bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementing a quality improvement initiative for the management of chronic obstructive pulmonary disease in rural Nepal
Authors: Mehanni Stephen , Jha Dhiraj , Kumar Anirudh , Choudhury Nandini , Dangal Binod , Deukmedjian Grace , Dhungana Santosh Kumar , Gauchan Bikash , Gupta Tula Krishna , Halliday Scott , Kalaunee S P , Mahar Ramesh , Poudel Sanjaya , Raut Anant , Schwarz Ryan , Singh Dipendra Raman , Thapa Aradhana , Thapa Roshan , Wong Lena , Maru Duncan , Schwarz Dan
Published: March 2019

Background

Chronic obstructive pulmonary disease accounts for a significant portion of the world’s morbidity and mortality, and disproportionately affects low/middle-income countries. Chronic obstructive pulmonary disease management in low-resource settings is suboptimal with diagnostics, medications and high-quality, evidence-based care largely unavailable or unaffordable for most people. In early 2016, we aimed to improve the quality of chronic obstructive pulmonary disease management at Bayalpata Hospital in rural Achham, Nepal. Given that quality improvement infrastructure is limited in our setting, we also aimed to model the use of an electronic health record system for quality improvement, and to build local quality improvement capacity.

Design

Using international chronic obstructive pulmonary disease guidelines, the quality improvement team designed a locally adapted chronic obstructive pulmonary disease protocol which was subsequently converted into an electronic health record template. Over several Plan-Do-Study-Act cycles, the team rolled out a multifaceted intervention including educational sessions, reminders, as well as audits and feedback.

Results

The rate of oral corticosteroid prescriptions for acute exacerbations of chronic obstructive pulmonary disease increased from 14% at baseline to >60% by month 7, with the mean monthly rate maintained above this level for the remainder of the initiative. The process measure of chronic obstructive pulmonary disease template completion rate increased from 44% at baseline to >60% by month 2 and remained between 50% and 70% for the remainder of the initiative.

Conclusion

This case study demonstrates the feasibility of robust quality improvement programmes in rural settings and the essential role of capacity building in ensuring sustainability. It also highlights how individual quality improvement initiatives can catalyse systems-level improvements, which in turn create a stronger foundation for continuous quality improvement and healthcare system strengthening.
Reducing inappropriately suspended VTE prophylaxis through a multidisciplinary shared learning programme and electronic prompting
Authors: Brewer Christopher Felix , Ip Dorothy , Drasar Emma , Aghakhani Poureya
Published: March 2019

Background

Venous thromboembolism (VTE) is a major cause of preventable hospital death, accounting for up to 10% of inpatient mortality. National guidelines recommend that all patients should be regularly assessed for VTE risk, and prescribed mechanical and pharmacological prophylaxis accordingly. While previous studies have focused on improving prescription uptake on admission, there has been relatively little emphasis on the inappropriate suspension of prophylaxis during inpatient stay.

Objective

The purpose of this project was to identify the reasons and scale of inappropriate suspension of pharmacological VTE prophylaxis for medical inpatients. We subsequently planned to introduce a number of interventions in order to reduce inappropriate suspension.

Methods

An initial audit of all medical inpatients was carried out to establish the number with inappropriately suspended pharmacological prophylaxis. We then designed a series of educational meetings and electronic prompting interventions to alert prescribers to these errors, followed by re-audit to assess their efficacy.

Results

The number of patients with inappropriately suspended VTE prophylaxis was significantly reduced following introduction of our intervention strategy.

Conclusions

Combined education and electronic email prompts are an effective way of alerting practitioners to reduce inappropriate suspension of VTE prophylaxis. With ongoing teaching and integration of prescribing software alerts, this reduction in VTE prescribing errors could be sustained.
EBV-requisitioning physicians’ guess on fatigue state 6 months after acute EBV infection
Authors: Asprusten Tarjei Tørre , Pedersen Maria , Skovlund Eva , Wyller Vegard Bruun
Published: March 2019

We assessed referring medical practitioner’s ability to predict chronic fatigue development in adolescents presenting with acute infectious mononucleosis. Compared with ‘not fatigued’ being predicted as ‘unsurely fatigued’ and ‘likely fatigued’ were both strongly associated with developing fatigue 6 months later (OR 2.5, 95% CI 1.16% to 5.47% and 3.2, 95% CI 1.19% to 8.61%, respectively, P=0.012). The positive and negative predictive values were 66% and 62%, respectively. Disentangling the physician’s intuition may be of interest in further investigations of risk factors and prophylactic factors for fatigue development.
Health examinations of child migrants in Europe: screening or assessment of healthcare needs?
Authors: Hjern Anders , Stubbe Østergaard Liv , Nörredam Marie-Louise
Published: March 2019

Background

More than 800 000 asylum-seeking children were registered in Europe during 2015–2017. Many of them arrived with accumulated needs of healthcare. In this study, we examined the legislation for health examinations on arrival for migrant children in the EU/EAA area.

Methods

We did a survey to child health professionals within the EU-funded MOCHA project, supplemented by desktop research of official documents.

Results

In all but three surveyed countries in the EU/EEA, there were systematic health examinations of newly settled migrant children. In most eastern European countries and Germany, this health examination was mandatory; while in the rest of western and northern Europe it was mostly voluntary. All countries that had a mandatory policy of health examinations screened for communicable diseases to protect the host population. Almost all countries with a voluntary policy also aimed to assess a child’s individual healthcare needs, but this was rarely the case in countries with a mandatory policy.

Conclusion

Systematic health examinations of migrant children are routinely performed in most countries in the EU/EEA; but in many countries, it could be improved considerably by extending the focus from screening for communicable diseases to assessing and addressing individual needs of healthcare.
Veterans Specific Activity Questionnaire (VSAQ): a new and efficient method of assessing exercise capacity in patients with pulmonary arteriovenous malformations
Authors: Gawecki Filip , Myers Jonathan , Shovlin Claire L.
Published: March 2019

Introduction

Assessment of performance status is an important component of clinical management of patients with pulmonary arteriovenous malformations (PAVMs). Usual methods are time-consuming and insensitive to variations within normal or supranormal exercise capacity.

Methods

The Veterans Specific Activity Questionnaire (VSAQ) was modified to facilitate completion by patients independently. Patient-reported activity limitations were converted to the Medical Research Council (MRC) Dyspnoea Scale, New York Heart Association (NYHA) classification and metabolic equivalents (METs) in which 1 MET equals the consumption of 3.5 mL O2per kilogram of body weight per minute.

Results

The study population consisted of 71 patients with PAVMs aged 20–85 (median 52) years. Oxygen saturation (SaO2) was 80%–99.5 % (median 96%), and haemoglobin was 73–169 g/L in women and 123–197 g/L in men (p<0.0001). Arterial oxygen content (CaO2) (1.34 × [haemoglobin × SaO2]/100) was maintained unless iron deficiency was present. Most patients (49/71, 69%) did not need to stop until activities more energetic than walking briskly at 4 mph were achieved (6.4 km per hour, VSAQ >5, MRC Dyspnoea Scale 1 or 2, NYHA class I). SaO2was inversely associated with the MRC Dyspnoea Scale and NYHA class, but not the VSAQ. Raw VSAQ scores captured a marked difference between men and women. METs were also higher in men at 3.97–15.55 (median 8.84) kcal/kg/min, compared with 1.33–14.4 (median 8.25) kcal/kg/min (p=0.0039). There was only a modest association between METs and SaO2(p=0.044), but a stronger association between METs and haemoglobin (p =0.001). In crude and sex-adjusted regression, the CaO2was more strongly associated with METs than either SaO2or haemoglobin in isolation.

Conclusion

The VSAQ, capturing patient-reported outcome measures, is an efficient and quantifiable measure of exercise capacity that can be readily employed in clinical services particularly where patients have normal to high exercise tolerance. In the PAVM population, exercise capacity reflects haemoglobin and CaO2more than SaO2, even where SaO2measurements are low.
Return to play following anterior cruciate ligament reconstruction: incorporating fatigue into a return to play functional battery. Part A: treadmill running
Authors: Connell Richard , Milne Ross , Paton Bruce
Published: March 2019

Background

The risk of reinjury and other sequelae following anterior cruciate ligament reconstruction (ACLR) remains high. Lack of knowledge regarding factors contributing to these risks limits our ability to develop sensitive return to play (RTP) tests. Using a running task, we evaluate whether fatigue induces alterations in foot progression angle (FPA), a proposed biomechanical risk factor and could be used to enhance RTP test sensitivity.

Method

Transverse plane foot kinematics (FPA) were assessed for 18 post-ACLR subjects during a treadmill running task, before and after a generalised lower limb fatigue protocol. Subject’s contralateral limbs were used as a control group.

Results

A small but significant difference between FPA for ACLR and contralateral limbs was observed before but not after fatigue. When confounding variables were considered, there was a significant difference in FPA change between ACLR and contralateral limbs from the prefatigue to postfatigue state.

Conclusions

Following ACLR athletes may develop a knee-protective movement strategy that delays the progression of osteoarthritis in the ACL-injured knee. This may, however, increase the risk of ACL reinjury. Following the onset of fatigue this proposed movement strategy, and thus osteoarthritis protection, is lost.
MSK30: a validated tool to assess clinical musculoskeletal knowledge
Authors: Cummings Danielle L , Smith Matthew , Merrigan Brian , Leggit Jeffrey
Published: March 2019

Background

Musculoskeletal (MSK) complaints comprise a large proportion of outpatient visits. However, multiple studies show that medical school curriculum often fails to adequately prepare graduates to diagnose and manage common MSK problems. Current standardised exams inadequately assess trainees’ MSK knowledge and other MSK-specific exams such as Freedman and Bernstein’s (1998) exam have limitations in implementation. We propose a new 30-question multiple choice exam for graduating medical students and primary care residents. Results highlight individual deficiencies and identify areas for curriculum improvement.

Methods/Results

We developed a bank of multiple choice questions based on 10 critical topics in MSK medicine. The questions were validated with subject-matter experts (SMEs) using a modified Delphi method to obtain consensus on the importance of each question. Based on the SME input, we compiled 30 questions in the assessment. Results of the large-scale pilot test (167 post-clerkship medical students) were an average score of 74 % (range 53% – 90 %, SD 7.8%). In addition, the tool contains detailed explanations and references were created for each question to allow an individual or group to review and enhance learning.

The proposed MSK30 exam evaluates clinically important topics and offers an assessment tool for clinical MSK knowledge of medical students and residents. It fills a gap in current curriculum and improves on previous MSK-specific assessments through better clinical relevance and consistent grading. Educators can use the results of the exam to guide curriculum development and individual education.
Impact of medical assistance in dying (MAiD) on family caregivers
Authors: Goldberg Rachel , Nissim Rinat , An Ekaterina , Hales Sarah
Published: March 2019

Medical assistance in dying (MAiD) is a globally polarising topic which often sparks debate surrounding the ethical and moral dilemmas that arise with a life-ending intervention. To gain a better understanding of this intervention, it is important to explore the experience of those most intimately affected by MAiD. Family caregivers of those with a terminal illness are the backbone of the healthcare and support team, often providing a substantial amount of informal care while at the same time coping with their own distress and anticipatory grief. However, we know the least about how MAiD impacts the psychosocial well-being of these same individuals. The aim of this article is to explore the experience of MAiD from the family caregiver perspective, namely their beliefs and opinions about the intervention, how the process of MAiD impacts them, how the intervention shapes their view of their loved one’s quality of death, and the psychosocial outcomes after the passing of their loved one. Beyond the literature, challenges within both the clinical and research realms will be discussed and future directions will be offered. While MAiD is currently legal in only a small number of countries, a better understanding of the impact of MAiD will help inform policy and legislation as they are developed in other jurisdictions. Further, this article aims to inform future research and clinical interventions in order to better understand and support those seeking MAiD and their families.
Practical guide to the management of acute pancreatitis
Authors: Goodchild George , Chouhan Manil , Johnson Gavin J
Published: March 2019

Acute pancreatitis (AP) is characterised by inflammation of the exocrine pancreas and is associated with acinar cell injury and both a local and systemic inflammatory response. AP may range in severity from self-limiting, characterised by mild pancreatic oedema, to severe systemic inflammation with pancreatic necrosis, organ failure and death. Several international guidelines have been developed including those from the joint International Association of Pancreatology and American Pancreatic Association, American College of Gastroenterology and British Society of Gastroenterology. Here we discuss current diagnostic and management challenges and address the common dilemmas in AP.
Medical liver biopsy: background, indications, procedure and histopathology
Authors: Boyd Alexander , Cain Owen , Chauhan Abhishek , Webb Gwilym James
Published: March 2019

Histological analysis of liver tissue continues to play an important role in modern hepatological practice. This review explores the indications for medical liver biopsy in addition to the procedure itself, potential complications, preparation of tissue and routine staining. A broad selection of histological images is included to illustrate the appearance of liver tissue both in health and in several important diseases.
Calculated plasma volume status and outcomes in patients undergoing coronary bypass graft surgery
Authors: Maznyczka Annette Marie , Barakat Mohamad Fahed , Ussen Bassey , Kaura Amit , Abu-Own Huda , Jouhra Fadi , Jaumdally Hannah , Amin-Youssef George , Nicou Niki , Baghai Max , Deshpande Ranjit , Wendler Olaf , Kolvekar Shyam , Okonko Darlington O
Published: March 2019

Objectives

Congestion is associated with worse outcomes in critically ill surgical patients but can be difficult to quantify noninvasively. We hypothesised that plasma volume status (PVS), estimated preoperatively using a validated formula that enumerates percentage change from ideal plasma volume (PV), would provide incremental prognostic utility after coronary artery bypass graft (CABG) surgery.

Methods

In this retrospective cohort study, patients who underwent CABG surgery (1999–2010) were identified from a prospectively collected database. Actual ([1-haematocrit] x [a+(b x weight [kg])]) and ideal (c x weight [kg]) PV were obtained from equations where a, b and c are sex-dependent constants. Calculated PVS was then derived (100% x [(actual−ideal)/ideal]).

Results

In 1887 patients (mean age 67±10 years; 79% male; median European System for Cardiac Operative Risk Evaluation [EuroSCORE] 4), mean PVS was −8.2±9%. While 8% of subjects had clinical evidence of congestion, a relatively increased PV (PVS >0%) was estimated in 17% and correlated with lower serum sodium, higher EuroSCORE and a diagnosis of diabetes mellitus. A PVS≥5.6% was optimally prognostic and associated with greater mortality (HR: 2.31, p=0.009), independently of, and incremental to, EuroSCORE, New York Heart Association class and serum sodium. A PVS≥5.6% also independently predicted longer intensive care (β: 0.65, p=0.007) and hospital (β: 2.01, p=0.006) stays, and greater postoperative renal (OR: 1.61, p=0.008) and arrhythmic (OR: 1.29, p=0.03) complications.

Conclusions

Higher PVS values, calculated simply from weight and haematocrit, are associated with worse inpatient outcomes after CABG. PVS could help refine risk stratification and further investigations are warranted to evaluate the potential clinical utility of PVS-guided management in patients undergoing CABG.
Integration of Telehealth Services in the Healthcare System: With Emphasis on the Experience of Patients Living with HIV
Authors: Dandachi Dima , Lee Celine , Morgan Robert O , Tavakoli-Tabasi Shahriar , Giordano Thomas P , Rodriguez-Barradas Maria C
Published: March 2019

The US Health Resources and Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration. Many studies have supported the use of telehealth to increase convenience to patients, improve patient satisfaction, diminish healthcare disparities, and reduce cost that will ultimately lead to improvement in clinical outcomes and quality of care. However, guaranteeing confidentiality, educating patients and providers, and obtaining insurance reimbursement are some of the challenges that face the implementation of telehealth program. The use of telehealth has been investigated in acute infections, such as endocarditis and chronic infections as in hepatitis C, and HIV. The purpose of this review is to focus on the use of telehealth services for people living with HIV (PLWH). For PLWH, telehealth could be particularly useful by connecting specialty providers to an underserved population and addressing many of the factors identified as barriers to HIV care. To date, the literature supports the use of telehealth for the management of chronic diseases including HIV. Most of the studies showed a high acceptability and positive experience with telehealth services among PLWH. However, fewer studies have evaluated telemedicine for chronic direct care of PLWH. Well-designed studies are needed to show that the implementation of telehealth could improve the HIV care continuum. In addition, future research should focus on identifying the group of patients that could benefit the most from such intervention.
Blister beetle dermatitis caused by cantharidin in South Sudan in Op TRENTON: a case series
Authors: Maynard-Burrows Caroline Linda , Mclennan J V , Nicholson-Roberts T C , Takano H
Published: March 2019

Cantharidin-producing blister beetles are found worldwide. The pathognomonic feature of their toxin is a blistering dermatitis that presents an environmental health hazard. Cutaneous exposure to cantharidin can produce blistering dermatitis, most commonly seen on exposed skin, in the Bentiu region of South Sudan. This should be treated with appropriate cleaning, debridement and regular dressing changes to cope with extensive initial exudate. The best dressing combinations found were initial treatment with povidone-iodine and hydrocolloid, followed by hydrocolloid only. Hydrocolloid dressings were found to be the most effective at staying in place with South Sudan’s high humidity. Prevention strategies should include covering exposed skin, wearing wide-brimmed hats, neck scarves and enclosed footwear, and avoidance of working under white light. Medical personnel should engage with the chain of command to include appropriate force protection education within the arrivals brief.
Is it just semantics? Medical students and their ‘first patients’
Authors: Cohen Natalie
Published: March 2019

There have been multiple factors involved in the decline of the anatomy course’s central role in medical education over the last century. The course has undergone a multitude of changes, in large part due to the rise in technology and cultural shifts away from physical dissection. This paper argues that, as the desire of medical schools to introduce clinical experiences earlier in the curriculum increased, anatomy courses began implementing changes that would align themselves with the shifting culture towards incorporating humanistic values early on in the medical curriculum. One of these changes, argued as a product of this shift, included calling a cadaver a ‘patient’ and introducing the cadaver as a student’s ‘first patient’. This change has been seen in different universities and textbooks. This paper argues that the use of the words ‘patient’ to describe the cadaver in order to promote principled habits in medical students may in fact create an environment that does the opposite. By equating an environment in which the subject of dissection is lifeless and incapable of participation, and the space is discouraging of emotions and conducive to untested coping mechanisms to the clinical environment through using the word ‘patient’, values like detached concern, a controversial practice in medicine, can be implicitly encouraged. An ethical analysis of the use of the word ’patient’ to describe the cadaver shows that this practice can promote unethical habits in students and that changing this aspect of anatomy lab culture could improve ethical dispositions of future physicians.
Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers
Authors: Kvist Lærke Marius , Vinter Nicklas , Urbonaviciene Grazina , Lindholt Jes Sanddal , Diederichsen Axel Cosmus Pyndt , Frost Lars
Published: March 2019

Aim

We examined the diagnostic accuracy of single-lead ECG as assessed by radiographers and 12-lead ECG as assessed by cardiac nurses for the diagnosis of atrial fibrillation (AF).

Methods

Based on the Danish Cardiovascular Screening Trial, we conducted a population-based, cross-sectional study of 1338 randomly selected Danish men aged 65–74 years with no exclusion criteria. The participants were screened with single-lead ECG during a CT scan assessed by radiographers and 12-lead ECG assessed by cardiac nurses. The diagnostic accuracy was evaluated compared with that produced by a 12-lead ECG assessed by two consenting cardiologists.

Results

The study identified 68 participants with ongoing AF, of whom 60 had self-reported AF and 8 had AF detected in the screening. Single-lead ECG assessed for AF by radiographers had a sensitivity of 60.3% (95% CI 47.7 to 72.0), specificity of 97.2% (95% CI 96.2 to 98.1), positive predictive value (PPV) of 53.9% (95% CI 42.1 to 65.5) and negative predictive value (NPV) of 97.9% (95% CI 96.9 to 98.6). 12-lead ECG assessed by cardiac nurses had a sensitivity of 97.1% (95% CI 89.8 to 99.6), specificity of 100% (95% CI 99.7 to 100), PPV of 100% (95% CI 94.6 to 100) and NPV of 99.8% (95% CI 99.4 to 100).

Conclusions

Single-lead ECG assessed by radiographers had a moderate sensitivity and PPV but a very high specificity and NPV. Using radiographers may be acceptable for opportunistic screening, in particular if radiographers are thoroughly trained. Thus, 12-lead ECG assessed by cardiac nurses is a potential diagnostic method for the detection of AF.
CCM3 and cerebral cavernous malformation disease
Authors: Wang Kang , Zhou Huanjiao Jenny , Wang Min
Published: March 2019

Cerebral cavernous malformations (CCMs) are vascular lesions characterised by enlarged and irregular structure of small blood vessels in the brain, which can result in increased risk of stroke, focal neurological defects and seizures. Three different genes,CCM1/Krev/Rap1 Interacting Trapped 1,CCM2/MGC4607andCCM3/PDCD10,are associated with the CCMs’ progression, and mutations in one of three CCM genes cause CCM disease. These three CCM proteins have similar function in maintaining the normal structure of small blood vessels. However,CCM3mutation results in a more severe form of the disease which may suggest thatCCM3has unique biological function in the vasculature. The current review focuses on the signalling pathways mediated by CCM3 in regulating endothelial cell junction, proliferation, migration and permeability. These findings may offer potential therapeutic strategies for the treatment of CCMs.
Stereotactic aspiration for hypertensive intracerebral haemorrhage in a Chinese population: a retrospective cohort study
Authors: Zhang Xuyang , Zhou Shaolong , Zhang Qiang , Fu Xudong , Wu Yuehui , Liu Jiasheng , Liang Bo , Yang Zhuo , Wang Xinjun
Published: March 2019

Objective

We aimed to compare the therapeutic effects of stereotactic aspiration and best medical management in patients who developed supratentorial hypertensive intracerebral haemorrhage (HICH) with a volume of haemorrhage between 20 and 40 mL.

Methods

The clinical data of 220 patients with supratentorial HICH with a volume between 20 and 40 mL were retrospectively analysed. Among them, 142 received stereotactic aspiration surgery (stereotactic aspiration group) and 78 received best medical management (conservative group). All were followed up for 6 months. Multivariate logistic regression and Kaplan-Meier survival curves were used to compare the outcome between the two groups.

Results

The rebleeding rate was lower in the group that had stereotactic aspiration when compared with the group with medical treatment (6 [4.2%] vs 9 [11.5%], χ2=4.364, p=0.037). After 6 months, although the mortality rate did not differ significantly between the two groups (8 cases [5.6%] vs 10 cases [12.8%], χ2=3.461, p=0.063), the rate of a favourable outcome was higher in the group who received stereotactic aspiration (χ2=15.870, p=0.000). Logistic regression identified that medical treatment (OR=1.64, p=0.000) was an independent risk factor for an unfavourable outcome. The Kaplan-Meier curves indicated that the median favourable outcome time in the stereotactic aspiration group was 59.5 days compared with that in the medically treated group (87.0 days). The log-rank test indicated that the prognosis at 6 months was better for those treated with stereotactic haematoma aspiration (χ2=29.866, p=0.000). However, the 6-month survival rate was similar between the two groups (χ2=3.253, p=0.068).

Conclusions

Stereotactic haematoma aspiration significantly improved the quality of life, although did not effectively reduce the rate of mortality. When selected appropriately, patients with HICH may benefit from this type of surgical intervention.
Non-coding RNA and neuroinflammation: implications for the therapy of stroke
Authors: Shen Ling , Bai Ying , Han Bing , Yao Honghong
Published: March 2019

Stroke is the major leading cause of death and serious, long-term disability with major economic consequences. At present, the lack of rapid diagnostic, prognostic biomarkers and effective treatment methods are two major challenges facing stroke. Circular RNAs (circRNAs) are potential clinical biomarkers in central nervous system diseases. However, the potential role of circRNAs in neuroinflammation and neuron functional recovery in acute ischaemic stroke (AIS) remains largely unknown. This review aimed to give an overview of the function of circRNAs in AIS and summarise the latest achievements in this field.
State of the art review: from the seaside to the bedside: insights from comparative diving physiology into respiratory, sleep and critical care
Authors: Ponganis Paul J
Published: March 2019

Anatomical and physiological adaptations of animals to extreme environments provide insight into basic physiological principles and potential therapies for human disease. In that regard, the diving physiology of marine mammals and seabirds is especially relevant to pulmonary and cardiovascular function, and to the pathology and potential treatment of patients with hypoxaemia and/or ischaemia. This review highlights past and recent progress in the field of comparative diving physiology with emphasis on its potential relevance to human medicine.
Successful medical management of multiple ‘Rattle’ magnet ingestion in a dog
Authors: Valiente Paula , Florey Jess
Published: March 2019

Multiple magnet ingestion requires emergency treatment given the serious associated complications. A four‐year, 10‐month‐old male neutered Border collie was referred for investigation of generalised tonic‐clonic seizures. On presentation, there was an episode of vomiting and possible ingestion of two ‘Rattle magnets’. Physical and neurological examination was unremarkable apart from mild cranial abdominal discomfort. Abdominal radiographs revealed the presence of two metallic foreign bodies suspected to be within the pyloric antrum and three mineralised foreign bodies within the small intestine. Endoscopy revealed the presence of one magnet in the pyloric antrum. After removal, a deep erosion of the gastric mucosa was observed. Gastroprotectants were administered and repeated abdominal radiographs showed the second magnet within the intestine. Thirty‐six hours later, the patient passed faeces containing three stones and one magnet and was discharged without further gastrointestinal signs or complications, prior to returning for neurological investigations.
Detection of Left Ventricular Hypertrophy Using Bayesian Additive Regression Trees: The MESA (Multi‐Ethnic Study of Atherosclerosis)
Authors: Sparapani Rodney , Dabbouseh Noura M. , Gutterman David , Zhang Jun , Chen Haiying , Bluemke David A. , Lima Joao A. C. , Burke Gregory L. , Soliman Elsayed Z.
Published: March 2019

Background

We developed a new left ventricular hypertrophy (LVH) criterion using a machine‐learning technique called Bayesian Additive Regression Trees (BART).

Methods and Results

This analysis included 4714 participants from MESA (Multi‐Ethnic Study of Atherosclerosis) free of clinically apparent cardiovascular disease at enrollment. We usedBARTto predictLVmass fromECGand participant characteristics using cardiac magnetic resonance imaging as the standard. Participants were randomly divided into a training set (n=3774) and a validation set (n=940). We compared the diagnostic/prognostic performance of our newBART‐LVHcriteria with traditionalECG‐LVHcriteria and cardiac magnetic resonance imaging–LVH. In the validation set,BART‐LVHshowed the highest sensitivity (29.0%; 95%CI, 18.3%–39.7%), followed by Sokolow‐Lyon‐LVH(21.7%; 95%CI, 12.0%–31.5%), Peguero–Lo Presti (14.5%; 95%CI, 6.2%–22.8%), Cornell voltage product (10.1%; 95%CI, 3.0%–17.3%), and Cornell voltage (5.8%; 95%CI, 0.3%–11.3%). The specificity was >93% for all criteria. During a median follow‐up of 12.3 years, 591 deaths, 492 cardiovascular disease events, and 332 coronary heart disease events were observed. In adjusted Cox models, bothBART‐LVHand cardiac magnetic resonance imaging–LVHwere associated with mortality (hazard ratio [95%CI], 1.88 [1.45–2.44] and 2.21 [1.74–2.81], respectively), cardiovascular disease events (hazard ratio [95%CI], 1.46 [1.08–1.98] and 1.91 [1.46–2.51], respectively), and coronary heart disease events (hazard ratio [95%CI], 1.72 [1.20–2.47] and 1.96 [1.41–2.73], respectively). These associations were stronger than associations observed with traditionalECG‐LVHcriteria.

Conclusions

Our newBART‐LVHcriteria have superior diagnostic/prognostic ability to traditionalECG‐LVHcriteria and similar performance to cardiac magnetic resonance imaging–LVHfor predicting events.
Nocturia as an Unrecognized Symptom of Uncontrolled Hypertension in Black Men Aged 35 to 49 Years
Authors: Victor Ronald G. , Li Ning , Blyler Ciantel A. , Mason O'Neil R. , Chang L. Cindy , Moy Norma Priscilla B. , Rashid Mohammad A. , Weiss Jeffrey P. , Handler Joel , Brettler Jeffrey W. , Sagisi Michael B. , Rader Florian , Elashoff Robert M.
Published: March 2019

Background

Hypertension is assumed to be asymptomatic. Yet, clinically significant nocturia (≥2 nightly voids) constitutes a putative symptom of uncontrolled hypertension. Black men with hypertension may be prone to nocturia because of blunted nocturnal blood pressure (
BP
) dipping, diuretic drug use for hypertension, and comorbidity that predisposes to nocturia. Here, we test the hypothesis that nocturia is a common and potentially reversible symptom of uncontrolled hypertension in black men.

Methods and Results

We determined the strength of association between nocturia (≥2 nightly voids) and high
BP
(≥135/85 mm Hg) by conducting in‐person health interviews and measuring
BP
with an automated monitor in a large community‐based sample of black men in their barbershops. Because nocturia is prevalent and steeply age‐dependent after age 50 years, we studied men aged 35 to 49 years. Among 1673 black men (mean age, 43±4 years [
SD
]), those with hypertension were 56% more likely than men with normotension to have nocturia after adjustment for diabetes mellitus and sleep apnea (adjusted odds ratio, 1.56; 95%
CI
, 1.25–1.94 [
P
<0.0001]). Nocturia prevalence varied by hypertension status, ranging from 24% in men with normotension to 49% in men whose hypertension was medically treated but uncontrolled. Men with untreated hypertension were 39% more likely than men with normotension to report nocturia (
P
=0.02), whereas men whose hypertension was treated and controlled were no more likely than men with normotension to report nocturia (
P
=0.69).

Conclusions

Uncontrolled hypertension was an independent determinant of clinically important nocturia in a large cross‐sectional community‐based study of non‐Hispanic black men aged 35 to 49 years.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unqiue identifier:
NCT
02321618.
1. Between Self and Memory
Authors: Toscano Ellyn
Published: March 2019

Ellyn Toscano writes about silences and secrets within her family. She explores the story of her grandmother’s migration from South Carolina to New York in the early twentieth century, and her essay ‘Between Self and Memory’ looks at the consequences of deracination, concealment, and the self-fashioning of transitive identities. She questions the reasoning behind why people move away from the familiar into the unknown and in some cases choose to conceal their identity to fit in with society. Reading about Belle da Costa Greene, a librarian at Princeton University in 1905 who worked for J. P. Morgan, Toscano starts to unravel the truth about her own grandmother and ancestry, and what migration means to her.and the idea of memory as a form of narrative. She recalls the violent events of Sri Lanka’s ‘Black July’ in 1983 and how its legacies and impact have directly shaped her scholarship. She explores the power of photography as both a tool to reconstruct her early memories and as a way to reconnect her with her family’s past. She delves into the differences of her experience living in Australia compared to Sri Lanka and looks at this in the context of image-making, memory, beginnings, and endings.
2. Fragments of Memory: Writing the Migrant’s Story
Authors: Arabindan-Kesson Anna
Published: March 2019

Reflecting on her journey from her birthplace in Sri Lanka to Australia, Anna Arabindan-Kesson’s essay ‘Fragments of Memory: Writing the Migrant’s Story’ looks at the relationship between her own experience of migration and the idea of memory as a form of narrative. She recalls the violent events of Sri Lanka’s ‘Black July’ in 1983 and how its legacies and impact have directly shaped her scholarship. She explores the power of photography as both a tool to reconstruct her early memories and as a way to reconnect her with her family’s past. She delves into the differences of her experience living in Australia compared to Sri Lanka and looks at this in the context of image-making, memory, beginnings, and endings.
4. Migrations
Authors: Engel Kathy
Published: March 2019

Kathy Engel’s ‘Migrations’ is a memoir-poem of the cultural work she has pursued over her lifetime working with women living in the United States, South America, the Caribbean, the Middle East, and in South Africa. Engel includes her own discovery of what it means to migrate, something she learned not by direct experience but by listening to stories as a child and working with women who were fleeing violence.
7. Strange Set of Circumstances
Authors: Finley Karen
Published: March 2019

Karen Finley’s ‘Strange Set of Circumstances: White Artistic Migration and Crazy Quilt’ is a personal reflection of her activism as an artist which was censored by the US during the 1990s. She discusses her own participation in the white migration that brought about the gentrification of low-income neighbourhoods and considers how she benefited from censorship, having received recognition at the expense of silencing of artists of colour, and the erasure of the cultural heritage of immigrant communities. In the second part of this essay, Finley shares a poetic text inspired by the image, work, and story of artist and fashion designer Gloria Vanderbilt.
8. Nora Holt: New Negro Composer and Jazz Age Goddess
Authors: Wall Cheryl A.
Published: March 2019

Cheryl Wall’s ‘Nora Holt: New Negro Composer and Jazz Age Goddess’ reflects on Holt’s extraordinary life and achievements and the connections between movement and female self-invention.
9. Silsila: Linking Bodies, Deserts, Water
Authors: Alshaibi Sama
Published: March 2019

‘Silsila: Linking Bodies, Deserts, Water’ is a series of photographs by the Palestinian-Iraqi artist Sama Alshaibi. Alshaibi, whose family was exiled from two homelands, spent her formative years migrating across Middle Eastern countries as a political refugee. She argues that any understanding of the socio-economic and political upheavals that Middle Eastern women experience is complicated by problematic historical and contemporary depictions of them in photographs, which often reduce their challenges to what they wear. Alshaibi’s photo essay offers an overview of various strategies she pursues in her own work to decode and subvert familiar images of Middle Eastern women, while using a personal vernacular to describe her relationship with the many countries and cultures that have formed her identity.
11. Visualizing Displacement Above The Fold
Authors: Novak Lorie
Published: March 2019

Lorie Novak’s ‘Visualizing Displacement Above The Fold’ looks at the placement of articles in the New York Times to explore how gender, displacement, and migration are visualised and, at the same time, to highlight what is not photographed.
13. A Different Lens
Authors: Mengiste Maaza
Published: March 2019

Maaza Mengiste’s ‘A Different Lens’ is a meditation on how photography reshapes memory, using photographs taken by Italian colonial forces in Ethiopia from 1935-41 to understand more about how war was experienced by women and children – those villagers who did not make it into the history books.
17. Black Women's Work: Resisting and Undoing Character Education and the 'Good' White Liberal Agenda
Authors: Love Bettina L.
Published: March 2019

Bettina Love’s ‘Black Women’s Work: Resisting and Undoing Character Education’ critiques concepts of civic engagement by Black women as they marshal new possibilities that focus on Black joy and Black radical imagination.
19. Women and Migrations: African Fashion’s Global Takeover
Authors: Finley Allana
Published: March 2019

In ‘Women & Migrations: African Fashion’s Global Takeover’, Allana Finley shares her journey through Africa’s diverse fashion industry, and chronicles her dedication to bringing African creatives into the global market.
22. Julia de Burgos: Cultural Crossing and Iconicity
Authors: Pérez-Rosario Vanessa
Published: March 2019

In ‘Cultural Crossing and Iconicity’ Vanessa Pérez-Rosario focuses on Julia de Burgos’s life, death, poetry, activism and legacy, while highlighting the escape routes she created to transcend the rigid confines of gender in Puerto Rico in the 1930s.
27. Controlled Images and Cultural Reassembly: Material Black Girls Living in an Avatar World
Authors: Morgan Joan
Published: March 2019

In ‘Controlled Images and Cultural Reassembly: Material Black Girls Living in an Avatar World’ Joan Morgan analyses the line between what is considered ‘the real’ self and what exists in digital space, suggesting that this division is at best blurred and more likely illusory.
32. 'The World is Ours, Too': Millennial Women and the New Black Travel Movement
Authors: Gill Tiffany M.
Published: March 2019

In “The World is Ours, Too”: Millennial Women and the New Black Travel Movement', Tiffany M. Gill recounts how Black women in the early years of the civil rights movement built a ‘travel movement’ and explores how, in the early twenty-first century, the Black Lives Matter crusade has seen its resurgence. In this iteration, Black millennial women, those 18–35-year-olds who, in true millennial fashion, think they are the first to engage in this phenomenon, are at the forefront. Gill’s essay explores the history of a movement that began in the 1940s and has a great deal to teach us about the tensions between political activism, leisure culture, and global freedom struggles.
34. 'I Don't Pay Those Borders No Mind At All:' Audley E. Moore ('Queen' Mother Moore) - Grassroots Global Traveler and Activist
Authors: Young Paulette
Published: March 2019

Sharon Harley’s chapter ‘“I Don't Pay Those Borders No Mind At All”: Audley E. Moore (‘Queen Mother’ Moore) - Grassroots Global Traveler and Activist’ expands the conversation about female activism by showing that gender roles and class identity played a major part in shaping Black women’s activism, vision, and travel at home and abroad.
38. Reconciliations at Sea: Reclaiming the Lusophone Archipelago in Mónica de Miranda’s Video Works
Authors: Jayawardane M. Neelika
Published: March 2019

M. Neelika Jayawardane’s ‘Reconciliations at Sea: Reclaiming the Lusophone Archipelago in Mónica de Miranda’s Video Works’ explores traditions of travel writing via memoir and film.
39. Transnational Minor Literature: Cristina Ali Farah’s Somali Italian Stories
Authors: Di Maio Alessandra
Published: March 2019

In ‘Transnational Minor Literature: Cristina Ali Farah’s Somali Italian Stories’, Alessandra Di Maio investigates Farah’s narratives and her use of language.
41. Migration as a Woman’s Right: Stories from Comparative and Transnational Slavery Histories in the North Atlantic and Indian Ocean Worlds
Authors: SenGupta Gunja
Published: March 2019

Gurja SenGupta’s ‘Migration as a Woman’s Right: Stories from Comparative and Transnational Slavery Histories in the North Atlantic and Indian Ocean Worlds’ explains that transnational history has yielded the important insight that migration makes meaning and that civic identities transform in transit from one place to another. This essay is woven from the archival traces of women on the margins, enslaved, and free, who, through flight or emigration, appeared to seek reinvention. By nudging, navigating, narrating, and sometimes reshaping the contours of international borderlands, these women rewrote themselves into the records that made and make history.
OTO-201 for the Treatment of Acute Otitis Externa: Results from a Phase 3 Randomized Clinical Study
Authors: Ansley John , Mair Eric A. , Namini Hamid , Lu Chung H. , LeBel Carl
Published: March 2019

Objectives:

OTO-201 is a ciprofloxacin otic suspension previously approved by the US Food and Drug Administration to treat children with bilateral otitis media with effusion requiring tympanostomy tube placement. In this phase 3, double-blind, randomized, prospective, sham-controlled, multicenter study, a single dose of OTO-201 was administered to the external auditory canal in subjects with unilateral or bilateral acute otitis externa.

Methods:

Two hundred sixty-two subjects, 3 to 83 years of age, were randomized, and 260 subjects were included in the intent-to-treat analysis population: OTO-201 (0.2 mL, 12 mg, n = 130) or sham (air injection, n = 130). The primary efficacy measure was clinical cure (CC) on day 8, judged by blinded assessor for erythema, edema, otorrhea, and tenderness. Subjects were monitored over 28 days for efficacy and safety.

Results:

OTO-201 demonstrated a significant increase in CC compared with sham at day 8 (69.2% vs 46.1%, P < .001). Higher CC was also noted on day 4 ( P = .028), day 15 ( P < .001), and day 29 ( P < .001). A similar effect was observed in the pathogen-positive population. Single OTO-201 administration in the office setting was well tolerated by subjects.

Conclusions:

In this study in subjects with acute otitis externa, a single administration of 12 mg OTO-201 to the external auditory canal demonstrated a significantly higher proportion of subjects with CC and bacterial eradication compared with sham starting on day 4 and on all other observation days through day 29, with no safety or tolerability concerns identified. OTO-201 is the first agent in a randomized phase 3 study to demonstrate the efficacy and safety of a single-dose, health care professional–administered topical antibiotic for the treatment of acute otitis externa.
Unsettling appearances: Diane Arbus, Erving Goffman and the sociological eye
Authors: Carrabine Eamonn
Published: March 2019

Both the photographer Diane Arbus and sociologist Erving Goffman were fascinated by the way we present ourselves to others and this article sets out how each understood the drama of human interaction. It begins by exploring how their work parallels some developments in the sociology of deviance, and notes how Goffman was one of the earliest critics of this field, before briefly sketching out Arbus’s controversial career and then turning to a more detailed look at three of her images. It concentrates on how the gap between intention and effect, or what Goffman terms the difference between the impressions we ‘give’ and those we actually ‘give off’, are at the core of her work and this sociological insight animates her compositions. The article then describes how their work unsettles ‘normal appearances’ and provides rich resources for understanding human conduct.
An experimental investigation of the yarn pull-out behavior of plain weave with leno and knitted insertions
Authors: Yi Zhou , Ali Muhammad , Gong Xiaozhou , Dai Hanming , Zhongmin Deng
Published: March 2019

Yarn–yarn sliding force plays a vital role in absorbing impact energy for plain fabrics. This paper reports the methods and results of an investigation on the mechanisms that enable higher yarn pull-out force of woven fabrics with the incorporation of lenos and knits. The experimental results suggested that the insertion of leno lines on plain weave gives an approximately 20% increase in junction rupture force over the original plain construction. With knitted structures inserted, the structure-modified fabrics showed a junction rupture force up to about 15 times higher than simple plain weave. It was even found that the yarns failed rather than pulled out in multiple yarn pull-out tests. This is because knitted structures tend to become self-locked and consequently restrict yarn displacement when subjected to external loading. This investigation reports a method to increase the frictional force between the warp and weft yarns based on textile technologies. It is expected that the results obtained could provide some useful information for the engineering design of flexible ballistic protection systems.