bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimizing the bioenergy water footprint by selecting SRC willow canopy phenotypes: regional scenario simulations
Authors: Richard Benjamin , Richter Goetz M , Cerasuolo Marianna , Shield Ian
Published: January 2019

Background and Aims

Bioenergy is central for the future energy mix to mitigate climate change impacts; however, its intricate link with the water cycle calls for an evaluation of the carbon–water nexus in biomass production. The great challenge is to optimize trade-offs between carbon harvest and water use by choosing cultivars that combine low water use with high productivity.

Methods

Regional scenarios were simulated over a range of willow genotype × environment interactions for the major UK soil × climate variations with the process-based model LUCASS. Soil available water capacity (SAWC) ranged from 51 to 251 mm and weather represented the north-west (wet, cool), north-east (dry, cool), south-west (wet, warm) and south-east (dry, warm) of the UK. Scenario simulations were evaluated for small/open narrow-leaf (NL) versus large/closed broad-leaf (BL) willow canopy phenotypes using baseline (1965–89) and warmer recent (1990–2014) weather data.

Key Results

The low productivity under baseline climate in the north could be compensated by choosing BL cultivars (e.g. ‘Endurance’). Recent warmer climate increased average productivity by 0.5–2.5 t ha−1, especially in the north. The modern NL cultivar ‘Resolution’ had the smallest and most efficient water use. On marginal soils (SAWC <100 mm), yields remained below an economic threshold of 9 t ha−1 more frequently under baseline than recent climate. In the drought-prone south-east, ‘Endurance’ yielded less than ‘Resolution’, which consumed on average 17 mm year−1 less water. Assuming a planting area of 10 000 ha, in droughty years between 1.3 and 4.5 × 106 m3 of water could be saved, with a small yield penalty, for ‘Resolution’.

Conclusions

With an increase in air temperature and occasional water scarcities expected with climate change, high-yielding NL cultivars should be the preferred choice for sustainable use of marginal lands and reduced competition with agricultural food crops.
Predicting the optimal growth temperatures of prokaryotes using only genome derived features
Authors: Sauer David B , Wang Da-Neng
Published: January 2019

Motivation

Optimal growth temperature is a fundamental characteristic of all living organisms. Knowledge of this temperature is central to the study of a prokaryote, the thermal stability and temperature dependent activity of its genes, and the bioprospecting of its genome for thermally adapted proteins. While high throughput sequencing methods have dramatically increased the availability of genomic information, the growth temperatures of the source organisms are often unknown. This limits the study and technological application of these species and their genomes. Here, we present a novel method for the prediction of growth temperatures of prokaryotes using only genomic sequences.

Results

By applying the reverse ecology principle that an organism’s genome includes identifiable adaptations to its native environment, we can predict a species’ optimal growth temperature with an accuracy of 5.17°C root-mean-square error and a coefficient of determination of 0.835. The accuracy can be further improved for specific taxonomic clades or by excluding psychrophiles. This method provides a valuable tool for the rapid calculation of organism growth temperature when only the genome sequence is known.

Availability and implementation

Source code, genomes analyzed and features calculated are available at: https://github.com/DavidBSauer/OGT_prediction.

Supplementary information

Supplementary data are available at Bioinformatics online.
Comorbidity4j: a tool for interactive analysis of disease comorbidities over large patient datasets
Authors: Ronzano Francesco , Gutiérrez-Sacristán Alba , Furlong Laura I
Published: January 2019

Pushed by the growing availability of Electronic Health Records for data mining, the identification of relevant patterns of co-occurring diseases over a population of individuals—referred to as comorbidity analysis—has become a common practice due to its great impact on life expectancy, quality of life and healthcare costs. In this scenario, the availability of scalable, easy-to-use software frameworks tailored to support the study of comorbidities over large datasets of patients is essential. We introduce Comorbidity4j, an open-source Java tool to perform systematic analyses of comorbidities by generating interactive Web visualizations to explore and refine results. Comorbidity4j processes user-provided clinical data by identifying significant disease co-occurrences and computing a comprehensive set of comorbidity indices. Patients can be stratified by sex, age and user-defined criteria. Comorbidity4j supports the analysis of the temporal directionality and the sex ratio of diseases. The incremental upload and validation of clinical input data and the customization of comorbidity analyses are performed by an interactive Web interface. With a Web browser, the results of such analyses can be filtered with respect to comorbidity indexes and disease names and explored by means of heat maps and network charts of disease associations. Comorbidity4j is optimized to efficiently process large datasets of clinical data. Besides a software tool for local execution, we provide Comorbidity4j as a Web service to enable users to perform online comorbidity analyses.

Availability and implementation

Doc: http://comorbidity4j.readthedocs.io/; Source code: https://github.com/fra82/comorbidity4j, Web tool: http://comorbidity.eu/comorbidity4web/.
Safety and Pharmacokinetics of Glecaprevir/Pibrentasvir in Adults With Chronic Genotype 1–6 Hepatitis C Virus Infections and Compensated Liver Disease
Authors: Gane Edward , Poordad Fred , Zadeikis Neddie , Valdes Joaquin , Lin Chih-Wei , Liu Wei , Asatryan Armen , Wang Stanley , Stedman Catherine , Greenbloom Susan , Nguyen Tuan , Elkhashab Magdy , Wörns Marcus-Alexander , Tran Albert , Mulkay Jean-Pierre , Setze Carolyn , Yu Yao , Pilot-Matias Tami , Porcalla Ariel , Mensa Federico J
Published: January 2019

Background

Untreated, chronic hepatitis C virus (HCV) infection may lead to progressive liver damage, which can be mitigated by successful treatment. This integrated analysis reports the safety, efficacy, and pharmacokinetics (PK) of the ribavirin-free, direct-acting, antiviral, fixed-dose combination of glecaprevir/pibrentasvir (G/P) in patients with chronic HCV genotype 1–6 infections and compensated liver disease, including patients with chronic kidney disease stages 4 or 5 (CKD 4/5).

Methods

Data from 9 Phase II and III clinical trials, assessing the efficacy and safety of G/P treatment for 8–16 weeks, were included. The presence of cirrhosis was determined at screening using a liver biopsy, transient elastography, or serum biomarkers. The objectives were to evaluate safety, the rate of sustained virologic response at post-treatment week 12 (SVR12), and steady-state PK by cirrhosis status.

Results

Among 2369 patients, 308 (13%) were Child-Pugh Class A, including 20 with CKD 4/5. Overall, <1% of patients experienced an adverse event (AE) that led to G/P discontinuation or G/P-related serious AEs (SAEs). The most common AEs were headache and fatigue, occurring at similar frequencies with and without cirrhosis. SAEs were more common in patients with CKD 4/5, but all were unrelated to G/P. There were no cases of drug-induced liver injury or clinically relevant hepatic decompensation. SVR12 rates were 96.4% (297/308) with compensated cirrhosis and 97.5% (2010/2061) without cirrhosis. PK analysis demonstrated a 2.2-fold increase in glecaprevir exposure, but not pibrentasvir exposure, in patients with compensated cirrhosis.

Conclusions

G/P was safe and efficacious in patients with compensated liver disease, including those with CKD 4/5.

Clinical Trials Registration

NCT02243280, NCT02243293, NCT02604017, NCT02640482, NCT02640157, NCT02636595, NCT02642432, NCT02651194, and NCT02446717
Risk Factors for Infant Colonization by Hypervirulent CC17 Group B Streptococcus: Toward the Understanding of Late-onset Disease
Authors: Tazi Asmaa , Plainvert Céline , Anselem Olivia , Ballon Morgane , Marcou Valérie , Seco Aurélien , El Alaoui Fatma , Joubrel Caroline , El Helali Najoua , Falloukh Emile , Frigo Amandine , Raymond Josette , Trieu-Cuot Patrick , Branger Catherine , Le Monnier Alban , Azria Elie , Ancel Pierre-Yves , Jarreau Pierre Henri , Mandelbrot Laurent , Goffinet François , Poyart Claire
Published: January 2019

The hypervirulent group B Streptococcus clone CC17 accounts for the majority of infant late-onset disease (LOD). We provide evidence that the high incidence of CC17 in LOD is likely due to an enhanced post-delivery mother-to-infant transmission.
Increased Fragility Fracture Rates in Older Men With Osteomyelitis
Authors: Hsieh Evelyn , Shiau Stephanie , Nolan Olivia , Gibert Cynthia L , Bedimo Roger J , Rodriguez-Barradas Maria C , Justice Amy C , Womack Julie A , Yin Michael T
Published: January 2019

In this study, we evaluated fracture incidence over a 10-year period among men with and without osteomyelitis from the Veterans Aging Cohort Study. Fracture incidence was significantly higher among those with osteomyelitis at all osteoporotic fracture sites after adjusting for key related risk factors. Future prospective studies are warranted.
Intensified Infliximab Induction is Associated with Improved Response and Decreased Colectomy in Steroid-Refractory Paediatric Ulcerative Colitis
Authors: Church Peter C , Ho Shaun , Sharma Ajay , Tomalty Diane , Frost Karen , Muise Aleixo , Walters Thomas D , Griffiths Anne M
Published: January 2019

Background

Infliximab pharmacokinetics in steroid-refractory [SR] ulcerative colitis [UC] suggest a need for higher dosing, but data concerning efficacy of intensification in this setting are lacking in children and inconsistent overall.

Methods

Paediatric patients [N = 125] treated with infliximab for SR or steroid-dependent UC were retrospectively reviewed. Outcomes [clinical response and remission, colectomy, mucosal healing, safety] with standard vs intensified induction [mean induction dose ≥7 mg/kg or interval ≤5 weeks between doses 1 and 3] were compared.

Results

Among 125 patients [median age 14 years, median UC duration 0.7 years, 74 SR], 73 [58%] received standard induction and 52 [42%] received intensified induction. Overall, 73 [58%] achieved remission (judged by physician global assessment [PGA] and paediatric UC activity index [PUCAI]≤10]. Among patients in remission, 7 [10%] experienced secondary loss of response by a median of 0.7 [IQR 0.4–1.0] years. Of the 74 SR patients, 17 [23%] underwent colectomy, and of the 51 steroid-dependent patients, 12 [24%] underwent colectomy. Intensified induction in SR patients was associated with a higher chance of remission (hazard ratio [HR] 3.2, p = 0.02) and a lower chance of colectomy [HR 0.4, p = 0.05], but did not improve outcomes in steroid-dependent patients. During follow-up, 46/73 [63%] patients in remission had regimen individualization, with similar rates of return to standard dosing after 1 year between those with initial intensified or standard induction. Follow-up endoscopy, performed in 35/73 patients in remission, demonstrated mucosal healing for 66%. Adverse events were rare, despite use of intensified regimens.

Conclusions

These data suggest a benefit from intensified infliximab induction specifically among children with steroid-refractory UC. Prospective studies comparing dosing regimens and incorporating therapeutic drug monitoring should be undertaken.
The Kosovo Specialist Chambers from a Political Realism Perspective
Authors: Muharremi Robert
Published: January 2019

Abstract∞

This article complements current legal research on the Kosovo Specialist Chambers and the Specialist Prosecutor’s Office – the ‘Special Court’ – by tracing the political process and the interests which influenced the court’s establishment. A key question is why the Special Court was established at all and why it was established as a national court, despite being under full international control. Political realism provides a useful theoretical framework to discuss these questions since it claims that international criminal tribunals are established to serve the interests of powerful states and not necessarily to provide international justice. The article’s main hypothesis is that the Special Court was created as a national court not only to address war crimes and prosecute the perpetrators of those crimes, but also to protect international actors from possible legal exposure in connection with their involvement in Kosovo during the time when the alleged crimes were committed.
Optimal investment and consumption problems under correlation ambiguity
Authors: Han Bingyan , Wong Hoi Ying
Published: January 2019

Consider an economy with $d$ stochastic factors that have an ambiguous variance–covariance matrix. An ambiguity- and risk-averse agent seeks to determine the optimal investment and consumption strategy that is robust to the uncertainty in the covariances. We formulate the robust decision rule as an expected utility maximization over the worst-case scenario with respect to all possible covariances. As this variance–covariance ambiguity leads to robust optimal decisions over a set of non-equivalent probability measures, the $G$-expectation framework is adopted to characterize the problem as a maximin optimization. Our problem formulation can be applied to finite and infinite horizon investment–consumption problems with or without a subsistence consumption constraint. We demonstrate our models using two examples including the defined contribution pension problem and lifetime optimal investment–consumption problems.
Spaces of Low-Degree Rational Curves on Fano Complete Intersections
Authors: Pan Xuanyu
Published: January 2019

In this paper, we prove that the moduli space of low degree rational curves on a low-degree complete intersection passing several suitable points is a complete intersection. The proof involves some relationships among some divisors on the Kontsevich spaces, advanced techniques of deformations of rational curves, and classical projective geometry.
The Influence of Adjuvant Systemic Regimens on Contralateral Breast Cancer Risk and Receptor Subtype
Authors: Kramer Iris , Schaapveld Michael , Oldenburg Hester S A , Sonke Gabe S , McCool Danielle , van Leeuwen Flora E , Van de Vijver Koen K , Russell Nicola S , Linn Sabine C , Siesling Sabine , Menke-van der Houven van Oordt C Willemien , Schmidt Marjanka K
Published: January 2019

Background

An increasing number of breast cancer (BC) survivors are at risk of developing contralateral breast cancer (CBC). We aimed to investigate the influence of various adjuvant systemic regimens on, subtype-specific, risk of CBC.

Methods

This population-based cohort study included female patients diagnosed with first invasive BC between 2003 and 2010; follow-up was complete until 2016. Clinico-pathological data were obtained from the Netherlands Cancer Registry and additional data on receptor status through linkage with PALGA: the Dutch Pathology Registry. Cumulative incidences (death and distant metastases as competing risk) and hazard ratios (HRs) were estimated for all invasive metachronous CBC and CBC subtypes.

Results

Of 83 144 BC patients, 2816 developed a CBC; the 10-year cumulative incidence was 3.8% (95% confidence interval [CI] = 3.7% to 4.0%). Overall, adjuvant chemotherapy (HR = 0.70, 95% CI = 0.62 to 0.80), endocrine therapy (HR = 0.46, 95% CI = 0.41 to 0.52), and trastuzumab with chemotherapy (HR = 0.57, 95% CI = 0.45 to 0.73) were strongly associated with a reduced CBC risk. Specifically, taxane-containing chemotherapy (HR = 0.48, 95% CI = 0.36 to 0.62) and aromatase inhibitors (HR = 0.32, 95% CI = 0.23 to 0.44) were associated with a large CBC risk reduction. More detailed analyses showed that endocrine therapy statistically significantly decreased the risk of estrogen receptor (ER)-positive CBC (HR = 0.41, 95% CI = 0.36 to 0.47) but not ER-negative CBC (HR = 1.32, 95% CI = 0.90 to 1.93) compared with no endocrine therapy. Patients receiving chemotherapy for ER-negative first BC had a higher risk of ER-negative CBC from 5 years of follow-up (HR = 2.84, 95% CI = 1.62 to 4.99) compared with patients not receiving chemotherapy for ER-negative first BC.

Conclusion

Endocrine therapy, chemotherapy, as well as trastuzumab with chemotherapy reduce CBC risk. However, each adjuvant therapy regimen had a different impact on the CBC subtype distribution. Taxane-containing chemotherapy and aromatase inhibitors were associated with the largest CBC risk reduction.
Randomized Trial of a Positive Psychology Intervention for Adolescents With Type 1 Diabetes
Authors: Jaser Sarah S , Whittemore Robin , Choi Leena , Nwosu Samuel , Russell William E
Published: January 2019

Objective

To evaluate the effects of a positive psychology intervention for adolescents with type 1 diabetes (T1D) on adherence, glycemic control, and quality of life.

Methods

Adolescents with T1D (n = 120) and their caregivers were randomized to either an Education (EDU) (n = 60) or Positive Affect (PA) intervention (n = 60). Adolescents in the PA group received the intervention reminders (gratitude, self-affirmation, parental affirmation, and small gifts) via text messages or phone calls over 8 weeks. Questionnaires were completed by adolescents and caregivers and clinical data (glucometer and HbA1c) were collected at baseline 3 and 6 months. Data were analyzed using generalized linear modeling.

Results

After adjusting for covariates, adolescents in the PA group demonstrated significant improvement in quality of life at 3 months, compared to the EDU group, but this was not sustained at 6 months. Similarly, the PA group showed a significant decrease in disengagement coping at 3 months but not at 6 months. There was no significant intervention effect on blood glucose monitoring, but the odds of clinically significantly improvement (checking at least one more time/day) were about twice as high in the PA group as the EDU group. No significant effects were found for glycemic control.

Conclusions

A positive psychology intervention had initial significant, positive effects on coping and quality of life in adolescents with T1D. A more intensive or longer-lasting intervention may be needed to sustain these effects and to improve adherence and glycemic control.
Endogenous Pain Inhibitory Function: Endurance-Trained Athletes vs Active Controls
Authors: Peterson Jessica A , Schubert Daniel J , Campbell Jason , Bemben Michael G , Black Christopher D
Published: January 2019

Objective

Athletes are at risk for developing chronic pain conditions, but the role of exercise in the modulation of pain in athletes has not been well established. The aim of this study was to investigate conditioned pain modulation (CPM) and exercise-induced hypoalgesia (EIH) responses between 13 endurance-trained athletes and 13 normally active controls.

Methods

In a cross-sectional, nonrandomized study with two independent groups of college-aged males and females, pressure pain thresholds (PPTs) were assessed in the vastus lateralis (VL) and brachioradialis (BR) using a pressure algometer before and after a conditioning stimulus, an isometric hand grip exercise to failure, and a 30-minute run.

Results

PPTs increased following the conditioning stimulus, indicating a CPM response, to a similar degree in the BR (19.3% ± 26.5% vs 18.6% ± 16.2%, P = 0.93) and VL (18.9% ± 25.9% vs 28.7% ± 27.4%, P = 0.73) in the athletes and controls. PPTs increased following isometric exercise to a similar extent in athletes and controls in the BR (23.9% ± 22.8% vs 28.2% ± 24.0%, P = 0.75) and VL (15.8% ± 14.8% vs 15.5% ± 11.6%, P = 0.94). Following 30 minutes of running, EIH was similar between athletes and controls in the VL (21.2% ± 17.2% vs 13.8% ± 13.3%, P = 0.23) but was attenuated in the BR of the athletes (6.1% ± 16.9% vs 20.9% ± 20%, P = 0.047).

Conclusions

Athletes and controls exhibited similar endogenous pain inhibitory function both locally and systemically following CPM and isometric, upper body exercise. After the 30-minute run, BR EIH was reduced in the athletes compared with controls, suggesting a reduced systemic response following familiar exercise—perhaps due to the exercise being perceived as less painful and/or effortful.
Learning across the UK: a review of public health systems and policy approaches to early child development since political devolution
Authors: Black Michelle , Barnes Amy , Baxter Susan , Beynon Claire , Clowes Mark , Dallat Mary , Davies Alisha R , Furber Andrew , Goyder Elizabeth , Jeffery Catherine , Kritsotakis Evangelos I , Strong Mark
Published: January 2019

Background

Giving children the best start in life is critical for their future health and wellbeing. Political devolution in the UK provides a natural experiment to explore how public health systems contribute to children’s early developmental outcomes across four countries.

Method

A systematic literature review and input from a stakeholder group was used to develop a public health systems framework. This framework then informed analysis of public health policy approaches to early child development.

Results

A total of 118 studies met the inclusion criteria. All national policies championed a ‘prevention approach’ to early child development. Political factors shaped divergence, with variation in national conceptualizations of child development (‘preparing for life’ versus ‘preparing for school’) and pre-school provision (‘universal entitlement’ or ‘earned benefit’). Poverty and resourcing were identified as key system factors that influenced outcomes. Scotland and Wales have enacted distinctive legislation focusing on wider determinants. However, this is limited by the extent of devolved powers.

Conclusion

The systems framework clarifies policy complexity relating to early child development. The divergence of child development policies in the four countries and, particularly, the explicit recognition in Scottish and Welsh policy of wider determinants, creates scope for this topic to be a tracer area to compare UK public health systems longer term.
Immunogenicity of biologic agents in juvenile idiopathic arthritis: a systematic review and meta-analysis
Authors: Doeleman Martijn J H , van Maarseveen Erik M , Swart Joost F
Published: January 2019

Objective

The clinical impact of anti-drug antibodies (ADAbs) in paediatric patients with JIA remains unknown. This systematic review and meta-analysis aimed to summarize the prevalence of ADAbs in JIA studies; investigate the effect of ADAbs on treatment efficacy and adverse events; and explore the effect of immunosuppressive therapy on antibody formation.

Methods

PubMed, Embase and the Cochrane Library were systematically searched to identify relevant clinical trials and observational studies that reported prevalence of ADAbs. Studies were systematically reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses and appropriate proportional and pairwise meta-analyses were performed.

Results

A total of 5183 references were screened; 28 articles, involving 26 studies and 2354 JIA patients, met eligibility criteria. Prevalence of ADAbs ranged from 0% to 82% across nine biologic agents. Overall pooled prevalence of ADAbs was 16.9% (95% CI, 9.5, 25.9). Qualitative analysis of included studies indicated that antibodies to infliximab, adalimumab, anakinra and tocilizumab were associated with treatment failure and/or hypersensitivity reactions. Concomitant MTX uniformly reduced the risk of antibody formation during adalimumab treatment (risk ratio 0.33; 95% CI 0.21, 0.52).

Conclusion

The association of ADAbs with treatment failure and hypersensitivity reactions indicates their clinical relevance in paediatric patients with JIA. Based on our findings, we recommend a preliminary course of action regarding immunogenicity of biologic agents in patients with JIA. Further strategies to predict, prevent, detect and manage immunogenicity could optimize treatment outcomes and personalize treatment with biologic therapies.
Characterization of Botrytis cinerea From Commercial Cut Flower Roses
Authors: Muñoz M. , Faust J. E. , Schnabel G.
Published: January 2019

Botrytis cinerea Pers. infects cut flower roses (Rosa × hybrida L.) during greenhouse production and gray mold symptoms are often expressed in the postharvest environment, resulting in significant economic losses. Disease management is based on cultural practices and preventative chemical treatments; however, gray mold outbreaks continue to occur. Rose tissues from six commercial shipments from two greenhouses in Colombia were evaluated to determine the Botrytis species composition as well as identify other pathogens present, gray mold incidence and severity, and fungicide resistance profiles. Botrytis isolates (49 total) were grouped into six morphological phenotypes, and all were identified to be B. cinerea sensu stricto. Disease incidence was higher in the petals than in the stem, stamen, ovary, sepal, or leaf tissues. Other fungi were isolated infrequently and included Alternaria alternata, Cladosporium cladosporioides, Epicoccum nigrum, Penicillium citrinum, Aspergillus brasiliensis, and Diplodia sp. Fungicide resistance profiles were determined using previously established discriminatory doses. Isolates resistant to thiophanate-methyl, iprodione, boscalid, and cyprodinil were found frequently in all shipments and in both greenhouses. The frequency of resistance to penthiopyrad, fenhexamid, fluopyram, isofetamid, and fludioxonil varied between shipments and greenhouses. No resistance to pydiflumetofen was observed at the discriminatory doses tested. Isolates with resistance to multiple chemical classes were commonly found. These results indicate that fungicide resistance management practices may improve preharvest and postharvest gray mold control of cut flower roses.
Psychometric Evaluation of a Rubric to Assess Basic Performance During Simulation in Nursing
Authors: Bernat-Adell María Desamparados , Moles-Julio Pilar , Esteve-Clavero Aurora , Collado-Boira Eladio Joaquín
Published: January 2019

AIM

This study was conducted to evaluate the psychometric properties of a rubric to assess nursing student performance in medium- and low-fidelity simulation.

METHOD

A psychometric study was carried out. Content validity was explored by a group of experts. Internal consistency was determined by means of Cronbach’s coefficient alpha. Interrater agreement and the level of concordance were established by the kappa coefficient and intraclass correlation index.

RESULTS

The relevance of the dimensions and the definition of each category scored higher than 3.25 on a Likert-type scale (maximum value of 4); content validity ratio values were close to +1. The kappa index was above 0.61 (p < .001) in all dimensions, thereby indicating a good level of interrater agreement; the intraclass correlation index showed values above .82 (p < .001).

CONCLUSION

The rubric appears to be psychometrically sound, thus supporting its reliability.
Does the Infant-Driven Feeding Method Positively Impact Preterm Infant Feeding Outcomes?
Authors: Settle Margaret , Francis Kim
Published: January 2019

Background:

Achievement of independent oral feeding is a major determinant of discharge and contributes to long lengths of stay. Accumulating evidence suggests that there is great variation between and within newborn intensive care units in the initiation and advancement of oral feeding. The Infant-Driven Feeding (IDF) method is composed of 3 behavioral assessments including feeding readiness, quality of feeding, and caregiver support. Each assessment includes 5 categories and is intended as a method of communication among caregivers regarding the infant's readiness and progression toward independent oral feeding.

Purpose:

To identify and summarize the available evidence on the use of the IDF method at initiation of oral feeds, time to independent oral feedings, and length of stay in the newborn intensive care unit or level II nursery for preterm infants.

Methods/Search Strategy:

Four databases including CINAHL, Medline/PubMed, Ovid Nursing, and Embase were searched for “infant guided feedings,” “infant driven feeding,” “cue-based feeding,” and “co regulated feeding.” The full text of 32 articles was reviewed to identify experimental, quasiexperimental, or retrospective design to assess the evidence related to cue-based feeding.

Findings:

There were no randomized control, quasi-experimental, or retrospective studies utilizing the IDF method. There were 3 quality improvement projects utilizing the IDF method. The findings were conflicting: 1 project found the IDF method favorable in the achievement of full oral feedings, 2 projects found the IDF method favorable for reducing length of stay, and 1 project did not find differences in initiation, achievement of oral feedings, or length of stay.

Implications for Practice:

There is scant evidence limited to quality improvement projects to support the use of the IDF method.

Implications for Research:

Research is needed to empirically validate the IDF method and to inform practice related to the initiation and advancement of oral feeding for preterm infants.
Measuring outcomes in ankylosing spondylitis: pearls and pitfalls
Authors: Magrey Marina , Ritchlin Christopher
Published: January 2019

Purpose of review

Patients with ankylosing spondylitis (AS) warrant a comprehensive clinical assessment because of the lack of biomarkers of disease activity, prognosis and response to biologic therapy. Multiple AS-related questionnaires have been developed to assess the disease status accurately, but feasibility remains a problem in clinical practice. The purpose of this review is to assess the pearls and pitfalls of AS-related outcome measures.

Recent findings

Single-item questionnaires to measure pain, stiffness and fatigue in patients with AS are easily administrable but may lack a sufficient degree of responsiveness on an individual patient level. The Bath Ankylosing Disease Activity Index remains the gold standard for assessing disease activity in a routine practice, despite poor correlation with C-reactive protein (CRP) levels and MRI inflammation. The Ankylosing Spondylitis Disease Activity Score, a validated and highly discriminatory tool for assessing disease activity in AS, has been developed but lacks feasibility as erythrocytic sedimentation rate and CRP values are often not available during a clinic visit. RAPID-3 appears feasible to assess patients with AS quantitatively over time in busy clinical settings.

The assessment of disease status in AS is complex and is impacted by multiple factors. The biggest challenge in AS is to incorporate the disease-specific indices into a routine practice.

Video abstract

http://links.lww.com/COR/A42.
The Reliability of Intraoperative Crossbar Technique in Determining the Upper Instrumented Vertebra (UIV) Tilt Angle for Adolescent Idiopathic Scoliosis (AIS) Undergoing Posterior Spinal Fusion
Authors: Kwan Mun Keong , Chiu Chee Kidd , Goh Saw Huan , Ng Sherwin Johan , Tan Pheng Hian , Chian Xue Han , Ng Yun Hui , Ler Xin Yi , Bashir Elrofai Suliman , Chan Chris Yin Wei
Published: January 2019

Study Design:

Retrospective study.

Objective:

This study looked into whether crossbar can reliably measure Upper Instrumend Vertebra (UIV) tilt angle intraoperatively and accurately predict the UIV tilt angle postoperatively and at final follow-up.

Summary of Background Data:

Postoperative shoulder imbalance is a common cause of poor cosmetic appearance leading to patient dissatisfaction. There were no reports describing the technique or method in measuring the UIV tilt angle intraoperatively. Therefore, this study was designed to look into the reliability and accuracy of the usage of intraoperative crossbar in measuring the UIV tilt angle intraoperatively.

Methods:

Lenke 1 and 2 Adolescent Idiopathic Scoliosis patients who underwent instrumented Posterior Spinal Fusion using pedicle screw constructs with minimum follow-up of 24 months were recruited for this study. After surgical correction, intraoperative UIV tilt angle was measured using a crossbar. Immediate postoperative and final follow up UIV tilt angle was measured on the standing anteroposterior radiographs.

Results:

A total of 100 patients were included into this study. The reliability of the intraoperative crossbar to measure the optimal UIV tilt angle intraoperatively was determined by repeated measurements by assessors and measurement by different assessors. We found that the intra observer and inter observer reliability was very good with intraclass correlation coefficient values of >0.9. The accuracy of the intraoperative crossbar to measure the optimal UIV tilt angle intraoperatively was determined by comparing this measurement with the postoperative UIV tilt angle. We found that there was no significant difference (P>0.05) between intraoperative, immediate postoperative, and follow-up UIV tilt angle.

Conclusions:

The crossbar can be used to measure the intraoperative UIV tilt angle consistently and was able to predict the postoperative UIV tilt angle. It was a cheap, simple, reliable, and accurate instrument to measure the intraoperative UIV tilt angle.
Does Prophylactic Administration of TXA Reduce Mean Operative Time and Postoperative Blood Loss in Posterior Approach Lumbar Spinal Fusion Surgery Performed for Degenerative Spinal Disease?
Authors: Larson Evan , Evans Tyler , Long Jake , Gannon Emmett , Lyden Elizabeth , Cornett Chris
Published: January 2019

Study Design:

This is a level III retrospective cohort study.

Objective:

To investigate association between prophylactic tranexamic acid (TXA) administration before 1 and 2-level posterior lumbar interbody fusion operations and perioperative blood loss (including intraoperative blood loss and postoperative drain output), mean operative time, postoperative transfusion, and postoperative venous thromboembolic events.

Summary of Background Data:

TXA is a systemic antifibrinolytic that competitively inhibits lysine binding sites on plasminogen, reversibly blocking its binding to fibrin and impeding fibrinolysis and clot degradation. TXA’s role in routine spinal surgery remains poorly described. Most spinal literature on perioperative TXA administration has considered operations performed for major adult and pediatric spinal deformity.

Methods:

Two groups, a study group composed of 75 patients who underwent 1 and 2-level posterior lumbar interbody fusion operations for degenerative indications who received TXA before the start of the procedure, and a control group composed of 75 patients who underwent similar surgeries for the same indications and did not receive TXA preoperatively, were retrospectively enrolled. Demographic, laboratory, and surgical data were collected and analyzed.

Results:

No statistically significant differences were found between groups with respect to surgery type, home anticoagulation, postoperative anticoagulation, preoperative hemoglobin and hematocrit, estimated intraoperative blood loss, postoperative day 2 drain output, postoperative day 3 drain output, rate of postoperative transfusion, and rate of postoperative thromboembolic events. Statistically significant reductions were noted in the TXA group with regards to postoperative day 1 drain output (P<0.0041), total postoperative drain output (P=0.027), and mean surgical time (P<0.0001).

Conclusions:

In the present study, perioperative TXA administration was associated with reduced postoperative drain output and surgical time. Further higher-level studies are required to investigate the safety and utility of TXA’s routine use in 1 and 2-level posterior lumbar fusion operations performed for degenerative indications.
Dimensions of the Subaxial Lateral Mass
Authors: Schroeder Gregory D. , Kepler Christopher K. , McKenzie James C. , Casper David S. , Sutton Ryan , Hecht Andrew C. , O’Shaughnessy Brian A. , Skelly Andrea C. , Brodt Erika D. , Vaccaro Alexander R.
Published: January 2019

Study Design:

This was a systematic review.

Objective:

To review and synthesize information on subaxial lateral mass dimensions in order to determine the ideal starting point, trajectory, and size of a lateral mass screw.

Summary of Background Data:

The use of lateral mass instrumentation for posterior cervical decompression and fusion has become routine as these constructs have increased rigidity and fusion rates.

Methods:

A systematic search of Medline and EMBASE was conducted. Studies that provided subaxial cervical lateral mass measurements, distance to the facet, vertebral artery and neuroforamen and facet angle made either directly (eg, cadaver specimen) or from patient imaging were considered for inclusion. Pooled estimates of mean dimensions were reported with corresponding 95% confidence intervals. Stratified analysis based on level, sex, imaging plane, source (cadaver or imaging), and measurement method was done.

Results:

Of the 194 citations identified, 12 cadaver and 10 imaging studies were included. Pooled estimates for C3–C6 were generally consistent for lateral mass height (12.1 mm), width (12.0 mm), depth (10.8 mm), distance to the transverse foramen (11.8 mm), and distance to the nerve. C7 dimensions were most variable. Small sex-based differences in dimensions were noted for height (1.2 mm), width (1.3 mm), depth (0.43 mm), transverse foramen distance (0.9 mm), and nerve distance (0.3–0.8 mm). No firm conclusions regarding differences between measurements made on cadavers and those based on patient computed tomographic images are possible; findings were not consistent across dimensions. The overall strength of evidence is considered very low for all findings.

Conclusions:

Although estimates of height, width, and depth were generally consistent for C3–C6, C7 dimensions were variable. Small sex differences in dimensions may suggest that surgeons should use a slightly smaller screw in female patients. Firm conclusions regarding facet angulation, source of measurement, and method of measurement were not possible.
Anteriorization of the Tibial Tubercle With Osteotomy, Combined With Cartilage Restoration in the Patellofemoral Joint: A Surgical Technique
Authors: DiBartola Alex C. , Leger-St-Jean Benjamin , Magnussen Robert A. , Flanigan David C.
Published: January 2019

Left untreated, cartilage defects of the knee are responsible for substantial patient morbidity and may lead to osteoarthritis. This has led to the development of several techniques to improve healing potential, including microfracture, osteochondral autograft, osteochondral allografts, autologous chondrocyte implantation, and matrix-assisted autologous chondrocyte implantation. Of paramount importance when addressing patellofemoral (PF) cartilage defects is treating associated PF malalignment. We describe a surgical technique for tibial tubercle anteriorization in conjunction with autologous chondrocyte implantation for the treatment of PF cartilage lesions. In our opinion, a distal realignment procedure should be routinely performed for any cartilage restoration procedure of the PF joint as it may delay the onset of osteoarthritis.
Midazolam Dose Optimization in Critically Ill Pediatric Patients With Acute Respiratory Failure: A Population Pharmacokinetic-Pharmacogenomic Study
Authors: Zuppa Athena F. , Conrado Daniela J. , Zane Nicole R. , Curley Martha A. Q. , Bradfield Jonathan , Hakonarson Hakon , Gastonguay Madeleine S. , Moorthy Ganesh , Prodell Janice , Gastonguay Marc R.
Published: January 2019

Objectives:

To develop a pharmacokinetic-pharmacogenomic population model of midazolam in critically ill children with primary respiratory failure.

Design:

Prospective pharmacokinetic-pharmacogenomic observational study.

Setting:

Thirteen PICUs across the United States.

Patients:

Pediatric subjects mechanically ventilated for acute respiratory failure, weight greater than or equal to 7 kg, receiving morphine and/or midazolam continuous infusions.

Interventions:

Serial blood sampling for drug quantification and a single blood collection for genomic evaluation.

Measurements and Main Results:

Concentrations of midazolam, the 1’ (1`-hydroxymidazolam metabolite) and 4’ (4`-hydroxymidazolam metabolite) hydroxyl, and the 1’ and 4’ glucuronide metabolites were measured. Subjects were genotyped using the Illumina HumanOmniExpress genome-wide single nucleotide polymorphism chip. Nonlinear mixed effects modeling was performed to develop the pharmacokinetic-pharmacogenomic model. Body weight, age, hepatic and renal functions, and the UGT2B7 rs62298861 polymorphism are relevant predictors of midazolam pharmacokinetic variables. The estimated midazolam clearance was 0.61 L/min/70kg. Time to reach 50% complete mature midazolam and 1`-hydroxymidazolam metabolite/4`-hydroxymidazolam metabolite clearances was 1.0 and 0.97 years postmenstrual age. The final model suggested a decrease in midazolam clearance with increase in alanine transaminase and a lower clearance of the glucuronide metabolites with a renal dysfunction. In the pharmacogenomic analysis, rs62298861 and rs28365062 in the UGT2B7 gene were in high linkage disequilibrium. Minor alleles were associated with a higher 1`-hydroxymidazolam metabolite clearance in Caucasians. In the pharmacokinetic-pharmacogenomic model, clearance was expected to increase by 10% in heterozygous and 20% in homozygous for the minor allele with respect to homozygous for the major allele.

Conclusions:

This work leveraged available knowledge on nonheritable and heritable factors affecting midazolam pharmacokinetic in pediatric subjects with primary respiratory failure requiring mechanical ventilation, providing the basis for a future implementation of an individual-based approach to sedation.
The Development of Chronic Critical Illness Determines Physical Function, Quality of Life, and Long-Term Survival Among Early Survivors of Sepsis in Surgical ICUs*
Authors: Gardner Anna K. , Ghita Gabriela L. , Wang Zhongkai , Ozrazgat-Baslanti Tezcan , Raymond Steven L. , Mankowski Robert T. , Brumback Babette A. , Efron Philip A. , Bihorac Azra , Moore Frederick A. , Anton Stephen D. , Brakenridge Scott C.
Published: January 2019

Objectives:

This study sought to examine mortality, health-related quality of life, and physical function among sepsis survivors who developed chronic critical illness.

Design:

Single-institution, prospective, longitudinal, observational cohort study assessing 12-month outcomes.

Setting:

Two surgical/trauma ICUs at an academic tertiary medical and level 1 trauma center.

Patients:

Adult critically ill patients that survived 14 days or longer after sepsis onset.

Interventions:

None.

Measurements and Main Results:

Baseline patient characteristics and function, sepsis severity, and clinical outcomes of the index hospitalization were collected. Follow-up physical function (short physical performance battery; Zubrod; hand grip strength) and health-related quality of life (EuroQol-5D-3L, Short Form-36) were measured at 3, 6, and 12 months. Hospital-free days and mortality were determined at 12 months. We compared differences in long-term outcomes between subjects who developed chronic critical illness (≥ 14 ICU days with persistent organ dysfunction) versus those with rapid recovery. The cohort consisted of 173 sepsis patients; 63 (36%) developed chronic critical illness and 110 (64%) exhibited rapid recovery. Baseline physical function and health-related quality of life did not differ between groups. Those who developed chronic critical illness had significantly fewer hospital-free days (196 ± 148 vs 321 ± 65; p < 0.0001) and reduced survival at 12-months compared with rapid recovery subjects (54% vs 92%; p < 0.0001). At 3- and 6-month follow-up, chronic critical illness patients had significantly lower physical function (3 mo: short physical performance battery, Zubrod, and hand grip; 6 mo: short physical performance battery, Zubrod) and health-related quality of life (3- and 6-mo: EuroQol-5D-3L) compared with patients who rapidly recovered. By 12-month follow-up, chronic critical illness patients had significantly lower physical function and health-related quality of life on all measures.

Conclusions:

Surgical patients who develop chronic critical illness after sepsis exhibit high healthcare resource utilization and ultimately suffer dismal long-term clinical, functional, and health-related quality of life outcomes. Further understanding of the mechanisms driving the development and persistence of chronic critical illness will be necessary to improve long-term outcomes after sepsis.
Repair of Anterior Ear Defects Using Transcartilage Island Pedicle Flaps
Authors: Dyson Mary E. , Orangi Maideh , Goldberg Leonard H. , Kimyai-Asadi Arash
Published: January 2019

BACKGROUND

Surgical reconstruction of the anterior surface of the ear (concha, antihelix, scapha, and triangular fossa) is complicated by the paucity of mobile local skin.

OBJECTIVE

This is a retrospective study of the transcartilage island pedicle flap for reconstruction of surgical defects of the anterior ear.

METHODS AND MATERIALS

Two hundred thirty-two Mohs micrographic surgery defects were included in the study. The technique involves circumferential incision of the flap in the postauricular sulcus, transfer of the flap to the anterior ear through a surgically created cartilage slit, suturing of the flap on the anterior surface of the ear, and repair of the secondary postauricular defect. Preoperative, intraoperative, and postoperative details of each case were tabulated and analyzed.

RESULTS

The mean defect size was 1.9 × 1.5 cm. Complications included flap edema (n = 6, 2.6%), postoperative bleeding (n = 4, 1.7%), partial thickness flap necrosis (n = 2, 0.9%), pinning back of the ear (n = 2, 0.9%), and central flap dimpling (n = 2, 0.9%). There was 1 acute staphylococcal abscess and 1 sterile abscess that developed 13 months postoperatively. All complications resolved with medical or surgical management.

CONCLUSION

Transcartilage island pedicle flaps may be considered for single-stage surgical reconstruction of defects involving the anterior ear.
Squamous Cell Carcinoma of the Nail Unit: A Clinical Histopathologic Study and a Proposal for Classification
Authors: Dika Emi , Starace Michela , Patrizi Annalisa , Fanti Pieralessandro A. , Piraccini Bianca Maria
Published: January 2019

BACKGROUND

There is no consensus on the classification, grading, and the treatment of nail squamous cell carcinoma (NSCC).

OBJECTIVE

The aim of the study was to propose a possible classification of NSCC.

MATERIALS AND METHODS

Nail squamous cell carcinoma referred from January 2006 till December 2014 was included. On the basis of the clinical presentation, patients with NSCC were divided in 2 groups. Group A tumors presented as nodular or ulcerated masses of the nail bed, whereas Group B tumors presented as hyperkeratotic bands. In these 2 groups, differences in proportions (sex, histopathologic grading, and treatment performed) were evaluated with the chi-square test.

RESULTS

Forty-one NSCCs were included. The groups of NSCC differed regarding: (1) the age of the patients, (2) histopathology, and (3) surgical approach.

CONCLUSION

Nail squamous cell carcinomas may originate from 2 different epithelia, presenting a diverse clinical behavior. The correct identification and diagnosis of each subgroup of NSCC could be helpful in standardizing management of this tumor. Future studies considering human papillomavirus subtyping and including a major number of tumors should be performed to confirm or reject the authors' hypothesis.

Limitations

This is a retrospective study, presenting the data and the experience of a single institute.