bluuebunny/crossref_metadata_2025 huggingface dataset:
Multicultural and Transnational Novels
Authors: Meffan James
Published: June 2018

This chapter discusses the history of multicultural and transnational novels in New Zealand. A novel set in New Zealand will have to deal with questions about cultural access rights on the one hand and cultural coverage on the other. The term ‘transnational novel’ gains its relevance from questions about cultural and national identity, questions that have particularly exercised nations formed from colonial history. The chapter considers novels that demonstrate and respond to perceived deficiencies in wider discourses of cultural and national identity by way of comparison between New Zealand and somewhere else. These include Amelia Batistich's Another Mountain, Another Song (1981), Albert Wendt's Sons for the Return Home (1973) and Black Rainbow (1992), James McNeish's Penelope's Island (1990), Stephanie Johnson's The Heart's Wild Surf (2003), and Lloyd Jones's Mister Pip (2006).
Major Authors: Albert Wendt, Sia Figiel, Epeli Hau‘ofa
Authors: Keown Michelle
Published: June 2018

This chapter discusses the work of three Indigenous Pacific novelists: Albert Wendt, Sia Figiel, and Epeli Hauʻofa. Wendt, Figiel, and Hauʻofa all come from the anglophone south-west of Oceania, where Indigenous Pacific literature in English first emerged and became established as an academic field of study in the 1970s. The establishment of the University of the South Pacific (USP) in Fiji in 1968 played an important part in their literary trajectories, particularly Wendt and Hauʻofa. The South Pacific Creative Arts Society (SPCAS), founded at USP in 1972, provided publishing opportunities for many emerging writers from the countries served by USP. The chapter examines examples of fiction by Wendt, Figiel, and Hauʻofa, such as Leaves of the Banyan Tree (1979, Wendt), Where We Once Belonged (1996, Figiel), and Tales of the Tikongs (1983, Hauʻofa).
Newspapers and Journals
Authors: Crowl Linda , Fisher Susan , Webby Elizabeth , Wevers Lydia
Published: June 2018

This chapter examines how novels in Australia, Canada, New Zealand, and the South Pacific were reviewed and publicized, and how readerships were informed and created. Literary journalism in Australia, Canada, New Zealand, and the South Pacific varies according to the populations, histories, and communications infrastructure of each location. In general, a common pattern has been initial evaluations of work against British and European, then latterly American, models, during which time commentators promoted local writing and sketched national ideals for an independent artistic expression. The chapter considers how book reviews were undertaken, as well as the role of reviewers, in newspapers, magazines, literary journals, academic periodicals, and on radio and television programmes. It shows that all the emergent national literatures in English functioned in an increasingly transnational space in the four nations from the 1950s, first under the rubric of Commonwealth literature and then as postcolonial literatures.
Literary Histories
Authors: Kröller Eva-Marie
Published: June 2018

This chapter discusses national literary histories in Australia, Canada, New Zealand, and the South Pacific and summarises the book's main findings regarding the construction and revision of narratives of national identity since 1950. In colonial and postcolonial cultures, literary history is often based on a paradox that says much about their evolving sense of collective identity, but perhaps even more about the strains within it. The chapter considers the complications typical of postcolonial literary history by focusing on the conflict between collective celebration and its refutation. It examines three issues relating to the histories of English-language fiction in Australia, Canada, New Zealand, and the South Pacific: problems of chronology and beginnings, with a special emphasis on Indigenous peoples; the role of the cultural elite and the history wars in the Australian context; and the influence of postcolonial networks on historical methodology.
Global Health Governance as Shared Health Governance
Authors: Prah Ruger Jennifer
Published: June 2018

PG as a global health justice theory joins with the theory of SHG to apply justice principles to health governance. SHG rests on a genuine commitment among global health actors to achieve health justice as opposed to pursuing narrow self, group, or state interests alone. SHG elucidates standards of global and domestic responsibility and accountability for health equity. It proposes a common conceptual and policy framework with a set of distinct but complementary responsibilities for governments, nongovernmental organizations (NGOs), the private sector, and individuals themselves. In the SHG framework, the state has duties to create conditions in which all individuals have the opportunity to be healthy and to reduce and prevent the shortfall between actual and potential health within their countries. Global actors have a duty to help shape conditions in which countries can develop and flourish and promote the health of their populations.
International and Global Health Law
Authors: Prah Ruger Jennifer
Published: June 2018

International health law and global health law comprise a rather new field of academic study. Most broadly, this field encompasses all international legal arrangements pertinent to health—international environmental law, humanitarian and human rights law, trade and labor law, laws relating to arms control, and so on. More narrowly, it incorporates only international legal systems targeting health threats. The two most prominent examples are the International Health Regulations (IHR), focused on infectious diseases, and WHO’s Framework Convention on Tobacco Control (FCTC), concerned with chronic diseases. The PG/SHG approach reaches beyond international health law to offer a normative global health law theory. It sees human flourishing as global society’s end goal and proposes an ethical demand for health equity as the criterion for evaluating global health law. Realizing this ethical goal will likely require legal instruments, but, more fundamentally, it will require public moral norms.
Emerging Countries
Authors: Prah Ruger Jennifer
Published: June 2018

With a growing presence on the world stage, the BRICS nations—Brazil, Russia, India, China, and South Africa—are expanding their influence and impact worldwide. These countries can address global health issues as they build their own health systems. They are growing in significance, separately as nations and collectively as a center of gravity. They are assuming multiplying roles in global health, including funding, knowledge generation and dissemination, technical assistance and policy advice, empowerment and agency enhancement, advocacy, surveillance and outbreak response, and health system development. Their emerging economies and health systems link them closely to the developing world’s concerns, while their growing economic and political influence draws them into the company of industrialized countries and gives them a more powerful voice in global affairs. Their emergence as global health actors may call more attention to developing countries’ perspectives and needs.
Fulfilling Global Health Justice Requirements
Authors: Prah Ruger Jennifer
Published: June 2018

Ensuring that medically necessary and appropriate health care and public health goods and services are available to all is the job of justice. The PG/SHG framework aspires to a goal of self-actualized societies imbued with a commitment to social justice, where governments and people promote the central health capabilities of all. Individual states have primary obligations to prevent and address health inequalities and externalities and to realize their populations’ health capabilities. The global community provides help and guidance when states fail to deliver, though this framework eschews coercive tactics. Rather, PG/SHG deploys public dialogue and education programs to swell support for these commitments. PG/SHG offers a conceptual model of health capability and guidance for operationalization.
Personality Development in Emerging Adulthood
Authors: Pratt Michael W. , Matsuba M. Kyle
Published: June 2018

In Chapter 1, the authors describe the general purposes of the book, and more specifically, its focus on Erik Erikson’s approach to personality development, using Erikson’s own life as a way of illustrating some of the issues of the transition to adulthood as framed in his own theory. Erikson’s theory is then reviewed, and its role in the development of identity research streams, both traditional and narrative in nature, is outlined. The idea of emerging adulthood as a framework for thinking about historical changes in the patterning of the transition from adolescence to adulthood is introduced, and some of its insights and controversies are discussed, as well as its relations to the Erikson stage model. Finally, the chapter covers the history of the Futures Study of young Canadians making the transition to adulthood, and explains the general features of the sample and its broad patterns of development across this period.
Mixed Methods Approaches, Narrative Research, and the Futures Study
Authors: Pratt Michael W. , Matsuba M. Kyle
Published: June 2018

Chapter 3 begins with the story of the Canadian Futures Study and its growth and change over the 15 years of its research “life span.” To orient the reader to the issues of research on personality and narrative that are the focus of this book, the authors first cover mixed methods, which integrate both qualitative and quantitative approaches to research, and their epistemological and research underpinnings in general. The authors then turn specifically to recent approaches to narrative research, including methods for studying the life story. Broader approaches to developmental methods and longitudinal analyses over time are briefly discussed. The chapter ends with a discussion of the specific research methods used in the collection of data and the analyses of narrative and personality development in the Futures Study.
Vocational Development in Emerging Adulthood
Authors: Pratt Michael W. , Matsuba M. Kyle
Published: June 2018

Chapter 6 reviews research on the topic of vocational/occupational development in relation to the McAdams and Pals tripartite personality framework of traits, goals, and life stories. Distinctions between types of motivations for the work role (as a job, career, or calling) are particularly highlighted. The authors then turn to research from the Futures Study on work motivations and their links to personality traits, identity, generativity, and the life story, drawing on analyses and quotes from the data set. To illustrate the key concepts from this vocation chapter, the authors end with a case study on Charles Darwin’s pivotal turning point, his round-the-world voyage as naturalist for the HMS Beagle. Darwin was an emerging adult in his 20s at the time, and we highlight the role of this journey as a turning point in his adult vocational development.
Civic Engagement and Environmentalism in Emerging Adulthood
Authors: Pratt Michael W. , Matsuba M. Kyle
Published: June 2018

Chapter 9 focuses on contexts of positive engagement in the domain of the wider society among emerging adults. The authors examine the growing research literature on civic engagement and volunteering, covering patterns of development and change during emerging to young adulthood, describing how this development is linked to the three personality levels of the McAdams and Pals model. They also describe work on one salient contemporary type of civic engagement, environmentalism, and review what is known on this particular topic in youth. The authors cover the evidence on both of these domains from their Futures Study sample, using both questionnaire and narrative material to expand these findings. As a way of illuminating the key points, the chapter ends with a case study of the early life story of John Muir, an important founder of the environmental and conservation movement in the United States.
Deletion of muscle IGF‐I transiently impairs growth and progressively disrupts glucose homeostasis in male mice
Authors: Vassilakos Georgios , Lei Hanqin , Yang Yun , Puglise Jason , Matheny Michael , Durzynska Julia , Ozery Matan , Bennett Katherine , Spradlin Ray , Bonanno Heather , Park Soohyun , Ahima Rexford S. , Barton Elisabeth R.
Published: June 2018

Insulin‐like growth factors (IGFs) are essential for local skeletal muscle growth and organismal physiology, but these actions are entwined with glucose homeostasis through convergence with insulin signaling. The objective of this work was to determine whether the effects of IGF‐I on growth and metabolism could be separated. We generated muscle‐specific IGF‐I‐deficient (MID) mice that afford inducible deletion of Igf1 at any age. After Igf1 deletion at birth or in young adult mice, evaluations of muscle physiology and glucose homeostasis were performed up to 16 wk of age. MID mice generated at birth had lower muscle and circulating IGF‐I, decreased muscle and body mass, and impaired muscle force production. Eight‐wk‐old male MID had heightened insulin levels with trends of elevated fasting glucose. This phenotype progressed to impaired glucose handling and increased fat deposition without significant muscle mass loss at 16 wk of age. The same phenotype emerged in 16‐wk‐old MID mice induced at 12 wk of age, compounded with heightened muscle fatigability and exercise intolerance. We assert that muscle IGF‐I independently modulates anabolism and metabolism in an age‐dependent manner, thus positioning muscle IGF‐I maintenance to be critical for both muscle growth and metabolic homeostasis.—Vassilakos, G., Lei, H., Yang, Y., Puglise, J., Matheny, M., Durzynska, J., Ozery, M., Bennett, K., Spradlin, R., Bonanno, H., Park, S., Ahima, R. S., Barton, E. R. Deletion of muscle IGF‐I transiently impairs growth and progressively disrupts glucose homeostasis in male mice. FASEB J. 33, 181–194 (2019). www.fasebj.org
Medication Related Osteonecrosis of the Jaw: Basic Research and Clinical Practice for Prevention and Treatment by Ultrasound/Laser Pulsation
Authors: Mikuni-Takagaki Yuko , Hidaka Kouki , Kuroshima Shinichiro
Published: June 2018

Objective:

The latest survey by Japanese Society of Oral and Maxillofacial Surgeons suggested that the number of medication related osteonecrosis of the jaw (MRONJ) patients who received oral bisphosphonate, mostly for postmenopausal osteoporosis, may exceed that by intravenous bisphosphonate for cancer treatment. Consequently, the number of female patients with MRONJ can be 3 times that of male in Japan. The predominance of oral bisphosphonate related cases is more apparent in Korea. MRONJ treatment by laser including that by low level laser (LLLT) is uncommon in Japan partly because of insufficient referrals and collaboration between medical and dental professionals. Here, we evaluated the potential and prospective effectiveness of low-intensity pulsed ultrasound (LIPUS) treatment for MRONJ in terms of translational research.

Materials and Methods:

Primary pathophysiology of MRONJ described in the revised position paper (2016) by the allied task force committee of 6 Japanese societies was listed and used as outcome measures to compare the following therapeutic methods: LIPUS, LLLT, parathyroid hormone (PTH) and cellular transplantation in a review of laboratory and clinical (PTH and LLLT) studies.

Results:

Characteristics of periodontal lesions observed in early stages, including periosteal reaction, thickening of lamina dura and persisting alveolar sockets, were all prevented by LIPUS treatment in model rat experiments.

Discussion:

While half of patients diagnosed as stage 0 may have been overdiagnosed, not progressing to later stages, it remains important to diagnose and treat early stage patients to prevent deterioration of their condition. Non-invasive LIPUS treatment prevented all early symptoms of MRONJ and is promising as a preventive measure for MRONJ.
Response of Osteoblasts and Osteoclasts to Low-Intensity Pulsed Ultrasound: In Vitro and In Vivo Analyses Using Goldfish Scales
Authors: Suzuki Nobuo , Taizo Hanmoto , Yoshiaki Tabuchi
Published: June 2018

Objectives:

Low-intensity pulsed ultrasound (LIPUS), which is known as a noninvasive therapy, promotes the repair of bone fractures. Until now, studies of LIPUS have focused on the proliferation and the differentiation of osteoblasts. However, the effects of LIPUS on osteoclasts are still not fully understood. Therefore, we examined the effects of LIPUS on osteoclastogenesis using goldfish scales with both osteoclasts and osteoblasts as a model of bone.

Materials and Methods:

Ultrasound was generated by the Sonic Accelerated Fracture Healing System (SAFHS 4000J; Teijin Pharma, Ltd). Scales were collected from goldfish under anesthesia; they were then treated with LIPUS for 20 minutes, incubated at 15°C for 3, 6, 12, and 24 hours in L-15 medium, and their mRNA expression was measured. Next, the influence of LIPUS on scale regeneration was investigated to confirm the results obtained from an in vitro experiment.

Results and Discussion:

After 6 hours of incubation following LIPUS treatment, RANKL mRNA increased significantly. Resulting from the increased RANKL mRNA level, the expression of transcription-regulating factors significantly increased after 6 hours of incubation, and the mRNA expression of functional genes was significantly upregulated after 12 hours of incubation. However, the mRNA expression of osteoprotegerin, which is known as an osteoclastogenesis inhibitory factor, also significantly increased after 6 hours of incubation. Thus, we determined that LIPUS moderately activates osteoclasts via RANK/RANKL signaling and may induce bone formation. Next, we performed an in vivo experiment with goldfish. After 2 weeks of daily LIPUS exposure, the regeneration rate of the LIPUS-treated scales was significantly higher than that of control scales. These data support the hypothesis that LIPUS moderately activates osteoclasts and induces bone formation.
Bone Response to Physical Stimulus From In Vitro to In Vivo
Authors: Naruse Kouji
Published: June 2018

Low-intensity pulsed ultrasound (LIPUS) is considered as a type of mechanical stimulus (mechanical stress). When the bone fracture part is treated with a low power ultrasonic pulse, various cells present in the fracture part act as a sensor of the mechanism. It has been reported that the acceptance of mechanical stress is mediated through the cell adhesion factor integrin at the cytoskeleton. Bone response to physical stimulus is different from acceptance of extension (compression) stimulus, which is well-known as mechanical stress acceptance. Accepted information is delivered intracellularly via various intracellular transmission systems and regulates the transcriptional regulatory region of the target gene. The reacted cells act on these stimuli to autocrine, paracrine, differentiation promoting action, cell migration action and the like.

At the fracture site, the fracture healing process as wound healing is progressing, and various cell reactions occur simultaneously or overlapping in time and space. It is thought that when the low power ultrasonic pulse is irradiated, reaction by the above-mentioned mechanical stress occurs in each cell, thereby promoting the overall fracture healing process.
Managing the airway in acute care patients
Authors: Meissen Heather , Johnson Laura
Published: June 2018

Understanding how to assess, secure, and manage an airway can save a patient's life in an emergent situation. This article briefly describes the basics of airway management in the acute care setting.
Addressing pediatric intoeing in primary care
Authors: Davis Lauren , Nativio Donna G.
Published: June 2018

Primary care providers frequently encounter children with an intoed gait. Intoeing is most often a normal variation of development that resolves without treatment. The well-informed primary care NP can identify the small subset who need referral through child and/or family history, physical exam, and identification of red flags.
Cancer incidence in Mozambique in 2015–2016: data from the Maputo Central Hospital Cancer Registry
Authors: Carrilho Carla , Fontes Filipa , Tulsidás Satish , Lorenzoni Cesaltina , Ferro Josefo , Brandão Mariana , Ferro Ana , Lunet Nuno
Published: June 2018

There is scarce information on cancer incidence in Mozambique. We aimed to describe cancer incidence data from the Cancer Registry of the Maputo Central Hospital (MCH) in 2015–2016, for Maputo City dwellers, and to compare the incidence rates with those observed in 1956–1961. Cancers with incidence data in 2015–2016 were identified by the Cancer Registry of the MCH. Crude and age-standardized incident rates (ASIR, per 100 000) – direct method, world standard population – were computed for Maputo City, under the assumption that most cancer cases among this population were identified at the MCH. A total of 1707 incident cases in Maputo City dwellers were registered (76.6% confirmed histologically). Prostate cancer, Kaposi sarcoma, and liver cancer were the most frequent in men (ASIR: 24.5, 19.8, and 13.3, respectively). Cervical and breast cancers, and Kaposi sarcoma were the most common among women (ASIR: 32.4, 11.8, and 9.5, respectively). Compared with the data from 1956 to 1961, the most pronounced declines in ASIR were for bladder and liver cancers, in both sexes, and increases were greater for prostate cancer among men (172.2%) and breast cancer (237.1%) among women. Our study highlights the high frequency of infection-related cancers in Maputo, but also of those related to the ongoing demographic and socioeconomic transition.
Use of Communication Tools for Mechanically Ventilated Patients in the Intensive Care Unit
Authors: Holm Anna , Dreyer Pia
Published: June 2018

The use of light and no sedation is gaining currency in the intensive care unit, resulting in more conscious patients. Due to mechanical ventilation, patients are unable to communicate verbally, and may feel frustration. Communication tools may help; however, they are not used systematically in clinical practice. Based on “complex interventions” and a qualitative approach, a communication tool was modified, tested, and evaluated in this study. The tools consisted of a tablet with communication software and a laminated “communication book” with identical structure. Seven nonsedated, mechanically ventilated patients tested the tools and were observed in field studies. Findings show that challenges in using communication tools may be related to the patient, nurses, and/or technology. Patients may experience difficulties in using the tools, especially if they are extremely fatigued or have cognitive impairments and/or reduced muscle strength. Communication tools were not always necessary; however, some found them very helpful and the only way of conveying a message. Findings also show that the best way to facilitate communication is through a systematic communication strategy initiated by the nurse.
A Longitudinal Study of Road Traffic Noise and Body Mass Index Trajectories from Birth to 8 Years
Authors: Weyde Kjell Vegard , Krog Norun Hjertager , Oftedal Bente , Magnus Per , White Richard , Stansfeld Stephen , Øverland Simon , Aasvang Gunn Marit
Published: June 2018

Background:

Being overweight constitutes a health risk, and the proportion of overweight and obese children is increasing. It has been argued that road traffic noise could be linked to adiposity through its influence on sleep and stress. Few studies, to our knowledge, have investigated whether noise and adiposity are associated. Most of them were on adults, and we are not aware of any longitudinal study using repeated measures.

Objectives:

The present longitudinal study investigated whether road traffic noise exposures in pregnancy (N = 6,963; obs = 22,975) or childhood (N = 6,403; obs = 14,585) were associated with body mass index (BMI) trajectories in children.

Methods:

We obtained information on BMI and covariates from questionnaires used in the Norwegian Mother and Child Cohort Study, Statistics Norway, and Medical Birth Registry of Norway. We modeled road traffic noise for the most exposed façade of children’s present and historical addresses at 6 time points from pregnancy to age 8. We investigated effects on BMI trajectories using repeated measures and linear mixed models.

Results:

The results indicated that BMI curves depended on road traffic noise exposure during pregnancy, but not on exposure during childhood. Children in the highest decile of traffic noise exposure had increased BMI, with 0.35 kg/m2 more than children in the lowest decile, from birth to age 8 years.

Conclusions:

The results indicate that exposure to road traffic noise during pregnancy may be associated with children’s BMI trajectories. Future studies should investigate this further, using anthropometric measures such as waist-hip ratio and skinfold thickness, in addition to BMI.
Hysteroscopic myomectomy: a comparison of techniques and review of current evidence in the management of abnormal uterine bleeding
Authors: Friedman Jaclyn A. , Wong Jacqueline M.K. , Chaudhari Angela , Tsai Susan , Milad Magdy P.
Published: June 2018

Purpose of review

Submucosal uterine leiomyomas are a common benign pelvic tumor that can cause abnormal uterine bleeding and may contribute to infertility and miscarriage. Hysteroscopic myomectomy is the treatment of choice to alleviate bleeding from these myomas and to normalize the uterine cavity. This review discusses the techniques and recent evidence for hysteroscopic myomectomy and examines the two primary surgical tools employed today: the bipolar resectoscope and hysteroscopic mechanical morcellator.

Recent findings

Hysteroscopic myomectomy has been a popular treatment for symptomatic submucosal fibroids for decades; it is a minimally invasive, low-cost, low-risk procedure, and is associated with high patient satisfaction. There have been rapid advances in the surgical technology available for this procedure. Both the bipolar resectoscope and the hysteroscopic mechanical morcellator are appropriate tools to remove submucosal myomas. Although the hysteroscopic morcellators have been associated with shortened operative time and a decreased learning curve, the data are limited for their use on type 2 fibroids. The strength of the bipolar resectoscope lies in its ability to resect deeper type 2 fibroids.

The evidence suggests that no one technique should be used for all patients, but rather a choice of technique should be taken on a case-by-case basis, depending on the myoma number, size, type, and location. Gynecologists must become knowledgeable about each of these techniques and their associated risks to safely offer these surgeries to their patients.
SHANK3 variant as a cause of nonsyndromal autism in an 11-year-old boy and a review of published literature
Authors: Kanani Farah , Study DDD , Balasubramanian Meena
Published: June 2018

Autism spectrum disorder (ASD) encompasses a spectrum of pervasive neuropsychiatric disorders characterized by deficits in social interaction, communication, unusual and repetitive behaviours. The aetiology of ASD is believed to involve complex interactions between genetic and environmental factors; it can be further classified as syndromic or nonsyndromic, according to whether it is the primary diagnosis or secondary to an existing condition where both common and rare genetic variants contribute to the development of ASD or are clearly causal. The prevalence of ASD in children is increasing with higher rates of diagnosis and an estimated one in 100 affected in the UK. Given that heritability is a major contributing factor, we aim to discuss research findings to-date in the context of a high-risk autism candidate gene, SHANK3 (SH3 and multiple ankyrin repeat domain 3), with its loss resulting in synaptic function disruption. We present a 10-year-old patient with a pathogenic de novo heterozygous c.1231delC, p.Arg411Val frameshift variant in SHANK3. He presented with severe autism, attention deficit hyperactivity disorder and pathological demand avoidance, on a background of developmental impairment and language regression. The number of genes associated with autism is ever increasing. It is a heterogeneous group of disorders with no single gene conferring pathogenesis in the majority of cases. Genetic abnormalities can be detected in ~15% of ASD and these range from copy number variants in 16p11.2 and 15q13.2q13.3 to several well-known genetic disorders including tuberous sclerosis and fragile X syndrome. Further, high confidence autism genes include but are not limited to NRXN, NLGN3, NLGN4, SHANK2 and SHANK3.
Impact of Comorbidity on Symptoms and Quality of Life Among Patients Being Treated for Breast Cancer
Authors: Wu Horng-Shiuann , Davis Jean E. , Chen Ling
Published: June 2018

Background

Cancer patients often have other noncancer medical conditions. Presence of comorbidities negatively affects cancer survival.

Objective

The aim of this study was to investigate comorbidity, risk factors for comorbidity, and how comorbidity was associated with symptoms and quality of life in patients being treated for breast cancer.

Methods

One hundred and one breast cancer chemotherapy outpatients completed this study. Comorbid conditions, weight, height, and smoking status were identified by chart review. Symptoms and quality of life were self-reported using psychometrically sound instruments. Log-linear regression analyses with age as the covariate examined impact of ethnicity, body mass index (BMI), and smoking on comorbidities.

Results

Approximately 84% of the participants had 1 or more comorbid conditions. Adjusting for age, number of comorbidities differed by BMI (P = .000); the obese group had significantly more comorbidities than the normal and overweight groups. The interaction between BMI and smoking was significant (P = .047). The obese participants who smoked had significantly more comorbidities compared with those who were obese but did not smoke (P = .001). More comorbid conditions were associated with greater pain (P < .05) and poorer sleep quality (P < .05). Comorbidity significantly correlated with symptoms and functional aspects of quality of life (P < .01 and P < .05, respectively). A greater number of comorbidities was associated with lower physical and role functioning and worse fatigue, dyspnea, appetite loss, and nausea and vomiting (all P < .05).

Conclusions

Comorbidity exerts negative impacts on symptoms and quality of life. Weight and smoking status are strong determinants of breast cancer comorbidity.

Implications for Practice

Personalized care planning, weight management, and smoking cessation may lead to better cancer outcomes.
Admission Hyperoxia Is a Risk Factor for Mortality in Pediatric Intensive Care*
Authors: Numa Andrew , Aneja Himanshu , Awad John , Ravindranathan Hari , Singh Puneet , Swil Kevin , Williams Gary
Published: June 2018

Objectives:

To determine whether the association between hyperoxia and increased risk-adjusted mortality in adult intensive care patients is also observed in a pediatric intensive care population.

Design:

Single-center retrospective analysis of admissions to ICU over a 5-year period commencing January 1, 2012, examining the relationship between Pao
2 measured within the first hour of admission and risk-adjusted mortality. Standardized mortality rates were calculated using the Pediatric Index of Mortality-3, and patients were grouped into 50 mm Hg (6.67 kPa) Pao
2 bands to assess the relationship between initial Pao
2 and risk-adjusted mortality.

Setting:

Tertiary PICU with 17 beds and 1,100 annual admissions located in metropolitan Sydney, Australia.

Patients:

A total of 1,447 patients 0–18 years old with Pao
2 recorded at admission to the ICU.

Interventions:

None.

Measurements and Main Results:

There were 5,176 patients admitted to the ICU during the study period and 1,447 (28%) with Pao
2 recorded at admission. A U-shaped relationship between raw mortality and admission Pao
2 was observed, with lowest mortality (2.3% and 2.6%, respectively) observed in the 101–150 (13.5–20.0 kPa) and 151–200 mm Hg (20.1–26.7 kPa) bands and the highest mortality observed in patients with Pao
2 less than 50 mm Hg (6.67 kPa) with mortality of 5.3%, or greater than 350 mm Hg (46.7 kPa) with mortality of 18.2%. Hyperoxia at admission was associated with an increase in risk-adjusted mortality, with polynomial regression indicating a strong correlation between Pao
2 band and risk-adjusted outcome (r
2 = 0.845). When included in a multivariate model that included the Pediatric Index of Mortality-3 variables, the odds ratio for hyperoxia (defined as Pao
2 > 250 mm Hg [33.3 kPa]) predicting death was 2.66 (p = 0.047).

Conclusions:

In this single-center study, hyperoxia at admission to the PICU was highly correlated with increased risk-adjusted mortality. Further investigation of these observations in a large multicenter cohort is warranted.
Short-Term Effects of Normocapnic Hyperpnea and Exercise Training in Patients With Chronic Obstructive Pulmonary Disease
Authors: Paneroni Mara , Simonelli Carla , Saleri Manuela , Trainini Debora , Fokom Georges , Speltoni Ilaria , Piaggi Giancarlo , Ambrosino Nicolino , Vitacca Michele
Published: June 2018

Objective

The aim of the study was to evaluate the short-term physiologic effects of respiratory muscle training with normocapnic hyperpnea added to standard exercise training on respiratory muscle endurance/strength and exercise tolerance in patients with chronic obstructive pulmonary disease.

Design

The study used a randomized controlled trial. Patients referred for rehabilitation were randomly assigned to 20 sessions (twice daily 5 d/wk) of either normocapnic hyperpnea (group 1, n = 12) or sham maneuvers (group 2, n = 10) in addition to individualized cycle training and abdominal, upper, and lower limb muscle exercise. At baseline and end of study, patients underwent evaluation of respiratory muscle endurance, maximum voluntary ventilation, maximal inspiratory, and expiratory pressures, and 6-min walking distance.

Results

After training, a significant improvement was found only for group 1 in respiratory muscle endurance time (by 654 [481] secs versus 149 [216] secs for group 2, P = 0.0108) and maximal inspiratory (group 1: from 81.2 [21.9] cmH2O to 107.6 [23.0] cmH2O, P = 0.018 versus group 2: from 75.4 [13.8] cmH2O to 81.3 [18.9] cmH2O, P = 0.139). The difference between groups for 6-min walking distance, maximum voluntary ventilation, and expiratory pressures was not significant.

Conclusions

Short-term normocapnic hyperpnea training added to standard exercise, compared with exercise training alone, improves respiratory muscle endurance and strength but not exercise tolerance in patients with chronic obstructive pulmonary disease.
Treatment of Digital Melanonychia with Atypia
Authors: Lans Jonathan , van Leeuwen Wouter , Jupiter Jesse B. , Eberlin Kyle R.
Published: June 2018

Background:

Melanonychia of the digit is uncommon in the Caucasian population and is concerning because of potential malignant transformation. Several histologic changes occur before malignant transformation, including melanocytic atypia. The authors evaluated patients with melanonychia with melanocytic hyperplasia to determine the risk factors for malignant transformation.

Methods:

The authors retrospectively reviewed records for patients older than 18 years that underwent biopsy for melanonychia. They identified 22 patients with melanocytic hyperplasia with a median age of 61 years (interquartile range, 44 to 71 years). A bivariate analysis was performed to evaluate whether the degree of atypia was associated with malignant transformation and whether treatment choices by surgeons were based on melanocytic atypia.

Results:

Following biopsy, patients were followed for a median of 41.0 months (interquartile range, 4.8 to 100.6 months). Melanocytic atypia was present in nine patients and transformed into a malignancy in three: in two patients it became a melanoma in situ, and in one it became an acral lentiginous melanoma. Moderate-severe and severe melanocytic atypia was associated with malignant transformation. After initial biopsy, 14 patients were monitored (11 without atypia and three with atypia). One patient with slight atypia, two patients with moderate-severe atypia, and two patients with severe atypia underwent additional treatment. Patients with melanocytic hyperplasia without atypia were monitored more often (78.6 percent versus 21.4 percent).

Conclusions:

Melanonychia presents a challenge to the hand surgeon, as some patients may be monitored and some should undergo additional resection. Patients with moderate-severe melanocytic atypia following biopsy should undergo resection, and those with mild to slight atypia can most often be monitored clinically.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Mobile Apps for Individuals With Rheumatoid Arthritis
Authors: Luo Dee , Wang Penny , Lu Fengxin , Elias Josephine , Sparks Jeffrey A. , Lee Yvonne C.
Published: June 2018

Background

Mobile health applications (apps) have the potential to help individuals with chronic illnesses learn about, monitor, and manage their condition, but these apps are largely unexamined, with the state and direction of development unclear.

Objective

We performed a systematic review of publicly available apps, directed toward individuals with rheumatoid arthritis (RA); described their current features; and determined areas of unmet need.

Methods

We searched the iTunes and Google Play App Stores for the term “arthritis” and reviewed the descriptions of these apps for specific mentions of RA. Applications that met inclusion criteria were downloaded and reviewed. Using a set of quality measures identified from literature review, we assessed each app for 4 features: basic characteristics, content source, functionality, and security. Frequencies for each feature were recorded, and percentages were calculated.

Results

Twenty apps intended for use by RA patients were identified in December 2016. Fifty percent of apps (n = 10) offered only symptom tracking. Five (20%) provided only information about RA, and 5 (20%) engaged patients by providing both symptom tracking and educational information. Fewer than 50% of apps provided means to contact health care providers or link to an online community, and only 6 (30%) offered security protection for the user.

Conclusions

Most current RA apps do not provide a comprehensive experience for individuals with RA. Areas for optimization include the implementation of smartphone accessibility features and secure methods of protecting individual health information.
Factors Associated With Inadequate Intraoperative Baseline Lower Extremity Somatosensory Evoked Potentials
Authors: Chen Jonathan H. , Shilian Parastou , Cheongsiatmoy Justin , Gonzalez Andres A.
Published: June 2018

Purpose:

Intraoperative neurophysiologic monitoring involves the use of various modalities, including somatosensory evoked potentials (SEP), to assess the integrity of the at-risk nervous system during surgeries. Reliable baseline tracings are important because they are data against which future tracings are compared to detect potential injury. In some cases, adequate baselines may be difficult to achieve. Therefore, we analyzed several patient-specific factors to determine which variables are associated with inadequate intraoperative SEP baseline signals.

Methods:

This is a single-center, retrospective chart review of 631 consecutive patients who underwent spine or cranial surgeries between 2010 and 2011. Variables analyzed included age, glucose levels, diabetes mellitus type 2, hypertension, hyperlipidemia, height, weight, sex, smoking, preexisting neurologic conditions, surgical history, lower extremity edema, and neurologic examination findings. Association between these patient factors and baseline lower extremity SEP signals were analyzed.

Results:

Height, weight, neurologic deficits, lower extremity edema, and history of neurologic disease are each associated with inadequate baseline lower extremity SEPs after controlling for confounding variables. Baseline signals were able to be acquired in 94.1% of patients.

Conclusions:

Adequate baselines are paramount for successful intraoperative neurophysiologic monitoring. However, certain patient-specific factors are associated with inadequate baseline SEP signals. Physical examination findings and a detailed chart review can be done to identify these factors and guide expectations during monitoring. Further research related to patient-specific factors amenable to modification can further improve our capacity to protect the nervous system during surgery.
Multiparametric Signature of Glioblastoma Differentiation Revealed by Imaging of Cellular Epigenetic Landscapes
Authors: Farhy Chen , Hariharan Santosh , Ylanko Jarkko , Woudenberg Lotte van , Cimadamore Flavio , Ugarte Fernando , Forsberg Camilla , Huang Chun-Teng , Andrews David W. , Terskikh Alexey V.
Published: June 2018

The resistance of Glioblastoma (GBM) to conventional cytotoxic drugs has prompted novel therapeutic strategies, including differentiating tumor propagating cells (TPCs) into less tumorigenic cells using small molecule inducers of TPC differentiation. However, high-throughput screening for such molecules is hampered by the lack of robust markers of GBM differentiation. To obtain a signature of differentiated TPCs, we developed “Microscopic Imaging of Epigenetic Landscapes” (MIEL), which captures patterns of nuclear staining for epigenetic marks to derive feature-fingerprints of individual cells. We confirmed MIEL’s ability to accurately distinguish multiple cell fates and identified a multiparametric epigenetic signature of differentiated TPCs. Critically, we validated epigenetic imaging-based signature using global gene expression thus providing the proof of principle for the MIEL’s ability to select and prioritize small molecules, which induce TPC differentiation.
Validation and automation of a high-throughput multi-targeted method for semi-quantification of endogenous metabolites from different biological matrices using tandem mass spectrometry
Authors: Nandania Jatin , Peddinti Gopal , Pessia Alberto , Kokkonen Meri , Velagapudi Vidya
Published: June 2018

The use of metabolomics profiling to understand metabolism under different physiological states has increased in recent years, which created the need for robust analytical platforms. Here, we present a validated method for targeted and semi-quantitative analysis of 102 polar metabolites that covers major metabolic pathways from 24 classes in a single 17.5-min assay. The method has been optimized for a wide range of biological matrices from various organisms, and involves automated sample preparation, and data processing using in-house developed R package. To ensure reliability, the method was validated for accuracy, precision, selectivity, specificity, linearity, recovery, and stability according to European Medicines Agency guidelines. We demonstrated excellent repeatability of the retention times (CV<4%), calibration curves (R2≥0.980) in their respective wide dynamic concentration ranges (CV<3%), and concentrations (CV<25%) of quality control samples interspersed within 25 batches analyzed over a period of one-year. The robustness was demonstrated through high correlation between metabolite concentrations measured using our method and NIST reference values (R2=0.967), including cross-platform comparability against the BIOCRATES AbsoluteIDQp180 kit (R2=0.975) and NMR analyses (R2=0.884). We have shown that our method can be successfully applied in many biomedical research fields and clinical trials, including epidemiological studies for biomarker discovery. In summary, a thorough validation demonstrated that our method is reproducible, robust, reliable, and suitable for metabolomics studies.
Spatial-temporal clustering analysis of yaws on Lihir Island, Papua New Guinea to enhance planning and implementation of eradication programs
Authors: Mooring Eric Q. , Mitjà Oriol , Murray Megan B.
Published: June 2018

Background

In the global program for the eradication of yaws, assessments of the prevalence of the disease are used to decide where to initiate mass treatment. However, the smallest administrative unit which should be used as the basis for making decisions is not clear. We investigated spatial and temporal clustering of yaws to help inform the choice of implementation unit.

Methodology/Principal findings

We analyzed 11 years of passive surveillance data on incident yaws cases (n = 1448) from Lihir Island, Papua New Guinea. After adjusting for age, sex, and trends in health-seeking, we detected three non-overlapping spatiotemporal clusters (p < 1 × 10−17, p = 1.4 × 10−14, p = 1.4 × 10−8). These lasted from 28 to 47 months in duration and each encompassed between 4 and 6 villages. We also assessed spatial clustering of prevalent yaws cases (n = 532) that had been detected in 7 biannual active case finding surveys beginning in 2013. We identified 1 statistically significant cluster in each survey. We considered the possibility that schools that serve multiple villages might be loci of transmission, but we found no evidence that incident cases of yaws among 8- to 14-year-olds clustered within primary school attendance areas (p = 0.684).

Conclusions/Significance

These clusters likely reflect transmission of yaws across village boundaries; villages may be epidemiologically linked to a degree such that mass drug administration may be more effectively implemented at a spatial scale larger than the individual village.

Author Summary

The World Health Organization aims to eradicate yaws using mass drug administration (MDA), which consists of treating everyone in an administrative unit with antibiotics. The administrative unit in a country which is used as the basis for making decisions about implementing MDA is called the implementation unit. Prevalence assessments are used to identify endemic communities for mass treatment programs, but the spatial scale (e.g. village, sub-district, district, or province) at which mass treatment should be implemented is currently unclear. The choice of implementation unit depends on many factors; one of these is the underlying transmission patterns of the disease. Using data from Lihir Island, Papua New Guinea, we found that geographic clusters of yaws often spanned multiple villages. These clusters likely reflect transmission of the infectious disease across village boundaries and suggest that it may be best to implement MDA at a spatial scale larger than the individual village, for example at sub-district level.