bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of the Clinical Course of Tourette Syndrome: A Longitudinal Study
Authors: Groth Camilla , Skov Liselotte , Lange Theis , Debes Nanette M.
Published: August 2019

Objective:

Tourette syndrome (TS) is a chronic childhood neurodevelopmental disorder characterized by motor and vocal tics and frequent comorbidities. The clinical presentation of Tourette syndrome is heterogeneous and the prognosis for each individual child is difficult to define. This large prospective longitudinal study explores predictors in childhood of the clinical course of tics and comorbidities in early adulthood.

Methods:

The cohort was recruited at the Danish National Tourette Clinic. Data were collected at baseline (N = 314; ages, 5-19 years) and follow-up 6 years later (n = 227; ages, 11-26 years) to examine changes in the expression of tics and comorbidities. Childhood clinical factors, represented by 4 binary clinical outcomes, were selected as possible predictors of the clinical course of tics and comorbidities in early adulthood; these were tic severity and diagnoses of obsessive compulsive disorder (OCD), attention-deficit hyperactivity disorder (ADHD), and emotional disorders.

Results:

The strongest predictors of high tic scores, OCD, or ADHD diagnoses in early adulthood were the corresponding tic (odds ratio [OR]: 1.09), OCD (OR: 1.08), and ADHD (OR: 1.13) severity scores (per scale point) in childhood. Being female (OR: 3.94) and childhood ADHD severity (OR: 1.11) predicted future emotional disorders. Special education, genetic factors, and psychosocial factors were also predictive for the clinical course of Tourette syndrome.

Conclusion:

We identified strong clinical predictors of Tourette syndrome–associated outcomes in early adulthood that are directly applicable to clinical Tourette syndrome populations and may help to guide new patients, plan early interventions, and implement preventive measures.
Effects of the Number of Open-Ended Probing Questions on Response Quality in Cognitive Online Pretests
Authors: Neuert Cornelia E. , Lenzner Timo
Published: August 2019

Cognitive online pretests have, in recent years, become recognized as a promising tool for evaluating questions prior to their use in actual surveys. While existing research has shown that cognitive online pretests produce similar results to face-to-face cognitive interviews with regard to the problems detected and the item revisions suggested, little is known about the ideal design of a cognitive online pretest. This study examines whether the number of open-ended probing questions asked during a cognitive online pretest has an effect on the quality and depth of respondents’ answers as well as on respondents’ satisfaction with the survey. We conducted an experiment in which we varied the number of open-ended probing questions that respondents received during a cognitive online pretest. The questionnaire consisted of 26 survey questions, and respondents received either 13 probing questions ( n = 120, short version) or 21 probing questions ( n = 120, long version). The findings suggest that asking a greater number of open-ended probes in a cognitive online pretest does not undermine the quality of respondents’ answers represented by the response quality indicators: (1) amount of probe nonresponse, (2) number of uninterpretable answers, (3) number of dropouts, (4) number of words, (5) response times, and (6) number and type of themes covered by the probes. Furthermore, the respondents’ satisfaction with the survey is not affected by the number of probes being asked.
College Students’ Adult Attachment and Career Adaptability: Mediation by Maladaptive Perfectionism and Moderation by Gender
Authors: Jahng Kyung Eun , Kim Daeun
Published: August 2019

Career adaptability is a prerequisite for ensuring college students’ career development and effectively solving career-related problems. Given that secure attachment positively contributes to adaptive functioning, this study examined the mediating effect of South Korean college students’ maladaptive perfectionism on the relation between adult attachment insecurity and career adaptability. Further, gender differences in the mediational pathways from attachment insecurity to career adaptability were investigated. Participants include 212 college students (male = 49.1%, female = 50.9%) aged between 19 and 31 years ( M age = 22.50, SD = 2.15) living in South Korea. Results indicated that for male and female students, the relation between attachment insecurity and career adaptability is mediated by maladaptive perfectionism. The multigroup analysis revealed that the relations between attachment insecurity, maladaptive perfectionism, and career adaptability differed by gender. These results emphasize the importance of understanding college students’ personality profiles and supporting their career adaptability based on their personality traits.
Rationalities in the pedagogical regime of practice
Authors: Falster Emil Søbjerg , Warming Hanne
Published: August 2019

Using a Foucauldian governmentality approach, this article examines the connections and tensions between rationalities relying on recognition and democratic ideals, and the educationally and developmentally oriented rationality that characterises the pedagogical regime of practice in Denmark. The conclusion is that rationalities of recognition and democracy are subordinated to an educationally and developmentally oriented rationality. Thus, in practice, the former are transformed into an instrument for fulfilling educational and developmental objectives, with a primary focus on the child achieving an age-appropriate level of development.
Phenomenology and mechanisms of consciousness: Considering the theoretical integration of phenomenology with a mechanistic framework
Authors: Pokropski Marek
Published: August 2019

In this article, I consider the possibility of a theoretical integration of phenomenology and a mechanistic framework. First, I discuss the mechanistic model of explanation and the idea of theoretical integration in science as opposed to unification. I argue that the mechanistic model of explanation is preferable for integrating the cognitive sciences, although it is limited and in the case of consciousness studies should be complemented with phenomenology. Second, I examine three possible approaches to the integration of phenomenology and the mechanistic model of explanation. First, I discuss Integrated Information Theory (IIT) of consciousness and propose a new argument against IIT’s axiomatic method—namely, I argue that IIT misuses the notion of axiom. Next, I discuss two different proposals for the integration of phenomenology with cognitive sciences: front-loaded phenomenology and neurophenomenology. I argue that these proposals cannot be integrated with a mechanistic framework unless requisite modifications are made.
Risk factors for bone loss in juvenile-onset systemic lupus erythematosus: a prospective study
Authors: de Sousa L F A , Paupitz J A , Aikawa N E , Takayama L , Caparbo V F , Pereira R M R
Published: August 2019

Objective

Juvenile-onset systemic lupus erythematosus (JoSLE) is associated with low bone mass for age and fractures; nevertheless, risk factors for bone impairment are poorly understood. The aim of this study was to evaluate risk factors for bone mass loss in JoSLE patients.

Methods

Forty-nine female JoSLE patients were evaluated at baseline and after a 3.5-year follow-up regarding clinical, laboratory (including bone turnover markers), areal bone mineral density (aBMD) and bone microarchitecture parameters using high-resolution peripheral quantitative computed tomography (HR-pQCT). Based on the difference between final and baseline aBMD value, the patients were divided into three groups: aBMD gain (BG), aBMD loss (BL) and aBMD no change (NC).

Results

The mean patient age was 18.7 ± 3.3 years. Sixty-one percent of patients presented with aBMD gain, 18.4% aBMD loss, and 20.4% remained stable during this follow-up period. Comparing the BL with the BG group, there was a higher frequency of alcohol consumption ( p = 0.009), a higher frequency of inadequate calcium intake ( p = 0.047) and lower levels of baseline procollagen type 1 amino-terminal propeptide (P1NP) ( p = 0.036) in the BL group. Moreover, worsening of HR-pQCT parameters trabecular volumetric density ( p = 0.003) and cortical thickness ( p = 0.009) was observed in the BL group. In addition, a higher frequency of renal activity was observed comparing the BL + NC with the BG group ( p = 0.036).

Conclusions

This is the first longitudinal study that has analyzed the risk factors of bone loss in JoSLE patients. The authors emphasize the importance of evaluating lifestyle habits and renal disease activity in these young women. Furthermore, this study suggests that trabecular and cortical compartments deteriorated, and low levels of P1NP may be a predictor of bone impairment in JoSLE.
Augmented Reality as a Tool for Studying Visual Plasticity: 2009 to 2018
Authors: Bao Min , Engel Stephen A.
Published: August 2019

Augmented reality (AR) has developed rapidly since its conception less than 30 years ago and is now a hot topic for both consumers and scientists. Although much attention has been paid to its application in industry, medicine, education, and entertainment, the use of AR in psychological research has been less noted. In this article, we survey recent progress in basic research that uses AR to explore the plasticity of the adult visual system. We focus on a particular application of AR called altered reality, which has been used to shed new light on mechanisms of long-term contrast adaptation and ocular-dominance plasticity. The results suggest that AR could also be a useful tool for the treatment of visual disorders.
Breaking water-in-oil emulsion of Northern Iraq’s crude oil using commercial polymers and surfactants
Authors: Thayee Al-Janabi Omer Yasin , Ibrahim Miran Sabah , Waheed Ibrahim F , Sayda Amanj Wahab , Spearman Peter
Published: August 2019

Water (W) and oil (O) normally mix during production and while passing through valves and pumps to form a persistent water-in-oil (W/O) emulsion, which is a serious restriction in oil production and transporting and refining processes. The objective of this work is to treat emulsions of two crude oil samples labeled KD1 and DGH2 using commercial polymers and surfactants which are also known as demulsifiers. Hydrophile–lipophile balance (HLB) in the demulsifier structure has demonstrated a great effect on breaking W/O emulsion. Emulsion breakers with low HLB value showed better reduction in the dynamic IFT, high diffusivity at the W/O interface, and accelerated coalescence of water droplets. Concomitantly, high emulsion temperatures were found to reduce the interfacial film viscosity and accelerate water droplets coalescence. A maximum water separation efficiency (WSE) of 97% was achieved in the case of KD1 and 88% for DGH2, and using a (1:1) polymer blend demulsifier further increased WSE to 99% after 100 min.
A Simplified Environmental Assessment Methodology for Research Projects as an Alternative to Life-Cycle Assessment
Authors: Fulton Matt , Nurse Alex , Plater Andy
Published: August 2019

Small and medium enterprises and research institutes engaged on eco-innovative research projects are often required to account for environmental benefits of new products, processes, or services. This article describes an environmental assessment methodology for calculating auditable environmental benefits, highlighting case studies as examples. It addresses the challenges involved in conducting assessments of products that have yet to be commercialized by taking into account the quality and confidence of the data and enabling nonexperts to engage with the process to a well-informed level. The method draws on the most pertinent and accessible information to develop a reliable overview of the reportable outputs while minimizing the resource and expertise required by measuring only the change in circumstance. The process is flexible enough to cater to projects from a range of sectors, with different expertise levels, but in-depth enough to be considered an acceptable quantification of environmental outputs by rigid external reporting requirements.
Systematic Review of Community- and Home-Based Interventions to Support Parenting and Reduce Risk of Child Maltreatment Among Families With Substance-Exposed Newborns
Authors: West Allison L. , Dauber Sarah , Gagliardi Laina , Correll Leeya , Lilli Alexandra Cirillo , Daniels Jane
Published: August 2019

Substance-exposed newborns (SENs) are at increased risk of child maltreatment, out-of-home placement, and poor health and developmental outcomes. The purpose of this systematic review is to synthesize existing research on community- and home-based interventions designed to improve parenting and reduce risk of maltreatment for families with SENs, applying a program logic framework. The review includes studies that used preexperimental, quasi-experimental, and experimental designs. Twelve interventions were identified. Of the nine studies that used more rigorous experimental or quasi-experimental designs, five showed positive effects on at least one parenting or child maltreatment outcome, although some studies showed high risk of bias. Full coherence among the intended participants, theory of change, and program components was observed for only two interventions. The findings suggest a need for more rigorous research to develop and test interventions that are grounded in theory and prior research and that address the unique needs of families with SENs.
Queer Temporalities, Spacetimematterings, and a Pedagogy of Vulnerability in Qualitative Inquiry
Authors: Shelton Stephanie Anne , Melchior Shelly
Published: August 2019

This interview project began with a daughter’s innocent desire to ask “Why?” but we find ourselves in an ever-looping liminality that recognizes both the impossibility of such innocence and the power of an “ability to live on the boundaries” of wanting-to-know and never-knowing. This article concludes by considering the implications of maintaining such a space within the context of a qualitative inquiry course and within the scholarly and personal engagements between a qualitative inquiry instructor and student. We examine the ways that this liminal space has shaped our co-writing, our course-based co-learning, and our interactions and has helped to support a “pedagogy of vulnerability” based on (intentional and unwanted) liminalities within Stephanie’s qualitative inquiry courses.
Perioperative Management of Bleeding and Transfusion for Lung Transplantation
Authors: Pena Joseph J. , Bottiger Brandi A. , Miltiades Andrea N.
Published: August 2019

Perioperative allogeneic blood product transfusion is common in lung transplantation and has various implications on the short- and long-term outcomes of lung recipients. This review summarizes the effect of transfusion on outcomes including primary graft dysfunction, chronic lung allograft dysfunction, and all-cause mortality. We outline known risk factors for increased transfusion requirement in lung transplantation and present current evidence regarding the effect of hemostatic agents including antifibrinolytics, recombinant factor VII, and prothrombin complex concentrates. Finally, we highlight the roles of point-of-care coagulation testing and goal-directed transfusion strategies in reducing transfusion requirements in lung transplantation.
Temporally separated feline calicivirus isolates do not cluster phylogenetically and are similarly neutralised by high-titre vaccine strain FCV-F9 antisera in vitro
Authors: Smith Shirley L , Afonso Maria M , Pinchbeck Gina L , Gaskell Rosalind M , Dawson Susan , Radford Alan D
Published: August 2019

Objectives

Feline calicivirus (FCV) is a highly variable and globally important feline pathogen for which vaccination has been the mainstay of control. Here, we test whether the continued use of FCV-F9, one of the most frequently used vaccine strains globally, is driving the emergence of vaccine-resistant viruses in the field.

Methods

This study made use of two representative panels of field isolates previously collected from cats visiting randomly selected veterinary practices across the UK as part of separate cross-sectional studies from 2001 and 2013/2014. Phylogenetic analysis and in vitro virus neutralisation tests were used to compare the genetic and antigenic relationships between these populations and FCV-F9.

Results

Phylogenetic analysis showed a typically radial distribution dominated by 52 distinct strains, with strains from both 2001 and 2013/2014 intermingled. The sequence for FCV-F9 appeared to be integral to this phylogeny and there were no significant differences in the genetic distances within each studied population (intra-population distances), or between them (inter-population distances), or between each population and FCV-F9. A 1 in 8 dilution neutralised 97% and 100% of the 2001 and 2013/14 isolates, respectively, and a 1 in 16 dilution neutralised 87% and 75% of isolates, respectively. There was no significant difference either in variance between the FCV-F9 neutralising titres for the two populations, or in the distribution of neutralisation titres across the two populations.

Conclusions and relevance

Although FCV is a highly variable virus, we found no evidence for a progressive divergence of field virus from vaccine strain FCV-F9, either phylogenetically or antigenically, with FCV-F9 antisera remaining broadly and equally cross-reactive to two geographically representative and temporally separated FCV populations. We suggest this may be because the immunodominant region of the FCV capsid responsible for neutralisation may have structural constraints preventing its longer term progressive antigenic evolution.
Potential Impact on Lipoprotein Subfractions in Type 2 Diabetes
Authors: Kamijo Yuka , Ishii Hideto , Yamamoto Tomohiko , Kobayashi Kunihisa , Asano Hiroyuki , Miake Shunji , Kanda Eiichiro , Urata Hidenori , Yoshida Masayuki
Published: August 2019

Introduction:

Recently, the sodium-glucose cotransporter2 (SGLT2) inhibitor empagliflozin has been shown to lower cardiovascular risk among diabetic patients. It is intriguing that some SGLT2 inhibitors have been found to increase low-density lipoprotein (LDL) cholesterol levels, while the relevance to high-density lipoprotein (HDL) cholesterol is unknown. Although the inhibitory effect of SGLT2 inhibitors on glucose reabsorption may accelerate compensatory lipid metabolism and subsequently reduce body weight and affect the lipid profile, much remains unclear about this mechanism. Therefore, we conducted this study to investigate in detail how canagliflozin affects lipoprotein fractions including LDL and HDL subclasses.

Materials and Methods:

This study is a multicenter prospective study. The participants were patients with 22 type 2 diabetes (60.7 ± 11.6 years, 59.1% of men) who had HbA1c ⩾ 7.0% and consented to participate in the study. They were administered 100 mg canagliflozin orally once per day. Biochemistry test and cholesterol levels of 20 lipoprotein fractions (G1-G20) using high performance liquid chromatography methods were examined before and after 12 weeks of treatment period.

Results:

Significant decreases were observed in the participants’ body weight (69.7 to 67.9 kg, P < .001), systolic blood pressure (129.3 to 119.5 mm Hg, P < .01), and HbA1c (8.5% to 7.4%, P < .001). Cholesterol levels in the 20 lipoprotein fractions increased for very large HDL (G14, G15) and large HDL (G16) ( P < .05).

Conclusions:

Reduction in body weight, improvement of blood glucose levels, and increases in very large HDL and large HDL subclasses were observed after canagliflozin treatment. These beneficial changes might contribute to subsequent suppression of cardiovascular outcomes.
Do pollution havens restrict tourism-led growth? Achieving sustainable tourism via a mix of environmental and tourism policies
Authors: Hamaguchi Yoshihiro
Published: August 2019

Using an R&D-based growth model with endogenous location choices and movement of tourists, we investigate the effect that a grandfathered emission permit and an airfare including alien tax have on international tourism. We find that improved environmental quality, achieved by the restricted allocation of grandfathered permits, leads to tourism-led growth. That is, both the number of tourists and the tourism growth rate increase. By contrast, we find that worsened environmental quality, caused by generous allocation of grandfathered permits and reduced airfares including alien tax, leads to the creation of pollution havens because the policy prompts polluting firms to relocate to the area with the respective regulations. Our findings imply sustainable tourism can be achieved when the respective environmental and tourism policies are implemented.
Reading and writing news: Why consumption and production modes matter
Authors: Fortunati Leopoldina , O’Sullivan John
Published: August 2019

In this article, we analyze two central features of newspaper consumption and production. Reading and writing concern both journalists and readerships, and are closely interconnected. The modes of these practices require a systematizing framework of analysis grounded in theories from sociology, communication studies, and the humanities. At an operational level, we focus first on reading, positing that consumption of newspapers is not confined to browsing, or leafing through them, as traditionally has been maintained. In their practices of newspaper use, audiences apply two contrasting modes, which are distant reading and close reading. Second, we posit that corresponding categories can be applied to writing. The article reflects on a loss of capacity in writing by journalists and by new actors who for the most part have acquired, not so much the ability to write in accordance with accepted norms, but a new habit in and familiarity with casual, quotidian writing. The modes of reading and writing, and especially recent changes around them, are examined with the purpose of considering their implications for journalism and, by extension, for the wider society.
Creepypasta, ‘Candle Cove’, and the digital gothic
Authors: Balanzategui Jessica
Published: August 2019

Throughout the past decade, a multimodal type of internet storytelling has developed that extends upon the early Web 2.0 viral narrative practices of chain emails as well as pre-digital folkloric storytelling traditions such as the ghost story and urban legend. This popular mode of digital storytelling, known broadly as ‘Creepypasta’, is produced and consumed according to folkloric practices that in turn shape its form and aesthetics. The author suggests that a precise genre has emerged out of the originally wide-ranging terrain of Creepypasta, a generic mode constituted of specific thematic preoccupations and aesthetics that she refers to as ‘the digital gothic’. Through analysis of the foundational story ‘Candle Cove’, the article outlines the digital gothic’s anxious preoccupation with dead and residual media, and with the interface between technological and personal change. She demonstrates how ‘Candle Cove’ deconstructs nostalgia in its tense negotiation of the relationship between analogue and digital cultures. The author’s analysis thus illuminates how vernacular online genres such as the digital gothic productively work through the aesthetic and conceptual tensions underpinning technological change in the networked digital era.
The Organisational Evolution of Contemporary International Schools
Authors: Machin Denry
Published: August 2019

Whereas growth in international school numbers is widely reported, less attention has been given to how these schools have developed as organisations. Drawing on organisational life-cycle models (Greiner, 1972) and the work of DiMaggio and Powell (1983), this paper addresses that gap. As international schools grow individually, and as the field expands collectively, processes of institutionalism are affecting the legitimacy of claims to ‘international’ status and, this paper argues, are also normalising organisational shape, structure, form and function. Schools (and their leaders) face isomorphic pressures to mimic each other, are being coerced into similar form and are adopting field-wide normative practices. The paper concludes, however, by showing that culturalist perspectives and institutional entrepreneurship offer an alternative. Reproduction of organisational form may to some extent be inevitable, but that reproduction is moderated by diversity and can be manipulated and resisted by school leaders strong enough to escape the iron cage.
Investigating the perspective of Theory of Knowledge teachers in International Baccalaureate World Schools
Authors: Bergeron Liz , Rogers Leslie
Published: August 2019

As a part of the International Baccalaureate (IB) Diploma Programme (DP) students participate in the Theory of Knowledge (TOK) course. This research used a mixed methods design to investigate the perspective of TOK teachers in IB schools worldwide. To address the research questions, quantitative survey data were analyzed from 1,534 participants, and focus groups with 33 TOK teachers were conducted in Australia, The Netherlands, and the United States. Quantitative data were analyzed using descriptive statistics, t-tests, ANOVA, and linear trends analysis to identify group differences. Qualitative data were coded and analyzed using an inductive approach. Overwhelmingly, survey results indicated that teachers value the TOK course. Teachers ranked the main purposes of the TOK course as 1) to develop an awareness of how knowledge is constructed, critically examined, and renewed by individuals and communities and 2) to help students make connections among academic disciplines and among thoughts, feelings and actions. Teachers ranked the main benefits to students as 1) students better able to critically evaluate knowledge and 2) students better able to identify and reflect on personal assumptions. Teachers strongly agreed that teaching TOK has been a valuable professional development experience for them. Specifically, they indicated it enhanced their own critical thinking and developed their interdisciplinary understanding. Survey results and focus groups suggest the main challenges are 1) assessment, 2) time, and 3) administrative issues (scheduling and class size). Regarding implementation, approximately half of DP coordinators indicated that TOK implementation was different than other IB Diploma Programme aspects, specifically that teacher support and time were different.
The Impact of Variable Pricing, Dynamic Pricing, and Sponsored Secondary Markets in Major League Baseball
Authors: Courty Pascal , Davey Luke
Published: August 2019

Toward the end of the 1990s and into the 2000s, Major League Baseball teams moved away from fixed ticket prices, to first setting prices according to expected game demand, and subsequently to dynamically changing prices in response to demand. Teams have also collaborated with secondary ticket marketplaces to sponsor resale. By exploiting a team panel covering seasons 1999-2017, we use fixed effect models to estimate the impact of these pricing innovations on team revenue and team value. Variable pricing increases revenue and team value by 4.2% and 9.5%, respectively. The introduction of dynamic pricing and sponsored secondary markets has no statistically significant effect on revenue or team value.
Latino Judges on the Federal District Court: ¿Cómo Deciden?
Authors: Hofer Scott , Casellas Jason
Published: August 2019

As the Latino population in the United States grows, it is increasingly important to understand how the unique experience of Latino judges translates into legal decisions. This experience has included, until recently, a bipartisan prioritization to appoint Latinos to the federal judiciary. For the first time, we analyze the judicial decision-making of Latino judges with enough observations to provide robust results. We find that the differences in priorities between the two parties have typically meant more conservative Latino judges on the bench. Using the Carp-Manning U.S. District Court Case Database, we analyze the decisions of Latino judges to determine policy areas where they diverge from their non-Latino counterparts. We find strong evidence that, under certain partisan, ideological, and policy-specific conditions, Latino judges decide differently than non-Latino judges.
Multifactorial Painful Leg Ulcers Due to Hyperhomocysteinemia, Plasminogen Activator Inhibitor-1 4G/5G Heterozygote Gene Mutation, and Beta Thalassemia Minor: A Case Report
Authors: Çaytemel Ceyda , Topaloğlu Demir Filiz , Büyükbabani Nesimi , Türkoğlu Zafer , Uzuner Esen Gül
Published: August 2019

Leg ulcers may occur due to many autoimmune, hereditary, inflammatory, and infectious causes including venous, arterial, and neuropathic ulcers. Hyperhomocysteinemia is a metabolic disorder caused by various enzyme defects in methionine metabolism. The most common cause is methylenetetrahydrofolatreductase (MTHFR) enzyme gene mutations. Hyperhomocysteinemia is an independent risk factor for deep vein thrombosis and peripheral arterial disease. The effects of endothelial cell damage on smooth muscle hypertrophy, platelet aggregation, coagulation, and fibrinolysis cause atherogenesis and thrombosis, leading to venous and arterial lower extremity ulcers. In this article, we report the case of a 47-year-old male patient who was admitted to our clinic due to painful leg ulcers that started 1 year ago. He had a history of vena cava inferior thrombosis, deep vein thrombosis, and 40 pack-year smoking. Histopathological examination of punch biopsy taken from ulcerative lesion showed intense inflammatory infiltration in the middle dermis, erythrocyte extravasation, leukocytoclasia, and thrombus formation in a small diameter venule lumen. There were nonspecific findings in direct immunofluorescence examination. He was found as having MTHFR C677T homozygote and plasminogen activator inhibitor-1 4G/5G heterozygote gene mutation with high homocysteine level of 22.90 µmol/L, and he was diagnosed as hyperhomocysteinemia. He was recommended to quit smoking because it triggered thrombosis in hyperhomocysteinemia. Herein, we present a case of hyperhomocysteinemia due to MTHFR mutation, which is one of the rare hereditary thrombophilia causes.
Oligodendrocyte Kir4.1 Channels Clear Out Congested K+
Authors: Lyman Kyle A. , Chetkovich Dane M.
Published: August 2019

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What Is the Best Target for Ablation of Mesial Temporal Lobe Epilepsy?
Authors: King-Stephens David
Published: August 2019

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Encapsulated Neuroprotection to the Rescue—or How to Safely Protect a Brain From Seizing
Authors: Gross Christina
Published: August 2019

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Risk Factors for a False-Negative Examination in Complete Upper Extremity Nerve Lacerations
Authors: Loewenstein Scott N. , Wulbrecht Reed , Leonhard Vanessa , Sasor Sarah , Cook Julia , Timsina Lava , Adkinson Joshua
Published: August 2019

Background: Many patients with complete nerve lacerations after upper extremity trauma have a documented normal peripheral nerve examination at the time of initial evaluation. The purpose of this study was to determine whether physician-, patient-, and injury-related factors increase the risk of false-negative nerve examinations. Methods: A statewide health information exchange was used to identify complete upper extremity nerve lacerations subsequently confirmed by surgical exploration at 1 pediatric and 2 adult level I trauma centers in a single city from January 2013 to January 2017. Charts were manually reviewed to build a database that included Glasgow Coma Scale score, urine drug screen results, blood alcohol level, presence of concomitant trauma, type of injury, level of injury, laterality, initial provider examination, and initial specialist examination. Bivariate and multivariable analyses were performed to evaluate risk factors for a false-negative examination. Results: Two hundred eighty-eight patients met inclusion criteria. The overall false-negative examination rate was 32.5% at initial encounter, which was higher among emergency medicine physicians compared with extremity subspecialists ( P < .001) and among trauma surgeons compared with surgical subspecialists ( P = .002). The false-negative rate decreased to 8% at subsequent encounter ( P < .001). Risk factors for a false-negative nerve examination included physician specialty, a gunshot wound mechanism of injury, injury at the elbow, and age greater than 71 years. Conclusion: There is a high false-negative rate among upper extremity neurotmesis injuries. Patients with an injury pattern that may lead to nerve injury warrant prompt referral to an upper extremity specialist in an effort to optimize outcomes.
Contemporary optimized practice in the management of pulmonary sarcoidosis
Authors: Aryal Shambhu , Nathan Steven D.
Published: August 2019

Pulmonary sarcoidosis is the most common form of sarcoidosis, accounting for the initial presentation in over 70% patients and with eventual presence in 90% of patients with sarcoidosis. However, the course of the disease is often unpredictable; its manifestations can be highly variable and its treatment may not be effective in all patients. As such, the optimized treatment of pulmonary sarcoidosis often requires a thoughtful personalized approach with the need to get the patient involved in decisions of management. In many patients with pulmonary sarcoidosis, the disease is self-limited and nonprogressive, thus treatment is not necessary. In other patients, the presence of significant symptoms or functional limitation often associated with worsening radiological changes and pulmonary function tests warrants treatment. Corticosteroids are the first-line treatment for pulmonary sarcoidosis; antimetabolites are second-line agents, with methotrexate being most commonly employed. Antitumor necrosis alpha antibodies, especially infliximab, are emerging as potential third-line agents. A high index of suspicion should be held for pulmonary hypertension and other comorbidities that may complicate the course of patients with advanced sarcoidosis. Lung transplantation may be the only option for patients who have refractory disease despite maximal medical therapy.
Outcomes of scapulothoracic fusion in facioscapulohumeral muscular dystrophy: A systematic review
Authors: Kord Dorsa , Liu Eva , Horner Nolan S , Athwal George S , Khan Moin , Alolabi Bashar
Published: August 2019

Background

Facioscapulohumeral muscular dystrophy (FSHD) is a rare condition associated with selective weakness of the muscles of the upper arm, face, and shoulder girdle, negatively affecting daily activities. Scapulothoracic arthrodesis may restore shoulder function and improve quality of life. The purpose of this review is to evaluate the outcomes and complications of scapulothoracic arthrodesis in FSHD patients.

Methods

Medline, Pubmed, and Embase were systematically searched. Studies were included if they described scapulothoracic arthrodesis in FSHD with follow-up, and outcomes were adequately reported. Thirteen eligible articles reported the outcomes of 199 arthrodesis in 130 patients.

Results

The mean gain of shoulder forward elevation and abduction were 45° (p < 0.05) and 40° (p < 0.05), respectively. There was an overall cosmetic satisfaction and improved performance of daily activities. There is limited and heterogeneous data on changes in pulmonary function, but such changes are clinically insignificant. The rate of complications was 41% of which 10% were serious, requiring an intervention or re-admission. The most common complications were hardware failure (8%), non-union (6%), and pneumothorax (5%).

Discussion

Scapulothoracic arthrodesis improved cosmesis, performance of daily activities and shoulder motion with no clinically significant loss of pulmonary function. The complication rate is high, and some are potentially serious.
Mid-term results of a stemless ceramic on polyethylene shoulder prosthesis – A prospective multicentre study
Authors: Jordan RW , Kelly CP , Pap G , Joudet T , Nyffeler RW , Reuther F , Irlenbusch U
Published: August 2019

Introduction

Early reports of stemless shoulder arthroplasty have shown promising clinical and radiological outcomes. The purpose of this study was to report on the mid-term results of an implant that utilises a ceramic humeral head.

Methods

A prospective, consecutive, multicentre study of stemless shoulder prosthesis with a minimum of four years of follow-up was conducted between August 2009 and May 2012. The adjusted Constant–Murley Score (CMS), revision rate and presence of radiolucent lines were recorded at intervals.

Results

A total of 207 patients were eligible for study inclusion; 62.8% were female and mean age was 64.8 years (range 30–86). Mean follow-up was 70.7 months (range 48–100), 73% underwent TSA and 27% hemiarthroplasty. The mean CMS improvement was 42.6 (p < 0.0001) at 48 months. Radiolucencies were present in 2.7% of humeral zones and 14% of glenoid zones at 48-month follow-up. The revision rate was 6.3% with rotator cuff failure (2.9%) the most common indication.

Conclusions

Mid-term results demonstrate that the studied stemless implant with a ceramic humeral head had clinical and radiological outcomes that are comparable to other reported studies.
Tarsal Tunnel Syndrome Secondary to Accessory Musculature: A Case Report
Authors: Neary Kaitlin C. , Chang Eric , Kreulen Christopher , Giza Eric
Published: August 2019

Tarsal tunnel syndrome (TTS) is a relatively uncommon compression neuropathy caused by impingement of the tibial nerve or one of the terminal branches. The presence of accessory musculature at the posteromedial aspect of the ankle has been identified as a rare cause of this condition. Despite the rarity of this condition, it must be considered in patients with refractory symptoms consistent with tibial nerve dysfunction. The accurate diagnosis of this condition relies heavily on a detailed history and physical examination, adequate imaging read by both surgeon and trained musculoskeletal radiologist, as well as a high level of suspicion for such pathology. In this case report, we describe a 46-year-old male with history, examination, and imaging all consistent with TTS secondary to accessory musculature. Following excision of an accessory soleus and flexor digitorum accessorius longus, as well as simultaneous tarsal tunnel release, the patient experienced full resolution of his symptoms. This highlights the importance of considering accessory musculature as a potential cause of TTS in patients presenting with tibial compression neuropathy.

Levels of Evidence: Level V: Case Report
Clinical Spectrum of West Nile Virus Neuroinvasive Disease
Authors: Yu Andrew , Ferenczi Emily , Moussa Kareem , Eliott Dean , Matiello Marcelo
Published: August 2019

West Nile virus (WNV) is the most common arbovirus infection in the United States. The diagnosis requires consideration of not only a broad spectrum of presenting symptoms, ranging from a mild febrile illness to severe encephalitis and acute flaccid paralysis, but also public health risk factors and seasonality. There is no approved targeted therapy for WNV, so treatment relies on supportive care, management of neurologic sequelae and airway, treatment of other systems including the eye, and aggressive rehabilitation. Here, we describe a series of 3 cases of WNV encountered in September 2018 at one institution. First, we describe a case of WNV encephalitis with worsened dyskinesias and a relatively good recovery. Second, we describe a severe WNV encephalitis with overlying motor neuron involvement with a poor outcome. Finally, we describe a case of a WNV meningitis with significant bilateral chorioretinitis, an underappreciated complication of WNV infections. Through these cases, we review the epidemiology of WNV, risk factors for infection, the neurologic sequalae and long-term outcomes, and the importance of recognizing ocular involvement to prevent ophthalmologic complications.
Combined melatonin and poricoic acid A inhibits renal fibrosis through modulating the interaction of Smad3 and β-catenin pathway in AKI-to-CKD continuum
Authors: Chen Dan-Qian , Cao Gang , Zhao Hui , Chen Lin , Yang Tian , Wang Ming , Vaziri Nosratola D. , Guo Yan , Zhao Ying-Yong
Published: August 2019

Background:

Acute kidney injury (AKI) is one of the major risk factors for progression to chronic kidney disease (CKD) and renal fibrosis. However, effective therapies remain poorly understood. Here, we examined the renoprotective effects of melatonin and poricoic acid A (PAA) isolated from the surface layer of Poria cocos, and investigated the effects of combined therapy on the interaction of TGF-β/Smad and Wnt/β-catenin in a rat model of renal ischemia-reperfusion injury (IRI) and hypoxia/reoxygenation (H/R) or TGF-β1-induced HK-2 cells.

Methods:

Western blot and immunohistochemical staining were used to examine protein expression, while qRT-PCR was used to examine mRNA expression. Coimmunoprecipitation, chromatin immunoprecipitation, RNA interference, and luciferase reporter gene analysis were employed to explore the mechanisms of PAA and melatonin’s renoprotective effects.

Results:

PAA and combined therapy exhibited renoprotective and antifibrotic effects, but the underlying mechanisms were different during AKI-to-CKD continuum. Melatonin suppressed Smad-dependent and Smad-independent pathways, while PAA selectively inhibited Smad3 phosphorylation through distrupting the interactions of Smad3 with TGFβRI and SARA. Further studies demonstrated that the inhibitory effects of melatonin and PAA were partially depended on Smad3, especially PAA. Melatonin and PAA also inhibited the Wnt/β-catenin pathway and its profibrotic downstream targets, and PAA performed better. We further determined that IRI induced a nuclear Smad3/β-catenin complex, while melatonin and PAA disturbed the interaction of Smad3 and β-catenin, and supplementing with PAA could enhance the inhibitory effects of melatonin on the TGF-β/Smad and Wnt/β-catenin pathways.

Conclusions:

Combined melatonin and PAA provides a promising therapeutic strategy to treat renal fibrosis during the AKI-to-CKD continuum.
Acupressure to Reduce Treatment-Related Symptoms for Children With Cancer and Recipients of Hematopoietic Stem Cell Transplant: Protocol for a Randomized Controlled Trial
Authors: Lown E Anne , Banerjee Anu , Vittinghoff Eric , Dvorak Christopher C , Hartogensis Wendy , Melton Alexis , Mangurian Christina , Hu Hiroe , Shear Deborah , Adcock Robyn , Morgan Michael , Golden Carla , Hecht Frederick M
Published: August 2019

Background

We describe the study design and protocol of a pragmatic randomized controlled trial (RCT) Acupressure for Children in Treatment for a Childhood Cancer (ACT-CC).

Objective

To describe the feasibility and effectiveness of an acupressure intervention to decrease treatment-related symptoms in children in treatment for cancer or recipients of a chemotherapy-based hematopoietic stem cell transplant (HSCT).

Design

Two-armed RCTs with enrollment of 5 to 30 study days.

Setting

Two pediatric teaching hospitals.

Patients

Eighty-five children receiving cancer treatment or a chemotherapy-based HSCT each with 1 parent or caregiver.

Intervention

Patients are randomized 1:1 to receive either usual care plus daily professional acupressure and caregiver delivered acupressure versus usual care alone for symptom management. Participants receive up to 20 professional treatments.

Main Outcome

A composite nausea/vomiting measure for the child.

Secondary Outcomes

Child’s nausea, vomiting, pain, fatigue, depression, anxiety, and positive affect.

Parent Outcomes

Depression, anxiety, posttraumatic stress symptoms, caregiver self-efficacy, and positive affect. Feasibility of delivering the semistandardized intervention will be described. Linear mixed models will be used to compare outcomes between arms in children and parents, allowing for variability in diagnosis, treatment, and age.

Discussion

Trial results could help childhood cancer and HSCT treatment centers decide about the regular inclusion of trained acupressure providers to support symptom management.
An Overview and Critique of US Immigration and Asylum Policies in the Trump Era
Authors: Schmidt Paul Wickham
Published: August 2019

Executive Summary

This article provides an overview and critique of US immigration and asylum policies from the perspective of the author’s 46 years as a public servant. The article offers a taxonomy of the US immigration system by positing different categories of membership: full members of the “club” (US citizens), associate members (lawful permanent residents, refugees, and “asylees”), friends (nonimmigrants and holders of temporary status), and persons outside the club (the undocumented). It describes the legal framework that applies to these distinct populations and recent developments in federal law and policy that relate to them. It also identifies a series of cross-cutting issues that affect these populations, including immigrant detention, immigration court backlogs, state and local immigration policies, and constitutional rights that extend to noncitizens. It ends with a series of recommendations for reform of the US asylum system, and a short conclusion.
PET-CT in neuroradiology
Authors: Lövblad Karl-Olof , Bouchez Laurie , Altrichter Stephen , Ratib Osman , Zaidi Habib , Vargas Maria Isabel
Published: August 2019

Positron emission tomography (PET) has a long history in the assessment of brain physiology and pathology; however, its initial use was limited to more academic and scientific settings. This changed radically with the clinical introduction of PET–computed tomography (PET-CT). PET-CT has become an integral part of the radiological armamentarium, especially in the assessment of patients with oncological or cardiovascular disorders. It has until now not found a clear role in neuroradiology. Indeed, magnetic resonance techniques have proven superior for the investigation of brain tumors and inflammatory diseases. However, some newer applications are emerging that can re-center PET-CT clearly in the neuroradiological world such as the investigation of vascular diseases.