bluuebunny/crossref_metadata_2025 huggingface dataset:
Mitigating the Gender Gap in the Willingness to Compete: Evidence from a Randomized Field Experiment
Authors: Alan Sule , Ertac Seda
Published: September 2018

We evaluate the impact on competitiveness of a randomized educational intervention that aims to foster grit, a skill that is highly predictive of achievement. The intervention is implemented in elementary schools, and we measure its impact using a dynamic competition task with interim performance feedback. We find that when children are exposed to a worldview that emphasizes the role of effort in achievement and encourages perseverance, the gender gap in the willingness to compete disappears. We show that the elimination of this gap implies significant efficiency gains. We also provide suggestive evidence on a plausible causal mechanism that runs through the positive impact of enhanced grit on girls' optimism about their future performance.
Helium giant stars as progenitors of rapidly fading Type Ibc supernovae
Authors: Kleiser Io , Fuller Jim , Kasen Daniel
Published: September 2018

Type I rapidly fading supernovae (RFSNe) appear to originate from hydrogen-free stars with large radii that produce predominantly shock-cooling light curves, in contrast with more typical $^{56}\rm {Ni}$-rich SNe Ibc. However, it remains to be determined what types of stars would produce bright shock-cooling light curves without significant contribution from radioactive nickel. Bare helium stars in the mass range ${\sim }2\hbox{--}4 \, \rm {M}_\odot$ are known to hydrostatically develop radii as large as 100 $\rm {R}_\odot$ or more due to strong He and C shell burning outside of a core with a sharp density gradient. We produce several such stellar models and demonstrate that, when exploded, these helium giants can naturally produce RFSN light curves. Since many prototypical SNe Ibc should come from large-radius stars in this mass range as well, we predict that these RFSNe may be distinct from SNe Ibc solely due to the absence of substantial $^{56}\rm {Ni}$.
Attitudes toward fertility and fertility preservation in women with glioma
Authors: Stiner Rachel K , Clarke Jennifer L , Sinha Nikita , Chan Jessica , Letourneau Joseph M , Niemasik Erin E , Rabbitt Jane E , Chang Susan M , Butowski Nicholas A , Prados Michael D , Rosen Mitchell P
Published: September 2018

Background

No studies have examined the fertility priorities of women undergoing treatment for their glioma. Glioma patients frequently undergo chemotherapy as part of their treatment; however, it is unknown whether patients truly are aware of its possible effects on their fertility. Our objective was to assess the fertility priorities of glioma patients and ascertain whether female glioma patients are being effectively counseled on the effects of chemotherapy on their fertility prior to beginning treatment.

Methods

The sample was composed of female patients from the Neuro-oncology clinic of the University of California, San Francisco. Participants completed a cross-sectional survey between October 2010 and December 2013 exploring their attitudes toward fertility and their experience with fertility counseling prior to chemotherapy initiation.

Results

Seventy-two women completed the survey. Analysis of the survey results showed that 30% of women receiving chemotherapy reported having a discussion regarding fertility preservation prior to beginning treatment. Of those who reported having this discussion, 80% were aware that chemotherapy could negatively affect their fertility. Many women reported that while fertility preservation was not important to them at the time of diagnosis, it was a priority for them at the time of survey completion. Although interest in having children tended to decrease after cancer treatment, the majority of respondents reported wanting a child after treatment.

Conclusions

The data obtained in this study suggest a lack of understanding of reproductive priorities, which may be addressed with a more comprehensive fertility discussion prior to beginning treatment.
Function and Distribution of a Lantipeptide in Strawberry Fusarium Wilt Disease–Suppressive Soils
Authors: Kim Da-Ran , Jeon Chang-Wook , Shin Jae-Ho , Weller David M. , Thomashow Linda , Kwak Youn-Sig
Published: September 2018

Streptomyces griseus S4-7 is representative of strains responsible for the specific soil suppressiveness of Fusarium wilt of strawberry caused by Fusarium oxysporum f. sp. fragariae. Members of the genus Streptomyces secrete diverse secondary metabolites including lantipeptides, heat-stable lanthionine-containing compounds that can exhibit antibiotic activity. In this study, a class II lantipeptide provisionally named grisin, of previously unknown biological function, was shown to inhibit F. oxysporum. The inhibitory activity of grisin distinguishes it from other class II lantipeptides from Streptomyces spp. Results of quantitative reverse transcription-polymerase chain reaction with lanM-specific primers showed that the density of grisin-producing Streptomyces spp. in the rhizosphere of strawberry was positively correlated with the number of years of monoculture and a minimum of seven years was required for development of specific soil suppressiveness to Fusarium wilt disease. We suggest that lanM can be used as a diagnostic marker of whether a soil is conducive or suppressive to the disease.
Effects of Atmospheric CO2 Level on the Metabolic Response of Resistant and Susceptible Wheat to Fusarium graminearum Infection
Authors: Cuperlovic-Culf Miroslava , Vaughan Martha M. , Vermillion Karl , Surendra Anu , Teresi Jennifer , McCormick Susan P.
Published: September 2018

Rising atmospheric CO2 concentrations and associated climate changes are thought to have contributed to the steady increase of Fusarium head blight (FHB) on wheat. However, our understanding of precisely how elevated CO2 influences the defense response of wheat against Fusarium graminearum remains limited. In this study, we evaluated the metabolic profiles of susceptible (Norm) and moderately resistant (Alsen) spring wheat in response to whole-head inoculation with two deoxynivalenol (DON)-producing F. graminearum isolates (DON+), isolates 9F1 and Gz3639, and a DON-deficient (DON−) isolate (Gzt40) at ambient (400 ppm) and elevated (800 ppm) CO2 concentrations. The effects of elevated CO2 were dependent on both the Fusarium strain and the wheat variety, but metabolic differences in the host can explain the observed changes in F. graminearum biomass and DON accumulation. The complexity of abiotic and biotic stress interactions makes it difficult to determine if the observed metabolic changes in wheat are a result of CO2-induced changes in the host, the pathogen, or a combination of both. However, the effects of elevated CO2 were not dependent on DON production. Finally, we identified several metabolic biomarkers for wheat that can reliably predict FHB resistance or susceptibility, even as atmospheric CO2 levels rise.
Characterization of Oomycete Species Associated With Root and Crown Rot of English Walnut in Chile
Authors: Guajardo Jeannette , Saa Sebastián , Riquelme Natalia , Browne Gregory , Youlton Cristian , Castro Mónica , Besoain Ximena
Published: September 2018

English (Persian) walnut (Juglans regia) trees affected by root and crown rot were surveyed in five regions of central Chile between 2015 and 2017. In each region, nine orchards, ranging from 1 to 21 years old, were randomly selected and inspected for incidence and severity of tree decline associated with crown and root rot. Soil and symptomatic crown and root tissues were collected and cultured in P5ARP semiselective medium to isolate potential oomycete pathogens, which were identified through morphology and molecularly using ITS sequences in the rDNA gene and beta tubulin gene. The most frequently isolated species was Phytophthora cinnamomi. Pathogenicity tests were conducted with representative oomycete isolates. P. cinnamomi, P. citrophthora, and Pythium ultimum were all pathogenic in J. regia. Nevertheless, only P. cinnamomi and P. citrophthora were pathogenic to English walnut. Py. ultimum caused limited levels of root damage to English walnut seedlings. Our research indicates that as the Chilean walnut industry has expanded, so have walnut crown and root rots induced by oomycetes.
Prevalence and Genome Characterization of Field Isolates of Sugarcane Mosaic Virus (SCMV) in Nigeria
Authors: Yahaya Adama , Dangora Danladi B. , Kumar P. Lava , Alegbejo Matthew D. , Gregg Lori , Alabi Olufemi J.
Published: September 2018

Maize and sugarcane are two economically important crops often grown in adjacent fields or co-cultivated in the northern guinea savannah agroecological zone, a major cereal production region of Nigeria. This study was conducted to determine the prevalence of mosaic disease in sugarcane and maize fields in the northern guinea savannah agroecological zone and to molecularly characterize the associated sugarcane mosaic virus (SCMV, genus Potyvirus) isolates. Surveys were conducted from June to July 2015, and sugarcane mosaic disease (SCMD) incidence was assessed across 21 farmer’s fields. Mean SCMD incidence varied across states with ∼82% (308/376), ∼66% (143/218), and ∼67% (36/54) recorded in Kaduna, Kano, and Katsina states, respectively. RT-PCR analysis of 415 field-collected samples using genus-specific primers confirmed potyvirus infection in 63.7% (156/245) of sugarcane, 29.7% (42/141) of maize crops, and 45% (13/29) of itch grass samples. Cloning and sequencing of gene-specific DNA amplicons from a subset of 45 samples (sugarcane = 33, maize = 9, itch grass = 3) confirmed their specificities to SCMV. Phylogenetic analysis of the partial gene sequences showed that they all belong to a single monophyletic clade of SCMV. These results were supported by analysis of complete polyprotein sequences of representative maize and sugarcane isolates from Nigeria. Both isolates shared 94.9%/97.3% complete polyprotein nucleotide (nt)/amino acid (aa) identities with each other and 75.2%/97.6% nt/aa identities with corresponding sequences of global SCMV isolates. The detection of identical populations of SCMV isolates in both crop species and a weed host suggests possible vector mediated interspecies spread within cereal landscapes in the study area with implications for the integrated and sustainable management of SCMD in cereal cropping systems in Nigeria.
Survey of Fungal Foliar and Panicle Diseases of Sorghum in Important Agroecological Zones of Tanzania and Uganda
Authors: Njoroge Samuel M. C. , Takan John Peter , Letayo Elias A. , Okoth Patrick S. , Ajaku Daniel O. , Kumar Anil , Rathore Abhishek , Ojulong Henry , Manyasa Eric
Published: September 2018

A survey was conducted in 2014 to determine the prevalence of fungal diseases on sorghum across different agroecological zones in Tanzania and Uganda. In Tanzania, 37 sorghum fields were sampled in Dodoma and Singida Provinces, representing the central drier areas, and in Simiyu, Shinyanga, Mwanza, and Mara Provinces, representing the lake-zone region. In Uganda, 134 fields were sampled across four agroecological zones of Teso, Western, Northern, and West Nile. Farmers were purposively selected, and at least 30 plants per field along two diagonal transects were visually assessed for disease. Ten and 14 diseases were identified in Tanzania and Uganda, respectively. Among the major diseases identified, those more prevalent in Tanzania than in Uganda were leaf blight caused by Setosphaeria turcica (P = 0.0031) and rust caused by Puccinia purpurea (P < 0.0001). Major diseases more prevalent in Uganda than in Tanzania were anthracnose caused by Colletotrichum sublineola (P = 0.0207) and zonate leaf spot caused by Gloeocercospora sorghi (P = 0.0312). We report for the first time the occurrence of ladder leaf spot caused by Cercospora fusimaculans in Uganda and confirm its occurrence in Tanzania. This is the first comprehensive sorghum disease survey report in over 15 years in both countries.
In-Grove Spatiotemporal Spread of Citrus Huanglongbing and Its Psyllid Vector in Relation to Weather
Authors: Shimwela M. M. , Halbert S. E. , Keremane M. L. , Mears P. , Singer B. H. , Lee W. S. , Jones J. B. , Ploetz R. C. , van Bruggen A. H. C.
Published: September 2018

Reports of spatial patterns of ‘Candidatus Liberibacter asiaticus’-infected asymptomatic citrus trees and ‘Ca. L. asiaticus’-positive Asian citrus psyllids (ACP) are rare, as are published relationships between huanglongbing (HLB), ACP, and weather. Here, spatial patterns of ‘Ca. L. asiaticus’-positive asymptomatic and symptomatic trees were determined every half year in a small grove over 2.5 years, and of HLB-symptomatic trees and (‘Ca. L. asiaticus’-positive) ACP populations every month in two commercial groves for 1 year. Spread of symptomatic trees followed that of asymptomatic ‘Ca. L. asiaticus’-positive trees with <6 months’ delay. ‘Ca. L. asiaticus’-positive asymptomatic and symptomatic fronts moved at 2.5 to 3.6 m month−1. No spatial relationship was detected between ACP populations and HLB-infected trees. HLB incidence and ‘Ca. L. asiaticus’-positive ACP dynamics were tentatively positively correlated with monthly rainfall data and, to a lesser extent, with average minimum temperature.
Assessing the Impact of Acupuncture Therapy on Medical Resident Well-being: A Feasibility and Acceptance Study
Authors: Guan Xin , Citkovitz Claudia , Kraus Tzivya , Garcia Alexandra , Kesavan Nasir Meera
Published: September 2018

PURPOSE:

The aim of this study is to determine the feasibility and acceptability of group auricular acupuncture therapy to address burnout during residency training.

BACKGROUND:

Resident physicians experience high levels of job-related stress and associated symptoms of burnout. Auricular acupuncture has found to be associated with reductions in burnout, secondary traumatic stress and measurements of state and trait anxiety among health care providers.

METHODS:

In this single-arm study, residents of the NYU Brooklyn Campus Ob/Gyn Program were offered three acupuncture treatments over one month. The ProQOL (Professional Quality of Life) instrument was administered before and after each treatment. The residents' scores were calculated using the instrument's three domains: compassion satisfaction (CS), burnout (BO) and secondary traumatic stress (STS). Pre- and post-treatment scores were compared using the Wilcoxon Rank Sum test. A post-treatment survey at 1 week was administered.

RESULTS:

The study included 11 residents. Although the study was not powered for hypothesis testing, post-treatment scores on the ProQOL improved significantly in all domains. Mean CS scores were higher (m=40.35 vs. 37.75, P=.004), while BO and STS were lower (m=24.05 vs. 26.55, P=.002 and m=19.95 vs. 23.2, P<.001, respectively). Eighty percent of the residents responded to the post-treatment survey. All denied negative impacts of the therapy and 80% reported positive impacts. All responded positively to adding acupuncture to the workflow, although 20% would rather have time to relax or do other activities.

DISCUSSION:

Auricular acupuncture therapy was accepted by residents and can be a feasible intervention for reducing burnout in medical residents as measured by the ProQOL instrument.
The Effect of a Shortened OB/GYN Clerkship on Student Performance and Perception of Quality
Authors: Kempner Samantha , Zaidi Nikki , Skinner Bethany , Santen Sally , Hammoud Maya
Published: September 2018

PURPOSE:

To examine medical student performance and perception of clerkship quality during the shortened, third-year OB/GYN rotation.

BACKGROUND:

As medical school curricula evolve, core clinical clerkships often become shortened to allow more time for career exploration and other professional development. There is conflicting data regarding the impact of duration of clerkships on student performance, and little is known about the impact of shortened clerkships on student satisfaction.

METHODS:

We collected data from NBME subject exam scores and clerkship evaluation scores for third-year clerkships over three academic years. In years 2014-2015 and 2015-2016, students had traditional clerkship lengths. In 2016-2017, clerkship durations were shortened by 25%. Analysis of variance was conducted to examine the effect of academic year on mean NBME scores and student evaluation scores.

RESULTS:

There was no significant difference in mean OB/GYN NBME scores between students participating in the traditional vs. shortened clerkship (mean score 79.7±8.1 in 2014-2015, 79.7±6.8 in 2015-2016, and 79.8±7.0 in 2016-2017; P=.991). Student perception of quality of the OB/GYN clerkship decreased with the shortened clerkships; however, these differences were not statistically significant (4.0±0.9 in 2014-2015, 4.0±0.9 in 2015-2016, and 3.8±0.9 in 2016-2017; P=.074). By comparison, other clerkships experienced an increase in perception of quality over the same time-period.

DISCUSSION:

A shortened OB/GYN student clerkship does not appear to adversely affect objective performance on the rotation; however, medical student perception of quality of the rotation did trend towards lower clerkship scores.
Describing Surgical Skill Learning Curves in OBGYN Residency: A Process Using myTIPreport
Authors: Schuler Kevin , Maetzold Erin , Buys Elizabeth , Galvin Shelley , Connolly AnnaMarie
Published: September 2018

Faculty Advisor:

Nancy Gaba, MD

PURPOSE:

To describe a process for generating procedural learning curves in OB/GYN Residency.

BACKGROUND:

Most data demonstrating OB/GYN resident surgical proficiency have used operative time as a surrogate for proficiency. The actual number of procedures required to achieve proficiency has not been reported. Our goal was to describe a process for reporting the number of procedures needed to achieve a mean “Supervision Only” rating as reported by faculty using the myTIPreport program.

METHODS:

This descriptive study was a secondary analysis of the myTIPreport database from July 2015–June 2016. For this database, each resident receives a procedure-specific surgical proficiency score, rated 1-5, with surgical proficiency defined as Level 4 (Resident requires “Supervision Only”). Using database time stamps, chronologic case numbers were generated. Fitted Linear Modeling was used to generate an approximate number of cases to achieve this proficiency. To reduce the effect of prior experience influencing the data, only PGY-1 residents were included. To reduce type I error, procedures were examined when at least 100 feedback encounters were reported.

RESULTS:

Of the 1045 intern feedback encounters reported, 2 procedures met inclusion criteria. Using this modeling, PGY-1's needed 13 cesarean deliveries to achieve a mean Level 4 rating. Similarly, 9 procedures were needed for PGY-1 spontaneous deliveries.

DISCUSSION:

A process for reporting surgical skill progression for PGY-1 learners on select procedures was demonstrated using the myTIPreport program. Learner and faculty development tool use may allow for both establishing “learning curves” for other procedures as well as eventually allow for earlier identification and remediation of at-risk learners.
Changing theories on the pathogenesis and risk factors for diverticulitis
Authors: Liner Kristina , Sandor Peter
Published: September 2018

Diverticulitis was thought to be a simple complication of an even simpler disease (diverticulosis), but may in fact result from an entirely new set of complex pathologies. Considering diverticulitis is increasing in annual incidence and becoming more prevalent in younger populations, the implications of appropriate management become more vital than ever. This article reviews old and new understandings of diverticulitis and current recommendations for prevention and clinical management.
A Framework for Resident Participation in Population Health
Authors: Jiménez Jonathan , Andolsek Kathryn M. , Martinez-Bianchi Viviana , Michener J. Lloyd
Published: September 2018

Population health experiences have become more common in medical education. Yet, most resident population health experiences are in patient panel management and fail to connect with the rapidly growing movement of cross-sector, data-driven, and community-led initiatives dedicated to improving the health of populations defined by geography rather than insurer or employer. In this Perspective, the authors present a five-stage framework for residents’ participation in the work of these initiatives. The five stages of this framework are (1) organize and prepare, (2) plan and prioritize, (3) implement, (4) monitor and evaluate, and (5) sustain. In applying this approach, residents stand to acquire new population health skills and augment the value and meaning of their work, while institutions stand to improve the health of the communities they serve, including the health of their own employees. However, a paucity of experienced role models and demanding residency schedules present significant challenges to residents effectively partnering with the community. Residencies and institutions will have to be flexible and committed to being a part of these cross-sector, data-driven, and community-led partnerships over the long term.
Staircase-evoked Pain May be More Sensitive Than Traditional Pain Assessments in Discriminating Analgesic Effects
Authors: Treister Roi , Suzan Erica , Lawal Oluwadolapo D. , Katz Nathaniel P.
Published: September 2018

Objectives:

Analgesic trials often fail to show a significant effect even when medications with known efficacy are tested. This could be attributed to insufficient assay sensitivity of analgesic trials, which may be due, in part, to the insensitivity of pain-related outcome measures. The aim of this methodological study was to assess the responsiveness of evoked pain generated by the staircase procedure compared with other commonly used pain outcomes in knee osteoarthritis.

Methods:

This was a randomized, double-blind, placebo-controlled, cross-over trial of 1-week treatment of naproxen versus placebo. Participants were assigned to one of the 2 treatment sequences (naproxen-placebo or placebo-naproxen). Pain-at-rest, evoked pain using the Staircase-Evoked Pain Procedure (StEPP), pain diary, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) data were collected before and at the end of each treatment sequence.

Results:

A total of 55 osteoarthritis patients (30 M, 25 F) completed the study. Among all pain assessments, evoked pain was the most sensitive outcome to detect treatment effects, with Standardized Effect Size (SES) of 0.47 followed by the WOMAC and pain-at-rest with SES of 0.43 and 0.36, respectively. Sample size calculations demonstrated that compared with spontaneous pain, the evoked pain model reduces required number of subjects by 40%.

Discussion:

Study results support our hypothesis that evoked pain using the StEPP may demonstrate greater responsiveness to treatment effects compared with traditional pain-related outcome measures. Accordingly, these results may facilitate development and validation of other chronic pain-related evoked pain models, which could contribute to future research and development of new analgesics.
Evaluation of the Neuropathic Component of Chronic Low Back Pain
Authors: Andrasinova Tereza , Kalikova Eva , Kopacik Roman , Srotova Iva , Vlckova Eva , Dusek Ladislav , Bednarik Josef , Adamova Blanka
Published: September 2018

Objectives:

Assessment of neuropathic pain in chronic low back syndromes is important. However, there is currently no gold standard for its diagnosis. The aim of this observational cross-sectional study was to assess the neuropathic component of pain in various chronic low back pain syndromes using a range of diagnostic tests.

Materials and Methods:

Included in this study were 63 patients with chronic axial low back pain (ALBP), 48 patients with chronic radicular syndromes (CRS) comprising 23 with discogenic compression (CDRS) and 25 with lumbar spinal stenosis (LSS), and 74 controls. PainDETECT questionnaire (PDQ), quantitative sensory testing (QST), and skin biopsy with evaluation of intraepidermal nerve fiber density (IENFD) were used to assess the neuropathic pain component.

Results:

Positive PDQ (≥19) was obtained more frequently in patients with CDRS and LSS (26.1% and 12.0%, respectively) compared with patients with ALBP (1.6%, P<0.001). The proportion of patients with sensory loss confirmed by QST was lowest in the ALBP subgroup (23.8%) compared with CDRS (47.8%), and LSS (68.0%) subgroups (P<0.001). A reduction in IENFD was disclosed in a proportion of up to 52.0% of affected roots in patients with CRS.

Discussion:

Neuropathic pain is quite frequent in CRS, and QST reveals sensory loss as a frequent abnormality in patients with CRS. Using a cut-off value of 19, PDQ identified a neuropathic component in a relatively low proportion of patients with CRS. CRS may be associated with a reduction in IENFD.
Modification of Descending Analgesia in Aging
Authors: Lithfous Ségolène , Després Olivier , Pebayle Thierry , Dufour André
Published: September 2018

Objective:

Aging has been associated with increases in pain threshold and reductions in tolerance threshold, as well as a deficiency in endogenous pain inhibition. Top-down pain modulation mainly involves the frontal cortex network, which is also one of the most vulnerable brain regions in aging. As the frontal cortex also sustains executive functions, we aimed to determine whether reductions in executive functions subtended by the frontal network are associated with the lack of descending inhibitor control in pain-free elderly participants.

Methods:

Executive functions were assessed in pain-free elderly participants using neuropsychological tests. Endogenous inhibition of pain was investigated using the paradigm of conditioned pain modulation. We compared pain thresholds before and after the conditioned pain modulation procedure in older and younger participants and in seniors with poor and good performances on executive tests.

Results:

Younger participants showed a significant inhibitory effect of phasic pain during prolonged pain stimulation. Older participants with good performance on executive tests showed an absence of inhibiting effect, whereas older participants with poor performance showed a facilitating effect, indicating a significant link between cognitive functions and mechanisms of endogenous inhibition of pain.

Discussion:

These results highlight a significant link between cognitive functions and mechanisms of endogenous inhibition of pain and open new perspectives in investigations of chronic pain in aging.
The Magnitude of Offset Analgesia as a Measure of Endogenous Pain Modulation in Healthy Participants and Patients With Chronic Pain
Authors: Szikszay Tibor M. , Adamczyk Waclaw M. , Luedtke Kerstin
Published: September 2018

Objective:

Offset analgesia (OA) is a test paradigm increasingly used to estimate endogenous pain modulation characterized by a disproportionally profound analgesia after a small decrease of a heat stimulus. This systematic review and meta-analysis examined the magnitude and difference of OA in healthy participants and chronic pain patients.

Materials and Methods:

Controlled trials, case-control studies, cross-sectional studies, case-series or other observational studies evaluating the effect of a ±1°C offset trial in healthy controls and patients with chronic pain were searched in PubMed, Web of Science, CINAHL, PEDro, PsycINFO, and Cochrane CENTRAL. An additional hand search was conducted. Studies fulfilling the eligibility criteria were independently assessed for methodological quality with the Downs and Black scale by 2 reviewers.

Results:

Twenty-six studies (healthy participants n=758; chronic pain patients n=134) were included in the qualitative synthesis and 12 in meta-analyses (healthy participants n=366; chronic pain patients n=73). A significant difference between offset and constant temperature trials was found for continuous pain intensity rating immediately after a 1°C decrease in temperature (−0.46 [visual analogue scale, 0 to 10]; 95% confidence interval, −0.75 to −0.17; P=0.002), but not after a fixed time period of 5 seconds. Furthermore, a significant difference of the magnitude of OA between chronic pain patients and healthy controls was calculated (−29.9%; 95% confidence interval, −40.3 to −19.5; P<0.00001).

Discussion:

Results indicate that pain-free participants show a larger OA response when rating pain continuously compared with individuals with chronic pain.
Evaluating Patient’s Understanding of Pain Neurophysiology
Authors: Vaughan Brett , Mulcahy Jane , Fitzgerald Kylie , Austin Philip
Published: September 2018

Objective:

Educating patients about the neurobiologic basis of their pain experience is an important part of managing patients with pain disorders. The aim of this study was to evaluate the measurement properties of the Neurophysiology of Pain Questionnaire (NPQ) in a population seeking osteopathy treatment for both acute and chronic musculoskeletal pain symptoms.

Materials and Methods:

Patients attending the Victoria University Osteopathy Clinic for their initial osteopathy consultation were recruited consecutively. Before their consultation patients were invited to complete a health information questionnaire and the NPQ. The measurement properties of the NPQ were evaluated using Rasch analysis.

Results:

Two-hundred and ninety-four patients completed the NPQ (female, 51.7%; mean age, 35.5 y). Over two-thirds of these patients presented with a spinal symptoms and 53% of patient presentations were acute. Initial analysis suggested the NPQ responses did not fit the Rasch model. Modifications to the NPQ including removing items and removing person responses, resulted in the development of a 14-item unidimensional version of the NPQ that was free from differential item functioning.

Discussion:

The study provides further evidence for the validity of the NPQ total score, derived from a population seeking care for an acute or chronic musculoskeletal pain complaint. The total score is interval-level data and can be used to evaluate changes in pain knowledge before, during, and after pain education interventions. Future studies could utilize this revised version of the NPQ in longitudinal designs and also evaluate pain knowledge changes in conjunction with other objective or subjective pain measures.
Pain-specific Reactions or Indicators of a General Stress Response?
Authors: Kappesser Judith , Kamper-Fuhrmann Elisa , de Laffolie Jan , Faas Dirk , Ehrhardt Harald , Franck Linda S. , Hermann Christiane
Published: September 2018

Objectives:

There are many neonatal pain assessment tools available. However, systematic psychometric comparisons between tools are lacking, particularly those comparing tools regarding their ability to differentiate between pain and stressful procedures. The aim of the present study was to compare 5 widely used neonatal pain assessment tools: Neonatal Facial Coding System-Revised, Premature Infant Pain Profile-Revised, Neonatal Pain, Agitation and Sedation Scale, Neonatal Infant Pain Scale, and Bernese Pain Scale Neonates.

Materials and Methods:

Two coders applied all pain assessment tools to videos of 42 neonates who were videotaped during a pain and a stressful procedure.

Results:

Interrater reliability and relative convergent validity were high and internal consistency good to excellent for all 5 assessment tools. All tools discriminated between painful and stressful events. Tools differed regarding their overall effect sizes as well as their items’ effect sizes. Behavioral items tended to have larger effect sizes than physiological ones. Yet, effect sizes of items from one behavioral category differed greatly, which may be due to different operationalization of coding schemes.

Discussion:

Given that the tools investigated in the present study appear to be fairly comparable psychometrically. Aspects of their clinical utility are discussed and ways of improvement identified.
Effects of Spinal Cord and Peripheral Nerve Stimulation Reflected in Sensory Profiles and Endogenous Pain Modulation
Authors: Meyer-Frießem Christine H. , Wiegand Theresa , Eitner Lynn , Maier Christoph , Mainka Tina , Vollert Jan , Enax-Krumova Elena K.
Published: September 2018

Objectives:

Spinal cord and peripheral nerve stimulation (SCS/PNS) may alleviate chronic pain; however, the underlying mechanisms remain controversial. The aim of this observational study was to assess sensory changes in the ON-conditions and OFF-conditions to obtain insights into the mechanism of analgesic effects of SCS/PNS.

Materials and Methods:

We contacted 85 patients and selected 28 patients with sufficient pain relief by SCS (n=15) or PNS (n=13) to assess their ongoing pain intensity (Numerical Rating Scale, 0 to 10), pain thresholds using Quantitative Sensory Testing (DFNS-protocol), and conditioned pain modulation (CPM) in a nonrandomized manner 2 to 4 hours after SCS/PNS deactivation (OFF-condition) and during stimulation (ON-condition). For each patient, the number of abnormally decreased pain thresholds, the presence of dynamic mechanical allodynia, and/or increased pain sensitivity was additionally totaled OR summed.

Results:

In the ON-condition, pain intensity decreased (Numerical Rating Scale SCS: 6.5±2.1 vs. 3.7±2.3, P<0.01; PNS: 6.2±1.4 vs. 4±1.9, P<0.01), but this did not correlate with any single sensory parameter. However, for SCS, the total number of parameters indicating hyperalgesia was significantly reduced in the ON-condition (45 vs. 23, P=0.001). A smaller CPM effect in the OFF-condition correlated with a greater CPM improvement during stimulation (SCS: r=−0.741, P=0.002; PNS: r=−0.773, P=0.003), independently from the spontaneous pain intensity.

Discussion:

The analgesic effect of SCS/PNS did not correlate with changes of single sensory parameters, but SCS/PNS reduced the number of abnormal hyperalgesic findings disregarding the kind of applied stimuli, suggesting a general antihyperalgesic effect. In addition, stimulation improved the endogenous pain inhibition. Both findings indicate that SCS/PNS may modulate central circuits.
Morbidity and Mortality of Crystalloids Compared to Colloids in Critically Ill Surgical Patients
Authors: Heming Nicholas , Lamothe Laure , Jaber Samir , Trouillet Jean Louis , Martin Claude , Chevret Sylvie , Annane Djillali
Published: September 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

The multicenter randomized Colloids versus Crystalloids for the Resuscitation of the Critically Ill (CRISTAL) trial was designed to test whether colloids altered mortality compared to crystalloids in the resuscitation of intensive care unit patients with hypovolemic shock. This preplanned analysis tested the same hypothesis in the subgroup of surgical patients.

Methods

The CRISTAL trial prospectively defined patients as critically ill surgical patients whenever they underwent emergency or scheduled surgery immediately before or within 24 h of intensive care unit admission and had hypovolemic shock. The primary outcome measure was death by day 28. Secondary outcome measures included death by day 90, the need for renal replacement therapy, or the need for fresh frozen plasma transfusion.

Results

There were 741 critically ill surgical patients, 356 and 385 in the crystalloid and colloid arm, respectively. Median (interquartile range) age was 66 (52 to 76) yr, and 484 (65.3%) patients were male. Surgery was unscheduled in 543 (73.3%) cases. Mortality by day 28 did not significantly differ for crystalloids 84 (23.6%) versus colloids 100 (26%; adjusted odds ratio, 0.86; 95% CI, 0.61 to 1.21; P = 0.768). Death by day 90 (111 [31.2%] vs. 122 [31.7%]; adjusted odds ratio, 0.97; 95% CI, 0.70 to 1.33; P = 0.919) did not significantly differ between groups. Renal replacement therapy was required for 42 (11.8%) patients in the crystalloids arm versus 49 (12.7%) in the colloids arm (P = 0.871).

Conclusions

The authors found no survival benefit when comparing crystalloids to colloids in critically ill surgical patients.
Ultrasound Elastography for Rapid, Real-time Detection of Localized Muscular Reaction in Malignant Hyperthermia–susceptible Pigs
Authors: Johannsen Stephan , Türkmeneli Ismail , Isbary Susanne , Roewer Norbert , Schuster Frank
Published: September 2018

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Background

Halothane and caffeine induce excessive sarcoplasmic calcium liberation and skeletal muscle contracture in patients susceptible to malignant hyperthermia (MH) and are utilized for diagnosis in the in vitro contracture test. Intramuscular injection previously caused a marked local lactate increase in MH-susceptible but not in MH-nonsusceptible individuals in vivo. Using shear-wave elastography, this study evaluated localized changes in muscle stiffness after intramuscular injection of halothane and caffeine.

Methods

Microdialysis probes were placed into the gracilis muscle of 16 pigs (9 MH-susceptible and 7 MH-nonsusceptible). After local injection of either halothane or caffeine in different concentrations, changes of tissue elasticity surrounding the probe were examined by quantitative shear-wave elastography. Local lactate concentrations were analyzed spectrophotometrically.

Results

Ultrasound elastography detected a temporary increase in local muscle rigidity in MH-susceptible but not in MH-nonsusceptible pigs after 2.5 and 5 vol% halothane and after 10, 40, and 80 mM caffeine, whereas there were no differences in the control groups (median [interquartile range] for maximum effect after 5 vol% halothane: MH-susceptible: 97 [31 to 148] vs. MH-nonsusceptible: 5 [−6 to 18] kPa; P = 0.0006; maximum effect after 80 mM caffeine: 112 [64 to 174] vs. −3 [−6 to 35] kPa; P = 0.0002). These effects were seen rapidly within 5 min. Local lactate concentrations were higher in MH-susceptible versus nonsusceptible pigs after 1 and 2.5 vol% halothane and 10, 40, and 80 mM caffeine (2.5 vol% halothane: MH-susceptible: 2.8 [1.9 to 4.4] vs. MH-nonsusceptible: 0.6 [0.6 to 0.7] mmol/l; P < 0.0001; 80 mM caffeine: 5.2 [4.1 to 6.3] vs. 1.6 [1.2 to 2.4] mmol/l; P < 0.0001). After 10 vol% halothane, rigidity and lactate levels were increased in both MH-susceptible and MH-nonsusceptible animals.

Conclusions

This pilot study revealed shear-wave elastography as a suitable technique for real-time detection of altered tissue elasticity in response to pharmacologic stimulation. By considering the variability of these results, further test protocol optimization is required before elastography could serve as a minimally invasive MH diagnostic test.
Prediction Score for Postoperative Neurologic Complications after Brain Tumor Craniotomy
Authors: Cinotti Raphaël , Bruder Nicolas , Srairi Mohamed , Paugam-Burtz Catherine , Beloeil Hélène , Pottecher Julien , Geeraerts Thomas , Atthar Vincent , Guéguen Anaïs , Triglia Thibault , Josserand Julien , Vigouroux Doris , Viquesnel Simon , Lakhal Karim , Galliez Michel , Blanloeil Yvonnick , Le Thuaut Aurélie , Feuillet Fanny , Rozec Bertrand , Asehnoune Karim ,   the Société Française d’Anesthésie-Réanimation (SFAR) Research Network
Published: September 2018

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Background

Craniotomy for brain tumor displays significant morbidity and mortality, and no score is available to discriminate high-risk patients. Our objective was to validate a prediction score for postoperative neurosurgical complications in this setting.

Methods

Creation of a score in a learning cohort from a prospective specific database of 1,094 patients undergoing elective brain tumor craniotomy in one center from 2008 to 2012. The validation cohort was validated in a prospective multicenter independent cohort of 830 patients from 2013 to 2015 in six university hospitals in France. The primary outcome variable was postoperative neurologic complications requiring in–intensive care unit management (intracranial hypertension, intracranial bleeding, status epilepticus, respiratory failure, impaired consciousness, unexpected motor deficit). The least absolute shrinkage and selection operator method was used for potential risk factor selection with logistic regression.

Results

Severe complications occurred in 125 (11.4%) and 90 (10.8%) patients in the learning and validation cohorts, respectively. The independent risk factors for severe complications were related to the patient (Glasgow Coma Score before surgery at or below 14, history of brain tumor surgery), tumor characteristics (greatest diameter, cerebral midline shift at least 3 mm), and perioperative management (transfusion of blood products, maximum and minimal systolic arterial pressure, duration of surgery). The positive predictive value of the score at or below 3% was 12.1%, and the negative predictive value was 100% in the learning cohort. In–intensive care unit mortality was observed in eight (0.7%) and six (0.7%) patients in the learning and validation cohorts, respectively.

Conclusions

The validation of prediction scores is the first step toward on-demand intensive care unit admission. Further research is needed to improve the score’s performance before routine use.
Non–steady State Modeling of the Ventilatory Depressant Effect of Remifentanil in Awake Patients Experiencing Moderate-to-severe Obstructive Sleep Apnea
Authors: Doufas Anthony G. , Shafer Steven L. , Rashid Nur Hashima Abdul , Kushida Clete A. , Capasso Robson
Published: September 2018

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Background

Evidence suggests that obstructive sleep apnea promotes postoperative pulmonary complications by enhancing vulnerability to opioid-induced ventilatory depression. We hypothesized that patients with moderate-to-severe obstructive sleep apnea are more sensitive to remifentanil-induced ventilatory depression than controls.

Methods

After institutional approval and written informed consent, patients received a brief remifentanil infusion during continuous monitoring of ventilation. We compared minute ventilation in 30 patients with moderate-to-severe obstructive sleep apnea diagnosed by polysomnography and 20 controls with no to mild obstructive sleep apnea per polysomnography. Effect site concentrations were estimated by a published pharmacologic model. We modeled minute ventilation as a function of effect site concentration and the estimated carbon dioxide. Obstructive sleep apnea status, body mass index, sex, age, use of continuous positive airway pressure, apnea/hypopnea events per hour of sleep, and minimum nocturnal oxygen saturation measured by pulse oximetry in polysomnography were tested as covariates for remifentanil effect site concentration at half-maximal depression of minute ventilation (Ce50) and included in the model if a threshold of 6.63 (P < 0.01) in the reduction of objective function was reached and improved model fit.

Results

Our model described the observed minute ventilation with reasonable accuracy (22% median absolute error). We estimated a remifentanil Ce50 of 2.20 ng · ml–1 (95% CI, 2.09 to 2.33). The estimated value for Ce50 was 2.1 ng · ml–1 (95% CI, 1.9 to 2.3) in patients without obstructive sleep apnea and 2.3 ng · ml–1 (95% CI, 2.2 to 2.5) in patients with obstructive sleep apnea, a statistically nonsignificant difference (P = 0.081). None of the tested covariates demonstrated a significant effect on Ce50. Likelihood profiling with the model including obstructive sleep apnea suggested that the effect of obstructive sleep apnea on remifentanil Ce50 was less than 5%.

Conclusions

Obstructive sleep apnea status, apnea/hypopnea events per hour of sleep, or minimum nocturnal oxygen saturation measured by pulse oximetry did not influence the sensitivity to remifentanil-induced ventilatory depression in awake patients receiving a remifentanil infusion of 0.2 μg · kg–1 of ideal body weight per minute.
Individual Positive End-expiratory Pressure Settings Optimize Intraoperative Mechanical Ventilation and Reduce Postoperative Atelectasis
Authors: Pereira Sérgio M. , Tucci Mauro R. , Morais Caio C. A. , Simões Claudia M. , Tonelotto Bruno F. F. , Pompeo Michel S. , Kay Fernando U. , Pelosi Paolo , Vieira Joaquim E. , Amato Marcelo B. P.
Published: September 2018

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Background

Intraoperative lung-protective ventilation has been recommended to reduce postoperative pulmonary complications after abdominal surgery. Although the protective role of a more physiologic tidal volume has been established, the added protection afforded by positive end-expiratory pressure (PEEP) remains uncertain. The authors hypothesized that a low fixed PEEP might not fit all patients and that an individually titrated PEEP during anesthesia might improve lung function during and after surgery.

Methods

Forty patients were studied in the operating room (20 laparoscopic and 20 open-abdominal). They underwent elective abdominal surgery and were randomized to institutional PEEP (4 cm H2O) or electrical impedance tomography–guided PEEP (applied after recruitment maneuvers and targeted at minimizing lung collapse and hyperdistension, simultaneously). Patients were extubated without changing selected PEEP or fractional inspired oxygen tension while under anesthesia and submitted to chest computed tomography after extubation. Our primary goal was to individually identify the electrical impedance tomography–guided PEEP value producing the best compromise of lung collapse and hyperdistention.

Results

Electrical impedance tomography–guided PEEP varied markedly across individuals (median, 12 cm H2O; range, 6 to 16 cm H2O; 95% CI, 10–14). Compared with PEEP of 4 cm H2O, patients randomized to the electrical impedance tomography–guided strategy had less postoperative atelectasis (6.2 ± 4.1 vs. 10.8 ± 7.1% of lung tissue mass; P = 0.017) and lower intraoperative driving pressures (mean values during surgery of 8.0 ± 1.7 vs. 11.6 ± 3.8 cm H2O; P < 0.001). The electrical impedance tomography–guided PEEP arm had higher intraoperative oxygenation (435 ± 62 vs. 266 ± 76 mmHg for laparoscopic group; P < 0.001), while presenting equivalent hemodynamics (mean arterial pressure during surgery of 80 ± 14 vs. 78 ± 15 mmHg; P = 0.821).

Conclusions

PEEP requirements vary widely among patients receiving protective tidal volumes during anesthesia for abdominal surgery. Individualized PEEP settings could reduce postoperative atelectasis (measured by computed tomography) while improving intraoperative oxygenation and driving pressures, causing minimum side effects.