bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Associated with Previable Delivery following Second Trimester Rupture of Membranes
Authors: Panzer Alexis , Dotters-Katz Sarah , Smid Marcela , Boggess Kim , Manuck Tracy
Published: November 2018

Objective To identify factors associated with previable delivery in second trimester preterm rupture of membranes (PROM).

Study Design We conducted a single-center retrospective cohort study of women with pregnancies complicated by second trimester PROM (14.0–21.9 weeks' gestation) from 2000 to 2015 who elected expectant pregnancy management and achieved at least 24 hours latency. Maternal characteristics and clinical factors were compared among pregnancies that reached viability (≥ 23.0 weeks) and pregnancies delivered before viability (< 23.0 weeks) using appropriate statistical methods.

Results Of 73 pregnancies complicated by second trimester PROM, 49 (67%) delivered before viability. Maternal race, history of preterm birth, and tobacco use were similar between women who delivered < 23 weeks versus ≥ 23 weeks. Gestational age at PROM, cervical dilation > 1cm, Group B streptococcus carrier status, bacterial vaginosis, and chlamydial infection during pregnancy were similar between groups. Median time to delivery was significantly shorter in women who delivered < 23 weeks compared with those who reached ≥ 23 weeks (6 vs. 46 days, p < 0.01).

Conclusion Previable delivery occurred in the majority of women with second trimester PROM. No maternal or clinical factors were associated with delivery prior to viability. Counseling women with second trimester PROM should include the inability to determine which pregnancies will reach viability.
Approach Selection and Surgical Planning in Posterior Cranial Fossa Meningiomas: How I Do It
Authors: Beer-Furlan André , Vellutini Eduardo A. , Gomes Marcos Q. T. , Cardoso Alberto C. , Prevedello Luciano M. , Todeschini Alexandre B. , Prevedello Daniel M.
Published: November 2018

Posterior cranial fossa meningiomas represent approximately 9% of all the intracranial meningiomas. Despite the recent reports of radiation therapy in the management of these tumors, surgical resection continues to be the first line of treatment method aiming the permanent meningioma eradication. The evolution of imaging studies improved the preoperative evaluation of meningiomas providing greater anatomical detail of small structures not previously visualized. Nonetheless, the preoperative radiological evaluation should go beyond the differential diagnosis of a posterior fossa tumor. Anatomo-radiological assessment of meningiomas is discussed in detail. Based on our clinical experience, literature review, and case illustration, we highlight important preoperative anatomo-radiological aspects of posterior fossa meningiomas and their implications in the surgical management of these tumors.
Analysis of the symmetry group and exact solutions of the dispersionless KP equation in n + 1 dimensions
Authors: Conde J. M. , Güngör F.
Published: November 2018

The Lie algebra of the symmetry group of the (n + 1)-dimensional generalization of the dispersionless Kadomtsev–Petviashvili equation is obtained and identified as a semi-direct sum of a finite dimensional simple Lie algebra and an infinite dimensional nilpotent subalgebra. Group transformation properties of solutions under the subalgebra sl(2,R) are presented. Known explicit analytic solutions in the literature are shown to be actually group-invariant solutions corresponding to certain specific infinitesimal generators of the symmetry group.
Testimonials within health advertising in Australia: an analysis of current policy
Authors: Holden Alexander C. L.
Published: November 2018

The advertising of regulated health services to consumers is strictly regulated in Australia. The advertising prohibitions within the National Law that ban the use of testimonials relating to services provided by health practitioners have caused controversy, garnering mixed reactions from the health professions, health consumers and other stakeholders. Advertising that misleads health consumers may promote unnecessary and inappropriate engagement in health services and may therefore negatively affect consumers’ ability to exercise autonomous decisions relating to their care. This article considers policy implications relating to advertising with a focus on the use of testimonials, particularly those that are online. Although there would seem to be appetite for amending the current legislative framework, there is uncertainty as to the form change may take and the effect this could have.

What is known about the topic?
Testimonials relating to health care are a prohibited form of advertising, but a form still used by non-regulated health providers and those who are regulated but who are either ignorant of the law or defiant of its requirements. Views are split as to whether the restriction on consumer reviews of regulated health services is reasonable; frequently, arguments are put forward stating that the status quo inhibits consumers’ ability to discuss their care. Other jurisdictions outside Australia permit the use of patient reviews and testimonials.

What does this paper add?
This paper discusses the greater policy implications of the current restrictions within the National Law and analyses the arguments placed forward by different stakeholders from the health professions and those that consume health services. The ethical and market arguments surrounding advertising and testimonials are examined. Suggestions are then made as to the deficits in knowledge that presently exist relating to this area and the actions required before future policy may be developed.

What are the implications for practitioners?
Practitioners should be aware of the current restrictions upon advertising within regulated health services. This paper develops an understanding of the complex arguments surrounding advertising and testimonials in health care, as well as when testimonials may be permitted and not subject to the current regulations. Before any amendment to the current legislation is actioned, regulators should consider instead the need to develop an evidence-based approach to understanding the effects of health advertising on the decision making of healthcare consumers.
Digital transformation of hospital quality and safety: real-time data for real-time action
Authors: Barnett Amy , Winning Michelle , Canaris Stephen , Cleary Michael , Staib Andrew , Sullivan Clair
Published: November 2018

The Australian Commission for Safety and Quality in Health Care has created the National Safety and Quality Health Service standards that all hospitals must address in order to remain accredited. This case study details the first known digitisation of the 10 national quality and safety standards mandated in a quaternary integrated digital hospital. A team of clinical informaticians, information technology experts and clinicians was assembled. Data were chosen and the data were then extracted and validated and presented (often in near real time) in an easily consumable dashboard format with appropriate governance to allow clinicians and executives to monitor the quality and safety standards across the hospital. All 10 standards were defined and extracted contemporaneously from the digital hospital for every patient, every time. This is in stark contrast with traditional retrospective point prevalence surveys. This case study details the first known fully digital accreditation in a sophisticated integrated digital hospital. Digitisation of hospital quality and safety to produce real-time data is the future of clinical redesign to improve patient care.

What is known about the topic?
Healthcare delivery is complex and the ability of healthcare providers to maintain consistent standards of quality and safety is variable. Traditionally, these standards have been assessed by intermittent retrospective point-prevalence survey activity. Sophisticated digital hospitals provide the opportunity to develop data and analytics that monitor quality and safety standards across every patient, every time in near real time.

What does this paper add?
This paper describes a digital hospital which has created streaming analytics to monitor live performance of quality and safety standards. The necessary skills, leadership and governance for this process are outlined and the products described.

What are the implications for practitioners?
Shifting from retrospective paper-based point prevalence surveys to a digital platform has several implications. Firstly, it is an imperative to drive digital transformation of Australian hospitals. Secondly, it provides data for intervention to the hospital staff, so that issues can be addressed and improved in real-time, rather than waiting for survey results. Lastly, this new model of maintaining quality and safety also requires the development of new skills in the hospital setting including data literacy, digital clinical governance and clinical informatics.
Effect of experimental fire on seedlings of Australian and Gondwanan trees species from a Tasmanian montane vegetation mosaic
Authors: Prior Lynda D. , French Ben J. , Bowman David M. J. S.
Published: November 2018

The montane area of the Tasmanian Wilderness World Heritage Area was recently burnt by large fires ignited by lightning, and such fires are predicted to become more frequent with climate change. The region has a mix of fire-sensitive and fire-tolerant vegetation, but there is little information available on resprouting ability of seedlings of the dominant species of these mosaics. We predicted that seedlings of species found in fire-prone locations would exhibit more post-fire resprouting than seedlings of Gondwanan relictual species, which typically occur in fire-protected locations. To test this hypothesis we compared topkill and resprouting ability of seedlings from five tree species characteristic of the montane vegetation mosaics by exposing them to a propane burner flame for 0, 15, 30, 45 and 60s, simulating a fire intensity of 33 kW m–1. Overall, 93 of 100 flame-exposed plants were topkilled. Topkill was related to duration of flame exposure and seedling size rather than species. By contrast, resprouting of topkilled seedlings was strongly correlated with species rather than seedling size, and was not affected by duration of flame exposure. Contrary to expectations, the rainforest plant Nothofagus cunninghamii was the strongest resprouter, whereas few of the topkilled eucalypt seedlings resprouted. Our study shows the commonly held association between palaeoendemic Gondwanan species and low fire tolerance versus Australian species and high fire tolerance is overly simplistic. We need to better understand fire recovery mechanisms in the Tasmanian flora using a combination of field observation and experimental approaches.
Early initiation of antiretroviral therapy (ART): from point-of-care test to ART at a peer-led community-based testing site in Sydney
Authors: Houghton R. , Knight V. , Clifton B. , Varma R.
Published: November 2018

The effect of performing baseline HIV investigations (BLHIVI) at the time of a reactive HIV point-of-care test in the pathway to antiretroviral therapy (ART) in a community setting has not been described. In this study, 67 men newly diagnosed with HIV across three service models were analysed. The median time to ART was 30, 29.5 and 38 days (P=0.29) at a peer-led community testing site intervention group, in a historical control group and in an urban publicly funded sexual health service respectively. In a community setting, the inclusion of BLHIVI has the potential to reduce the time to early ART initiation.
Resolving distribution and population fragmentation in two leaf-tailed gecko species of north-east Australia: key steps in the conservation of microendemic species
Authors: Bertola Lorenzo V. , Higgie Megan , Hoskin Conrad J.
Published: November 2018

North Queensland harbours many microendemic species. These species are of conservation concern due to their small and fragmented populations, coupled with threats such as fire and climate change. We aimed to resolve the distribution and population genetic structure in two localised Phyllurus leaf-tailed geckos: P. gulbaru and P. amnicola. We conducted field surveys to better resolve distributions, used Species Distribution Models (SDMs) to assess the potential distribution, and then used the SDMs to target further surveys. We also sequenced all populations for a mitochondrial gene to assess population genetic structure. Our surveys found additional small, isolated populations of both species, including significant range extensions. SDMs revealed the climatic and non-climatic variables that best predict the distribution of these species. Targeted surveys based on the SDMs found P. gulbaru at an additional two sites but failed to find either species at other sites, suggesting that we have broadly resolved their distributions. Genetic analysis revealed population genetic structuring in both species, including deeply divergent mitochondrial lineages. Current and potential threats are overlain on these results to determine conservation listings and identify management actions. More broadly, this study highlights how targeted surveys, SDMs, and genetic data can rapidly increase our knowledge of microendemic species, and direct management.
Interviewing for accountability
Authors: Rivers Damian J. , Ross Andrew S.
Published: November 2018

During the National Policy Institute’s national conference in Washington D.C. on Saturday November 19th, 2016, Richard Spencer
delivered a speech in praise of the election victory of President Donald Trump. Shortly after the conference, Spencer was an
invited guest on the News One Now programme in which he participated in a 32-minute interview with black
journalist, host and managing editor Roland Martin. Drawing attention to the ideological aspects of the Martin/Spencer interview
performance, we adopt the analytical lens of the Discourse-Historical Approach (DHA) to Critical Discourse Analysis (CDA) (Musolff 2014; Reisigl and Wodak 2009; Wodak 2001, 2009) to explore argumentation as
a discursive strategy through topoi or argumentative warrants (Reisigl and
Wodak 2009; Wodak 2009, 2011,
2015; Wodak and Boukala 2015).
The facilitator’s communicative actions to construct meetings in a semi-informal educational
context
Authors: Vasilyeva Alena L.
Published: November 2018

The study examines how interactivity is constructed in the course of multi-person interaction in a semi-informal
educational context. The audio-recordings of seven meetings of a female discussion club in Belarus and their transcripts
serve as interactional data. The club was organized with a goal of providing a platform for females to engage in
intellectual discussions in an informal setting. The study takes the communication design approach and uses discourse
analysis. The analysis of the audio recordings and the transcripts is guided by the following question: how the
participants’ use of linguistic and interactional resources contributes to the construction of a meeting. The particular
attention is paid to the facilitator’s communicative actions to shape interaction and their local context.
Optimal spaces and hyphens
Authors: Symanczyk Joppe Vilma
Published: November 2018

The paper deals with the insertion of spaces and hyphens in German. It summarizes the existing optimality-theoretic approach and extends it to capture the use of hyphens. Hyphenation is often excluded in the literature on the writing of complex words, as forms with hyphens are thought to be mere variants of solid forms. The paper offers an alternative view in which hyphens are treated as an intermediate form between solid and open forms and are placed as a result of conflict between constraints which demand or forbid insertion of spaces. The analysis focuses on the products of nominal compounding, which is one of the most productive processes of word formation in German. Firstly, it is shown for which types of compounds hyphenation is optional and obligatory according to the official rules of orthography. Based on this, constraints are postulated, which do not only decide in which cases hyphenation is allowed but also in which positions the hyphens must be placed in the respective compound. Finally, the hyphenation of phrasal compounds and other complex compounds is modeled.
Khargāhand Other Terms for Tents in Firdawsī’sShāh-nāmah
Authors: Durand-Guédy David
Published: November 2018

This article aims to contribute to the wider debate on the historicity of theShāh-nāmahby focusing on the way Firdawsī uses the wordkhargāh. The word, which is first attested in Rūdakī poetry, has not been dealt with adequately in previous scholarship dedicated to theShāh-nāmah. An analysis of all the occurrences in the text provides results consistent with those obtained from contemporary sources: thekhargāhappeared in Central Asia (here, Tūrān); it was the standard dwelling of Turkic-speaking pastoral nomads (here, Tūrānians), whatever their social rank; and it was adopted later as a status symbol by non-Turkish elites (here, during Kay-Khusraw’s reign). In Firdawsī’sShāh-nāmah khargāhshould therefore also be understood as the type of framed tent known as “trellis tent” (the so-called yurt).
Understory Bird Community of An Oil Palm Plantation in Central Kalimantan
Authors: Mulyani Y A , Kaban A , Hadi N K , Tirtaningytas F N , Ramadhan G F
Published: November 2018

The implementation of High Conservation Value (HCV) area in oil palm plantation in Indonesia has caused the occurrence of remnant natural areas within oil palm landscape. Such forest remnants increase habitat heterogeneity that is important to maintain biodiversity in oil palm plantation including birds. Understory birds are the most prone to habitat degradation compared to other bird group species. This study aims at examining understory bird community in an oil palm plantation with different distance from HCV area. Mist nets were set up in June 2014 and January/February 2015 in areas adjacent to HCV area and 1 km from the HCV area. A total of 24 species from 13 families were caught in the mist nests. The highest bird diversity (S=14; H’=2.14) were recorded in location adjacent to HCV area in June 2014. Most birds captured were insectivores. However, based on the number of individuals, the understory bird community in oil palm plantation was dominated by frugivores from the family of Pycnonotidae. Brood patch was detected in birds found in both locations indicating use of the habitat for breeding.
Detection of Mild Cognitive Impairment Among Community-Dwelling African Americans Using the Montreal Cognitive Assessment
Authors: Rossetti Heidi C , Smith Emily E , Hynan Linda S , Lacritz Laura H , Cullum C Munro , Van Wright Aaron , Weiner Myron F
Published: November 2018

Objective

To establish a cut score for the Montreal Cognitive Assessment (MoCA) that distinguishes mild cognitive impairment (MCI) from normal cognition (NC) in a community-based African American (AA) sample.

Methods

A total of 135 AA participants, from a larger aging study, diagnosed MCI (n = 90) or NC (n = 45) via consensus diagnosis using clinical history, Clinical Dementia Rating score, and comprehensive neuropsychological testing. Logistic regression models utilized sex, education, age, and MoCA score to predict MCI versus NC. Receiver operating characteristic (ROC) curve analysis determined a cut score to distinguish MCI from NC based on optimal sensitivity, specificity, diagnostic accuracy, and greatest perpendicular distance above the identity line. ROC results were compared with previously published MoCA cut scores.

Results

The MCI group was slightly older (MMCI = 64.76[5.87], MNC = 62.33[6.76]; p = .033) and less educated (MMCI = 13.07[2.37], MNC = 14.36[2.51]; p = .004) and had lower MoCA scores (MMCI=21.26[3.85], MNC = 25.47[2.13]; p < .001) than the NC group. Demographics were non-significant in regression models. The area under the curve (AUC) was significant (MoCA = .83, p < .01) and an optimal cut score of <24 maximized sensitivity (72%), specificity (84%), and provided 76% diagnostic accuracy. In comparison, the traditional cut score of <26 had higher sensitivity (84%), similar accuracy (76%), but much lower specificity (58%).

Conclusions

This study provides a MoCA cut score to help differentiate persons with MCI from NC in a community-dwelling AA sample. A cut score of <24 reduces the likelihood of misclassifying normal AA individuals as impaired than the traditional cut score. This study underscores the importance of culturally appropriate norms to optimize the utility of commonly used cognitive screening measures.
Sequence kernel association test for survival outcomes in the presence of a non-susceptible fraction
Authors: Lakhal-Chaieb Lajmi , Simard Jacques , Bull Shelley
Published: November 2018

In this work, we propose a single nucleotide polymorphism set association test for survival phenotypes in the presence of a non-susceptible fraction. We consider a mixture model with a logistic regression for the susceptibility indicator and a proportional hazards regression to model survival in the susceptible group. We propose a joint test to assess the significance of the genetic variant in both logistic and survival regressions simultaneously. We adopt the spirit of SKAT and conduct a variance-component test treating the genetic effects of multiple variants as random. We derive score-type test statistics, and we investigate several approaches to compute their $p$-values. The finite-sample properties of the proposed tests are assessed and compared to existing approaches by simulations and their use is illustrated through an application to ovarian cancer data from the Consortium of Investigators of Modifiers of BRCA1 and BRCA2.
A Community Choir Intervention to Promote Well-Being Among Diverse Older Adults: Results From the Community of Voices Trial
Authors: Johnson Julene K , Stewart Anita L , Acree Michael , Nápoles Anna M , Flatt Jason D , Max Wendy B , Gregorich Steven E
Published: November 2018

Objectives

To test effects of the Community of Voices choir intervention on the health, well-being, and health care costs of racial/ethnically diverse older adults.

Method

Twelve Administration-on-Aging-supported senior centers were cluster randomized into two groups: the intervention group started the choir immediately and a wait-list control group began the choir 6 months later. The choir program was designed for community-dwelling adults aged 60 years and older. The multimodal intervention comprises activities that engage participants cognitively, physically, and socially. Outcome measures assessed these three domains as well as health care utilization and costs. The intention-to-treat comparison was at 6 months.

Results

The sample (N = 390) had a mean age of 71.3 years (SD = 7.2); 65% were nonwhite. Six-month retention was 92%. Compared to controls, intervention group members experienced significantly greater improvements in loneliness (p = .02; standardized effect size [ES = 0.34] and interest in life (p = .008, ES = 0.39). No significant group differences were observed for cognitive or physical outcomes or for health care costs.

Discussion

Findings support adoption of community choirs for reducing loneliness and increasing interest in life among diverse older adults. Further efforts need to examine the mechanisms by which engagement in choirs improves aspects of well-being and reduces health disparities among older adults, including potential longer-term effects.

ClinicalTrials.gov Registration

NCT01869179 registered January 9, 2013.
The dismembered collection of antiquities of Lowther Castle
Authors: Fadda Salvatore
Published: November 2018

From 1842 until his death in 1872, Sir William Lowther, 2nd Earl of Lonsdale, gathered a remarkable collection of ancient works of art. The collection was displayed in two galleries added to his manor for this purpose in 1866. Of the great assemblage, acquired through the dismemberment of previous British collections, little information has come down to our day. It was composed of more than 100 pieces of Egyptian, Etruscan, Greek, and mostly Roman sculpture, whose selection reflected the spirit of the collections of the ‘Golden Age of Dilettantism’ during the Victorian era. The collection, unusually for the time, also included a selection of Romano-British antiquities. The purpose of this paper is to give an overview of the formation and the dispersal of the collection and to clarify the cultural factors that determined the gathering of this eclectic assemblage of ancient objects.
Comparative Evaluation of Commercial Concentration Procedures for Human Intestinal Parasite Detection
Authors: Leméteil Denis , Gargala Gilles , Razakandrainibe Romy , Ballet Jean Jacques , Favennec Loic , Costa Damien
Published: November 2018

Background

Effective stool concentration is essential in microscopically based diagnosis of human intestinal parasite infections.

Objective

To compare the performances of 4 concentration commercial kits and 1 homemade procedure in 96 clinical stool specimens that tested positive for the detection of 9 helminth and 8 protozoa parasites.

Methods

The presence or absence of parasite forms was microscopically determined under conditions of standard practice. Also, we established the accuracies, concentration factors, and extraction yields.

Results

No difference was observed between procedures for preconcentration specimens that tested positive. However, for preconcentration specimens that tested negative, we discovered that the homemade procedure was the most effective, and 2 of the 4 commercial kits were discovered to be satisfactory for routine applications.

Conclusions

For all parasites, procedures with biphasic solvents exhibited higher performances than organic solvent-free procedures. For the first time, the effectiveness of commercial concentration kits has been evaluated on several common stool parasites, and the results suggest that improvement of commercial procedures is possible.
Evaluation software for effects produced by MOOC in mediums with different linguistically levels
Authors: Samoilă Cornel , Ursuţiu Doru , Jinga Vlad
Published: November 2018

MOOC appearance has produced, in a first phase, more discussions than contributions. Despite pessimistic opinions or those catastrophic foreseeing the end of the classic education by accepting MOOC, the authors consider that, as it is happening in all situations when a field is reformed, instead of criticism or catastrophic predictions, an assessment should be simply made. MOOC will not be better or worse if it is discussed and dissected but can be tested in action, perfected by results, or abandoned if it has no prospects. Without testing, no decision is valid. A similarity between the MOOC appearance and the appearance of the idea of flying machines heavier than air can be made. In the flight case, the first reaction was a strong negation (including at Academies level) and only performing the first independent flight with an apparatus heavier than air has shifted orientation from denial to contributions. So, practical tests clarified the battle between ideas. The authors of this article encourage the idea of testing–assessment and, therefore, imagined and proposed one software for quickly assess whether MOOC produces changes in knowledge, by simply transferring courses from ‘face-to-face’ environment into the virtual one. Among the methods of statistical analysis for student behavioral changes was chosen the Keppel method. It underpins the assessment method of this work being approached using both the version with one variable and also with three variables. It is intended that this attempts to pave the way for other series of rapid assessment regarding MOOC effects (using other statistical methods). We believe, that this is the only approach that can lead either to improve the system or to renunciation.
A Qualitative Exploration of Police Officers’ Experiences, Challenges, and Perceptions of Cybercrime
Authors: Hadlington Lee , Lumsden Karen , Black Alexandra , Ferra Fenia
Published: November 2018

Victimization from cybercrime has increased exponentially over the past decade. Frontline police officers are dealing with a variety of crimes different than those existing in an era before the advent of digital technology. Frontline officers are expected to encourage members of the public to report such crimes, to investigate them, as well as keeping up-to-date with the latest developments in this ever-changing landscape. This study explored the issues that frontline officers are dealing with on a daily basis when it comes to cybercrime. Sixteen frontline police officers took part in focus groups exploring key questions around aspects of cybercrime. The key themes discussed in this article include the difficulty of defining what is cybercrime, the contrast between the speed of developments in cybercrime and the speed of investigation, and the ineffectiveness of current training. The results are discussed in the context of a need for clearer training information to be delivered to all officers and staff who come into contact with aspects of cybercrime.
Who benefits from ex ante societal impact evaluation in the European funding arena? A cross-country comparison of societal impact capacity in the social sciences and humanities
Authors: de Jong Stefan P L , Muhonen Reetta
Published: November 2018

Increasingly, research funders include societal impact as a criterion in evaluation procedures. The European Commission is no exception to this trend. Societal impact determines one-third of a project’s success in receiving funding from the Societal Challenges in Horizon 2020 (H2020). Yet, there are large differences in terms of science and technology performance between countries that participate in the programme. In this article, we (1) compare societal impact practices in the social sciences and humanities in high-performing countries (HPCs) and low-performing countries (LPCs) to the evaluation of societal impact in funding procedures at the European level and (2) reflect upon consequences for the competition for research funding in the European funding arena. To this end, we introduce the concept of ‘societal impact capacity’ as well as a framework to analyse it. The analysis of 60 case studies from 16 countries across Europe shows that (1) researchers from HPCs have a higher impact capacity than those from LPCs and (2) researchers from HPCs report more details about impact than those from LPCs. This suggests that researchers from HPCs are better equipped to score well on the impact criterion when applying for funding than researchers from LPCs. We conclude with policy recommendations for the organization and evaluation of societal impact.
Risk of tuberculosis in patients with immune-mediated diseases on biological therapies: a population-based study in a tuberculosis endemic region
Authors: Wang Xing , Wong Sunny H , Wang Xian-Song , Tang Whitney , Liu Chang-Qin , Niamul Gani , Wu Bin , Tam Lai-Shan , Wu Justin C Y , Chan Francis K L , Sung Joseph J Y , Ng Siew C
Published: November 2018

Objective

Real-world epidemiological data on the risk of tuberculosis (TB) in patients with immune-mediated diseases treated with biologics are scarce in TB endemic areas. We investigated the incidence of TB in a population-based setting and stratified the risk of TB among different biological therapies.

Methods

We collected medical data from a territory-wide computerized database in Hong Kong. We reported the incidence of TB in patients treated with various classes of biologics, and calculated standardized incidence ratio by comparing with the general population. Subgroup analyses were performed based on disease subtypes and biological drugs.

Results

Among 2485 subjects with immune-mediated diseases (82.5% rheumatology diseases; 10.6% IBD; 6.9% dermatology diseases), 54 subjects developed active TB during 6921 person-years of follow-up. The mean age (±s.d.) was 43 (14) years, and the median follow-up duration was 24.9 months (interquartile range 4.9–45.0). The overall standardized incidence ratio of TB was 10.91 (95% CI 8.00–13.82), and patients treated with infliximab had a nearly 26 times increased risk of TB compared with the general population (standardized incidence ratio 25.95; 95% CI 17.23–34.67). The risk of TB with TNF inhibitor was higher than with a non-TNF biologic (hazard ratio 4.34; 95% CI 1.31–14.39), while the risk of infliximab was higher than etanercept and adalimumab (hazard ratio: 4.10 and 2.08, respectively).

Conclusion

The risk of TB is much higher in patients with immune-mediated diseases on biological therapy compared with the general population, and infliximab is associated with the highest risk of TB among the biologics analysed.
Ambiguity in the Definition: The Need for Caution in Prosecuting Persons Under the Anti-pornography Act
Authors: Doya Nanima Robert
Published: November 2018

The purpose of Parliamentary scrutiny and debates in drafting a law is to avoid ambiguity, vagueness and definitional deficiencies. The penal provisions in the criminal laws should be clear on the acts that constitute the offence, and the intention of the accused person. A look at the drafting history of a law may aid one to ascertain the intention of Parliament. It is argued that there are challenges to the implementation of the Anti-pornography Act from an interpretational perspective. This contribution critiques the role of Parliament in defining pornography in the process of enacting the Anti-pornography Act. The possible challenges to prosecution that arise from this role are identified. Recommendations on the drafting process follow.
A Decision Analysis for Rectal-Sparing Familial Adenomatous Polyposis: Total Colectomy With Ileorectal Anastomosis Versus Proctocolectomy With IPAA
Authors: Melnitchouk Nelya , Saadat Lily Victoria , Bleday Ronald , Goldberg Joel E.
Published: November 2018

BACKGROUND:

There are different approaches for the surgical management of rectal-sparing familial adenomatous polyposis with variable impacts on both quality of life and survival.

OBJECTIVE:

The aim of this study was to quantify the trade-offs between total proctocolectomy with IPAA versus total colectomy with ileorectal anastomosis using decision analysis.

DESIGN:

We created a disease simulation Markov model to simulate the clinical events after IPAA and ileorectal anastomosis for rectal-sparing familial adenomatous polyposis in a cohort of individuals at the age 30 years. We used available literature to obtain different transition probabilities and health-states utilities. The output parameters were quality-adjusted life-years and life-years. Deterministic and probabilistic sensitivity analyses were performed.

SETTINGS:

A decision analysis using a Markov model was conducted at a single center.

PATIENTS:

Patients with rectal-sparing familial adenomatous polyposis at age 30 years were included. Rectal-sparing familial adenomatous polyposis is defined as the presence of 0 to 20 polyps that can be removed endoscopically.

MAIN OUTCOME MEASURES:

Quality-adjusted life-years were measured.

RESULTS:

Our model showed that the mean quality-adjusted life-years for IPAA was 25.12 and for ileorectal anastomosis was 27.12 in base-case analysis. Mean life-years for IPAA were 28.81 and 28.28 for ileorectal anastomosis. A 1-way sensitivity analysis was performed for all of the parameters in the model. None of the deterministic sensitivity analyses changed the model results across the range of plausible values. Probabilistic analysis identified that, in 86.9% of scenarios, ileorectal anastomosis had improved quality-adjusted life-years compared with IPAA.

LIMITATIONS:

The study was limited by characteristics inherent to modeling studies.

CONCLUSIONS:

Ileorectal anastomosis was found to be preferable for patients with rectal-sparing familial adenomatous polyposis when quality of life is taken into consideration. This model was robust based on both deterministic and probabilistic sensitivity analyses. These data should be taken into consideration when counseling patients regarding a surgical approach in rectal-sparing familial adenomatous polyposis. See Video Abstract at http://links.lww.com/DCR/A715.
Evaluation of the Repeatability and Reproducibility of Corneal Epithelial Thickness Mapping for a 9-mm Zone Using Optical Coherence Tomography
Authors: Ma Jack X. , Wang Li , Weikert Mitchell P. , Montes de Oca Ildamaris , Koch Douglas D.
Published: November 2018

Purpose:

To evaluate the repeatability and between-machine/operator reproducibility of optical coherence tomography (RTVue-XR) for mapping corneal epithelial thickness (ET) and corneal thickness (CT) over a 9-mm zone.

Methods:

In 5 groups of eyes (normal, contact lens, dry eye, post-LASIK/PRK, and keratoconus), corneal ET and CT were evaluated in 25 areas in the following 4 regions: 1) 1 central zone within 0 to 2.0 mm diameter, 2) 8 paracentral zones from 2.0 to 5.0 mm diameter, 3) 8 midperipheral zones from 5.0 to 7.0 mm diameter, and 4) 8 peripheral zones from 7.0 to 9.0 mm diameter. Three devices with designated operators were used to obtain 3 scans per device for each eye. The repeatability, reproducibility, and coefficient of variation were calculated.

Results:

For all areas up to 9 mm diameter, in normal eyes, contact lens eyes, dry eyes, post- LASIK/PRK eyes, and keratoconic eyes, repeatability and reproducibility ranged from 0.7 to 1.5, 1.0 to 2.6, 0.9 to 2.0, 0.7 to 2.5, and 1.1 to 2.3 μm for ET and 1.5 to 8.3, 2.3 to 12.1, 1.7 to 14.2, 1.4 to 13.7, and 6.9 to 18.9 μm for CT, respectively. The ranges of coefficient of variation values were 1.2% to 3.0%, 1.9% to 5.5%, 1.8% to 4.3%, 1.3% to 5.2%, and 2.2% to 4.5% for ET and 0.3% to 1.2%, 0.4% to 1.8%, 0.4% to 2.1%, 0.3% to 2.0%, and 1.2% to 3.0% for CT, respectively.

Conclusions:

Optical coherence tomography produced excellent repeatability and reproducibility for corneal ET and CT measurements up to a 9-mm zone in normal eyes and eyes with different corneal conditions. The CT measurements in keratoconic eyes were more variable than those in eyes with other corneal conditions.
Respiratory Viruses Frequently Mimic Pertussis in Young Infants
Authors: Damouni Shalabi Ranaa , Srugo Isaac , Golan-Shany Orit , Kugelman Amir , Bamberger Ellen
Published: November 2018

Bordetella pertussis is prevalent among infants, but its diagnosis is complicated by the fact that its signs and symptoms overlap with respiratory viruses. Indeed, when evaluating the etiology of infants less than 1 year of age suspected of having pertussis, we found that respiratory viruses frequently mimic B. pertussis and are more likely to be the causative agent.
Surgical Management of Proximal Long Head Biceps Tendon Disorders
Authors: Angelo Richard L.
Published: November 2018

Disorders of the long head of the biceps tendon can make a significant contribution to shoulder pain and dysfunction. Historically, open biceps tenotomy or a proximal tenodesis of the tendon through a deltopectoral approach was used to manage biceps tendonitis and instability. Recent developments have added additional options. Arthroscopic techniques offer minimally invasive methods to secure the biceps in the suprapectoral region at the appropriate length. An open subpectoral tenodesis provides for simple exposure that secures the tendon just proximal to the musculotendinous junction and eliminates potentially diseased tendon and synovium from the biceps groove. Common fixation methods include the use of interference screws, suture anchors, and button devices. Future developments will likely add modified tenotomy techniques that will minimize the Popeye deformity in low-demand individuals. Simpler, but secure methods of fixation for higher demand patients will minimize the operative time required.
Knee Dislocation and Multiple Ligament Injuries of the Knee
Authors: Fanelli Gregory C.
Published: November 2018

The purpose of this paper is to present an overview of the progress in treatment of knee dislocations and posterior cruciate ligament (PCL)-based multiple ligament knee injuries over the past 25 years. The perspectives of where we were 25 years ago, where we are today, and where we will be in the future will be explored.
Catastrophic Return to Play in Rugby After Double Cervical Arthrodesis
Authors: Brauge David , Sol Jean C. , Djidjeli Imène , Roux Franck E.
Published: November 2018

For high-level athletes, most experts consider that 1-level arthrodesis in cervical spine surgery does not prevent return to play. Nevertheless, return remains controversial in cases of 2-level fusions. We report the case of a 27-year-old professional rugby player. He had had a double cervical fusion C5C6 and C6C7 for cervical hernia and was allowed to continue rugby activities afterward. Four years after this surgery, his neck was forced in hyperflexion during a match and complete tetraplegia occurred. A computed tomography scan showed a C3C4 unilateral facet dislocation. The patient was rapidly operated on. At follow-up, 2 years after the accident, the patient remained tetraplegic with no neurologic improvement. If no definitive conclusion can be established on this first observation, many precautions must be taken before a return-to-play decision, especially in contact sports.
Use of Seva Stress Release Acupressure to Reduce Pain, Stress, and Fatigue in Patients Hospitalized for Cancer Treatment
Authors: Sand-Jecklin Kari , Reiser Victoria
Published: November 2018

Patients undergoing treatment for cancer often experience stress, fatigue, and pain during their treatment. Medical management of these symptoms can cause additional adverse effects, but it is possible that noninvasive complementary therapies may be able to reduce these symptoms without unwanted adverse effects. The purpose of this study was to assess the feasibility and impact of the Seva Stress Release acupressure protocol on stress, fatigue, pain, and vital signs of patients hospitalized for cancer treatment. Thirty patients receiving cancer treatment and experiencing stress, fatigue, and pain were recruited for the study. After obtaining informed consent, baseline data (survey and vital signs) were obtained, followed by administration of the Seva Stress Release. After the intervention, vital signs were obtained, and patients completed 2 additional surveys. After Seva, patient stress, fatigue, pain, heart rate, and respirations were significantly decreased (P = .000). Sixty-six percent of participants experienced symptom relief for at least 1 to 4 hours. Qualitative findings also indicated that patients reported better sleep and mental clarity after the intervention. The Seva protocol could be taught to nurses and be used as an independent intervention for patients experiencing adverse effects of cancer treatment, to promote comfort and reduce stress and fatigue.
A National Survey on Interhospital Transport of Children in Cardiac Arrest*
Authors: Noje Corina , Bembea Melania M. , Nelson McMillan Kristen L. , Brunetti Marissa A. , Bernier Meghan L. , Costabile Philomena M. , Klein Bruce L. , Duval-Arnould Jordan , Hunt Elizabeth A. , Shaffner Donald H.
Published: November 2018

Objectives:

To describe the U.S. experience with interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation.

Design:

Self-administered electronic survey.

Setting:

Pediatric transport teams listed with the American Academy of Pediatrics Section on Transport Medicine.

Subjects:

Leaders of U.S. pediatric transport teams.

Interventions:

None.

Measurements and Main Results:

Sixty of the 88 teams surveyed (68%) responded. Nineteen teams (32%) from 13 states transport children undergoing cardiopulmonary resuscitation between hospitals. The most common reasons for transfer of children in cardiac arrest are higher level-of-care (70%), extracorporeal life support (60%), and advanced trauma resuscitation (35%). Eligibility is typically decided on a case-by-case basis (85%) and sometimes involves a short interhospital distance (35%), or prompt institution of high-quality cardiopulmonary resuscitation (20%). Of the 19 teams that transport with ongoing cardiopulmonary resuscitation, 42% report no special staff safety features, 42% have guidelines or protocols, 37% train staff on resuscitation during transport, 11% brace with another provider, and 5% use mechanical cardiopulmonary resuscitation devices for patients less than 18 years. In the past 5 years, 18 teams report having done such cardiopulmonary resuscitation transports: 22% did greater than five transports, 44% did two to five transports, 6% did one transport, and the remaining 28% did not recall the number of transports. Seventy-eight percent recall having transported by ambulance, 44% by helicopter, and 22% by fixed-wing. Although patient outcomes were varied, eight teams (44%) reported survivors to ICU and/or hospital discharge.

Conclusions:

A minority of U.S. teams perform interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Eligibility criteria, transport logistics, and patient outcomes are heterogeneous. Importantly, there is a paucity of established safety protocols for the staff performing cardiopulmonary resuscitation in transport.
The Role of Education in Developing a Culture of Safety Through the Perceptions of Undergraduate Nursing Students: An Integrative Literature Review
Authors: Bedgood Amie L. , Mellott Susan
Published: November 2018

Objective

This integrative literature review seeks to examine research-based knowledge about the role of education in developing a culture of safety through the perspectives of undergraduate nursing students.

Methods

An integrative literature review of nursing and health databases was conducted and literature from 2009 to 2018 were reviewed. Studies focusing on patient safety education in undergraduate nursing students were analyzed to identify the current state of safety education in academia. The results and findings from the articles reviewed were included in the final synthesis of the literature.

Results

A total of 336 articles were identified from the onset and 14 were selected for inclusion in the review. There were 3 qualitative studies, 8 quantitative studies, and 3 mixed-methods research studies included. Four themes emerged: students perceive patient safety education is important, safety education in the curriculum is important, students are afraid to speak up, and students perceive a lack of knowledge and support for speaking up.

Conclusions

The results of this integrative literature review demonstrate that nursing education plays an integral role in creating a culture of safety among nursing students. Nursing students lack a strong understanding of their role in patient safety. This translates into a need for dedicated patient safety curriculum to establish a culture of safety in nursing education.