bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding and Confronting Physical Sensations
Authors: Barlow David H. , Sauer-Zavala Shannon , Farchione Todd J. , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 10 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook looks at the third part of an emotional experience—the physical sensations associated with our emotions. Physical sensations refer to any physical symptoms that we might experience during strong emotions (e.g., racing heart, sweating, or nausea). We learn to identify these physical sensations and how they impact our experience of emotions. We then learn to confront uncomfortable physical sensations through physical exercises designed to bring on the sensations that come up when we have strong emotions. We do this because facing physical sensations over and over makes them easier to tolerate.
The Role of Medication in the Treatment of Emotional Disorders
Authors: Barlow David H. , Sauer-Zavala Shannon , Farchione Todd J. , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 12 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook describes medications that are commonly prescribed for emotional disorders. These include anti-anxiety medications such as benzodiazepines and beta blockers, as well as antidepressant medications like selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. In addition, individuals with emotional disorders are sometimes prescribed mood stabilizers or antipsychotic medications. The chapter answers frequently asked questions about medications. It also provides recommendations for how to discontinue medications under the supervision of the prescribing physician. This treatment program can be completed in combination with the use of medication and considerations for this practice are described in this chapter.
A black hole–white dwarf compact binary model for long gamma-ray bursts without supernova association
Authors: Dong Yi-Ze , Gu Wei-Min , Liu Tong , Wang Junfeng
Published: January 2018

Gamma-ray bursts (GRBs) are luminous and violent phenomena in the Universe. Traditionally, long GRBs are expected to be produced by the collapse of massive stars and associated with supernovae. However, some low-redshift long GRBs have no detection of supernova association, such as GRBs 060505, 060614, and 111005A. It is hard to classify these events convincingly according to usual classifications, and the lack of the supernova implies a non-massive star origin. We propose a new path to produce long GRBs without supernova association, the unstable and extremely violent accretion in a contact binary system consisting of a stellar-mass black hole and a white dwarf, which fills an important gap in compact binary evolution.
An Open-Label Clinical Trial of Hypothalamic Deep Brain Stimulation for Human Morbid Obesity: BLESS Study Protocol
Authors: De Salles Antonio A F , Barbosa Daniel A N , Fernandes Fernando , Abucham Julio , Nazato Debora M , Oliveira Juliana D , Cury Abrão , Biasi Alexandre , Rossi Ronaldo , Lasagno Camila , Bueno Priscila T , Santos Renato H N , Damiani Lucas P , Gorgulho Alessandra A
Published: January 2018

BACKGROUND

Human morbid obesity is increasing worldwide in an alarming way. The hypothalamus is known to mediate its mechanisms. Deep brain stimulation (DBS) of the ventromedial hypothalamus (VMH) may be an alternative to treat patients refractory to standard medical and surgical therapies.

OBJECTIVE

To assess the safety, identify possible side effects, and to optimize stimulation parameters of continuous VMH-DBS. Additionally, this study aims to determine if continuous VMH-DBS will lead to weight loss by causing changes in body composition, basal metabolism, or food intake control.

METHODS

The BLESS study is a feasibility study, single-center open-label trial. Six patients (body mass index > 40) will undergo low-frequency VMH-DBS. Data concerning timing, duration, frequency, severity, causal relationships, and associated electrical stimulation patterns regarding side effects or weight changes will be recorded.

EXPECTED OUTCOMES

We expect to demonstrate the safety, identify possible side effects, and to optimize electrophysiological parameters related to VMH-DBS. No clinical or behavioral adverse changes are expected. Weight loss ≥ 3% of the basal weight after 3 mo of electrical stimulation will be considered adequate. Changes in body composition and increase in basal metabolism are expected. The amount of food intake is likely to remain unchanged.

DISCUSSION

The design of this study protocol is to define the safety of the procedure, the surgical parameters important for target localization, and additionally the safety of long-term stimulation of the VMH in morbidly obese patients. Novel neurosurgical approaches to treat metabolic and autonomic diseases can be developed based on the data made available by this investigation.
Degradation of Neuronal Encoding of Speech in the Subthalamic Nucleus in Parkinson's Disease
Authors: Tankus Ariel , Fried Itzhak
Published: January 2018

BACKGROUND

Most of the patients with Parkinson's disease suffer from speech disorders characterized mainly by dysarthria and hypophonia.

OBJECTIVE

To understand the deterioration of speech in the course of Parkinson's disease.

METHODS

We intraoperatively recorded single neuron activity in the subthalamic nucleus of 18 neurosurgical patients with Parkinson's disease undergoing implantation of deep brain stimulator while patients articulated 5 vowel sounds.

RESULTS

Here, we report that single subthalamic neurons encode individual vowel phonemes and employ 1 of 2 encoding schemes: broad or sharp tuning. Broadly tuned units respond to all examined phonemes, each with a different firing rate, whereas sharply tuned ones are specific to 1 to 2 phonemes. We then show that in comparison with patients without speech deficits, the spiking activity in patients with speech disorders was lower during speech production, overt or imagined, but not during perception. However, patients with speech disorders employed a larger percentage of the neurons for the aforementioned tasks. Whereas the lower firing rates affect mainly sharply tuned units, the extra units used a broad tuning encoding scheme.

CONCLUSION

Our findings suggest mechanisms of neuronal degradation due to Parkinsonian speech disorders and their possible compensation. As impairment in sharply tuned units may be compensated by broadly tuned ones, the proposed compensation model appears to be suboptimal, lending support to the persistence of speech disorders in the course of the disease.
Spontaneous Regression of a Retroodontoid Transverse Ligament Cyst: A Case Report
Authors: Oushy Soliman , Carlstrom Lucas P , Krauss William E
Published: January 2018

BACKGROUND AND IMPORTANCE

Transverse ligament cysts (TLC) are rare, surgically complex lesions arising posterior to the odontoid process of C2. Direct compression of the cervicomedullary junction is a devastating consequence of untreated lesions. We report the first case of spontaneous TLC regression without surgical intervention.

CLINICAL PRESENTATION

A 75-yr-old woman presented to an outside hospital with acute episodes of left face and upper extremity numbness. Magnetic resonance imaging (MRI) demonstrated a well-circumscribed 5.8 mm cystic mass at the atlantoaxial junction, posterior to the odontoid process, most consistent with a TLC. She presented to our institution 1 yr later with symptoms of progressive occipital neuralgia seeking surgical treatment. No evidence of cervical myelopathy was identified on clinical examination. Repeat MRI showed near doubling of the cyst, with no brainstem edema. The patient elected for surveillance of the cyst with a transforaminal steroid injection at C1-C2 for her occipital neuralgia. One year later, symptoms of occipital neuralgia had resolved and she remained neurologically intact; MRI of the cervical spine showed near complete involution of the cyst.

CONCLUSION

Symptomatic TLCs are often managed with surgical decompression and, in selected cases, fusion with good functional outcome. However, these interventions carry high risk of postoperative morbidity, particularly in the elderly. Conservative surveillance is rarely reported as a viable option. We present the first case of spontaneous TLC regression in the absence surgery or neck bracing. In select patients without acute myelopathy, clinical and radiographic surveillance may be considered for the management of TLCs.
Physical Therapists’ Ability to Identify Psychological Factors and Their Self-Reported Competence to Manage Chronic Low Back Pain
Authors: Brunner Emanuel , Dankaerts Wim , Meichtry André , O’Sullivan Kieran , Probst Michel
Published: January 2018

Background

In the management of chronic low back pain (LBP), identifying and managing more patients who are at high risk and who have psychological barriers to recovery is important yet difficult.

Objective

The objective of this study was to test physical therapists’ ability to allocate patients into risk stratification groups, test correlations between therapists’ assessments of psychological factors and patient questionnaires, and explore relationships between psychological factors and therapists’ self-reported competence to manage patients with chronic LBP.

Design

This was a pragmatic, observational study.

Methods

Patients completed the STarT Back Tool (SBT, for risk stratification), the Four-Dimensional Symptom Questionnaire (distress, depression, anxiety), and the Tampa Scale of Kinesiophobia (kinesiophobia) prior to the intake session. After this session, physical therapists estimated patient prognostic risk using the 3 SBT categories and rated patient psychological factors using a 0-to-10 scale. Finally, therapists reported their self-reported competence to manage the patient. Intraclass and Spearman rank correlations tested correlations between therapists’ intuitive assessments and patient questionnaires. A linear-mixed model explored relationships between psychological factors and therapists’ self-reported competence.

Results

Forty-nine patients were managed by 20 therapists. Therapists accurately estimated SBT risk allocation in only 41% of patients. Correlations between therapist perceptions and patient questionnaires were moderate for distress (r = 0.602) and fair for depression (r = 0.304) and anxiety (r = 0.327). There was no correlation for kinesiophobia (r = −0.007). Patient distress was identified as a negative predictor of therapists’ self–reported competence.

Limitations

This was a cross-sectional study, conducted in only 1 center.

Conclusions

Physical therapists were not very accurate at allocating patients into risk stratification groups or identifying psychological factors. Therapists’ self-reported competence in managing patients was lowest when patients reported higher distress.
Construct Validity of the Societal Outreach Scale (SOS)
Authors: Fike David S , Denton Jason , Walk Matt , Kish Jennifer , Gorman Ira
Published: January 2018

Background

The American Physical Therapy Association (APTA) has been working toward a vision of increasing professional focus on societal-level health. However, performance of social responsibility and related behaviors by physical therapists remain relatively poorly integrated into practice. Promoting a focus on societal outreach is necessary for all health care professionals to impact the health of their communities.

Objective

The objective was to document the validity of the 14-item Societal Outreach Scale (SOS) for use with practicing physical therapists.

Design

This study used a cross-sectional survey.

Methods

The SOS was transmitted via email to all therapists who were licensed and practicing in 10 states in the United States that were purposefully selected to assure a broad representation. A sample of 2612 usable responses was received. Factor analysis was applied to assess construct validity of the instrument.

Results

Of alternate models, a 3-factor model best demonstrated goodness of fit with the sample data according to conventional indices (standardized root mean squared residual = .03, comparative fit index .96, root mean square error of approximation = .06). The 3 factors measured by the SOS were labeled Societal-Level Health Advocacy, Community Engagement/Social Integration, and Political Engagement. Internal consistency reliability was 0.7 for all factors. The 3-factor SOS demonstrated acceptable validity and reliability.

Limitations

Though the sample included a broad representation of physical therapists, this was a single cross-sectional study. Additional confirmatory factor analysis, reliability testing, and word refinement of the tool are warranted.

Conclusions

Given the construct validity and reliability of the 3-factor SOS, it is recommended for use as a validated instrument to measure physical therapists’ performance of social responsibility and related behaviors.
Advances in anticoagulation therapy
Authors: Webster Emily , Gil Michael
Published: January 2018

Because atrial fibrillation (AF) is a major risk for thrombotic disease, many patients with AF are managed with anticoagulation for primary or secondary prevention of these events. The emergence of novel oral anticoagulants offers patients and providers options to consider beyond warfarin. Decision making should address safety, tolerability, efficacy, price, and simplicity of use; and decisions should be individualized for each patient.
An opportunity for PAs as obstetrical laborists
Authors: Berkowitz Oren , White Susan E.
Published: January 2018

The obstetrical laborist, based on the hospitalist model, can improve quality and safety of labor and delivery care. A laborist can be a physician assistant (PA), certified nurse midwife, or obstetrician/gynecologist who provides care using a scheduled shifts model. Workforce trends show a rapid increase in certified nurse midwives and PAs, which could stimulate the laborist movement and increase opportunities for PAs.
Identifying acute cervicitis in an era of less-frequent routine gynecologic examinations
Authors: Allen Margaret
Published: January 2018

Acute inflammation of the uterine cervix can lead to serious problems such as pelvic inflammatory disease (PID), endometritis, and complications of pregnancy and childbirth. As intervals for routine gynecologic screening examinations lengthen, cervical infections, especially if asymptomatic, may be missed. Annual wellness examinations and other patient visits outside routine gynecologic cancer screening visits should include brief evaluation with sexual risk assessment and a gynecologic examination if indicated. If cervicitis persists after standard treatment for sexually transmitted infections (STIs), consider Mycoplasma genitalium. Clinicians should be sensitive to the fact that the unexpected presence of infection may cause distress.
Updated Recommendations for Women's Health
Authors: Zolot Joan
Published: January 2018

ACOG addresses important issues in contraception and cesarean delivery.
Reducing Heart Failure Readmissions Has Risks
Authors: Mechcatie Elizabeth
Published: January 2018

Study finds mortality rates may increase as readmission rates drop.
Removing Practice Barriers
Authors: Kritz Fran
Published: January 2018

States continue to expand practice authority and innovation opportunities for APRNS.
The Effect of Yoga on Chronic Nonspecific Low Back Pain
Authors: Whitehead Phyllis Brown
Published: January 2018

Editor's note: This is a summary of a nursing care–related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.
Does the Angle of the Nail Matter for Pertrochanteric Fracture Reduction? Matching Nail Angle and Native Neck-Shaft Angle
Authors: Parry Joshua A. , Barrett Ian , Schoch Bradley , Yuan Brandon , Cass Joseph , Cross William
Published: January 2018

Objectives:

To determine whether fixation of pertrochanteric hip fractures with cephalomedullary nails (CMNs) with a neck-shaft angle (NSA) less than the native NSA affects reduction and lag screw cutout.

Design:

Retrospective comparative study.

Setting:

Level I trauma center.

Patients/Participants:

Patients treated with a CMN for unstable pertrochanteric femur fractures (OTA/AO 31-A2.2 and 31-A2.3) between 2005 and 2014.

Intervention:

CMN fixation.

Main Outcome Measurement:

NSA reduction and lag screw cutout.

Results:

Patients fixed with a nail angle less than their native NSA were less likely to have good reductions [17% vs. 60%, 95% confidence interval (CI), −63% to −18%; P = 0.0005], secondary to more varus reductions (41% vs. 10%, 95% CI, 9%–46%; P = 0.01) and more fractures with ≥4 mm of displacement (63% vs. 35%, 95% CI, 3%–49%; P = 0.03). The cutout was not associated with the use of a nail angle less than the native NSA (60% vs. 76%, 95% CI, −56% to 18%; P = 0.5), varus reductions (60% vs. 32%, 95% CI, −13% to 62%; P = 0.3), or poor reductions (20% vs. 17%, 95% CI, −24% to 44%; P = 1.0).

Conclusions:

The fixation of unstable pertrochanteric hip fractures with a nail angle less than the native NSA was associated with more varus reductions and fracture displacement but did not affect the lag screw cutout.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Urgent Chemotherapy in Sepsis-Like Shock Related to Hematologic Malignancies
Authors: Cherruault Marlène , Le Goff Marielle , Tamburini Jérôme , Pène Frédéric
Published: January 2018

Objectives:

Hematologic malignancies may result in multiple organ involvement including pulmonary and renal dysfunctions, and the less common acute circulatory failure. We herein addressed the outcome of patients with sepsis-like shock related to aggressive hematologic malignancies.

Design:

A 10-year (2007–2016) monocenter retrospective study.

Settings:

A medical ICU in a tertiary care center.

Patients:

Patients with circulatory shock requiring vasopressors and who subsequently received chemotherapy. Shock was presumably related to the underlying malignancy after ruling out an ongoing or new-onset infectious process. The extent and time course of organ failures was assessed by a modified Sequential Organ Failure Assessment score devoid of the platelet component.

Interventions:

None.

Measurements and Main Results:

Seventeen patients were included, including 13 with non-Hodgkin lymphoma, two with hyperleukocytic acute myeloid leukemia, and two with “Human Herpes virus 8”–associated multicentric Castleman’s disease. The following associated conditions prompted urgent administration of chemotherapy: tumor lysis syndrome (n = 10), hemophagocytic lymphohistiocytosis (n = 3), compressive bulky tumor (n = 3), pulmonary involvement (n = 3), and disseminated intravascular coagulation (n = 1). Following the initiation of chemotherapy, a number of patients died rapidly from untractable multiple organ failure. In contrast, chemotherapy led to a fast and dramatic improvement in organ failures in early survivors, as shown by the decrease in the modified Sequential Organ Failure Assessment score. However, the overall outcome was poor since only four and three patients could be discharged alive from the ICU and the hospital, and three and two patients remained alive at 6 months and 1 year.

Conclusions:

Multiple organ dysfunction syndrome related to hematologic malignancies is associated with a dismal outcome. A chemotherapy trial may provide a fast prognostic assessment of the reversibility of organ failure.
Free Flap Survival Despite Internal Jugular Vein Thrombosis in Head and Neck Reconstruction
Authors: Kiya Koichiro , Kubo Tateki , Seike Shien , Hosokawa Ko
Published: January 2018

Microvascular free tissue transfer is one of the most common techniques of reconstruction for complex head and neck surgical defects. Generally, venous thrombosis is more likely to occur than arterial thrombosis in vascular anastomosis. Thus, recipient veins must be chosen carefully. Although the internal jugular vein is preferred as a recipient vein by many microsurgeons, internal jugular vein thrombosis is a potential complication, as shown in our report. Therefore, we consider that the external jugular vein still is an option as a recipient for venous anastomosis and that it is better to perform multiple vein anastomoses with 2 different venous systems, such as the internal and external jugular systems, than anastomoses within the same venous system.
Review of Contact Lens–Related Complications
Authors: Lim Chris H. L. , Stapleton Fiona , Mehta Jodhbir S.
Published: January 2018

The purpose of this article is to provide a review of existing literature describing complications with contemporary contact lenses and their management. It is envisioned that this will serve as a useful summary of noninfectious and infectious complications associated with contact lens wear.
Association Between Enterovirus Infection and Asthma in Children
Authors: Wang Ying-Ching , Tsai Ching-Shu , Yang Yao-Hsu , Huang Kuo-You , Hsieh Wen-Chi , Kuo Ting-Yu , Chin-Hung Chen Vincent , Wong Jennifer , Ponton Lynn , Wang Tsu-Nai
Published: January 2018

Background:

Both virus-induced asthma and enterovirus (EV) infection are common in children; however, the relationship between EV infection and virus-induced asthma has not been systematically investigated in a cohort study. This nationwide population-based cohort study investigated the association between EV infection and asthma.

Methods:

We used data from the Taiwan National Health Insurance Research Database. The study sample consisted of insured children who were younger than 18 years and had EV infection between 1997 and 2013 and were followed until December 2013. We identified 36,935 children with EV infection and compared them based on 36,935 age-, sex-, urbanization- and income-matched controls to analyze the risk of subsequent asthma. Cox regression analyses were performed and adjusted for sex, age, urbanization, income, preterm labor and small for gestational age, perinatal complications, allergic rhinitis, allergic conjunctivitis, atopic dermatitis and bronchiolitis.

Results:

The mean follow-up interval for all patients was 8.59 years (standard deviation = 4.35 years). The mean latency period between initial EV infection and onset of asthma was 2.77 years (standard deviation = 2.43 years). EV infection was significantly associated with a higher incidence of asthma (hazard ratio = 1.65; 95% confidence interval: 1.60–1.71).

Conclusions:

A significant association was observed between EV infection and asthma in children. Health providers should be aware of the higher potential for children with EV to develop asthma in the future.
Lessons From an Outbreak of Varicella Infection in Pediatric Hemato-oncology Patients
Authors: Manistarski Michal , Levin Dror , Dvir Rina , Berger-Achituv Sivan , Rosenfeld Keidar Hila , Grisaru-Soen Galia , Carmeli Yehuda , Elhasid Ronit
Published: January 2018

Background:

Immunocompromised patients exposed to varicella may experience significant morbidity and a 7% mortality rate. Management and outcome of an outbreak of varicella infection among hospitalized pediatric hemato-oncology patients using the guidelines of the American Academy of Pediatrics Committee on Infectious Diseases are presented.

Methods:

This retrospective study describes an outbreak of varicella infection between February 2011 and June 2011. Data were retrieved from the patients’ files. Positive polymerase chain reaction results for varicella zoster virus from vesicular skin lesions were used for the diagnosis of varicella infection.

Results:

Twelve pediatric hemato-oncology patients experienced 13 episodes of varicella infection, 11 underwent 1 episode each and 1 patient had 2 episodes. All exposed patients without immunity received varicella zoster immune globulins or intravenous immunoglobulin and were isolated as recommended by the guidelines. Infected patients received intravenous acyclovir. One patient with acute lymphoblastic leukemia at induction chemotherapy died. All the other patients survived.

Conclusions:

Our experience in the management of hospitalized immunocompromised patients exposed to varicella was that a positive IgG serology did not confer protection after exposure to varicella infection and thus can not serve as a marker for immunity. Unlike the isolation period sufficient for immunocompetent patients, crusted lesions can be contagious and thus require extended isolation for immunocompromised patients. Patients receiving rituximab are at greater risk of having persistent or recurrent disease. Studies with a larger sample size should be performed to better assess the management of immunocompromized patients exposed to varicella.
Idiopathic Canalicular Inflammatory Disease: New Disease Description of Clinical Patterns, Investigations, Management, and Outcomes
Authors: Ali Mohammad Javed
Published: January 2018

Purpose:

The objective of this perspective is to present a separate disease description of “idiopathic canalicular inflammatory disease” and outline the diagnostic criteria and early experiences with its investigations and management.

Methods:

Retrospective case series of 44 canaliculi of 22 eyes of 11 patients presenting at a tertiary care Dacryology service over a period of 2 years with typical clinical patterns of inflammatory canaliculitis and its outcomes were studied. All the patients underwent microbiological work-up with culture and sensitivity, dacryoendoscopy imaging, serial Fourier domain ocular coherence tomography, and collagen vascular profiles. Stages in the evolution of the disease were studied. All patients were treated initially with topical steroids followed by punctal dilatation and placement of mini-monoka stents. Five patients in addition had a small biopsy from the inflamed portion of the vertical canaliculus. Stents were extubated at 6 weeks.

Results:

Forty-four canaliculi were diagnosed to have idiopathic canalicular inflammatory disease during the study period. There was a female preponderance (81.8%, 9/11) and the mean age at presentation was 57 years. All patients presented with unilateral epiphora without any discharge, pain, or swelling. Collagen vascular profiles and screening for autoimmune diseases were negative. Clinical picture ranged from stages 1 to 5, consisting of edema, progressive centripetal vascularization, pouting of vascularized mucosa, membrane formation, and progressive scarring. The presentation begins in 1 eye and usually involves the other eye at a mean of 6 months. Ocular coherence tomography and dacryoendoscopy were of adjunctive value in the diagnosis. Histopathological examination was suggestive of a chronic inflammation. All patients had relentless progression to end-stage disease, although delayed significantly by steroids and monoka intubation.

Conclusion:

Idiopathic canalicular inflammatory disease has a distinct and typical clinical behavior and the current study proposed diagnostic features and disease staging. The use of topical and systemic immunosuppressive agents needs to be explored to formulate effective protocols for its management.
Interlamellar Autogenous Tarsal Graft for the Correction of Lower Eyelid Trichiasis Associated With Eyelid Margin Thinning
Authors: Cruz Antonio A. V. , Garcez Cecilia , Duarte Ana , Akaishi Patricia M. S.
Published: January 2018

Purpose:

To evaluate the use of autogenous tarsal graft for surgical correction of lower eyelid trichiasis associated with eyelid thinning.

Methods:

A total of 23 eyelids of 19 consecutive patients with trichiasis were operated with a variant of the Van Millingen procedure. The surgery consisted of interposing a 3-mm high fragment of autogenous ipsilateral upper eyelid tarsus corresponding to the trichiasis segment between the pretarsal anterior lamella and the lower tarsal plate. Preoperative assessment included quantification of eyelid thickness on the midpoint of the segment with trichiasis, biomicroscopy of the eyelid margin and location of the trichiasis. All patients were examined at 1, 3, 6, and 12 months after surgery. Eyelid thickness was measured at 1 month and 12 months of follow up.

Results:

Preoperatively the mean thickness of the eyelid margin was 0.99 mm ± 0.06 standard error. One month postoperatively eyelid thickness increased to 2.08 ± 0.28 standard error, decreasing over time to reach 1. 48 mm ± 0.18 standard error 1 year after surgery, a value that did not differ from that of the control group. Small granulomas were diagnosed only in the early phases of the postoperative period. Trichiasis recurrence was seen in just 1 eyelid. Isolated abnormal lashes lateral or medial to the graft were present in 5 eyelids at the end of the study.

Conclusions:

Autogenous tarsal grafts placed parallel to the lower tarsus are a good option both to correct misdirected eyelashes and to restore normal lower eyelid thickness.
Yield and Costs of Evaluating Children With Cyclic Vomiting Syndrome
Authors: Lucia‐Casadonte Chantal J. , Whaley Kaitlin G. , Chogle Ashish S.
Published: January 2018

Background and Objectives:

Cyclic vomiting syndrome (CVS) clinical guidelines recommend an algorithm of basic testing for standard patients, and more targeted testing, including laboratory and imaging studies, in the presence of specific red flags. The cost‐effectiveness of this screening of children with suspected CVS is lacking. The objectives of this study are to determine whether screening studies in CVS patients results in diagnostic change and to estimate their healthcare cost.

Method:

Charts of patients (1–18 years) with suspected CVS were retrospectively reviewed at a single center. Results and cost of laboratory and imaging studies were analyzed.

Results:

A total of 503 charts were reviewed from electronic medical records with the International Classification of Diseases‐9 (ICD‐9) code 536.2 or search terms “CVS, cyclic vomiting, persistent emesis/vomiting, hyperemesis, or intractable/ periodic vomiting.” Of these, 165 (33%) had a diagnosis of CVS and 135 (82%) children (mean age 7.7 ± 4.3; 73 (54%) girls) met CVS criteria based on North American Society for Pediatric Gastroenterology, Hepatology and Nutrition diagnostic criteria. Of those meeting CVS criteria, 6 (4%) had a change in management based on the CVS screening evaluation. The mean cost of screening per patient that met CVS criteria was $6125.02 and the estimated total cost for all patients who met CVS criteria was $826,877.88.

Conclusions:

The screening metabolic laboratory results, pelvic ultrasound, magnetic resonance imaging, and upper endoscopy resulted in a diagnosis change in few patients screened for CVS. Most children who met criteria for CVS did not benefit from screening evaluation as results did not change clinical diagnosis or management, and were associated with higher cost.
Impact of Thyroid Autoimmunity on Thyroid Function in 12‐year‐old Children With Celiac Disease
Authors: Norström Fredrik , van der Pals Maria , Myléus Anna , Hammarroth Solveig , Högberg Lotta , Isaksson Anders , Ivarsson Anneli , Carlsson Annelie
Published: January 2018

Objectives:

Celiac disease (CD) is associated with thyroid autoimmunity and other autoimmune diseases. Data are, however, lacking regarding the relationship between thyroid autoimmunity and thyroid function, especially in regard to CD. Our aim was to investigate the impact of thyroid autoimmunity on thyroid function in 12‐year‐old children with CD compared to their healthy peers.

Methods:

A case‐referent study was conducted as part of a CD screening of 12‐year‐olds. Our study included 335 children with CD and 1695 randomly selected referents. Thyroid autoimmunity was assessed with antibodies against thyroid peroxidase (TPOAb). Thyroid function was assessed with thyroid‐stimulating hormone and free thyroxine.

Results:

TPOAb positivity significantly increased the risk of developing hypothyroidism in all children. The odds ratios (with 95% confidence intervals) were 5.3 (2.7–11) in healthy 12‐year‐olds, 10 (3.2–32) in screening‐detected CD cases, 19 (2.6–135) in previously diagnosed CD cases, and 12 (4.4–32) in all CD cases together. Among children with TPOAb positivity, hypothyroidism was significantly more common (odds ratio 3.1; 95% CI 1.03–9.6) in children with CD (10/19) than in children without CD (12/46).

Conclusions:

The risk of thyroid dysfunction due to thyroid autoimmunity is larger for those with CD than their healthy peers. Our study indicates that a gluten‐free diet does not reduce the risk of thyroid dysfunction. Further studies are required for improved understanding of the role of the gluten‐free diet for the risk of autoimmune diseases in children with CD.
Integrated HIV-Care Into Primary Health Care Clinics and the Influence on Diabetes and Hypertension Care: An Interrupted Time Series Analysis in Free State, South Africa Over 4 Years
Authors: Rawat Angeli , Uebel Kerry , Moore David , Yassi Annalee
Published: January 2018

Background:

Noncommunicable diseases (NCDs), specifically diabetes and hypertension, are rising in high HIV-burdened countries such as South Africa. How integrated HIV care into primary health care (PHC) influences NCD care is unknown. We aimed to understand whether differences existed in NCD care (pre- versus post-integration) and how changes may relate to HIV patient numbers.

Setting:

Public sector PHC clinics in Free State, South Africa.

Methods:

Using a quasiexperimental design, we analyzed monthly administrative data on 4 indicators for diabetes and hypertension (clinic and population levels) during 4 years as HIV integration was implemented in PHC. Data represented 131 PHC clinics with a catchment population of 1.5 million. We used interrupted time series analysis at ±18 and ±30 months from HIV integration in each clinic to identify changes in trends postintegration compared with those in preintegration. We used linear mixed-effect models to study relationships between HIV and NCD indicators.

Results:

Patients receiving antiretroviral therapy in the 131 PHC clinics studied increased from 1614 (April 2009) to 57, 958 (April 2013). Trends in new diabetes patients on treatment remained unchanged. However, population-level new hypertensives on treatment decreased at ±30 months from integration by 6/100, 000 (SE = 3, P < 0.02) and was associated with the number of new patients with HIV on treatment at the clinics.

Conclusions:

Our findings suggest that during the implementation of integrated HIV care into PHC clinics, care for hypertensive patients could be compromised. Further research is needed to understand determinants of NCD care in South Africa and other high HIV-burdened settings to ensure patient-centered PHC.
Leveraging Quick Response Code Technology to Facilitate Simulation-Based Leaderboard Competition
Authors: Chang Todd P. , Doughty Cara B. , Mitchell Diana , Rutledge Chrystal , Auerbach Marc A. , Frisell Karin , Jani Priti , Kessler David O. , Wolfe Heather , MacKinnon Ralph J. , Dewan Maya , Pirie Jonathan , Lemke Daniel , Khattab Mona , Tofil Nancy , Nagamuthu Chenthila , Walsh Catharine M.
Published: January 2018

Introduction

Leaderboards provide feedback on relative performance and a competitive atmosphere for both self-guided improvement and social comparison. Because simulation can provide substantial quantitative participant feedback, leaderboards can be used, not only locally but also in a multidepartment, multicenter fashion. Quick Response (QR) codes can be integrated to allow participants to access and upload data. We present the development, implementation, and initial evaluation of an online leaderboard employing principles of gamification using points, badges, and leaderboards designed to enhance competition among healthcare providers.

Method

This article details the fundamentals behind the development and implementation of a user-friendly, online, multinational leaderboard that employs principles of gamification to enhance competition and integrates a QR code system to promote both self-reporting of performance data and data integrity. An open-ended survey was administered to capture perceptions of leaderboard implementation.

Results

Conceptual step-by-step instructions detailing how to apply the QR code system to any leaderboard using simulated or real performance metrics are outlined using an illustrative example of a leaderboard that employed simulated cardiopulmonary resuscitation performance scores to compare participants across 17 hospitals in 4 countries for 16 months. The following three major descriptive categories that captured perceptions of leaderboard implementation emerged from initial evaluation data from 10 sites: (1) competition, (2) longevity, and (3) perceived deficits.

Conclusions

A well-designed leaderboard should be user-friendly and encompass best practices in gamification principles while collecting and storing data for research analyses. Easy storage and export of data allow for longitudinal record keeping that can be leveraged both to track compliance and to enable social competition.
Sarcopenia and Postoperative Complication Risk in Gastrointestinal Surgical Oncology
Authors: Simonsen Casper , de Heer Pieter , Bjerre Eik D. , Suetta Charlotte , Hojman Pernille , Pedersen Bente K. , Svendsen Lars B. , Christensen Jesper F.
Published: January 2018

Objective:

The aim of the study was to evaluate sarcopenia as a predictor of postoperative risk of major and total complications after surgery for gastrointestinal cancer.

Background:

Sarcopenia is associated with poor survival in gastrointestinal cancer patients, but the role of sarcopenia as prognostic tool in surgical oncology has not been established, and no consensus exists regarding assessment and management of sarcopenic patients.

Methods:

We performed a systematic search for citations in EMBASE, Web of Science, and PubMed from 2004 to January 31, 2017. Random effects meta-analyses were used to estimate the pooled risk ratio for postoperative complications by Clavien-Dindo grade (total complications: grade ≥2; major complications: grade ≥3) in patients with sarcopenia versus patients without sarcopenia. Stratified analyses were performed by sarcopenia criteria, cutoff level, assessment methods, study quality, cancer diagnosis, and “Enhanced Recovery After Surgery” care.

Results:

Twenty-nine studies (n = 7176) were included with sarcopenia prevalence ranging between 12% and 78%. Preoperative incidence of sarcopenia was associated with increased risk of major complications (risk ratio 1.40; 95% confidence interval, 1.20–1.64; P < 0.001; I
2 = 52%) and total complications (risk ratio 1.35; 95% confidence interval, 1.12–1.61; P = 0.001; I
2 = 60%). Moderate heterogeneity was found for both meta-analyses. Subgroup analyses showed that sarcopenia remained a consistent risk factor across stratification by sarcopenia criteria, assessment methods, study quality, and diagnoses.

Conclusions:

Sarcopenia was associated with an increased risk of complications after gastrointestinal tumor resection, but lack of methodological consensus hampers the interpretation and clinical utilization of these findings. Combining assessment of muscle mass with measures of physical function may increase the prognostic value and accuracy in preoperative risk stratification.
Adenosine 2A Receptor Activation Attenuates Ischemia Reperfusion Injury During Extracorporeal Cardiopulmonary Resuscitation
Authors: Mehaffey James H. , Money Dustin , Charles Eric J. , Schubert Sarah , Piñeros Angela Fernandez , Wu Di , Bontha Sai Vineela , Hawkins Robert , Teman Nicholas R. , Laubach Victor E. , Mas Valeria R. , Tribble Curtis G. , Maluf Daniel G. , Sharma Ashish K. , Yang Zequan , Kron Irving L. , Roeser Mark E.
Published: January 2018

Objective:

We tested the hypothesis that systemic administration of an A2AR agonist will reduce multiorgan IRI in a porcine model of ECPR.

Summary Background Data:

Advances in ECPR have decreased mortality after cardiac arrest; however, subsequent IRI contributes to late multisystem organ failure. Attenuation of IRI has been reported with the use of an A2AR agonist.

Methods:

Adult swine underwent 20 minutes of circulatory arrest, induced by ventricular fibrillation, followed by 6 hours of reperfusion with ECPR. Animals were randomized to vehicle control, low-dose A2AR agonist, or high-dose A2AR agonist. A perfusion specialist using a goal-directed resuscitation protocol managed all the animals during the reperfusion period. Hourly blood, urine, and tissue samples were collected. Biochemical and microarray analyses were performed to identify differential inflammatory markers and gene expression between groups.

Results:

Both the treatment groups demonstrated significantly higher percent reduction from peak lactate after reperfusion compared with vehicle controls. Control animals required significantly more fluid, epinephrine, and higher final pump flow while having lower urine output than both the treatment groups. The treatment groups had lower urine NGAL, an early marker of kidney injury (P = 0.01), lower plasma aspartate aminotransferase, and reduced rate of troponin rise (P = 0.01). Pro-inflammatory cytokines were lower while anti-inflammatory cytokines were significantly higher in the treatment groups.

Conclusions:

Using a novel and clinically relevant porcine model of circulatory arrest and ECPR, we demonstrated that a selective A2AR agonist significantly attenuated systemic IRI and warrants clinical investigation.
A Nationwide, Systematic, and Comprehensive Assessment of Surgical Capacity in Lebanon
Authors: Kaafarani Haytham M. A. , Khalifeh Jawad M. , Ramly Elie P. , Simon David , Safa Rawan , Khalil Lana , Raad Randa , Hoballah Jamal J.
Published: January 2018

Objective:

We sought to perform a systematic, comprehensive, and nationwide cross-sectional analysis of surgical capacity in Lebanon.

Background:

Providing surgical care in refugee areas is increasingly recognized as a global health priority. The surgical capacity of Lebanon where at least 1 in 6 inhabitants is currently a refugee remains unknown.

Methods:

The Surgical Capacity in Areas with Refugees cross-sectional study included 3 steps: (1) geographically mapping all hospitals providing surgical care in Lebanon, (2) systematically assessing each hospital's surgical capacity, and (3) identifying surgical care gaps/disparities. First, a list of hospitals in Lebanon and their locations was generated combining data from the Lebanese Ministry of Health and Syndicate of Hospitals. Specialty, rehabilitation, and maternity facilities were excluded. Second, the validated 5 domain Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) tool was administered in each hospital through a face-to-face or phone interview. Hospitals’ PIPES indices were computed; data were aggregated and analyzed for geographic and private/public disparities.

Results:

A total of 129 hospitals were geographically mapped; 20% were public. The PIPES tool was administered in all hospitals (100%). The mean PIPES index was 10.98 (Personnel = 14.91, Infrastructure = 15.36, Procedures = 37.47, Equipment = 21.63, Supplies = 24.78). The number of hospital beds, operating rooms, surgeons, and anesthesiologists per 100,000 people were 217, 8, 16, and 9, respectively. Deficiencies in infrastructure were significant, whereby 62%, 36%, 16%, and 5% of hospitals lack incinerators, pretested blood, intensive care units, and computed tomography, respectively. Continuous external electricity was lacking in 16 hospitals (12%). Compared to private hospitals, public hospitals had a lower PIPES index (10.48 vs 11.1, P = 0.022), including lower Personnel and Infrastructure scores (12.31 vs 15.57, P = 0.03; 14.04 vs 15.7, P = 0.003, respectively). Geographically, the administrative governorates with highest refugee concentrations had the lowest PIPES indices.

Conclusions:

Evaluating surgical capacity in Lebanon reveals significant deficiencies, most pronounced in public hospitals in which refugee care is provided and in areas with the highest refugee concentration.
Human posterior insula to posterior cingulate functional connectivity is related to the subjective intensity of acute pain
Authors: Becker Christopher J. , Vogt Keith M. , Ibinson James W.
Published: January 2018

Background

Several studies have shown that, in the context of chronic pain, alterations in functional connectivity between the insula and default mode network (DMN) are correlated with pain intensity. However, it is unknown whether a similar relationship between insula-to-DMN connectivity and pain intensity exists in the absence of chronic pain. Our aims were 1) to assess whether insula-to-DMN connectivity changes are correlated to the intensity of ongoing acute pain in healthy subjects, and 2) provide an initial assessment of the capacity of pIns-to-PCC connectivity to differentiate between painful and non-painful states. 3T BOLD functional imaging data were obtained from 13 healthy human subjects in three conditions: rest, non-painful tactile stimulation, and capsaicin-induced pain.

Results

Posterior insula to posterior cingulate (pIns-to-PCC) connectivity was significantly correlated with pain intensity. Additionally, we found that discrimination between painful and non-painful states could be achieved based on pIns-to-PCC connectivity.

Conclusions

Functional connectivity alterations in healthy subjects experiencing acute ongoing pain are similar to those observed in chronic pain patients, and can be used to classify pain state. This suggests that the inclusion of the pIns and PCC regions in future fcMRI-based methods to detect ongoing pain is warranted.