role that caregivers play in healthcare and other decision-making and the importance of advance directives for cancer patients.
Trauma to the urinary tract and other urological emergencies
Authors: Reynard John , Brewster Simon F , Biers Suzanne , Neal Naomi Laura
Published: February 2019

Management of urological trauma remains much as it was at the time of the third edition of this handbook, though selective renal artery embolization is increasingly used when compared with surgical exploration for renal trauma with persistent bleeding.
Suicide prohibition: Shame, blame, or social aim?
Authors: Knoll James L.
Published: February 2019

Szasz’s final book, Suicide Prohibition: The Shame of Medicine (2011), covers the medical, legal, and philosophical aspects of suicide. The question of suicide goes straight to the core of the human condition. Szasz’s fearless wisdom brought this ostensibly taboo—yet historically popular and philosophically rich—topic into a brighter light. However, this topic is too complex to be resolved by confining it to an overly simplistic dichotomy of autonomy versus paternalism. A critical examination of “rational suicide,” sociological and psychological research on suicide, and various legal opinions concerning several forms of suicide, reveal both agreement and disagreement with Szasz’s detailed, nuanced, and heavily existential position on the matter. His emigration analogy fails because suicide, whatever its benefits, is life-negating, while emigration is typically life-affirming. Throughout this examination runs an implicit juxtaposition of the rational and the normative, from both individualistic and sociopolitical points of view.
The clinical wisdom of Thomas Szasz
Authors: Dewan Mantosh J. , Kaplan Eugene A.
Published: February 2019

Besides Szasz’s controversial views are brilliant contributions to clinical practice, including the following examples: (1) He elaborated the physician-patient relationship with three models—“activity-passivity,” “guidance-cooperation,” and “mutual participation.” (2) In The Ethics of Psychoanalysis (1965), he promoted “autonomous psychotherapy,” which involved noncoercive dialogue between therapist and patient that would lead to education and growth for the latter. (3) He argued that transference is part of the analyst’s judgment and the patient’s experience, and that there is a relationship between transference and learning. (4) He used principles of “object relations” theory to explicate deeply the signs and symptoms of schizophrenia. Contrary to popular belief, he was not “antipsychiatry” simpliciter. As a theorist, he clarified language and tried to understand pain. As a practicing clinician, he advocated ways to help people in distress, urged embracing the freedom and autonomy of patients, and treated them as persons with abilities to help themselves.
Upper Extremity Anomalies
Authors: Clark Robin D. , Curry Cynthia J.
Published: February 2019

This chapter reviews background information about the incidence, epidemiology, genetics, and other anomalies associated with common congenital anomalies of the upper extremity. The discussion reviews the differential diagnosis of transverse, longitudinal (amelia, radial, ulnar), intercalary (phocomelia), and central (split hand/foot) defects of the radius and ulna and combined upper and lower extremity defects. The chapter summarizes common causes of upper extremity anomalies, including amniotic band disruption sequence, teratogenic agents (misoprostol, thalidomide, valproic acid), vascular disruption, chromosome anomalies, and Mendelian congenital malformation syndromes, and it gives recommendations for evaluation and management. A clinical case presentation features an infant with Holt–Oram syndrome.
Polycystic Ovary Syndrome in Active Duty Service Women: A Retrospective Analysis
Authors: Hopkins Dawnkimberly , Wilson Candy
Published: February 2019

Introduction

Women make up 16.3% of the Department of Defense (DoD) active duty military population. January 2016, the Secretary of the Defense opened all military positions to women, including combat positions. Identifying conditions that may impact health and military readiness are essential to maintaining a fit and ready force. Polycystic ovary syndrome (PCOS) is a condition that has significant health and military readiness implications for active duty service women (ADSW). Some of the common manifestations of PCOS, overweight, obesity, and abnormal menstrual cycles, have a direct impact on the deployment readiness of ADSW, which effects military operations. The prevalence of PCOS in ADSW must be identified to ascertain true numbers in the DoD to appropriately support, treat, and manage this population; therefore, the purpose of this study was to explore the prevalence of PCOS diagnosis, in ADSW.

Materials and Methods

A retrospective analysis of electronic health record data from the Department of Defense Military Health Systems DataMart was conducted for calendar years January 2011 – December 2016, using ICD 9 and 10 codes. ADSW with symptoms and conditions that were present with PCOS but did not have the ICD 9 or 10 code for PCOS were also identified to explore the potential undiagnosed prevalence of PCOS. The diagnosed symptoms and conditions included for analysis were weight gain, obesity, dyslipidemia, glucose intolerance, hypertension, acne, acanthosis nigricans, infertility, and menstrual irregularity.

Results

There are 11,190 (0.2%) ADSW diagnosed with PCOS, and 9,112 (0.17%) diagnosed with symptoms that meet the profile and characteristics present in PCOS, but have no diagnosis. All branches of service and ranks were represented in these numbers

Conclusions

PCOS is present in ADSW. Obtaining an accurate prevalence rate of this condition helps reveal the extent of its presence, helps increase awareness, and identify that there is a population in need of targeted support and interventions to maintain a fit and ready force.
A multi-institutional analysis of presentation and outcomes for leptomeningeal disease recurrence after surgical resection and radiosurgery for brain metastases
Authors: Prabhu Roshan S , Turner Brandon E , Asher Anthony L , Marcrom Samuel R , Fiveash John B , Foreman Paul M , Press Robert H , Patel Kirtesh R , Curran Walter J , Breen William G , Brown Paul D , Jethwa Krishan R , Grills Inga S , Arden Jessica D , Foster Lauren M , Manning Matthew A , Stern Joseph D , Soltys Scott G , Burri Stuart H
Published: February 2019

Background

Radiographic leptomeningeal disease (LMD) develops in up to 30% of patients following postoperative stereotactic radiosurgery (SRS) for brain metastases. However, the clinical relevancy of this finding and outcomes after various salvage treatments are not known.

Methods

Patients with brain metastases, of which 1 was resected and treated with adjunctive SRS, and who subsequently developed LMD were combined from 7 tertiary care centers. LMD pattern was categorized as nodular (nLMD) or classical (“sugarcoating,” cLMD).

Results

The study cohort was 147 patients. Most patients (60%) were symptomatic at LMD presentation, with cLMD more likely to be symptomatic than nLMD (71% vs. 51%, P = 0.01). Salvage therapy was whole brain radiotherapy (WBRT) alone (47%), SRS (27%), craniospinal radiotherapy (RT) (10%), and other (16%), with 58% receiving a WBRT-containing regimen. WBRT was associated with lower second LMD recurrence compared with focal RT (40% vs 68%, P = 0.02). Patients with nLMD had longer median overall survival (OS) than those with cLMD (8.2 vs 3.3 mo, P < 0.001). On multivariable analysis for OS, pattern of initial LMD (nodular vs classical) was significant, but type of salvage RT (WBRT vs focal) was not.

Conclusions

Nodular LMD is a distinct pattern of LMD associated with postoperative SRS that is less likely to be symptomatic and has better OS outcomes than classical “sugarcoating” LMD. Although focal RT demonstrated increased second LMD recurrence compared with WBRT, there was no associated OS detriment. Focal cranial RT for nLMD recurrence after surgery and SRS for brain metastases may be a reasonable alternative to WBRT.
Defining Transgene Insertion Sites and Off-Target Effects of Homology-Based Gene Silencing Informs the Application of Functional Genomics Tools in Phytophthora infestans
Authors: Vu Andrea L. , Leesutthiphonchai Wiphawee , Ah-Fong Audrey M. V. , Judelson Howard S.
Published: February 2019

DNA transformation and homology-based transcriptional silencing are frequently used to assess gene function in Phytophthora spp. Since unplanned side-effects of these tools are not well-characterized, we used P. infestans to study plasmid integration sites and whether knockdowns caused by homology-dependent silencing spread to other genes. Insertions occurred both in gene-dense and gene-sparse regions but disproportionately near the 5′ ends of genes, which disrupted native coding sequences. Microhomology at the recombination site between plasmid and chromosome was common. Studies of transformants silenced for 12 different gene targets indicated that neighbors within 500 nt were often cosilenced, regardless of whether hairpin or sense constructs were employed and the direction of transcription of the target. However, this cis spreading of silencing did not occur in all transformants obtained with the same plasmid. Genome-wide studies indicated that unlinked genes with partial complementarity with the silencing-inducing transgene were not usually down-regulated. We learned that hairpin or sense transgenes were not cosilenced with the target in all transformants, which informs how screens for silencing should be performed. We conclude that transformation and gene silencing can be reliable tools for functional genomics in Phytophthora spp. but must be used carefully, especially by testing for the spread of silencing to genes flanking the target.
Something Is Going to Happen Here
Authors: Quinn Kathleen
Published: February 2019

This article focuses on the use of mandalas as part of a reflective practice journaling process. In this article, there is an approach to the science of communication, empathy, and interdependent communication. Drawing from a previous article on the “space between” in communication spirals, this article uses mandalas as preparation for and instrument of diverse communication. Emphasis is on mandala usage within reflective practice to consider depth interiority and then using the mandala as metaphor for engaging and sharing with others externally in dialogue. How to construct the mandala is included in this article, and there is an exercise for observation and assessment of mandalas. This novel structure for reflective practice supports developing transformational leaders and communication skill through expressive arts, narratives, and stories in journaling. This article considers the function of mandalas, interruptions in communication patterns, mirror neurons, possible paths, and collaborative outcomes for understanding and achieving interprofessional wisdom. This transformational discovery pathway and narrative exercises can be used for creating professional learning communities. This form of reflective practice has innovative possibilities for increased self-awareness and self-care. Included in this article is a list of awareness/mindfulness behaviors to act as a guide and encourage readers to undertake the reflective journaling process. The discovery pathway journal creates a permanent record of thoughts and anchors through the expressive art. The process refers to the Sigma Theta Tau International's Scholarship of Reflective Practice as important to the practice of nursing.
Auditory Evoked Responses in Older Adults With Normal Hearing, Untreated, and Treated Age-Related Hearing Loss
Authors: McClannahan Katrina S. , Backer Kristina C. , Tremblay Kelly L.
Published: February 2019

Objectives:

The goal of this study was to identify the effects of auditory deprivation (age-related hearing loss) and auditory stimulation (history of hearing aid use) on the neural registration of sound across two stimulus presentation conditions: (1) equal sound pressure level and (2) equal sensation level.

Design:

We used a between-groups design, involving three groups of 14 older adults (n = 42; 62 to 84 years): (1) clinically defined normal hearing (≤25 dB from 250 to 8000 Hz, bilaterally), (2) bilateral mild–moderate/moderately severe sensorineural hearing loss who have never used hearing aids, and (3) bilateral mild–moderate/moderately severe sensorineural hearing loss who have worn bilateral hearing aids for at least the past 2 years.

Results:

There were significant delays in the auditory P1-N1-P2 complex in older adults with hearing loss compared with their normal hearing peers when using equal sound pressure levels for all participants. However, when the degree and configuration of hearing loss were accounted for through the presentation of equal sensation level stimuli, no latency delays were observed. These results suggest that stimulus audibility modulates P1-N1-P2 morphology and should be controlled for when defining deprivation and stimulus-related neuroplasticity in people with hearing loss. Moreover, a history of auditory stimulation, in the form of hearing aid use, does not appreciably alter the neural registration of unaided auditory evoked brain activity when quantified by the P1-N1-P2.

Conclusions:

When comparing auditory cortical responses in older adults with and without hearing loss, stimulus audibility, and not hearing loss–related neurophysiological changes, results in delayed response latency for those with age-related hearing loss. Future studies should carefully consider stimulus presentation levels when drawing conclusions about deprivation- and stimulation-related neuroplasticity. Additionally, auditory stimulation, in the form of a history of hearing aid use, does not significantly affect the neural registration of sound when quantified using the P1-N1-P2–evoked response.
Synovial chondromatosis of the iliopsoas tendon sheath
Authors: Niedermeier Steven R. , Iwenofu O. Hans , Mayerson Joel L.
Published: February 2019

Synovial chondromatosis (SC), or osteochondromatosis, is a rare, benign lesion that is characterized by synovial formation of cartilaginous or osteochondral bodies. This report describes synovial chondromatosis of the iliopsoas tendon sheath. Preoperative imaging and careful intraoperative dissection are key to not violating a disease-free joint in patients with this rare condition.
Posterior short-segment fixation with transforaminal lumbar interbody fusion for the treatment of unstable lower lumbar fracture
Authors: Khattab Mohamed Fawzy , Elkhateeb Tameem Mohamed
Published: February 2019

Background:

The objective of this study was to evaluate the clinical and radiographic results of posterior short-segment pedicle screw fixation and transforaminal lumbar interbody fusion (TLIF) in selected types of lower lumbar fractures.

Methods:

Twenty-seven patients with lower lumbar fractures were enrolled in this study. Demographic data, neurologic grade, anterior vertebral body heights, vertebral body translation, segmental Cobb angle, and management-related complications were assessed. The minimum follow-up period was 2 yr.

Results:

Twenty male patients and seven female patients underwent the procedure, with a mean operative time of 182 min. Mean blood loss was 588 mL. The mean preoperative local kyphotic angle was 9.5 degrees that improved to 2.5 degrees postoperatively. The loss of correction was insignificant at the final follow-up. The preoperative percentage of height lost improved from a mean of 52.5% to a mean of 89.05% postoperatively, and at last follow-up no loss of correction in height was noted compared to the postoperative results. No pseudarthrosis or metal failure was detected. All patients who were Frankle E on admission remained neurologically intact.

Conclusions:

Posterior short-segment fixation with pedicle screw fixation augmented with TLIF might be a possible choice for selected patients with unstable lower lumbar fractures, particularly in split fractures, burst fractures with a reversed cortex sign, and traumatic spondylolisthesis.
Factors influencing outcomes of endoprosthetic reconstruction of the distal end of the humerus
Authors: Chebli Caroline M. , Crimi Alberto , Letson Douglas , Binitie Odion
Published: February 2019

Background:

Reconstruction of the distal humerus with modular endoprostheses is an uncommon procedure. We report the outcomes from a single institution of distal humeral reconstructions with a modular endoprosthesis.

Methods:

A retrospective chart review of our database from 1/1/2001-12/31/2016 identified 20 patients who received a distal humeral endoprosthesis. The time to failure, type of failure, and final range of motion were evaluated. Comparisons were made between primary and revision endoprostheses. The relationship between resection level, range of motion, and time to failure were evaluated.

Results:

The average age was 69.9 yr with equal numbers of males and females. There were 13 primary and seven revision surgeries. The average follow-up was 40.9 mo. Eight patients experienced a failure requiring further surgical treatment: three soft tissue, two aseptic loosening, two infections and one tumor progression. The average range of motion was 65.86 degrees. The average resection length was 12.86 cm. Kaplan-Meier analysis showed no difference between failure or time to failure in primary versus revision procedures. There was a lower chance of failure with a resection level greater than 12 cm. There was no difference in range of motion and resection level.

Conclusions:

Distal humeral endoprostheses provide stable constructs in limb preserving surgeries. The complication profile is higher than standard total elbows. There was no difference in failures or time to failure between primary and revision surgeries. The major limitation of this study was the limited number of patients. It is one of the larger series evaluating distal humeral replacements.
Development and Evaluation of the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection
Authors: Hur Eun Young , Jin Yinji , Jin Taixian , Lee Sun-Mi
Published: February 2019

Catheter-associated urinary tract infection is one of the most common healthcare-acquired infections. It is important to institute preventive measures such as surveillance of the appropriate use of indwelling urinary catheters and timely removal by identifying patients at high risk for catheter-associated urinary tract infection. The purpose of this study was to develop an Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection and evaluate its predictive validity. This study involved secondary data analysis based on a case-control study and used the data extracted from electronic health records. The Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection was developed using a risk-scoring algorithm that was based on a logistic regression model and integrated into the electronic health records. The following eight risk factors for urinary tract infection were included in the logistic regression model: length of stay, admission to the Intensive Care Unit, dependent physical activity, highest neutrophil level (%), lowest blood sodium level of less than 136 mEq/L, lowest blood albumin level of less than 3.5 g/dL, highest blood urea nitrogen level of greater than 20 mg/dL, and indwelling urinary catheter application period (days). The risk groups classified by the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection were automatically displayed on the patient summary screen of the electronic health record. The predictive validity of the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection gradually increased up to the fifth and sixth assessment data after patients' admission; then, it leveled. It is possible to allocate nurses' time and effort for catheter-associated urinary tract infection risk assessment to surveillance of the use, removal, and management of indwelling urinary catheters and education and training by using the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection in clinical settings.
Changes in Efficiency and Quality of Nursing Electronic Health Record Documentation After Implementation of an Admission Patient History Essential Data Set
Authors: Karp Eva L. , Freeman Rebecca , Simpson Kit N. , Simpson Annie N.
Published: February 2019

The objective of this quality improvement study was to evaluate whether electronic health record system timers and event logs can measure the efficiency and quality of a clinical process in an electronic health record. Using an experimental pre– and post–nonrandomized prospective cohort design, the researchers introduced a newly defined admission patient history essential data set and examined the electronic health record event files and timers to analyze the nursing experience from an efficiency and quality perspective. The researchers evaluated efficiency by measuring the time and clicks required to complete an admission history. The average active time spent documenting the admission patient history decreased by 72% from the preintervention measure (mean = 9.30 minutes) to the postintervention measure (mean = 2.55 minutes). The number of clicks decreased by 76% from the preintervention number of clicks (mean = 151.5) to the postintervention number of clicks (mean = 35.93). The quality of documentation was measured as the proportion of completed essential items and the frequency of completing an assessment in one sequence. The capture of essential data elements improved by almost 6%, and admission patient history data completed in one sequence increased by 24%. These study results demonstrate that system timers and event logs can measure the preintervention and postintervention changes in efficiency and quality of a defined clinical workflow into an electronic health record.